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SUBHASH CHANDRA, J. RAJENDRA
Max Life Insurance Co. Ltd. – Appellant
Versus
Shalini Devendra Shasrakar – Respondent
JUDGMENT
AVM J. Rajendra, AVSM VSM (Retd.), Member—This Appeal is filed by the OP under Section 19 of the Consumer Protection Act, 1986 (“the Act”), against the Order dated 18.08.2016 passed by the State Consumer Disputes Redressal Commission, Maharashtra at Nagpur (“State Commission”) in CC No. 55 of 2013, wherein the State Commission partly allowed the complaint filed by the Complainant/Respondent.
2. As per the Registry report, there is 64 days delay in filing this Appeal and in the interest of justice, the delay is condoned.
3. Brief facts of the case, as per the complainant, are that the deceased Devendra Wamanrao Shastrakar was the husband of the complainant, hereinafter referred to as Deceased Life Assured (DLA). He had paid the premium of Rs.13370.84 to the Opposite Party (OP) Insurer and obtained an insurance policy covering the risk of his life for sum assured of Rs.25,00,000. The period of policy was from 01/12/2012 to 01/12/2032. The said policy was issued after due medical examination of the complainant and conducting Pathological Tests of his blood and Urine. The DLA suffered swelling on his leg on 15/03/2013 and was taken to the hospital of Dr. Kolte. He was diagnose
(1) Medical condition – There is a good possibility that the DLA was not aware of his medical condition prior to filling the Proposal Form and OP has not established anything to the contrary.(2) Duty....
(1) Burden of proving the fact which excludes liability of Insurer to pay compensation, lies on Insurer alone and no one else.(2) There is an essential distinction between burden of proof and onus of....
(1) Policy Document – Any ambiguity in policy documents, especially those regarding disclosure requirements, must be interpreted contra proferentem, favouring the insured.(2) Same cause of Action – C....
1) Per Sec. 45 of Insurance Act, claim can be repudiated, if it is proved that the assured knowingly and fraudulently suppressed the material facts.2) Contractual duty so imposed on the Insured is su....
(1) The “Three-Year Rule” (Section 45) – Under the amended Section 45, a policy cannot be questioned after three years from issuance or risk commencement on any ground.(2) Agent’s Responsibility – Th....
Insurers can reject life insurance claims for non-disclosure of previous policies, highlighting the necessity for utmost good faith in insurance contracts.
(1) Burden of proof – Insurance is a contract of utmost good faith, but the burden of proving that the insured suppressed material facts lies strictly on the Insurer. Exclusionary clauses and allegat....
(1) Full Knowledge – DLA had the full knowledge of pre-existing ailments at the time of filling the proposal form and there was a nexus with preexisting disease and the cause(s) of death.(2) Proposal....
Insurance – Repudiation of death claim – If insured had not been found to be medically deficient as on date of proposal form then question of any allegation about past disease has to be viewed accord....
Law imposes duty of uberrima fides [utmost good faith], on Proposer to disclose material facts truthfully in order to enable Insurer to exercise discretion to enter into contract of insurance.
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