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RAVISHANKAR, SUNITA CHANNABASAPPA BAGEWADI
Branch Manager, Life Insurance Corporation of India – Appellant
Versus
Mariya – Respondent
ORDER
Smt. Sunita C. Bagewadi, Member—This appeal is filed by the Appellant/OP’s being aggrieved by the order dated 07.09.2013 passed in CC. No.57/2012 on the file of District Consumer Disputes Redressal Commission, Uttara Kannada and prays to set aside the order and to allow the appeal in the interest of justice and equity.
2. The brief facts of the case are as under:—
The Husband of the complainant i.e., Shri Danny Francis Peter had obtained life insurance policy from the Op/s on 20/11/2009 for an assured sum of Rs.2,50,000/-. He died on 16/12/2010 during treatment in Goa Medical College hospital, Bambolim. The complainant is the wife of the deceased and as a nominee made a claim with the Op/s but, the claim of the complainant was repudiated by the OP/s vide letter dated: 13/03/2012 on untenable grounds hence, the complaint.
3. After service of the notice of the District Commission, the OP/s appeared through their counsel and filed their written statement denying the alleged deficiency in service by contending that the insured had suppressed material facts regarding pre-existing disease “Chronic Renal Failure” hence, the Op/s have prays for dismissal of the complaint.
4. After
Death – The death of the life assured within one month of obtaining the policy raises suspicious on its own.
Insurance – Repudiation of death claim on the ground of suppression of pre-existing ailment cannot be sustained when medical reports are categorically denied.
Repudiation of death claim on the ground of concealment of pre-existing ailment – Onus lies upon Insurance company to prove factum that at the time of taking insurance policy in question, deceased li....
Insurance—Repudiation of death claim on the ground of concealment of disease must be supported with reliable and cogent evidence.
Mere filing of some hospital records was not sufficient to show that the policy holder was suffering from the ailment at the time of filing of proposal form.
Pre-existing disease – life assured has deliberately concealed the true facts about his state of health and suppressed his pre-existing disease.
(1) Proposal form – In filling up the proposal form, the agent normally, ceases to act as agent of the insurer but becomes the agent of the insured and no agent can be assumed to have authority from ....
Life Insurance Policy – Repudiation of claim by Insurance Company justified – Suppression of pre-existing disease of TB by Life Assured.
Petitioners failed to point any illegality or irregularity in the order passed by the State Commission, warranting interference in exercise of revisional jurisdiction of this Commission.
(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....
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