R.S.Sharma, J. (President) - (1.) THIS appeal is directed against the order dated 7.10.2013, passed by the District Consumer Disputes Redressal Forum, Korba (C.G.) (henceforth "District Forum"), in Complaint Case No. 12/39. By the impugned order, the learned District Forum, has allowed the complaint of the respondent (complainant) and directed the appellant (O.P.) (Insurance Corporation): (a) to pay within a period of 2 months from the date of order a sum of Rs. 1,00,000, which is sum assured of the insurance policy No. 385284908, on account of death of husband of the respondent (complainant). The appellant (O.P.) (Insurance Corporation) has also been directed to pay interest @ 7% p.a. on the said amount from the date of filing of the complaint i.e. 4.7.2012 till today within 2 months otherwise the said amount would be payable along with interest @ 9% p.a. and also to pay a sum of Rs. 3,000 towards compensation for mental agony and Rs. 1,000 as cost of litigation. The facts of the complaint case filed before the District Forum are that the husband of the respondent (complainant) Yatendranath Thawait, during his lifetime purchased four insurance policies from the appellant (O.P.) (Insurance Corporation). He died on 12.6.2009. The appellant (O.P.) (Insurance Corporation) paid the amount of sum assured under three insurance policy, but the sum assured of fourth insurance policy No. 385284908 was not paid by the appellant (O.P.) (Insurance Corporation) to the respondent (complainant), therefore, she contacted the appellant (O.P.) (Insurance Corporation), then the appellant (O.P.) (Insurance Corporation) has given a letter to her on 23.1.2011 in which it has been stated that Yatendranath Thawait has given false information in the proposal form and has suppressed material fact regarding his health. In this letter it has also been stated that before taking insurance policy from the appellant (O.P.) (Insurance Corporation), Yatendranath Thawait was suffering from Hypertension and had also suffered heart disease. He had suppressed these facts, therefore the claim of the respondent (complainant) regarding the sum assured under the fourth insurance policy, has been denied and claim has been repudiated. The respondent (complainant) has also pleaded that the husband of the respondent (complainant) has not suppressed any facts, but the respondent (O.P.) with an intention to embezzle the amount of sum assured has rejected the claim of the respondent (complainant) and thus committed deficiency in service. Therefore, the appellant (complainant) filed complaint before the District Forum and prayed for grant reliefs as mentioned in the complaint.
(2.) THE appellant (O.P.) Insurance Corporation filed its written version and denied the allegations leveled by the respondent (complainant) in the complaint and pleaded that the husband of the respondent (complainant) had purchased four insurance policies from the appellant (O.P.), out of which three insurance policies were purchased by Yatendranath Thawait prior to two years from the date of his death. At the time of purchase of fourth insurance policy he suppressed material facts regarding his health, therefore, the claim submitted regarding the insurance policy obtained by the insured on the basis of incorrect facts has been investigated and the claim has been legally repudiated. The appellant (O.P.) has not committed any deficiency in service against the respondent (complainant). On 23.1.2011 when decision regarding the repudiation of claim of the respondent (complainant) was taken by the appellant (O.P.), the respondent (complainant) could have filed appeal before Zonal Manager, Bhopal and Bima Lokpal office Bhopal, but she had not filed any appeal and the order regarding repudiation of the claim of the respondent (complainant) became final, hence the complaint of the respondent (complainant) be dismissed having no substance. Learned District Forum after having considered the material placed before it by both the parties, allowed the complaint and awarded compensation in favour of the respondent (complainant), as mentioned in para 1 of this judgment.
(3.) THE respondent (complainant) has filed documents. Documents are photocopy of Original Policy Bond, letter dated 15.7.2009 sent by the respondent (complainant) to the Branch Manager, Life Insurance Corporation of India, Branch -2, which is containing intimation regarding death of her husband, letter dated 23.1.2011 sent by the appellant (O.P.) to the respondent (complainant), whereby her claim was repudiated by the Insurance Corporation, letter dated 17.7.2009 sent by Head of Department (Claim)/Branch Manager, Life Insurance Corporation of India, Branch No. 2, T.P. Nagar, Korba (C.G.) to the respondent (complainant).;