- (1.) THIS appeal, under Section 15 of the Consumer Protection Act, 1986 is directed against the order dated 29th May, 2004 in Complaint No. 27/2004 by the District Consumer Disputes Redressal Forum, Rajnandgaon, (hereinafter called the District Forum for short) directing the appellant to pay to the complainant/respondent No. 1 compensation of Rs. 25,000/ - with 9% interest besides cost of the complaint.
(2.) INDISPUTABLY , the insured/deceased Ankalharam was the husband of the complainant/respondent No. 1. The said insured on 28.2.2002 obtained a life insurance policy No. 382671882 covering the risk of his life till 28.2.2012. However, during the subsistence of the said policy, the insured Ankalharam died on 29th May, 2002. The complainant, therefore, through the respondent No. 2/agent of the appellant/insurer, submitted claim before the appellant, for payment of the assured amount under the policy. However, her claim was not accepted by the appellant/insurer who intimated the complainant that as there was suppression of material information regarding his ailment by her husband, the deceased/insured, the claim cannot be accepted. The complainant, therefore, served to legal notice dated 5.9.2003 by Registered Post to the appellant/insurer and since the complainant was even thereafter not paid the assured amount, the complainant approached the District Forum and filed a complaint.
(3.) THE stand of the appellant/insurer in its written version was that on inquiry, in the claim submitted by the complainant, it was discovered that though in his proposal form the insured has stated that he did not avail of any leave for his treatment, but it was found that the deceased/insured was on leave due to his illness from 8.11.2001 to 21.11.2001. It was stated that the claim of the complainant was, therefore, repudiated by letter dated 20.5.2003 on the ground of suppression of material facts by the deceased/insured. It was also averred that in view of above, the complainant was not entitled to any relief. The District Forum in the impugned order held that the deceased appears to have suffered from Moderate Gastritis with mild Duodenitis as certified by Dr. D.C. Jain who treated the deceased. However, thereafter the complainant became alright. In view of the recovery from the said ailment and that as the said disease was not cause of his death; therefore, the repudiation of the complainant s claim on the above ground, was not proper. Accordingly, it was held by the District Forum that there was deficiency in service by the appellant/insurer in not accepting the claim of the complainant/respondent No. 1. The complaint was, therefore, allowed and the sum assured by the deceased/insured was directed to be paid to the complainant/respondent No. 1.;