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Judgment
LIFE Insurance Corporation is appellant. Complainnt made a claim for settlement of the L.I.C. Policy as she was the wife and nominee of the deceased risk of whose life was assured.
LIFE assured died on 13.11.1989 Prior to his death, in December, 1988 he gave a proposal to the insurer to cover risk for an amount of Rs. 30,000/-. His proposal was accepted and a policy was insured commencing from 27.3.89. Thereafter, on account of death of life assured, claim was made. Insurer made some enquiries and repudiated claim of the complainant on ground that false assertions had been made in the proposal taking assistance of Section 45 of the Insurance Act.
Asserting that repudiation of the claim is deficiency in service on account of negligence of Insurer, complaint was filed in the District Forum which having been allowed and direction having been given these appeal has been filed.
ON receipt of a copy of complaint, appellant stated its case that it made enquiry from S.C.B. Medical College Hospital as well as from Pandalai Cardio Thoracic Foundation, Madras and came to know that the deceased was suffering from diabetes long before and death was on account of renal failure. In view of the observation of S.C.B. Medical College Hospital that it was deceased was suffering from diabetes since long, the claim was repudiated. There can be no doubt that a reasonable view taken on enquiry for repudiation of claim cannot be said to be deficiency in service. Redressal agency under the Act would not examine the correctness of such finding as an appellate forum of opposite party to reverse the repudiation. Where view taken is not reasonable either on the materials collected or on account of absence of enquiry, it is a clear case of deficiency in service and repudiation of claim would make Insurer liable for a direction from a redressal agency under the Consumer Protection Act. This is such a case.
THERE is absolutely no materials before the District Forum or in this Commission that while giving proposal complainant had any knowledge that he was suffering from any disease far less to speak of diabetes. After receipt of proposal it was not immediately accepted by the opposite party and was given effect from 27.3.89. Thus, opposite party had sufficient time to find the truth in the assertion. Opposite party had never intimated husband of complainant that in case he suffered from any disease between the period of giving the proposal and commencement of the policy or thereafter, such illness should be intimated to the Insurer. Source of informations in S.C.B. Medical College Hospital or in Madras Hospital has not been clearly proved in this case. In such circumstances, we agree with the District Forum that the repudiation of claim of complainant was on account of deficiency in service and a direction has been rightly given by the District Forum. In result, there is no merit in this appeal which is dismissed. The payment shall be made within two months from today. Appeal dismissed.