PRATIBHA BEVINAL Vs. METLIFE INDIA INSURANCE CO LTD

JUDGEMENT

(1.) This complaint case was dismissed in default on 04.07.2011. MA No.597 of 2016 has been filed for restoration of the Consumer complaint No.88 of 2011 on 19.08.2016.

(2.) Heard learned counsel for both the parties on this application and perused the record. Learned counsel for the complainant stated that the complaint was filed against the repudiation of the insurance claim of the complainant. Stating the brief facts, the learned counsel said that the complainant is the wife of deceased Amaresh Bevinal. Deceased Amaresh bevinal had obtained from opposite party on 05.06.2008 Life Insurance Policy No.1200800579746 under Plan- Metsmart Premium (a whole life unit linked insurance policy) for 59 years with effect from 04.06.2008, sum assured being Rs.1,50,00,000/- Premium amount was Rs.1,25,000/- payable quarterly. In terms of the Insurance Policy complainant herein being the wife of deceased Amaresh Bevinal was nominated as the sole beneficiary. On 20.01.2010, the life assured while crossing the Road (Raichur Road) Gangavati was hit by Motorcycle bearing No.KA-37/R-621 coming from Raichur Circle in a rash and negligent manner. Consequently he sustained grievous injuries. He was shifted to Dr. Chandrappa's private hospital at Gangavati and later to Lifeline 24 x 7 Hospital at Hubli, where he died on 24.01.2010. FIR was registered by Gangavati Traffic Police Station circle in Crime No.2/2010 in connection with the accident causing death of the deceased. On 26.02.2010 opposite party was notified of the death of Amaresh Bevinal in the stipulated format. Complainant being the beneficiary of the Life Insurance Policy of deceased submitted claim to opposite party in prescribed Form. Complainant also furnished to opposite party all requisite documents like family doctor's Certificate, last attending Physician's statement, Hospital Certificate, Identity Proof etc., as required by opposite party for processing the claim. On 10.05.2010 opposite party issued a communication to the complainant declining to admit liability for claim against the Life Insurance Policy on the ground of alleged nondisclosure of material facts by treating the said policy as void ab initio. Opposite Party also issued a Demand Draft for Rs.8,89,168/- bearing No.500612 dated 07.05.2010 drawn on Axis Bank Ltd., towards refund of value paid under the policy. In the said communication dated 10.5.2010 it was stated that while assessing the claim opposite party observed that the deceased was a known case of "Rheumatic Heart disease with Mitral Stenosis" since 2002 and Diabetes Mellitus since 2007 which was prior to taking of the Insurance Policy and that said material fact was not disclosed in the application for policy dated 28.3.2008. In this background, the complaint was filed.

(3.) It was further argued by the learned counsel that the complaint was dismissed in default on 04.07.2011 as the counsel for the complainant could not appear on that date. The counsel did not inform the complainant and the complainant was under the impression that the case was being conducted by the counsel for the complainant. Recently the complainant came to know that the learned counsel has expired and therefore, she contacted the office of the learned counsel and searched for the file. It came to her notice that the matter was already dismissed in default on 04.07.2011 and the certified copy of the same was also available on her file, which was issued on 08.07.2011. This clearly shows that the learned counsel had intention to file restoration application, but due to some circumstances the same could not be filed in time. When the complainant came to know of this order, the complainant filed present restoration application. Obviously, there is a huge delay, however, the delay has been explained in the application for condonation of delay as under:-