Order No.  3  dt.  28/06/2017

               The complainant is a policy holder of the opposite party no.1  for the product of Extra care vide policy no.OG-16-2401-8416-00001098 and the policy was valid from 16.03.2016 to 15.03.2017 under the coverage of floating sum of Rs.10,00,000/-. The complainant used to pay Rs.9,275/- as premium, the policy was issued to the complainant. Accordingly after the complainant felt some uneasiness in  taking breath  he was taken to Asian Heart Institute and Research Centre Pvt Ltd under Dr. Ramakanta Pandey on 21.02.2016. The complainant had also complain of abdomen pain  after getting admission in  the said hospital for treatment while he was released from the hospital for his medical treatment he had to bear expenses of Rs.9,11,713/-. Out of the said  sum the complainant received an amount of Rs.1,17,000/-  from National Insurance and accordingly the complainant demanded the balance amount of  Rs.7,94,713/- from the o.p.1. But the o.ps repudiated the claim of the complainant. On the basis of the said fact the complainant filed this case praying for direction upon the o.ps for releasing the said amount and also paid for compensation.

                On perusal of the record particularly the repudiation letter issued by o.ps being mentioned in the running page 41 of the petition Annexure E it appears that the complainant was suffering from KCO CA tongue since 2009. After detection of the said fact the o.ps issued a notice stating inter alia that under normal circumstances, life time renewal benefit is available under the policy except  on the grounds of fraud, mis-representation or moral  hazards. Accordingly a written notice was  issued upon the complainant for cancellation of the policy for reasons of non-disclosure while proposing for insurance and or lodging any fraudulent claim and as per point no.10 definitions point no.vi  in the policy it states that the policy shall be void and all premiums hereon shall be  forfeited to the company. Since the complainant’s practiced fraud, mis-representation and accordingly o.ps wanted to cancel the policy with the refund a pro-rata premium for the unexpired policy period. The complainant suppressed the  material fact and obtainedthe policy. On the basis of the said fact the repudiation made by the complainant had the justifiable ground for denial of the claim of the complainant. Therefore we hold that there is no substantive material to issue notice against the o.ps. Accordingly we hold that the case filed by the complainant is not maintainable and the same is dismissed in limini.