FINAL ORDER/JUDGEMENT

 SHRI  REYAZUDDIN KHAN, MEMBER.

This is an application u/s.12 of the C.P. Act, 1986.

The instant consumer case emanates from repudiation of insurance claim.The complainants are the legal heirs of late Rajen Kakkad died on 15^th April,2020.The deceased Rajen Kakkad received an IDBI  Federal Childsurance saving protection Insurance plane from the the OPs with a total premium of Rs,74,236.80/(Rupees Seventy Four thousand two hundred thirty six and eighty paisa)only per annum as a insured person under policy no.4001221186 and the date of commencement of the plan was 31^st July 2018.

To avail the assured death benefit of the said insurance plan,the complainants approached with all formalities to the OPs but the OPs refused to disbursed the assured death sum of amount Rs,10,00,000/ (Rupees Ten Lakh) only by issuing the Repudiation letter dated 19.09.2020 on the ground of pre-existing diseases The complainants stated that the deceased Rajen Kakkad never suffered any severe disease at the time of the said insurance plan nor conceal any facts and statements which were against the life insurance terms and condition. Repudiation is illegal. There is deficiency  in service, negligence and unfair trade practice  on the part of the OPs and the complainant has prayed for direction upon the OPs to reimburse the claim amount compensation and litigation cost.

              OP-1 & 2  have contested the case by filing Written Version and denied all the material allegations of the complainant. The written Version is being filed by Ageas Federal Life Insurance Co.Ltd.formaly known as IDBI Federal Life Insurance Co.Ltd.on be half of OP-1 and OP-2.The present complaint is false,frivolous,and vexatious.The complainants have not disclosed any cause of action. The said policy have rightly  repudiated by the OPs on the basis of non-disclosure of material facts with regard to prior medical ailment. The policy is a legal contract between life assured and the Insurer and they both are bound by its terms and conditions. The OPs were not informed that the life assured Mr Rajjan Kakkad was suffering from Hepatitis E for two years with Chronic Liver Disease prior to commencement of the said policy.The deceased life assured had never revealed about the same at the time of submission of proposal form.OPs have further stated that on receipt of the death claim,the OPs conducted a statutory investigation through an investigator under clause 8(3) of the IRDA,Regulation,2002 ,in order to verify the authenticity of the claim and it revealed that the DLA was addicted to alcoholic drinks since 2 years.It was also revealed that the DLA was diagnosed of Pancreatitis with past medical history of Hepatitis E since 2 years.The CT scan report suggested of Extra hepatic Portal Venous Obstruction with featured of Cirrhosis and Portal Hypertension.The test report has also confirmed that DLA was diagnosed for Hepatic Portal Vein Thrombosis .The DLA was under treatment of some ailment in May 2016.The OPs have stated that the DLA has suppressed his pre-existing illness in the proposal form.It clearly shows the malafide fraudulent  intention of the complainants. The present complaint is not maintainable.The claim is based on a policy which has been obtained fraudulently.Since,the issuance of the subject policy is an outcome of fraud and falsehood,therefore the complainants are not entitled for any benefit or relief under the subject policy and the complaint is liable to be dismissed.

Points for Determination

In the light of the above pleadings, the following points necessarily have come up for determination.

1) Whether the OPs are deficient in rendering proper service to the complainant?
            2)   Whether the OPs have indulged in unfair trade practice?

3)   Whether the complainant is entitled to get relief or reliefs as prayed for?

Decision with Reasons

Point Nos. 1 to 3:-

All the points are taken up together for sake of convenience and brevity in discussion. Upon perusal of the consumer complaint coupled with evidence of the complainants we find that the deceased Rajen Kakked took an an IDBI  Federal Childsurance saving protection Insurance plane from the the OPs with a total premium of Rs,74,236.80/(Rupees Seventy Four thousand two hundred thirty six and eighty paisa)only per annum as a insured person under policy no.4001221186 and the date of commencement of the plan was 31^st July 2018 with a sum assured of Rs 10 lakhs.To avail the assured death benefit of Rs,10 Lakhs of the said insurance plan the legal heirs of the deceased Rajen Kakked approached with all the documents before the OPs but the OPs have repudiated the claim by sending a letter on 19.09.2020 and refused to disbursed the assured death sum amount of Rs,10 Lakhs by citing the reasons of pre existing diseases and suppression of material facts that were not disclosed at the time of applying for insurance policy.

If we study the documents annexed by the OPs regarding the medical history of the deceased Rajen Kakked we find that Mr Rajen Kakked was examined in “Apollo Hospital” Chennai by Dr.Usha Srinivas(MD.DM,Gastro) dated 16^th May 2016 UHID:AC01.0003291205 and OP Number OP2525150 in which he mentioned Past Medical History,HEPATITIS E since 2 years Diagnosis(PANCREATITIS) and again on 18.05.2016 the test report confirmed that the life assured was diagnosed for Extra Hepatic Portal Vein Thrombosis with Cirrhosis Portal Hypertension with past medical history of Hepatitis E since 2 years.Again the test report dated 13.02.2019 and 14.02.2019 confirms that the Life assured was seen in May,2016.CT scan showed Extra Hepatic Portal Hypertension and Cirrhosis.It is also mentioned in the report that Alcohol intake over many years with past medical history of Hepatitis E since 2 years with Chronic Liver Disease Ethanol related with Extrahepatic Portal Venous Obstruction.

It is closely observed that the deceased Mr.Rajen Kakked was suffering from the above mentioned disease since long time.Thus,the above mentioned facts were not disclosed at the time of applying for insurance covers.It leads to suppression of material factsThe date of commencement of the insurance plan was 31^st July 2018 and the disease and the documents/prescriptions revealed

time prior to 2018.As per the provisions of Regulation 11(1) and Regulation 11(3) of the IRDA Regulations,2002 “11(1) superseded by 19(2), the requirements of disclosure of “material information” regarding a proposal or policy apply,under these regulation,both to the insurer and the insured.”

That the Hon’ble Andhra Pradesh High Court in SeelamRananamma Vs Divisional Manager Life Insurance Corporation of India (2000(1)ALD 406) held that “The person seeking insurance is bound to disclose all such material facts relating to the risk involved in the policy of insurance.The false answers or suppression or withholding of such material information in the proposal form submitted by the assured.Any suppression and non-disclosure thereto would have far reaching effect on the contract.The age and physical conditions are relevant for the premiums to be fixed and the insurability of the policy holder”

                                    Hence,the complainants failed to established the case against OPs.The deceased Mr Rajen Kakked was suffering from disease since long time

Going by foregoing discussion, we are of the view that the complainant is not entitled to get any relief  against the OPs. Thus,all the Points under determination are disposed of.

           In result, the case succeeds.

Hence,

Ordered

That the complaint case be and the same is dismissed on contest and against the OPs. No cost is imposed upon any of the parties.