The Complainant has filed this case alleging deficiency-in-service by the O.Ps, where O.P No.1 is the IFFCO-TOKIO GENERAL INSURANCE CO. LTD. represented through its M.D, New Delhi, O.P No.2 is the IFFCO-TOKIO GENERAL INSURANCE CO. LTD. represented through its Area Manager, Bhubaneswar and O.P No.3 is the IFFCO-TOKIO GENERAL INSURANCE CO. LTD. represented through its Branch Manager, Kalidaspur, Balasore.

                    2. The case of the Complainant in brief is that the Complainant had taken a critical illness policy vide policy No.52614026 for self, wife and daughter for sum insured of Rs.2.00 Lacs (Rupees Two lakhs) only from the O.Ps on payment of Rs.7,393/- (Rupees Seven thousand three hundred ninety three) only on 28.03.2016, covering up to 27.03.2017. During the policy in force, the wife of the Complainant Debasmita Mohanty was admitted in AMRI Hospital, Bhubaneswar on 13.08.2016 for treatment of critical illness (Acute Gastroenteritis) and was discharged from the hospital on 16.08.2016, thus spent more than Rs.22,723.94 ps. (Rupees Twenty two thousand seven hundred twenty three and ninety four paisa) only and she was under treatment also. Accordingly, the Complainant submitted the claim form along with all original relevant documents before the O.Ps on 06.09.2016, but the O.Ps have not settled the claim of the Complainant. The Complainant requested the O.Ps in several occasions, but the O.Ps vide their letter dtd.31.01.2017 refused to settle his claim. Cause of action to file this case arose on 31.01.2017. Such type of activity by the O.Ps amounts to deficiency in service and unfair trade practice, causing mental agony to the Complainant. The Complainant has prayed for payment of medical expenses incurred along with compensation for mental agony and litigation cost.

                    3. Written version filed by the O.Ps through their Advocate denying on the point of maintainability, jurisdiction as well as its cause of action. The O.Ps have further submitted that the Complainant had obtained Family Health Protector Policy No.52614026 for the period from 28.03.2016 to midnight of 27.03.2017 from the O.Ps covering risk for him, his spouse and his daughter with maximum limit up to Rs.2.00 Lacs (Rupees Two lakhs) only subject to terms and conditions of the policy. On 06.09.2016, the Complainant submitted claim form Part-A and B for reimbursement of Rs.22,723/- (Rupees Twenty two thousand seven hundred twenty three) only incurred by him during treatment of his spouse Devasmita Mohanty at Amri Hospital, Bhubaneswar for treatment of loose motion, nausea, vomiting for the period from 13.08.2016 to 16.08.2016 as indoor patient along with discharge summary of Amri Hospital, Bhubaneswar, admission slip, admission/ consent form. History and pathological record (General), treatment sheet, impatient medication record and haematology report of Amri Hospital, Bhubaneswar. On receiving the same, the O.Ps scrutinized the same and ascertained that the spouse of the Complainant was admitted in Amri Hospital, Bhubaneswar on 13.06.2016 having history of Diabetes since 2010 and LSCS surgery was done in 2006, which is prior to inception of the policy, for which the O.Ps wrote letter to the Complainant on 09.01.2016 to provide all past treatment records including 1st consultation papers relating to history of diabetes and a certificate from the treating doctor mentioning the indication for hospitalization in this case and while the patient could not be treated all OPD basis. From the history & physical record (general) of Amri Hospital, Bhubaneswar, submitted by the Complainant, it is ascertained that her wife was suffering from Diabetes since 2010, which is much prior to inception of the Family Health Protector Insurance policy in question and this fact was known to the insured Complainant at the time of submission of proposal, but he has given answer “No” against the question have any of the person proposed to be insured above suffered from current suffering diabetic of question No.(ii) of Section-A of col-13 of the proposal form. Thus, the Complainant has deliberately and dishonestly concealed the facts of suffering of diabetes of his spouse since 2010 at the time of submission of proposal form for Family Health Protector insurance policy on 28.03.2016 and gave wrong and false information and statements in the said proposal. Thus, the case of the Complainant being devoid of merit is liable to be dismissed with cost.

                    4. In view of the above averments of both the Parties, the points for determination of this case are as follows:-

(i) Whether this Consumer case is maintainable as per Law ?

(ii) Whether there is any cause of action to file this case ?

(iii) To what relief the Complainant is entitled for ?

                    5. In order to substantiate their claim, both the Parties have filed certain documents as per list. Perused the documents filed. It has been argued on behalf of the Complainant that though his Family Health Protector Policy No.52614026 was already valid at the time of admission of his wife in Amri Hospital, Bhubaneswar and he has spent Rs.22,723.94 ps. (Rupees Twenty two thousand seven hundred twenty three and ninety four paisa) only for medical treatment, the O.Ps have repudiated his medical claim on the ground of suppression of material facts having diabetes since 2010. Further, it has been argued that such repudiation of claim is not legal and this Forum has territorial jurisdiction as well as pecuniary jurisdiction to entertain this case. On the other hand, it has been argued on behalf of the O.Ps that there is suppression of material facts at the time of submission of proposal form, wherein the Complainant has denied about existence of diabetes at the time of taking of the policy. The condition No.49 of terms and conditions of the Family Health Protector Policy reads as follows:- “Disclosure to information norm- This means the policy shall be void and all premium paid hereon shall be forfeited to us, in the event of misrepresentation, mis-description or non-disclosure of any material fact”. Both the Parties have relied upon a number of decisions in support of their case. It has been further argued on behalf of the O.Ps that there is no cause of action in the jurisdiction of this Forum and merely existence of branch of the Insurance company at Balasore does not attract the jurisdiction of this Forum. In support of it, he has relied upon the authority reported in 2017(3) CPR-5 (NC) in the case of Ghaziabad Development Ghaziabad Authority (Vrs.) Shree Krishna Singhania (since deceased) through Lrs., wherein it has been held by the Hon’ble National C.D.R Commission, New Delhi that mere existence of a Branch office of a company would not ipso facto be determinative of territorial jurisdiction of District Forum and cause of action must also arise at that place. In this case, the Complainant has prayed regarding settlement of his claim in the Office of O.P No.3 vide his document as filed in this case though not marked as annexure under the head of Acknowledgement of Iffco Tokio General Insurance Company Limited having seal and signature of O.P No.3. So, taking into consideration of all the materials available in the case record, we are in the opinion that this Forum has jurisdiction to entertain this case. Strangely enough, the Complainant has filed a document regarding insurance of his Hero Honda Passion Plus vehicle bearing Regd. No.OR-11H-2877 insured under Iffco-Tokio General Insurance Co. Ltd., but this document is no way relevant to this case. The reason for filing of this document in this case is best known to the Complainant. Regarding prior knowledge of existence of diabetes of wife of the Complainant who has treated in Amri Hospital, Bhubaneswar is to be verified properly. Admittedly in this case, at the time of taking of the insurance policy, none of the members covered under the policy were medically examined by the doctor on behalf of the O.Ps. It is also be seen now whether the Complainant or his wife who covered under the policy has knowledge about existence of diabetes at the time of taking of the policy though the medical document furnished by the O.Ps discloses about existence of diabetes since 2010 and it is ascertained from the medical document of treatment of the wife of the Complainant in Amri Hospital, Bhubaneswar and in that medical document under the heading of past medical history, existence of type-2 diabetes since 2010 has been mentioned. This fact has also been disclosed in the written version of the O.Ps, but nowhere the Complainant has challenged this fact either at the time of taking copy of the written version or by filing any rejoinder against it. So, it is safely concluded that the Complainant has knowledge about existence of diabetes of his wife at the time of taking of the policy and he has also suppressed the material facts, for which the condition No.49 of terms and conditions of the policy is applicable in this case.    

                    6. So, now on careful consideration of all the materials available in the case record and on the basis of principle laid down by the above Authority as discussed earlier, I found no reasonable ground to differ in the opinion of the insurance company regarding repudiation of the claim of the Complainant and the insurance company has rightly repudiated the claim, for which the Complainant is not entitled for any relief as prayed for and accordingly, this Consumer case is liable to be dismissed. Hence, Ordered:-

                                                     O R D E R

                         The Consumer case is dismissed on contest against the O.Ps, but in the peculiar circumstances without cost.

                         Pronounced in the open Forum on this day i.e. the 20th day of March, 2019 given under my Signature & Seal of the Forum.