ORDER

SH. RAKESH KAPOOR, PRESIDENT

The complainant’s son Late Vibhor Jain had purchased a happy family floater policy from the OP on 15.12.2010.   The policy was valid for one year for an assured value of Rs. 6,00,000/-.  The policy was further renewed for another year ending on 14.12.2012. Late vibhor Jain had expired on 11.3.2012 at Fortis Malar Hospital , Chennai.  The complainant had submitted a claim for a sum of Rs 1,50,000/- under the policy which was ,however ,repudiated on the ground that the deceased was suffering from a pre-existing disease and as such the claim was not payable under the exclusion clause of the policy purchased by the deceased. The  complainant has alleged that the repudiation of the claim was uncalled-for and an act of deficiency on the part of OP. Hence, the complaint.

   The OP has contested the complaint and has filed a written statement. The OP has admitted that it had issued a policy of insurance which also covered the deceased . It has, however, justified its act of repudiation of the policy on the ground that the claim was not payable under exclusion clauses 4.1 and 4.3 and condition no. 5.9 of the policy of insurance.  It has claimed that there are no merits in this complaint and the same is liable to be  dismissed. It has prayed accordingly.

   We have heard arguments advanced at the bar and have perused the record.

    The learned counsel for the OP has drawn our attention to the death summary prepared at Fortis Malar Hospital, Chennai  which clearly records  that the deceased had  a history of  hypertension for the last five years and had been investigated for the same in New Delhi.  Our attention has also been drawn to a copy of the proposal form purported to have been signed by the deceased on 12.6.2008 while purchasing a mediclaim insurance policy from M/s United India Insurance Company Ltd.  In the said proposal form it has been specifically recorded that the proposer was suffering from high blood pressure since the last one year .  Since, the proposal was signed on 12.6.2008 , it  can be safely assumed  that the deceased had been suffering from high blood pressure since June 2007.   From these two documents, it is clear that the deceased had a history of hypertension for a period of five years.    The deceased had taken the insurance policy from the OP firstly in the year 2010 and had renewed it for a period of one year in the year 2011.   It is , therefore, clear that the claim was not payable under clause 4 of the exclusion clause of the policy purchased by the deceased . we are, therefore, of the considered opinion that in the facts and circumstances of the case , the OP was justified in repudiating the claim lodged by the complainant.  We see no merits in this complaint. The same is hereby dismissed. 

Copy of the order be made available to the parties as per rule.  File be consigned to record room.

    Announced in open sitting of the Forum on.....................