Order No.   19    Dated  26-03-2015.

          The case of the complainant in short is that complainant obtained the Family Health Optima Insurance Policy from o.p. through their policy issuing office at Howrah in joint named of herself and her husband Gouri Sankar Shaw (now deceased) vide Policy No.P/191113/01/2011/001310 and paid total premium to the tune of Rs.6105/- with the coverage of Rs.2 lakhs commencing from 23.12.10 to 22.12.11. After several clinical tests from the laboratory and on satisfaction the said policy was issued.

            On 17.10.11 the husband of the complainant (now deceased) visited Dr. S. K. Shah with a complain of pain in lower abdomen and after check up the doctor prescribed some tests, medicines and also referred to hospital. On 21.10.11 as per advice of the doctor the complainant admitted her husband in Apollo Gleneagles Hospital, Kolkata under Dr. M. K. Goenka. It may be mentioned here that the husband of the complainant expired on 22.10.11.

            Complainant paid a sum of Rs.1,50,834/- towards the hospital bills, tests, medicines, etc. On 17.11.11 complainant submitted the claim form along with relevant documents. O.p. vide their letter dt.29.5.12 repudiated the claim of the complainant. The repudiation was made thereby stating as follows:

            “As per exclusion no.10 of the above policy the company is not liable to make any payment in respect of expenses incurred at hospital for treatment of any disease / condition due to use of intoxicating drugs or alcohol”.

            O.p. repudiated the claim of the complainant under the Exclusion Clause 10 of the said policy. Complainant through the ld. advocate sent a letter dt.22.6.12 followed by 27.6.12 thereby expecting that o.p. shall reconsider the claim of a widow lady but in vain. Hence, the case was filed by the complainant with the prayers contained in the petition of complaint.

Decision with reasons:

            Sole o.p. had entered their appearance in this case by filing w/v and denied all the material allegations labeled against them and prayed for dismissal of the case. Ld. lawyer of o.p. in the course of argument submitted that the case has got no merit and the same is liable to be dismissed.

            We have gone through the pleadings of the parties, evidence and documents in particular and we find that it is a matter of record that complainant’s husband filled the self declaration form upon which a “Family Health Optima Insurance Policy” was issued in favour of complainant and her husband since deceased for the period from 23.12.10 to 22.12.11. In the said insurance policy it was clearly stated that the insurance under this policy is subject to conditions clause warrantees exclusion etc. attached and accordingly, a contract of insurance entered into between the complainant and her husband and o.p. From the record we find that the policy was taken on 23.12.10 within 10 months in Oct. 2011 and complainant’s husband suffered from chronic liver disease and was admitted in Apollo Hospital, Kolkata wherein the doctors of the said hospital observed that the patient Gourishankar Shaw was alcoholic and alcohol was the rout cause of such chronic liver disease.

            In view of the findings above and on careful scrutiny of the entire materials on record, we find that complainant has failed to substantiate and prove her case and is not entitled to relief.

            Hence, ordered,

            That the case is dismissed on contest without cost against the o.p.

            Supply certified copy of this order to the parties free of cost.