By Smt. Padmini Sudheesh, President The case of the petitioner is that the petitioner was a medi claim policy holder of respondent vide No.4876030115544 and the period of the policy was 22/11/01 to 21/11/02. During the insurance period he has undergone a surgery for Vericos vein and incurred medical expenses of Rs.20,000/- . The surgery was on 24/12/01. Later he has applied for the insurance benefit. But the claim was not provided. He has not furnished any false declaration. Lawyer notice sent on 16/7/02, but no remedy. Hence this complaint. 2.In the version it is stated that the medical report issued by the doctor who admittedly treated the petitioner that he has undergone surgeries for Ventral Hernia Abdomen and Meningloma, insured is also a known diabeticon Control with insulin and according to the opinion of the Doctors that the Venus ulcers develops on varicose veins of leg after very prolonged course, it is a complication of varicose vein leg of very long duration. Therefore the petitioner is not entitled to any compensation whatsoever under the terms of the policy. The insured has undergone surgeries for ventral hernia abdomen and meningloma and the insured also clarified about the surgeries made earlier and he has stated that they were done on 15/6/1995. Having declared that he has undergone surgeries as above, in the proposal submitted by the insured at the time of effecting insurance stated that he has never treated for hernia, and never undergone surgeries vide answer to questions 13(d) (1) (N) of proposal. Since the insured has made false declaration in proposal the policy is not valid as per the terms. The act of petitioner is deceiving, consciously suppressing the disease at the time of making the application for issuance of the policy. This is not a disease which suddenly appear. The compensation claimed is highly excessive. Hence dismiss the complaint. 3. The points for consideration are 1) Whether the petitioner is entitled for the insurance claim ? 2) Reliefs and costs ? 4. The evidence consists of Exhibit P1 and Exhibits R1 to R10. 5. Points: The insurance claim of the complainant is repudiated by the Company stating that the material facts were suppressed. The company also states that the disease is not which suddenly appears. It has to have a history. In the proposal form there are so many questions to be answered by the insured. The questions 13(d)(g) to (h) have answered by the petitioner as no. There is specific question that whether the petitioner ever suffered from fistula, piles, hernia, varicose vein. He has answered No. As per the medical records the insured has undergone surgeries for Ventral Hernia Abdomen and meningloma. The complainant is also a known diabeticon control with insulin. As per the record it can be seen that the venus ulcers develops on varicose veins of legs after a very prolonged course and it is a complication of varicose vein leg of very long duration. In the proposal form there are specific questions but he has answered No. It shows that he has suppressed the very material facts to get the policy benefits. He has started treatment long time back. He has not disclosed it while taking the policy. From the records it is clear that the disease is not suddenly occurs. The doctor who has treated made it clear that the petitioner had past history of surgeries and also known diabeticon control with insulin. The diseases are in existence for a long period and he had knowledge about it. He had also treated for it. But he has not revealed it. So he is not liable for insurance benefits. The counsel for complainant was argued that since the questions are in English he simply written as no, no. As he knows about it, he wrote so. So we are of the view that the claim is not based on true and genuine facts. Hence he is not entitled for any relief. 6. In the result the complaint is dismissed. No order as to costs and compensation. Dictated to the Confdl. Asst., transcribed by her, corrected by me and pronounced in the open forum this the 28th day of July 2008.
