IMPORTANT POINT
Suppression of material facts regarding health may vitiate insurance policy.

K. Ramanna, President—This complaint filed by Smt. Virupamma w/o. Late Doddappa against the OP Insurance Company seeking direction to the OP to pay sum assured amount of Rs. 26,00,000 along with death benefits in policy No.0017017984 dated 27.4.2006 along with 12% interest thereon since September 2006 till realization to the complainant and to pay compensation amount of Rs.1,00,000 towards mental harassment and agony suffered by the complainant and grant such other relief deems fit.

2. The case of the complainant in brief is that she is an illiterate widow and legally wedded wife of Doddappa who insured his life with the respondent/OP Insurance Company. To that effect insurance policy has been issued on 27.4.2006 under Bajaj Allianz UNIT Gain for an assured sum of Rs. 26,00,000 and complainant was the nominee to the said policy. Her husband was hale and healthy prior to his death and he was businessman by profession and owning saw mill at Sindhanoor, Raichur District. He was the income tax assessee and his pan card No. ADQPD 480J. He submitted his proposal form No.4638560 for life insurance on 24.2.2006 (Annexure A). Sum assured under the policy was Rs. 30,00,000 by opting payment of Rs. 50,000 towards annual premium through cheque No.236360 dated 25.2.2006. Subsequent to the receipt of the proposal form, OP faxed three letters dated 13.3.2006 (Annexure-B) to his insurance consultant/agent by intimating the insured to undergo various medical examinations through their panel doctor at Sindhanoor. Accordingly, insured undergone various medical tests on 21, 23 and 24th March, 2006 through respondent’s panal Dr. Totad H.S. Sindhanoor and he submitted medical examination report No.339168 to the respondent as per Annexure C. After receipt of additional requirements from insured as per its letter dated 30.3.2006 and 21.4.2006 (Annexures D and E) he sent revised letter dated 25.4.2006 (Annexure F) to the insured and upon acceptance of same revised offer by insured for Rs. 26,00,000 instead of Rs. 30,00,000, the respondent sent first premium receipt dated 27.4.2006 (Annexure G) by accepting the proposal of insured for Rs. 26,00,000 along with riders benefits mentioned therein and sent insurance policy on 13.5.2006 as per Annexure-H.

3. Further case of the complainant is that in the first week of 2006 the insured i.e. complainant’s husband fell illness due to fever and due to other problems like breathlessness. Therefore, he got admitted to Rajiv Gandhi Super Specialty Hospital, Raichur on 10.8.2006. In spite of treatment provided, he died on 15.8.2006 due to cardio respiratory failure. Accordingly it was intimated to the OP Insurance Company and claim was submitted to OP. In turn OP Insurance Company illegally repudiated the claim on the alleged ground of non-disclosure of material facts through letter dated 4.12.2006 (Annexure I) by intimating the complainant to write Claims Review Committee if not satisfied to their answer. Accordingly, complainant wrote a letter dated 4.12.2006 (Annexure J) to OP’s Claims Review Committee. But in vain. Repudiation of the OP amounts to deficiency of service. Therefore, she filed a complaint along with an application under Section 24A of the CP Act to condone the delay if any in a precautionary measure.

4. After service of notice, OP appeared through its Counsel rued its version denying all the averments made in the complaint. The medical certificate issued by the CMO of the Rajiv Gandhi Hospital at Raichur where the life assured Sri Doddappa died on 15.8.2006 clearly indicates that the life assured died as a result of “Cardio Respiratory failure, secondary to retroviral infection and secondary to acute pancreatitis”. OP further contended that the deceased Doddappa had a history of Retroviral disease since two years, prior to his death on 15.8.2006. He was admitted to Rajiv Gandhi Super Specialty Hospital at Raichur on 10.8.2006 with a complaint of “Breathlessness and Fever” and was inpatient in the