The central legal point established in the judgment is the justification for repudiating an insurance claim based on the deliberate withholding of information by the insured and the breach of terms and conditions of the insurance contract.

JUDGMENT/ORDER :

S. M. Kantikar, Presiding Member - Heard the learned counsel for both the parties and perused the material on record.

2. The dispute relates to repudiation of the complainant's insurance claim, made under the insurance contract entered into between the Insurance Co. and the complainant.

3. The District Forum had heard both sides, appraised the evidence, and, vide its Order dated 31.10.2015, partially admitted the complaint:

RATIONALE

5- Issue Nos. 1 to 3- The Opposite Party has raised objection to the jurisdiction of the Forum and given the reference of Hon. Supreme Court in case of Ravneet Singh Bagga v/s KLM Royal Dutch Airlines, (2000) 1 SCC 66 has propounded upon the issue of deficiency in service and has said that only on intentionally providing deficient service the issue of deficient service is proved. In the present complaint the Opposite Party has not, while providing service to the Complainant, intentionally provided deficient service to the Complainant and therefore the present complaint should not be heard in this Forum. Also they have referenced that the Hon. National Forum has propounded the legal principle in the case of Kishore Chandrakant Rathod vs. ICICI Prudential Life Insurance Co. Ltd. and Others (review petition no. 3390/2013) that the Complainant is an educated person and has fully read the terms and conditions of the contract and then taken insurance cover, and for any breach of these conditions resulting in the Opposite Party rejecting the insurance claim the complaint cannot be conducted in front of the Forum. The Opposite Party has said that therefore the Forum has no jurisdiction to conduct the hearing on this complaint. It is proved that after the insurance contract between the Opposite Party and the Complainant, the complainant has not given in writing to the Opposite Party within 15 days of the contract any intimation to cancel the said policy. After the documents submitted by the Complainant to the opposite Party were scrutinized by the specialists appointed by the Opposite Party it was diagnosed that the Complainant had diabetes and the Opposite Party came to know that treatment for the same had been taken and it was verified from the documents submitted by the Complainant but it was established that the Complainant had not disclosed this information to the Opposite Party voluntarily. Therefore it was proved that the complainant had intentionally not given this information to the Opposite Party - - - therefore the Opposite Party has repudiated the Complainant's insurance claim under section 45 of the Insurance Act 1938, as also under the terms mentioned in condition 5 B (i) of the contract. Therefore the Opposite Party have sent a letter to the Complainant dated 21/12/2012 informing him about the insurance claim being rejected. Since the complainant has breached the terms and conditions of the insurance contract, the Opposite Party has repudiated his claim justly and informed him about it and therefore the Forum does not have jurisdiction to conduct a hearing on the present complaint. Also the Complainant had deliberately withheld from the Opposite Party the information about the Complainant having been diagnosed with diabetes, thus the Opposite Party has no legal obligation to fulfill the insurance claim submitted by the Complainant and so the Opposite Party has committed no deficiency in service to the Complainant and therefore the present complaint should be rejected with expenses under section 26 of the Consumer Protection Act based on the available documents. After stating this, as held by Hon. Supreme Court in the judgments in the cases of United India Insurance Co. Ltd. v/s harchand Rai Chand Rai Chandalal, (2003) 1 CPJ 393 and Vikram Greentech (I) Ltd. & Another v/s New India Assurance Co. Ltd., (2009) 2 CPJ 34 and also Export Credit Guarantee Corporation of India Ltd. v/s Garg Sons International, (2013) 1 Scale 410 it was held that breach of terms and conditions of the insu