Suppression of material facts by the insured in the proposal form dis-entitles the claimant to receive the maturity amount under the medi-claim policy.

JUDGMENT :

(Prayer: Writ Petition filed under Article 226 of the Constitution of India to issue a Writ of Certiorarified Mandamus to call for the records relating to the proceedings dated 27.08.2013 passed in Award No.10 (CHN) L-053/2013-14 in complaint No.10 (CHN)/21.07.2026/2013-14 on the file of the first respondent herein and quash the same and direct the fourth respondent to pay the petitioner the Insurance amount covered under Policy No.321871731 dated 26.06.2006, with interest at the rate of 18% per annum from 16.12.2008 till the date of the settlement of the entire policy claim.)

1. This writ petition has been filed challenging the order dated 27.08.2013 passed by the 1st respondent confirming the orders passed by the 4th, 3rd and 2nd respondents.

2. The petitioner made a claim under the medi-claim policy issued by the Life Insurance Corporation of India on 26.06.2006 which was rejected by the 4th respondent on 01.02.2012. Aggrieved by the same, she preferred an appeal before the 3rd respondent and the 3rd respondent also confirmed the order of the 4th respondent by rejecting the appeal on 21.08.2012. Aggrieved by the same, she preferred a Second Appeal before the 2nd respondent and the 2nd respondent also rejected the Second Appeal on 29.01.2013, confirming the orders passed by the 4th and 3rd respondents. Aggrieved by the order dated 29.01.2013, the petitioner approached the 1st respondent and the 1st respondent also rejected the petitioner’s appeal on 27.08.2013 by justifying the repudiation of the policy by the 4th respondent. Aggrieved by the orders passed by the respective respondents, this writ petition has been filed.

3. The petitioner’s husband S.Thommai Raj was issued with the medi-claim policy by the Life Insurance Corporation of India and the assured sum under the policy dated 26.06.2006 was Rs.1,00,000/-. S.Thommai Raj died on 15.12.2008. Thereafter, his wife, the petitioner herein made a claim before the 4th respondent under the medi-claim policy on 28.01.2010. All the respondents have rejected the petitioner’s claim and they have repudiated the petitioner’s claim on the ground that there was suppression of material facts with regard to the health condition of S.Thommai Raj under the application submitted by her to the Life Insurance Corporation of India for medi-claim policy.

4. A counter affidavit has been filed by the respondents denying the petitioner’s claim on the ground of suppression of material facts in the application submitted by the petitioner seeking for medi-claim insurance amount for the petitioner’s husband S.Thommai Raj. According to the respondents, after investigation, it was found that the petitioner’s husband S.Thommai Raj underwent a by-pass surgery in the year 1999 and was a chronic heart patient. According to them, this fact was suppressed by S.Thommai Raj, while he approached the Life Insurance Corporation of India for medi-claim insurance amount. According to them, on account of suppression of material facts, the claim of the petitioner has been rightly rejected by all the respondents.

5. Heard Ms.Elizabeth Rani, learned counsel for the petitioner and Ms.Rajashree, learned counsel for the respondents 2 to 4. Despite service of notice on the 1st respondent and their name having been printed in the cause list, there is no representation on their side.

6. Ms.Elizabeth Ravi, learned counsel for the petitioner would submit that it is the responsibility of the Insurance Company to medically examine the insured (petitioner’s husband) before issuing the medi-claim policy to the insured. According to her, there was no suppression of material facts by the insured (petitioner’s husband), as alleged by the respondents. It is further submitted by her that there would have been scars in the body due to the by-pass surgery that the insured (petitioner’s husband) had underwent and therefore, the respondents could have very well noticed the same and could have rejected the petitioner’s application seeki