ORDER

1.      The present Revision Petition has been filed by the Petitioner under Section ­­­21(b) of the Consumer Protection Act, 1986 (the “Act”) against impugned order dated 07.07.2016, passed by the learned State Consumer Disputes Redressal Commission, Maharashtra, Circuit Bench at Kohlapur, (hereinafter to be referred as the ‘State Commission’) in FA No. A/14/1021, whereby the Appeal filed by the OP (Appellant herein) was dismissed and affirmed/ upheld the Order dated 29.09.2014, passed by the District Consumer Disputes Redressal Forum, Kolhapur (hereinafter to be referred as the “District Forum”) in Consumer Complaint No. 192 of 2012.

2.      For ease of reference, the parties are referred to as stated in the original Complaint filed before the District Forum. Mr. Shriraj Amar Mahagaonkar is referred to as the Complainant who is the nominee of his father namely Late Mr. Mahagaonkar Amar Nana Saheb. Meanwhile, Life Insurance Corporation of India is referred to as the Opposite Party Insurer (OP) in this matter.

3.      Brief facts, as per the Complainant, ate that the Complainant's father had obtained policies from the OP for saving, risk coverage, and future Policies Nos. 947558627, 947735717 and 947788896 respectively with respective sum assured amounts of Rs. 5,10,000/-, 1,50,000/- and 1,25,000/- were effective from 01.01.2009, 14.01.2009, and 01.10.2009. At the time of policy inception, the health condition of his father was comprehensively examined by LIC Medical Examiner, Dr. Sanjay A. Kandare and thereafter the policies were issued. The health of his father remained normal prior to obtaining policy. However, on 15.10.2010, he was hospitalized due to abdominal pain and vomiting under the care of Dr. Kothiwale. Later, on 20.10.2010, he experienced breathing difficulties and received treatment at KLE Hospital, Belgaum, and recovered on 04.11.2010. Again, on 07.11.2010, he underwent treatment at KLE Hospital, for abdominal pain and urinary retention and was discharged on 12.11.2010. Unfortunately, on 16.11.2010, he exhibited symptoms of body pain, weakness, yellowed eyes, and reduced liver efficiency, with a diagnosis of pneumonia. Tragically, he passed away on 27.11.2010 due to “septicemia and multiple organ dysfunction”. Allegedly, on 13.09.2011, the claim made by the Complainant was repudiated, purportedly due to discrepancies in his responses regarding his diabetes and cardiac conditions, despite the diseases being unrelated to the causes of his demise. The Complainant asserted that the treatment provided to his father solely addressed the conditions he was afflicted with. He contended that the OP's repudiation of the claim signifies deficient insurance services and unfair trade practices.

4.      Being aggrieved, the Complainant filed Complaint No. CC 192 of 2012, seeking claim of Rs.9,33,500/- from the OP, inclusive of insurance amounts, interest, and additional costs.

5.      In reply, OP denied the allegations of the Complainant and contended that the Complainant's father was fully aware of his illness and deteriorating health status at the time of obtaining the policies. Despite the known health issues, Dr. Kandare provided a certificate indicating his normal health condition. Notably, the deceased individual had been grappling with long-standing ailments including diabetes and cardiac disease from the outset and suffered complications such as multiple organ dysfunction stemming from pneumonia, as well as heart enlargement due to diabetes. Additionally, severe complications due to diabetes resulted in gangrene affecting the sole of the right foot, while dyspnea manifested due to cardiac weakening and compromised immunity. Given these circumstances, the underlying illnesses of diabetes and cardiac disease were attributed as primary contributors to the deceased's deteriorating health. The OP highlighted that the deceased concealed his prolonged diabetic condition for about 7 to 8 years before filing the proposal form