ORDER

BY HON’BLE Mr.JUSTICE HULUVADI G RAMESH : PRESIDENT

1. This complaint is filed U/s.35 of CPA 1986 by the Complainant against OP.1 to 3/LIC and prays to direct OP to pay a sum of Rs.1,01,00,000/- as basic sum insured under the policy along with interest at 18% p.a.; Rs.50,00,000/- with interest at 18% p.a. towards damages for mental agony, stress etc; Rs.4 lakhs towards litigation cost.

2. The brief facts of the complaint are: The Complainant and his late wife/Smt.Rajkanya Somany were the practicing Chartered Accountants, have obtained the individual life insurance policy from OP undergoing medical test by the panel doctors of OP and paying prescribed premium in the year 2020. While the policy was in force, wife of the Complainant died due to Ovarian Cancer on 30.06.2022. In the same grief, Complainant has submitted claim form along with all relevant documents, but the same was repudiated on 31.03.2023 on the ground that deceased insured had not revealed her past illness such as MI, Diabetes Mellitus, HTN, Hypothyroidism, cancer of ovary before obtaining the policy.

Hence, being aggrieved by the act of OP, Complainant filed this complaint.

3. The OP.1 to 3/LIC appeared through their counsel and filed version justifying their repudiation. They submit that as the deceased insured has suppressed her various pre-existing illness before obtaining the policy, they rightly repudiated the claim.

Hence prays for dismissal of the complaint.

4. To substantiate the case, the Complainant filed his affidavit evidence and marked the documents at Ex-C1 to C14. The OPs also filed their affidavit evidence and marked the documents at Ex- R1 to R22. Heard. Now, the following questions that arise for our consideration:

(1) Whether the Complainant proved there is deficiency in service on the part of OPs ?

(2) If yes, for what relief does he entitle ?

Our answer to the above points are:

(1) Partly in the Affirmative (2) As per the final order REASONS

5. Point.1: We perused the complaint, OP’s version, affidavit evidence, written arguments and the documents. The undisputed facts are: Wife of the Complainant had obtained LIC’s Jeevan Labh policy/Ex-C3 bearing no.650688738, wherein could see, insured name is Smt.Rajkanya W/o Ramakanth Somani, policy term is 25 years, date of commencement of risk: 15.07.2020, date of maturity:15.06.2045, yearly instalment premium Rs.5,42,188/-, basic sum assured Rs.1,01,00,000/-, nominee Ramakant/husband – percentage share 100%. As she/life assured was passed away on 30.06.2022 (Death certificate/Ex-C8 & C9) hence, the Complainant being nominee intimated the OPs the death of her wife and submitted request/Ex-C10 dtd.29.07.2022 along with relevant documents to OPs claiming for settlement of the policy/death claim, but the same was came to be repudiated vide letter/Ex-C12 dtd.31.03.2023 on the ground, the deceased life assured has answered ‘No’ to the diseases such as hypertension, diabetes, thyroid and cancer and also ‘No’ for taken treatment, undergone investigation, hospitalisation while obtaining the policy, but from the hospital records, when it was found all these answers were false, amounted to suppression of material facts. Hence, Complainant approached this Commission seeking reliefs as sought in prayer.

6. It is the contention of the OPs that, by answering ‘No’ to the pre-

existing diseases, and also ‘No’ to the treatment underwent, she obtained the policy, but the hospital records revealed, the diseased life assured was suffering from certain pre existing illness, underwent treatment, investigation and hospitalised . Thus, death claim cannot be honoured in view of the violation of terms & conditions of the policy. In this regard, let us peruse the hospital records, to know, whether the diseased life assured was in fact suffered from certain illness and also underwent treatment before obtaining the policy ? Ex-C5/discharge summary of the Hospital/Durgabai Deshmukh Mahila Sabha, Hyderabad, wherein, it is seen that wife