IN THE TAMILNADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI.

Present: Hon’ble THIRU. JUSTICE R. SUBBIAH:

PRESIDENT C.C.No.10 of 2016 Friday, the 31^st day of May 2024 Dr.R.Jagan, Door No.A-9/47, Kalaimagal Ramasamy Salai, Jothi Nagar, D-Colony, Pollachi – 642 001. ... Complainant - Vs –

1. M/s HDFC Standard Life Insurance Co. Ltd., Rep. by Senior Vice President-Operations, Ramon House H.T. Parekh Marg, 169, Backbay Reclamation, Churchgate, Mumbai -400 020.

2. M/s HDFC Standard Life Insurance Co. Ltd., Rep. by the Manager, Indsil House, 2nd Floor, Nos. 103-107, T.V.Samy Road, R.S.Puram, Coimbatore – 641 002. ... Opposite Parties Counsel for the Complaint : M/s. G.R.Hari Counsel for the Opposite Parties: M/s. P.D.Selvaraj This Complaint came up for final hearing on

04.04.2024, and on hearing the arguments of the counsel for the Complainant and the opposite parties and upon perusing the material records, this Commission made the following:-

ORDER

R.SUBBIAH J., PRESIDENT This Complaint has been filed under Section 17 of the Consumer Protection Act, 1986, to direct the opposite parties to pay the complainant a sum of Rs.62,62,500/- being the sum assured under the policy with interest and costs.

2. The case of the complainant is that his wife Mrs.Selvi Jagan had taken a HDFC SL Crest life insurance policy with the opposite parties for a sum of Rs.62,62,500/- towards death benefits. The policy number 13930610 was issued on 11.11.2010 and was valid till 11.11.2020. The yearly premium payable on the said policy was Rs.4,99,999/-. The name of the complainant was given as the nominee of the policy. The yearly premium was paid for three successive years and the same was accepted by the opposite parties and the receipts were issued. Unfortunately, Mrs.Selvi Jagan, expired on 21.12.2012 due to carcinoma of gall bladder at Gem Hospital, Coimbatore. The complainant submitted the standard death claim to the opposite parties on 03.07.2023 along with the medical certificate and other requisite documents. But to the great shock and surprise of the complainant the opposite parties repudiated the claim of the complainant by a communication dated 22.11.2013 falsely stating that the assured was suffering from carcinoma of gall bladder prior to the issuance of the policy. In the said communication it was also stated that in case the complainant wished to represent his claim he could do so within 30 days from the date of the repudiation. The complainant therefore represented his claim to the Claims Review Board by way of letter dated 21.12.2023. But the complainant has not received any response from the Claims Review Board. At the time of issuance of the policy the deceased Mrs.Selvi Jagan was not aware of her disease since it was silent at that time. She was normal, active and asymptomatic for nearly two years after the issuance of the policy. Further still, the policy was issued only after Mrs.Selvi Jagan was subjected to extensive medical, clinical, cardiac, radiological, sonological, physical, chemical and special examinations and investigations to the satisfaction of the opposite parties. In fact diagnostic laparoscopy scars were present on the abdomen of the assured at the time of medical examination and the same was disclosed by the proposer. There was no suppression of fact or intention to fraudulently suppress by the policy holder. As per Clause 18(ii) of the policy there are two types of proposals for underwriting policies. In the first proposal, policy was issued solely based on the short medical questionnaire of the assured without subjecting them to any medical examination. The condition precedents are that the annual premium should be Rs.2 lakhs or less and the total sum assured should not exceed Rs.20 lakhs. In the second proposal the policy was issued only after undergoing normal medical underwriting process. The assured opted for this proposal and the policy was issued only after special and extensive medical investigations. The