IN THE CIRCUIT BENCH OF THE TAMILNADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION, MADURAI.

Present: THIRU. S.KARUPPIAH, PRESIDING JUDICIAL MEMBER C.C.No.39/2017 Date of complaint filed : 17.08.2017 Date of orders pronounced : 04.08.2023 Smt.S.Vidya, W/o (Late) V.K.Suresh, B2/12, High Court Officers & Staff Quarters, Mattuthavani, Madurai – 625 007. Complainant -Vs-

M/s.HDFC ERGO General Insurance Company Limited, HDFC House, 1^st Floor, 165-166 Back bay Reclamation, H.T.Parekh Marg, Church gate, Mumbai – 400 020. Opposite Party Counsel for Complainant : Mr.S.Mahesh Babu, Advocate.

Counsel for Opposite Party : Mr.S.Suresh, Advocate.

This complaint came before me for final hearing on 02.08.2023 and upon perusing the material records this Commission made the following:-

ORDER

THIRU.S.KARUPPIAH, PRESIDING JUDICIAL MEMBER.

1. The complainant’s case :

The complainant’s husband one V.K.Suresh since deceased obtained a ‘Home Suraksha Plus Policy’ with the opposite party on 30.03.2013 and it is valid up to 17.01.2017. A premium of Rs.91,553/- was also paid. The complainant’s husband was working as Sub Assistant Registrar of Madurai Bench of Madras High Court. The complainant husband took treatment with C.Rama Subramanian for his work related tension and not for Hypertension and Hemiplegia. The complainant husband suddenly experienced Cardio Pulmonary Arrest and died on 29.07.2016. When the claim was made with the opposite party they repudiated the claim stating that the deceased Suresh had a history of Hypertension and Hemiplegia from 2012 i.e., prior to taking the policy. There is no suppression of any material fact even the deceased suffered from Hypertension i.e., not the root cause of his premature death. The repudiation amounted to deficiency in service. Hence, she filed this complaint seeking death claim of Rs.20,00,000/- and Rs.10,00,000/- towards compensation for mental agony and also Rs.5,00,000/- towards costs of the proceedings.

2. The opposite party though entered into appearance, did not file any written version.

3. In this complaint, the complainant alone was examined as PW1 by filing proof affidavit and on her side Ex.A1 to Ex.A8 were marked.

4. As stated earlier the complainant husband one V.K.Suresh took ’Home Suraksha Plus Policy’ with the opposite party as evidenced from Ex.A1. The complainant died on 29.07.2016 and a claim was made through Ex.A2 for which the opposite party requested further documents as per Ex.A3. Finally, as per Ex.A7 dated 10.10.2016 her claim was repudiated stating that, deceased Suresh had a history of Hypertension and Hemiplegia since 2012 and he did not disclose pre-existing disease. As per the above repudiation letter, the sole reason to repudiate the claim was the medical conditions of Hypertension was not disclosed at the time of proposal. The complainant in her letter Ex.A8 dated 14.12.2016 clearly stated that the illness of ‘Hemiplegia and Hypertension’ were never hidden by them to the opposite party/insurance company. So, it is the case of the complainant that the pre-existing Hypertension was informed to the opposite party/insurance company at the time of taking the policy.

5. Now the point for consideration is:

Whether the above repudiation of the claim (Ex.A7) is valid, if not what relief the complainant is entitled?

6. Discussion on Point: It is the case of the complainant that her husband’s pre-existing health conditions was informed to the opposite party/insurance company and it is for the insurance company to deny the same by filing written version and also by marking the proposal form filled by the complainant husband. Since they failed to file written version to deny the factual aspect stated by the complainant the Commission have to accept that the above statement as proved. Once, the insurance company issued the policy after knowing the health conditions and there is no willful suppression of any material fact then the repudiation is not valid.

7. The Commission also viewed this case in y