IN THE DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION Date of Institution: 20.07.2023 Date of Hearing: 21.01.2025 Date of Decision: 24.02.2025 FIRST APPEAL 327/2023 IN THE MATTER OF:

FUTURE GENERAL INDIA INSURAANCE CO. LTD., HAVING ITS HEAD OFFICE AT:

UNIT NO. 801 & 802, TOWER C, 247 EMBASSY PARK, LBS MARG, VIKHROLI (WEST), MUMBAI – 400083.

ALSO., AT:

303-310, 3^RD FLOOR, KAILASH BUILDING, K.G. MARG, CANNAUGHT PLACE, NEW DELHI.

(Through: AUA Legal LLP)

…. Appellant VERSUS MR. NARESH KUMAR, S/O MR. KASHI RAM, R/O 29-A, N-BLOCK, GOPAL NAGAR, NEAR KHORWAL DHRAMKANTA, NAJAFGARH, NEW DELHI. (Through: Mr. Shripal, AR)

…. Respondent CORAM:

HON’BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)

HON’BLE MR. J.P. AGRAWAL MEMBER (GENERAL)

Present: None for the appellant.

Mr. Shripal, counsel for the respondent.

PER: HON’BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)

JUDGMENT

1. The facts of the case as per the District Commission record are under:

“1. The present complaint has been filed under section 12 of the Consumer Protection Act, 1986 (in short CP Act) against Opposite Party (in short OP) alleging deficiency of services. Briefly stated the facts as borne out from thecomplaint are thal the complainant is the holder of Future Health Suraksha (Individual Policy) from the OP which was renewed from time to time.

2. The complainant further alleged that he filed a claim in August, 2013 before the OP but the said claim was rejected by OP without any reasonable ground vide letter dated 23.08.2013. It is further alleged that claim was rejected on the ground that complainant had concealed material facts and violated the terms and conditions of the Policy. It is also alleged that complainant completed all the necessary formalities as required at the time of taking policy and disclosed all the queries made by OP but the OP was adamant to cancel the policy in on illegal and arbitrary manner. Complainant replied to the letter dated 26.08.2013 of OP controverting the allegations of OP and requested not to cancel the same. It is further stated that the action of OP is highly illegally and arbitrary as the OP has no right to cancel the policy. It is stated that complainant suffered great mental torture and harassment from the above conduct of the OP and was unable to get treatment due to above letter of the OP.

3. It is also alleged that at the time of purchase of the policy, the copy of the terms and conditions of the said policy was not provided to the complainant despite repeated requests.

4. It is prayed that OP be directed not to cancel the policy in question no. 2012-H0047382-FHI and the complainant be compensated by awarding compensation of Rs.2,00,000/- (Rupees Two Lakh) for unfair trade practice and causing mental harassment/ tension to the complainant by OP. Cost of litigation be also awarded.”

2. The District Commission after taking into consideration the material available on record passed the order dated 01.06.2023, whereby it held as under:

“9. The complainant had denied the allegations made in the said communication and stated that he had sent a letter to OP 6th September, 2013. The OP has drawn our attention to a judgment of the Hon'ble Supreme Court of India in 'Civil Appeal No. 3944 of 2019 'Life Insurance Corporation of India Vs. Manish Gupta'. In the said case, though the insured did not disclose the past history and denied of any pre-existing disease but the hospital records where he was treated revealed that the insured suffered from rheumatic heart disease since childhood and on this ground his claim was repudiated in terms of the exclusions contained in the policy. The Hon'ble Apex Court was pleased to hold that the failure of the insured to disclose the past history of cardiovascular disease was a valid ground for repudiation.

10. The plea of the OP is that the insured has not disclosed or declared in his proposal form that he is suffering from the disease. However, the argument of the complainant is that he was not supplied with copy of terms