STATE CONSUMER DISPUTES REDRESSAL COMMISSION KERALA FIRST APPEAL NO. SC/32/A/16/475 LIC INDIA DIVISIONAL HEALTH UNIT PRESENT ADDRESS - DIVISIONAL OFFICE NAGAMPADAM KOTTAYAM 686001 ,KERALA.

.......Appellant(s)

Versus N A ZACHARIAH PRESENT ADDRESS - NELLICKAL HOUSE JUBILY NAGAR RUBBER BOARD ROAD VADAVATHOOR PO KOTTAYAM 686010 ,KERALA.

.......Respondent(s)

BEFORE:

SRI.RADHAKRISHNAN.K.R , PRESIDING MEMBER FOR THE APPELLANT:

NEMO FOR THE RESPONDENT:

NEMO DATED: 25/06/2025

ORDER

KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM APPEAL No.475/2016 JUDGEMENTDATED: 25.06.2025 (Against the order in C.C.No.287/2013 on the files of DCDRC, Kottayam)

PRESENT:

SRI. AJITH KUMAR D. : JUDICIAL MEMBER SRI. K.R. RADHAKRISHNAN : MEMBER APPELLANT:

LIC of India, Divisional Health Unit, Divisional Office, Nagampadam, Kottayam – 686 001 (by Adv. Anitha Aji)

Vs.

RESPONDENT:

N.A. Zachariah, Nellickal House, Jubily Nagar, Rubber Board Road,

Vadavathoor P.O., Kottayam – 686 010

(by Adv. S. Reghukumar & Preeja Rajeev)

JUDGEMENT

SRI. K.R. RADHAKRISHNAN: MEMBER st This is an appeal filed by the 1 opposite party in C.C.No.287/2013 on the files of the District Consumer Disputes Redressal Commission, Kottayam (the ‘District Commission’ for short). As per the order dated 30.05.2016, the District Commission allowed the complaint and directed as under:

1) The opposite parties are directed to pay Rs.5,00,000/-to the complainant with

12% interest from 15.03.2013, the date of repudiation till realisation; 2) Since interest is allowed, no separate compensation is allowed;

3) Opposite parties are ordered to pay Rs.5,000/- as cost of litigation.

st Aggrieved by the said order, the 1 opposite party has filed the appeal.

2. The brief details of the complaint are as follows:

st The complainant had taken a “Health Plus” policy No.394139776 (plan 901) from the 1 opposite party on 28.08.2008 covering himself and his wife for a term of 18 years. The complainant was covered for a sum insured of Rs.5,00,000/-(Rupees Five Lakhs only) and spouse for a sum insured of Rs.3,00,000/-(Rupees Three Lakhs only). The policy provides coverage for Hospital Cash Benefit (HCB) for accidental bodily injury or sickness, Major Surgical Benefit (MSB) and domiciliary treatment benefits. Major surgical benefit shall be a percentage of the sum insured depending on the benefit opted by the insured. The policy also provided for reimbursement of domiciliary treatment expenses. The annual premium was Rs.19,500/-(Rupees Nineteen Thousand Five Hundred only) and the premiums were remitted in time up to 28.08.2012. The complainant was admitted in Bharat Cardio Vascular Institute, Kottayam on 13.11.2012 due to Retrosternal Chest Discomfort and he was discharged with an advice to undergo Coronary Angiogram and Tread Mill test. The said tests were carried out in Carithas Hospital, Thellakom on 28.11.2012. They recommended him to undergo Coronary Artery Bypass Graft surgery. Thereafter he went to Lisie Heart Institute, Kochi and was treated as an inpatient from 11.12.2012 to 18.12.2012. He underwent Coronary Artery Bypass Graft surgery (CABG) on 13.12.2012. According to the complainant he is entitled to get Rs.5,00,000/-(Rupees Five Lakhs only) as MSB irrespective of the amount spent for the treatment for Coronary Artery Bypass surgery as it is classified a major surgery in the policy. The complainant submitted the claim papers to the opposite party on 01.01.2013.The claim was repudiated by the opposite parties on the ground that the complainant was suffering from diabetes mellitus for six years and it was not disclosed by the insured at the time of taking the policy. According to the insurer, in view of the suppression of material facts regarding pre-existing illness, the contract of insurance became null and void abinitio. However the insured stated that he was not having diabetes mellitus at the time of taking the policy and there was no suppression of material fact. The complainant submitted th