ORDER

JUSTICE A.P. SAHI, PRESIDENT

IA/10388/2024 (C/Delay)   

1.       Heard Mr. Rajul Shrivastav, learned counsel for the appellant. Delay of 41 days as reported by the office has been prayed to be condoned.

2.       Having heard learned counsel for the appellant, the cause shown is sufficient and the delay deserves to be condoned. The application is allowed and the appeal shall be treated to be within time.

Appeal

3.       The appeal questions the correctness of the impugned order dated 08.02.2024 passed by the Karnataka State Consumer Disputes Redressal Commission, Bengaluru.

4.       The dispute centers around a life insurance claim policy. Upon the death of the insured, who was 45 years of age and had been suffering from cancer,  a claim was set up by the appellant , who is the husband of the insured.

5.       The insurance policy, according to the appellant was acquired after a medical examination conducted by the LIC officials. The policy acquired in 2020 was subsisting on the date of the death of the insured on 30.06.2022.

6.       The appellant set up his claim before the Insurance Company that was repudiated vide letter dated 31.03.2023, which is extracted herein under:

“Ret Clams/Repudiations/2022-2023/646          Date 31-03-2023

To.

Ramakanth Somani,

H/o Late Smt Rajkanya,

H.No.3-553, Somani Avenue, Milan Chowk Gazipur,

KALABURAGI

PIN:585101

Sir,

Re: Death claim under Policy Number. 650688738 on the life of Late Smt. Raikanya

This has reference to your claim under the above policy on the life of Late Raikanya received by us. In this connection we have to inform you that afore stated policy has not completed three years from the date of commencement of risk, i.e. 15-06-2020.

As such we have examined the claim, keeping in view of provisions of Section 45 of the Insurance Act 1938. While examining the claim, we note that from the proposal form dated 11-06-2020 that, the deceased life assured had answered the following questions as noted below.

1. Personal and Family details of health/habits

We may, however, state that all these answers were false as can be seen from the Hospital reports. The DISCHARGE SUMMARY OF DURGABAI DESHMUKH HOSPITAL (ANDHRA MAHILA SABHAL HYDERABAD, DLA has a history of Ml from 2013 (THROMBOLYSED Right Angiogram), DLA was a known case of DIABETES MALLITUS from 2019, DLA was a known case of HTN from 2018, also a known case of HYPOTHYRODISM from 5 years, DLA had undergone 3 cycles of IVF, 6 cycles of IUI, DLA has OVARIAN MALIGNANCY STAGE III C (CANCER OF OVARY) and DLA was on MEDICATION.

This suppression of material facts, which have had a bearing on the granting of risk was clearly done with an intent to play fraud and deceive LIC. Hence the competent authority repudiated the claim as per policy terms and conditions.

In case, if you disagree with our decision and feel that we have not considered any particular facts and circumstances in support of your claim, you may send your representation within three months from the date of receipt of this letter for re-consideration of your claim to our Zonal Office at the following address.

The Zonal Manager,

LIC of India,

South Central Zonal Office,

Saifabad,

HYDERABAD-500 063

Yours faithfully,

Sd/-

Senior Divisional Manager

CC TO: CLAIMS DEPARTMENT, LICI B.O-1. KALABURAGI(646).”

7.       The ground for repudiation is categorical that the insured at the time of filling up of the proposal form and acquiring the policy had made a false disclosure regarding the status of the diseases from which the insured was already suffering. A perusal of the repudiation letter clearly demonstrates that the discharge summary of the hospital, where the insured had been admitted in 2021, against the column of complaints at the time of admission and clinical findings, the insured seems to have also intimated the concerned doctor that the patient had a history of Myocardial Infarction in 2013 (Thromobolysed). This endorsement is made on the discharge summary on 26.04.2021 by the Durga Bai Deshmuk