Decided on August 19,2014

Ravinder Kaur Widow Appellant
Icici Prudential Life Insurance Company Limited, Having Its Regd Respondents


- (1.) THE appellant (complainant in the complaint) has filed this appeal against the impugned order dated 06.07.2010 passed by the Additional Bench of the District Consumer Disputes Redressal Forum, Ludhiana (in short, "the District Forum"), dismissing her complaint filed against the respondents of this appeal (opposite parties in the complaint) .
(2.) THE brief facts of the complaint are that Smt. Ravinder Kaur, complainant filed the complaint u/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the opposite parties, on the allegations that her husband Sh. Paramjit Singh S/o Amar Singh was policy holder from the opposite parties, vide policy no.09294577 issued on 11.07.2008 for the sum insured of Rs.2.50 lacs with maturity date as 11.07.2018. The premium was payable on yearly basis. The husband of the complainant died natural death on 20.03.2009 at his house. The complainant lodged the insurance claim with the opposite parties after death of her husband, but the opposite parties only sat over the matter. The opposite parties finally repudiated the insurance claim on 31.07.2009. The opposite parties got the husband of the complainant thoroughly medically checked up before accepting the insurance policy. All the tests were conducted on the husband of the complainant before he was insured with the opposite parties. The insurance claim of the complainant has been repudiated on flimsy grounds without any valid reason. The complainant has, thus, prayed that the opposite parties be directed to pay Rs.2.50 lacs along with interest @ 18% p.a. and to pay Rs.1 lac as compensation for harassment.
(3.) UPON notice, opposite parties appeared and filed written reply, raising preliminary objections that the complainant is guilty of suppressio vari and suggestio falsi. Even u/s 45 of Insurance Act, the policy of insurance can be called in question on account of deliberate concealment of material fact within two years of commencement of policy. The life assured died within two years of commencement of policy. He died within 8 -1/2 months from the date of issue of the policy only. The opposite parties repudiated the insurance claim correctly. The complaint has been filed with malafide intention. The complainant has not established any nexus between the damages claimed by her and the damages suffered by her. On merits, the opposite parties admitted that Paramjit Singh, husband of the complainant, took insurance policy from them and that the complainant was nominee of her husband u/s 39 of the Insurance Act. The insurance is a contract of utmost good faith, requiring the proposer and the life assured to disclose all material facts in the questionnaire of the proposal form. The proposer declared in the column of declaration -cum -authorization in the proposal form that he has not concealed any material information or suppressed any fact. The insurance claim was received from the complainant. During processing of the claim, it was discovered that the life assured was chronic alcoholic and has developed alcoholic liver disease along with portal hypertension, HCV positive (hepatitis C) and Decompensated Ascites etc. The life assured had not disclosed about his habit of consuming alcohol. These facts came to light, when the Medical Attendant Certificate was issued by Apollo Hospital, stating that the life assured was chronic alcoholic user in Cirrhogenic dosages for many years. The assured was suffering from preexisting disease of liver, which he has not disclosed in the questionnaire in the proposal form, while filling up the proposal form. The complainant has suppressed the material facts regarding suffering of her husband from alcoholic liver disease along with portal hypertension, HCV positive (hepatitis C) and Decompensated Ascites etc. The assured replied question no.20 (e) in the questionnaire regarding ever consuming tobacco, alcohol or any narcotics, in negative only. The assured even replied in negative regarding consulting any doctor regarding any ailment of liver etc. This is the concealment of material facts by the life assured, which was known to him. The opposite parties prayed for dismissal of the complaint. The complainant tendered in evidence her affidavit Ex.CA along with documents Ex.C -1 to Ex.C -6 and closed the evidence. On the other hand, the opposite parties tendered affidavit of Vipin Bansal, their Manager Ex.RW -1/1 along with documents Ex.R -1 to Ex.R -7 and closed the evidence. On conclusion of evidence and arguments, the District Forum dismissed the complaint of the complainant. Aggrieved by the impugned order, the complainant has come up in this appeal.;

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