Decided on June 05,2020

Vinita Sethi Appellant
Icici Prudential Life Insurance Company Ltd. Respondents


S. M. Kantikar, Presiding Member - (1.) The brief facts of the case are that in the month of March, 2014 the complainant's husband Mr. Gagan Sethi (hereinafter referred to as 'insured') obtained a home loan from ICICI Bank at Gurgaon (OP-2) for a sum of Rs. 1,18,00,000/-. He also, for the purpose of insuring the loan amount, opted for "Loan Protect-FP Mortgage Policy" from the ICICI Prudential Life Insurance Co. Ltd (OP-1). On the basis of available relevant medical records, the OP-1 confirmed the eligibility of the insured to get the insurance cover and he handed over to the agent of OP-1, the blank application form signed on 31.03.2014. The yearly premium was fixed to Rs. 76464/-. In the month of June 2014, the insured suffered very high grade fever and the Platelet count reduced drastically. He took treatment and hospitalized for few days in different places. In the month of December 2014 the insured got admitted to Medanta Medicity for abdominal distension - Ascites. After examination and investigation, he was advised to undergo liver transplant. However, prior to liver transplant during the treatment, his health suddenly deteriorated, suffered cardiac arrest and the insured died on 11.12.2014. For the settlement of insurance claim, the deceased wife Smt. Vinita Sethi - the complainant submitted the relevant documents to the insurance co. (OP-1). The insurance co. repudiated the claim vide letter dated 02.07.2015 on the ground of non-disclosure of medical history of the insured. Being aggrieved by the illegal repudiation of insurance claim, the complainant filed a consumer complaint before this commission and prayed for sum assured of Rs. 1,18,00,000/- and the compensation from the insurance co.
(2.) The OPs filed their respective written versions and denied any deficiency on their part. The insurance co. contended that the deceased insured provided incorrect information and suppressed material fact about his health. The insured was hospitalized from 06.10.2011 to 12.10.2011 for the complaints of upper Gastro Intestinal (GI) bleed. He was diagnosed as Grade III Esophageal Varices, Multiple Gastric Ulcers and Chronic Liver Disease (CLD). He was chronic smoker and alcoholic for long time. On 15.10.2013 he took some treatment. He was hospitalized on 19.10.2013 with a diagnosis of CLD and Gastropathy due to possible ethanol with dyslipidemia with obesity. The life assured was required to disclose correct facts, but he falsely filled the proposal forms.
(3.) Both the sides filed their respective affidavits of evidence. The OP-1 filed the relevant documents like repudiation letter, the proposal form and medical record of the deceased.;

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