SUBRAMONIUM PRASAD,J. - (1.) The instant writ petition is directed against award no. 10(CHN)/L-24/2007-2008 of 16.07.2007 passed by the Insurance Ombudsman and the order dated 24.08.2007 passed by the Branch Manager, LIC, No.5, Dr. Sankaran Road, Namakkal District rejecting the claim of the petitioner and for further direction to the respondent Life Insurance Corporation of India Ltd, Salem, to restore the benefits applicable to the insurance policies of the petitioner covering major ailments as per the terms and conditions of the policy issued and for payment the medical expenses of the petitioner who had undergone treatment/operation for coronary artery heart disease.
(2.) It is the case of the petitioner that, despite having valid insurance policies the respondents have wrongfully deprived him from the insurance cover for the heart bypass surgery, which he underwent and that the petitioner is entitled for insurance coverage and the respondent's insurance company must bear the payment to be made for the bills which have been raised on him for the treatment. The facts in the brief are stated as under:- "(a) The petitioner had taken two policies under the "Asha Dep Policy" bearing policy numbers 700280675 in the year 1993 and 700492778 in the year 1995 respectively from Namakkal Brach, Life Insurance Corporation of India. As per the said policy, the petitioner would avail the following benefits:- 1. 50% of the sum assured immediately at the happening of the event. 2. 10% maintenance amount per annum till the date of the event. 3. Waiver of future premium of the policies. (b) That the petitioner was granted the said policies under "Asha Deep" scheme only after thorough medical examination by the panel doctors of the 4th respondent and the doctors had granted "A Class" to the petitioner and the petitioner was asked to pay basic premiums. (c) This petitioner had taken up four more policies bearing policy numbers 700493307, 700771798, 701267351 and 760930604 from various branches of the Life Insurance Corporation and that the petitioner had been paying premiums for the said policies too without any default. (d) The petitioner had to undergo a coronary heart surgery in the year 2006 and the petitioner had made applications to the Life Insurance corporation to grant him policy benefits under "Asha Deep" policies taken up by the petitioner based upon discharge summary dated 14.06.2006 issued by Vijaya Hospital, thereafter Frontier Lifeline Pvt. Ltd., Chennai. (e) The Life Insurance corporation had declined the request made by petitioner stating that the petitioner is eligible for benefits under "Asha Deep" policies as the petitioner had failed to disclose that the petitioner had undergone a "disc prolapse" surgery in the year 1996 and further the petitioner had also failed to disclose that the petitioner was a diabetic and hypertensive."
(3.) The respondent would submit that, they repudiated the claim made by the petitioner on the ground of non-disclosure of having undergone a surgery in the year 1992 for disc prolapse. Further they would submit that, it is an acceptable principle that a contract of insurance is a contract based on utmost good faith and the petitioner herein is obliged to disclose the treatment undergone by him and the ailments from which he is suffering at the time of taking the policy. The discharge summary of the Vijaya Hospital and International Centre for Cardio Thoracic and Vascular diseases shows that the petitioner was diabetic for nearly 12 years, hypertensive for 15 years,a chronic smoker for 25 years, was in the habit of consuming alcohol daily for 20 years and had presented with complaints of giddiness for 8-10 years. These facts which were material at the time of taking the insurance cover had been suppressed and in the event of these facts having been brought to the notice of the respondents, the petitioner would have been permitted to take aforesaid policies. The respondents would contend that they would have undoubtedly refused to insure the petitioner under the policies aforesaid if he had disclosed that he was a chronic diabetic and that he had habits which caused coronary heart disease and other major ailments. Apprehending that the respondents would refuse to insure him, the petitioner had suppressed the ailments from which he was suffering. The life insurance corporation would states that, it is open to the petitioner to contend that the respondents herein cannot avoid their obligation under the policy on the ground of mis-statement of facts.;