A.AKILAN Vs. CENTRAL OFFICE CLAIMS REVIEW COMMITTEE

JUDGEMENT

(1.) This writ petition has been filed challenging the order passed by the first respondent repudiating the petitioner's claim in respect of the Life Insurance Policy taken by the petitioner's mother.

(2.) According to the petitioner, his mother by name Mrs.T.Mary Manimozhi has taken insurance policy with the respondent corporation on 08.02.2010, for a assured sum of Rs.3 lakhs. The annual premium was fixed at Rs.14,412/- payable for 15 years. The petitioner was appointed as a nominee in the above said policy and the maturity date of the said policy is on 08.02.2026. At the time of taking the policy, the petitioner's mother was hale and healthy and she was working as a Headmistress in a Panchayat Union Middle School. All of a sudden, she fell ill and died due to cardiac arrest on 14.09.2011. After the death of his mother, the petitioner filed an application before the third respondent claiming the policy amount. Thereafter, the third respondent directed the petitioner to furnish the medical certificate of the petitioner's mother and the same was also furnished. After receipt of the same, the third respondent, by an order dated 17.04.2012, repudiated the claim of the petitioner on the ground that at the time of taking policy, the petitioner's mother has made a false statement about her health, even though she had suffered from Gynecological problem, Menorrhagia and Hyper tension and she had suppressed the same. Challenging the said order, the petitioner filed an appeal before the second respondent and the same has been disposed of with a direction to the petitioner to approach the Central Office Claims Review Committee, 1st respondent herein. Hence, the petitioner preferred an appeal dated 01.1.2012 before the first respondent. However, the first respondent, by an order dated 12.08.2013, has rejected the petitioner's appeal. Challenging the said order, the present writ petition has been filed.

(3.) The respondent has filed a counter affidavit stating that at the time of proposal, the proposer has given false answers to question Nos.11(a), 11(b), 11(c) and 11(i) of the proposal form, thereby, given a wrong information about her health condition. Further, she did not disclose the fact that she was suffering from Gynecological problem, Menorrhagia and Hyper tension and she was on medical leave for many spells. The respondent corporation came to know about the said fact at the time of investigation of the the death claim of the deceased. The petitioner himself has submitted a claim form, wherein it is stated that the deceased has obtained medical leave on three occasions. Thereafter, on 06.02.2012, the respondent corporation sent a letter to the Superintendent, CMC Hospital, Vellore, requesting them to furnish a medical history of the deceased. From the medical records furnished by the hospital, it could be seen that the deceased suffered from hypertension and various gynecological problems and taking treatment continuously since 2006. Hypertension and diabetics are the base for heart attack and these facts are wantonly suppressed by the deceased at the time of taking policy. The deceased had made deliberate misstatements and withheld correct information regarding her health at the time of effecting the assurance and hence, in terms of the policy contract, the respondent corporation repudiated the claim.