Document Fragment View

Matching Fragments

3.                The complaint was contested by the Ops by filing written reply before the District Forum, while denying the allegations made in the complaint. It was pleaded that the complainant had concealed the facts from the District Forum and did not come to the District Forum with clean hands and as such the complaint deserved to be dismissed. This complaint was filed by the complainant merely to harass and gain undue advantage and unjustified claim from them. The contract of Insurance was based on the Principle of good faith. The Life Assured concealed the facts that he was suffering from Chronic Liver Disease and hypertension for the last 8 years and Diabetes Mellitus for the last 6 years prior to filling up the proposal for Insurance policy. The Ops after exhaustive investigation of the claim and after collecting all the documents procured at the time of investigation had come to the findings that the said policy was taken after concealment of all the aforesaid material facts therefore, the claim of the complainant was rightly repudiated by them. It was further stated that the District Forum was having no jurisdiction to entertain the present complaint. It was stated that they had received death claim intimation on 16.10.2010, wherein it was stated that the Life Assured died on 21.09.2010 and the cause of death was mentioned as natural. But as per "Lama certificate issued by Daya Nand Medical College and Hospital, in which it was written that patient deceased Gurmail Singh was suffering from hypertension for 8 years on irregular medication and diabetes mellitus for 6 years. Treating doctors treatment certificates by Daya Nand Medical College and Hospital shows Chronic Liver Disease for 8 years, hypertension 8 years, diabetes 6 years and suffering from Chronic Alcohol Respiratory disease with PD with PL. Treating Doctors certificates issued by Shri. Rajeev Sharma MD, Physician of Rishi Hospital, Dhuri described the patient suffering from T2 and diabetes mellitus, Septicemia (post operative) primary cause death Cardiac Respiratory. Secondary cause of death Septicemia. Since the deceased had provided wrong information at the time of issuance of the policy the claim under the said policy was repudiated due to non-disclosure and suppression of material information and the same was communicated to the complainant vide their letter dated 31.03.2011 and Ops prayed for dismissal of the complainant.