IMPORTANT POINT
Repudiation of death claim on ground of suppression of pre-existing ailment is justified.

Rekha Gupta, Presiding Member—The present revision petition has been filed against the judgment dated 03.10.2016 of the Punjab State Consumer Disputes Redressal Commission, Chandigarh (‘the State Commission’) in FA No. 1252 of 2015.

2. The brief facts of the case as per the petitioner-complainant are that the petitioner had filed a complaint under section 12 of the Consumer Protection Act, 1986, wherein the petitioner has averred that Bhsuhan Kumar her husband had obtained an insurance policy bearing no. 20664379 for a period of five years with effect from 21.10.2011 to 20.10.2016 having annual premium of Rs.1.00 lakh. After completion of five years the insured was to get maturity amount of Rs.13 lakh. In case the insured died during the subsistence of the policy, the nominee was entitled to get the insured amount of Rs.13 lakh. Bhushan Kumar (now referred as DLA) paid two annual premiums of Rs.1.00 lakh each, i.e., in the year 2011 and in the year 2012. Unfortunately, the assured expired on 08.04.2013. After the death of the DLA, petitioner being the nominee was entitled for the sum assured. The petitioner lodged the claim with the respondent/ insurance company for disbursement of sum assured of Rs.13 lakh and also submitted the relevant documents including insurance policy as well as receipts of paid premiums. The respondent – insurance company assured the petitioner that her claim would be settled within a short period, but vide letter dated 13.06.2013 her genuine claim was rejected on the ground that DLA was suffering from Hypertension since three years and Diabetes Mellitus since 10 to 12 years and that fact was not disclosed at the time of obtaining the insurance policy. She averred that the DLA had never suffered from any such alleged disease and the respondent rejected her claim on a false plea. DLA was medically checked by the empanelled doctors of respondent before issuing the insurance policy and DLA was found fit and healthy. Hence, repudiation of her genuine claim amounted to unfair trade practice and deficiency in service on the part of the respondent/ insurance. Therefore, the petitioner filed the complaint before the District Forum seeking following directions against the respondent:

“1. To pay Rs.13 lakh as insured amount along with interest @ 18% per annum from the date of lodging of the claim till payment;

2. To pay Rs.50,000/- as compensation for mental tension and harassment.”

3. The complaint was contested by the respondent/ insurance company who filed the written reply and took the preliminary objection that DLA, after understanding the terms and conditions of the policy had submitted the proposal form on 21.10.2011. He had filed the proposal form, which was attested by one witness Mr Sanjeev Kumar, and the insured was explained the contents of the proposal form in vernacular language. It was admitted that the petitioner was the nominee/ beneficiary under the policy. The proposal form was filled on the basis of the information furnished by DLA and thereafter, the policy in question was issued. Petitioner had informed this respondent that the insured had died on 08.04.2013 due to sudden cardiac attack. Petitioner submitted the death claim and other documents with the respondent. The claim of the petitioner was investigated by investigating agency, i.e., Eagle Eye Consultant Private Limited. During investigation it was revealed that DLA was suffering from Hypertension (HTN) since three years and Diabetes Mellitus (DM – II) for the last 10 to 12 years and was on insulin prior to applying for the said policy. DLA took treatment from Smt Parvati Devi Hospital, Ranjit Avenue, Amrtisar. DLA was well aware about his health condition before filling up the proposal form but he did not disclose the fact in the proposal form. Further, even if the DLA had undergone a medical examination with the doctors appointed by the respondent he was bound to disclose the treatment taken by him. However, the DLA had sup