IMPORTANT POINT
Insurance – PNB Metlife Mera Term Plan Policy – Repudiation of death claim on the ground of misrepresentation of material facts by Deceased Life Insured is justified.

JUDGMENT

Simarjot Kaur, Member—The Appellants/Opposite Parties No.1&2 have filed the present Appeal to challenge the impugned order dated 11.06.2024 passed by the District Consumer Disputes Redressal Commission, Ferozepur (in short, “the District Commission”), whereby the Complaint filed by the Complainant had been partly allowed.

2. It would be apposite to mention here that hereinafter the parties will be referred, as were arrayed before the District Commission.

3. Briefly, the facts of the case as made out by the Complainant in the Complaint filed before the District Commission are that the husband of complainant namely Patras purchased PNB Metlife Mera Term Plan policy No.23077022 dated 30.10.2019. The term for the policy was 20 years with sum assured of Rs.25 Lacs. The online payment of Insurance premium was paid by the husband of complainant to the opposite parties. This fact had also been mentioned in the policy term plan. Before issuance of the policy, all the medical tests with regard to the health of husband of complainant including TMT, ECG, X-ray Chest and blood samples were conducted by the opposite parties. Thereafter, the policy was issued to him (Ex.C-1). The said tests were also conducted from the approved laboratory of opposite parties. The Complainant was the nominee in the said policy. The husband of the Complainant was regularly paying the premium during his life time. Unfortunately, the husband of complainant died on 09.04.2021. After the death of the husband of the complainant, she had lodged claim for Insurance cover. The OPs lingered the matter on one pretext or the other. The complainant through her Counsel had served a legal notice on 27.7.2021 to the opposite parties to settle the claim, but no action was taken. The act and conduct of OPs amounts to ‘unfair trade practice’ and ‘deficiency in service’ towards complainant. Hence, the Complaint was filed by the Complainant with the prayer to issue directions to the OPs to pay an amount of Rs.25,00,000/- being sum assured of policy alongwith interest, to pay an amount of Rs.2 lac as compensation and damages on account of mental pain and agony and harassment, to pay Rs.11,000/- as cost of litigation.

4. Upon issuance of notice of the Complaint to the OPs No.1&2. They had appeared and filed their joint written version by raising certain preliminary objections that the claim of the Complainant was not maintainable. The risk cover of the subject policy was cancelled by opposite party during the life time of policy holder. Therefore, the present Complaint was not maintainable as there was no legally valid contract of Insurance between the opposite parties and deceased. The policy of Mr Patras son of Karram Masih bearing No.23077022 dated 29.10.2019 was cancelled on 6.1.2021 due to non-compliance of the requirement to the satisfaction of Insurance Company i.e. PNB Met Life. It was submitted that the Complaint was false and frivolous. It was an abuse of process of law. There was neither any ‘deficiency in service’ nor any ‘unfair trade practice’ adopted by the answering OPs. It was admitted that the opposite party had submitted an online Application Form bearing No.519400248315 & Proposal No.449606944 in the name of Patras (Deceased Life Insured/DLI) for obtaining a policy of life Insurance under “PNB MetLife Mera Term Plan”. Upon receipt of Proposal Form along with the initial premium, the opposite party had processed it presuming that the information furnished in the application form was true. He was issued the policy bearing No.23077022 with risk commencement date of 14.10.2019 for a sum assured of Rs.25,00,000/-. The Complainant was the nominee in the said policy. As per the process, the opposite party had carried out the investigation under Section 45 of the Insurance Act, 1956 to verify the veracity of the details incorporated in the Proposal Form and other relevant documents submitted by the DLI. During the investigation, it was discovered that the DLI ha