Insurers cannot refuse claims based on non-material misrepresentations if no prejudice is shown, ensuring fair treatment and adherence to the duty of good faith in insurance contracts.

1. Heard Mr. Rajan Khosla, Advocate, for the complainant and Ms. Meenakshi Midha, Advocate, for the opposite party.

2. Mrs. Dipti Yogesh Parekh (the nominee of the Deceased Life Assured) has filed above complaint, for directing Birla Sun Life Insurance Compay Limited (the Insurer) to pay (i) Rs.5 crores with interest @10% per annum from 20.2.2015 till the date of payment, towards insurance claim; (ii) Rs. 50 lakhs, as compensation for mental agony and physical harassment; (iii) litigation costs; and (iv) any other relief which is deemed fit and proper in the facts and circumstance of the case.

3. The complainant stated that Late Yogesh Balwantrai Parekh (her husband) (the DLA) applied for ˜Birla Sun Life Insurance Protector Plus Plan' policy for a sum assured of Rs. 5 crores and term of 20 years and deposited basic premium of Rs. 376181.28 on 25.9.2012. The opposite party, through its approved doctor of namely Dr. Milan Mehta, conducted medical examination at Healthcare Medical Centre Diagnostics and obtained pathological test reports of the DLA in respect of blood sugar fasting, serum cholesterol, biochemical report, liver function test, biochemistry report (serum), Australia Antigen test (HBsAg), Elisa for HIV I & II, complete blood count, routine urine examination, stress test, nicotine (urine) test etc. After examination of the medical examination reports and other papers, the competent authority issued Policy No. 005889092, for a sum of Rs. 5,00,00,000 and term of 20 years i.e. from 31.12.2012 to 31.12.2032. Annual premium of the policy was payable till 31st December of every year. The DLA went to Rajkot on 25.4.2014 on a business trip along with his son. In intervening night of 25/26.4.2014, the DLA developed sudden chest pain. He was taken to Patel Clinic, where Dr. Hiren K. Patel, advised for X - ray of the chest. The pain was increased in the morning then the DLA was admitted at Ratnam Hospital, Rajkot on 26.4.2014 at 10:30 hours, where he expired at 11:00 hours on 26.4.2014. The hospital informed the local police,who conducted inquest of the dead body and sent it for post mortem. After post mortem, the dead body was released and brought to Mumbai and cremated on 27.4.2014. The complainant lodged insurance claim on 13.6.2014 before the opposite party. The opposite party demanded some papers, through letter dated 18.6.2018, which were provided. Instead of settlement of the claim, the opposite party referred the matter to reinsurer as the insurance amount was of high valuation. As asked by reinsurer, the opposite party investigated the matter and rejected the claim letter dated 20.2.2015, on the ground that in proposal form, the DLA had replied in respect of the queries relating to his health and previous insurance policies, in negative, which were incorrect. In investigation, it was found that the DLA had applied for insurance policy from Birla Sun Life Insurance Compay Limited on 03.01.2004, which was rejected for adverse medical history of the DLA. Date of birth of the DLA as mentioned in the proposal form was not tallying with his Birth Certificate as issued by ˜Sangli Miraj and Kupwad City Corporation'and his PAN card. Due to concealment of material facts, the policy was void. This complaint has been filed on the ground that this policy was issued after in - depth medical examination of the DLA, in which, nothing adverse was diagnosed and date birth as mentioned by the DLA in Proposal Form was as mentioned in his PAN Card. Date of birth was relevant to charge the premium. In this case on basis of date of birth as 14.10.1960, higher premium was charged and no prejudice was caused to the Insurer