Insurers must honor claims when prior medical examinations show no pre-existing conditions, upholding principles of good faith and fair dealing.

1. The complainant has filed the instant complaint seeking directions to the opposite parties to pay the balance personal claim amount of Rs.50.00 lacs due under the policy along with interest @12% per annum from the date of death of late Sru Thakur Singh, till its realization, to pay Rs.1.00 lac as damages on account of mental agony & harassment, besides litigation charges to the tune of Rs.30,000.

2. Brief facts of Case:
Briefly, the case of the complainant is that her brother late Sh. Thakur Singh was employee of opposite parties No. 2 and late Sh. Thakur Singh was insured under Group Insurance Policy No. 0003390 purchased by opposite parties No. 2 & 3 for their employees. The complainant was mentioned as nominee in the policy since late Sh. Thakur Singh was un - married.
According to the complainant, during the subsistence of the insurance policy, Mr. Thakur Singh, her brother died on 08/08/2016. As per post mortem report, the life assured died due to emphysema. The cause of death was natural. Neither the deceased nor she (complainant) was aware about the said disease and the same was not detected till his death.
Per the complainant, the deceased - life assured was insured for a sum of Rs.1 Crore. However, opposite party No. 1 only paid Rs.50.00 lacs. Rest of the policy amount was declined vide letter dated 02/06/2017 on the ground of concealment of material fact by the deceased - life assured, who was suffering from diabetes prior to obtaining the insurance policy. As per the complainant, the deceased had not died on account of diabetes. At the time of taking insurance policy, the deceased life assured was medically checked up by the penal of doctors of PNB MetLife India Insurance Company Ltd., and thereafter policy has been issued. There is no concealment of any material fact. Non settlement of the claim for the entire sum assured amounts to deficiency in service and unfair trade practice on the part of opposite party No. 1. Hence, this complaint.

3. The complaint is contested by the opposite parties by filing separate replies.
Opposite party No. 1 in its reply has not disputed issuance of group insurance policy No. 00003390 purchased by opposite parties No. 2 and 3, in which the deceased Mr. Thakur Singh was also covered for Rs.50.00 lacs. It is also not disputed that the deceased life assured had opted for additional cover of Rs.50.00 lacs. It is submitted that taking into consideration the replies given to the questions regarding health and lifestyle and depending upon the age, no extensive medical examination was triggered by the company. The result of the medical test was within the normal range. Even diabetes test also came within the normal range. As such, company had not done any further detailed medical investigation and the said additional cover of Rs.50.00 lacs was extended in favour of the deceased life assured, by believing the information provided by him in the proposal form as truthful.
According to opposite party No. 1, the deceased life assured had suppressed the material fact qua his previous ailment, as he was suffering from diabetes mellitus since 15 years and was taking insulin through injections as is evident from discharge summary of Max Healthcare Hospital (Annexure R - 4).
The contract of insurance is a contract based on "uberrimaefidei" i.e., utmost good faith. Since the deceased has suppressed past history of his ailment of diabetes mellitus, therefore, h