Non-healing ulcer symptoms without formal cancer diagnosis or insured's knowledge at proposal stage do not constitute material suppression justifying claim repudiation; insurer's onus not met by hospital summary alone.

DR. INDER JIT SINGH, PRESIDING MEMBER

1.ZYXWTVUhTeS RpQrPeOsNeMnLtK JSIHeGcFoEDnCdB AAppeals (SAs) have been filed by the Appellants against Respondent as detailed above, under section 51 (2) of Consumer Protection Act 2019, against the order dated 12.11.2025 of the State Consumer Disputes Redressal Commission U.T.Chandigarh (hereinafter referred to as the ‘State Commission’), in First Appeal (FA) No. 92 of 2025 and 99 of 2025 in which order dated 16.12.2024 of District Consumer Disputes Redressal Commission, UT Chandigarh (hereinafter referred to as District Commission) in Consumer Complaint (CC) no. 394 of 2023 was SA/37&42/2026 Page 2 of25 ZYXWVUTSRQPONMLKJIHGFEDCBA I challenged, inter alia praying for setting aside the order dated 12.11.2025.

Appellant filed Written Arguments/Synopsis on 09.04.2026.

2. Brief facts of the case, as emerged from the SAs, Order of the State Commission, Order of the District Commission and other case records are that it is the case of the complainant that her deceased husband Mr. Ashish Mehta (hereinafter referred to as "DLA") had availed of a life insurance policy from the Opposite Parties, namely the PNB MetLife Super Saver Plan, with a sum assured of Rs. 1,01,89,948/- payable to his family in the event of his. death. The annual premium for the policy was Rs. 10,00,000/-, and the complainant was the sole nominee under the policy. It is the case of the complainant that the proposal form for the policy was completed by the agent of the Opposite. Parties, and the DLA had signed on the dotted lines of the prescribed form; no terms and conditions had been supplied along with the policy certificate. Moreover, the Opposite, Parties 'had not conducted any medical examination of the DLA prior to issuing the policy. In December 2021, the DLA was diagnosed for the first time with carcinoma of the tongue (CA tongue) and underwent surgery on 21.12.2021, followed by chemotherapy and radiotherapy. Meanwhile the second premium instalment of Rs. 9,78,469/- was also paid by the DLA, which was encashed by the Opposite Parties on 30.09.2022. Unfortunately, the DLA passed away on 15.01.2023 due to the disease. Subsequently, the complainant submitted the claim form along with all requisite documents on 22.02.2023. The Opposite Parties had appointed an investigator, and the complainant had provided all requested documents in a timely manner. However, , the Opposite Parties, through an email dated 29.03.2023, rejected the claim on the flimsy ground that the DLA had deliberately and fraudulently misrepresented facts. Despite multiple requests by the complainant to reconsider the claim, no action was taken. Ultimately, the Opposite Parties unilaterally credited an amount of Rs.19,78,469/- to the complainant, being only the premiums paid by DLA instead of full sum assured. Being aggrieved, the complainant filed Consumer Complaint before the District Forum and District Forum vide order date 16.12.2024 allowed the SA/37&42/2026 Page 3 of25 I Complaint. Being aggrieved of the said order of the District Forum, both Complainant and OPs filed an Appeal before the State Commission and State Commission vide order dated 12.11.2025 partly allowed the Appeal filed by the Complainant ( Appeal No. 99 of 2025) and dismissed the appeal filed by the OPs ( appeal no. 92 of 2025). Therefore, the Appellants are before this Commission now in the present SAs.

3. Main contentions of the Appellant:

(>) That Proposal Form specifically required disclosure of medical history,gfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA including:

1. Ul