The insurance company's repudiation of the claim was unjustified due to its failure to prove that the insured concealed material pre-existing health conditions.

ORDER

PER: - JUSTICE GAUTAM CHOURDIYA, PRESIDENT

This appeal is filed under section 41 of the Consumer Protection Act 2019 (hereinafter referred to as “the Act” for short) against order dated 23.09.2024 passed by District Consumer Disputes Redressal Commission, Rajnandgaon (C.G.) (hereinafter called “District Commission” for short) in complaint case No.CC/2023/21, whereby observing that the life assured had not given correct information about his pre-existing diseases in the proposal form, dismissed the complaint as not proved.

2. In brief, the case of the complainant/appellant, as stated in the complaint, is that her husband Lekh Ram Sahu obtained a mortgage loan of Rs.16,50,000/- from the opposite party No.1/ respondent No.1. For security of the said mortgage loan Bharti AXA Life Loan Secure of the complainant/ appellant‟s husband Lekh Ram Sahu was obtained on 12.07.2019 from the opposite party No.2 & 3/ respondent Nos.2 & 3 insurer. Under the mortgage loan original sale deed and rin pustika of the land and House vide Kha. No.1213/2 situated in village Sursuli, P.S. Deori Bangla, Teh. Doundi Lohara, Dist. Balod of ownership of the complainant/ appellant’s husband was kept by the opposite party No.1/ respondent No.1 Bank. Before receiving the loan amount, the opposite parties/ respondents directed to get a health check-up done of the proposed life assured, which was conducted, in which mainly TMT, ECG, BP & HB test were done, in the Paras Nursing Home in Rajnandgaon between March-April 2019 and report was submitted to the opposite party Nos.1 & 3/ respondent Nos.1 & 3. After which the loan amount of Rs.16,50,000 was paid to the husband of the complainant/ appellant. The complainant/ appellant‟s husband life assured died on 04.01.2020, but due to Covid 2019 pandemic, death claim was presented on 17.03.2020 through opposite party No.1/ respondent No.1 to the opposite party Nos.2 & 3/ respondent Nos.2 & 3 along with all relevant documents for the insurance claim amount of Rs.16,30,624/-, which was repudiated by the opposite party No.2/ respondent No.2 on 31.03.2021 on the basis of false statements and hiding the fact of health test, which amounted to deficiency in service towards the complainant/ appellant. Legal notice was sent to the opposite parties/ respondents on 04.07.2022, but even after service the said notice was not replied. Hence, alleging deficiency in service complaint was filed before the District Commission seeking direction to the opposite parties/ respondents to pay the complainant/ appellant the insurance claim amount of Rs.16,30,624/- with interest and compensation for mental agony Rs.50,000/- etc. As an alternative to deposit the insurance claim amount of Rs.16,30,624/- with the opposite party No.1 / respondent No.1 Branch of the financier.

3. The opposite party No.1/ respondent No.1 in its written version denied all the allegations leveled in the complaint and averred that the complainant/ appellant does not come under the category of „consumer‟ of the opposite party No.1/ respondent No.1 nor does the dispute under the category of „consumer dispute‟ as defined under the Act. In fact the opposite party No.1/ respondent No.1 is unnecessary party in this case and no cause of action had aroused against them, thus the complaint is liable to be dismissed with cost. It was denied that any deficiency in service or unfair trade practice was done by the opposite party No.1/ respondent No.1 against the complainant/ appellant.

4. The opposite party Nos.2 & 3/ respondent Nos.2 & 3 also in their written version refuting the allegations leveled in the complaint admitted the issuance of