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2025 Supreme(Online)(SCDRC) 7029
STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Justice Inder Singh Mehta, President, Partap Singh Thakur, Member, Yogita Dutta, Member
Tara Devi Since deceased through her LRs – Appellant
Versus
Sh. Raghubir Singh – Respondent
First Appeal No.: 176/2023
For the Appellants/Petitioners: Ms. Pragti
For the Respondents: Mr. Rahul Manhas
Failure to disclose a pre-existing condition constitutes misrepresentation and justifies insurance policy cancellation.
Headnote:(A) Consumer Protection Act, 2019 - Section 2(1)(g) - Insurance Policy - Claims denied due to non-disclosure of pre-existing condition - The insured purchased policy disclosing no medical history but was suffering from cancer pre-application. Dismissed on grounds of fraud and misrepresentation. (Paras 2-18)
(B) Misrepresentation - The court ruled that failure to disclose pre-existing conditions constitutes mis-selling and warrants policy cancellation. Importance of agent's disclosure emphasized, with no rebuttal from complainants. (Paras 10-16)
Facts of the case:
The complainants allege deficiency in service after being denied insurance claim due to non-disclosure of prior cancer diagnosis. The policy was cancelled after being informed of Tara Devi's medical condition, despite payment of premium.
Findings of Court:
The court found no cause of action as the insured failed to disclose a prior medical condition that invalidated the insurance claim.
Issues: The main issues were whether the policy was mis-sold and if the complainant had a case for deficiency in service.
Ratio Decidendi: The ruling stated that undisclosed pre-existing conditions justify policy cancellation, reaffirming agents' responsibilities to inform clients of policy terms.
Result: Appeal dismissed.
| Table of Content |
|---|
| 1. insured concealed pre-existing condition. (Para 2 , 3 , 4) |
| 2. agent's duty to inform about coverage conditions was fulfilled. (Para 8 , 12 , 13 , 16) |
| 3. policy was cancelled due to non-disclosure of cancer. (Para 10 , 11) |
| 4. court ruled against the appeal affirming policy terms were binding. (Para 17 , 18) |
Justice Inder Singh Mehta, President O R D E R:
Instant appeal is arising out of the order dated 02.06.2023 of learned District Consumer Commission, Kullu, passed in Consumer Complaint No.41/2019, titled Tara Devi since deceased through LRs. Versus Raghubir Singh & Anr., whereby the complaint was dismissed.
Brief facts of Case:
2. Briefly, the case of the complainants is that opposite party No.1 is agent of opposite party No.2 and narrated the benefits of PNB Met Life Policy to insured Tara Devi and she accordingly purchased PNB Met Life Endowment Saving Plan on 13.04.2018 and paid premium of Rs.54,340/- to the opposite party No.2. After purchase of policy, Tara Devi informed the opposite party No.2 that she is suffering from cancer and submitted her claim and requested to settle her claim by waiving off future premiums, but opposite party No.2 vide letter dated 29.03.2019 cancelled the policy of Tara Devi on the ground that Tara Devi did not disclose about her disease of cancer before obtaining the policy. The opposite parties never disclosed to Tara Devi that disease prior to policy was not covered. By alleging deficiency in service and unfair trade practice on the part of the opposite parties, the complainant has filed the complaint before District Commission.
3. The opposite party No.1 filed reply and stated that the policy was purchased by Tara Devi voluntarily from opposite party No.2 and she intentionally suppressed her disease and she even did not mention the same while filling in the form at the time of purchasing policy. Tara Devi has been duly informed that pre-disease was not covered under the insurance policy. Had the disease of cancer known to the opposite parties, they would not have sold the policy to Tara Devi. As Tara Devi had been suffering from cancer prior to purchase of policy, therefore, she was not entitled to the relief as claimed. There is no deficiency in service or unfair trade practice on the part of the opposite party No.1. A prayer for dismissal of complaint was made.
4. The opposite party No.2 filed reply and stated that policy was sold as per Rules. Tara Devi did not disclose her medical history and suppressed the material facts regarding pre-disease of cancer. On perusal of documents submitted by Tara Devi, it came to notice of opposite parties that she was suffering from cancer since 14.12.2017, hence, Tara Devi was guilty of fraud and misrepresentation and her policy was legally cancelled. There is no deficiency in service or unfair trade practice on the part of the opposite party No.2. A prayer for dismissal of complaint was made.
5. Thereafter, the parties led evidence in support of their respective pleadings.
6. After hearing learned counsel for the parties, learned District Commission dismissed the complaint.
7. Feeling aggrieved by the order of learned District Commission, the appellants/complainants have preferred the instant appeal before this Commission.
8. Arguments heard on behalf of the parties and entire record perused carefully including written arguments filed by appellants.
9. Learned counsel for the respondent No.2 has submitted that Tara Devi had concealed material facts regarding pre-disease from insurance company. He has submitted that insurance company legally cancelled the insurance policy and the premium amount so deposited was refunded. He has submitted that there is no cause of action in favour of the complainants. He has submitted that impugned order does not require any interference and prays that appeal be dismissed.
FINDINGS
10. It is an undisputed fact emerging from record that Tara Devi had obtained the policy bearing No.
22536712 from the opposite partie
