AMARDEEP SINGH SHERGILL PRESIDENT:- Complainant has approached to the Commission seeking directions to the opposite parties to pay whole claim, to pay Rs.50,000/- as compensation for mental agony, pain and harassment and Rs.22000/- as litigation expenses.

2. Brief facts of the complaint are that the husband of the complainant namely Charnjit Kumar son of Harmesh Ram was died on 13.8.2017 leaving behind the complainant and his minor children as his legal heirs. Charanjit Kumar was Inspector in Department of Pepsu Roadways Transport Limited and he purchased a policy bearing No.IK064237609 with product name SBI Life Smart Builder on 26.9.2016 for sum assured amount of Rs.5,00,000/-. The date of commencement of policy dated 20.09.2016 and date of risk on 20.09.2016 and premium due date is 20/9 every year. The maturity date of policy is on 20.09.2026 for the sum insured of Rs.5,00,000/-. It has been averred that the complainant is nominee of the said policy and is a wife of deceased Charanjit Kumar policy holder. The deceased husband of the complainant had been paid his first premium of his policy of Rs.50,000/- to the opposite parties. On 13.08.2017 unfortunately the husband of the complainant died suddenly . The husband of the complainant C.C.No.773 of 2019 //3// was healthy at the time of issuance of policy even prior to the issuance of policy and at the time of death also and had not suffered from any type of disease. After the death of Charanjit Kumar policy holder, the complainant approached opposite party No.3 and opposite party No.3 directed the complainant for collect the required documents for claim of the policy. The complainant submitted all the required documents for settling the claim with the opposite parties. After the submission of documents, the complainant received Rs.50,000/- on 12.12.2017 in her account, whereas, as per the policy of the sum assured amount of Rs.5,00,000/-. The complainant approached the opposite parties and requested them to pay the entire claim, but the opposite parties did not redress the grievance of the complainant and wrongly and illegally retain the genuine claim of the complainant. The complainant lodged a complaint through email and Toll Free number to the opposite parties. But the opposite parties rejected the claim of the complainant on the ground of misrepresentation of health without any sufficient reason. Pleading deficiency in service and unfair trade practice on the part of the opposite parties, hence this complaint.

3. Upon notice, the opposite party Nos.1 & 3 have appeared and filed their joint written reply to the complaint raising certain preliminary objections interalia that the Life Insurance Contract is a contract of Utmost Good Faith, wherein the proponent is duty bound to disclose everything concerning his/her health, habits and other related matter, which are within his/her knowledge at the C.C.No.773 of 2019 //4// time of making the proposal, failing which the Insurer has every right to repudiate the claim. In the instant case, the deceased life assured Charanjit Kumar committed a breach of the principle of utmost good faith by suppressing the material fact that he was suffering from Heart disease and was taking treatment for the same prior to the date of commencement of risk. During the death claim investigation it was revealed that the DLA was suffering from heart disease and was under treatment for the same prior to the date of signing of proposal form. In the Resting ECG report dated 24.5.2020 of Mr Charanjit Kumar the interpretation is noted as left bundle branch block, Abnormal ECG As per Colour Doppler report dated 23.6.2012 of Dr. Sethis Heart Centre stated that High Resolution octav tissue harmonic colour dopper & quantitive tissue velocity mapping revealed Dilated Size LV.RWM-Ab of the Literal LV & Apical Wall (AKINESIA) Mild Concentric hypertrophy of LV Cavity . MOD Diastolic LV Dysfunction with MOD systolic Function with a global LVEF 36% (Normal Level 55-80%). As per the prescription of Dr. Sudhir Sethi dated 7.8.2012, the history is noted asC/O DOE (dyspnea on exertion) gr II and advised him medication. The DLA was done colour Doppler dated 29.3.2013 and 10.8.2013 from the Dr. Sethis Heart Center. The proposal form is dated 5.9.2016. If the DLA had disclosed the existence of heart disease at the time of taking the policy, the insurance cover would not have been granted to the DLA by the opposite parties; that there is no negligence, carelessness or deficiency in service on the C.C.No.773 of 2019 //5// part of the opposite parties; that the DLA committed a fraud with an intention to obtain the insurance cover by suppressing the history of pre existing disease, which was very well within his knowledge. On merits, it has been pleaded that on the basis of information furnished in the proposal form and declaration given at the end of the proposal form, a SBI Life Smart Wealth builder policy bearing No.1K064237609 with date of commencement 20.09.2016 was issued. The policy was issued for a basic sum assured of Rs.5 lac. It has been pleaded that DLA is reported to have died on 13.08.2017. The policy resulted in a claim in just

10 months and 24 days. During the death claim investigation , it was revealed that the DLA was suffering from heart disease and was under treatment for the same prior to the date of signing of proposal form. Hence the claim under the policy was repudiated as per the terms and conditions of the policy and the premium amount of Rs.50,000/- paid under the policy was refunded to the complainants account held in Jammu and Kashmir Bank, Malwal Road, Ferozepur City Branch on 5.12.2017. The decision to repudiate the claim was communicated to the complainant vide claim repudiation letter dated 6.12.2017. Other allegations of the complaint have been denied and a prayer for dismissal of the complaint has been prayed for.

4. Opposite party No.2 was proceeded against exparte.

5. The learned counsel for the complainant has closed evidence on behalf of the complainant after tendering into evidence Ex.C-1 to Ex.C-6. On the C.C.No.773 of 2019 //6// other hand, the learned counsel for the opposite party Nos.1 & 3 has closed evidence on behalf of the opposite party Nos.1 & 3 after tendering into evidence Ex.OP1 & 3/1 to Ex.OP1 & 3/10.

6. We have heard the learned counsel for the complainant and have also gone through the record.

7. The grievance of the complainant is that the husband of the complainant namely Charnjit Kumar had died on 13.8.2017 leaving behind the complainant and his minor children as his legal heirs. He had purchased a policy bearing No.IK064237609 on 26.9.2016 for sum assured amount of Rs.5,00,000/, copy of policy accounts for Ex.C-2. The date of commencement of policy/date of risk was 20.09.2016 and premium due date is 20/9 every year. The maturity date of policy is on 20.09.2026 for the sum insured of Rs.5,00,000/-. Complainant is nominee of the said policy and is a wife of deceased Charanjit Kumar policy holder. The deceased husband of the complainant had been paid his first premium of his policy of Rs.50,000/- to the opposite parties. On 13.08.2017 unfortunately the husband of the complainant died suddenly . The husband of the complainant was healthy at the time of issuance of policy even prior to the issuance of policy and at the time of death also and had not suffered from any type of disease. After the death of Charanjit Kumar policy holder, the complainant approached opposite party No.3 and opposite party No.3 directed the complainant for collect the required documents for claim of the policy. The complainant submitted all the C.C.No.773 of 2019 //7// required documents for settling the claim with the opposite parties, copy of claimants statement-death claim Ex.C-3, copy of bank pass book Ex.C-4 After the submission of documents, the complainant received Rs.50,000/- on 12.12.2017 in her account, whereas, as per the policy of the sum assured amount of Rs.5,00,000/-. The complainant approached the opposite parties and requested them to pay the entire claim, but the opposite parties did not redress the grievance of the complainant and wrongly and illegally retain the genuine claim of the complainant. The complainant lodged a complaint through email and Toll Free number to the opposite parties. But the opposite parties rejected the claim of the complainant on the ground of misrepresentation of health without any sufficient reason.

8. The stand of the opposite party Nos. 1 & 3 is that the deceased life assured Charanjit Kumar committed a breach of the principle of utmost good faith by suppressing the material fact that he was suffering from Heart disease and was taking treatment for the same prior to the date of commencement of risk. If the DLA had disclosed the existence of heart disease at the time of taking the policy, the insurance cover would not have been granted to the DLA by the opposite parties. It is the admitted case of the opposite parties that on the basis of information furnished in the proposal form and declaration given at the end of the proposal form, a SBI Life Smart Wealth builder policy bearing No.1K064237609 with date of commencement 20.09.2016 was issued. The policy was issued for a C.C.No.773 of 2019 //8// basic sum assured of Rs.5 lac. DLA is reported to have died on 13.08.2017. The policy resulted in a claim in just 10 months and 24 days. During the death claim investigation it was revealed that the DLA was suffering from heart disease and was under treatment for the same prior to the date of signing of proposal form. In the Resting ECG report dated 24.5.2020 of Mr Charanjit Kumar the interpretation is noted as left bundle branch block, Abnormal ECG As per Colour Doppler report dated 23.6.2012 of Dr. Sethis Heart Centre stated that High Resolution octav tissue harmonic colour dopper & quantitive tissue velocity mapping revealed Dilated Size LV.RWM-Ab of the Literal LV & Apical Wall (AKINESIA) Mild Concentric hypertrophy of LV Cavity . MOD Diastolic LV Dysfunction with MOD systolic Function with a global LVEF 36% (Normal Levl 55-80%). As per the prescription of Dr. Sudhir Sethi dated 7.8.2012, the history is noted asC/O DOE (dyspnea on exertion) gr II and advised him medication. The DLA was done colour Doppler dated 29.3.2013 and 10.8.2013 from the Dr. Sethis Heart Center. The proposal form is dated 5.9.2016.Hence the claim under the policy was repudiated as per the terms and conditions of the policy and the premium amount of Rs.50,000/- paid under the policy was refunded to the complainants account held in Jammu and Kashmir Bank, Malwal Road, Ferozepur City Branch on 5.12.2017. The decision to repudiate the claim was communicated to the complainant vide claim repudiation letter dated 6.12.2017. In support of their version, the opposite party Nos.1 & 3 have placed on record C.C.No.773 of 2019 //9// copy of application Ex.OP1 & 3/2, copy of policy document Ex. OP 1 & 3/3, copy of investigation report Ex.OP1 & 3/4, copy of resting ECG Report Ex.OP1 & 3/5, copy of comments Ex. Ops 1 & 3/6 to Ex. OP1 &3/8, copy of letter dated Ex. Ops 1 & 3/9 and affidavit of Pardeep Gupta Ex. OP1 & 3/10.

9. From the above discussed evidence, it is clearly proved that the DLA was suffering from disease prior to taking the insurance policy, in question, by filling up the aforesaid Proposal Form. It is also proved that DLA gave misstatement, knowingly well that he was already suffering from disease for which he took treatment. Had the material information regarding the health of the DLA been disclosed by him at the time of filling up the Proposal Form, that would have certainly affected the decision of the Insurance Company in issuing the insurance policy. Therefore, it is clearly proved on record that the DLA obtained the insurance policy, in question, by concealing material information regarding his health and by giving wrong declaration in the Proposal Form, in which he declared that he had made complete, true and accurate disclosure of all the facts to the best of his knowledge. As a result, the contract of insurance between the parties, which is based on utmost good faith, stood vitiated. It was categorically held by the Honble Supreme Court in Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. (IV) (2009) CPJ 8 (SC) that where there is concealment of fact regarding the health of the insured, which was in his/her knowledge, the same amounts to suppression of material fact and the Insurance C.C.No.773 of 2019 //10// Company is justified in repudiating the Insurance Contract. The similar view has been taken in Reliance Life Insurance Co. Ltd. & Anr. v. Rekhaben Nareshbhai Rathod 2019 (2) CPJ 53 (SC).

10. In P.C. Chacko & Anr. v. Chairman, Life Insurance Corporation of India & Ors. 2008(3) CPC 248 (SC) also, the insured had undergone thyroid operation, which was not disclosed by him at the time of obtaining the policy and he died within six months after taking that policy. It was held therein that the deliberate wrong answer may lead to policy being vitiated in law. The contract of insurance was held to be null and void and the repudiation of the claim was upheld. It was held therein that it is a well settled law in the field of insurance that contracts of insurance including the contracts of life assurance are contacts uberrima fides and every fact of materiality must be disclosed otherwise there is good ground for rescission.

11. In LIC of India v. Dalbir Kaur 2011(2) CLT 281 (NC) before taking the insurance policy, the insured had undergone treatment as an inpatient in Sony Nursing Home from 8.5.1999 to 16.5.1999 and from 1.2.2002 to 28.2.2002. He was also an outpatient in the same Nursing Home till 22.4.2012 and it was also on the record that he had been sanctioned two months earned leave from 11.4.2002. While filling up the proposal form, he had given answers in the negative to the relevant questions. It was held by the Honble National Commission that the Insurance Company was entitled to repudiate the insurance C.C.No.773 of 2019 //11// claim as the declaration made by the insured was found to be false.

12. Still further, in Maya Devi Petitioner(S) v. Life Insurance Corpn. Of India (S). 2011 (3) CPJ 43 (NC), it was held by the Honble National Commission that insurance policy is an agreement of utmost good faith between the insurer and the insuree and breach by suppressing material facts on the part of the insuree would result in repudiation of claim by the insurer.

13. In view of the law laid down in the above noted authorities as well as in view of our above discussion, it has been clearly proved that the DLA intentionally and willfully concealed the material information and gave wrong answers, while filling up the Proposal Form. Therefore, the claim of the complainant has been legally and rightly repudiated by the opposite party.

14. In view of our above discussion, there is no merit in the present complaint and the same is hereby dismissed

15. The complaint could not be decided within the statutory period due to Covid-19 and incomplete of quorum. A copy of this order be communicated to the parties concerned free of costs. File be consigned to the record room. Announced (Amardeep Singh Shergill) 03.08.2021 President (Sukhwinder Kaur) Member