ORDERS:

Charanjit Singh, President;

1        The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 34 and 35 against the opposite parties on the allegations that the opposite party No. 1 is Axis Bank Limited. In this bank the complainant maintains an account. The opposite party No. 2 is the company of which insurance policy was bought by the complainant. The complainant is aged about 57 years. The insurance ID of the complainant is 336832162. The insurance card has been annexed with (C-1). The complainant took one health insurance policy bearing No. 0237868334 under plan floater for a sum of Rs. 5,00,000/-. The opposite party No. 1 is the bank which acted as an intermediary. The bank allegedly represented the complainant that he should take the policy to cover his health. The complainant paid the premium including taxes of Rs 9,931/- for cover period 2019-2020, Rs. 9931.00 for cover period 2020-2021, and Rs. 12,910 for the cover period 2021- 2022. The receipts of the premiums paid have been annexed with (C2,C3,C4). The said policy was issued by the company after completing all the formalities and after satisfying itself as to insurable interest, with bank acting as the intermediary. At the time of issuance of policy, the complainant was hale and hearty and was not suffering from any other disease. At the time of issuance of policy no terms and conditions were supplied to the complainant or explained in any way. In the first week of November 2021, the complainant all of a sudden started to forget names of people around him and objects around him. Rather than directly speaking, he started to describe them. Before this, the complainant was absolutely healthy and fine and was not having any co-morbidity. There was no history of forgetfulness of reading and writing. There was no history of forgetting ways/navigation to his house. The complainant was well till first week on November. There was no history of forgetfulness for recent or remote events. When it appeared to the family that the behavior of the complainant is not natural, they immediately took him to PARAS HOSPITALS, C-I, SUSHANT LOK, PHASE- I, SEC 43, Gurgaon Haryana. After consultation in Outpatient Department(Neurosurgery) dated 19/11/21(C-5) the complainant was advised to undergo surgery. The complainant was diagnosed with Glioma and Venus infarct. On diagnoses, it was advised by the doctors of the above said hospital to get admitted on 26^th of November, 2021 in the above said hospital and will have to undergo surgery which will be conducted on 27^th November, 2021. On the same day i.e. 19^th November 2021, the complainant came back to his home town from Gurgaon. The surgery being an expensive one, hence the complainant enquired from the bank as to if he can use his insurance policy and pay through the same. The intermediary bank gave him full assurance and guarantee that the complainant will be able to use the policy to pay for his medical surgery. Relying on the assurance given by the bank, the complainant arranged and carried only some amount of money under the view that the remaining was to be paid by insurance company through insurance policy. As advised the complainant got himself admitted on 26^th November, 2021 in the above said hospital. On 26^th November, 2021 it was brought to notice of the hospital authorities that the complainant has taken one health insurance policy from opposite parties and regarding the same hospital lodged the claim with the opposite party No. 2. The opposite party No. 2 rejected the claim. Without any justification without any reason the complainant was denied the claim which is sheer mental and physical harassment. Hence, the above-said act of the opposite party amounts to deficiency in service and has caused mental pain, agony and harassment to the complainant. On 15/12/2021 complainant paid his last premium of Rs. 12,910. The bank detail for the same has been annexed with (C-6). The complainant got his further treatment of radiotherapy done. Before its completion the complainant again informed the hospital authorities that the complainant has taken health insurance and is eligible for cashless facility. The insurance company received the email for same on 4^th February, 2021 (C-7) but did not reply for the same. But on 7^th February, 2021 the insurance company notifies the complainant that 'Basis on the policy cancellation request received from you, We have cancelled the policy w.e.f 30/12/2021 and 'We have processed the cancellation and you should receive refund of your amount soon'.(C-8) The complainant did not cancel the policy. No email, No telephone call or any verbal exchanges were made by the complainant or his nominee or any of the family members in order to cancel the insurance policy. Furthermore, the payment of last premium on 15/12/2021 prima facie tells about the intention of the complainant to keep the policy and use it in the future. And it is brought to notice that if the insurance company cancelled the policy, till date no refund of amount has been received by the complainant. It seems that these companies are only interested in earning premiums and find ways and means to decline claims. Due to inefficiency of the opposite parties, the complainant had to suffer financially as well as medically. As the complainant could not get financial assistance on time, he was not able to get further advance treatments and checkups for himself which in turn deteriorated his health. Recently, in the month of April, the complainant has been diagnosed with Carcinoma in the right kidney. The purpose of the insurance companies and their intermediaries is to serve their clients and not exploit them and extort money. But with every passing day the latter is growing which is a grave injustice for the community. The complainant had to pay a hefty bill, all by himself in these hard times despite of buying the policy. The bills suffered by the complainant during the glioma and venus infarct surgery, Radiotherapy and Carcinoma in the right kidney surgery have been annexed with (C-9). Intermediary bank frauded complainant, mocked him up and his family. The intermediary bank just to have wrongful gains painted a good policy, sold it to the complainant and then helped the opposite party No. 2 in their fraudulent and bogus ideas. The complainant prayed that the complainant may kindly be allowed with costs and this commission may please issue the following relieves in favour of complainant and against the opposite parties.

1. Opposite parties be directed to pay a sum of Rs. 5,00,000/- medical claim of the complainant as per the policy alongwith interest @ 18%  p.a. from the date of accrual of cause of action till the date of payment.
2. Compensation to the tune of Rs. 10,00,000/- alongwith litigation expenses to the tune of Rs. 30,000/- may also be awarded to the complainant.

Alongwith the complaint, the complainant has placed on record affidavit Ex. C-1/A, documents Ex. C-1 to Ex. C-9.

2        Notice of this complaint was sent to the opposite parties and the opposite party No. 1 appeared through counsel and filed written version by interalia pleadings that the present complaint is not maintainable and is liable to be dismissed. The complainant has suppressed so many material facts from this commission and not placed true and full facts before this commission. So the complainant is not entitled to any relief from this commission. The complainant has not approached before this commission with the clean hands and suppressed so many material facts from this commission, so the complainant is not entitled to any relief from this commission. The opposite party/ bank is not liable to pay any compensation amount to the complainant, in fact the opposite party No. 2 is liable to pay compensation amount as well as other expenses to the complainant because the complainant got insurance from the opposite party No. 2 and paid installments to the opposite party No. 2.  The complainant has got no locus standi and cause of action to file the present complaint. The present complaint is an abuse of the process of the court and is liable to be dismissed. The complainant has got no cause of action against the opposite parties. The complainant is a wrong doer and is not entitled to any relief. The present complaint has been filed by the complainant with malafide intention with ulterior motive with intent to harass the opposite party.  The opposite party No. 2 is liable to compensation amount to the complainant.  The opposite party No. 1 has denied the other contents of the complaint and prayed for dismissal of the same.

3        The opposite party No. 2 appeared through counsel and filed written version by interalia pleadings that the complaint filed by the complainant is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead this commission. The complainant has suppressed material facts from this commission and as such the complaint is liable to be dismissed. The policy in question bearing No. 0237868334/056289-Tata AIG was issued by the opposite party on the basis of the information provided by the complainant. The copy of the policy issued by opposite party is Ex. OP-1. Since the information provided by complainant was established to be incorrect by the Opposite Party, hence the Opposite Party was well within its right to repudiate the said claim of the complainant. Since the Opposite Party has acted within the four corners of the statutory provisions. No case of deficiency in services can be said to have arisen, and as such, the present complaint is not maintainable before this Commission. As per the information received by the opposite party No. 2, it was found that the complainant was having history of LEFT TEMPORAL GRADE-III GLIOMA and was operated in December 2010 at Paras Hospital followed by Radiotherapy and Kemo Threapy and during his stay in the said hospital and he was operated in year 2010 for the above said reason, but at the time of taking the policy in the year 2019, the said fact has been concealed by the complainant. The complainant was suffering from the aforesaid disease much prior to taking of policy. The said fact has come to the knowledge of the opposite party No. 2 after going through the record submitted by the complainant. Therefore, from the stated circumstances, it is evident that the insured had given wrong information and suppressed material facts in order to wrongfully obtain the subject policy from the Opposite Party No. 2. Therefore the present complaint is liable to be dismissed. As such, the claim of the complainant was repudiated as per section 4(VII) (I) of the terms and conditions of the policy. The copy of the claim form is Ex.OP-2 and the copy of complete medical record submitted by the complainant alongwith claim form is Ex.OP-3, the copy of Proposal form is Ex. OP-4, the copy of acknowledgment letter dated 21/12/2021 is Ex.OP-5, the Copy of repudiation letter dated 31/12/2021 15 Ex. OP-5 in which it has categorically stated that as per the scrutiny of the documents, member is a known case of left temporal glioma 10 years back i.e. prior to taking the policy start date i.e. 04/12/2019. The same have not been disclosed, hence policy is being canceled and we regret to inform you that your claim is repudiated under nondisclosure 4(7). The copy of Insurance policy alongiwth terms and conditions are Ex. OP-4. Even the policy in question is also cancelled being void as the same is an outcome of concealment of facts. Insurance contracts are contracts based on "Utmost Good Faith" and that the Life Assured/Proposer being a party to the contract is bound to disclose all material facts known to him at the time of proposal. The Proposer/Life Assured under a legal and solemnly obligation to disclose all material facts correctly, honestly and truthfully to the insurance company at the time of obtaining the policy, failing which the contract is rendered void. The contract of insurance is based on the Doctrine of "Uberrimae Fide" and even if any due diligence is done by the insurance company, it does not change the basic element of an insurance contract. The insured is obliged to give full and correct information on all matters, which would influence the judgment of a prudent Insurer in determining whether he will accept the risk, and if he would, at what rate of premium and subject to what conditions. The material facts, as having a bearing on the risk in the life insurance contract, include the state of health and illness (present or past) occupation and habits, particulars of previous insurance etc., which are only within the knowledge of the proposer/life assured. The insurer, therefore, has to rely entirely on the information, which the Proposer / Life Assured gives at the time of proposal. If a material fact is suppressed, the insurer will be misled about the risk covered, and hence the same will vitiate the contract. The insurer will then be well within its right to treat the contract as void as per the terms conditions of the policy document. The complainant has concealed and has suppressed the material and relevant facts of the case. The complaint has been filed with malafide and dishonest intention and has not only concealed the material facts from this commission but has also twisted and distorted the same to suit their own convenience and to mislead this commission. In the present case, the opposite party company had sought answers to specific health related question from the complainant during the proposal stage. Despites specific questions being asked in the proposal form, the complainant deliberately and fraudulently concealed his prior medical ailments and replied all answers incorrectly for questions relating to past medical history.  In view of above information, the repudiation of claim was validly made, after deliberating on the terms and conditions of the said policy. Therefore, even entering the said case would be against the principal of natural justice and this would not be in the interest of consumer of services of a life insurance company. Therefore the present complaint is liable to be dismissed. When information on a specific aspect is asked for in the proposal form, an assured is under solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge. Any fact which goes to the root of the contract of insurance and has a bearing on the risk involved would be material. There is no general duty to speak or to disclose facts, which are or might be equally within the means of knowledge of both parties. There are special duties of disclosure in particular classes of contracts, viz. in contracts between an insurer and the life assured, and where one party stands in a fiduciary relationship with the other. In such contracts of uberrima fides there is a legal and equitable duty on the party, not only to state truly whatever is stated, but also to divulge with candor and completeness, facts regarding which there is no objection to disclose.  The health condition of the Life assured is a vital material fact which helps the insurer to determine the Life Assureds, eligibility for availing the insurance policy and nondisclosure of the same provides the reasonable ground to the opposite party to reject the claim and hence the complaint is liable to be dismissed. Nondisclosure amounts to fraud.  The opposite party had taken in to consideration the provisions of Section 2(d) of the Protection of Policy holder’s interests Regulations, 2002, at the time of issuing the policy to the life assured.  The complainant has tried to challenge the veracity of the decision of the opposite party to repudiate the claim. The opposite party has repudiated the claim under the said policy by a speaking order, which lists out the specific reasons for the decision. By no stretch of imagination the said decision can be brought under the umbrella of Deficiency in service. The complainant should approach the civil courts in order to challenge the veracity of the decision of the opposite party to repudiate the claim. The complicated question of law and facts are involved in the present complaint, which requires voluminous evidence i.e. examination and cross examination of witness which is not possible in the summary proceeding of consumer Protection Act. Therefore, only the civil court has the jurisdiction to try and decide the present complaint. Therefore, the present complaint is liable to be dismissed. The present complaint is not maintainable for want of cause of action as from a simple perusal of the whole complaint it is clear that there is no cause of action has arisen in favour of complainant and against the opposite party. There is no negligence or unfair trade practice on the part of the opposite party, As such, the complainant is not entitled to any compensation as alleged.  The opposite party No. 2 has denied the other contents of the complaint and prayed for dismissal of the same. Alongwith the written version, the opposite party No. 2 has placed on record affidavit of Amit Chawla  Ex. OP2/1 alongwith documents Ex. OP2/2 to Ex. OP2/7.

4        We have heard the Ld. counsel for the complainant and opposite parties and have carefully gone through the record.

5        Ld. Counsel for the complainant contended that the complainant maintains an account with Axis Bank i.e. opposite party No. 1 and opposite party No.2 is the company of which insurance policy was bought by the complainant. The complainant is aged about 57 years. The complainant took one health insurance policy bearing No. 0237868334 under plan floater for a sum of Rs. 5,00,000/-. The insurance ID of the complainant is 336832162. The opposite party No. 1 is the bank which acted as an intermediary. The complainant paid the premium including taxes of Rs 9,931/- for cover period 2019-2020, Rs. 9931.00 for cover period 2020-2021, and Rs. 12,910 for the cover period 2021- 2022. The receipts of the premiums paid have been annexed with (C2,C3,C4). At the time of taking the policy, the complainant was hale and hearty and was not suffering from any other disease. Ld. Counsel for complainant further contended that at the time of issuance of policy no terms and conditions were supplied to the complainant or explained in any way. In the first week of November 2021, the complainant all of a sudden started to forget names of people around him and objects around him. Rather than directly speaking, he started to describe them. Before this, the complainant was absolutely healthy and fine and was not having any co-morbidity. There was no history of forgetfulness of reading and writing. There was no history of forgetting ways/navigation to his house. The complainant was well till first week on November. There was no history of forgetfulness for recent or remote events. When it appeared to the family that the behavior of the complainant is not natural, they immediately took him to PARAS HOSPITALS, C-I, SUSHANT LOK, PHASE- I, SEC 43, Gurgaon Haryana. After consultation in Outpatient Department(Neurosurgery) dated 19/11/21(C-5) the complainant was advised to undergo surgery. The complainant was diagnosed with Glioma and Venus infarct. On diagnoses, it was advised by the doctors of the above said hospital to get admitted on 26^th of November, 2021 in the above said hospital and will have to undergo surgery which was conducted on 27^th November, 2021. After that claim was lodged and the opposite party No. 2 rejected the claim. Without any justification without any reason the claim was denied which is sheer mental and physical harassment. Hence, the above-said act of the opposite party amounts to deficiency in service and has caused mental pain, agony and harassment to the complainant. On 15/12/2021 complainant paid his last premium of Rs. 12,910. The bank detail for the same has been annexed with (C-6). The complainant got his further treatment of radiotherapy done. Before its completion the complainant again informed the hospital authorities that the complainant has taken health insurance and is eligible for cashless facility. The insurance company received the email for same on 4^th February, 2021 (C-7) but did not reply for the same. But on 7^th February, 2021 the insurance company notifies the complainant that 'Basis on the policy cancellation request received from you, We have cancelled the policy w.e.f 30/12/2021 and 'We have processed the cancellation and you should receive refund of your amount soon'(C-8).  Ld. Counsel for the complainant further contended that the complainant did not cancel the policy. No email, No telephone call or any verbal exchanges were made by the complainant or his nominee or any of the family members in order to cancel the insurance policy. Furthermore, the payment of last premium on 15/12/2021 prima facie tells about the intention of the complainant to keep the policy and use it in the future. And it is brought to notice that if the insurance company cancelled the policy, till date no refund of amount has been received by the complainant and complainant prayed that the present complaint may be allowed with costs.

6        Ld. Counsel for the opposite party No. 1 contended that the opposite party No. 1 appeared through counsel and filed written version by interalia pleadings that the present complaint is not maintainable and is liable to be dismissed. The complainant has suppressed so many material facts from this commission and not placed true and full facts before this commission. So the complainant is not entitled to any relief from this commission. The complainant has not approached before this commission with the clean hands and suppressed so many material facts from this commission, so the complainant is not entitled to any relief from this commission. The opposite party/ bank is not liable to pay any compensation amount to the complainant, in fact the opposite party No. 2 is liable to pay compensation amount as well as other expenses to the complainant because the complainant got insurance from the opposite party No. 2 and paid installments to the opposite party No. 2. The present complaint has been filed by the complainant with malafide intention with ulterior motive just to harass the opposite party No. 1 and prayed that the present complaint may  kindly be dismissed.

7        Ld. Counsel for the opposite party No. 2 contended that complaint filed by the complainant is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead this commission. The complainant has suppressed material facts from this commission and as such the complaint is liable to be dismissed. The policy in question bearing No. 0237868334/056289-Tata AIG was issued by the opposite party on the basis of the information provided by the complainant. The copy of the policy issued by opposite party is Ex. OP-1. Since the information provided by complainant was established to be incorrect by the Opposite Party, hence the Opposite Party was well within its right to repudiate the said claim of the complainant.  Ld. Counsel for the opposite party No.2  further contended that as per the information received by the opposite party No. 2, it was found that the complainant was having history of LEFT TEMPORAL GRADE-III GLIOMA and was operated in December 2010 at Paras Hospital followed by Radiotherapy and Kemo Threapy and during his stay in the said hospital and he was operated in year 2010 for the above said reason, but at the time of taking the policy in the year 2019, the said fact has been concealed by the complainant. The complainant was suffering from the aforesaid disease much prior to taking of policy. The said fact has come to the knowledge of the opposite party No. 2 after going through the record submitted by the complainant. As such the claim of the complainant was repudiated as per section 4(VII) (I) of the terms and conditions of the policy.  The copy of the claim form is Ex.OP-2 and the copy of complete medical record submitted by the complainant alongwith claim form is Ex.OP-3, the copy of Proposal form is Ex. OP-4, the copy of acknowledgment letter dated 21/12/2021 is Ex.OP-5, the Copy of repudiation letter dated 31/12/2021 15 Ex. OP-5 in which it has categorically stated that as per the scrutiny of the documents, member is a known case of left temporal glioma 10 years back i.e. prior to taking the policy start date i.e. 04/12/2019. The same have not been disclosed, hence policy is being canceled and we regret to inform you that your claim is repudiated under nondisclosure 4(7). The copy of Insurance policy alongwith terms and conditions are Ex. OP-4 and prayed that the present complaint may kindly be dismissed.

8        We have carefully gone through the rival contention of the parties.

9        The combined and harmonious reading of the documents and pleadings is going to prove on record that the complainant is availing health insurance policy for the last three years and receipts of the premium paid are Ex. C-2, C-3, C-4 for a sum of Rs. 5,00,000/-. It is admitted that on 26.11.2021 the complainant was admitted in the PARAS HOSPITALS, C-I, SUSHANT LOK, PHASE- I, SEC 43, Gurgaon Haryana where that complainant was advised to undergo surgery as the complainant was diagnosed with Glioma and Venus infract and surgery was conducted on 27.11.2021. The claim of the complainant was rejected as per repudiation letter Ex. OP2/6 on the ground that “as per the scrutiny of the documents member is known case of left temporal glioma 10 years back that is prior to policy inception and the policy start date is 4.12.2019. The same have not been disclosed in proposal form. Hence, your policy is being cancelled and we regret to inform you that your claim is repudiated under non-disclosure Section 4(7)(i)”  It is pertinent to mention here that the opposite party No. 2 has repudiated the claim on the basis of discharge summary of above said Paras Hospital on the ground that male 56 years old is a follow up case of left temporal grade III Glioma operated in December 2010 at Paras Hospital. But the opposite party No. 2 has not placed on record of surgery which was allegedly conducted in the month December, 2010. If the complainant was operated in the month of December, 2010 in the same hospital why the opposite party No. 2 has not annexed the entire record of the said hospital and whose instance the history of patient was recorded, which is written in the column of discharge summary and how the doctor came to know that the patient was operated in the year 2010. The said documents regarding the discharge summary of patient is not supported by the affidavit of any treating doctor and any official of the said hospital. Mere writing that the complainant was operated for Glioma in the month of December 2010 has no consequences and as such, it is not admitted and there is no relevancy in the absence of conclusive evidence. The opposite party has failed to produce on record any medical expert which suggests that the complainant was suffering from any pre-existing disease.  In this regard, a reference can be made to the judgment of the Hon'ble National Commission in Revision Petition No. 200 of 2007 "Mr. Satinder Singh versus National Insurance Co. Ltd." decided on 24.1.2011 wherein it has been observed that "recording of history of patient in the above stated manner does not become a substantiate piece of evidence and convincing evidence be brought on record that complainant was aware of preexisting disease." Further, it has been observed by the Hon'ble National Commission in the III 2014 CPJ 340 (NC) "New India Assurance Company Limited through its duly Constituted Attorney, Manager versus Rakesh Kumar" that people can live months/years without knowing the disease and it is diagnosed accidentally after routine checkup and on that ground repudiation is not justified. Further it has been observed by the Hon'ble National Commission in its judgment IV (2008) CPJ 89 (NC) "Life Insurance Corporation of India & Ors. Versus Kunari Devi" that history recorded in the hospital bed head ticket is not to be taken as evidence as Doctor recording history not examined and suppression of disease not proved. In the present case, except the medical record of the present ailment, Ops have not placed on the record any independent evidence that the insured had the knowledge or that he had been taking the treatment of the disease, in question, before purchasing this policy and in the absence of any specific evidence on the record how the disease, if any, to First Appeal No 220 of 2020 which the insured does not have the knowledge can be termed as pre-existing disease. Therefore, we are of the opinion that repudiation of the claim is not justified.  

10      Further, the age of the complainant was above 45 years at the time of taking the insurance policy in question and it was the duty of the opposite party No. 2 to medically examine the insured before issuance of insurance policy in question.  In support of his contention Ld.counsel for the complainant placed reliance upon I.R.D.A.I Rules and Instructions with regard to thorough medical examination if the insured is more than 45 years which is reproduced as under:-

“As per instructions issued by the Insurance Regulatory and Development Authority of India (IRDAI), it was bounded duty of the insurer to put insured to thorough medical examination in case Mediclaim insured was more than 45 years and if insurance company failed to do so then insurance company has no right to decline the insurance claim on account of non disclosure of the facts of pre existing disease when the policy was taken. The above observations is supported by law cited in SBI General Insurance Company Limited Vs. Balwinder Singh Jolly” 2016(4) CLT 372 of the Hon’ble State Commission, Chandigarh.”

As such, at this stage, the opposite party No. 2 cannot repudiate the claim of the complainant on the ground of pre-existing disease.

11      Further the opposite party No. 2 has repudiated the claim of the complainant as per condition No. 4(7) under non disclosure of the policy. But on the other hands, the complainant has specifically pleaded in his complaint that no terms and conditions were ever supplied and explained to the complainant by the opposite party No. 2 at the time of inception of policy. Reliance has been placed on citation 2001(1)CPR 93 (Supreme Court) 242 titled as M/s Modern Insulators Ltd Vs The Oriental Insurance Company Ltd, wherein Hon’ble Apex Court held that clauses which are not explained to complainant are not binding upon the insured and are required to be ignored. Furthermore, It is usual with the insurance company to show all types of green pastures to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of DharmendraGoel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation.  This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.  It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.UshaYadav& Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-

“It seams that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.        The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.

Opposite party No. 2 is making self contradictory statements, on the one hand in their written version stating that as the complainant has suppressed the pre-existing disease and hence the policy was cancelled whereas on the other hand bare perusal of Ex. C-8, opposite party No. 2 is stating that on the basis of policy cancellation request received from you, We have cancelled the policy w.e.f. 31.12.2021. The opposite party No. 2 has failed to produce on record any document which shows that complainant has ever requested for cancellation of policy.  Hence, it is produced on record beyond any imagination that opposite party No. 2 is making false statement just to repudiate the genuine claim of the complainant.

12      By not issuing and withholding the genuine claim of the complainant by the opposite party No. 2, it constitutes deficiency in service and unfair trade practice on the part of the opposite party No.2.

13      In light of the above discussion, the complaint succeeds and the same is hereby allowed with costs in favour of the complainant and against the Opposite Party No. 2. The opposite Party No. 2 is directed to make the payment of Rs. 5,00,000/- to the complainant. The complainant has been harassed by the opposite party No. 2 unnecessarily for a long time. The complainant is also entitled to Rs.25,000/- as compensation on account of harassment and mental agony and Rs 15,000/- as litigation expenses. Opposite Party No. 2 is directed to comply with the order within one month from the date of receipt of copy of the order, failing which the complainants are entitled to interest @ 9% per annum, on the awarded amount, from the date of complaint till its realisation.  The present complaint against the opposite party No. 1 stands dismissed. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Commission. Copy of order be supplied to the parties free of costs as per rules. File be consigned to record room.

Announced in Open Commission.

19.9.2024