Naveen Puri, President;

1        The complainants Sukhdev Singh and others have filed the present complaint under Section 12 of the Consumer Protection Act (herein after called as 'the Act') against Bajaj Allianz Life Insurance Company 5^th Floor GE Plaza Air Port Road Yerwada Pune-411006 and others (Opposite parties) on the allegations of deficiency in service and negligence in service on the part of the opposite parties with further prayer to direct the opposite parties to pay Rs. 2,50,000/- as sum insured besides this the complainants request for damages and compensation of Rs. 20,000/- and Rs. 5,000/- as costs of litigation alongwith interest.

2        The case of the complainant in brief is that the opposite party No. 1 has a tie up arrangement with head office of opposite party No. 3 against Group master Policy No. 0177675666 to the effect that any loan account holder who is member of group insurance is eligible for insurance cover of Rs. 2,50,000/- under Serve Shakti Suraksha Policy in case of death of account holder. Terms and conditions of the policy were not explained to the account holder.  The insurance amount was to be debited from the account of the account holder by the bank Branch concerned from time to time and credited to the account of insurance company. Swaran Singh son of Puran Singh resident of village Bhalojala was having loan account with opposite party No. 2. As per arrangement, Sh. Swaran Singh was also insured against insured membership No. 0309190692 against policy starting from 28.11.2013 which was to remain in force for 5 years subject to condition premium is paid regularly year-wise and opposite party No. 2 had debited the premium amount from the account of Sh. Swaran Singh and paid to opposite party No. 1 from time to time and policy was in force and deceased was insured and fulfilled the conditions of claim benefit of insurance. Unluckily, Swraan Singh died on 22.10.2015 and the policy was in force at that time. Therefore, after the death of Swaran Singh, legal heirs of Swaran Singh are entitled to insurance claim of Rs. 2,50,000/- from insurance company. The complainants submitted the insurance claim with the opposite party No.1 through proper channel and submitted all papers required and demanded by opposite party No. 1 but opposite parties No. 1 and 2 rejected the claim without any reason and basis.   Hence complaint was filed.

3        After formal admission of the complaint, notice was issued to Opposite Parties. Opposite Parties No. 1 and 2 appeared through counsel and filed written version contesting the complaint on the preliminary objections that the complainant has no locus standi to file the instant complaint against the opposite parties No. 1 and 2 as there is no privity of contract between the deceased and insurance company. The contract of the insurance was entered in to between the Master Policy holder i.e. Punjab Gramin Bank and the opposite parties No. 1 and 2 under Group Master Serve Shakti Suraksha Policy No. 0177675666 administrated by Punjab Gramin Bank and the deceased was enrolled as a member of the said master policy. Thus, the contract of insurance was never entered in to between the complainant and the opposite parties No. 1 and 2.  The complainant is not a consumer. No cause of action has arisen in favor of complainant against the  opposite parties No. 1 and 2 as claim for the permissible fund value amounting to Rs. 15631/-stands already paid to the complainant and the said amount stands credited to the Punjab Gramin Bank account No. 84160100070418 vide UTR No. SIN00101Q9188362 dated 2.2.2016 strictly in accordance with the terms and conditions of the master policy as well as certificate of insurance. The opposite parties No. 1 and 2 have already discharged contractual obligations under the master policy and no case is made out against the insurance company. There is no deficiency in service on the part of the opposite parties No. 1, 2. The deceased member Mr. Swarn Singh deliberately and intentionally concealed the material facts relating to his health and gave wrong and false answers, information statements and declaration in enrollment form dated 12.2.2014 knowing well that those were false and incorrect. The deceased maliciously and fraudulently did not disclose the true and correct facts which were known to him at the time of filling up and signing the enrollment form with an intent to induce the opposite parties No. 1 and 2 to accept risk on his life. The various medical reports, investigations and hospital records confirmed that the deceased was a diagnosed case of B Cell chronic Lymphotic Lekumia Stage IV, Post First Cycle Fludarabine Cyclophosphamide, induced Hemolytic Anemia, initiated on Bendmustine and Rituximab Chemotherapy and Benign Hypertrophy & Right Nephrolithiasis and remained admitted in Christian Medical College (CMC), Ludhiana from 30.112010 to 3.12.2010 for the treatment of said diseases vide Hospital No. C-7169175. Thus, the deceased Mr. Swarn Singh who was known case of said diseases even prior to the date of filling up the enrollment form dated 12.2.2014. The deceased member however, suppressed the material facts regarding his ill health which were known to him prior to signing and submitting the enrollment form, just to induce the opposite parties No. 1 and 2 to enroll as member of the Master Policy. Had he disclosed true and correct facts regarding his health and habits which were known to him prior to submission of enrollment form, the risk on his life would not have been accepted by the opposite parties No. 1 and 2 and the certificate of insurance bearing membership Number 0312884927 with date of commencement as 1.3.2014 for Risk Cover of Rs. 2,50,000/- would not have been issued to him. The death claim has legally and rightly been repudiated for non disclosure of material facts vide letter dated 2.2.2016 and the permissible fund value amounting to Rs. 15,631/- stand already credited to the bank account of the complainant, hence, nothing more is liable to be paid and the complaint is liable to be dismissed at the outset. The complainant has not approached this Forum with clean hands as the complainant did not disclose the true facts regarding the health & habits of the deceased life assured even while submitting the death claim and deliberately gave wrong and false information just to deprive illegal pecuniary benefits under the membership. The contract of insurance is a contract of Utmost Good faith technically known as Uberrima Fides. According to this doctrine the proposer who is one of the party of the contract, is presumed to have means of knowledge which are not accessible to the opposite party who is the other party to the contract.  The present complaint has been filed by the complainant only to injure the goodwill and reputation of the opposite party Nos. 1. 2. The complainant has got no locus standi or cause of action to file the present complaint against the opposite parties No. 1, 2. The issues involved in the complaint are complex in nature and needs full scale trial enabling all the parties to examine number of witnesses, thus, the instant complaint cannot be adjudicated in the summary trial before this Forum.  On Merits,  it was pleaded that the insurance policy obtained by the complainant has been declared void ab initio and the contract of the insurance has come to an end on account of concealment of material facts made by the complainant at the time of obtaining the insurance policy, therefore, the complainant s not a consumer qua the opposite parties No. 1, 2. The opposite party Nos. 1 and 2 denied all the other allegations and prayer was made for dismissal of the complaint with costs. 

4        The opposite party No.3 has duly served but the opposite party No. 3 did not appear and consequently, the opposite party No. 3 was proceeded against exparte vide order dated 1.11.2017.

5        Sufficient opportunities were granted to the parties to lead evidence in order to prove their respective case. The complainant tendered in to evidence his affidavit Ex. C-1, alongwith documents Ex. C-2 to Ex. C-10 and closed the evidence and thereafter, the opposite party Nos.1,  2 tendered in evidence affidavit of Sandeep Guru OPs 1,2/1 alongwith documents Ex. OPs1, 2/2 to Ex. OPs 1,2/21 and closed the evidence.

6        We have heard the Ld. Counsels for the complainant and opposite party Nos. 1, 2 and have gone through the evidence and documents placed on the file by the parties.

7        We analytically observe with the judicial precision to determine that the OP insurers here have fairly/ righteously (and quite judiciously) repudiated on 02.02.2016 (vide Ex.C10) the complainants’ impugned insurance claim on the strength of the contained/ comprised Investigator’s Report vide Ex.OP1,2/12 to Ex.OP1,2/21. The here-instated death claim (in question) has been orderly repudiated alleging non-disclosure of his pre-ailments by the DLI (deceased life insured) at the time of purchase vide Proposal Application (Ex.OP1,2/2) of the related life-insurance. Somehow, the opposite party insurers here have successfully proved its charges/ allegations of non-disclosure of pre-existing ailment(s) by the DLI (Deceased Life Insured) through its evidentiary papers (Ex.OP1,2/1 to Ex.OP1,2/21) to justify its impugned repudiation through the necessarily requisite evidence as produced during the present proceedings and as such the same are found to be in conformity with the terms of the related insurance policy.

8        We find that the purchase and validity of the related policy along with dispatch/ receipt of its terms (including non-disclosure and other clauses etc) have been duly admitted (not contested) along with the factum of the insured’s death. The complainants here seem to have tamely admitted ‘non-disclosure’ of pre-existing ailments at the DLI’s end at the time of purchase in clear violation of the cardinal policy-clause. Further, the complainants have failed to prove the complaint-contented fall-outs through presentation of their evidentiary documents exhibited here as Ex. C1 to Ex.C10. The OP insurers in turn have produced its affidavit Ex.OPs1,2/1 by its Branch Manager duly deposing the alleged non-disclosure of any past/ continuing hospitalization/ ailment by the DLA in his proposal-declaration as revealed out later during the conduct of claim-investigation vide the Treating Hospitals discharge and other papers reporting of pre-existing ailments. There have been some cogent pieces of evidence by way of depositions of the treating doctors/ hospitals and/ or others to successfully prove the charges/ allegations upon which the impugned repudiation has been based. Somehow, the OP insurers have also produced the previous Doctors’ treatment- examinations, discharge summary, treatment history and other schedules etc to prove their allegation of pre-existing disease/ ailment etc and that validly addresses its repudiation as fair, ethical and in conformity with the policy terms.

9        Thus, the alleged misrepresentation/ concealment/ non-disclosure of material facts etc by the DLI (Deceased Life Insured) do hereby stand proved along with the clear violation of the material terms of the related policy and that deprives the present complainant of any statutory relief. In such like repudiations the o. n. p. (onus of proof) always lay heavily upon the insurers but here they have somehow discharged the same successfully. We also find that the policy-claim as put forth by the complainants has been duly paid to the permissible extent under the policy terms by the OP insurers and as such they (the complainants) are presently not entitled to the prayed relief qua the present complaint.

10      In the light of the all above, we find the present complaint as devoid of all statutory merit and thus we ORDER for its dismissal with however no orders as to its costs.

11      Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.