1        The complainant Gurinder Singh filed the present complaint under Section 11, 12 and 13 of the Consumer Protection Act (herein after called as 'the Act') against DHFL Pramerica Life Insurance Company Limited and others (Opposite Parties- Insurance Company) on the allegations of deficiency in service with further prayer to direct the Opposite Parties- Insurance Company to pay Rs. 5,00,000/- as death benefit under the policy besides Rs. 20,000/- as compensation for mental and physical harassment and Rs. 10,000/- as litigation expenses.

2        The case of the complainant in brief is that the Opposite Parties- Insurance Company deals in life insurance policies and agents of the Opposite Parties- Insurance Company gave lucrative offers for life insurance policies and family of the complainant also attracted to the offers given by agent of Opposite Parties- Insurance Company and proposed to insure the life of Balwinder Kaur mother of the complainant and Opposite Parties- Insurance Company issued policy ‘DLF PRAMERICA EZEE WEALTH+’ bearing policy number 000269527 with date of commencement as 9.10.2013 vide which assured value was Rs. 5,00,000/- and annual premium was fixed as Rs. 25,000/- and complainant was appointed as nominee in the policy and as such, complainant is competent to file the present complaint; that Balwinder Kaur died a natural death on 25.1.2014 at her residence and complainant filed claim case with the Opposite Parties- Insurance Company regarding the death of Balwinder Kaur and supplied all the information and requisite documents to the official of Opposite Parties- Insurance Company but Opposite Parties- Insurance Company did not clear the claim case of the complainant and at last declined the genuine claim of the complainant in an arbitrary manner vide repudiation letter dated 29.7.2014 and only refunded the amount of Rs.21573.95 Paise to the complainant in arbitrary manner and on baseless and frivolous documents; that Opposite Parties- Insurance Company has declined the genuine and legal claim of the complainant though Balwinder Kaur was duly examined at the time of issuance of the policy and Opposite Parties- Insurance Company also made investigation at the time of issuance of policy and as such, repudiation of claim case amounts to deficiency in service on the part of Opposite Parties- Insurance Company; that the complainant also sent an application to the Insurance Ombudsman Chandigarh for obtaining the claim amount but the same was also rejected. Hence the present complaint was filed.

3        After formal admission of the complaint, notice was issued to Opposite Parties- Insurance Company and Opposite Parties- Insurance Company appeared through counsel and filed written version contesting the complaint on the preliminary objections that the complaint is false, malicious , incorrect and malafide and is an abuse of process of law and is an attempt to waste the time of the Forum as the same has been filed just to avail undue advantage ; that complaint is not maintainable in law nor on facts and is liable to be dismissed in limine; that complaint is vague, baseless, misconceived and the allegations of deficiency in service is without any documentary evidence; that  the complaint does not fall within the definition of consumer dispute as there is neither any unfair trade practice nor any deficiency in service on the part of the Opposite Parties- Insurance Company and the allegations leveled in the complaint are false, frivolous, baseless and misconceived; that there was no negligence or deficiency in service on the part of the Opposite Parties- Insurance Company while dealing with the policy in  dispute, as DLI herself had not disclosed the material information to Opposite Parties- Insurance Company at the time of filling up of proposal form and as such Opposite Parties- Insurance Company has rightly repudiated the claim of the complainant; that the correct facts of the case are that deceased mother of the complainant after completely understanding the terms and conditions of the product ‘DLF Pramerica Ezee Wealth Plus’  plan submitted duly signed proposal form No. OT 001328499 on 5.10.2013 and proposer and life assured after understanding the terms and conditions which were duly explained to her signed the same and also signed the declaration of the proposal form; that the questions of the application form were explained and understood by her and she gave an undertaking that all the answers in the application form are true and complete in all aspect and she has not withheld any material information and suppressed any material facts; that after receiving the proposal form alongwith declaration, the Opposite Parties- Insurance Company issued the insurance policy in dispute to the DLA with risk commencement date as 9.10.2013; that the Opposite Parties- Insurance Company received the death claim on 10.2.2014 from the complainant on the ground that DLI suddenly expired on 25.1.2014 due to heart attack and claimed the sum assured; that the Opposite Parties- Insurance Company as per standard procedure to ascertain the factual correctness of death claim carried out the investigation and during investigation, it was revealed that DLI has suppressed the material information from the Opposite Parties- Insurance Company at the time of filling up the proposal form; that the DLI at the time of filling up the proposal form was suffering from Malignant Ovarian Tumour prior to taking of the policy and she was on regular treatment for her illness from Mahajan Hospital Amritsar and in the IPD record of DLA, it is clearly mentioned that she was known case of “Ca Ovary” and she was on regular treatment for this but this fact was concealed by the DLA despite specific question asked in the proposal from and concealment of these facts affect the decision of Insurer for acceptance or rejection of contract of insurance; that suffering from “Ovarian Cancer” cannot be considered as a normal disease and she was suffering from same much prior to availing of said policy and DLA was duty bound to answer the questions with regard to her health condition and as such, the contract of insurance being of utmost good faith, DLA was obliged to give full and correct information on all matters which would influence the judgment of a prudent insurer in determining whether it will accept the risk and if it would, at what rate of premium and subject to what condition; that if a material fact is suppressed, the insurer will be misled about the risk covered and hence the same will vitiate the contract of insurance and insurer will be within its right to treat the contract as void as per terms and conditions of the policy documents; that the policy was obtained by DLA by suppression of material facts about her health condition and had the Opposite Parties- Insurance Company been aware of the “Ovarian Cancer” of DLA at the time of signing of the Proposal Form by DLI for insurance,  the Opposite Parties- Insurance Company would not have issued the said policy to the DLI at the first instance and as such, non- disclosure of material facts or misrepresentation in the Proposal Form would render the contract voidable at the option of the Insurer and as such, Opposite Parties- Insurance Company have rightly repudiated the claim of the complainant on the ground of suppression of material facts by the DLI at the time of filling up the proposal form; that the grounds of repudiation were duly communicated by Opposite Parties- Insurance Company to the complainant vide letter dated 29.7.2014 and the earlier complaint filed by the complainant before Ombudsman was dismissed vide order dated 19.6.2015. It was asserted that Opposite Parties- Insurance Company does not hold any liability under the said policy as the life insurance contracts are contracts ‘uberrimae fides’ where observance of utmost good faith is enjoined on the parties to the contract. If a material fact is suppressed, the insurer will be misled about the risk covered and hence the same will vitiate the contract. On merits, the complaint is also contested on the same lines as taken by the Opposite Parties- Insurance Company in the preliminary objections and prayer was made for dismissal of the complaint with costs.

4        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, affidavit of Kuldeep Singh Ex. C-2 alongwith documents Ex. C-3 to C-12 and closed his evidence and thereafter Ld. Counsel for the Opposite Parties tendered in to evidence affidavit of Yogesh Rohilla Ex. OPs/1 alongwith documents Ex. OPs/2 to Ex. OPs/7 and closed the evidence.

5        We have heard the Ld. Counsel for parties and have gone through the evidence and documents placed on the file by the parties.

6        Ld. counsel for the complainant argued the case on the same assertion as were taken in the complaint and contended that Balwinder Kaur took the insurance policy from the Opposite Parties- Insurance Company and at that time she was duly medically examined and thereafter the Opposite Parties- Insurance Company issued the insurance policy Ex. C-3. He contended that the complainant Gurinder Singh is nominee of Balwinder Kaur in the insurance policy and Balwinder Kaur died a natural death in her house and complainant in order to avail the insurance benefits under the policy filed the claim with the Opposite Parties- Insurance Company but the Opposite Parties- Insurance Company wrongly repudiated the insurance claim on the flimsy ground that Balwinder Kaur concealed the material facts. He contended that Balwinder Kaur gave the correct particulars sought in the application form and as such the repudiation of the claim by Opposite Parties- Insurance Company is wrong and illegal and it amounts to deficiency in service on the part of Opposite Parties- Insurance Company and as such complaint is required to be allowed and complainant is entitled to the relief mentioned in the complaint.

7        The Ld. counsel for the Opposite Parties- Insurance Company contended that Balwinder Kaur took the insurance policy in question from Opposite Parties- Insurance Company in 2013 with commencement date as 9.10.2013 and Balwinder Kaur died on 25.1.2014 i.e. within 3 to 4 months from taking insurance policy. He contended that insurance contract is based on utmost good faith and the life insured is required to give the correct and clear and complete particulars about her health and to the questions given in the proposal form as the detailed reply given in the proposal form is the criteria for acceptance and rejection by the Opposite Parties- Insurance Company to undertake the risk covered under the insurance policy and if the risk is to be undertaken then at what rate of premium and under which condition. He contended that immediately before filing of the proposal form,  Balwinder Kaur was suffering from ‘Cancer Ovary’ as she was a known case of ‘Malignant Ovarian Tumour’ immediately prior to the taking of insurance policy but she did not disclose this fact in the proposal form nor she disclosed correctly that she was hospitalized immediately before filing the proposal form or within the period mentioned in the proposal form and this attitude of Balwinder Kaur misled the Opposite Parties- Insurance Company in accepting and issuing the policy in question. He contended that documents placed on the file clearly shows that Balwinder Kaur was suffering from known pre-existing disease but she did not disclose this fact in the proposal form and as such repudiation of the claim filed by the complainant was in accordance with the rules. He further contended that as insurance policy in question was a unit linked policy, therefore, claim to the extent of refund of funds available at that time was made to the complainant and as such there was no deficiency in service on the part of the Opposite Parties- Insurance Company and complaint is false, frivolous and has been unnecessarily filed and is liable to be dismissed with costs. .

8        It is admitted fact in this case that Balwinder Kaur took the insurance policy in question Ex. C-3 from Opposite Parties- Insurance Company. It is mentioned in the letter Ex. C-4 issued by Opposite Parties- Insurance Company to insured Balwinder Kaur which is proved on the file by the complainant that “for unit linked product, we will         refund you the fund value on date of cancellation and any charges paid by you”. It is the contention of the complainant that Balwinder Kaur was not suffering from any disease much less ‘cancer’ immediately before purchase of insurance policy in question and she died a natural death at her house. Otherwise, the insurance contact is based on utmost good faith on the part of parties to the insurance contract and life assured was required to disclose all the true and correct facts about her health and to the questions asked in the proposal form. Opposite Parties- Insurance Company has proved the proposal from Ex. OP/2 on the file. This proposal form was signed by Balwinder Kaur on 5.10.2013. She has replied to the questions given at serial No. 46 that she never had any signs or symptoms or been told that she has any heart condition, hypertension, stroke, disability, paralysis, cancer, tumour or abnormal growth, diabetes, kidney problem, liver disease, lung disease, gastrointestinal disease, mental illness, HIV infection or AIDS. She also replied that she has not been hospitalized due to illness or injury for continuous period of 2 days or received medical treatment for continuous period of more than 6 days during the last 5 years period. She has also replied that she had not under gone and is not awaiting to undergo any surgical procedure, any investigative or diagnostic test or medical examination other than for routine health screen. She has replied all these questions in negative form. Opposite Parties- Insurance Company has also proved investigation report Ex. OP/5 in which it is stated that insured had cancer and she was on regular treatment from Mahajan Hospital Amritsar. The case history of Balwinder Kaur is also attached with the investigation report vide which she took treatment from Mahajan Hospital from 17.6.2013 to 21.6.2013. It is mentioned in this case history of Balwinder Kaur given by Mahajan Hospital under the head diagnosis as ‘Cancer Ovary’ and it clearly shows that Balwinder Kaur remained admitted in Mahajan Hospital from 17.6.2013 to 21.6.2013 i.e. for more than 2 days and she has also undergone investigation for the disease but she has replied these questions in negative in the proposal form that she had not been hospitalized for any illness for more than 2 days nor she was suffering from Cancer Tumor etc. It clearly shows that the reply given by Balwinder Kaur was incorrect and she concealed the facts about her health and pre-existing disease and as such has misled the Opposite Parties- Insurance Company for issuance of insurance policy in question. Moreover investigation report of Navya Diagnostic Centre dated 18.6.2013 is also attached with the investigation report showing that she got the investigation for ‘complaint of Cancer Ovary’. The diagnostic report of Nijjar Lab and Diagnostic Center dated 21.9.2012 is also attached with the investigation report which shows that Balwinder Kaur also took diagnostic investigation prior to taking insurance policy in question and it was reported in this diagnostic report that features were suggestive of “Malignant Ovarian Tumour”. It clearly shows that complainant was suffering from serious pre-existing disease immediately prior to taking insurance policy but she has concealed this fact in the proposal form and has misled the Opposite Parties- Insurance Company for acceptance of risk and for issuing insurance policy in question. Inspite of this Opposite Parties- Insurance Company has refunded the funds under insurance policy in question because it was an unit linked policy and complainant was entitled for refund of the amount under the insurance policy in case of its cancellation or the happening of the event. As such the Opposite Parties- Insurance Company has rightly repudiated the claim of the complainant and there was no deficiency in service on the part of the Opposite Parties- Insurance Company as the life assured had concealed the material facts regarding her pre-existing disease and rather misled the Opposite Parties- Insurance Company in acceptance of risk and for issuance of insurance policy in question and as such, complainant is not entitled for any relief under the policy in question.

9        In the light of above discussion, complaint fails and same is hereby dismissed. However, keeping in view the peculiar circumstances of the case, the parties are left to bear their own costs. Copy of order be supplied to the parties free of costs as per rules. File be consigned to record room.