The titled complainant Smt. Dalbir Kaur has filed the present complaint against the titled opposite party insurers aggrieved at their arbitrary repudiation of her Son’s Death-Claim seeking directives to them to settle the impugned claim at its full S.I. (Sum Insured) of Rs.50 Lac along with death cover of Rs.5.0 Lac and Critical Illness Cover of Rs.5.0 Lac with interest @ 18% PA besides Rs.50,000/- as compensation and Rs.5,000/- as litigation cost. The complainant’s deceased-son Sandeep Singh during his life time had purchased the OP product i-Protect-Smart Policy # 73726130 with a Sum Insured for Rs.50 Lac along with the other benefits @ a premium of Rs.37,280/- per annum. The DLI (Deceased Life Insured) has been in good health but unfortunately fell ill on 07.08.2020 and was diagnosed Lymphoma; Further, he was hospitalized at Amritsar/Ludhiana but could not recover and breathed his last on 15.09.2020; cause of death being Cardio Pulmonary Arrest. The complainant filed the related claim along with the requisite papers/documents that was finally repudiated by the OP insurers on 17.03.2021; in response to which the complainant got served the legal notice upon the OP insurers and finally the present complaint seeking the above said reliefs. The complainant in order to accomplish a successful prosecution of her complaint has also filed her duly Sworn-in Affidavit (Ex.CW1/A) along with i) Copy of the Insurance Policy (Ex.C1); ii) Copy of Death Certificate (Ex.C2); iii) Copy of the Legal Notice (Ex.C3); iv) Copy of Repudiation Letter (Ex.C4); v) Copy of Report (Ex.C5) of 25.05.2021; vi) Copy of the IVY Hospital Admission/(Ex.C6) Discharge Certificate; vii) Copy of the DMC Hosp., Ludhiana Admission/(Ex.C7) Discharge Certificate; viii) Copy Aadhar Card (Ex.C8); and ix) Copies of the Postal Receipts (Ex C9 to C11).      

2.        The titled opposite party insurers (the OP insurers), in response to the commission’s summons appeared through their learned counsel who filed their written reply stating therein preliminary as well as other (on merits) objections as:

3.        The complainant has no cause of action to file the present complaint as the parties to the contract of insurance are bound by the terms of the related policy and it has been the duty of the DLI (Deceased Life Insured) proposer to have disclosed all material facts at the time of purchase of the policy but the DLI failed to make a full and honest disclosure. It has been an early claim within two months of the date of the policy so the OP insurers had conducted investigations into the whole matter. The DLI had submitted the proposal form on 27.07.2020 and that he knew to have been suffering from chronic disease of Recurrent Thrombi Embolism but he had not disclosed the same in the proposal form. He had to be admitted in IVY Hospital from 10.08.2020 to 14.08.2020 and was diagnosed of the disease; and, it amounted to suppression of the material information and the OP insurers were deceived into undertaking Risk on the life of the Life Assured i.e., the herein DLI.

4.        The OP insurers have further quoted excerpts from the senior court judgments in support of their pleadings/allegations of non-disclosure along with the others and thus the claim was rightly repudiated as the policy itself turned void ab-initio and was canceled. The OP insurers have mentioned of the past treatments undergone by the insured and have also quoted Senior Court Judgments to support and strengthen their resolve determining repudiation to the impugned insurance-claim. The insured/ Life Assured had replied, in negative, thus suppressing the pre-existing diseases in reply to the questionnaire accompanying the proposal form, as has also been re-produced in the written reply. Lastly, the complaint has been sought to be dismissed with costs. Again, on merits, the OP insurers have categorically denied all the contents n allegations as put forth by the complainant in the present complaint except that specifically admitted during the course of the herein trial/ proceedings.  The written reply is supported by self-attested Affidavit (Ex.OPW1,2,3/A) of Sh. Thejus Joseph Legal Manager along with other documents as: Ex.OP1– Proposal Form; Ex.OP2– Policy Document– Terms & conditions of the Policy; Ex.OP3– Claimant Statement Form (Death Claims); Ex.OP4– Discharge Summary IVY Hospital; Ex.OP5 – Query cum Requisition Letter dated 03.03.2021; Ex.OP6– Repudiation dated 17.03.2021;   Ex.OP7– Affidavit of Dr. C.H. Asrani with Medical Opinion;Ex.OP8– Reply to Legal Notice dated 25.05.2021.

5.       We have examined the available documents/evidence on the records so as to statutorily interpret the meaning and purpose of each document and also the scope of adverse inference on account of some of the documents ignored to be produced by the contesting litigants against the back-drop of the arguments/oral as well as written, as put forth by the learned counsels for their respective litigants.

6.        In the meantime, the Honorable Pb. & Haryana High Court in its orders of 01.09.2022 in CWP/9681/2022 in has directed this Commission to decide the present complaint within a period of two months and since then we have been hearing both the sides on regular basis, at briefest possible adjournments etc.

7.       We find that the present dispute has arisen on account of the impugned ‘repudiation' of insurance-death-claim pertaining to the complainant’s DLI son, by the OP insurers who allege non-disclosure of the pre-existing/continuing ailments etc by the DLI, at the time of insurance. We have minutely examined all the documents produced in evidence by the complainant and also by the OP insurers as produced and as collected by them during the course of their investigations and find that the insured's health status as well as all clinical and medical-examination reports as produced on the records of the proceedings present/ pose serious questions of fact as well as of law and resolve of the same shall not be feasible under the herein prescribed summary procedure for consumer complaints since the same shall involve voluminous evidence placed-forth through examination/cross-examinations/re-examinations of witnesses and others etc., and, thus we are of the considered opinion that it shall be more appropriate and just in the interest of justice to set the herein litigants at liberty to get their dispute resolved under the one legal-remedy of their own choice and advice as available to them, in law; and thus we dispose-off the present complaint accordingly with however no orders as to its cost etc.

8.        The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.

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

                                                          (Naveen Puri)

                                                                President.

ANNOUNCED:                                (R.S.Sukhija)

NOV. 17, 2022.                                          Member.

YP.