Case No.42/2017   

IN THE MATTER OF

Smt. Bilkis Begum W/o Late Israj Khan R/o 780 ADA  DA Idgah Road Sheravar, Shahjamal Aligarh  (Through: Advocate Dr. Rajiv Mohan)

                                                         V/s

1. PNB Met Life India Insurance Company Ltd, Brigrade Sheshmahalas 5 Vani Vilas Road Basavanagudi Bangulare 560004 by MD (Through: Advocate Rajdev Singh )

2. PNB GT Road Near Banna Devi Police Chowki Aligarh by Branch Manager 

CORAM

 Present:

1. Shri Hasnain Qureshi, President
2. Shri Alok Upadhayay, Member
3. Smt. Purnima Singh Rajpoot, Member

PRONOUNCED by Shri Hasnain Qureshi, President

JUDGMENT

1. The present complaint has been filed by the complainant before this commission prayed for  the following reliefs-

(a)Op be directed to pay the amount Rs.916982 with interest at the rate 24%.

(b) Op be directed to pay to the complainant Rs.5000/ for mental agony and cost of the case Rs.11000/.

2. The Complainant has stated that her husband Late Israj Khan had purchased PNB Met Smart Platinum policy no. 21436055 on 4.12.2014 and he had been making the payment of premium throughout his life till his death on 5.10.2016. Complainant submitted claim from to the Op and an amount of Rs.103017.52 was paid instead of the amount Rs.1020000/ and bonus. It was informed by the Op vide letter dated 12.3.2017 that the full payment was not made because the insured had been suffering from diabetes. It was wrongly shown that the policy holder had been suffering from diabetes. Policy holder had died at the age of 60 years which entitled him for all the benefits.       
3. Op has filed WS in which it was stated Late Israj Khan had submitted proposal on 24.11.2014 for the product Met Smart  Platinum having under stood the terms and conditions of the products. In proposal form it was replied of the question that he was not suffering from any disease and he was not given any medical treatment in the past five years. There was also a specific question with respect to diabetes and the insured had replied it in negative. The OP processed and evaluated the proposal form on basis of information given in proposal form and evaluated the assured sum Rs.1020000/. The claim form was received on 3.1.2017 and it was found during the course of investigation and assessment of the claim that the insured did not provide correct information with respect to his medical history. It revealed that he had been suffering from diabetes mellitus prior to issuance of the policy. The summary report of Fortis Hospital reveals that he had been suffering from K/C/O diabetes mellitus since last 7-8 years. The material fact was suppressed and contract of insurance stood vitiated and the Op has rightly repudiated the claim.  
4. Complainants have filed his affidavit and papers in support of his pleadings.  Op has also filed his affidavit and papers  in support of his pleadings
5. We have perused the material available on record and heard the parties counsel.
6. The first question of consideration before us is whether the deceased life insured is liable for suppression of material fact? If not so, its effect.
7. Admittedly, the complainant’s husband Late Israj Khan had obtained the policy from the OP for the assured sum Rs. 1020000/. The only ground for repudiating the claim was suppression of the fact of suffering from the disease diabetes mellitus by the insured prior to issuance of the policy. It cannot be denied that the diseases like diabetes and blood pressure are common in the society and these diseases are controlled by the person by adopting a different life style and exercise and by taking general medicines. There is nothing on record to show that the insured remained hospitalized for a long period for treatment of his disease. The nature of disease alleged to have been suffered by the insured does not appear to be so serious that the insured should have taken cognizance of the same and answering the question in negative by the insured with respect to his medical history cannot be treated to suppress the important fact and such a fact is not the material fact. It is held   that the deceased life insured is not liable or suppression of the material fact. Therefore the complainant is entitled for the full assured sum Rs.1020000. Complainant was paid only Rs.103017/ and thus she is entitled for Rs.916982/ with pendente lite and future interest at the rate 9% per annum.
8.   The question formulated above is decided in favour of the complainant.
9.   We hereby direct the Op insurance company to pay to the complainant the amount Rs. 916982/ with pendente lite and future interest at the rate 9% per annum and compensation for mental agony at Rs. 5000/ with cost of the case Rs.10000/.  
10. Op shall comply with the direction within 45 days failing which OPs shall be prosecuted for non-compliance in accordance with section 72 of the Act for awarding punishment against him.
11. A copy of this judgment be provided to all the parties as per rule as mandated by Consumer Protection Act, 2019. The judgment be uploaded forthwith on the website of the commission for the perusal of the parties. 
12. File be consigned to record room along with a copy of this judgment.