Punjab

Ludhiana

CC/19/344

Harpreet Kaur - Complainant(s)

Versus

Birla Sun Life Insurance Co.Ltd. - Opp.Party(s)

Anshu gupta Adv.

31 May 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No:344 dated 15.07.2019.                                                         Date of decision: 31.05.2022.

 

Harpreet Kaur wife of Late Shri Jaswinder Singh son of Gurcharan Singh, resident of Village Lamma, Tehsil Jagraon, District Ludhiana.                                                                                                           ..…Complainant

                                                Versus

1. Birla Sun Life Insurance Co. Ltd., Regd. Office: One India Bulls Centre, Tower-1, 16^th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai-400013 through its Director/M.D.              
2. IndusInd Bank Ltd., Consumer Finance Division, Jagraon, District Ludhiana, through its Manager.

…..Opposite parties 

          Complaint Under Section 12 and 14 of the Consumer                                      Protection Act.

QUORUM:

SH. K.K. KAREER, PRESIDENT

SH. JASWINDER SINGH, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. Anshu Gupta, Advocate.

For OP1                         :         Sh. Ajay Chawla Advocate.

For OP2                         :         Exparte.

 

ORDER

PER K.K. KAREER, PRESIDENT

1.                Briefly stated, the case of the complainant is that her husband Jaswinder Singh availed a tractor loan from OP2 to the extent of Rs.5,09,217/- on 22.05.2018 which was payable in installments. Jaswinder Singh was also issued one Life Insurance Policy bearing certificate No.2012213, Policy No.503690 for Rs.5,00,000/- by OP1 which was valid for a period of 3 years. It was a group insurance policy valid for the period from 22.05.2018 to 22.05.2021. The complainant was the nominee of her husband Jaswinder Singh in the said policy. As per the terms and conditions of the insurance policy, OP2 was to repay the outstanding loan amount in the event of death of the group policy holder. The husband of the complainant Jaswiner Singh died on 30.07.2018. Till his death, Jaswinder Singh repaid all the loan installments to OP2. After the death of Jaswinder Singh, the complainant lodged the claim with OP1 to make the payment of the outstanding amount with interest as per terms and conditions of the policy. However, OP2 arbitrarily repudiated the claim without assigning any reasonable cause. This amounts to deficiency of service. A legal notice dated 26.06.2019 failed to evoke a positive response. Hence the complaint whereby it has been requested that the OPs be made to pay the claim amount of Rs.5,00,000/- along with compensation of Rs.1,00,000/- and litigation expenses of Rs.21,000/-.

2.                Upon notice, none appeared on behalf of OP2 despite service and as such, OP2 was proceeded against exparte.

 

 

 

3.                The complaint has, however, been resisted by the OP1. In the written statement filed on behalf of the OP1, it has been, inter alia, pleaded that the complaint is not maintainable and further that the complainant is not a consumer as the transaction entered into between the husband of the complainant Jaswinder Singh and OP2 was a commercial transaction. According to OP1, a proposal cum application form dated 22.05.2018 was received from OP2 for the enrollment of Jaswinder Singh as a member and for purchase of Birla Sun Life Insurance Group Asset Assure Plan. To secure the repayment of the loan, Jaswinder Singh obtained insurance policy from OP1 and submitted declaration of good health. On the basis of the information furnished by Jaswinder Singh in the enrolment form, the certificate of insurance No.2012213 was issued for initial sum assured of Rs.5,00,000/- towards death benefits. However, the said insurance was linked with the loan payable by the DLA to OP2 and in this regard, the insurance coverage was to the extent of Rs.5,00,000/- during the first year of the repayment, Rs.3,00,550/- in the second year, Rs.1,95,450/- in the third year. OP1 received the death claim from the complainant wherein it was reported that DLA died on 30.07.2018 within a period of less than 3 months from the date of purchase of the policy. The claim was got investigated and it was found that DLA was suffering from epilepsy prior to purchase of the policy and was under treatment of PGI, Chandigarh. This fact was not disclosed by the DLA in the proposal form at the time of the policy. Had Jaswinder Singh disclosed the true facts in the declaration of good health, OP1 would not have issued the policy. Therefore, the claim was rightly repudiated by OP1 vide letter dated 28.02.2019 because there was willful intent to deceive the OP on the part of Jaswinder Singh. According to OP1, Jaswinder Singh did not die due to heart attack on 30.07.2018 but died due to pre-existing disease of epilepsy for which he was taking treatment from PGI Chandigarh since the year 2016 and this fact was not disclosed in the declaration form. The rest of the averments made in the complaint have been denied as wrong and in the end, a prayer for dismissal of the complaint has been made.

4.                In evidence, the complainant submitted her affidavit as Ex. CA along with documents Ex. C1 to Ex. C9 and closed the evidence.

5.                On the other hand, the counsel for the OP1 tendered affidavit Ex. RA of Ms. Aakriti Manocha, Senior Manager Legal of OP1 along with documents Ex. OP1/1 and Ex. OP1/9 and closed the evidence.

6.                We have heard the counsel for the parties and have gone through the record carefully. 

7.                During the course of the arguments, the counsel for the complainant has argued that OP1 has wrongly repudiated the claim on false and frivolous grounds. According to the counsel for the complainant, as a matter of fat Jaswinder Singh died due to heart attack and not due to any pre-existing disease of epilepsy nor there is any evidence placed on record to prove that he died due to epilepsy and not heart attack. The counsel for the complainant has further pointed out that even the proposal form is not filled in the hands of the deceased Jaswinder Singh. Therefore, in the given circumstances, OPs are bound to pay the claim as the repudiation of the claim is totally unjustified and arbitrary.

8.                On the other hand, the counsel for the OP1 has argued that Jaswinder Singh concealed the fact that he was suffering from epilepsy with aspiration  of which he was getting treatment from PGI Chandigarh since the year 2016. According to the counsel for OP1, the concealment of material facts which might have affected the decision of OP1 to issue the policy or not is material concealment and therefore, OP1 was fully justified in repudiating the claim on this ground.

9.                We have weighed the contentions raised by the counsel for the parties and have gone through the record carefully.

10.              In this case, before taking the policy, the life assured Jaswinder Singh filled the declaration of good health form, copy of which is Ex. OP1/3 on the record. In this declaration, Jaswinder Singh claimed himself to be in good health. In the declaration as against the point No.4h whereby the complainant was asked as to whether he suffered from any mental or psychiatric condition, any genetic disease or any disease related to central nervous system, the life assured answered in negative. The declaration of good health was signed by the life assured Jaswinder Singh on 20.05.2018. However, during the investigation, it was found that Jaswinder Singh was suffering from epilepsy with aspiration and he was taking regular treatment from PGI in respect of the said disease since the year 2016. It is mentioned in the investigation report Ex. OP1/5 that in her statement Harpreet Kaur, the wife of life assured gave a written statement that her husband was suffering from illness from the last 6-7 months and was taking treatment from PGI, Chandigarh. OP1 has further placed on record OPD slips of the life assured regarding the treatment taken by Jaswinder Singh from PGI which are Ex. OP1/6. It is mentioned in the outpatient record Ex. OP1/6 that the complainant suffered from one episode seizure in the year 2016. It is further evident from the record of PGI that the life assured left PGI hospital on 30.07.2018 against medical advice and he died on the same day. It is further mentioned in the record Ex. OP1/6 that Jaswinder Singh was diagnosed with epilepsy and aspiration. It is further mentioned in the record that even in the year 2017 Jaswinder Singh suffered from ‘seizure –ve’ which is another name of epilepsy. Though there is no concrete evidence on record that Jaswinder Sigh died of either heart attack or not of anything relating to seizure disorder or epilepsy, however, the facts remains that he was suffering from epilepsy since the year 2016 and this fact was not deliberately disclosed in the declaration. In this regard, a reference can be made to the law laid down in Branch Manager Bajaj Allianz Vs Dalbir Kaur (Civil Appeal No.3397 of 2020 decided on 09.10.2020) whereby it has been held by the Hon’ble Supreme Court of India that a proposer who seeks to obtain a policy of life insurance is duty bound to disclose all material facts bearing upon the issue as to whether or not the insurer would consider it appropriate to assume the risk which is proposed. It has been further held that in view of that the proposal form requires a specific disclosure of pre-existing ailments, so as to enable the insurer to arrive at a considered decision based on the actuarial risk and if the proposer fails to disclose that he was suffering from vomiting of blood barely a month prior to issuance of the policy and of the hospitalization which had been occasioned as a consequence, the claim was not payable. In the cited case there is further reference to the law laid down in Life Insurance Corporation of India Vs Asha Goel in Civil Appeal No.4186-87 of 1988 decided on 13.12.2000 whereby it has been held by the Hon’ble Supreme Court of India that if there is any misstatement or suppression of material facts, the policy can be called in question. It is not the case of the complainant that the pre-existing disease of epilepsy was not in his knowledge as he was taking treatment for this disease from PGI Chandigarh since 2016. Therefore, in the light of the law laid down in the cited cases, it has to be held that non-disclosure of the disease of epilepsy,  which the life assured had suffering from since the year 2016 while taking the policy in the year 2018 is a serious lapse which entitles the OP to repudiate the claim on the ground of non-disclosure of pre-existing disease. Therefore, it cannot be said that the claim has been wrongly repudiated by the OPs.

11.            As a result of the above discussion, the complaint fails and the same is hereby dismissed. However, there shall be no order as to costs. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

12.              Due to rush of work and spread of COVID-19, the case could not be decided within statutory period.

 

                             (Jaswinder Singh)                            (K.K. Kareer)

                    Member                                           President

 

Announced in Open Commission.

Dated:31.05.2022.

Gobind Ram.

Harpreet Kaur Vs Birla Sun Life Insurance Co. Ltd.                  CC/19/344

Present:       Sh. Anshu Gupta, Advocate for the complainant.

                   Sh. Ajay Chawla, Advocate for the OP1.

                   OP2 exparte.

                  

                   Arguments heard. Vide separate detailed order of today, the complaint fails and the same is hereby dismissed. However, there shall be no order as to costs. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

 

                             (Jaswinder Singh)                            (K.K. Kareer)

                    Member                                           President

 

Announced in Open Commission.

Dated:31.05.2022.

Gobind Ram.