Chandigarh

DF-II

CC/65/2019

Sahil Aggarwal - Complainant(s)

Versus

Durian Industries Limited - Opp.Party(s)

Yugansh Siwach Adv.

21 Jan 2020

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II, U.T. CHANDIGARH

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Consumer Complaint  No	:	720 of 2018
Date  of  Institution	:	18.12.2018
Date   of   Decision	:	22.01.2020

 

 

 

 

Sumit Kumar Bhagria s/o Sh.Mohinder Pal, R/o House No.843, Curzon Lane-3, TDI City, Sector 117, Mohali -160055

             ……..Complainant

 

Versus

 

1]  Punjab National Bank, Branch Office,Phase-5, SAS Nagar, Mohali.

 

2]  PNB Metlife, Office at SCO 68/69, Second Floor, Sector 17-B, Chandigarh 160017

 

  ………. Opposite Parties

 

BEFORE:  SH.RAJAN DEWAN        PRESIDENT

            SMT.PRITI MALHOTRA    MEMBER

 

Argued By:

Sh.Munish Goeal, Adv. for complainant.

None for Opposite Party No.1.

Sh.Gaurav Bhardwaj, Adv. for Opposite Party No.2

 

PER PRITI MALHOTRA, MEMBER

         Briefly stated, the complainant along with his mother Smt.Veeran Devi, availed loan of Rs.20 lacs from OP No.1 Bank in Dec., 2017, which REQUIRED to be repaid in 360 monthly installments.  It is averred that Opposite Party No.1 get the said loan insured from PNB Metlife on 31.12.2017 whereby both the loanees i.e. complainant and his mother have been provided insurance cover by Opposite Party No.2 for a sum assured of Rs.18,50,000/- (Ann.C-4).  It is averred that unfortunately Mrs.Veeran Devi expired on 8.4.2018 (Ann.C-6), which was intimated to Opposite Party NO.1 on 21.4.2018 (Ann.C-7).  Thereafter, Opposite Party NO.1 gave intimation of death of Veeran Devi to Opposite Party No.2 and submitted claim form along with letter dated 5.5.2018 mentioning the total outstanding loan balance of complainant as Rs.16,73,394/- (Ann.C-8). However, the Opposite Party No.2 repudiated the claim of the complainant wrongly and arbitrarily vide letter dated 27.6.2018 (Ann.C-11).  Thereafter, a legal notice was also sent to OPs, but to no avail. Hence, this complaint. 

 

2]       The Opposite Party No.1/P.N.B. has filed reply and while admitting the factual matrix of the case, stated that the complainant took the insurance policy from PNB Metlife on 31.12.2017 and complainant himself took the said policy from Opposite Party No.2 to get the house loan insured and Opposite Party No.1 has no role whatsoever in taking the policy by the complainant.  It is submitted that the matter regarding the issuance of policy and its formalities relates to complainant and Opposite Party No.2 whereas the Opposite Party No.1 has no concern whatsoever with the issuance of the policy.  Other allegations have been denied being related to Opposite Party No.2 and it is prayed that the complaint qua Opposite Party No.1 be dismissed.

 

         The Opposite Party No.2/PNB Metlife India has also filed reply admitting the issuance of the policy in question to secure the loan account of the complainant.  It has been stated that since the Deceased Life Assured (hereinafter to be referred as DLA) Veeran Devi died just within three months & twelve days only from the date of proposing the policy, therefore, the company appointed Investigator to investigate the genuineness of the claim. It is stated that during investigation, the Investigator got previous medical treatment record of deceased Veeran Devi from PGI, Chandigarh, according to which, she was admitted in Hospital on 5.6.2017 in department of Gastroenterology & was Discharged on 6.6.2017 with brief summary of “MASS Lesion head of pancreas” and diagnosed with cancer.  It is also stated that as per report of Investigator, the DLA Veerna Devi was suffering from ‘Cancer’ approximately since 7-8 months prior to taking the policy and was getting the treatment from PGI, Chandigarh and Ayurvedic Centre, Himachal Pradesh and as such it is proved that she was suffering from cancer disease much prior to taking the policy in question, which has been concealed by her while proposing for the policy in question.  It is submitted that Veerna Devi, DLA has given wrong information and suppressed material facts in order to obtain the policy in question and therefore, the claim of complainant was rightly repudiated vide letter dated 27.6.2018 (Ann.C-11). Denying all other allegations and pleading no deficiency in service, the Opposite Party No.2 has prayed for dismissal of the complaint.

 

3]       Rejoider has also been filed by the complainant thereby reiterating the assertions as made in the complaint and controverting that of the OPs made in reply.

 

4]       Parties led evidence in support of their contentions.

5]       We have heard the ld.Counsel for the parties and have also perused the entire record.

 

6]       Firstly we would like to deal with the objection raised by the OPs qua territorial jurisdiction of this Forum at Chandigarh.  Ann.C-8, letter dated 5.5.2018 proves that the claim of the complainant has been processed by OP No.2/PNB Metlife, Sector 17, Chandigarh.  Further, the complainant also submitted letter dated 29.5.2018 (Ann.C-10) to OP No.2, duly received by it having its stamp, seeking status of his claim. Therefore, the part of caution of action has certainly accrued to the complainant at Chandigarh and thus, this Forum has the jurisdiction to try & adjudicate the present complaint. Hence the objection raised by the OPs is not tenable.

 

7]       On merits, after going through the documents thoroughly, we are of the opinion that record available clearly establishes that there is no contradiction to the fact that deceased Veeran Devi (insured under the policy in question) was suffering from Gall Bladder Cancer and had been taking treatment for the same from Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh i.e. immediately before taking the policy in question. The policy in question was taken on 31.12.2017 and death of insured Veeran Devi occurred on 8.4.2018 i.e. within 4 months of taking the policy. 

 

8]       Further, we have taken notice of the fact that the insured Veeran Devi had not disclosed the material information regarding her ailment with which she was suffering at that time while filling the proposal form with OP No.2.  The documents annexed with the report of Investigator appointed by the OP No.2 clearly establish that the deceased insured Veeran Devi remained admitted in PGIMER, Chandigarh in June, 2017 against CR No.201702685711, but this fact has not been disclosed by her while proposing for the policy with OP No.2.  Had the true disclosure been made in the proposal form by the deceased insured Veeran Devi regarding her state of health and treatment taken by her before availing the policy, then the OP No.2/Insurer would have fairly considered the said fact while issuing the policy.      The complainant himself also not made any fair disclosure to the OPs about his mother’s health status while getting the loan secured vide present policy. 

         The non-disclosure and active concealment of material information about the ailment suffered by the deceased insured Veeran Devi, had certainly hampered the free volition of the OP No.2 to exercise their option to consider that the policy be issued to her or not. The whole record, especially the Investigator’s Report, placed on record by OP No.2, cogently establish that the policy in question has been obtained by the insured by fraudulent means and concealing material information and thus the OP No.2/Insurance Company has rightly rejected the claim of the complainant while relying on Section 45 of Insurance Act, 1938, which is reproduced as under, for ready reference, which has also been mentioned in the proposal form:-

 

Section 45 of Insurance Act, 1938

1.       No Policy of Life Insurance shall be called in question on any ground whatsoever after expiry of 3 yrs from a. the date of issuance of Policy or b. the date of commencement of risk or c. the date of revival of Policy or d. the date of rider to the Policy whichever is later. 02. On the ground of fraud, a Policy of Life Insurance may be called in question within 3 years from a. the date of issuance of Policy or b. the date of commencement of risk or c. the date of revival of Policy or d. the date of rider to the Policy whichever is later. For this, the insurer should communicate in writing to the insured or legal representative or nominee or assignees of insured, as applicable, mentioning the ground and materials on which such decision is based. 03. Fraud means any of the following acts committed by insured or by his agent, with the intent to deceive the insurer or to induce the insurer to issue a life insurance Policy: a. The suggestion, as a fact of that which is not true and which the insured does not believe to be true; b. The active concealment of a fact by the insured having knowledge or belief of the fact; c. Any other act fitted to deceive; and d. Any such act or omission as the law specifically declares to be fraudulent. 04. Mere silence is not fraud unless, depending on circumstances of the case, it is the duty of the insured or his agent keeping silence to speak or silence is in itself equivalent to speak.

 

9]       From the entire facts & circumstances of the case, as discussed in the preceding paragraphs, it is proved that the policy in question has been subscribed by concealing material information and as such, the policy has been obtained by fraudulent means and therefore, the OP No.2 has rightly rejected the claim.  We do not find any deficiency in service on the part of Opposite parties.  Therefore, the present complaint being without merit is hereby dismissed. No order as to costs.

        Certified copy of this order be sent to the parties, free of cost. File be consigned to record room.

Announced

22^nd January,2020                                                                  sd/-

                                                                   (RAJAN DEWAN)

PRESIDENT

 

 

Sd/-

                                                                    (PRITI MALHOTRA)

MEMBER