DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BARNALA, CAMP COURT AT AMRITSAR, PUNJAB.

 

Complaint Case No : RBT/CC/2018/43

Date of Institution : 17.01.2018/29.11.2021

Date of Decision : 16.08.2022

Rahul Khanna son of Ashwani Kumar resident of H. No. 424-425, Universal Screw Factory, Chheharta, Amritsar.      …Complainant

Versus

1. The Head/Chief Manager of HDFC Standard Life Insurance Company Limited, Corporate and Registered Office at Lodha Excelus, 13th Floor, Apollo Mills Compound, NM Joshi Marg, Mahalaxmi, Mumbai. 

2. The Chief Manager/Manager of HDFC Standard Life Insurance Company Limited, 2nd Floor, Aventura Mall, PN 35B/36/13, The Mall Road, Amritsar. 

…Opposite Parties

Complaint U/S 12 and 13 of The Consumer Protection Act, 1986 as amended up to date.

Present: Sh. Ajay Sharma Adv counsel for complainant.

Sh. SK Vyas Adv counsel for the opposite parties.

Quorum.-

1. Sh. Ashish Kumar Grover : President

2. Sh. Navdeep Kumar Garg : Member

(ORDER BY ASHISH KUMAR GROVER PRESIDENT):

    The present complaint has been received by transfer from District Consumer Commission, Amritsar in compliance of the order dated 26.11.2021 of the Hon'ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh. The complainant filed the present complaint under Section 12 and 13 of the Consumer Protection Act against HDFC Standard Life Insurance Company Limited, Mumbai and another. (in short the opposite parties). 

2. The facts leading to the present complaint as stated by the complainant are that Smt. Madhu alias Poonam was mother of the complainant who during her lifetime purchased one life insurance policy No. 16879590 from the opposite parties for which premium of Rs. 50,000/- was payable every year. The said policy commenced from 3.6.2014 and first premium was paid on 3.6.2014, second premium was paid on 3.6.2015 and third premium was paid on 3.6.2016. The sum assured under the policy was Rs. 3,50,000/- and premium was to be paid was for six years. The said policy was provided to the complainant as she was having her bank account with the HDFC Bank Limited, Amritsar. After the inception of the said policy mother of the complainant suffered ailment in her uterus and she remained under treatment of Dr. Madhu Nagpal and then Sri Guru Ram Dass Institute of medical Sciences and Research, Amritsar and then with Ludhiana Mediways Hospital. She suffered from ovary cancer and ultimately died on 27.3.2017 in the said hospital at Ludhiana. The complainant and his family were not aware about the said policy and it was only in the month of May 2017 the complainant alongwith his father went to HDFC Bank to close the account of his deceased mother and only at that time bank officials disclosed about the life insurance policy obtained by the mother of the complainant from the opposite parties and complainant was nominee in the said policy.  

3. It is further alleged that as per law the complainant being nominee is entitled to death claim of his mother who was fully insured with the opposite parties for sum assured of Rs. 3,50,000/- and complainant lodged the claim with the opposite parties. But to the surprise of the complainant opposite parties issued letter dated 7.7.2017 with the pleas that at the time of obtaining insurance personal details of the life assured were shown as occupation agriculture and income of Rs. 3,50,000/- and she was not suffering from any disease whereas the mother of the complainant was housewife and she was not owner of any agriculture land nor was doing agriculture work which shows that form of insurance was filled by the Agent of the opposite parties and further taken plea that mother of the complainant was suffering from cancer disease prior to the inception of policy and policy was obtained by misrepresentation so policy is cancelled and an amount of Rs. 1,70,874.03 paise was transferred to the account of the complainant. The mother of the complainant not suffering from said disease prior to inception of policy and as per medical record also she suffered the said ailment after the inception of policy. The complainant also sent email on 2.9.2017 to opposite parties to withdraw the said repudiation letter and to settle the death claim of the mother of the complainant by reconsidering the claim and complainant was asked to resubmit the documents and complainant again submitted the requisite documents with the opposite parties but no response is received from the opposite parties. The complainant also served a legal notice dated 30.12.2017 to the opposite parties to get the death claim of his mother but to no effect which amounts to deficiency in service and unfair trade practice on the part of opposite parties. Hence, the present complaint is filed seeking the following reliefs.-

1) The opposite parties may be directed to pay a sum of Rs. 3,50,000/- being the death claim of the deceased mother of the complainant alongwith interest at the rate of 24% per annum from the date of death of the mother of the complainant till date of payment. 

2) To pay Rs. 50,000/- on account of compensation for mental agony and harassment. 

4) To pay Rs. 11,000/- as litigation expenses and Rs. 22,000/- as counsel fee. 

5) Any other relief to which the complainant is found entitled. 

4. Upon notice of this complaint, the opposite parties filed written reply taking preliminary objections that the insured willfully concealed material facts about her income and health condition at the time of purchase of insurance policy on 3.6.2014. The insured gave wrong answers to the questions of personal statement at the time of proposal for purchase of insurance knowing well that those were incorrect and she stated that she is in good health. However, she died on 27.3.2017. The claim was investigated by the opposite parties and from investigation it was established that the life assured was suffering from cancer disease prior to policy issuance and also misrepresented her income and occupation. This was not disclosed in the application dated 29.5.2014. Had this information been provided to the company the application for obtaining insurance policy would have been declined. Had she disclosed history of her pre-existing disease the insurance policy would not have been issued in favour of the insured. Due to these reasons the competent authority repudiated the liability under the said policy vide letter dated 7.7.2017. There is no deficiency in service on the part of the opposite parties. The insured deliberately gave false answers to the questions of proposal form like present occupation details Agriculture, Designation Owner, Gross yearly income Rs. 3,50,000/-, name of present business Agriculture and Have you suffered from any disease mentioned in the proposal form like cancer etc. No. 

5. On merits, it is submitted that the claim of the complainant on account of death of the insured was rightly declined and amount towards fund value of the premium deposited amounting to Rs. 1,70,874.03 was duly transferred to the account of the complainant which was duly received by him without raising any objection. Rest of the submissions submitted on merits are same as mentioned in the preliminary objections so there is no need to repeat the same. The claim was already rejected and the policy issued as such was cancelled. Lastly, the opposite parties prayed for the dismissal of the present complaint with cost.

6. To prove his case the complainant tendered in evidence his  own affidavit Ex.CW-1/A, legal notice Ex.C-1, postal receipts Ex.C-2 and Ex.C-3, copy of death claim Ex.C-4, copies of emails Ex.C-5 to Ex.C-7, copy of additional requirement reminder Ex.C-8, copy of receipt of documents Ex.C-9, copy of letter Ex.C-10, copy of report of Dhillon Scan Centre Ex.C-11, copy of prescription slip Ex.C-12, copy of prescription slip of Guru Ram Dass Hospital Ex.C-13 and Ex.C-14, copy of lab report Ex.C-15, copy of OPD record Ex.C-16, copy of OPD record Ex.C-17, copy of certificate issued by Medicate Hospital, Ludhiana Ex.C-18, copy of death certificate of Madhu Ex.C-19, affidavit of Ashwani Kumar Ex.CW-2/A and closed the evidence. 

7. To rebut the case of the complainant the opposite parties tendered in evidence affidavit of Arpit Higghis Ex.OP-1, copy of letter dated 7.7.2017 Ex.OP-2, copy of report of Middle Hospital Ex.OP-3, copy of MRI Scan report Ex.OP-4, copy of death certificate Ex.OP-5,  documents Ex.OP-6 to Ex.OP-17 and closed the evidence.   

8. We have heard the learned counsel for the parties and gone through the record on the file.

9. It is not disputed between the parties that the mother of the complainant purchased the life insurance policy from the opposite parties for sum assured of Rs. 3,50,000/- and complainant is the nominee of his mother in the said insurance policy. It is also not disputed that the said policy was commenced from 3.6.2014 and mother of the complainant paid three premiums of the said policy of Rs. 50,000/- each. Further, it is also not denied by the opposite parties that the said policy was provided to the mother of the complainant as she was having bank account with the HDFC Bank Limited, Amritsar. The death of the mother of the complainant also not disputed during the currency of the insurance policy. Further, it is also not denied by the complainant that the opposite parties transferred the amount of Rs. 1,70,874.03 paise in his account against the insurance policy in question. 

10. The main grievance of the complainant in the present complaint is that as his mother died during the validity of the insurance policy for the sum assured of Rs. 3,50,000/- so he is entitled for the amount of Rs. 3,50,000/- as insurance claim on account of death of the insured. But the opposite parties repudiated the insurance claim of the complainant vide letter dated 7.7.2017 Ex.C-4 on the ground that the mother of the complainant was suffering from cancer disease prior to the policy issuance which was not disclosed by her in the application dated 29.5.2014 and this vital information was not provided to the opposite parties by the mother of the complainant at the time of purchase of the insurance policy from the opposite parties.

11. We have perused the file and also documents on the file. It is not disputed between the parties that the policy was commenced from 3.6.2014 against the application of the mother of the complainant dated 29.5.2014. The opposite parties mentioned in their written version and letter dated 7.7.2017 Ex.C-4 that the mother of the complainant suffering from cancer disease prior to the policy issuance which was not disclosed by her in the proposal form and concealed the vital information from the opposite parties, but the opposite parties have not produced on the file copy of proposal form signed by the mother of the complainant which is the best evidence to prove that she has concealed her disease if any from the opposite parties.

12. The Hon'ble National Commission, New Delhi in case titled Aviva Life Insurance Company Limited Versus Chander Kanta and others Revision Petition No. 20 of 2015 decided on 3.9.2015 held as under.-

“Life Insurance Policy-Repudiation of claim-Ground of concealment of material fact-Complaint-District Forum decided the case expart against complainant and dismissed complaint-State Commission allowed appeal and directed the petitioner to pay Rs. 1,35,000/- alongwith interest-Hence Revision petition before National Commission-Cause of death is not real issue in case-Contention that deceased was suffering from cancer-No proposal form produced and petitioner withheld the best evidence-Held-No illegality or jurisdictional error in the impugned order, confirmed- Revision petition dismissed.

13. Further, the opposite parties also not produced any document to prove that the mother of the complainant was suffering from cancer disease prior to inception of the insurance policy. They have produced on record medical record of the mother of the complainant Ex.OP-3, Ex.OP-4, Ex.OP-6 to Ex.OP-17 to prove that the mother of the complainant was suffering from cancer disease. We have perused this record and found that all medical record is after the issuance of the insurance policy i.e. 3.6.2014 whereas as per medical certificate Ex.OP-3 the mother of the complainant first time visited for her check up on 28.6.2014 and expired on 27.3.2017, which fact itself proved that at the time of commencement of the policy the mother of the complainant did not know about her cancer disease. 

14. The Hon'ble National Consumer Disputes Redressal Commission in case titled Life Insurance Corporation of India and another Versus Gowramma Revision Petition No. 2582 of 2005 decided on 11.5.2009 held that.-

“B. Life Insurance-Repudiation of claim on ground of suppression of material facts-Contention, raised that insured suffering from cancer not disclosed-Two years elapsed after issuance of policy-Insurer is under burden to prove concealment of facts-Failure on part of insurer to lead sufficient evidence-Insured suffered from cancer 3-1/2 years after taking of original policy proved-No suppression of fact at time of taking of policy-Complaint allowed by Forum- Impugned order upheld.”

15. The Hon'ble National Commission in case titled Life Insurance Corporation of India Versus Kamla Devi Gupta Revision Petition No. 4000 of 2006 decided on 16.1.2007 held that.-

“No evidence that life insured ever remained admitted in any hospital and/or treated for cancer prior to his obtaining policy-Suppression of material fact not made out-Insurer liable-Revision dismissed.”

Both these citations of the Hon'ble National Commission are fully applicable to the facts and circumstances of the present case. In the present case also the opposite parties failed to produce any evidence to prove that the mother of the complainant suffering from cancer disease or remained admitted in any hospital or treated for cancer prior to her obtaining the insurance policy. So, by not paying the insurance claim to the complainant on account of death of her mother being nominee is clear cut deficiency in service and unfair trade practice on the part of the opposite parties. 

16. In view of the above discussion, present complaint is partly allowed. It is not denied by the complainant that the opposite parties transferred the amount of Rs. 1,70,874.03 paise in his account against the insurance policy in question. So, the opposite parties are directed to pay the remaining amount of Rs. 1,79,126/- to the complainant on account of insurance claim for the death of his mother alongwith interest at the rate of 6% per annum from the date of filing of present complaint till actual realization. The opposite parties are also directed to pay Rs. 5,500/- to the complainant as compensation for mental tension and harassment and Rs. 3,300/- as costs and litigation expenses. Compliance of this order be made within the period of 45 days from the date of the receipt of the copy of this order. Both the parties jointly and severally liable to comply with this order. Copy of the order will be supplied to the parties by the District Consumer Disputes Redressal Commission, Amritsar as per rules. File be sent back to the District Consumer Disputes Redressal Commission, Amritsar. 

ANNOUNCED IN THE OPEN COMMISSION:

        16th Day of August 2022

 

 

            (Ashish Kumar Grover)

            President

              

(Navdeep Kumar Garg)

Member