DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BATHINDA

C.C. No. 224 of 27-08-2019

Decided on : 23-08-2022

Soma Rani wd/o Rangla Mall Singh s/o Sudesh Kumar resident of H.No. 24215,
B-1, Guru Ki Nagari, Bathinda.

• ​........Complainant

Versus

1. HDFC Standard Life Insurance Co. Ltd. regd. Office 13^th Floor Appllo Mills compound NM Joshi Marg Mumbai, through its MD/DM/Incharge.

2. HDFC Standard Life Insurance Co. Ltd. 8^th A ground floor Dalip Singh wala Complex, Guru Kanshi Marg, Bathinda through its MD/DM/Incharge.

3. HDFC Standard Life Insurance Co. Ltd. SCHO 149 to 151 Ground, 1^st, 2^nd floor, Sector 43 B Chandigarh through its MD/DM/Incharge.

4. HDFC Standard Life Insurance Co. Ltd. Ahluwalia Complex Guru Kanshi Marg, Bathinda, through its Manager. (Deleted vide order dated 3-9-2019)

.......Opposite parties

Complaint under Section 12 of the Consumer Protection Act, 1986

QUORUM:-

Kanwar Sandeep Singh, President

Smt. Paramjeet Kaur, Member

Present:-

For the complainant : Sh.Harsatnam Singh, Advocate.

For opposite parties : Sh.Vinod Garg, counsel for OPs No.1 to 3

Opposite party No.4 deleted.

ORDER

Kanwar Sandeep Singh, President:-

1. The complainant Soma Rani (here-in-after referred to as complainant) has filed this complaint U/s 12 of Consumer Protection Act, 1986 (Now C.P. Act, 2019, here-in after referred to as 'Act') before this Forum (Now Commission) against HDFC and others (here-in-after referred to as opposite parties).

2. Briefly stated the case of the complainant that one health insurance bearing policy No. 20036142 has been purchased by complainant on 01.02.2018. As per policy, opposite parties are responsible to pay claim of Rs.1,75,000/- to the beneficiary Rangla Mall Singh. Policy term was 10 years and expiry is on 01.02.2028.

3. It is alleged that Rangla Mall, husband of complainant died on 05.09.2018 and only Rs.21,000/- has been paid to the complainant being claim amount. No reason has been given by the opposite parties for payment of less claim. The complainant also paid Rs. 2,000/- to Sh. Harpal Singh, surveyor, but no receipt was given by him.

4. The complainant alleged she requested the opposite parties for payment of full claim but the official of the opposite party refused to pay the same. The complainant also got issued legal notice on 24.07.2019, but to no effect. Hence, this complaint.

5. On this backdrop of facts, the complainant has prayed directions to the opposite parties to pay claim amount of Rs. 1,74,000/- with 18% interest from the date of accident till realization and also pay Rs.10,000/- as compensation in addition to Rs.11,000/- as litigation expenses.

6. Upon notice, the opposite parties appeared through counsel and contested the complaint by filing written reply raising legal objections that the complainant has concealed material facts and documents from this Commission as well as the opposite parties therefore, the complainant is not entitled to any relief.

7. It has been pleaded that complainant has concealed the fact that the policy was issued on the basis of proposal for HDFC Life Sampooran Nivesh for sum assured Rs. 1,75,000/-. The proposal was accepted on the basis of information provided in the proposal form and the policy issued on 01.02.2018. In this connection, the opposite parties referred to the "Personal Details of Life to be Assured" in the said application. Under this section, the following relevant questions had been answered incorrectly:

   12	Have you ever suffered from: Diabetes/high blood sugar/ sugar in urine, High blood pressure/hypertension, heart disease, Stroke	No
   18	Are you currently suffering from any illness, Impairment or taking any medication or pills or drugs?	No
   21	During last 5 years have you undergone or recommended to undergo hospitalization?	No

   The opposite parties got the matter thoroughly investigated and it was established that the life assured was suffering from Diabetes Mellitus prior to the date of policy issuance. This was not disclosed in the application dated Feb 01, 2018. Had this information been provided to the opposite parties at the time of applying for insurance policy, the opposite parties would have declined the application. Since, there was material concealment of vital information at the time of applying for policy, the opposite parties repudiated the claim against the policy vide repudiation letter dated 24.06.2019 and released/paid Rs.21,740/- being fund value by crediting into the account of complainant.

8. The other legal objections raised by the opposite parties are that the complainant has no locus standi or cause of action to file the complaint and that the complaint is not maintainable.

9. On merits, it has been pleaded that the complainant was suffering from Diabetes Mellitus at the time of purchase of the said policy and policy was obtained by concealing these material facts as such the complainant is not entitled to any amount of the said policy. As per Lab records of Bhangu Hospital Lab, dated 20.3.2014 postprandial glucose level was 212 mg/dl and as per slip of Mittal Labs, dated 2.09.18, fasting suger level was 182 mg/dl. The opposite parties rightly paid/refunded the fund value of Rs. 21,740.48 to the complainant's by credit to bank account. Due to concealment of the vital information from the opposite parties, the claim of the complainant was declined rightly.

10. In further reply, the opposite parties reiterated their version as pleaded in legal objections and detailed above. After controverting all other averments of the complainant, the opposite parties prayed for dismissal of complaint.

11. In support of his complaint, the complainant has tendered into evidence Affidavit of Soma Rani dated 27.8.2019 (Ex. C-8) and documents (Ex.C-1 to Ex.C-7).

12. In order to rebut the evidence of complainant, the opposite parties tendered into evidence affidavit dated 08.10.2019 of Gurpreet Singh (Ex. OP-1/6) and documents (Ex. OP-1/1 to Ex.OP-1/5).

13. The learned counsel for the parties reiterated their stand as taken in their respective pleadings.

14. We have heard learned counsel for the parties and gone through the record.

15. In the case in hand, the opposite parties repudiated the claim of the complainant vide letter dated 24-6-2019 (Ex. OP-1/5). The relevant portion of this letter reads as under :-

    “However, from investigations, it was established that the Life Assured was suffering from Diabetes Mellitus prior to the policy Insurance. This was not disclosed in the application dated 1-2-2018. Had this information been provided to the Company at the time of applying for the insurance policy, we would have declined this application.”

16. In the case of Virpal Nagar Vs. HDFC Standard life Insurance Co. Ltd., II (2019) CPJ 59 (Del.), Hon'ble Delhi State Commission after noticing the observations of Hon'ble National Commission and Hon'ble Supreme Court in various judgements, concluded that :-

    “Unless and until a person is hospitalised or undergoes operation for a particular disease in near proximity of obtaining insurance policy or any disease for which he has never been hospitalised or undergone operation is not a pre-existing disease.”

    It was also observed :-

    “Malaise of hypertension, diabetes, occasional pain, cold, headache, arthritis and the like in the body are normal wear and tear of modern day life which is full of tension at the place of work, in or out of the house and are controllable on day-to-day basis by standard medication and cannot be used as concealment of pre-existing disease for repudiation of the insurance claim unless an insured in the near proximity of taking of the policy is hospitalised or operated upon for treatment of these disease or any other disease.”

17. In this case admittedly, Rangla Mall Singh, hunsband of complainant was availing insurance policy from 1-2-2018 (Ex. OP-1/3). As per Investigation Report Ex. OP-1/7 Life Assured died due to heart attack. There is nothing on record to prove that in near proximity of obtaining insurance policy i.e. year 2018, he was hospitalised or took any treatment. In Investigation report of Inside Trace Services Pvt. Ltd., (Ex. OP-1/7), the investigator after thorough investigation has specificially mentioned that “LA was not suffering from any kind of illness.” and “Report Status – Postitive”. In remarks column it is also mentioned that it emerged that LA demised on 05-09-2018 suddenly due to heart attack at his residence and it further mention that it was revealed that LA was not suffering from any kind of illness.

18. Therefore, keeping in view the above observation also, the conclusion is that the repudiation on the ground of pre-existing disease of Diabetes Mellitus is not sustainable and repudiation of claim amounts to deficiency in service on the part of the opposite parties. As such, the complainant is entitled to Death Benefit - Sum Assured as per Insurance policy (Ex. OP-1/3) alongwith interest from the date of repudiation. Complainant is also entitled to compensation for harassment and mental agony caused to her on account of non-payment of claim.

19. In the result, this complaint is partly allowed with Rs.10,000/- as cost and compensation. The opposite party is directed to pay Death Benefit - Sum Assured to the tune of Rs. 1,75,000/- of Mr. Rangal Mall Singh, after deducted the amount already paid to complainant, with interest @ 8% p.a. w.e.f the date of repudiation i.e. 24-06-2019 till payment.

20. The compliance of this order be made by the opposite parties jointly and severally within 45 days from the date of receipt of copy of this order.

21. The complaint could not be decided within the statutory period due to heavy pendency of cases.

22. Copy of order be sent to the parties concerned free of cost and file be consigned to the record room.

    Announced :

    23-08-2022

    (Kanwar Sandeep Singh)

    President

     

     

    (Paramjeet Kaur)

    Member