District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No.168/2020.
Date of Institution: 18.06.2020
Date of Order: 26.02.2024.
Ritik Choudhary S/o late Shri Virender Singh Choudhary, 369/2, Choudhary Farms, Subedar Colony, Ballabgarh, Faridabad – 121004 (Haryana).
…….Complainant……..
Versus
HDFC Standard Life Insurance Company Limited, 11th Floor, Lodha Excelus, Apollo Mills Compound, N.M.Joshi Marg, Mahalaxmi Mumbai – 400 011.
Through Branch Manager at:
HDFC Standard Life Insurance Company Limited, Ist Floor B.K.Chowk, Block 5R, 1A, New Industrial Town, Faridabad, Haryana – 121001.
…Opposite party……
Complaint under section-12 of Consumer Protection Act, 1986
Now amended Section 34 of Consumer protection Act 2019.
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
Indira Bhadana………….Member.
PRESENT: Sh. R.N.Kansal, counsel for the complainant.
Sh. Sagar Bhatia, counsel for opposite party.
ORDER:
The facts in brief of the complaint are that the complainant was a resident of the above stated address and was the son of late Shri Virender Singh Choudhary who had expired on 10.08.2016 at Apollo Hospital, New Delhi. The complainant was the legal heir of late Shri Virender Singh Choudhary to all his estate and was covered as a consumer of opposite parties, his late father having purchased an Life Insurance Policy from the opposite parties. Late Shri Virender Singh Choudhary had purchased a life insurance policy of the opposite party code name “HDFC Life Progrowth Plus” vide policy NO. 17669351 on 05.06.2015, having an annual premium of Rs.50,000/- with maturity as 05.06.2030. The said policy, besides providing the market linked NAV based fund value at the time of payment , also provided a life coverage of Rs.5,00,000/- payable to the LRs in case of pre-mature death of the insured. Late Shri Virender Singh Choudhary, on 01.08.2016, suddenly felt uneasiness and Ghabrahat in the late evening at about 10.30P.M. and he was immediately brought to the Asian Hospital, Faridabad by the complainant, where the late Shri Virender Singh walked to the emergency for examination. He was admitted at about 11.50p.m. and various examinations were conducted besides providing medications. However, by late evening on 2.08.2016, his condition worsened and he was, after discharge from Asian Hospital at about 11.30 P.M brought to Apollo Hospital, New Delhi immediately in the wee hours of 02.08.2016/03.08.2016 and admitted there. Unfortunately, the late Shri Virender Singh Choudhary expired at about 8.15AM on 10.08.2016. The complainant lodged the death claim with the opposite prty. The opposite party released the sum of Rs.1,05,792.29 towards the NAV Fund Value as on that date but declined to release the insurance amount of Rs.5,00,000/- on the ground that “Life Assured was suffering from Hypertension & known case of Dyslipidemia prior to the policy insurance which was not declared by the Life Assured”. The rejection of the claim was objected to by the complainant and the matter was referred to the ”Claims Review Committee” of the opposite party by the opposite party. The matter remained under review of the said committee. Lot of mails were exchanged between the parties and papers were also produced before the Committee by the complainant as demanded form time to time. On 01.06.2018, the opposite party once again rejected the claim after the review by the said Claims Review Committee. No ground whatsoever was mentioned by the Committee for rejecting the claim. Mere statement that “No Merit” found to revise the decision was not sufficient and highly arbitrary. The committee failed to apply its mind to arrive at a judicious decision and hence, the same was not binding on the complainant. The complainant had a right to receive Rs.5,00,000/-, the sum assured under the policy from the opposite party alongwith interest. The complainant had been visiting the office of the opposite party and meeting the officials time and again so that they review the decision dated 01.06.2018 by taking up the matter at further higher levels. The aforesaid act of opposite parties amounts to deficiency of service and hence the complaint. The complainant has prayed for directions to the opposite parties to:
a) settle the claim of the complainant under the policy as above and be directed to release payment of claim amount of Rs.5,00,000/- to the complainant alongwith interest @ 18% p.a. from the due date to the date of actual payment by the opposite parties.
b) pay Rs. 1,00,000/- as compensation for causing mental agony and harassment .
c) any other relief which this Hon’ble Court deems fit and proper may also be awarded to the complainant with cists of the complaint.
2. Opposite parties put in appearance through counsel and filed written statement wherein Opposite parties refuted claim of the complainant and submitted that the complaint was not maintainable in as much as the same was barred by limitation period specified in Section 24A of Consumer Protection Act,1986. It was submitted that Shri Virender Singh Choudhary (hereinafter referred to as “Deceased Life Assured”) had applied to the opposite party for an Unit Liked Insurance Plan “HDFC Life ProGrowth Plus” vide Electronic Proposal Form No. 1100000135109 on 05.06.2015 for total sum assured of Rs.5,00,000/- on his own life by paying Annual Premium of Rs.50,000/- under Annual payment mode. The policy terms and Premium Paying Term opted was 15 years. Alongwith the proposal form, the Deceased Life Assured had also submitted copies of authoritative documents in proof of the Insured’s age, income, address and identification in support of the information provided in Proposal Form. Opposite party process the proposal for insurance of the Deceased Life Assured at Standard Rates by taking into consideration the facts disclosed by Deceased Life Assured in the Proposal Form as true and correct. Thereafter, policy N. 17669351 was issued in the name of Deceased Life Assured with risk commencement from 02nd July 2015. The policy Bond alongwith Free Look Period Intimation and copy of Proposal Form was duly delivered to the insured. In Freelook period of 15 days, the insured had opinion to cancel the policy in case of any discrepancies in the terms and conditions of policy including the details in the policy but the DLA did not raise any concern regarding the policy features and its terms and conditions within the said period of 15 days of receipt of policy documents. The complainant informed the opposite party about the sad demise of Deceased Life Assured on 10.08.2016 and death claim was lodged under the aforesaid insurance policy. In furtherance of the claim and in compliance of statutory provisions, an investigation was conducted for the disposal of the claim lodged but during course of investigation it was revealed that the Deceased Life Assured had obtained the said policy by misrepresenting and concealing his previous medical history. From investigations, it was established that the Life Assured was suffering from Hypertension & Known case of Dyslipidemia prior to the policy issuance, which was not disclosed in the Application-cum-Proposal Forum date 05.06.2015. The opposite party had issued the aforesaid insurance policy to the Deceased Life Assured on the basis of facts disclosed by DLA in the said proposal, thereby the contract stands vitiated at the opposite party’s end on the grounds of Fraudulent Suppression Of Material Information , as the policy in question was obtained by playing fraud by DLA concealing the true, material and actual facts of his previous medical history and health and thus, the opposite party could not get a reasonable opportunity to assess the risk insuring the DLA. Since policy in question was obtained by concealing & misrepresenting the material facts with regard to medical history, the opposite party, in the light of aforementioned medical history of DLA and facts and circumstances, rightfully repudiated the claim of complainant vide letter dated 04.11.2016 which was just and reasonable as per the insurance laws as well as the terms and conditions of the said policy. However, as per terms & conditions of the policy governing Benefits under the policy in case of death, the opposite party released an amount of Rs.1,05,792.29 i.e. Fund Value of the policy on the date of death of LA, to the nominee of the LA i.e the complainant. On the request of the complainant dated 16.02.2018, the opposite party company referred the case to the Claims Review Committee to reconsider the decision. After consideration, the Claims Review Committee found no merit to reverse the decision of the claim and as such, the claim repudiation decision on the grounds mentioned in letter dated 04.11.2016 remained the same. The decision of the Claims Review Committee was conveyed to the complainant vide letter dated 01.06.2018. In such prevailing facts and circumstances of the case, it was stated the opposite party acted in terms of the Insurance Contact and had not committed any wrong against the Life Assured and it was Deceased Life Assured who acted against the principle of uberrima fides and did not disclose the facts correctly and truthfully at proposal stage and by this reason the complainant was stopped from raising any concerns which were result of suppression of material facts by Deceased Life Assured. Opposite parties denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
3. The parties led evidence in support of their respective versions.
4. We have heard learned counsel for the parties and have gone through the record on the file.
5. In this case the complaint was filed by the complainant against opposite party – HDFC Life Insurance Company Limited with the prayer to: a) settle the claim of the complainant under the policy as above and be directed to release payment of claim amount of Rs.5,00,000/- to the complainant alongwith interest @ 18% p.a. from the due date to the date of actual payment by the opposite parties. b) pay Rs. 1,00,000/- as compensation for causing mental agony and harassment . c) Any other relief which this Hon’ble Court deems fit and proper may also be awarded to the complainant with cists of the complaint.
To establish his case, the complainant has led in his evidence Ex.C-1 – Proposal Form, Ex.C-2 – policy dated 05.06.2015, Ex.C-3 – Discharge Summary (LAMA), Ex.C-4 – Progress Sheet, Ex.C-5 – Progress Sheet, Ex.C-6 – Death Summary, Ex.C-7 – Death Claim for Policy, Ex.C-8 – email dated 2.11.2017, Ex.C-9 – letter dated June 01,2018.
On the other hand counsel for the opposite party strongly agitated and opposed. As per the evidence of the opposite party, Ex.RW-1/A – affidavit of Kunal Aurora, Deputy Manager-Legal, HDFC Standard Life Insurance Co. Ltd., Ex.R-1 – Proposal Form, Ex.R-2 – Policy Bond, Ex.R-3 – Discharge Summary (LAMA), Ex.R-4 – letter, Ex.R-5 - note written by the complainant to HDFC, Ex.R-6 – letter dated June 01,2018 regarding Death Claim Reconsideration.
6. As per Death Summary vide Ex.C6 in which it has been mentioned in Diagnosis column “Subarachnoid Haemorrhage and right artery aneurysm with severe Vasospasm with brainstam Ischemia with sudden cardiac arrest. It is evident form Death Claim for policy vide Ex.C7 it has been mentioned “However from investigations it was established that the Life Assured was suffering form Hypertension & known case of Dyslipidemia prior to the policy issuance, which was not disclosed in the application dated June 05, 2015. Had this information been provided to the Company at the time of applying for the insurance policy, we would have declined the application.
7. In this case, limitation period to two years for filing the complaint under Consumer Protection Act,1986, started from the date of receipt of Claim Repudiation Letter dated 04.11.2016.
Limitation period from 05.11.2016 to 16.02.2018 :15-1/2 months.
Claim Review Filed on: 16.02.2018
Decision of Review Intimation on: 01.06.2018
Complaint filed on 18.06.2020
Period from 02.06.2018 to 18.06.2020 : 2 years 16 Days
Time Period from date of Repudiation till filing of complaint = 3 years 7 months 12 days.
Time period from date of repudiation till filing of complaint (leaving period of Claim Review Pendency):15-1/2 Months + 2 Years 16 days = 3 Years 4 Months.
Counsel for the complainant has placed on reliance authority in case titled Experion Developers Private Limited Vs. Himanshu Dewan And Sonali Dewan passed by the Hon’ble Supreme Court of India 2023(3) Law Herald (SC) 2036 decided on 18.08.2023.
Counsel for the complainant has also placed on record the Insurance Act, 1938 The Redressal of Public Grievances Rules, 1998 Section 13 (3) (b) in which it has been mentioned that “The complaint is made not later than one year after the insurer had rejected the representation or sent his final reply on the representation of the complainant; and
Ratio of these authorities are not applicable to the facts of the present case.
8. Keeping in view of the above, the complaint is dismissed being time barred. Copy of this order be given to the parties free of costs and file be consigned to the record room.
Announced on: 26.02.2024. (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharma)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
(Indira Bhadana)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
