| Final Order / Judgement | DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BATHINDA C.C. No. 345 of 21-12-2018 Decided on : 1-12-2021 Manjit Kaur aged about 45 years Wd/o Sh. Parminder Singh Sidhu, R/o Near School, VPO Neor, District Bathinda. ........Complainant Versus HDFC Standard Life Insurance Company Ltd., Branch Office at Guru Kanshi Marg, Opposite Bank of Baroda, G.T. Road, Bathinda, through its Branch Manager/Authorized Signatory HDFC Standard Life Insurance Company Ltd., Regd. Office : 18th Floor, Lodha Excelus, Apolo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai 400 011 through its Managing Director
.......Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986 QUORUM Kanwar Sandeep Singh, President Sh. Shivdev Singh, Member. Smt. Paramjeet Kaur, Member Present For the complainant : Sh. Sanjay Goyal, Advocate For opposite parties : Sh. Vinod Garg, Advocate. ORDER Kanwar Sandeep Singh, President The complainant Manjeet Kaur (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 Standard Life Insurance Company Ltd., and another (here-in-after referred to as opposite parties). Briefly stated, the case of the complainant is that in the month of May, 2018 agent/officials of opposite parties approached Parminder Singh Sidhu, husband of the complainant and conveyed features of the insurance policy. Being allured by the agent/officials of opposite parties, husband of the complainant purchased insurance policy bearing No. 20385956 with sum insured of Rs. 2,50,000/-, of the opposite parties. The complainant was appointed as Nominee in the said policy. At the time of selling of above said insurance policy, agent/official of opposite parties took signatures of husband of the complainant on blank printed forms and filled in the proposal form on their own and term of the insurance policy was conveyed as 10 years. The said policy commenced w.e.f. 17-05-2018. It is alleged that unfortunately, Parminder Singh husband of the complainant died on 14-07-2018. Parminder Singh was hale and hearty and was not suffering from any ailment and he died on 14-07-2018 suddenly without any prior ailment. After the death of Parminder Singh death claim of Rs. 2,50,000/- was lodged with opposite parties by the complainant and all the formalities as required by the opposite parties such as Bank account detail, death certificate of Parminder Singh and other documents were duly submitted with opposite parties by the complainant. The opposite parties assured the complainant that claim of Rs. 2,50,000/- on account of death of her husband Parminder Singh will be paid shortly. It is further alleged that vide their letter dated 04-10-2018, the opposite parties repudiated the claim of the complainant on flimsy grounds that life assured Parminder Singh had a history of Alcohol consumption and seizure disorder prior to the issuance of insurance policy and refunded the premium amount of Rs. 23540.97 through NEFT in the account of complainant. The repudiation made by the opposite parties is illegal, null and void and against the facts. It is further pleaded that Parminder Singh husband of the complainant never consumed Alcohol nor he was suffering from any seizure disorder, as falsely alleged, rather he died suddenly due to severe heart attack and no such disease was in the knowledge of life assured at the time of taking policy neither he was suffering from any ailment nor he ever got treatment from any hospital prior to his death. The repudiation of genuine claim of the compliment by the opposite parties is illegal,without any reasoning and against the facts and is on flimsy grounds and as such the same is not binding upon the rights of the complainant. The complainant several times approached the opposite parties and requested them to settle her lawful claim and make payment of the same, but to no effect. Due to this act of the opposite parties, the complainant has suffered mental tension, agony, botheration etc., for which he claims compensation to the tune of Rs. 1,50,000/-. On this backdrop of facts, the complainant has prayed for directions to the opposite parties to settle and pay claim amount of Rs. 2,50,000/- with interest @12% p.a. to complainant and also pay him compensation to the tune of Rs. 1,50,000/- in addition to Rs. 22,000/- as litigation expenses. Upon notice the opposite parties put in appearance through counsel and contested the complaint by filing written reply. In written reply, the opposite parties raised legal objections that intricate questions of law and facts are involved in the complaint which requires voluminous documents and evidence for determination which is not possible in summary procedure under the 'Act'; 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. The complainant has concealed that the opposite parties issued policy on the basis of proposal dated May, 15,2018 for purchase of HDFC SL Pro Growth Super II for a sum assured of INR 2,50,000/-. The proposal form was accepted on the basis of information provided in the proposal form with the policy being issued on 17-05-2018. The opposite parties thoroughly investigated the claim of the complainant through Centre Point Services, Investigators and it was established from the investigation that the life assured/deceased had a history of alcohol consumption and seizure disorder prior to the policy issuance. This was not disclosed in the application dated 16-05-2018. As such, the claim of the complainant has been repudiated vide letter dated 04-10-2018 . However, the opposite party refunded a sum of Rs.23,540.97 against the premium to the complainant through her account maintained with Sutlej Gramin Bank as provided by the complainant. Further legal objections are that the complaint is not maintainable ; that the complainant has no locus standi or cause of action to file the present complaint against opposite parties and that the complaint is bad for non-joinder of necessary parties as the complainant has not joined all the legal heirs of deceased. On merits, the opposite parties have pleaded that insurance policy in question is subject to terms and conditions thereof. The deceased himself purchased the policy by submitting electronic proposal form and benefit of illustrations and customer consent form at his own without disclosing the true facts about his death. The opposite parties denied that Parminder Singh was hale and hearty or was not suffering from any ailment or died suddenly. It has been pleaded that Parminder Singh insured was having history of alcohol consumption and seizure disorder prior to the policy issuance which is so clearly mentioned in medical records of DMC. It is denied that opposite parties assured the complainant that the claim of Rs. 2,50,000/- on account of death of her husband will be paid shortly as alleged. It is pleaded that repudiation of claim vide letter dated 04-10-2018 and refund of Rs. 23,540.97 to the complainant through NEFT is matter of record. After controverting all other averments, the opposite parties have prayed for dismissal of complaint. In support of his claim, the complainant, has tendered into evidence affidavit of Manjit Kaur dated 19-12-2018 ( Ex.C-1), photo copy of death certificate ( Ex.C-2), photocopy of repudiation letter ( Ex.C-3), photocopy of medical certificate (Ex.C-4), photocopy of first premium receipt ( Ex.C-5), and closed the evidence. In order to rebut the evidence led by the complainant, the opposite parties tendered into evidence photocopy of proposal form containing pages 1 to 4 ( Ex.OP1/1), photocopy of illustration containing pages 1 to3 (Ex.OP1/2 ), photocopy of investigation report containing pages 1 to 11( Ex.OP1/3), affidavit of Gurpreet Singh Deputy Manager dated 12-02-2019 (Ex.OP1/4), photocopy of letter (Ex.OP1/5), photocopy of repudiation letter containing pages 1 to 3(Ex.OP1/6), photocopy of policy containing 26 pages (Ex.OP1/7), affidavit of investigator dated 11-03-2019 (Ex.OP1/8) and closed evidence. We have heard learned counsel for the parties and gone through the record. These are undisputed facts between the parties that Parminder Singh, husband of the complainant purchased insurance policy bearing No. 20385956 with sum insured of Rs. 2,50,000/- (Ex. OP-1/7) of the opposite parties. The complainant was appointed as Nominee in the said policy. Parminder Singh, died, all of sudden on 14-7-2018. The complainant filed claim with the opposite parties claiming sum assured of her husband but the opposite parties vide their letter dated 04-10-2018 (Ex. C-3), repudiated the claim of the complainant. Ex. C-3/Ex. OP-1/6 is the repudiation letter. A perusal of this letter reveals that opposite parties repudiated the claim of the complainant on the ground that from investigation it was established that Life Assured had a history of alcohol consumption and seizure disorder prior to the policy issuance. This was not disclosed in the application dated March 27, 2017. The opposite parties have further mentioned in this letter that - Had this information been provided to the Company at the time of applying for the insurance policy, they would have declined the application. In written reply, the opposite parties have pleaded that they thoroughly investigated the claim of the complainant through Centre Point Services, Investigators and it was established from the investigation that the life assured/deceased had a history of alcohol consumption and seizure disorder prior to the policy issuance and this was not disclosed in the application dated 16-05-2018 due to which claim of the complainant has been repudiated vide letter dated 04-10-2018. The opposite parties have placed on file Investigation Report (Ex. OP-1/3) of Centre Point Services. In this report, In Life Assured's Profile, it is mentioned that :- “LA was a son of current Sarpanch Mr. Harbans Singh and he used to indulge in agricultural work. He was reportedly an alcoholic and due to excess consumption of alcohol he allegedly suffered with liver disease which is assumed to be a prime cause of death.”
Under the heading 'Summary of the details shared by the neighbours – it is mentioned that Investigator met neighbour who in their written statement revealed that life assured was absolutely healthy person prior to his death and did not have any health issue. They confirmed that life assured had died on 14-7-2018 at residence. Investigator also mentioned in his report that Asha & ANM workers also revealed that life assured was absolutely healthy person prior to his death and died of heart attack on 14-7-2018. He has also specifically mentioned that he investigated this case from all angles and could not find any solid evidence against this case inspite of best efforts. Ofcourse, the said investigator revealed in his report that he met couple of guys who (did not wish to be named) reveals that life assured was on alcoholic and due to excess consumption of alcohol, he suffered with liver disease and was being treated from DMC & Hospital, Ludhiana. The name and identity of persons who have given this statement was not revealed by Investigator whereas the person who have disclosed that life assured was hale & hearty at the time of accident and died due to heart attack have given such statement in writing and revealed their identity and investigator has mentioned in his report that those statements were attached with his report. The plea of the opposite parties and as opined by Investigator that life assured remained admitted in DMC & Hospital, Ludhiana, also does not support their version because liver disease, if any, cannot be cured in just one day admission in hospital. Moreover, prescription slip attached with Investigator Report does not reveal that Parminder Singh mentioned in that slip and life assured is the same person. No any other evidence produced by the opposite parties on file to prove that deceased husband of complainant was ever admitted in any hospital or took treatment for liver problem etc., As mentioned above, the investigator has also given opinion that liver disease is ASSUMED to be a prime cause of death. This Commission is of the view that mere assumptions cannot take shape of proof unless and until supported by cogent and convincing evidence. In the case SBI General Insurance Co. Ltd., Vs. Balwinder Singh Jolly & Anr., 2016(4) CLT 372, Hon'ble Chandigarh State Commission, U.T. Chandigarh has held that : Pre-existing disease – Age of insured when mediclaim insurance policy was issued was more than 45 years – Held – In that event, as per instructions issued by Insurance Regulatory & Development Authority of India (IRDA), it was duty of the insurer to put insured to thorough medical examination – Claim raised after issuance of insurance policy cannot be rejected on account of non-disclosure of the fact of pre-existing disease when policy was obtained.” Therefore, there is no evidence on file to prove that life assured Parminder Singh was alcoholic and he died due to liver disease. Thus, repudiation of claim of the complainant on this flimsy ground amounts to deficiency in service on their part. In view of what has been discussed above, this complaint is partly accepted with Rs. 10,000/- as cost and compensation against the opposite parties. The opposite parties are directed to pay to complainant Rs. 2,26,460/- being Sum Assured of her deceased husband Parminder Singh (Rs. 2,50,000/- minus Rs. 23,540/- premium refunded to complainant ) with interest @9% p.a. w.e.f. 4-10-2018 i.e. date of repudiation of claim, till payment. 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. The complaint could not be decided within the statutory period due to heavy pendency of cases. Copy of order be sent to the parties concerned free of cost and file be consigned to the record. Announced : 01-12-2021 (Kanwar Sandeep Singh) President (Shivdev Singh) Member (Paramjeet Kaur) Member
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