Haryana

Fatehabad

CC/503/2019

Priyanka Rani - Complainant(s)

Versus

HDFC Standard life Insurance - Opp.Party(s)

N.S Malik

03 Jun 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM; FATEHABAD.

                              Sh. Rajbir Singh, President.                                                 

Dr.K.S.Nirania & Smt.Harisha Mehta, Members

 

                                                          Complaint case No.503 of 2019.                                                      

Date of Instt.: 26.12.2019.                                                                 Date of Decision: 03.06.2024.

 

Smt.Priyanka Rani wife of Surender son of Ram Kumar resident of H.No.635 village Indachhui, Tehsil Tohana District Fatehabad.

                                                                             ..Complainant.                                   Versus

1.HDFC Standard Life Insurance Company Limited, Central Plaza Sector-53, Golf Dr.Parsvnath Exotica, DLF Phase-5, Sector-33, Gurugram, Haryana 122001 through its Manager.

2.HDFC Bank Limited, Branch Bhuna District Fatehabad through its Branch Manager/Authorized signatory.

                                                                   ..Opposite Parties.

 

          Complaint U/S 12 of the CP Act,1986              

Present:                  Sh. N.S.Malik, Advocate for complainant.                                                   Sh. Yogesh Gupta, Advocate for Op No.1.                                        Sh. Amit Wadhera, Advocate for Op No.2.

ORDER

Sh.Rajbir Singh, President

                              Briefly stated the facts of the present complaint are that Surender (husband of the complainant) got his life insured with Ops for a sum of Rs.7,50,000/- and regarding this an amount of Rs.75,000/- was paid as annual premium; that policy No.20755970 dated 10.01.2018 for a duration of one year one month was issued  to the insured after getting his medico legal examination done; that unfortunately, the life insured (Surender) died on 28.10.2018 and regarding this the complainant, being nominee, intimated the Ops besides submitting all the relevant documents with the Ops for releasing the claim amount but the Ops lingered on the matter and in the end refused to make the payment of the insurance sum. The act and conduct of the Ops clearly amounts to deficiency in service on their part. In evidence, the complainant has tendered Ex.CW1/A with documents Annexure C1 to Annexure C3.

2.                On notice, OPs appeared and resisted the claim of the complainant by filing their separate replies. Op No.1 in its reply has submitted that the cardinal principle of contract of insurance is uberrama fides and the insured had to furnish  all the material facts pertaining to his health and other history; that the husband of the complainant had applied for life insurance policy  by submitting an online proposal form and after considering the declarations as made in the proposal form true, insurance policy for a sum of Rs.7,50,000/- with date of commencement on 25.09.2018; that the demise of life assured has allegedly taken place on 20.10.2018  but on the date of applying for the policy in question, DLA had already died on 16.09.2018  and the entry regarding his death was mentioned in Anganwari register but the said policy was obtained by playing fraud upon the replying Op, therefore, the claim was rightly repudiated vide letter dated 15.02.2019. Other contentions have been controverted and prayer for dismissal of the complaint has been made.

3.                          Op No.2 in its reply has taken preliminary objections such as cause of action, jurisdiction, barred by limitation, cause of action and concealment of material facts from this Commission etc. It has been further submitted that as per Section 230 of Indian Contract Act, the agent cannot be sued  and cannot be personally enforce contracts entered into by him on behalf of his principal and he cannot be personally bound.  It has been further submitted that the contract of insurance is between Op No.1 and complainant. The role of OP No.2 is only limited to that of a facilitator/referral agent and the actual insurance is issued by the Op No.1 and the replying Op does not deal in the business of insurance. The term and conditions, issuance and repudiation of any claim if any has totally been made by the Op No.1, therefore, the Op  No.1 only is liable for any kind of dispute between the complainant and Op No.1 being insurer. By denying the all other pleas, prayer for dismissal of the complaint has been made. In evidence, the Op No.1 has tendered affidavit Ex.RW1/A with documents Annexure R1/1 to Annexure R1/5. No evidence on behalf of Op No.2 has been led.

4.                          We have heard learned counsels for the parties and perused the case file minutely.

5.                          Undisputedly, husband of the complainant (Surender) got his life insured with the Op No.1 through Op No.2 and the policy period was from 25.09.2018 to 25.09.2028  (Annexure  R1/2) after making a premium amount of Rs.75,000/- for a sum of Rs.7,50,000/-.  Perusal of Annexure C2 death certificate of DLA reveals that he died on 28.10.2018 and regarding this certificate was also issued by the Gram Panchayat Indachoi.  The complainant has come with the plea that the DLA died during the subsistence of the policy, therefore, it was the legal duty of the Ops to make the payment of sum insured to the complainant as huge premium of Rs.75,000/- was received by them.

6.                          On the other hand, the Op No.1/insurance company has come with the plea that at the time of obtaining the policy the DLA was not alive and he had already died on 16.09.2018 and in support of this plea learned counsel for the Op No.1 drew the attention of this Commission towards Annexure R1/3 i.e. copy of register maintained by the Anganwari worker during the regular course.  He stressed hard on the point that the DLA was expired due to snake biting and he had not died naturally, therefore, the claim was rightly repudiated vide letter Annexure R1/4.

7.                          The ground taken by the insurance company in repudiating the claim of the complainant does not appear to be plausible because in the death certificate issued by the Registrar, Death and Birth (Annexure C2) the date of death has been mentioned as 28.10.2018 and this document is persi-admissible document until and unless contrary to it has been produced. The Op No.1/insurance company is stressing hard on the point that the DLA was not alive at the time of obtaining the policy, therefore, the burden was on the insurance company to prove this fact because the complainant had already produced the best evidence qua the death of DLA in the shape of death certificate (Annexure C2) on the case file. The copy of register (Annexure R1/3) on the Op No.1/insurance company is heavily relied upon does not appear to be material document because it does not contain any signature of the authority who had issued the same and even it also does not bear any stamp of any department/Anganwari branch. Moreover, the Sarpanch of village Inda Choi in his certificate Annexure C3 has also mentioned that Surender Kumar had died on 28.10.2018 due to heart attack. It is worthwhile to mention here that the insurance company is not supposed to get only premium but it also liable to act fairly without taking the benefits of the weaknesses of the assured and it is also liable to indemnify all the responsibilities for which the premium has been received, therefore, we are of the considered opinion that the present complaint deserve acceptance as the premium is still lying with the Ops.

8.                          Keeping in view the above facts and circumstances, the present complaint is allowed against OPs with a direction to pay Rs.7,50,000/- (insured sum) to the complainant alongwith interest @ 7 % per annum from the date of filing of complaint till realization. We further direct the OPs to pay Rs.11,000/- in lump sum for mental agony, harassment and litigation expenses to the complainant. Compliance of this order be made within 45 days failing which the awarded amount would carry 9 % interest from the date of filing of the complaint till its realization. The liability of the Ops will be joint and several.

9.                          In default of compliance of this order, proceedings against respondents shall be initiated under Section 72 of Consumer Protection Act, 2019 as non-compliance of court order shall be punishable with imprisonment for a term which shall not be less than one month, but which may extend to three years, or with fine, which shall not be less than twenty five thousand rupees, but which may extend to one lakh rupees, or with both. A copy of this order be sent to the parties free of cost. File be consigned to the record room after due compliance.     

Announced in open Commission.                                                            Dated: 03.06.2024

 

 

                                                                                                        

                             (K.S.Nirania)        (Harisha Mehta)       (Rajbir Singh)                                           Member                  Member                    President