Karnataka

Bangalore Urban

CC/152/2023

Mrs. Padma - Complainant(s)

Versus

IDBI Bank Ltd - Opp.Party(s)

K.A Patil

30 May 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,
8TH FLOOR, B.W.S.S.B BUILDING, K.G.ROAD,BANGALORE-09
 
Complaint Case No. CC/152/2023
( Date of Filing : 26 Apr 2023 )
 
1. Mrs. Padma
W/o Late Rajegowda, Aged 47 Years, Occ Home Maker, R/o No.52, M S B Lane, Mysore Road,CAR(HQ) Police quarters, Chamarajpet, Bengaluru-560018
...........Complainant(s)
Versus
1. IDBI Bank Ltd
Between 8th & No.12 Siddhi Plaza, Margosa Road,9th Cross Road,Malleshwaram,Bengaluru-560003. By its Authorised Person
2. IDBI Federal Life Insurance Company
22nd Floor,A Wing, Marathon Futurex, N M Joshi Marg, Lower Parel East.Mubai-400013,Maharastra,BY its Authorised Person
............Opp.Party(s)
 
BEFORE: 
 HON'BLE MRS. M. SHOBHA PRESIDENT
 HON'BLE MRS. K Anita Shivakumar MEMBER
 HON'BLE MRS. SUMA ANIL KUMAR MEMBER
 
PRESENT:
 
Dated : 30 May 2024
Final Order / Judgement

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION AT BANGALORE (URBAN)

DATED 30th DAY OF MAY 2024

PRESENT:- 

SMT.M.SHOBHA

                                             BSC., LLB

 

:

 

PRESIDENT

      SMT.K.ANITA SHIVAKUMAR

M.S.W, LL.B., PGDCLP

:

MEMBER

                     

SMT.SUMA ANIL KUMAR

BA., LL.B., IWIL-IIMB

:

MEMBER

   

 

COMPLAINT No.152/2023

 

 

 

 

COMPLAINANT

1

Mrs. Padma,

W/o Late Rajegowda,

Aged 47 years, Occ: Home makers,

R/at: No.52, MSB Lane, Mysore Road, CAR (HQ) Police Quarters, Chamrajpet, Bengaluru-560009.

Mob: 9066559088

 

 

 

(Sri. K.A. Patil, Adv.)

 

  •  

 

OPPOSITE PARTY

1

IDBI Band Ltd.,

B/w 8th and No.12 Siddhi Plaza, Margosa Road, 9th cross road, Malleshwaram, Bengaluru-560003.

By its Authorized person.

 

 

 

(Sri. I.M. Devaiah, Adv.)

 

 

2

IDBI Federal Life Insurance Company,

22nd floor, A Wing Marathon Futurex,

N M Joshi Marg, Lower Parel-East, Mumbai-400013. Maharashtra

Rep. by its Authorized person

 

 

 

(Sri. I. Gopalakrishna, Adv.)

     

 

 

ORDER

SMT. K. ANITA SHIVAKUMAR, MEMBER

Complaint filed by the complainant U/S 35 of Consumer Protection Act 2019, complainant sought relief from OP’s to pay Rs.27,15,837/- with interest at the rate of 18% p.a. from the date of death of life assured till its realization, to pay Rs.5,00,000/- for mental agony and harassment, Rs.50,000/- towards cost of litigation and such other reliefs.

2. Brief facts of this case are as follows:-

Complainant’s husband namely Sri Rajegowda served as Arm Head Constable (AHC) since 1996, served as a gun man to the Hon’ble Justice of High Court of Karnataka, to President of ISRO and worked in Reserved Bank of India, Bangalore, Commissioner of Police, Bangalore and at the office of Hon’ble Governor of Karnataka. Complainant stated that late Sri Rajegowdaeven got the certification of appreciation for excellent service rendered as a front line warrior and exhibiting exemplary courage and dedication in keeping Bangalore city safe during the Covid-19 pandemic from the Commissioner of Police, Bangalore city.

3. Complainant stated that in the year 2020, her husband intend to construct the house and borrowed the loan from OP No.1 bank. At the time of obtaining the loan, OP No.1 compelled the complainant and her husband to go for Group Loan Secured Plan Insurance with OP No.2. For availing loan, complainants husband has to compulsorily subscribe for the insurance to avail the loan at the behest of OP NO.1 banker. Complainant’s husband complied the formalities for the insurance. Later, complainants husband was given the master policy bearing No.2000000259, certificate No.4001413730 for which singly premium of Rs.95,051/- was paid. The risk under the insurance covered was Rs.27,15,837/-. The complainant being the wife of the life assured/deceased is the nominee under the policy. During the tenure of the policy, i.e. on 12.10.2021, the policy holder Rajegowda was admitted in HCG hospital and was daigonized with Metastatic Carcinoma Stomach Cancer, unfortunately he breathed his last on 10.11.2021 at the age of 54 years.

4. After the death of policy holder, complainant being nominee approached OP No.2 with the claim and fairly submitted all the required documents along with medical documents, seeking settlement of her insurance claim. After receiving the required information, OP No.2 has illegaly repudiated the claim of the complainant in the letter dated 31.01.2022, on the false ground that the policy while applying for enrollment under Group Loan Secure Plan, had signed “declaration of good health” which is mentioned that he was of sound health and was not suffering and had never suffered from any critical illness or any condition requiring medical treatment for illness. As on the date of enrollment, in the repudiation letter it has been further mentioned that medical records of the Sagar Hospital confirmed that life assured was admitted on 11.01.2020 and was diagnosed with Peptic stricture at esophagogastric junction and also noted that a past history of liver abscess in April 2019 for which life assured was admitted and treated. The medical records also revealed that the life assured underwent controlled radial expansion balloon dilatation. The treatment for the above reasons was prior to the date of enrollment of the policy. The letter further stated that, “as the deceased/life assured had given a false declaration of good health and had not disclosed material facts at the time of entry into this scheme. Therefore the claim has been repudiated”.

5. Complainant alleged in her complaint that while repudiating the claim, OP No.2 has not at all perused the records and without application of mind, mechanically concluded disowning its liability without any valid grounds. The policy holder was in good state of health at the time of making the proposal, he was healthy and was enjoying the sound health, there was no occasion at all for him to suspect the existence of any ailments. As he did not have any symptoms and neither consulted the doctor nor taken treatment as falsely alleged by the OP No.2. Therefore the insurer has committed a serious lapse in repudiating the claim based on the past proposal problems, which is not only a deficiency in service, but is even unethical conduct on the part of insurer i.e. OP No.2. The alleged Metastatic Carcinoma Stomach Cancer disease if any post insurance problem and not a pre-insurance problem, thus at any stretch of the imagination it cannot be the basis for the repudiation.

6. Complainant further stated that, after the receipt of the repudiation and having been not satisfied with the insurer’s decision, she again requested OP No.2 to reconsider its wrongful repudiation. Op No.2 by its letter reiterated its stand, stating that complainant request was placed before the review committee and it has taken the decision to uphold the repudiation. OP NO.2 stated if the complainant feels that her case deserves further reconsideration she may represent the insurance Ombudsman Karnataka. Accordingly, aggrieved by the repudiation and reconsideration of her claim, she submitted her representation before insurance ombudsman with all the details. The ombudsman without enquiring the matter in detail by its order dated 30.12.2022 has upheld the decision of the insurer, stating that the forum does not wish to interfere with the decision of the insurer.

7. Complainant further stated that OP No.2 being the insurer ought to have acted diligently when analyzing the same and allowed the same, but has acted contrary to the norms and neglected the actual facts. OP No.1 being a banker is also hand in glow with the insurer as it compelled the policy holder to have insurance personal cover compulsorily. For the loan of Rs.27,15,837/-, OP NO.1 has forced complainants husband obtaining the insurance and has paid premium of Rs.95,051/- for insurance coverage with OP No.2. Hence complainant alleged the deficiency of service on the part of OP No.1&2 by repudiating the claim of the complainant, without any proper reason for the loan availed from OP No.1. Hence this complaint by the complainant.

8. OP NO.1& 2 have represented through their counsels, and filed their statement of objections with documents. OP No.1 denies the averments made in the complaint, particularly OP No.1 denied the allegation made by the complainant with regard to the OP No.1 compelled them to go for group loan secure plan Insurance with OP No.2 for availing loan and also denied with regard to after the death of policy holder, complainant being nominee submitted all the required documents along with medical records, seeking settlement of the insurance claim. After the information received by OP No.2, has illegally repudiated the complainants claim. OP No.1 taken contention that it is not a proper party to this complaint when complainants claim is against OP No.2, hence OP NO.1 prays to dismiss the complaint as against it.

9. The written statement if being filed by “Ageas Federal Life Insurance Company Limited” (formerly known as IDBI Federal Life Insurance Company Limited) i.e. with effect from 21.01.2021, the OP NO.2 i.e. “IDBI Federal Life Insurance Company Limited” has changed its company name from IDBI Federal Life Insurance Company Limited to “Ageas Federal Life Insurance Company Limited”. 

10. In the version filed by OP No.2 elaborately taken their contention that on 03.12.2021 OP No.2 received death claim intimation subject group policy informing that Mr. Rajegowda who is deceased life assured (DLA) under subject policy expired on 10.11.2021, as a result of Metastatic Carcinoma Stomach i.e. stomach cancer with progressive disease. The death of DLA occurred within 11 months 25 days approximately from the date of issuance of policy. Hence the claim of the complainant was squarely covered under the definition of early claim. Thus investigation was conducted by insurance company through which it was revealed the material facts suppressed by DLA. That is life assured was diagnosed of Peptic Stricture at Esophagogastric junction and noted past history of liver abscess in April 2019 as well as underwent Controlled Radial Expansion (CRE) Balloon dilatation prior to the issuance of the policy.However, DLA deliberately suppressed the same in his proposal form by giving negative responses in specific questions asked and submitted a false “declaration of good health” which amount to material suppression of facts.

11. Suppression was fraudulently made by policy holder or a deliberate wrong answer which has great bearing on contract of insurance, if discovered may lead to the policy being vitiated in law. Hence in present case, there was no question of deficiency in service rendered by repudiation was duly supported by medical documents. OP 2 stated that contracts of insurance are governed by principle of utmost good faith which requires that all the party to the contract to be fair and honest in the dealing. It is a contractual obligation upon the insured to ensure that all true facts are communicated to the insurer and in case of any suppression, untruth or inaccuracy in the statement in the proposal form, it would be a breach of duty of good faith and will render the policy voidable by the insurer.

12. OP No.2 taken contention that DLA had an opportunity to approach insurance company during the free look period in case there was any dissatisfaction with the terms and conditions of the policy or if there was any discrepancy in his details in the proposal forms. OP No.2 referred judgements of Hon’ble National Commission with respect to the nexus point in various judgements including ICICI Prudential Life Insurance V/s. Yashika alia Meera and others (revision petition No.470/2015), Roshan Lal V/s. Life Insurance Corporation of India (revision petition No. 470/2013) as well as LIC of India and others and Ramamani Patra and another (in revision petition No.1061/2011) that it is not necessary to establish nexus between diseases suppressed and cause of death as a same would violate the principle the utmost good faith. Hence impugned order which has been passed merely on the ground of no nexus between diseases suppressed and the cause of death is liable to be set aside.

13. OP No.2 contended that medical examination while issuing the policy is not mandatory to be conducted. It varies from policy to policy and plan to plan and are decided basis the declarations made by the proposed insured in the proposal form and the underwriting process of the insurer. It also contends that this is a non-medical case wherein no medical adversary was triggered in the proposal form. However even if medical examinations would have conducted on a proposed life assured by the company, it is only to have an additional comfort and does not absolve the proposal/life assured from making the required disclosures. The said principle has been duly laid by Hon’ble Chandigarh State Commission in Ashok Kumar V/s. Appollo Munich Health Insurance Company Limited.

14. Complainant has baselessly denied DLAs medical history and failed to present any document supporting the same that complainant is nearly trying to shift the onus upon insurance company through false and baseless contentions. Insurance Company procured documentary proof with respect to medical history of DLA which was suppressed by him at the time of proposal which is admitted on the part of complainant. Therefore decision of insurance company to repudiate the claim is just proper and reasonable.

15. OP No.2 taken contention that policy was issued under the IDBI Federal Life Insurance Group Loan Secure Plan which is a group life insurance policy linked to loans. The said plan has been floated by the insurance company after approval from IRDAI. In order to offer insurance policy which provides a cover on the outstanding loan amount so that the policy holder do not have to bear the burden of loan in case an unexpected event strikes. Such plans are introduced in best interest of public to protect their families from the burden of loan in case of any sudden unforeseen event. The insurance company right from inception of contract at a proposal stage itself made clear about the consequences of making the wrong statement. In present case death of LA occurred within 11 months 25 days from the date of coverage i.e. 16.11.2020.

16. OP No.2 stated in its version that non disclosure of medical history of DLA amounts to suppression. It is also noteworthy to mention that DLA was an educated and prudent person who could read and affix his signature on the documents. It is clear that, a person who affixes his signature to a proposal form, contains a statement which is not true cannot ordinarily escape from the consequences arising therefrom by pleading that he chose to sign the proposal containing such statement without either reading or understanding it. That is because, in filling up the proposal form the agent normally seizes to act as agent of insurer but becomes the agent of insured and no agent can be assumed to have authority from the insurer to write the answers in the proposal form.

17. In the present case subject policy was obtained with the cover typed as “reducing” as evident from the certificate of insurance wherein the sum assured reduces as per the loan repayment schedule and sum assured is equal to outstanding loan amount in the month of death as per the loan repayment schedule. As on date of death of LA, sum assured had reduced to Rs.25,67,560/- (as per 12th month RTA schedule as DLA expired in 12th month from issuance of policy). Hence even if claim would have been admitted complainant would not have been entitled to Rs.27,15,837/- being original sum assured under the subject policy. In view of suppression of material facts, complainant is not entitled to any benefits of any amount under subject policy, is liable to be dismissed.

18. OP No.2 stated that agents are licensed with IRDAI and function independently of any insurance company. The primary function of an insurance agent is to service the insurance needs of its customers and an insurance agents categorically acts on behalf of the customers but not on behalf of the insurance company. At the filling up of the proposal form, the agent acts as agent of insured, not of insurance company. It is settled principle of law that if any person signs any documents, it is presumed that he has signed the same after reading and understanding it properly. As per the information given by DLA insurance company issued the subject policy as per the details mentioned below:-

Policy plan

IDBI Federal Life Insurance Group Loan Secure Plan

Master policy No.

2000000259

Application NO.

124429555

Certificate No.

4001413730

Life Assured

Mr. Rajegowda

Nominee

Mrs. Padma

Death benefit (reducing cover)

Rs.27,15,836.85/-

Proposal Date

11/11/2020

 Risk commencement date

16/11/2020

 Policy term

13 years

Premium

Rs.95,051.03/-

Premium Frequency

Single

 

On the aforementioned reasons OP No.2 contends that there is no deficiency in the service on their part, repudiation is rightly made, hence prays to dismiss this complaint with cost.

19. At this stage complainant filed affidavit evidence by filing affidavit. In support of the affidavit, complainant has filed 10 documents which are marked as Ex.P.1 to Ex.P.10. Complainant reiterated as mentioned in the complaint. One SamratYelgonda, senior manager legal at Ageas Federal Life Insurance Company is authorized to lead evidence on behalf on OP No.2. In support of oral evidence OP No.2 has filed 9 document which are marked as Ex.R.1 to Ex.R.10.One Ganesh Aithal DGM of OP No.1 adduced evidence on behalf of OP No.1, with no documents. Both the authorized person reiterated in the affidavit as they mentioned in their  version.

20. Heard arguments of OP No.1 and 2, both the parties filed their written arguments with citation. Perused the documents on record and to proceed to pass the following order.

21. On the basis of above pleadings for our consideration are as follows:-

i) Whether the complainant proves the deficiency of service on the part of OP’s?

ii) Whether complainant is entitled for the relief?

iii) What order?

22.  Our answers to the above points are as follows:-

Point No.1:-Affirmative.

Point No.2:-Partly Affirmative.

Point No.3:- As per the final order.

REASONS

23. Point No.1&2:-These points are inter-connected to each other and for the sake of convenience, to avoid repetition of facts, these points are taken up together for common discussion.

24. After perusal of the pleadings and the documents available on the record, it is proved that complainant was working in several Government departments as an armed head constable at Bangalore and has taken certificate of appreciation from the Head of the Institutions i.e. from Commissioner of Police, Bangalore city police has issued certificate for his service during the time of Covid-19 which is at Ex.P.2. Complainant also produced annual performance report, filled format of personal data dated 08.03.2021 and self-assessment form dated 31.03.2021 signed by deceased Ramegowda who is a policy holder in the present case for the period ending on 31.03.2021 which is at Ex.P.1.

25. Complainant’s husband availed loan for Rs.27,15,837/- from IDBI bank limited. During the period, bank officials compelled the complainant and her husband to go for group loan secure plan insurance with OP No.2 for availing/securing the loan, accordingly complainant was convinced with the representation of OP No.1 and agreed to obtain insurance against the said loan amount. In our considered view it is no doubt beneficial to the policy holder, as OP 2 stated in its version. The IDBI federal life insurance group loan secure plan issued certificate of insurance to complainant with master policy holder as a IDBI bank Limited. In the said certificate the details of premium payment and certificate number bearing 4001413730 with client ID 1002478664 for the death sum assured is Rs.27,15,837/-. The risk covered for the term of 11 years, which has 11 years of repayment tenure, not 13 years. For that policy holder paid one time premium of Rs.95,051/- towards insurance policy against loan which is at Ex.P.3. Complainant also produced Ex.P.4 pertains to Home loan facility for the amount of Rs.26,24,000/- along with Rs.95,051/- towards premium amount of getting insurance for the said amount. OP NO.1 issued the document Ex.P.4 discloses that policy holder has to repay the said amount of loan with interest in 132 EMIs with floating rate of interest. Complainant has to pay Rs.30,096/- towards EMI every month. When this was the situation, policy holder admitted in HCG hospital on 12.10.2021 and was diagnosed with Metastatic Carcinoma Stomach Cancer and died on 10.11.2021, death certificate at Ex.P.5. After his death nominee of the insurance/complainant approached OP No.2 with all the required documents and medical reports of deceased policy holder and submitted for the claim. OP No.2 (Ageas Federal Life Insurance Company which is changed from IDBI Federal Life Insurance Company Limited as per the document Ex.R.2 with effect from 21.01.2021) rejected the claim of the complainant in letter dated 31.01.2022 stating that “the material facts were suppressed by the policy holder at the time of application with an intend to induce the company to accept the application. Therefore, regret that OP No.2 is unable to honor the claim and have to rescind the cover for joint member from inception accordingly.  Further death benefit cover will continue for the remaining term for surviving member as per the terms and conditions” which is at Ex.P.7. In the same letter they also stated that in case of complainant is not satisfied with decision of the company, may approach claim review committee at the below address within 30 days. Complainant raised her complaint before IRDAI, in turn they sent to insurance company. Ageas Federal Insurance Company has a written letter dated 04.03.2022 stating the deciding committee was stand by the company’s earlier decision of repudiation of the claim and also stated, in case of dissatisfaction of this letter, complainant may approach insurance ombudsman within 8 weeks. Based on their reply, complainant written letter to OP No.2 dated 24.02.2022 which is at Ex.P.9 requesting the sanctioning of the insurance claimed under policy No.4001413730 to reconsider the claim and requesting for honoring the claim referring the doctor’s certificate issued by Sagar Hospital dated 22.02.2022 which is at Ex.P.8 who has clearly stated twice policy holder was admitted for peptic strictures and for carcinoma stomach with skeletal metastasis all two deceases are different admission and are not linked to carcinoma of stomach. Even after submission of reconsidering letter, filed by the complainant, OP No.2 has repudiated the claim of the complainant on the basis of suppression of material facts while taking the insurance policy.

26. For the contention of OP No.2 complainant has denied that the material facts related to the policy holders health condition. She stated that policy holder was in a good state of health at the time of making proposal, was healthy and was enjoying the sound health. There was no occasion at all for him to suspect the existence of any ailments. Even she denied that he had any symptoms and neither consulted the doctors nor taken treatment as alleged by OP No.2. Considering the statement of complainant and also the documents produced at Ex.P.1 & P.2, policy holder was in a good health and served as a frontline warrior during Covid-19 and also he submitted his self-assessment form on 31.03.2021, he was in good health and served with a better hopes. In our considered view, complainant is not joint member to the loan account or policy , the repudiation with remarks that “torescind the cover for joint member from inception accordingly.  Further death benefit cover will continue for the remaining term for surviving member as per the terms and condition” does not have justification. The stand of Op 2 is visible to bare eye that it is unjust and unfair. 

27. OP NO.1&2 has no dispute with regard to the availment of Rs.27,15,837/- for the period of 11 years and also not disputed with regard to the insurance policy obtained against the loan for the security of loan amount. OP No.2 contention is only after the 11 month of period from the issuance of the policy, policy holder suffered with a stomach cancer and died by suppressing the fact of having serious issue in the health. As per Ex.P.8, the Sagar Hospital Doctor has issued a certificate stated that the cause of death is not related to the earlier treatments for which the policy admitted and taken treatment.

28. It is pertinent to note that the question only with regard to the repudiation of the claim which is to be paid by OP insurance company, towards repayment of loan amount availed by policy holder. For the same OP No.2 has taken contention of suppression of material facts, the policy holder while taking policy he has not disclosed the ailments he was suffering from. Suppressing the same, he obtained insurance policy against loan he has availed, within a year time he died and the insurance company has not liable to repay the loan amount.

29. Here the question arises and denied about the material facts are not suppressed since he was serving with his profession till October 2021. When he was in good condition of a health, he might not aware about the ailment he has and he has not suffered any symptoms till then. Such being the case, the suppression of the material facts does not arise. It may be the reason, he admitted on 12.10.2021 and within a month time i.e. 10.11.2021, he died. If in case, OP has any such perception, OP No.2 could get a medical examination of policy holder before issuing the policy. It was a proper reason for getting him a medical examination since he has crossed the 50 years of age. But OP did not do so.

30. OP No.2 also contends that medical examination while issuing the policy is not mandatory to be conducted and varies from policy to policy and plan to plan. We can observe that OP No.2 admitted in its version that it is a non-medical policy wherein no medical adversary was triggered in the proposal form. In our considered view, the said insurance policy is against the loan he availed i.e. also called as loan suraksha policy, not life insurance policy. Hence, the medical examination was not conducted by OP and also not serious to take information about the health condition of the insured.

31. OP No.2 contends that policy holder/DLA had an opportunity to approach insurance company during the free look period, in case there was any dissatisfaction with the terms and conditions of the policy or if there was any discrepancy in his details in the proposal form. In our considered view, when he was having good health condition and has no symptoms, variations in his health condition, there is no question of discrepancy in the details to correct it in the free look period. OP NO.2 also taken contention that DLA was an educated person should be conscious before signing on the proposal form when he could read and understand the information filled in the format. And also taken contention about the agent of insurance company is licensed by IRDAI and functions independently with an insurance company but the primary function of an insurance agent is to act as agent of insured not insurer. Insurance agent filled and the same has been signed by the policy holder with a full knowledge there is no question arises about the discrepancy in the proposal form and the complainant has nowhere stated and shifted fault on the shoulder of insurance agent.

32. OP No.2 itself stated that it is a group loan secured plan linked to loans, in order to offer the insurance policy, provides a cover on the outstanding loan amount, so that the policy holder do not have to bear the burden of loan, in case an unexpected events. Such plans are in the best interest of public to protect the families from the burden of the loan in case of any sudden unforeseen event. Such being the case, OP No.2 is taken premium of Rs.95,051/- for issuing insurance policy against the loan amount of Rs.27,15,837/-. Complainant also opted the same by paying premium amount and secured his loan amount in case of any unexpected incidents come before them. When he has taken insurance policy against the loan, OP No.2 is liable for the repayment of the loan amount which is still due to repay. The said insurance policy is not health insurance or any life insurance policy which is relied on the health condition of the policy holder, it is purely against the loan which is availed by the policy holder that was the reason OP No.2 has not conducted any medical examination before issuing the insurance policy.

33. It is immaterial whether he died within a year of issuance of policy or on the last day of risk coverage period, he is entitled for the repayment of the loan amount by the insurance company on behalf of the policy holder when he is not survived. In many caseslike vehicle insurance policy or health insurance policy, if the insurance policy is not existed on the date of accident, insurance company denied the claim of the policy holder and if the health policy lapsed and before renewal of the same, any admission/treatment taken by policy holder, insurance company without any second thought rejects the claim.  Such being the case, policy holder died after 11 months when the risk coverage still exists and the nominee of the policy holder who is the complainant in the present case is entitled for the insurance company to repay the loan amount which is still due to the bank.

34. Here we would like to discuss about the amount of entitlement from OP No.2 under the Group Loan Secure Policy.  Policy holder repaid 11 months principle amount and the interest as scheduled by the OP NO.1 and the complainant is only entitled after 10.11.2021. OP NO.2 has taken contention in its version that, as on death of policy holder, sum assured had reduced to Rs.25,67,560/- as per the 12th month RTA schedule, as against Rs.27,15,837/-.  The amount of Rs.25,67,560/- will be repaid to OP No.1 bank by OP No.2, if in case complainant has already repaid the amount by any source, OP No.2 to reimbursed the amount to the complainant. OP 1 nowhere stated about the amount still due from the Loan account No.0551675100007412. It shows, Op1 bank maintained silence in the case because of OP 1 received the amount.

35. As complainant alleged OP No.2 has caused deficiency in service even they have collected premium of Rs.95,051/- towards the policy and has repudiated the claim of the complainant caused deficiency of the service on the part of OP No.2. Even after repudiation, she approached several authorities for honoring the claim, but OP No.1&2 has not materialized the request of the complainant by dishonoring the claim. Here the material of facts has suppressed by policy holder, not related to the insurance policy was issued against the loan, hence the loan should be repaid either by policy holder or by insurance company. When the policy holder is not alive in the present case, onus on OP NO.2 to repay the loan amount of the policy holder, which is the main objective of the loan suraksha policy i.e. group loan secure plan.

36. Complainant has claimed repayment of Rs.27,15,837/- with interest and also claimed Rs.50,000/- towards cost of litigation and Rs.5,00,000/- towards the compensation. AS we discussed above, complainant is entitled for balance amount i.e. Rs.25,67,560/-to be paid to the repayment of loan, not entitled for the entire loan amount . Compensation and the cost of litigation seems to exorbitantly claimed by the complainant, but OPNo. 2 well versed with the objective of policy and well stated in its version that the said policy was not required medical examination. When OPNo.2 itself admitted that policy doesn’t require medical examination, there is no point in rejecting the claim on the medical grounds. Might be complainant not aware about the objective of policy, but OPNo. 2 conversant with the same. More so, OP. No.2 instructed the complainant to approach many of the authorities to waste her time, obviously caused mental agony. When she struggled hard and got the same negative reply, made her to approach this commission. Hence, OP’s are liable to compensate the same. Therefore, complainantis entitled for compensation of Rs.50,000/- and Rs.15,000/- towards litigation cost. OPNo.1 and 2 may be different entities with different name, but primafacie functions under same umbrella. Giving from one hand i.e. OP No.1 bank and snatching from another hand, is unjust and unfair. Both caused deficiency of service even after collecting premium, repudiated the claim. On the above reasons we answer Point No.1&2 accordingly.

37.Point No.3:-In view of the discussion referred above, we proceed to pass the following:-

ORDER

  1. Complaint filed by the complainant U/S 35 of Consumer Protection Act, is hereby allowed in part.
  2. OP No.2 is directed to repay Rs.25,67,560/- to OP No.1 till the date as scheduled by Op No.1, with accrued interest if any,within 30 days from the date of order.
  3. OP NO.1 is directed to issue NOC after the receipt of the entire amount towards the repayment in the loan account No.0551675100007412 to the complainant.
  4. OP No.1 and 2 jointly and severally liable to pay Rs.50,000/- towards compensation and Rs.15,000/- towards cost of litigation within 30 days from the date of order, failing OPs shall have to pay interest at the rate of 10% p.a. on Award amount from the date of order till realization.

 

  1. Furnish the copies of the order and return the extra copies of pleadings and documents to the parties, with no cost.

(Dictated to the Stenographer, got it transcribed and corrected, pronounced in the Open Commission on this 30th day of May 2024)

 

 

 

 

(SUMA ANIL KUMAR)

MEMBER

(K.ANITA SHIVAKUMAR)

     MEMBER

(M.SHOBHA)

PRESIDENT

 

 

 

Documents produced by the Complainant-P.W.1 are as follows:

1.

Ex.P.1

Copy of form of annual performance report.

2.

Ex.P.2

Copy of appreciation certificate.

3.

Ex.P.3

Copy of insurance copy along with cover note

4.

Ex.P.4

Copy of home loan facility

5.

Ex.P.5&P.6

Copy of death certificate.

6.

Ex.P .7

Copy of repudiation letter.

7.

Ex.P.8

Copy of letter dated 2.02.2022.

8.

Ex.P.9

Copy of request letter dated 24.02.2022

9.

Ex.P.10

Copy of scan report, analysis dated 20.05.2021.

 

 

 

 

Documents produced by the representative of opposite party – R.W.2;

1.

Ex.R.1

 

2.

Ex.R.2

Copy of certificate of incorporation pursuant to change of name.

3.

Ex.R.3

Copy of member enrollment form bearing NO.124429555 dated 11.11.2020.

4.

Ex.R.4

Copy of policy document dated 16.11.2020.

5.

Ex.R.5

Copy of death benefit claim form dated 03.12.021, copy of death certificate.

6.

Ex.R.6

Copy of investigation report.

7.

Ex.R.7

Copy of medical documents (colly)

8.

Ex.R.8

Copy of affidavit from investigator in support of his report

9.

Ex.R.9

Copy of repudiation letter dated 31.01.2022.

10.

Ex.R.10

Copy of letter dated 04.03.2022.

 

 

 

(SUMA ANIL KUMAR)

MEMBER

(K.ANITA SHIVAKUMAR)

     MEMBER

(M.SHOBHA)

PRESIDENT

 

 

 

 

 

 

 

 
 
[HON'BLE MRS. M. SHOBHA]
PRESIDENT
 
 
[HON'BLE MRS. K Anita Shivakumar]
MEMBER
 
 
[HON'BLE MRS. SUMA ANIL KUMAR]
MEMBER
 

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