Haryana

StateCommission

A/389/2019

SHRI RAM LIFE INSURANCE - Complainant(s)

Versus

PARAMJEET - Opp.Party(s)

PRADEEP SHARMA

03 Aug 2023

ORDER

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

                  

  Date of Institution:23.04.2019

                Date of final hearing:03.08.2023

                                                Date of pronouncement: 10.08.2023

 

First Appeal No.389 of 2019

 

IN THE MATTER OF

 

1.      The Manager, Shriram Life Insurance Company Ltd., 5^th Floor, Ramky Selenium, Plot No.31-32, Financial District (Beside Andhra Bank, Training Center), Gachibowli, Hyderabad-500032.

2.      The Manager, Shriram Life Insurance Company Ltd., 1^st & 2^nd Floor, Ashok Nagar, Meerut Road, opposite R.K. Cinema and Nirmal Hero, Sector-14, Karnal.

 

.….Appellants.

 

Through Counsel Shri Pardeep Sharma, Advocate

 

Versus

 

Paramjeet Kaur widow of Shri Balvinder Singh, R/o House No.151, near Hospital, Lalyani, Taraori, District Kanral.

 

….Respondent.

 

Through counsel Shri Sikander Bakshi, Advocate

 

CORAM:   S.C. Kaushik, Member.

 

Present:-    Shri Pardeep Sharma, counsel for the appellants.

                   Shri Sikander Bakshi, counsel for respondent.

 

O R D E R

S. C. KAUSHIK, MEMBER:

 

                   Present appeal is preferred against the order dated 12.02.2019 in Consumer Complaint No.106 of 2018, passed by learned District Consumer Disputes Redressal Forum, Karnal (now ‘learned District Commission’), vide which complaint filed by the complainant was allowed and opposite parties (‘OPs’) were directed as under:-

“…to pay Rs.11,82,834/- the insured amount to the complainant with interest @ 9% per annum from the date of repudiation of claim till its realization. We further direct the OPs to pay Rs.25,000/- to the complainant on account of mental agony, harassment and towards the litigation expenses. This order shall be complied within 30 days from the receipt of copy of this order.”

 

2.                Brief facts of the complaint filed before learned District Commission are that the complainant was registered owner of truck bearing registration No.HR-37C-6401 and truck was financed by India Infoline Ltd. For Rs.12,04,714/- and in addition the complainant’s husband namely Shri Balwinder Singh accepted the proposal of OPs group life protector plan SP vide policy No.MN160608016131400 on 31.05.2016 of cover amount of Rs.11,82,834/-. The loan amount was to be paid in monthly installments. The husband of complainant after taking the loan started repaying the loan amount regularly and unfortunately, on 17.10.2016 the husband of complainant (Balwinder Singh) expired. Thereafter, complainant approached OP No.2 for claiming cover amount because in OPs plan, the OPs have protected the life of insured and clearly stated that in the unfortunate event of death of insured member during the tenure, OPs will pay the cover amount to the nominee, but no satisfactory reply was given by OP No.2. Complainant also served legal notice dated 12.12.2018 upon the OPs, but all in vain. Thus, there was deficiency in service on the part of OPs.

3.                Upon notice, OPs appeared before learned District Commission and filed their written version by submitting therein that Mr. Balwinder Singh (husband of complainant) had taken the policy through India Infoline Ltd. (IIFL), who was the master policy holder with Shriram Life Insurance Company under the plan “Shriram Life Group Life Protector Plan SP” against the loan ID No.1000095070 under the master policy No.GN011504000330 vide member policy No.MN160608016131500 for a cover amount of Rs.11,82,834/- starting from 31.05.2016 to 31.05.2020, wherein the life cover reduces each month as per the risk cover schedule. It was submitted that the insurance cover was given on the disclosure of health made by deceased life assured late Shri Balwinder Singh in declaration of good health (DOGH) form given at the time of joining the group. It was further submitted that the master policy holder (IIFL) intimated the death of deceased life assured to the OPs on 23.02.2017 stating that the life assured died on 17.10.2016. Thereafter, the claim was entrusted for investigation being an early death claim which arose within 4 months and 17 days from the commencement/joining the group policy. On perusal of the investigation report, it came to light that the deceased life assured Balwinder Singh was a chronic alcoholic and was admitted to Rehabilitation Centre for treatment. He was admitted to Jiwan Jyoti, Nasha Mukti Samiti at Bidoli from 31.03.2013 top 23.09.2013 for treatment. It was further submitted that during the investigation it was found that deceased life assured continued his drinking habits within 3 months after returning from Rehabilitation Centre, which shows that deceased life assured was suffering from health issues prior to the commencement of policy and willfully did not disclose the same, which ought to have been disclosed. Further, it was submitted that OPs rightly repudiated the claim of complainant and there was no deficiency in service on the part of OPs and prayed for dismissal of the complaint.

4.                After hearing the parties, learned District Commission accepted the complaint of complainant and issued directions as mentioned in 1^st para supra.

5.                Aggrieved from the impugned order passed by learned District Commission, OPs-appellants have preferred present appeal for setting aside the impugned order by accepting the present appeal.

6.                The arguments have been advanced by Mr. Pardeep Sharma, learned counsel for the appellants and Mr. Sikander Bakshi, counsel for respondent. With their kind assistance, contents of the appeal as well as entire record has also been properly perused and examined.

7.                While unfolding the arguments it has been argued by Mr. Pardeep Sharma, learned counsel for the appellants that Balwinder Singh (deceased) had taken the policy through India Infoline Finance Ltd (IFFL) who is the master policy holder with Shriram Life Insurance Co. under the plan “Shriram Life Group Protector Plan SP”. It has been vehemently argued by learned counsel for appellants that Balwinder Singh (deceased) has concealed the issues relating to his health in declaration of good health (DGH) form given at the time of joining group. Moreover, at the time of investigation, it came into light that deceased (Balwinder Singh) was a chronic alcoholic and was also admitted in Rehabilitation Centre for treatment prior to taking the policy and continued the drinking habit within 3 months after returning from the Rehabilitation Centre. It is further argued that deceased (Balwinder Singh) life assured had willfully not disclosed his pre-existing habits and health ailment at the time of taking policy and OPs rightly repudiated the claim of the complainant. He further argued that there was no deficiency in service on the part of appellants and prayed for acceptance of the appeal by setting-aside the impugned order.

8.                Mr. Sikander Bakshi, learned counsel for respondent has argued that husband of the complainant namely Shri Balwinder Singh (deceased) was the registered owner of truck bearing No.HR-37C-6401 and the said truck was financed by India Infoline Finance Ltd. for a sum of Rs.12,04, 714/-. Further, he argued that in addition the complainant’s husband accepted the proposal of OPs group life protector plan SP, vide policy No. No.MN160608016131500 for a cover amount of Rs.11,82,834/- starting from 31.05.2016 to 31.05.2020. He further argued that husband of the complainant had expired unfortunately on 17.10.2016 and complainant approached OP No.2 for claiming cover amount, but OPs failed to do the same. He further argued that there was deficiency in service on the part of appellants. Further, he prayed that learned District Commission rightly allowed the complaint vide its impugned order and the present appeal may kindly be dismissed.

9.                In view of the above submissions and on a careful perusal of the entire record, it is admitted that the husband of respondent-complainant namely Shri Balwinder Singh (deceased) had taken the policy through India Infoline Finance Ltd. (IFFL) who is the master policy holder with Shriram Life Insurance Company under the plan “Shriram Life Group Life Protection Plan SP” against the loan ID No.1000005070 under the master policy No.GN01150400030 vide member policy No.MN160608016131500 for a cover amount of Rs.11,82,834/-. It is also an admitted fact that the Balwinder Singh (life assured) expired on 17.10.2016. However, the claim of the complainant was repudiated on the ground that late Balwinder Singh was suffering from pre-existing ailments, which he did not disclose in declaration of good health (DGH) from at the time of joining the group policy.

10.              The main plea taken by the appellants in the present appeal is that the complainant was having pre-existing disease/ailment and that he did not disclose the same at the time of taking the said policy. Moreover, the ground of repudiation of claim was also the same. From the perusal of record, it reveals that as per investigation report conducted by appellants, Balwinder Singh (deceased) was admitted in Jeevan Jyoti Nasha Mukti Samiti (Bidoli) for rehabilitation program prior to taking the policy for the period 31.03.2013 to 23.09.2013 and he was perfectly fine at the time of discharge from there. It is also revealed from the record as well as admitted by the appellants that policy in question was taken by the deceased (Balwinder Singh) on 31.05.2016 i.e. almost three years after discharge from the said Nasha Mukti Samiti. However, appellants failed to prove that Balwinder Singh (deceased) was habitual of drinking alcohol after his discharge from abovementioned Nasha Mukti Samiti and that he was suffering from any pre-existing ailment. It is pertinent to mention here that habit of drinking alcohol does not fall under the definition of a pre-existing disease.

11.              The Learned District Commission rightly allowed the complaint of the complainant. The impugned order dated 12^th February, 2019 passed by learned District Commission, Karnal is well reasoned, based on facts and as per law and there is no need to interfere with it. In view of above, present appeal is without any merit and is thereafter liable to be dismissed and thus stands dismissed.

12.              Statutory amount of Rs.25,000/- deposited at the time of present appeal be refunded to the appellants against proper receipt, identification and as per rules.

13.              A copy of this order be provided to all the parties free of cost as mandated by the Consumer Protection Act, 2019. This order be uploaded forthwith on the website of the Commission for the perusal of the parties.

14.              Application(s), pending, if any, stand disposed off in terms of the aforesaid order.

15.              File be consigned to record room alongwith a copy of this order.

 

Pronounced on 10^th August, 2023                                                                                                                                                                                                     

                                                                                                            S.C. Kaushik                                                                                                                        Member                                                                                                                                 Addl. Bench