PRESIDENT, DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SAMBALPUR

                             CONSUMER COMPLAINT NO. 39/2022

Present-Dr. Ramakanta Satapathy, President,

  Sri. Sadananda Tripathy, Member,

1. Bijeswari Patel, Aged about 52 years

S/O-Pradyumna Kumar Patel,

2. Swaraj Kumar Patel, Aged about 30 years

S/O-Pradyumna Kumar Patel,

3. Sourav Kumar Patel @ Sorav Kumar Patel,

Aged about 29 years,

All are R/O-At-Bhojpur, Ps-Kuchinda

Dist-Sambalpur-768107.                                              ……..Complainants

Versus

1. The Manager, HDFC life,

M/s Hota Complex, Main Road,

Budharaja, near Jagannath Temple, Odisha-768004.

2. The Branch Head,

HDFC Standard Life Insurance Company Ltd.

At-13th Floor, Lodha Excelus, Apollo Mills Compound,

N.M.Joshi Marg, Mahalaxmi, Mumbai-400011            …...Opp.Parties

Counsels:-

1. For the Complainant      :-          Sri. D.Mishra, Advocate & Associates
2. For the O.P. s                  :-          Sri. C.Patra, Advocate & Associates

Date of Filing:31.05.2022,  Date of Hearing :13.03.2023  Date of Judgement : 08.05.2023

  Presented by Dr. Ramakanta Satapathy, PRESIDENT

1. The Complainants, filed the complaint alleging deficiency in service by the O.Ps. The Complainants are legal heirs of deceased Pradyumna Patel who has a life Insurance Policy from the O.Ps Vehicle No. OD-15K 2624 was purchased on 19.02.2018 and insured with policy No. 345600/31/2018/9029 by Pradyumna Patel. Tata Motors Finance Ltd; Sambalpur was the financier of the vehicle and Master policy holder of the vehicle having policy No. PP000150 & Member No. WD-500. Rs. 75,244.82P. premium was paid and sum insured was Rs. 17,75,145/-. The Complainant No.2 was appointed as nominee.

Pradyumna Patel was affected by jaundice, admitted in KIIMs, Bhubaneswar and later shifted to Maa Samaleswari Nurshing Home, Burla and for serious complications admitted to VSSMCH, Burla and died on 08.03.2019. The nominee claimed Rs. 17,75,245/- making application and submission of documents. On 30.12.2019 complainant received letter dated 30.12.2019 of the O.Ps rejecting the claim with the ground that the deceased was having pre-existing (PED) Diabetes Mellitus prior to availing the policy. The life assured has correctly given the personal medical details in the medical questionnaire. The O.Ps conducted investigation and report was not provided. A representation was made to the I.R.D.A. but no any relief received for the violation of insurance agreement and defrauding the Complainants.

2. The O.Ps in their version submitted that this Commission has no jurisdiction. The Complainant is not a consumer of the O.Ps Pradyumna Patel availed the HDFC Life Group credit plus policy on 13.02.2018 and with S.A. Rs. 17,75,245/- and paid premium of Rs. 75,245/-. The policy term was for 4 years. The sum assured in case of death of life assured is payable to the financier as against the loan outstanding. On 12.07.2019 claim intimation made and disclosed that the policy holder died on 08.03.2018 just within 15 months of doing the policy. The policy holder suppressed material facts, gave false information. Policy was issued in the proposal dated 02.02.2018. The life assured was suffering from diabetes for past 13 years and was under continuous use of insulin which was not disclosed in the application. There is no any deficiency on the part of the O.Ps and prayed for rejection of complaint.

The Complainant’s are not entitled to receive any claim. The Complainants not paid the premium in time, hence policy was terminated and a new policy No. 23628850 was issued on the basis of which the Complainant is receiving Rs. 18,917/- annual annuity and prayed for dismissal of the Complainant.

3. Perused the documents filed by the Complainant and O.Ps.

The Complainants filed:-

Annexure 1 - Copy of legal heir certificate

Annexure 2 - Invoice dated 19.02.2018

Annexure 3 - Member Certificate No. 5002575429

Annexure 4 - Death Certificate Regd. No. 1700/2019

Annexure 5 - letter dated 30.12.2019 of the O.Ps.

Annexure 6 - Discharge Summary of KIIMS and Samaleswari Nurshing

Annexure 7-Copy of certificate of admission and declaration of death in

VSSMCH, Burla

The O.Ps filed:

Annexure R/1(Series) - Copy of policy documents, investigation report.

Annexure R/1(Series)-Medical papers.

4. Basing on the complaint version and documents filed following issues are framed:
103606587.  

1. Whether the Complainants are not consumer of the O.Ps and this commission has no jurisdiction to entertain the complaint?
2. Whether the deceased assured suppressed the material facts and violated insurance contact and repudiation of the claim is proper?
3. What relief the Complainant are entitled to get?

Issue No.1 Whether the Complainants are not consumer of the O.Ps and this commission has no jurisdiction to entertain the complaint?

It is the admission of both the parties that Pradyumna Kumar Patel was having HDFC standard Life Insurance Policy No. PP000150 having Membership No. WD500 and the sum assured was Rs. 17,75,245/-. Sourav Patel was nominee and premium paid Rs. 75,244.82P. The insured died on 08.03.2019 and the Complainants are the legal heirs of deceased Pradyumna Kumar Patel. As per sec. 2(5) (vi) in case of death of consumer his legal heirs or legal representatives may be complainants. As payment of premium is admitted by the O.Ps the Complainants are consumers of the O.Ps.

Relating to jurisdiction of the Commission, the Complainants are resident of Sambalpur district and the O.Ps are having office at Budharaja, hence this Commission has jurisdiction to entertain the complaint.

Issue No.2  Whether the deceased assured suppressed the material facts and violated insurance contact and repudiation of the claim is proper?

As per Annexure R/1 while filling the membership form on 23.02.2018 the insured answered and the BDM filled up the form. While entering into an insurance contract the parties should disclose all the material facts and the proposal form is the very basis of the contract. The proposers duty is to disclose all material facts in proposal form so that the insurer shall take the risk. Sec 45 of the Insurance, Act, 1938 stipulates that material for the purpose and I.R.D.A. Regulations shall mean and include all important, essential and relevant information in the context of underwriting the risk to be covered by the insurer. In the present case the D.L.A. deliberately suppressed the material facts about his health ailments in the past and he had never undergone for any treatment pertaining to any kind of diseases excluding cough and flue. From the investigation report it reveals that the D.L.A. was suffering from diabetes for last 13 years and he was under continuous insulin. This fact has been reflected in Annexure R/2 series. While making proposal the DLA suppressed this fact. It violates the insurance contract. In such case decision of hon’ble Supreme Court of India. B.M. Bajaj Allianz Life Insurance Co. Ltd. Vs Dalbir Kaur (Civil Appeal No. 3397/2020) is squarely applicable. Further the said principle of utmost good faith reported in Reliance Life Insurance Co.Ltd. vs Rekhaben Naresh Bhoi Rathod(Civil Appeal No. 4261/2019) is applicable. The issue is answered accordingly.

Issue No.3   What relief the Complainant are entitled to get?

          As per ratio of supra decisions the following order is passed:

ORDER

The Complaint is dismissed on contest against the O.Ps. No cost.

Order pronounced in open court on this 8^th May 2023.

Supply free copies to the parties.