PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SAMBALPUR

                             CONSUMER COMPLAINT NO. 108/2023

Present-Dr. Ramakanta Satapathy, President,

  Sri. SadanandaTripathy, Member,

Reena Agrawal, Aged about 48 years

W/o- Late KanhaiyaLal Agrawal,

R/O-Rengali, PS/PO-Rengali.

Dist-Sambalpur, Odisha.                                                 …………........Complainant

Vrs.

1. Branch Manager, Punjab National Bank, Rengali,

R/O/Po/PS-Rengali, Dist-Sambalpur.

2. Claims Manager- PNB MetLife India Insurance Co. Ltd,

Unit No.701,702,703 7^th Floor, West Wing Raheja Towers,

26/27 MG Road, Banglore-560001.….…...…….Opp. Parties

Counsels:-

1. For the Complainant         :- Sri. R.L.Agrawal& Associates
2. For the O.P.No.1                :- Sri. Rajesh Kumar, Adv.
3. For the O.P.No.2                :- Ex-parte

Date of Filing:03.07.2023,  Date of Hearing :22.07.2024,  Date of Judgement :02.09.2024

Presented by Dr. Ramakanta Satapathy, PRESIDENT

1. The case of the Complainant is that Late husband of the Complainant namely Kanheiyalal Agrawal purchased a car in Feb. 2022 after obtaining loan from O.P.No.1. The insured was having a policy PNB met life covering the loan tenure and paid Rs. 56,221/- premium. O.P.No.2 insurer issued policy No. 24209815 against loan account with sum assured Rs. 11,50,000/-. During tenure of the loan Kanheiyalal died on 11.07.2022. After funeral ceremony the O.P.No.1 was approached to issue no dues certificate. The O.P.No.1 told the Complainant to continue payment of EMIs and after claim payment the extra amount will be refunded. The O.P.No.2 sent a claim rejection letter in March 2023 on the ground that the insured was suffering from cancer and the premium was returned to the account and O.P.No.1 adjusted same without any information. The Complainant is the nominee to the loan account.

Being aggrieved complaint has been filed.

2. The financing Bank, O.P.No.1 submitted that loan has been granted to the borrower Kanheiyalal Argarawal. Premium amount has been remitted to the O.P.No.2 insurer. The O.P.No.2 is having separate entity than the O.P.No.1 Bank. The O.P.No.1 forwarded the claim to O.P. No.2. Claim rejection letter has been issued by O.P.No.2. Premium has been refunded to the account of Complainant by O.P.No.2. The insured in proposal form declared that he was no suffering from any disease. The premium of Rs. 56,221/- has been transferred to the loan account. The Complainant not paid the EMIs for which it has been classified as NPA. There is no any deficiency on the part of answering Bank and complaint is liable to be dismissed.
3. The O.P.No.2 insurer has been set ex-parte.
4. The Complainant submitted the sanction letter dated 31.01.2022. Rs. 11.50lakhs was sanctioned and EMI was fixed @Rs.17,272.43P per month for 84 months. Against loan A/C No. 178420NG-00000087 certificate No. 24209815 was issued by insurer, O.P.No.2 wherein the O.P.No.1 is the Group policy holder. The insured paid Rs. 56,221.10P. Premium against sum assured Rs. 11.50 lakhs. The Complainant also filed the claim decision letter dated 13.03.2023. The vehicle OD 15U-0858 is in the name of Reena Agrawal. Now the vehicle is insured with IFFCO-TOKIO G.I.C Ltd. valid from 12.06.2023 to 11.06.2024.
5. Perused the contention of the parties and documents. The vehicle loan was sanctioned by O.P.No.1 on 31.01.2022. The insurance coverage period of the vehicle is 24.02.2022 to 24.02.2029. The O.P.No.2 vide letter dated 13.03.2023 repudiated the claim on the ground that the insured Kanheiyalal Agrawal was suffering from cancer and while making application on 24.02.2022 this fact has not been disclosed. On the ground of non-disclosure of facts and pre-existing disease the policy claim was repudiated. The premium amount paid Rs. 56,221/- has been refunded through electronics mode to Bank account.
6. After receipt of notice also the O.P.No.2 insurer not turned up nor submitted its version and documents to substantiate its case of repudiation of claim. How the insurer came to conclusion that the insured was suffering before 24.02.2022 was remain unexplained.
7. The Complainant submitted prescription of Dr. S.H. Advani, Sushrut Hospital, Mumbai, dated 18.01.2022 and whole body CT scan report dated 18.01.2022. The department of nuclear medicine, Sushut Hospital opined that the case is of carcinoma gallbladder post op, post chemotherapy status, compared with prior PET CT study dated August 2021 was impressed upon.
8. The contention of the Complainant is that her husband was not suffering from any disease at the time of availing loan and loan Suraksha policy. As per direction of hospital authority while body CT PET SCAN was done it does not disclose any pre-existing disease. While accepting the proposal the insurer should have taken into account this aspect first through medical examination report. The Complainant cited care Health Insurance Co. ltd. Vs Harjinder Singh Sohel case decided by hon’ble NCDRC, New Delhi dated 10^th April 2024. The Commission observed “By accepting the premium and issuing the policy despite the blank columns, the O.P. cannot later repudiate the claim based on alleged suppression or non-disclosure by the Complainant.”

In the present complaint the insurer, O.P.No.2 failed to submit:

1. The proposal form.
2. Basis of decision taken for repudiation of claim.
3. Documents showing pre-existing disease of assured Kanheiyalal Agrawal.

Taking into consideration the circumstances of the complaint following order is passed:

ORDER

The complaint is allowed ex-parte against the O.P.No.2 insurer. The O.P.No.2 is directed to disburse the claim of the Complainant to O.P.No.1 Bank, the outstanding position as on 11.07.2022. The O.P.No.1 is directed to issue NOC in favour of Complainant after receipt of the claim amount from O.P.No.2. The repudiation letter dated 13.03.2023 issued by O.P.No.2 is set aside and claim is allowed. In case of non-settlement of the loan account within one month of this order the O.P.No.2 shall be liable to pay compensation of Rs. 2.00 lakhs and litigations expenses of Rs. 50,000/-.

Order pronounced in the open court on 2^nd day of Sept. 2024.

Supply free copies to the parties.