Before the District Consumer Disputes Redressal Commission, Rohtak.
Consumer Complaint No. 212
Instituted on: 01/05/2019
Decided on : 15.10.2024
Smt. Santosh ate 55 years, wife of late Shri Kailash R/o House No.5603, Ward No.12, Meham, Tehsil Meham, District Rohtak.
….Complainant
Vs
- Aadhar Housing Finance Limited, Near Chhotu Ram Chowk,Rohtak.
- D.H.F.L. Pramerica Life Insurance Co. Limited, 4th Floor, Building No.9, Tower B, CyberCity, DLFCity, Ph.-III, Gurgaon (Haryana).
……Opposite Parties
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT, 1986.
BEFORE: SH. NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
Present: Sh.Satnam Singh Luthra, Adv. for Complainant.
Sh.NeerajRathi, Adv. for the OP no.2.
OP no.1 already exparte.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case as per the complainant are that husband of complainant late Shri Kailash had availed a home loan of Rs.7,55,589/-sanctioned by opposite party No. 1 on 31-12-2017 at the rate of 13% per annuminterestvide loan no.166748 to be repaid by 30-12-2025. The complainant was designated as the nominee under the loan agreement. At the time of loan disbursement, opposite Party No. 1 issued a cheque of Rs.6,80,000/- on 30-12-2017, after deducting Rs.75,589/- towards insurance premium and GST. The loan was duly insured with opposite party No. 2. Unfortunately, the husband of the complainant passed away on 18-08-2018 and after his demise, opposite Party No. 2 became liable to settle the outstanding loan amount as per the insurance policy terms and conditions. However, despite repeated requests of the complainant, the opposite party No. 2 failed to fulfill its obligation to pay the outstanding loan amount. The opposite party No. 1 made pressure on the complainant to deposit the arrears of loan amount with the Bank, which was contrary to the terms of the insurance policy.Despite repeated requests and a legal notice served on 18-02-2019, opposite party No. 2 failed to settle the loan amount, causing mental pain, agony, and harassment to the complainant. The act and conduct of the respondent amounts to deficiency in service an. Hence this complaint and it is prayed that opposite party no.2 may kindly be directed to deposit the arrears of loan due against the husband of the complainant and also to pay compensation of Rs.50,000/- for causing mental agony and harassment to the complainant and Rs.22,000/-as litigation expenses to the complainant. .
2. Upon registered notice, opposite parties No. 1 & 2 appeared and filed their written statement separately. Opposite party No. 1 in its written statement has took some preliminary objections such as; the complaint filed by the complainant is false, frivolous and the same has been filed with ulterior motive, by concealing material facts from the Hon'ble Commission. The opposite party no.1 asserted that the complainant has not approached the Commission with clean hands and has suppressed the material facts. Furthermore, the Opposite party no.1 asserts that there is no cause of action against them, and the complaint is not maintainable in its current form. The Opposite party no.1 also challenges the jurisdiction of the Commission saying that it is not competent to hear and decide the case. On merits, the opposite party clarifies that the husband of complainanthad insured himself with opposite party No. 2 and not by opposite party No. 1. The opposite party no.1 denies certain allegations made by the complainant including the claim of undue pressure to deposit the loan amount except taking of legal action. It is further stated that the complainant being the widow as well as co-borrower in the loan account, is legally bound to repay the loan amount to the answering opposite party. Ultimately, dismissal of complaint qua opposite party No. 1 has been sought.
3. Opposite party no. 2 in its preliminary objections of written statement contended that the deceased life insured (the husband of the complainant), concealed significant pre-existing health conditions ofCVA, B.P. Type 2 Diabetes Mellitus, Brain Illness, and Ischemic Heart Disease (IHD) at the time of obtaining the insurance policy. In the insurance proposal form, the deceased falsely declared that he had no prior illnesses, thus, violated the principle of utmost good faith, essential in insurance contracts. The opposite party No. 2 further states that under Section 45 of the Insurance Act, the policy is rendered null and void due to the non-disclosure of these material facts. The company conducted both internal and third-party investigations through D-Cipher Solutions, which confirmed that the deceased had been suffering from these ailments for several years before the policy was issued. Medical records obtained from PGIMS, Rohtak, and AIIMS, New Delhi, substantiate these findings. As a result, the insurance claim was repudiated on 26.12.2018 and a refund of Rs.75,589/- (the insurance premium) was offered to the complainant as a goodwill gesture.The opposite party stated that there is no valid cause of action in the complaint and it appears that the insurance contract was based on the fraudulent misrepresentation of health facts by the deceased. Legal precedents, such as Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. (2009) 8 SCC 316 and P.C. Chacko Vs. Life Insurance Corporation of India (2008) SC 424, are cited to emphasize the importance of disclosing material facts in insurance contracts. The Opposite Party No.2 denies any negligence or deficiency in service asserting that the insurance policy was issued in compliance with all requisite procedures. The opposite party No.2 prayed for the dismissal of the complaint with costs alleging that it is without merit and based on erroneous principles of law.
4. Learned counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A and documents Ex.C-1 to Ex.C-12 but failed to adduce any further evidence, hence, the evidence of complainant was closed by the court order on 14.07.2022. On the other hand, the learned counsel for opposite party No. 1 tendered in his evidence affidavit Ex.RW1/A and documents Ex.R-1 to Ex.R-5 and closed his evidence on 06.03.2023. Learned counsel for opposite party no.2 has also tendered in his evidence affidavit Ex.RW2/A and documents Ex.R2/1 to Ex R2/7 and closed his evidence on 12.01.2023.
5. However, at the stage of arguments, the opposite party no.1 did not appear despite several calls and hence, the opposite party No. 1 has been proceeded against exparte vide order dated 10.04.2024 passed by this Commission.
6. We have heard the arguments of learned counsel for the parties, perused the documents placed on record and have gone through material aspects of the case very carefully.
7. In the present complaint, the claim of the complainant has been repudiated by the opposite party No.2 vide its letter dated 26.11.2018 on the ground that the claim cannot be admitted for the following reasons: “it was found that late Mr. Kailash had history of Heart Disease(Ischemic Heart Disease), Hypertension and Diabetes Mellitus Type-II prior to the date of application and this information was not disclosed in the said application. We have perused the documents placed on record by both the parties. As per hospital record of PGIMS, Rohtak, the deceased LA took treatment w.e.f. 24.10.2016 to 27.10.2016 and at that time he was suffering from heart disease and the diagnosis is mentioned as “CVA alongwith Type 2, DM with IHD problem”. On the other hand as per proposal form Ex.R2/2 dated 31.12.2017, some questions were asked from the deceased life assured about his health e.g. i) Have you ever suffered or are currently suffering from: a)Chest pain, or heart attack or any other heart disease and the answer is given as ‘No’. As per the investigation report Ex.R2/4 of D-Cipher Solution, it is submitted that LA was taking treatment from PGIM Rohtak as an Outdoor Patient for IHD, DM Type 2, CVA etc. before commencement of the policy. To prove the same respondent no.2 has placed on record a document Ex.R2/5 (page no.19 to 38). As per the Post Mortem Report annexed with the death certificate Ex.R2/6 also, the cause of death is ‘Heart Failure’. So the cause of death of life assured is also heart failure. Hence from the documents placed on record it is proved that the deceased Life Assured was suffering from heart disease prior to commencement of the policy and he had concealed the alleged facts from the opposite party. Hence there is no deficiency in service on the part of opposite party in repudiating the claim of the complainant. However the law cited in 2023 Live Law (SC) 509 titled as Om Parkash Ahuja Vs. Reliance General Insurance Co. Ltd. etc. of Hon’ble Supreme Court of India in Civil Appeal no.2769-2770 of 2023 is not fully applicable on the facts and circumstances of the case. As such the present complaint stands dismissed with no order as to costs.
8. Application(s) pending, if any, stand disposed of in terms of the aforesaid judgment.
9. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
15.10.2024
........................................................
Nagender Singh Kadian, President
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TriptiPannu, Member.
