Chandigarh

StateCommission

A/15/2024

HARLEEN KAUR PERHAR - Complainant(s)

Versus

ADITYA BIRLA SUN LIFE INSURANCE CO. LTD. - Opp.Party(s)

ANIMESH SHARMA

20 Jun 2024

ORDER

  STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

                                    U.T., CHANDIGARH 

                                    (Additional Bench)

 

Appeal No.	:	15 of 2024
Date of Institution	:	10.01.2024
Date of Decision	:	20.06.2024

 

Harleen Kaur Perhar, age about 58 years, W/o Late Upinder Singh Perhar, R/o H.No.330, Sector 35-A, Chandigarh-160036.

     ……Appellant/Complainant.

Versus

1. Aditya Birla Sun Life Insurance Co. Ltd., G-Corp Tech Park, 5^th & 6^th Floor, Ghodbunder Road, Kasarvadavali, Thane (W), Maharashtra-400607 through its Managing Director.
2. HDFC Bank Ltd., SCO 117-118, Sector 43-B, Chandigarh-160047.

 …..Respondents/Opposite Parties.

 

BEFORE:   MRS. PADMA PANDEY, PRESIDING MEMBER

                 MR. PREETINDER SINGH, MEMBER

 

ARGUED BY:-      

 

Sh. Animesh Sharma, Advocate for the Appellant.

Sh. Nitin Thatai, Advocate (on VC) alongwith

Ms. Monika Thatai, Advocate for Respondent No.1.

Sh. Sunil Narang, Advocate for Respondent No.2.

PER PADMA PANDEY, PRESIDING MEMBER

 

                  This appeal is directed against the order dated 01.11.2023, rendered by the District Consumer Disputes Redressal Commission-I, U.T. Chandigarh (hereinafter to be referred as “District Commission”), in Complaint Case No.43 of 2022, vide which, it disposed of the complaint in the following manner:-

“12.   In view of the above discussion, the complainant has failed to prove any deficiency on the part of OPs. But since claim of the complainant with regard to policy of DLA was rejected on the ground of non-declaration of material facts information, as such policy was required to be declared null and void. Hence, the OP No.1 was duly bound to refund the premium amount. Hence, we are of the view that the premium charged towards issue of policy be refunded by the OP No.1 to the complainant within a period of 45 days. The complaint is disposed of with above directions.”

2.           Before the District Commission, it was case of the complainant/appellant that her husband (Late Sh. Upinder Singh Perhar) obtained life insurance policy bearing No.007895472  (Annexure C-2) from Respondent/Opposite Party No.1 on 19.06.2021 of Rs.1,50,000/- on yearly basis and the appellant was the nominee therein. It was stated that the Respondent/Opposite Party No.1 did not conduct any medical test or examination before issuing the insurance policy, despite the fact that the complainant’s husband was a senior citizen. It was further stated that the appellant’s husband passed away unexpectedly on 08.12.2019, due to a stroke. Subsequently, the appellant filed an insurance claim with Respondent No.1, which was received on 15.01.2020. However, Respondent No.1 rejected the claim, alleging that the husband of the appellant had provided false information in the insurance proposal form with the intent to deceive Respondent No.1. This rejection is contested by the complainant and stated that the appellant's husband disclosed his complete medical history to the agents of Respondents No.1 & 2 and informed them about all his medical conditions, including being a patient of diabetes and hypertension. It was further stated that the appellant’s husband never objected to or opposed a medical test and consistently provided forthright information about his medical conditions to Respondent No.1.  It was further stated that there was deficiency in service and unfair trade practice on the part of the Opposite Parties and therefore a consumer complaint was filed before the District Commission.
3.           In its written statement, Opposite Party No.1 stated that before accepting the proposal, it provided adequate information to the Direct Lending Agent (DLA) and they attached a copy of the proposal form dated 13.06.2019 along with the terms and conditions (Annexure OP-2 & OP-3). It was further stated that the insurance policy was issued based on the duly filled and signed customer consent document submitted by the DLA alongwith the proposal form and the complainant has not denied the submission of the proposal form. It was further stated that the Deceased Life Assured (DLA) had various ailments, including diabetes mellitus-II, hypertension, and a history of Coronary Artery Bypass Grafting (CABG) in 1999, and was under medication. It was asserted that they discovered that the DLA had received treatments from various hospitals before applying for insurance, and this medical history and treatment, being material information, were not disclosed in the proposal form. The remaining averments made in the complaint were denied being false and it was pleaded that there was no deficiency in service on the part of Opposite Party No.1 and a prayer was made for  dismissal of the consumer complaint.
4. The Opposite Party No.2 filed its written statement and stated that the bank acts solely as a corporate agent for Opposite Party No.1, wherein account holders who are not interested in investing in the bank's fixed deposit scheme but seek higher returns with a life cover feature are directed to Opposite Party No.1 for insurance products. It was further stated that it is evident that the complainant understands that issues related to insurance can only be addressed by the organization from which the insurance was obtained. The answering Opposite Party denies all the allegation made in the complaint and prayed for dismissal of the complaint.
5.          The contesting parties led evidence before the District Commission.
6.          The District Commission after hearing the contesting parties and on going through the material available on record dismissed the consumer complaint. 
7.          We have heard counsel for the parties and have gone through the evidence and record of the case with utmost care and circumspection.
8.          After going through the record of this case and also the arguments of the parties we are of the considered opinion that the order of the learned District Commission-I dated 01.11.2023 in Consumer Complaint No.43 of 2022 wherein the prayer of the appellant asking for the insurance claim of Rs.15,75,000/- has been rejected and only a refund of the premium amount has been ordered. The main grievance of the appellant is that the respondent/Opposite Party No.1 vide written intimation dated 29.02.2020 has rejected the insurance claim pursuant to the death of the appellant on the sole ground that the deceased has given false information in the proposal form with an intent to deceive the Opposite Party No.1/Respondent. According to the appellant the grounds taken by the Opposite Party No.1/Respondent rejecting the claim was that the appellant/complainant has concealed the material facts about his health and given false information at the time of filing the proposal form. It is further averred by the appellant that the deceased had spoken to the agents that he is suffering from CABG, Diabetes, Kidney Stones and Cataract and that the insurance company is responsible for the negligence of the agent and that it is a responsibility of the insurance company and their agent to conduct proper medical tests and hence the appeal filed by the appellant/complainant for setting aside the order passed  by the District Commission by allowing the present appeal, and pay the due amount of Rs.15,75,000/-  alongwith interest @18%p.a. compounded monthly plus Rs.5.00 lacs as damages for mental harassment and Rs.55,000/- towards litigation charges.
9.          The stand taken by the respondent i.e. Aditya Birla Sun Life Insurance is that it had issued the subject policy to the appellant on the basis of duly filled and signed proposal form submitted by the DLA. It is pertinent to mention here that no prudent individual would simply sign on a form without being aware or satisfied with the contents of the same and it is held by the Hon’ble Supreme Court of India in M/s Grasin Industries Ltd. & Anr. Vs. M/s Aggarwal Steel 2010 (1) SC 33 that “When a person signs a document, there is a presumption, unless there is proof of force of fraud, that he has read the document properly and understood it and only then he has affixed his signatures thereon, otherwise no signature on a document can ever be accepted”.
10.          The respondent asserted that before acceptance of the proposal by it, adequate information was provided to the DLA. The subject policy was issued to the applicant on the basis of the duly filled and signed customer consent document submitted by the DLA alognwith proposal form and the complainant/appellant has at no place denied the submission of the proposal form. It is observed that the deceased life assured (DLA) was suffering from many ailments, which included diabetes mellitus-II, hypertension, CABG done in 1999 and was under medication. It was also discovered by the respondent that the DLA had taken treatments from various hospitals prior to the application for the insurance and the said medical history and treatment being material information was not disclosed by the DLA in the proposal form. A perusal of the Customer Consent Document  reveals that the appellant was aware of the content of the form and document which has been explained to him, the following paragraph substantiated the same:-

“I/we declare that the content of the form and document has been fully explained to me and I/ we have fully understood the significance of the proposed contract. I/we agree and understand that the insurance plan purchased is on the basis of the need analysis done and as suggested by HDFC Bank.”

and from above, it is crystal clear that the Deceased Life Assured was well aware about the terms and conditions.

11.          On a perusal of the Death Certificate dated 08.12.2019, there is a clear mention of the underlying/contributory conditions that the cause of death was due to Diabetes Mellitus-II, Hypertension, Coronary Artery Disease-Post CABG 1999. It is concluded from the above facts that DLA made a false statement in the proposal form, whereby he did not disclose the past-history of his ailments. Since the facts about the health condition of the insured member was incorrectly disclosed in the proposal form at the time of the application, it is observed that the respondent/Opposite Party No.1 rightly repudiated the claim of the complainant. Accordingly, the appeal is dismissed of the order of the learned District Commission is upheld.
12.          In view of the above, we find that the order passed by the Ld. District Commission is based on correct appreciation of   evidence and law on the point and does not suffer from illegality and perversity warranting any interference of this Commission.
13.          For the reasons recorded above, the appeal, being devoid of merit, must fail, and the same is dismissed, with no order as to costs. The order of the Ld. Lower Commission is upheld. 
14.          Certified copies of this order be sent to the parties free of charge.
15.           The file be consigned to Record Room, after completion.

 

 

Pronounced

20.06.2024

 

                                                                                          Sd/-

(PADMA PANDEY)

PRESIDING  MEMBER

Sd/-

(PREETINDER SINGH)

MEMBER

Gp/-