Delhi

North East

CC/324/2017

Mrs. Patni Minaben Bharatbhai - Complainant(s)

Versus

Aditya Birla Sun Life Insurance Co. Ltd. - Opp.Party(s)

07 Sep 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

Complaint Case No. 324/17

 

In the matter of:

 

	Mrs. Patni Minaben Bharatbhai R/o Z-110, Jayantilal Chunnilal Ki Chawl Sarva, Near Chamanpur, Ahmedabad Gujrat 380016	Complainant
	Versus
	Aditya Birla Sun Life Insurance Co. Ltd. 3rd Floor, Sikka Chamber, `B’-Block Market Shahdara, Dilshad Garden Delhi-110095	Opposite Parties

 

DATE OF INSTITUTION:         JUDGMENT RESERVED ON:               DATE OF DECISION      :

07.12.2017 06.09.2018 07.09.2018

 

N.K. Sharma, President

Ms. Sonica Mehrotra, Member

Ravindra Shankar Nagar, Member

Order passed by Ms. Sonica Mehrotra, Member

 

ORDER

1. The complainant is wife of the deceased life assured (DLA). The complainant has stated that her husband late Shri Bharat Bhai Menghabhai (DLA) took Life Insurance cover policy Vision Life Income Plan bearing No. 006572496 dated 28.08.2014 in his name from OP vide proposal form dated 18.08.2014. The said policy was having annual premium of Rs. 22,600/- and the basic sum assured was Rs. 7,02,980/-. The complainant was the Nominee in the said policy her husband expired on 16.12.2014 due to chest pain at Ahmadabad. Thereafter, the complainant filed claim form with the OP in respect to the aforesaid policy on 03.03.2015 and submitted the original policy and other supporting documents. However, no response to the claim processing was received by the complainant from OP for more than 2 ½ years and thus the complainant, on advice from her well wishers to initiate legal action against OP in Delhi since the policy was purchased by DLA in Delhi, contacted the counsel for the complainant who issued a legal notice dated 16.10.2017 calling upon the OP to process the claim of the complainant regarding the aforesaid policy within seven days from the receipt of the said notice and remit the amount due under the policy alongwith interest @ 18% p.a. w.e.f. 03.03.2015 till date of payment. It has been submitted by the complainant that the OP vide reply dated 26.10.2017 had informed the counsel for complainant that the claim of the complainant was repudiated vide letter dated 15.10.2015 in view of the DLA having taken concurrent policies from other insurance companies as well within very short span and suppressed past insurance history as well as misstated his personal details of qualification, income, occupation in the proposal form of other insurance companies prior to the proposal form of OP. However, the complainant had denied receipt of copy of any such repudiation letter dated 15.10.2015 as well as details of the alleged other policies. It has been submitted by the complainant that the said rejection is baseless, frivolous, arbitrary and false to their knowledge and non disclosure of the said fact does not in any way cause any loss, injury and therefore cannot render the contract voidable and as such the rejection by the OP is a clear case of deficiency in service and the repudiation is liable to be revoked. Therefore, the complainant was constrained to file the present complaint against the OP praying for issuance of directions to OP to pay a sum of Rs. 12,53,800/- (Rs. 7,20,980/- being sum assured against policy number 006572496 alongith interest thereon @18% from 03.03.2015 till 31.10.2017 to the tune of Rs. 3,25,820/- Rs. 1,50,000/- towards harassment and mental agony and Rs. 75,000/- towards litigation charges). The complainant also prayed for pendent-lite and future interest @ 18% p.a. on the aforesaid amount till realization.

The complainant has annexed copy of the policy bearing No. 006572496, first premium receipt dated 28.08.2014, application form dated 18.08.2014 bearing no. 49604312, insurance advisors report, copy of letter from the husband of the complainant addressed to OP, copy of death certificate of DLA, copy of the claim form dated 03.03.2015, copy of ECS mandate form, copy of NOC, copy of Medical Attended Certificate, copy of legal notice dated 16.10.2017 from counsel of the complainant to OP and copy of reply dated 26.10.2017 to the legal notice of the complainant dated 16.10.2017. In addition to above, the complainant had filed an application under Section 24A of the CP Act 1986, for condonation of delay on grounds that the complainant is an illiterate lady residing at Ahemdabad, Gujarat and when she didn’t receive any response from OP2 after 2 ½ years of filing claim on 03.03.2015 after the death of her husband to claim the insurance amount, she was advised to seek legal assistance in Delhi since the policy was taken by DLA in Delhi. Therefore, she contacted lawyer in Delhi in September 2017 who drafted the present complaint and sent it for signature to Ahmedabad, Gujarat and in this process there was delay of 31 days in filing the present complaint and prayed for condonation of the same.

2. Notice was issued to the OP on 07.12.2017 for appearance before this Forum on 04.01.2018 which was duly received by the OP on 23.12.2017. However, the OP failed to appear before this Forum despite several opportunities given to it and as such was proceeded against ex-parte vide order dated 28.02.2018.
3. The arguments on application under Section 24A of CP Act for condonation of delay were addressed by complainant and after hearing the same, this Forum had allowed the application and the delay of 31 days was condoned vide order dated 01.05.2018.
4. Ex-parte evidence by way of affidavit alongwith written submission were filed by the complainant on 01.05.2017 & 05.07.2018 respectively in reassertion/ reaffirmation of here grievance in her complaint were reiterated by the complainant. Complainant placed reliance upon the judgment of Hon’ble National Commission in the case of Aviva Life Insurance vs Rekhaben R. Parmar II(2017) CPJ in which the Hon’ble National Commission held that non-disclosure of other insurance policies doesn’t fall within the ambit of section 45 of Insurance Act since it is a normal practice that in non-mediclaim policies, question regarding existence of other insurance policies is not asked for and held the repudiation by insurance company unjustified since by no stretch of imagination it can be held to be a “material fact” fraudulently suppressed, entitling the insurance company to repudiate the claim on such a ground. The complainant further placed relied on the judgement of Hon’ble National Commission in Sahara India Life Insurance Co. Ltd Vs Rayani Ramanjaneyulu III (2014) CPJ 582 (NC) that for any omission or commission of an insurance agent, the insurer or his legal survivors cannot be made to suffer for omission and commission of agent and held that the repudiation by insurance company smacks of malafide intention in light of judgment of Hon’ble Apex Court in Satwant Kaur Sandhu V/s. New India Assurance Co. Ltd. IV (2009) CPJ 8(SC) in Para 17 of which the Hon’ble Apex Court has observed that it is difficult to fathom as to why these facts would influence the judgment of a prudent insurer in fixing the premium of determining the cover or whether he would like to take the risk. This appears to be a mistake committed by the agent. Agent is the villain and for his omissions and commissions, the insured or her LRs should not suffer. On the contrary, the repudiation on this ground alone smacks of mala fide intention on the part of the OP. By no stretch of imagination it can be held to be a material fact. It rather puts the insured in a solid and impregnable position.
5. We have heard the arguments forwarded by counsel for complainant and have thoroughly perused the documentary evidence placed on record as well as judgment relied upon and are of the considered view that in terms of the settle preposition of the law with respect to non-disclosure of other insurance policies not being concealment of a material fact, the repudiation of life insurance claim vide a letter dated 15.10.2015 referred to in its reply dated 26.10.2017 to legal notice dated 16.10.2017 by complainant was unlawful and unjustified and the act of rejection of claim of complainant, therefore, is deficiency of service on the part of OP. We, therefore, direct to OP to release the sum assured of Rs. 7,02,980/- with regard to policy no. 006572496 to the complainant alongwith interest thereon @9% from the date of filing of this present complaint till realization. We further, award a sum of Rs. 10,000/- to the complainant towards harassment, mental agony and inconvenience cost to the complainant by OP due to illegal rejection of claim and Rs. 5,000/- towards legal expenses. Let this order he complied with by OP within 30 days of receipt of copy of this order.
6.  Let a copy of this order be sent to each party free of cost as per regulation 21 of the Consumer Protection Regulations, 2005.
7.   File be consigned to record room.
8.   Announced on  07.09.2018

 

(N.K. Sharma)      President

(Sonica Mehrotra) Member

(Ravindra Shankar Nagar) Member