Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 526.
Instituted on : 07.09.2017.
Decided on : 23.01.2019.
- Mamta w/o Late Sh. Sat Pal Singh,
- Priya minor, 3.Preeti Ds/o Late Sh. Satpal singh minors through their mother and natural guardian Smt. Mamta w/o Satpal r/o village Kharak Bura, Teh. Narwana Distt. Jind.
………..Complainant.
Vs.
1. Bharti Axa Life Insurance Company Ltd. 418/29, 1st Floor, Chhotu Ram Chowk, Rohtak through its Branch Manager.
2. Bharti Axa Life Insurance Company Ltd: Unit 601-602, 6th Floor, Raheja Titanium, Off Western Express Highway, Goregaon, East Mumbai through its Chief Manager/ authorized signatory.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
SMT. SAROJ BALA BOHRA, MEMBER.
SH. VED PAL HOODA, MEMBER.
Present: Sh. Jasvir Kundu, Advocate for the complainant.
Sh. Rajesh Sharma, Advocate for the opposite parties.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that the husband of the complainant purchased a life insurance policy No.5013245583 on dated 19.05.2015 for a sum of Rs.8,15,661/- from the OPs. That complainant is nominee of her husband in this insurance policy. That at the time of issuance of said insurance policy, husband of the complainant was hale and hearty. Unfortunately, on 15.09.2015 the husband of the complainant naturally died due to heart attack. It is further alleged that after death of her husband, the complainant being nominee of her husband submitted death claim with OPs after completing all necessary formalities. But the OPs vide their letter dated 20.04.2016 have repudiated the death claim of the complainant on the ground that the life insured has not disclosed that he was having another insurance policy in his name. That the act and conduct of respondents is illegal and amounts to deficiency in service. Hence this complaint and it is prayed that OPs may kindly be directed to pay Rs.8,15,661/- alongwith policy plan benefits attached to the above said insurance policy to the complainant alongwith interest, Rs.50,000/- as compensation and litigation expenses as explained in relief clause.
2. Notice of the present complaint was issued to the opposite parties. Opposite parties in their written reply has submitted that the repudiation of the claim under the policy was on the grounds of mis-statement of information, suppression of material information and furnishing of false information in the proposal forms. That the life assured did not disclose the correct information with regard to his other life insurance policies with other insurers. As per the death claim investigation, it was revealed that the Life Assured had substantial life insurance cover with other insurance companies and the same was not disclosed prior to issuance of the present policy. That Life assured had taken the cover of Rs.3700000/- from other insurance companies like HDFC life, Bajaj Allianz and Aviva Life prior to applying for the present policy. That DLA had intentionally withheld the said material information from the OP and fraudulently obtained the alleged insurance policy from the opposite party. That the claim of the complainant was rightly repudiated. That there is no deficiency in service on the part of opposite parties and dismissal of complaint has been sought.
3. Both the parties led evidence in support of their case.
4. Ld. Counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C13 and closed his evidence. On the other hand ld. Counsel for the opposite parties has tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R8 and has closed his evidence.
5. We have heard ld. counsel for the parties and have gone through the material aspects of the case carefully.
6. The perusal of the documents itself shows that the Life Insured Satpal Singh had taken the policy of Rs.815661/- from the opposite parties and after his death the complainant being nominee has filed the death claim. In the present case, the claim of the complainant was repudiated by the respondent officials vide letter dated 20.04.2016 on the ground that the Life Insured had applied for Insurance policies from other companies and was already insured for a sum prior to applying with Bharti–Axa Life Insurance. That the material information has been suppressed by the deceased and he had not disclosed the true and correct facts in his proposal form. So the claim of the complainant was repudiated as per the terms and conditions of the policy. In support of their case, ld. counsel for the opposite parties has placed reliance upon the law of Hon’ble Supreme Court in Civil Appeal No.2776 of 2002, decided on 10.07.2009 tilted as Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. On the other hand, ld. counsel for the complainant has also placed reliance upon the law of Hon’ble State Commission, Hayrana, Panchkula in First Appeal no.1115 of 2017 decided on 10.09.2018 in case titled as Mithu Vs. Bajaj Allianz whereby Hon’ble State Commission has also relied upon the judgment of Hon’ble High Court –Punjab in case titled Life Insruance Coproration ofIindia Vs. Smt Narinder Kaur Batra and Ors. dated 06.08.2003 whereby the Hon’ble High Court has held that: Non–disclosure of earlier policies was not of material fact”. Ld. counsel for the complainant has also placed reliance upon the judgment dated 12.09.2014 of Hon’ble State Commission, Hayrana Panchkula in case titled as Sheela Vs. Aviva Life Ins. Co. , order dated 02.11.2017 of Hon’ble High Court of Punjab & Haryana in CWP No.24862 of 2017 in case titled as Bajaj Allianz Life Ins. Co. Vs. Santosh and another.
7. After going through the above referred cases, it is observed that the respondent placed on record the judgment of Hon’ble Supreme Court tilted as Satwant Kaur(Supra). The perusal of this judgment shows that “Material fact” means any fact which would influence the judgment of a prudent insurer in fixing the premium or determining whether to accept the risk or not- if the proposer has knowledge of such fact, he is obliged to disclose the same-Failure to do so entitled the insurer to repudiate his liability under the policy”. In the alleged case the deceased purchased a mediclaim policy from the respondent and he has not disclosed in his proposal form that the LA/deceased was suffering from chronic renal failure/Diabetic Nephropathy. So the claim of the complainant was not paid and final appeal was dismissed in the Apex Court. In the present case, the facts are different as in the case in hand, the deceased LA purchased life insurance policy and he gave all the relevant information in his claim form except the other policy purchased from the other life insurance companies. Except this information, he had filled all the correct information before the OPs. We have also placed reliance upon the case titled Aviva Life Insurance Co.Vs. Rekhaben Ramjibhi Armar decided by Hon’ble National commission on 12.04.2017, in which Apex Court in CEO Sahara India Life Insurance Co. Ltd. and another Vs. Rayani Ramayanjneyulu in SPL(c) No.30740 of 2014 dated 21.11.2014 has held that “The main question involved in Sahara India case(Supra) was that the insured did not mention about the previous insurance policies. The Hon’ble Apex Court upheld the view of this commission that by no stretch of imagination the information about any previous insurance policies could be held to be material. The court has observed that it was difficult to fathom as to why these facts would influence the judgment of a prudent insurer in fixing premium of determining the cover or whether he would like to take the risk.”
8. After considering the above mentioned case, we came to the conclusion that the repudiation made by the insurance company on the ground of non-disclosure of other policy is not legally justified. On the other hand, it is also observed that as per Claim Investigation Report Ex.R3, the investigator met with some of the neighbours who told that LA was fit and fine and died all of a sudden due to severe chest pain. However, some of the neighbours told that he was suffering from throat cancer and lastly it is submitted by the investigator that they checked the IPD as well as OPD records but did not find any record on the name of Satpal. Hence the LA had died natural death due to severe chest pain and the act of OPs of repudiating the genuine claim of the complainant on the ground of non-disclosure of other policies is illegal and amounts to deficiency in service.
9. In view of the facts and circumstances of the case, complaint is allowed and it is directed that the opposite parties shall pay the claim of policy no.5013245583 amounting to Rs.815661/-(Rupees eight lac fifteen thousand six hundred and sixty one only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 07.09.2017 till its actual realization and shall also pay a sum of Rs.5000/-(Rupees five thousand only) as compensation and litigation expenses to the complainants. It is also made clear that 50% share of the awarded amount will be paid the complainant no.1 Smt. Mamta wife of deceased Satpal and remaining awarded amount will be paid to the complainant no.2 & 3 minor daughters of deceased in equal share. However the amount after disbursement on account of complainant no.2 & 3 of minor daughters Priya and Preeti should be deposited in any nationalized bank till their majority and will be paid to them on attaining age of majority.
10. 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:
23.01.2019.
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Nagender Singh Kadian, President
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Ved Pal Hooda, Member.
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Saroj Bala Bohra, Member
