Karnataka

Gadag

CC/19/2022

Smt. Laxmi, Laxmibai W/o Maruti Sheshagiri - Complainant(s)

Versus

Branch Manager, Pramerica Life Insurance Company Ltd. (Erstwhile DHFL Pramerica Life Insurance Compa - Opp.Party(s)

M.M Kukanur

04 Feb 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, GADAG
DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSIONBehind Tahsildar Office, Basaveshwar Nagar, GADAG
 
Complaint Case No. CC/19/2022
( Date of Filing : 09 May 2022 )
 
1. Smt. Laxmi, Laxmibai W/o Maruti Sheshagiri
R/o Nandishwar Nagar, Tq & Dist: Gadag
Gadag
KARNATAKA
...........Complainant(s)
Versus
1. Branch Manager, Pramerica Life Insurance Company Ltd. (Erstwhile DHFL Pramerica Life Insurance Company Ltd)
4th Floor Building No.9, Tower-B, Cyber City, DLF City, Phase-14, Gurgaon 122002, Haryana.
Gurgaon
Haryana
2. The Branch Manager, Aadhar Housing Finance Ltd.
#19 & 20, 1st Floor, B Block, Revankar Complex, Torvi Circle, Hubballi-39
Dharwad
KARNATAKA
............Opp.Party(s)
 
BEFORE: 
 HON'BLE MR. D.Y Basapur PRESIDENT
 HON'BLE MR. Sri Raju Namadev Metri MEMBER
 HON'BLE MRS. Smt. Yashoda Bhaskar Patil MEMBER
 
PRESENT:
 
Dated : 04 Feb 2023
Final Order / Judgement

BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL COlMMISSION, GADAG.

Basaveshwar Nagar, Opp: Tahasildar Office, Gadag

 

 

COMPLAINT NO.19/2022

 

DATED 4TH DAY OF FEBRUARY-2022

 

BEFORE:

 

 

HON'BLE MR. D.Y. BASAPUR B.Com, L.L.B(Spl.,)

 

                                                                 PRESIDENT    

                                                 

 

 HON'BLE Mr. RAJU. N. METRI, B.Com, L.L.B(Spl.,)

                                                                    MEMBER

     

HON'BLE Mrs. YASHODA BHASKAR PATIL,

                                                 B.Com, L.L.B(Spl.,) M.Ed.,

                                                      WOMAN MEMBER                                                                                

 

 

 

Complainant:       1)   Smt. Laxmi @ Laxmibai W/o Maruti                                    Sheshagiri, Age:49 Yrs, Occ:Teacher,                                        R/o Nandishwar Nagar,
                                        Tq & Dist:Gadag.                                              

 

                                       (Rep. by Sri. M.M.Kukanur, Advocate)   

            

V/s

 Opposite Parties   :-

1)

 

 

 

 

 

 

 

 

 

 

 

2)

The Branch Manager,

Pramerica Life Insurance,

Company Ltd., (Erstwhile DHFL Pramerica Life Insurance Company Ltd)

4th Floor Building No.9, Tower-B Cyber City, DLF City, Phase – 14

Gurgaon-122002, Haryana.

 

(Rep. by Sri M.M.Kattimani, Advocate)   

 

 

The Branch Manager,

Aadhar Housing Finance Ltd.,

# 19 & 20, 1st  Floor, B Block

Revankar Complex, Toravi

Circle, Hubballi-39.

 

(Rep. by Smt. S.R.Govinakoppa, Advocate)   

 

 

 

 

 

 

JUDGEMENT

 

JUDGEMENT DELIVERED BY SMT.YASHODA.B.PATIL WOMAN, MEMBER

 

          The complainant has filed the complaint U/Sec. 35 of C.P Act, 2019, to direct the Op No.1 to pay the entire outstanding housing loan amount of Rs.15,66,859/- and Rs.9,29,499/- to Op No.2 and also direct Op No.2 to issue NOC to complainant and Rs.50,000/- towards mental agony.

          2. The brief facts of complaint is as under:

          Husband of the complainant late Shri. Maruti Sheshagiri borrowed a housing loan from Op No.2 on 31.01.2018 as sum of Rs.15,66,859/- bearing an account No.012901147127 and Rs.9,29,384/- and got insured against both the loans with Op No.1, with a policy bearing No.JC 000038 Member No.18483 and 01JC0003804 77100. The insured member later  died on 10.01.2021.  The (deceased) Maruti Sheshagiri kept on paying all the installments promptly till he survived. Complainant is the only legal heir of deceased Maruti. Later Op No.2 demanded the complainant to pay the remaining balance loan amount for which the complainant requested Op No.2 to collect the loan amount from Op No.1, but OP No.1 denied the same. Therefore, the complainant got issued a Legal notice on 20.01.2022, but an evasive reply was given by the OPs. So, Ops have committed the deficiency of service.  Hence, filed this complaint.

 

          3.      After admitting the complaint, notice were issued to the OPs, who appeared through their counsels and filed their written versions.

 

          4.     The brief facts of written version of OP No.1 is as under:

          The OP No.1 denied the contents of the complaint and contended that, insurance cover has been obtained fraudulently by misrepresentation. Upon receipt of death claim intimation, they have immediately initiated the process of investigation and certain facts were discovered. Maruti was suffering from diabetes prior to submitting the application form in which he has not disclosed. So, Life member has himself intentionally declared that, he is medically fit to avail the insurance by suppressing material facts.  In the  present case, Op No.2 Aadhar Housing Finance Ltd. was the master policy holder and had entered into policy contract with Op No.1 for issuance of two Group Scheme mainly. “DHFL Pramerica Group Credit Life +” Aadhar Shila.  Therefore, for non-discloser the claim of the complainant was repudiated. There is no any deficiency of service committed by the OP No.1. Hence, prays to dismiss the complaint. 

5.     The brief facts of written version of OP No.2 is as under:

          The OP No.2 admitted that, Maruti had borrowed a loan from this OP, prior to his death. The contention of Op No.2 is that, Op No.1 is a Insurance Company and there is no relationship between Op No.2 and Op No.1 both have separate identity. Op No.2 admits the loan transaction, but no agreement or contract of insurance between the complainant husband (deceased) Maruti Sheshagiri and Op No.2. Op submits that, Maruti Sheshagiri during his life availed two loans 1) Loan Account No.19200001617 for Rs.15,66,859/- 2) Loan Account No.19200001629 for Rs.9,20,491/- and the complainant herself is the co-applicant to both the said loans. The Op submits that, it has tie up with Pramerica Life Insurance Company and those who take the policy issued by the said company will get benefit of waiver of payments for further EMI’s by the co-applicant in case of untoward incident to life of the primary borrower.  The Op contends that they are not party to the Insurance Policy issued by Op No.1 and deceased Maruti has not disclosed about diabetes to Op No.1, therefore, they have declined the claim and this Op has no knowledge about it.  Complainant being a legal heir and representative of the estate of the deceased Maruti is liable to repay the said loan amount. There is no any deficiency of service committed by the OP No.2. Hence, prays to dismiss the complaint. 

          6.  To prove the case, the complainant has filed affidavit and was examined as PW-1 and got the documents marked as  Ex.C-1 to Ex.C-5. Shri. Yogesh Potdar for Op No.1 and Shri. Channvirayya Mathapathi have filed affidavits  and were examined as RW-1 & RW-2 and got marked the documents as Ex.OP-1 to Ex.OP-8.

 

7. Counsel for complainant and Ops have filed their written

    arguments. Heard the argument on both sides.


          8. The points for consideration are,


                   1. Whether the complainant proves the deficiency of                        service committed by the Opponents?


                   2. Whether the complainant is entitled for the reliefs

                     as sought for?


                   3. What order?


          9.  Our findings on the above points are as under:


               Point No 1. In the affirmative.

               Point No 2. In the partly affirmative.

              Point No 3. See final order.

 

REASONS

10 .Point No.1 and 2: The point No.1 and 2 are taken together to avoid the repetition of facts. The learned counsel for complainant argued that, as per evidence of PW-1 and Ex.C-1 to Ex.C-5 complainant has proved the deficiency of service committed by the OPs. The learned counsel for Op No.1 argued that, policy is repudiated due to false declaration filed and suppressing the material facts. The learned counsel for op No.2 argued that, no deficiency of service is committed and complainant is liable to repay the loan amount.

11. On careful perusal of all the documents and materials placed before the commission, complainant has filed affidavit and was examined as PW-1 and has reiterated the contents of the complaint.  PW-1 has stated that, husband of the complainant late Shri. Maruti Sheshagiri borrowed a housing loan from Op No.2 on 31.01.2018 as sum of Rs.15,66,859/- bearing an account No.012901147127 and Rs.9,29,384/- and got insured against both the loans with Op No.1, with a policy bearing No.JC 000038 Member No.18483 and 01JC0003804 77100. The insured member later  died on 10.01.2021.  The (deceased) Maruti Sheshagiri kept on paying all the installments promptly till he survived. Complainant is the only legal heir of deceased Maruti. Later Op No.2 demanded the complainant to pay the remaining balance loan amount for which the complainant requested Op No.2 to collect the outstanding loan amount from Op No.1, but OP No.1 denied the same. Therefore, the complainant got issued a Legal notice on 20.01.2022, but an evasive reply was given by the OPs. So, Ops have committed the deficiency of service. 

RW-1 has filed affidavit and reiterated the contents of the written version filed by OP NO.1. RW-1 has stated that, insurance cover has been obtained fraudulently by misrepresentation. Upon receipt of death claim intimation, immediately initiated the process of investigation and certain facts were discovered. Maruti was suffering from diabetes prior to submitting the application forms which was not disclosed in the application form. So. Life member has himself intentionally declared that, he is medically fit to avail the cover by suppressing material facts. In the  present case, Op No.2 Aadhar Housing Finance Ltd. was the master policy holder and had entered into policy contract with Op No.1 for issuance of two group scheme mainly. “DHFL Pramerica Group Credit Life +” Aadhar Shila.  Therefore, repudiated the above claim of the complainant. There is no any deficiency of service committed by the OP No.1.

RW-2 has filed affidavit and reiterated the contents of the written version filed by OP NO.2. RW-2 has stated that, The contention of Op No.2 is that, Op No.1 is a Insurance Company and there is no relationship between Op No.2 and Op No.1 both have separate identity. Op No.2 admits the loan transaction, but does not admit agreement or contract of insurance between the complainant husband (deceased) Maruti Sheshagiri and Op No.2. Op submits that, Maruti Sheshagiri during his life availed two loans 1) Loan Account No.19200001617 for Rs.15,66,859/- 2) Loan Account No.19200001629 for Rs.9,20,491/- and the complainant herself is the co-applicant to both the said loans. The Op submits that, it has tie up with Prameria Life Insurance Company and those who take the policy issued by the said company will get benefit of waiver of payments for further EMI’s by the Co-applicant in case of untoward incident to life of the primary borrower.  The Op contends that they are not party to the Insurance Policy issued by Op No.1 and deceased Maruti has not disclosed about diabetes to Op No.1, therefore, they have declined the claim and this Op has no knowledge about it.  Complainant being a legal heir and representative of the estate of the deceased Maruti is liable to repay the said loan amount. There is no any deficiency of service committed by the OP No.2.

          12. At the very outset, Ops have admitted that, deceased Maruti borrowed a housing loan of Rs.15,66,859/- and Rs.9,29,384/- from Op No.2 and got insured with Op No.1 for both the loans and the complainant is legal representative. The main contention of Op No.1 is that, Maruti fraudulently submitted declaration and suppressed the material facts that he was suffering from Diabetes prior to availing the said insurance cover, thereby they repudiated the claim of complainant. Ex.C-1 &
Ex.C-2 legal notice, Ex.C-3 Postal acknowledgement Ex.C-4 reply issued by Op No.2 and Ex.C-5 reply letter are not disputed by Ops.  The contention of OP No.2 is that there is no relationship between them and the insurance company, as they both have separate identity which is admitted by them at para-3 of written version and Op No.2 further, states that, they are not party to the insurance policy issued by Op No.1 to the borrower i.e. Maruti Sheshagiri (deceased) which can be perused at para No.3 of the affidavit. The statements of the Op No.2 are not stable as at one breath they denied the relationship and being a party to the said insurance policy, but at the other instance they admit at para No.5 stating that, this Op has a tie up with Pramerica Life Insurance Co. Ltd., and those who take the policy issued by the said insurance Company will get benefits of waiver of payments and further EMI’s by the Co-Applicant, in case of happening of any untoward incidence to the life of the primary borrower.  At para No.5 of the written version they admit having sanctioned a home loan and LAP loan against property and for the said loan it covers the insurance and for the said coverage premium is collected and at another point in their affidavit at para No.5 they state that, the borrower had not intimated about his diabetes illness and further existence of diabetes illness does not prevent the Op No.2 from disbursing the sanction loan amount, whether the deceased had intimated about his existing illness or not, it is not within the knowledge of this said Op No.2 and they are not a party to the discussion held between the complainant’s husband deceased Maruti and Op No.1.  For the above facts, the contention taken in the version of Op No.2 are contradictory and does not match their own statement, which cannot be believed.
As a master policy holder, when the sanctioned the loan and covered him for insurance and terminal illness, they should have done the medical of the insured member, if the said policy required, now they cannot shifting the responsibility.

          13. As far as Op No.2 Aadhar Housing Finance Ltd., is concerned, at one breath they say that they are not a party to the insurance contract and at other breath, they say that they have tie up with Op No.1. To substantiate, whether it is true or not, documents produced by Op No.1 Ex.Op-2, Ex.Op-3 and  Ex.Op-4 which reflexes that, the policy itself is a Group Insurance Policy and Maruti Sheshagiri the deceased is a insured member for the both the policies and the main Master policy holder is Aadhar Housing Finance Ltd., under DHPL Pramerica Group Credit Life + Aadhar Shila + UIN-140N039VO2. The first policy details are COI No.JC 00003800BTV00 for a terms of 5 years coverage sum assured is Rs.9,20,940/- in addition to terminal benefits Rs.1,34,372.82 premium paid is Rs.20,940/-, under policy name Pramarica Life Group Credit Life + Plan-A,  policy commences from 27.02.2018 to 26.02.2023.  The insurance covered is for loan against property and the loan account number is 1920001629 and the premium towards this insurance is funded by Master Policy Holder. Similarly, the second policy details are COI No.GC0000380477100 for a terms of 5 years coverage sum assured is Rs.15,66,858.00 in addition to terminal benefits Rs.2,13,904.98 under policy name Pramarica Life Group Credit Life + Plan-A, premium paid is Rs.30,580.67, coverage commences from 31.01.2018 to 31.01.2023 which is  towards home loan. In both the policies, which are covered under Group Scheme Sri. Maruti Revanappa Sheshagiri has been admitted as a member, issued to Aadhar Housing Finance Ltd., who is Master Policy Holder, under Master `policy No.GC000038 and the premium paid towards both the policies are funded by MPH i.e. Master Policy Holder, at the time of sanctioning the loan, as, there is a relationship between the Op No.2 and Op No.1. The details are found in Ex.Op-2, which are well come letter, Insurance policy details, abstract of  terms and conditions and benefits schedule.  Ex.Op-3 Proposal term, which are forwarded by Op No.2 Aadhar Housing Finance Ltd, as a Master Policy Holder, under their seal and signature.  Similarly, Ex.Op-4  the policy claims submitted through the Master Policy Holder Op No.2 to Op No.1 Insurance Company under their seal and signature on 25.02.2021.

For the above, it is crystal clear that, both the loans were sanctioned  by Op No.2 and were covered under Group Scheme themself as Master Policy Holder with Op No.1 and they had very well the knowledge about the insurance being done and there was a tie up with the insurance company which is proved.

          14. It is the duty of Op No.1 to  prove by adducing cogent evidence regarding the ground of concealment of pre-existing ailment of deceased Maruti.  Ex.Op-2 & Ex.Op-3 are well come letters, Insurance policy details, abstract of terms and conditions and benefits, benefit schedule insurance proposal form signed by MPH, Ex.Op-4 is Group insurance claim form which are not  disputed by the parties. Ex.Op-5 are Zerox copies of prescription issued by Dr. Kori’s Neuro Care Clinic, which reveals that, treatment given for diabetes. Ex.Op-5 are all zerox copies which are neither attested, nor true copies. Even, Op No.1 has neither produced the original of Ex.Op-5, nor examined the Author of the document or the Doctor, who issued Ex.Op-5. In the absence of original prescriptions or examining the author of the document Ex.Op-5, the contention of OP No.1 cannot be accepted. So, Op No.1 has not produced rebuttal evidence to show that, deceased Maruti was suffering from diabetes and he intentionally suppressed the material fact in declaration. Moreover, diabetes is not a serious disease and insurance claim cannot be denied on the ground of common life style diseases. Hon’ble NSDRC, and Hon’ble Apex Court repeatedly held that, diabetes and BP are not a serious disease for repudiating the insurance claim on such flimsy grounds.  The true fact on record is that insured died due to Heart Attack. Ex.Op-6 letter written to legal head, repudiating the claim, Ex.Op-7 death claim investigation report and Ex.Op-8 reply notice, are not sufficient to disprove the case of the complainant.  Even, investigator who submitted the report Ex.Op-7 is also not examined by Op No.1. Such being the case, mere contention raised in written version, without proving the oral and documentary reliable evidence, the act of Op No.1 repudiating the claim is not proper and correct.

          15. On perusal of all the above documents, and specifically the copy of insurance and the abstract of terms and conditions and benefits of the policy and the proposal application form and claim form which is insured under plan-A what is construed is as under:-

Master Policy Holder Means:- The person named in the schedule who has concluded this policy with the company with respect to insured members.

Nominee Means:- The person named in the membership register who has been nominated by the insured member in accordance with Sec.39 of Insurance Act, 1938 as amended from time to time to receive the benefits under the policy 

Terminal Illness Means:- Any condition from which the insured member is suffering which is likely to result in the death of the insured member within six month from the date of first diagnose of such terminal illness.

Benefits under Plan A        

a) Death benefit:- if, an insured member dies when his insurance coverage under the policy is inforce, the coverage inforce will be payable to the claimant.

b) Terminal illness benefits:- The terminal illness benefit shall be payable to the insured member by the company in accordance with the terms and conditions of the policy. The benefits amount shall be as specified in the COI above.

c) In case of death of the insured members, the benefit will be payable to the respective claimants:- In case of ATPD/TI the insured member shall have an option to issue an authorization in favour of the company to the effect that, in the unfortunate event of insured member death during the coverage term the claim amount, if any payable  under the policy shall first be utilized for payment to master policy holder for the outstanding loan amount as specified in master policy holders credit account statement and the balance amount, if any, payable under the master policy will be payable to the insured members nominees/legal heir or legal representatives are applicable to certain categories of Master policy holder. The eligible categories of master policy holders are RBI, schedule banks (Co-Operative Banks) NBFC’s having certificate of registration from RBI National House Board regulated housing finance companies in accordance with IRDAI guidelines as amended from time to time in all case, the death benefit shall be payable to the respective claimants. Therefore, as a master policy holder Op No.2 is responsible to get the claim settled through Op No.1 as he is the one who had concluded the proposal form and declaration is submitted under the seal and signature while getting the policy for the insured member with all the loan details about both the loans which can be perused at Ex.OP-2, Ex.OP-3 and even the claim form Ex.OP-4 which was very well in their knowledge claim is submitted on 25.02.2021 repudiation is after five months on 28.07.2021 and investigator started three months after repudiation claim.

          16. On perusal of the exclusions clause, there is no such condition, as regards to exclusion of diabetes is written/shown in the clause.  Therefore, Op under taking the declaration is only to avoid the claim without their being any exclusion clause shown in the abstracts terms and conditions of the policy.  Ongoing through the Ex.OP-7 the investigation report, the investigation was entrusted to Gold Stem investigation service Mr. Manish Acharya, who’s representative Mr. Rajendran was assigned the case on 07.06.2021. Investigator visited the insured house (deceased), on 20.06.2021 and collected all the information during investigation from insured place and final report was submitted on 24.06.2021. The cause of death shown is cardiac arrest.  The investigator as per his details he visited the doctor on 14.07.2021 i.e. after submitting the final report.  The details of the investigation are submitted by representative to the company Gold stem investigation services and Mr. Manish Acharya has filed an affidavit declaring the details given as true and correct on 06.06.2022 the investigation has taken long time and the affidavit filed by investigation company is after a period of one year and all the documents submitted are zerox copies. The investigator has not produced any original copies or what is the procedure followed, and what best efforts were made to obtain the documents is not found. After seeing the documents, it can be construed that during the investigation, he has obtained all the documents from the  complainant. All the documents produced by Ops Ex.OP-2 to Ex.OP-7 are all zerox copies, which are not sufficient to disprove the case of the complainant. The Onus was on the Ops, it is their bounden duty to prove by adducing cogent evidence. The terms and conditions of the policy itself, in the exclusion clause, neither mentioned about pre-existing disease (PED), nor there is mention about Sec.45 in the terms and conditions. The policy itself is only for a period of five years and policy had finished its period almost nearing three years at the time of the death of deceased. As per the assurance given by Op No.2 to the insured member the plan DHFL Pramerica Group Credit Life+, offers loan liabilities coverage for the nominee of defendant of the Group member in case of untimely death of the Group member.

          At the cost of repetition, it is said that, the object seeking Medi-claim and Medical Insurance is to seek indemnification of the illness. Even the insurance companies provide insurance for pre-existing medical disease after some waiting period.  In view of this repudiation of the claim shows the high handedness of the Op No.1, which has no concern at all to the ailing patients from whom the insurance companies are deriving business and surviving. Moreover, it is not a health policy, it is life policy issued for covering the home loan and property loan. Therefore, Op No. 1 & 2 have committed the deficiency of service.

          17. The learned counsel for complainant relying on a observation made by Apex Court, in Edition : 2020, Tomar’s Supreme Court Civil Referencer 2015-2019, wherein it is held as under:-

          Section 2 (1) (g) – Consumer – Insurance Claim – Housing loan – SBI Life insurance cover under Group Insurance Scheme for home loan borrowers – Death of borrower – Rejection of request to settle the insurance claim and to discharge the outstanding loan amount in house loan account – Deficiency in service – Condition precedent of acceptance of the premium was the medical examination – It would be logical for an underwriter to accept the premium based on the medical examination and not otherwise – By the very fact that they accepted the premium waived the condition precedent of medical examination.

        …….There is clear presumption of the acceptance of the proposal in favour of the proposer – Order of the National Commission dismissing the complaint liable to be set aside and the order of the State Commission restore.

 

          Facts, circumstances and ratio of the above decision is aptly applicable with case on hand, as Op No.1 accepted the premium waived  the condition precedent of medical examination.

 

          As per the decisions, in Sunita Goyal V/s Bajaj Allianz Life Insurance,  2018 (1) CPR 167 (NC) in Allauddin V/ Kotak Mahidra Old Life Insurance, 2017 (3) CPR 520 (NC), in SiddhanthKhare V/ Branch Manager SBI Life Insurance and Smt. Sunita V/s HDFC Standard Life Insurance Co., Ltd., and another, and IV (2011) CPJ 6 (P. Venkata Naidu V/s LIC of India, 2017 (2) CPR 658 (LIC of India V/s Sarojini and another, wherein, Hon’ble NCDRC, New Delhi, held that, U/Sec. 45 of Insurance Act, claim can be repudiated, if, it is proved that, assured knowingly and fraudulently  suppressed the material facts. Contractual duty on the insured is such that, any suppression untruth in proposal form will be considered as a breach of the duty of good faith will render the policy voidable by the insurer and also held that, ground of concealment of pre-existing ailment by deceased must be proved by insurance Co., by adducing cogent evidence.

          Facts, circumstances and ratio of the above decisions are aptly applicable with case on hand as, Op No.1 failed to prove by adducing cogent evidence.

Facts, circumstances and ratio of the above decisions are aptly applicable with case on hand as, Op No.1 failed to prove by adducing cogent evidence that, deceased died due to not sudden illness or sickness.

 In the written version Op No.1 as relying a decisions, P.C, Chacko and Anr. V/s Chairman, LIC India & Ors. Reported AIR 2008 SC 424, AIR 1991 SC 392 in LIC of India V/s Smt. G.M.Channabasamma, Kajol through Guardian Chander Kanta V/ LIC (II (2011) CPJ 104 (NC), Satwant Kaur Sandhu V/ New India Assurance Company Ltd., (2009) 8 SCC 316, United India Insurance Company V/s WKJ Corporation (1996)  6 SCC,  Modern Insulators Ltd V/s Oriental Insurance Ltd., (2000) 2 SCC 734,  on careful reading of the above decisions Hon’ble Supreme Court held that, while construing the terms of the contract of insurance, the court must give
para amount importance to the terms used in the said contract and it is not open for the court to add, delete any words.

 

With due respect of the above ratio, Court or Commission gave importance to the terms and conditions of the policy. However, facts and circumstances of the above decisions are not applicable with case on hand, as Op No.1 failed to prove the pre-existing disease.

           18. Op No.2 Aadhar Housing Finance being a master policy holder and had entered into policy contract with Op No.1 for issuance of two group scheme mainly. “DHFL Pramerica Group Credit Life +” Aadhar Shila. Such being the case Op No.2 did not make any efforts to claim the assured amount from Op No.1 even after knowing real facts for which the policy was taken towards. In addition to that Op No.2  repeatedly demanded the complainant to pay the entire loan amount borrowed by her husband instead of helping the complainant who is their esteemed customer, who is in a bereaved situation with nobody to support and Op No.2 being a responsible institution covered under RBI guidelines it becomes its bounden duty as a master policy holder to diligently get settled the outstanding dues through Op No.1 and help the complainant.  Therefore, Op No.2 has also committed the deficiency of service.

           19. For the above reasons, the complainant has proved that OPs have committed deficiency of service and she is entitled for the relief. Complainant being widow, has suffered mentally a lot, due to death of her husband and the repeated demanding  to pay the entire loan amount by Op No.2 and also the policy being repudiated by Op No.1, without reasonable grounds, therefore, she is entitled a sum of Rs.50,000/- towards mental agony and Rs.25,000/- towards cost of the litigation. Accordingly, we answer point No.1 in affirmative and point No.2 partly in affirmative. 

          20.    Point No.3:- In the result, we proceed to pass the following: 

ORDER

          The complaint filed U/Sec. 35 of  the consumer Protection Act, 2019 is hereby partly allowed against Op No.1 & 2.

Op No.1 is directed to settle the claim amount of   Rs.15,66,859/- and Rs.9,29,384/- pertaining to the deceased Maruti Revenappa Sheshagiri the insured member through Op No.2 Aadhar Housing Finance Ltd., who is the master policy holder and Op No.2 is directed to settle the outstanding dues along with accrued interest including other charges thereon, within two months from the date of this order.

Further, Op No.1 is directed to pay Rs.50,000/- towards mental agony and Rs.25,000/- towards cost of litigation, within a period of two months from the date of this order.

After settling the entire loan transaction and the balance amount, if any be paid to the insured members nominee i.e. the complainant.  The Op No.2 is directed to issue no due certificate within one month. 

          Office is directed to send the copies of this order to the parties free of cost.

           (Dictated to the Stenographer, directly on computer corrected and then pronounced by us in the Open Commission on this   4th  day of February-2023)

 

 

(Shri Raju N. Metri)      (Shri. D.Y. Basapur)   (Smt.Yashoda Bhaskar. Patil)

        MEMBER                 PRESIDENT              WOMAN MEMBER

 

 

 

 

-: ANNEXURE :-

 

EVIDENCE ON BEHALF OF COMPLAINANT/S:

PW-1: Smt. Laxmi @ Laxmibai W/o Maruti                                        

          Sheshagiri,

DOCUMENTS ON BEHALF OF COMPLAINANT/S

Ex.C-1 & 2: Legal notices

Ex.C-3 : Postal acknowledge.

Ex.C-4 & 5: Copy of legal notices.

EVIDENCE ON BEHALF OF OPs:

RW-1 : Yogesh Potdar,

RW-2: Channaverayya Mathapati

DOCUMENTS ON BEHALF OF OPs

Ex.OP-1 : Authorization letter.

Ex.OP-2 : Copy of welcome letter of pramerica Life Insurance Ltd.,

                Company.

Ex.OP-3 : Copy of application for Pramerica Group Credit Life.

Ex.Op-4 : Group Insurance Claim form.

Ex.OP-5 : Copy of Dr.Kori’s Neuro Care Clinic Prescriptions.

Ex.Op-6 : Copy of issue the letter to company secretary and

               legal head Mumbai. 

Ex.Op-7 : Copy of death claim investigation report.

Ex.Op-8 : Reply notice.

 

 

(Shri Raju N. Metri)    (Shri. D.Y. Basapur)   (Smt.Yashoda Bhaskar. Patil)

        MEMBER                 PRESIDENT              WOMAN MEMBER

 
 
[HON'BLE MR. D.Y Basapur]
PRESIDENT
 
 
[HON'BLE MR. Sri Raju Namadev Metri]
MEMBER
 
 
[HON'BLE MRS. Smt. Yashoda Bhaskar Patil]
MEMBER
 

Consumer Court Lawyer

Best Law Firm for all your Consumer Court related cases.

Bhanu Pratap

Featured Recomended
Highly recommended!
5.0 (615)

Bhanu Pratap

Featured Recomended
Highly recommended!

Experties

Consumer Court | Cheque Bounce | Civil Cases | Criminal Cases | Matrimonial Disputes

Phone Number

7982270319

Dedicated team of best lawyers for all your legal queries. Our lawyers can help you for you Consumer Court related cases at very affordable fee.