Haryana

StateCommission

A/338/2020

PNB METLIFE INDIA INSURANCE CO. LTD. - Complainant(s)

Versus

CHARANJIT KAUR AND ANOTHER - Opp.Party(s)

SANJEEV GOYAL

04 Aug 2021

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                               

                                      First Appeal No.338 of 2020

                                                          Date of Institution:20.08.2020                                              Date of Decision:04.08.2021

 

1.      PNB MetLife India Insurance Co. Ltd, 1^st Floor, Techniplex 1, Techniplex Complex, Off Veer Sawakar Flyover, Goregaon West, Mumbai-400062, through its Chairman/Authorised Signatory.

2.      PNB MetLife India Insurance Co. Ltd., 2^nd & 3^rd Floor, SCO 68-69, Sector 17-B, Chandigarh. Both through their authorised signatory Mr. Pardeep Basra, Authorised Signatory PNB MetLife India Insurance Company Limited, available at branch office, SCO-68/69, 2^nd Floor, Sector 17-B, Chandigarh.

…..Appellants

Versus

 

1.      Charanajit Kaur widow of Shri Sandeep Kumar, R/o Village Sunarian, Post Office Babain, District Kurukshetra.

2.      Punjab National Bank, Babain (Kurukshetra) through its Branch Manager.

 

…..Respondents

 

Present:-             Mr. Nitin Gupta, Advocate for the appellants.

                            

CORAM:             Hon’ble Mr. Justice T.P.S Mann, President.

                             Mr. Harnam Singh Thakur, Judicial Member.

 

O R D E R

 

HARNAM SINGH THAKUR, JUDICIAL MEMBER

 

          Delay of 159 (One Hundred Fifty Nine) days in filing the present appeal is condoned for the reasons stated in the application for condonation of delay itself as well as in the interest of justice.

2.                It has been alleged by complainant-appellant that complainant’s husband Sh. Sandeep Kumar (since deceased) had obtained a PNB MetLife Insurance policy bearing No. 21124235 having plan of Insurance Met Money Back for a sum assured of Rs 3,00,000/- from the Ops on 22.07.2013 and paying regular installment. He had also obtained another policy from Ops bearing No. 21912316 for a sum assured of Rs. 12,00,000/-. During the continuation of said policies, her husband suffered heart attack and expired on 15.06.2016. Complainant being nominee and legal heirs of Sh. Sandeep Kumar, lodged a claim alongwith all the documents. A surveyor appointed by the Ops, who visited her house and recorded her statement and of Sh. Brij Bhan, Numberdar of village. Complainant received a letter dated 23.09.2017 in which Ops mentioned that Lt. Sh. Sandeep Kumar was suffering from Liver and Kidney problems and took treatment from PGI, Rohtak prior to issuance of policy. However, her husband was quite hale and hearty and was not suffering from any disease. Neither he was admitted in PGI, Rohtak nor taken any treatment from there. It is further alleged that in spite of submitting all the requisite documents, the OPs failed to do so. Thus, there was deficiency in service on the part of OPs.

3.                The complaint has been resisted by the Ops No. 1 & 2 by alleging that the policies were issued by the Ops on the basis of information provided by the deceased life assured (in short “DLA) in the proposal form dated 16.07.2013 and 01.06.2016 respectively. The information provided by the DLA in the respective proposal forms were established to be incorrect by the Ops. Hence, the Ops repudiated the said claim of complainant. The policy bearing No. 21912316 commenced on 02.06.2016 and DLA died on 15.09.2016 just within 13 days from the date of commencing of policy. During the investigation, it was found that DLA was suffering from Liver and Kidney problems before the date of proposing the policies in question. He was getting treatment from BBC Hospital Shahabad, PGI Chandigarh, and also at Singhal Nursing Home. So, it is evident that he had given wrong information and suppressed the material facts from the Ops. Thus, there was no deficiency in service on the part of OPs and prayed for dismissal of the complaint.

4.               After hearing both the parties by the learned District Consumer Disputes Redressal Commission, Kurukshetra (In short “District Commission”) allowed the complaint of complainant against Ops No. 1 & 2.

5.               Feeling aggrieved therefrom, appellants-respondents has preferred this appeal.

6.                The arguments have been advanced by Sh. Nitin Gupta, counsel for appellants-respondents. With his kind assistance the entire records had been properly perused and examined.

7.                During the course of arguments, it is contended by learned counsel for appellants that impugned order dated 27.01.2020 is incorrect on both facts and law. Learned District Commission ignored the fact that complainant has not approached the Commission with clean hands and has suppressed true and material facts by concealing previous ailment of DLA. Learned District Commission has wrongly observed that appellant did not produce any documentary evidence to prove that DLA was suffering from Liver and Kidney problems prior to taking the policies. It has failed to appreciate that appellant filed application under RTI Act to PGI Rohtak for providing medical record of DLA. However, PGI authorities asked the appellant to provide consent from complainant for supplying the medical record. Thereupon, appellants sent letter to complainant for consent but she did not revert to the letter. Moreover, learned District Commission has arbitrarily dismissed the application for summoning the relevant medical record from PGI, Rohtak.

8.                It is further contended by learned counsel for appellants that DLA died on 15.06.2016 just within 13 days from the commencing the insurance policy bearing No. 21912316 with effect from 02.06.2016. In support of his arguments learned counsel placed reliance upon “Hon’ble National Consumer Disputes Redressal Commission in case of LIC of India & Anr. Vs Balbir Kaur 1 (2009) 212 (NC), Hon’ble State Consumer Disputes Redressal Commission Punjab in Life Insurance Corporation of India Vs Smt. Piari Devi & Others, II (2008) CPJ 156 and by Hon’ble Uttarakhand State Consumer Disputes Redressal Commission in LIC of India Vs Radhika Devi, III (2008) CPJ 226, wherein it has been held that the very fact of early claim is a good corroborative evidence to prove misrepresentation, material non-disclosure or contemplation of death.

9.                It is further contended by learned counsel for appellants that the insurance contracts are based on the doctrine of  Uberrimae Fides and life assured is under a legal and solemn obligation to disclose all material facts correctly, honestly and truthfully to the insurance company at the time of obtaining the policy failing which the contract is rendered void. In support of his arguments, learned counsel placed reliance upon “Reliance life Insurance Co. Ltd. Versus Rekhaben Nareshbhai Rathore 2019 (2) CPJ 53, Life Insurance Corporation of India Versus Manish Gupta in Civil Appeal No. 3944 of 2019 arising out of SLP (C) No. 5001 of 2019 decided on 15.04.2019 & Meenaben Ashok Kumar Patel Versus Life Insurance Corporation of India, 2012 (2) CLT 415 (NC), wherein it has been held that in the contract of insurance is a contract of “Uberrimae Fides” proposer/life assured under obligation to make true and full disclosure of statement within his knowledge and in case of non disclosure the repudiation of the claim is justified. It is submitted by learned counsel for appellants that impugned order passed by learned District Commission may be set aside by accepting the appeal.

10.              After hearing learned counsel for appellants and careful perusal of the impugned order and record of learned District Commission, we are of the considered view that above-mentioned contentions raised by learned counsel are devoid of legal force

11.              At the outset, it is the contention of learned counsel for appellants that DLA was suffering from Liver and Kidney diseases which were not disclosed by him at the time of filling of form. Thus, he has committed breach of trust with appellant-insurance company but this contention is not much convincing because appellant has failed to prove on record that deceased was suffering from Liver and Kidney problems. No doubt he made efforts to collect some information from PGI, Rohtak and other hospitals but unable to do so. Similarly, his application to summon the medical record from PGI, Rohtak and other hospitals was rightly rejected by learned District Commission on the ground that no details of DLA treatment has been mentioned in the said application. Moreso, it is the case of complainant that DLA died of heart attack but appellant failed to corelate the suffering of heart attack by DLA due to Liver and Kidney diseases. Another plank of arguments advanced by appellant is that DLA died within 13 days of taking policy bearing No. 21912316 dated 02.06.2016. However, this argument is also bereft of legal force because DLA had not only taken the above said policy bearing No. 21912316 dated 02.06.2016 but admittedly before that he had taken another insurance policy bearing No. 21124235 dated 22.07.2013 for a sum of Rs. 3 lakhs. Now, when DLA was taking second life insurance policy from the same company and that too for a much higher amount then it was bounden duty of appellant-company to verify his status of health through medical check-up before issuing second policy.

12.              In these circumstances, it is immaterial whether DLA died within 13 days and after 3 years of taking the insurance policies. The authorities (supra) relied on by learned counsel for appellants are not applicable to the facts and circumstances of the case in hand because appellant-insurance company failed to prove that DLA suffering from Liver and Kidney problems before taking the above said policies and he concealed the material fact of his pre-existing disease. It is pertinent to mention that even the investigation report prepared by the investigator of the appellant-insurance company is also not on the record.

13.              As a sequel to above discussion, we do not find any illegality or perversity in the impugned order passed by learned District Commission. Present appeal is devoid of any merits and the same is hereby dismissed in limine without any order of costs.
File be consigned to the records.

 

August 04^th, 2021                 Harnam Singh Thakur                       T.P.S. Mann                                                  Judicial Member                               President      

Manoj