District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No.274/2019.
Date of Institution: 30.05.2019.
Date of Order: 01.08.2022.
1. Smt. Meena Devi aged about 40 years wife of late Jai dev Bhatt son of Shri Ishwar Dev Bhatt.
2. Yash Bhatt aged about 18 years.
3. Piyush Bhatt minor aged about 15 years both sons of late Jai Dev Bhatt, minor complaint No.3 through his mother (complainant No.1) next friend and natural guardian Smt. Meena Devi wife of late Jai Dev Bhatt so of Shri Ishwar Devi Bhatt All R/o Block –C, 27 ft. road, House No. 8, Dabua Basti, ward No. 8, Faridabad, Haryana – 121001 Adhar No. 4879 9033 3370 Mobile Jo. 9210258128.
…….Complainant……..
Versus
1. DHFL Pramerica Life Insurance Limited, 4th floor Building NO.2, Cyber City, DLF City, Phase-III, Gurugram – 120202 Haryana. Through its Manager.
2. DHFL Pramerica Life Insurance Limited, Branch office: Second floor, SCO-3, Sector-16, Faridabad – 121002 Haryana through its Branch Manager.
3. Dewan housing Corporation Limited,, DHFL C-93, 9th floor, Himalaya House, K.G.Marg, Connaught Place, New Delhi – 110 001.
…Opposite party……
Complaint under section-12 of Consumer Protection Act, 1986
Now amended Section 34 of Consumer protection Act 2019.
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
PRESENT: Sh. R.C.Parashar, counsel for the Complainant..
Sh. Jayant Pawar, counsel for opposite parties Nos.1 & 2.
Opposite party No.3 ex-parte vide order dated 25.02.2020.
MUKESH SHARMA, MEMBER,
ORDER:
The facts in brief of the complaint are that the husband of the complainant No.1 namely Jai dev Bhatt son of Shri Ishwar Dev Bhatt applied for a loan from the accused No.3 for Rs.14,14,350/- vide loan No. 1487661 dated 30.04.2017 which was repayable within the period of 15 years and the EMI of Rs.16,534/- was payable by the husband of the complainant No.1 to opposite party No.3. At the time of sanctioning the loan the opposite party NOs.1 & 2 was engaged by opposite party No.3 as insurer after the consent of husband of the complainant No.1 and opposite party No.3 had charged the premium amount of insurance for the year 2017-18 and 2018-2019. Later on the opposite parties Nos.1 & 2 issued the insurance policy No. GC000006N895800 under Plan Group DHFL Pr-America Group credit Life Plus Plan “A” in the name of husband of the complainant No.1 for the total insured amount of rs.14,14,350/-. The husband of the complainant No.1 paid the amounts of installments with opposite party No.3 and premium insurance from time to time to the opposite parties. The husband of the complainant No.1 expired on 28.09.2018 and the intimation in this regard was given by the complainant No.1 to the opposite parties on 29.09.2018. The complainant No.1 requested the opposite parties to make the payment of insured amount of Rs.14,14,350/- and the opposite parties demanded the application and original documents of the insurance policy, premium, death certificate, copy of the PMR, Copy of passbook of bank account form the complainant No.1. opposite parties rejected the claim of the complainants vide their letter dated 03.01.2019 on the ground that the information of the illness was not mentioned in the application. Thus the opposite parties rejected the claim of the complainants on the false and baseless ground. The aforesaid act of opposite party amounts to deficiency of service and hence the complaint. The complainant has prayed for directions to the opposite parties to:
a) make the payment of insurance amount to make the payment of insurance amount of Rs.14,14,350/- alongwith interest @ 24% per annum form the date of due till upto date to the complainants jointly & severally.
b) pay Rs. 2,00,000/- as compensation for causing mental agony and harassment .
c) pay Rs. 11,000 /-as litigation expenses.
2. Opposite parties Nos.1 & 2 put in appearance through counsel and filed written statement wherein Opposite parties Nos.1 & 2 refuted claim of the complainant and submitted that it was submitted that the Deceased Life Assured availed the home loan of Rs.14,14,347/- for 4 years from opposite party No.3 and to secure the said loan liability shown his willingness to avail the insurance policy “DHFL Pramerica Group credit Life Plus Plan” in which opposite party No3 was the Master Policy Holder. It was submitted that the DLA after completely understanding the terms and conditions of the policy applied for the same vide Application No. 01487661 dated 30.04.2017 for a sum assured of Rs.14,14,347/- i.e equivalent to the outstanding loan amount, for which a single premium amounting to Rs.14,459.57/- was proposed to be paid and the Coverage Term was of 4 years, In the said proposal form, the deceased was the Life Assured and his wife namely Smt. Meena Devi was the nominee. The DLA had given all relevant details and information in the prescribed form. It was pertinent to note that the DLA after understanding all the terms and conditions which was duly explained to him, had sighed the proposal form. It was further submitted that while declaring about the status of his health and medical problems through questions and answer i.e in Yes/No; the life assured in reply to medical questionnaire on page No.2 of the proposal form, had replied in negative for all the options. For a ready reference, they were extracting therein below the aforesaid questions and the replies thereto in the said application:
(ii) Have you even suffered or are currently suffering from any of the following:-
…….
f) disease or disorder of the kidney, digestive system, (stomach, pancreas, gall bladder, intenstines), liver, hepatitis B or HIV/AIDS infection : No.
g. Diabetes : No.
h. High blood pressure : No.
Based on the information and declaration containing in the application form and further believing the same to be true and upon receipt of the duly filled form alongwith the Single Premium, the opposite party had issued the certificate of insurance bearing No. GC000006N895800 under DHFL Pramercia Group Credit Life + being the deceased as life insured member based on the information furnished by the life insured in the said application, the said application was accepted by the opposite party and policy was issued to the Life insured on 30.04.2017 and coverage commencement dated 30.04.2017,. Further the nominee/complainant herein under the policy, informed the opposite parties Nos.1 & 2 about the said demise of life assured and submitted the claimant’s death alongwith death certificate and other documents, which was received by the opposite party. Thereafter as a matter of practice, an investigation was carried out by the opposite party through Third Eye Investigations Pvt. Ltd., Durn investigation it revealed to the opposite party that the deceased life assured was suffering from heart disease (Akinetic inferior and Posterior Wall Severely Hypokinetic with LVEF 30-35%) as well as kidney disease prior to apply for the subject policy and the diseased life assured failed to disclose the aforesaid ailments suffered and the past treatment undergone by him. It was submitted DLA and nominee were aware of the ailments with an intention to grab monetary gain had suppressed the material medical facts. It was pertinent to mention that the insurance contract being a contract of utmost good faith such non-closure of material medical facts renders the contract void ab-intio. It was found during investigation that DLA was suffering from and had undergone with kidney function test on 05.06.2013 and later on he was admitted in Fortis Hospital on 07.06.2016 and diagnosed with “Facial Abscess Right Side with facial Cellulitis”. It was submitted that had the said information being disclosed in the application form at the time of taking policy, the opposite party would not have issued the policy to DLA at the first instance. Considering all the foregoing facts which were transpired during investigation, the opposite party repudiated the claim due to non disclosure of material information pertaining to medical adversities suffered by him. The aforesaid affidavit and investigation of the opposite party clearly shows that the deceased was suffering from heart and kidney disease and disorder on the date of applying for the policy, however concealed the said fact from the opposite parties Nos.1 & 2 in his application form and wrongly gave his declaration that all information in the application were true and correct. The said disease and disorder was in very much existence ever prior to apply for the policy in question by the life assured. The life assured and nominee obtained the policy by suppressing and concealing the material fact and which suppression being led to issue the policy on account of suppression of material facts and gross representation by the life assured and thus opposite parties Nos.1 & 2 rightly repudiated the claim of the complainant and duly informed complainant vide its repudiation letter dated 03.01.2019. The said claim was repudiated and premium amount of Rs.14,459/- paid by DLA was refunded back to master policyholder i.e opposite party No.3 towards full and final settlement in respect of said COI, who shall in turn refund the same to the complainant. Opposite parties Nos.1 & 2 denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
3. Registered notice was sent to opposite party No.3 on 17.01.2020 received back served alongwith tracking details. Case called several times since morning. But none appeared on behalf of opposite party No.3. Therefore, opposite party No.3 was proceeded against exparte vide order dated 25.02.2020.
4. The parties led evidence in support of their respective versions.
5, We have heard learned counsel for the parties and have gone through the record on the file.
6. In this case the complaint was filed by the complainant against opposite parties – DHFL Pramerica Life Insurance Limited with the prayer to a) make the payment of insurance amount to make the payment of insurance amount of Rs.14,14,350/- alongwith interest @ 24% per annum form the date of due till upto date to the complainants jointly & severally. b) pay Rs. 2,00,000/- as compensation for causing mental agony and harassment. c) pay Rs. 11,000/- as litigation expenses.
To establish his case the complainant has led in his evidence, Ex.C-1 – affidavit of Smt. Meena Devi,, Ex.C-1 - Certificate of insurance, Ex.C-2 – letter dated Jan.03,2019, Ex.C-4 – Attach following to this Form, Ex.C-5 – list of
documents submitted, Ex.C-6 – Revised loan amount and the revised terms and conditions,, Ex.C-7 - processing fees – housing loan & non housing loans. Ex.C-8 - Most important terms and conditions (MITC), Ex.C-9 Revised letter of offer cum acceptance, Ex.C-10 – Revised loan amount and the revised terms and conditions, Ex.C-11 & 12 – Post Mortem Examination Reports, Ex.C-13 – attach the following to this form,, Ex.C-14 – death certificate, Ex.C-16 - not readable, Ex.C-17- letter, Ex.C-18 – covering page of pass book,, Ex.C-19 – attach the following to this Form,, Ex.C-20 – certificate of insurance, Ex.C-21 – post Morem report dated 29.09.2018,, Ex.C-23 to C26 – payment receipts, Ex.C-27 & C-28– Adhaar cards, Ex.C-29 – legal notice, Ex.C-30 to C-32 -postal receipts.
On the other hand counsel for the opposite party No.1 strongly agitated and opposed. As per the evidence of the opposite party No.1 – affidavit of Shri Sahil Mahajan working as Manager – legal at Pramerica Life Insurance Ltd. (Erstwhile known as DHFL Pramerica Life Insurance Company Ltd.) situated at 4th floor, Building No. 9, Tower B, Cyber City, DLF City, Phase III, Gurgaon, Ex.OP-1W-11 – Certificat eof Incorporation Pursuant to change of name, Ex.OP-1-W/2 – Special power of attorney, Ex.OP1-Q-1/3 – application form, Ex.OP-1-W-1/4 – letter dated 30.04.2017 regarding welcome letter,, Ex.OP-1W-1/5 – Group Insurance Claim Form,, Ex.OP-1W-1/6 (colly) – letter dated 5th June 2013,, Ex.OP-1W-1/7 – not readable, Ex.OP-1-W-1/8 – legal notice.
Shri Jayant Pawar, counsel for OP Nos./1 & 2 has made a statement that OP Nos.1 & 2 both are the same parties hence, kindly read the evidence affidavit of OP No.1 as also on behalf of opposite party No.2.
7. It is evident from payment receipt vide Ex.C-25, the DLA (Deceased
Life Assured) had paid an EMI of Rs.16,534/- to the opposite party vide receipt No. 0981561 dated 17.08.2018 to maintain his claim of said policy. But unfortunately the DLA passed away after a few days on 29.09.2018. Hence, in this situation the right of DLA to take advantage of the policy on account of such premium being paid remained. If the opposite parties wanted proper information about the health of their client, they should have made arrangement to check the health of DLA. But without doing so, the opposite parties accepted the amount of premium which is an indication that they have ignored the issue of health checkup of the DLA. Similarly the return of the amount of premium by the opposite parties Nos.1 & 2 to opposite party No.3 on 03.01.2019 after the death of DLA is not justified vide Ex.C-2.
Counsel for the complainant has placed on reliance the following authorities:
- Manmohan Nanda Vs. United India Assurance co. Ltd. and Another passed by the Hon’ble Supreme court of India in Civil Appeal No. 8386/2015 Decided on December 6,2021.
b) D.Srinivas Versus SBI Life Insurance Co. Ltd. and Ors. Passed by the Hon’ble Supreme Court of India in Civil Appeal No. 2216 of 2018 (Arising out of SLP© NO. 14021 of 2017), D/D. 16.2.2018.
Ratio of the above authorities are applicable to the facts of the present case.
8. After going through the evidence led by parties, the Commission is of the opinion that the complaint is allowed. Opposite parties are directed to process the claim of the complainant within 30 days of receipt of the copy of order and pay the due amount to the complainant along with interest @ 6% p.a. from the date of filing of complaint till its realization. The opposite parties are also directed to pay Rs.2200/- as compensation on account of mental tension, agony and harassment alongwith Rs.2200/- as litigation expenses to the complainant. The opposite parties are liable jointly and severally to comply with the orders. Copy of this order be given to the parties concerned free of costs and file be consigned to record room.
Announced on: 01.08.2022 (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharm)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
