Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 540.
Instituted on : 27.11.2015.
Decided on : 16.10.2018.
Smt. Sunita w/o late Sh. Phool Singh r/o H.No.409/1 Shastri Marg, Gali No.2, Indira Colony, Rohtak.
………..Complainant.
Vs.
- DLF Pramerica Life Insurance Company Ltd., 4th Floor, Building No.98, Cyber DLF City Gurgaon through its Manager.
- DLF Pramerica Life Insurance Company Ltd. Rohtak through its Branch Manager.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
SH. VED PAL, MEMBER.
SMT. SAROJ BALA BOHRA, MEMBER
Present: Sh.O.P.Chugh, Advocate for the complainant.
Sh.Gulshan Chawla, Advocate for the opposite party No.1.
Opposite party No.2 already exparte.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that husband of complainant had got his life insured from the opposite party vide policy No.000047636 for an amount of Rs.960000/-. That the husband of the complainant had died on 06.06.2011 and after his death, complainant filed the claim with the opposite party and completed all the required formalities. That despite her repeated requests, nothing has been paid to her. That the opposite party has issued a letter dated 29.07.2013 vide which claim of the complainant has been treated as no claim on the ground that husband of the complainant has withheld material information regarding depression at the time of affecting the assurance. That the plea taken by the opposite party is absolutely wrong and claim of the complainant is fully covered under the said policy. It is also submitted that husband of the complainant has also taken insurance policy of HDFC life amounting to Rs.10 lacs and claim under the said policy has already been paid to the complainant. That the act of opposite parties is illegal and amounts to deficiency in service. As such it is prayed that opposite parties may kindly be directed to pay Rs.960000/- alongwith other benefits, interest and litigation expenses as explained in relief clause.
2. After registration of complaint, notice was issued to the opposite parties. Opposite party No.1 filed its reply submitting therein that the complaint is liable to be dismissed and the same has been filed beyond the limitation period of 2 years. That the complainant was informed regarding rejection of his claim vide letter dated 29.07.2013 and the complaint has been filed on 27.11.2015 beyond the period of limitation. On merits it is submitted that on receipt of the claim intimation, answering opposite party without any delay appointed an Independent Investigator and as per investigation, it was found that the DLA was suffering from acute depression before filling up the proposal form, which was deliberately concealed from the opposite party at the time of filling up of proposal form. That the DLA had consumed eight tablets of salfas which is a prudent human will not consume under ordinary circumstances applying sanity of mind and because of which the claim was rejected by the opposite parties. Thus the opposite parties had repudiated the claim of the complainant. There is no deficiency in service on the part of OP and dismissal of complaint has been sought. OP no.2 was proceeded against exparte vide order dated 18.11.2017 of this Forum.
3. Ld. counsel for the complainant has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C6 and closed his evidence. On the other hand, ld. counsel for OPs tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R8 and closed his evidence.
4. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
5. After going through the file and hearing the parties it is observed that in the present case the deceased LA has purchased the policy on dated 31.12.2010 and the sum assured was Rs.960000/-/. L.A.died on 06.06.2011 and a claim was filed by the complainant Smt. Sunita wife of deceased LA. The claim of the complainant was repudiated by the insurance company on dated 29.07.2013. In the present complaint the respondent counsel advanced an arguments on the following grounds: Firstly, that the complaint is highly time barred because the claim of the complaint was repudiated on dated 29.07.2013 and the present complaint has been filed by the complainant on 27.11.2015. Secondly on the point of territorial jurisdiction and submitted that the deceased LA died in Sirsa, the policy was purchased from Sirsa and intimation regarding death has been submitted in Gurgaon office. So this Forum has no territorial jurisdiction to entertain the present complaint. That there is no office of the respondents’ life insurance company situated at Rohtak.
6. After considering the objections made by the respondent counsel and bare perusal of the all relevant documents we came to the conclusion that firstly the claim of the complainant was repudiated on 29.07.2013 whereas as per the complainant she received the letter on dated 18.04.2015 from HDFC Life Insurance Company i.e Ex.C1. She received an amount of Rs.10 lacs as death claim of deceased LA because the deceased has a policy from HDFC life Insurance Company. After considering this letter the new cause of action arisen against the respondent because they have wrongly repudiated the claim of the complainant on the flimsy grounds. The legal notice was immediately issued to the respondent office by the complainant’s counsel on dated 11.05.2015 so after considering the above mentioned facts we came to the conclusion that the complaint is not time barred because a fresh cause of action arisen to the complainant.
7. Regarding the territorial jurisdiction, the complainant’s counsel submitted that the complainant had filed the claim form at Rohtak and initiated proceedings at Rohtak. He also mentioned the residential address of Rothak. Complainant also received no claim letter at Rohtak. Moreover the respondent officials issued letter Ex.R3, Ex.R5 and Ex.R6 to the complainant at her residential address at Rohtak. So the present Forum has jurisdiction to entertain the complaint.
8. The main question whether the complainant is entitled for claim regarding the death of deceased LA, the respondent officials investigated the matter through NNB Investigation Pvt. Ltd. In the investigation, the investigator visited to the different doctors and chemist shops in District Sirsa and other places. As per investigation report itself, neither any doctor nor chemist made any statement that the deceased LA was treated regarding depression and he never take any medicine of depression from any chemist shop. Moreover as per the investigator itself an OPD card of LA dated 16.05.2011 is annexed with the investigation report as Annexure F which is not with the investigation report and on the case file. If this fact that the deceased LA took treatment from AIIMS Hospital Delhi on 16.05.2011, this fact also does not favour the version of the respondent that the deceased LA was suffering from depression at the time of purchase of policy because the policy was purchased on 31.12.2010 is also against the OP. After considering the above mentioned facts we came to the conclusion that the complainant and LRs of the deceased are entitled for the claim amount.
9. We also perused the investigation report, claim form and the complaint filed by the complainant. In the present complaint, the complainant is not a nominee of the deceased LA. In fact the perusal of Ex.R1 proposal form itself shows that Shubham Saini son of deceased is the nominee and the complainant is merely an appointee in the proposal form but perusal of the complaint itself shows that this fact has not been disclosed by the complainant herself in the complaint or affidavit or have not placed on record the list of LRs of the deceased on the file. As per Ex.R1 and investigation report i.e. Ex.R6 itself shows that the complainant is the wife of deceased LA and Ms. Sakshi is daughter and Shubham (nominee) is son of deceased LA. In this way it is proved that complainant intentionally concealed the material facts from the Forum, but in the interest of justice, the amount be awarded to the LRs of the complainant.
10. In view of the facts and circumstances of the case, we hereby allow the complaint and direct the opposite parties jointly and severally to pay Rs.960000/-(Rupees nine lacs sixty thousand only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e.27.11.2015 till its actual realization and shall also pay a sum of Rs.2000/-(Rupees two thousand only) as litigation expenses to the complainants maximum within one month from the date of decision. It is made clear that 50% share of the awarded amount will be paid to the son of deceased namely Shubham, 30% share of the awarded amount will be paid to the daughter of deceased namely Sakshi and remaining 20% share of awarded amount will be paid to the complainant i.e. wife of deceased namely Sunita, all the alleged amounts alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 27.11.2015 till its actual realization respectively to the complainant and LRs as explained above.
11. Copy of this order be supplied to both the parties free of costs.
12. File be consigned to the record room after due compliance.
Announced in open court:
16.10.2018.
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Nagender Singh Kadian, President
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Ved Pal Hooda, Member.
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Saroj Bala Bohra, Member.
