District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No. 494/2019.
Date of Institution:14.10.2019.
Date of Order:.28.08.2023.
Smt. Krishna Devi widow of late Shri Kulwant Singh R/o Village Kalsara The. Hathin District Palwal, Haryana.
…….Complainant……..
Versus
1. Future Generali India Life Insurance Company Limited, Corporate office at India Bulls Finance Centre, Tower-3, 6th floor, Senapati Bapat Marg Elphinstone (W) Mumbai – 400 013.
2. Future Generali India Life Insurance Company Limited, Branch office, 2nd floor, SCO No. 89, Sector-16, Shopping Complex, HUDA Staff Colony, Faridabad The & Distt. Faridabad.
3. Ms. Shweta Jain, Future Planning Advisor, Futue Generali India Life Insurance Company Limited, D/o Sh. Kulbhushan Jain r/o Main Market Palwal teh & Distt. Palwal.
…Opposite parties
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
Indira Bhadana………….Member.
PRESENT: Sh. Khagesh Goyal, counsel for the complainant.
Sh. Vijay Singh, counsel for opposite parties Nos.1 & 2.
Opposite party No.3 ex-parte vide order dated 09.03.2022.
ORDER:
The facts in brief of the complaint are that the husband of the complainant late Shri Kulwant Singh purchased a Life Insurance Policy with product name Future Generali Assured Money Back Plan, bearing its No. 01449297 from opposite party No.1 through opposite party No.3 (code No. 80152059) for herself. The customer ID was allotted as 60290299 qua the said policy by the opposite party No.` with product UIN No. 133N056V02. The said policy was non linked, non participating life insurance plan. Premium qua the said policy was to be paid for the continuous 12 years and the sum assured qua the said policy. The said policy was for a term of 17 years, the date of commencement of the said policy was 13.07.2018 with saving oriented plan. The premium was settled for Rs.93,906/- per annum and the date of last premium was to be paid upto 13.07.2029 The total premium was Rs.11,26,872/-. The husband of the complainant namely late Sh. Kulwant Singh paid a sum of Rs.98,132/- to the opposite party No.1 through opposite party No.2 for the first installment amount and a receipt to this effect was also issued to the husband of the complainant as receipt No. 14570253 dated 13.07.2018. All of a sudden late Shri Kulwant Singh was got ill on 31.07.20189 and he was taken to Guru Nanak Hospital at Palwal where he remained admitted for 2 days and thereafter he was referred by the doctors of Guru Nanak Hospital to Metro Hospital Faridabad for his further treatment. Late Shri Kulwant Singh remained admitted therein Metro Hospital at Faridabad upto 16.08.2018 in MICU. The doctors at Metro Hospital at Faridabad conducted all the possible measures to save the life of Kulwant Singh during his treatment but unfortunately he expired on 16.08.2019 on about 9.45am. Towards the above said treatment of late Shri Kulwant Singh the complainant also spent huge amount of Rs.6,74,399/- in order to save the life of her husband but all in vain. The complainant being the nominee of her deceased husband qua the life insurance policy stated in para No1 & 2 of this compliant filed her claim alongwith all annexed documents as well death certificate of her deceased husband which were duly received the opposite parties. As per the terms and conditions of the policy and the plan chosen by the deceased husband of the complainant, (option B) the illustration of benefit was also provided the opposite party No.1 alongwith the policy, the wife of the complainant being nominee was liable to be paid a sum of Rs.14,40,000/- against the benefit as stated in the said policy. The complainant visited the office of opposite party No.1 at Faridabad to submit the claim papers but the opposite party No.1 and the same were duly received by the opposite party No.2. All the queries related to death were duly replied by the complainant each and every paper requisite to the opposite parties were also handed over and policy with the relevant documents were also sent to opposite party No.1. Thereafter the complainant made enquiries about the status of her claim and but it was stated by the opposite parties at Faridabad and Palwal that the claim work was in progress and in a short span of time the claim would be settled and amount would be released to the complainant. The aforesaid act of opposite parties amounts to deficiency of service and hence the complaint. The complainant has prayed for directions to the opposite parties to:
a) pay Rs.14,40,000/- to the complainant on account of claim towards the said claim policy of Shri Kulwant Singh alongwith 15% interest till realization.
b) pay Rs. 50,000/- as compensation for causing mental agony and harassment .
c) pay Rs. 10,000 /-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 the policy under question Future Generali Assure Plus bearing No. 014449297 was issued on 13.07.2018 by the company on the basis of the information provided by the life assured in the proposal form dated 25.06.2018. Since the life assured had fraudulently suppressed his past medical history and disability from the proposal form, hence the company was well within its rights to repudiate the death claim preferred by the complainant. The repudiation of the death claim under the subject policy was on the grounds of fraudulent suppression of material information and furnishing of false information in the proposal form. The life assured at the time of filling up the proposal form did not disclose the correct information about his health and he deliberately and fraudulently failed to disclose that he was handicapped with his left leg and never informed the company before the issuance of the policy. Furthermore the disability certificate of the deceased life assured was issued on 18.02.2015 which clearly mentions that he was diagnosed of elephantiasis left lower limb with shortening of left limb by 3 inches and unable to work without any support. It also came to the knowledge of the company that the assured was even not a condition to walk without support and also was under treatment prior to his application for insurance despite being fully aware of the said disability/medical ailment and of his obligation to disclose the same in the proposal form. The said disability/medical history was prior to the application for the policy which was not disclosed in the proposal form. From the stated circumstances, it was evident that the life assured had given wrong information and suppressed material facts from the company, in order to fraudulently obtain the subject policy from the company. The life assured passed away within merely 34 days from the date of commencement of the policy and as such the company had rightly repudiated the claim preferred by the complainant. Insurance contracts were contracts based on “Utmost Good Faith” As per the contract the insurer was bound to honour the claim under the policy provided that the life assured at the time of applying for the policy had disclosed all relevant information accurately with regard to his disability health, habits, employment etc. which were the basis on which the insurer decides to cover the said life and at what rates. Since the life assured did not perform his duty to disclose all material information truthfully and correctly,
the contract of insurance between the company and the life assured was a void contact. Opposite parties Nos.1 & 2 denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
3. Opposite party No.3 put in appearance through counsel and filed written statement wherein Opposite party No.3 refuted claim of the complainant and submitted that the complainant had neither any cause of action nor locus standi to file the present complaint. The complainant had not approached this Hon’ble Forum with clean hands and had concealed and suppressed the true and material facts from this Hon’ble Forum. It was admitted to the extent that the policy issued by opposite party No.1 in favour of the deceased, the complainant was arrayed as nominee of the deceased in the said policy which was issued to the deceased through the answering opposite party. Opposite party No.3 denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
4. Case called several times since morning but none appeared on behalf of oppsoite party No.3. Therefore, opposite party No.3 was proceeded against ex-parte vide order dated 09.03.2022.
5. The parties led evidence in support of their respective versions.
6. We have heard learned counsel for the parties and have gone through the record on the file.
7. In this case the complaint was filed by the complainant against opposite parties–Future Generali & Others with the prayer to: a) pay Rs.14,40,000/- to the complainant on account of claim towards the said claim policy of Shri Kulwant Singh alongwith 15% interest till realization. b)pay Rs. 50,000/- as compensation for causing mental agony and harassment . c) pay Rs. 10,000 /-as litigation expenses.
To establish his case the complainant has led in his evidence, Ex.CW1/A – affidavit of Krishna Devi, Ex.C-1 – policy,, Ex.C-2 – Life Insurance application,, Ex.C-3 – Death summary,, Ex.C-4 – Request for death claim,, Ex.C-5 – death certificate, Ex.C-6 – Final bill, E. C- 7 & 8– Simplicity is…speaking your language.
On the other hand counsel for the opposite parties Nos. 1 & 2 strongly agitated and opposed. As per the evidence of the opposite parties Nos.1 & 2 Ex.RW1/A – affidavit of Shri Vishal Kumar, presently working as SM of future Generali India Life Insurance Company Limited having its branch office at SCO 4-5,2nd floor, Madhya Marg, Sector-8-c, Chandigarh, Ex.R-1 – Life Insurance Application, copy of policy schedule, first premium receipt and future new assured money back plan terms and conditions, Ex.R-3 – Request for death claim, Ex.R-4 – Disability certificate (Form II), Ex..T-5 repudiation letter dated 02.01.2019.
8. In this complaint, the complaint was filed by the complaint with the prayer to pay Rs.14,40,000/- to the complainant on account of claim towards the said claim policy of Shri Kulwant Singh alongwith 15% interest till realization.
9. After going through the evidence by the complainant as well as the opposite parties, opposite parties Nos.1 & 2 has repudiated the claim of the complainant on the ground of shortening of left limb by 3 inches vide repudiation letter dated 02.01.2019 Ex.R-5. The complainant has exhibited his documents Ex. -1 to C-8 to prove his case. After going the evidence led by the complainant cause of death is different. Hence, the repudiation is not justified. Resultantly the complaint is allowed,
10. Opposite parries Nos.1 & 2 are directed to process the claim of the complainant within 30 days from the date of receipt of the copy of order and pay the due amount to the complainant alongwith interest @ 6% p.a. from the date of filing of complaint till its realization. Opposite parties are also directed to pay Rs.2200/- as compensation for causing mental agony & harassment alognwith Rs.2200/- as litigation expenses to the complainant. Compliance of this order be made within 30 days from the date of receipt of copy of this order. File be consigned to the record room.
Announced on: 28.08.2023 (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharma)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
(Indira Bhadana)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
