Punjab

Ludhiana

CC/21/267

Amandeep Kaur - Complainant(s)

Versus

Future Generali India Life Insurance Co.Ltd. - Opp.Party(s)

M.S.Sethi

01 Feb 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No:267 dated 17.05.2021.                                                         Date of decision: 01.02.2024.

 

Amandeep Kaur W/o. Late Okar Singh, R/o. H. No.209, Village Basti, Dharamkot, Moga, Punjab-142042.                                                                                                                                                    ..…Complainant

                                                Versus

1. Future Generali India Life Insurance Co. Ltd., Indiabulls Finance Centre, Tower-3, 6^th Floor, Senapati Bapat Marg, Elphinstone (W), Mumbai-400013 through authorized signatory.
2. Future Generali India Life Insurance Co. Ltd., 2^nd Floor, Sandhu Towers, Ferozepur Road, Ludhiana, Punjab-141001 through authorized signatory.
3. Rajiv Kalra, Insurance Advisor c/o. Future Generali India Life Insurance Co. Ltd., 2^nd Floor, Sandhu Towers, Ferozepur Road, Ludhiana, Punjab-141001.                                                                                                                                                                      …..Opposite parties 

Complaint Under section 35 of the Consumer Protection Act, 2019.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

SH. JASWINDER SINGH, MEMBER

MS. MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         None.

For OP1 and OP2          :         Sh. V.S. Mand, Advocate.

For OP3                         :         Complaint against OP3 stands already                                                         dismissed as withdrawn vide order dated                                                    01.07.2021.

 

 

ORDER

PER SANJEEV BATRA, PRESIDENT

1.                In brief, the facts of the case are that the husband of the complainant Sh. Okar Singh (hereinafter called as DLA) purchased a Future Generali Assured Income Plan policy No.01512978 for sum assured of Rs.19,50,000/- towards yearly premium of Rs.62,700/- for 15 years having date of maturity as 24.03.2024. Representative of the OPs collected all the details from Okar Singh but no documents were alleged to be signed from him. The Ops supplied the policy No.01512978 along with copy of computerized copy of application form bearing sr. No.IA0010549 dated 22.03.2019. The complainant stated that during 1^st year of policy, Okar Singh died on 14.11.2019 and this fact was confirmed by the doctors. The complainant further stated that claim was lodged with the OPs along with some other policies taken from the OPs and also submitted claim documents but the OPs issued a letter dated 17.12.2019 in the name of DLA on the policy No.01512978 stating that the company had conducted investigation to verify the bonafides of the facts mentioned by the life assured in the proposal form for insurance. Our investigation has established that the Life assured had not disclosed previous insurance history on the proposal form. Vide letter dated 17.12.2019, the OPs further asked the DLA to supply certain documents within 7 days from receipt of said letter. According to the complainant she visited OP2 and submitted available documents to official Mandeep Sharma as claimed vide letter dated 17.12.2019 in two other policies. Then the OPs vide letter dated 10.01.2020 addressed to Okar Singh DLA, repudiated the claim on the grounds reproduced as under:-

“Thanks you for showing interest for Life Insurance Policy in Future Generali Life Insurance Company. With reference to your application number D00217644 and D00143914 dated 31/03/2019 and 16/11/ 2018 , we would like to share the following facts

Based on application D00217644 & D00143914, we have recently known that you have already covered for significantly high sum assured with multiple insurers and few of those proposals were rejected by other Insurer which was not disclosed to us in the above proposal.

A notice to this effect was issued to you by the Company on 17th December 2019 seeking explanation and you were given a timeline of seven working days for revert. The notice was received at your end on 26th December 2019 however you haven't come back to us on the same.

Considering the non-disclosed information regarding insurance details received now, we are unable to continue the cover under your policies that were issued basis information received in the proposals than. These policies will be made null and void and Company will not be on any risk on the said policies.

You will appreciate that all the information sought by the Company through the proposal form is material in nature and needs to be answered correctly. Please note as per Section 45 of the Insurance Act, the insurance company has right to call the policy in question if in its opinion the proposed/insured has misrepresented/concealed or represented incorrect facts to the Company.

Thus, based on the aforesaid information and non revert to the notice issued to you, the Company has a reason to believe that you have not revealed the facts and information which was material for the assessment of risk by the Company.

We, therefore, through this letter inform you that your above policy contracts are terminated and no benefits shall be payable. Premiums paid will be refunded back to you shortly.”

                   The complainant further averred that the OPs had not applied their mind properly and efficiently while issuing letter dated 27.12.2019 and 10.01.2020 as the same were issued in name of the DLA rather same were required to be addressed to her being nominee. Even the repudiation letter dated 10.01.2020 was wrongly issued on the ground that medical document is fake. The complainant further stated that she visited OP2 with demanded documents and clarification as sought in letter dated 17.12.2020 which was written against the policies No.01512978 and 01476687 on the basis of so-called proposal form dated 22.03.2019 towards policy named Future Generali Assured Income Plan – Annual bearing No.01512978 and Future Generali Assured Money Back Option B under policy 01476687 dated 14.11.2018. Whereas the OPs did not disclose the proposal form bearing sr. number in letter dated 17.12.2019 rather in repudiation letter dated 10.01.2020, the OPs disclosed the application form bearing sr. No.DO0217644 dated 31.03.2019 and sr. No.D001439 dated 16.11.2018 without disclosing policy numbers. According to the complainant, no such proposal form bearing sr. No.D00217644 dated 31.03.2019 was ever signed by DLA rather policy No.01512978 was issued on the basis of application no.IA0010549 dated 22.03.2019. The OPs sent copy of application bearing Sr. No.IA0010549 dated 22.03.2019 along with policy schedule of policy No.01512978 reflected in application bearing sr. No.IA0010549 dated 22.03.2019. As such, the OPs are debarred to take shelter of so-called proposal form which was never supplied nor signed by the DLA and also the same was not the part of application form bearing sr. No.IA0010549. The complainant further stated that the OPs created so-called proposal form bearing sr. No.D00217644 dated 31.03.2019 for repudiating the claim. However, the date of commencement of policy as well as risk was w.e.f. 24.03.2019 but the proposal form as disclosed by the OPs is dated 31.03.2019 which amounts to unfair trade practice on the part of the OPs. According to the complainant the application form No.IA0010549 is not hand written rather is computerized typed and column 1.24 of disclosing of insurance of other insurance company was left blank and same was not filled. As such, the OPs are debarred from take defence of non-disclosing of policies of other insurance companies for repudiation of the claim after death of DLA. The complainant further stated that no material information was concealed by the DLA. Further the OPs were competent to refuse to issue the policy but they issued the policy in question in favour of the DLA. The act and conduct of the OPs amounts to deficiency in service and adoption of unfair trade practice.  The DLA had paid yearly sum of Rs.62,700/- including taxes etc. till his death being premium to the OPs. Now the OPs are liable to pay the guaranteed claim amount of Rs.19,50,000/- being sum assured along with other benefits. In the end, the complainant has prayed for setting aside the repudiation letter dated 10.01.2020 to be illegal, arbitrary and also for issuing direction to the opposite parties to settle and pay the claim of Rs.19,50,000/- being guaranteed sum assured with benefits. The complainant further prayed for issuing directions to the OPs to pay compensation of Rs.5,00,000/- and litigation expenses of Rs.22,000/-.

2.                The complaint as against OP3 was dismissed as withdrawn by the complainant vide order dated 01.07.2021.

3.                Upon notice, OP1 and OP2 filed joint written statement and by taking preliminary objections, assailed the complaint on the ground of maintainability of the complaint, suppression of material facts by the complainant; lack of jurisdiction and cause of action etc. OP1 and OP2 stated that Sh. Okar Singh committed a breach of principle of UTMOST GOOD FAITH by suppressing the material facts that he had huge life insurance cover prior to taking policy in question. Further the insurer has to disclose all the material facts while obtaining the insurance policy. OP1 and OP2 stated as per section 45 of the Insurance Act, 1938, they conducted a pre-claim investigation and after careful evaluation of the records obtained during such investigation, it was found that the life assured had knowingly and intentionally not disclosed about his previous insurance with other companies and that he had over insured himself to the tune of Rs.Seven Crore including the present disputed policy. Further during the investigation, it was found that DLA had not disclosed other insurance policy that were proposed/taken by him prior to issuance of the policy in question in the proposal form at the time of issuance of the policy in question. As such, on the basis of findings of general industry check, a show cause notice dated 17.12.2019 was issued to DLA for explaining the reason of non disclosure within 7 days which the DLA did not respond. As such, on 10.01.2020, they confirmed converting the policy in question as valid policy and also mentioned that the Company shall not be liable to cover any risk under the policy.  

                   Under the column Brief Facts of the case, OP1 and OP2 reiterated the facts mentioned in the preliminary objections. However, OP1 and OP2 stated that that they received a duly filled and signed proposal form No.1A0010549 by the DLA for Future Generali Assured Income Plan for annual premium of Rs.62,700/-, on the basis of which policy No.01512978 commencing from 25.03.2019 was issued, the detail of which is reproduced as under:-

Application No.	IA0010549
Policy Number	01512978
Policy Plan	Future Generali Assured Income Plan
Life Assured	Mr. Okar Singh
Owner/proposer	Mr. Okar Singh
Premium	Rs.62,700/-
Premium Frequency	Annual
Proposal Date	22-March-2019
Proposal Received Date	22-March-2019
Risk Commencement Date	25-March-2019
Policy Issue Date	25-March-2019
Policy Dispatch Date	29-March-2019 through India Post
Policy received details	05-April2019
Airway Bill Number	RM062223025IN

The policy documents were sent at the address of the DLA. The opposite parties also submitted the detail of the policies purchased by the insured before the policy in question, which is reproduced as under:-

Company Name	Policy Number	Sum Assured	Risk Commencement date
Bajaj Allianz	330580012	3500000	28-Oct-16
HDFC	18900131	3500000	05-Nov-16
Exide Life	3434963	2600000	05-Nov-16
Edelweiss Tokio	000077490E	6500000	05-Jan-17
ICICI Prudential	22157581	5400000	04-Apr-18
Aviva India	10380696	1500000	18-Jul-18
SBI	2F358600308	3500000	21-Jul-18
Aegon	180814827070	3500000	21-Aug-18
Canara HSBC	1500763011	3500000	24-Aug-18
Aviva India	10386099	5000000	08-Oct-18
Max Life	521251751	544000	29-Oct-18
Max Life	564589976	3000000	02-Nov-18
Exide Life	3434963	5000000	17-Nov-18
RNLIC	53344614	164729	17-Nov-18
Canara HSBC	9100416375	3000000	19-Nov-18
Canara HSBC	9100416376	3000000	19-Nov-18
Star Union Dai-ichi	1263055	3000000	19-Nov-18
Edelweiss Tokio	000077505E	2500000	26-Nov-18
Canara HSBC	9100416378	3500000	27-Nov-18
RNLIC	53348356	3500000	30-Nov-18
Aegon	180815000000	1000000	04-Dec-18
Bajaj Allianz	352623201	1000000	04-Dec-18
Star Union Dai-ichi	1268922	3000000	13-Dec-18
Edelweiss Tokio	000035824E	2500000	06-Feb-19

         

The OPs further submitted the details of the total policies taken by the DLA, which are reproduced as under:-

Company Name	Policy Number	Sum Assured	Risk Commencement date
Bajaj Allianz	330580012	3500000	28-Oct-16
HDFC	18900131	3500000	05-Nov-16
Exide Life	3434963	2600000	05-Nov-16
Edelweiss Tokio	000077490E	6500000	05-Jan-17
ICICI	22157581	5400000	04-Apr-18
FGI	1512978	1950000	12-Apr-18
Aviva India	10380696	1500000	18-Jul-18
SBI	2F358600308	3500000	21-Jul-18
Aegon	180814827070	3500000	21-Aug-18
Canara HSBC	1500763011	3500000	24-Aug-18
Aviva India	10386099	5000000	08-Oct-18
Max Life	521251751	544000	29-Oct-18
Max Life	564589976	3000000	02-Nov-18
FGI	1475318	2000000	09-Nov-18
FGI	1476687	200000	16-Nov-18
Exide Life	3434963	5000000	17-Nov-18
RNLIC	53344614	164729	17-Nov-18
Canara HSBC	9100416375	3000000	19-Nov-18
Canara HSBC	9100416376	3000000	19-Nov-18
Star Union Dai-ichi	1263055	3000000	19-Nov-18
Edelweiss Tokio	000077505E	2500000	26-Nov-18
Canara HSBC	9100416378	3500000	27-Nov-18
RNLIC	53348356	3500000	30-Nov-18
Aegon	180815000000	1000000	04-Dec-18
Bajaj Allianz	352623201	1000000	04-Dec-18
Star Union Dai-ichi	1268922	3000000	13-Dec-18
Edelweiss Tokio	000035824E	2500000	06-Feb-19
Canara HSBC	9100416374	1950000	23-Mar-19
	Total	Rs.7,93,08,729.00

The complainant had lodged the claim under the policy on 10.01.2020 and the same was much before the issuance of show cause notice and the policy was cancelled on the same day the claim was raised. Proposal form shows that the DLA has committed malafide act. OP1 and OP2 further stated that the complainant had induced and mislead them to issue the policy in question by suppressing the material facts. Thus the DLA had committed breach of doctrine of UTMOST GOOD FAITH by giving false details regarding previous insurance policy/proposal. According to OP1 and OP2, they have refunded the premium of Rs.62,700/- to the complainant vide NEFT-UTR No.012300862GN00119 dated 23.01.2020 itself per section 45 of the Insurance Act, 1938 and now the complainant is not entitled to any further benefits under the policy or the compensation.

                   On merits, OP1 and OP2 reiterated the crux mentioned in the preliminary objections and brief facts of the case. OP1 and OP2 have denied that there is any deficiency of service and have also prayed for dismissal of the complaint.

3.                In support of her claim, the complainant tendered her affidavit Ex. CA in which she reiterated the allegations and the claim of compensation as stated in the complaint. The complainant also tendered documents Ex. C1 is the copy of the policy schedule, Ex. C2 is the copy of proposal form, Ex. C3 is the copy of letter dated 17.12.2019, Ex. C4 is the copy of letter dated 10.01.2020, Ex. C5 is the copy of death certificate of Okar Singh, Ex. C6 is the copy of Aadhar card of the complainant and closed the evidence.

4.                On the other hand, counsel for OP1 and OP2 tendered affidavit Ex. RA of Ms. Reena Kamath, Manager – Legal, Future Generali India Life
Insurance Company Limited, having its registered office at Unit 801 and 802, 8^th Floor, Tower C, Embassy 247 Park, B.S. Marg, Vikhroli (W), Mumbai along with documents Ex. R1 is the copy of customer declaration form, Ex. R2 is the copy of insurance application, Ex. R3 is the copy of insurance policy/documents, Ex. R4 is the copy of letter dated 17.12.2019, Ex. C5 is the copy of letter dated 10.01.2020, Ex. R6 is the copy of Email dated 27.06.2021, Ex. R7 is the request for death claim and closed the evidence.

5.                During the course of proceedings of the complaint, on 11.01.2024, Sh. M.S. Sethi, Advocate counsel for the complainant suffered statement having no instructions from the complainant to contest the case further and withdrew his power of attorney filed on behalf of the complainant. Accordingly, a fresh notice was issued to the complainant but neither the complainant nor anyone on her behalf turned up today.

6.                We have heard the arguments of the counsel for OP1 and OP2 and also gone through the complaint, affidavit and annexed documents and written reply along with affidavit and documents produced on record by both the parties. We proceed to decide the case on merits.

7.                The complainant, being wife and nominee of DLA Okar Singh, has raised a grievance with regard to repudiation letter dated 17.12.2019 Ex. C3 = Ex. R4 regarding death claim of LA Okar Singh. Admittedly, DLA was a holder of Future Generali Assured Income Plan policy No.01512978 Ex. C1 = Ex. R3, for sum assured of Rs.19,50,000/- towards yearly premium of Rs.62,700/- for 15 years having date of maturity as 24.03.2024. DLA had obtained this policy by submitting proposal form Ex. C2 = Ex. R1 wherein he had evaded to answer the relevant questions truthfully with regarding to holding of earlier insurance policies.

8.                Acting upon the information so received by OP1 and OP2, the insurance policy was issued and the policy/schedule documents Ex. C1 = Ex. R2 were issued to the DLA. The DLA died on 14.11.2019 and the complainant being his nominee, preferred a death claim with the insurance company vide death claim Ex. R7. During the settlement of the claim, OP1 and OP2 carried out a pre-claim investigation and found that the DLA has obtained multiple insurance policies from them as well as from other insurance companies, the list of which has been given hereinabove. On the basis of that pre-claim investigation, OP1 and OP2 vide letter dated 17.12.2019 Ex. C3 = Ex. R4 called upon to for written response regarding incorrect/incomplete information provided in the proposal form along with documents, which are reproduced as under:-

• Birth certificate of life assured
• Medical papers for treatment undergone.
• SSC, HSC Passing certificate of life assured
• ITR filled by Life Assured for last 5 years
• Last 5 years statement of all bank accounts held by the Life Assured.
• Additionally, we also call upon details of other life insurance & general insurance policies held by the Life Assured, if any.

 

As the complainant did not give any response to the letter dated 17.12.2019 and as such, OP1 and OP2 vide letter dated 10.01.2020 Ex. C4 = Ex. R5 terminated the policy contracts. The operative part of letter dated 10.01.2020 is reproduced as under:-

“Thank you for showing interest for Life insurance Policy in Future Generali Life Insurance Company. With reference to your application number IA0010549 & D00143914, dated 25/03/2019 & 15/11/2018, we would like to share the following facts:

Based on application IA0010549 & D00143914, we have recently known that you were already covered for significantly high sum assured with multiple insurers and few of those proposals were rejected by other insurer which was not disclosed to us in the above proposal.

A notice to this effect was issued to you by the Company on 17th December 2019 seeking explanation and you were given a timeline of seven working days for revert. The Notice was received at your end on 26th December 2019 however you haven't come back to us on the same.

Considering the not disclosed information regarding insurance details received now, we are unable to continue the cover under your policies that were issued basis information received in the proposals then. These policies will be made null and void and company will not be on any risk on the said policies.

You will appreciate that all the information sought by the Company through the proposal form is material in nature and needs to be answered correctly. Please note, as per Section 45 of the Insurance Act, the insurance Company has right to call the policy in question if in its opinion the proposer/insured has misrepresented/concealed or represented incorrect facts to the Company.

Thus, based on the aforesaid information and non-revert to the notice issued to you, the Company has a reason to believe that you have not revealed the facts and information which was material for the assessment of risk by the Company.

We, therefore, through this letter inform you that your above policy contracts are terminated and no benefits shall be payable. Premiums paid will be refunded back to you shortly.”

OP1 and OP2 have claimed in their written statement that they have refunded the premium of Rs.62,700/- to the complainant vide NEFT-UTR No.012300862GN00119 dated 23.01.2020 in view of section 45 of the Insurance Act, 1938 and now the complainant is not entitled to any further benefits under the policy or the compensation.

9.                Further perusal of record shows that DLA stated to have been died on account of “natural death” on 14.11.2019 i.e. after about 8 months from the issuance of the policy. Death certificate of DLA is Ex. C5. It is pertinent to mention that DLA was born on 01.01.1978 and at the time of obtaining the policy he was aged about 40-41 years and at the time of death, he was about 41 years of age. The complainant did not elaborate any facts and circumstances leading to natural death of DLA in a comparatively younger age nor any affidavit of herself or of any attendant was produced in whose presence DLA breathed his last. Even no medical document was brought on record to show that DLA was taken to some hospital before he was declared dead or brought dead. The complainant was required to dispel suspicion with regard to “natural death” of DLA.

10.              It is settled proposition of law that the contract of insurance is based upon the principle of  ‘Uberrima Fides’ and both insurer and insured are under legal obligation to provide the correct and authenticated information at the time of the policy. The information regarding holding of earlier prior insurance policies, age, proof of income and medical history are some of the criteria which are to be disclosed truthfully by the proposer. In the present case, the opposite parties had sought intimation from the DLA with respect of previous multiple policies which was not disclosed and suppressed the material facts.

11.              In its judgment Satwant Kaur Sandhu Vs New India Assurance Co. Ltd. Civil Appeal No.2776 of 2002 decided on 10.07.2009, the Hon’ble Supreme Court of India has held that if there was clear suppression of material facts in regard to the health of the insured, the insurer was fully justified in repudiating the insurance contract. The Hon’ble Supreme Court of India has further held in Reliance life Insurance Co. Ltd. and others Vs Rekhaben Nareshbhai Rathod in 2019 (2) R.C.R. (Civil) 909 that two months prior to policy obtained from appellant insured obtained policy from another company and this fact was not disclosed by the insured. Repudiation was made within two years period from commencement of insurance cover. The proposer was aware of contents of form that he was required to fill and disclosure of material for assessment of risk which was being taken by insurer which entitled the insurer to repudiate the claim. Moreover, the complainant has not filed any rejoinder controverting the facts mentioned in the written statement by challenging the pre-claim investigation conducted by the OPs. As such, the repudiation of the claim of the complainant is justified.

12.              As a result of above discussion, the complaint fails and the same is hereby dismissed. However, there shall be no order as to costs. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

13.              Due to huge pendency of cases, the complaint could not be decided within statutory period.

 

 

 

(Monika Bhagat)          (Jaswinder Singh)                      (Sanjeev Batra)                       Member                     Member                                       President         

 

Announced in Open Commission.

Dated:01.02.2024.

Gobind Ram.