Punjab

Faridkot

CC/21/119

Baljeet Kaur - Complainant(s)

Versus

HDFC LIC - Opp.Party(s)

Kiranpreet Kaur Dhaliwal

24 Jan 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, FARIDKOT

 

Complaint No. :     119 of 2021

Date of Institution:  03.08.2021

Date of Decision :   24.01.2024

 

Baljeet Kaur aged about 29 years wife of Gurpreet Singh deceased, resident of Rulia Singh Nagar, Village Bargari, Jaitu, Tehsil Jaitu, District Faridkot.

                                                                                        ...Complainant

Versus

 

HDFC Life Insurance Company Limited, Registered Office : Lodha Excelus, 13^th Floor, Apollo Mills Compound, N M Joshi Marg, Mahalaxmi, Mumbai 4000011 through its Managing Director/Director/Manager/ Authorized Person.                            

.......OP

Complaint under Section 35 of the

Consumer Protection Act, 2019.

                       

Quorum:     Smt Kiranjit Kaur Arora, President,

Sh Vishav Kant Garg, Member.

 

Present:       Ms Kiranpreet Kaur, Ld Counsel for complainant,

Sh Neeraj Maheshwary, Ld Counsel for OP.

                     

 

CC-119 of  2021

ORDER

(Kiranjit Kaur Arora, President)

                                          Complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against OP seeking directions to OPs to make payment of insurance claim on account of death claim of her husband, who was insured with OP against insurance policy bearing no.22538178 and for further directing OP to pay Rs.50,000/- as compensation for harassment, inconvenience, mental agony and litigation expenses of Rs.10,000/-.

2                                        Briefly stated, the case of the complainant is that on 06.05.2020, Gurpreet Singh deceased husband of complainant purchased Insurance Policy bearing no.22538178 under HDFC Life Click 2 Plan for sum assured of Rs.14,40,000/-and paid premium. Complainant was made nominee in said policy. Policy term was 15 years and at the time of purchase OP assured her late husband that since the date of inception of policy if anything unforeseen happens to the life of insured, then his nominee would be entitled to get sum insured of Rs. 14,40,000/-  under Policy in question. It is submitted that unfortunately, husband of complainant died on 14.05.2020 and complainant duly informed about his death to the OPs

                       CC-119 of  2021

and lodged claim with them. Complainant provided all the documents required by OPs like original policy documents, adhaar card, Pan Card etc  and they assured to settle the claim within short period, but till the completion of two years, OP did not pay even a single penny to clear the insurance claim. Complainant approached OP and made request to them to settle the claim but they finally refused to pay the claim vide letter dated 23.03.2021 on the ground that “From investigation, it is established that the life assured has other insurance company’s proposals/ policies which were declined/ withdrew/cancelled on the basis of adverse findings on health aspects and misrepresentation of policy”. OP repudiated the claim of complainant on false ground. Allegation levelled by Ops for repudiation of genuine insurance claim of complainant, is false, frivolous and has no  ground. Complainant made several requests to OPs to clear the insurance claim, but all in vain. Claimed that all this amounts to deficiency in service and trade mal practice. Complainant has prayed for accepting the present complaint with directions to OP to make payment of sum insured to complainant on account of death

                     

 

CC-119 of  2021

of her husband and has further prayed for compensation for harassment and mental agony suffered by him besides expenses incurred by him on present litigation. Hence, the present complaint.

3                                             The counsel for complainant was heard with regard to admission of the complaint and vide order dated 10.08.2021, complaint was admitted and notice was ordered to be issued to the opposite parties.

4                                          Ld Counsel for OP filed written statement taking legal objections that complainant has not disclosed or impleaded legal heirs of deceased Gurpreet Singh as party to present complaint and has concealed the material facts from this Commission as deceased life assured died on 14.04.2020 but it was manipulated to show as 14.05.2020 and even he had other insurance policies that were declined, withdrawn or cancelled on the basis of health grounds and misrepresentation. It is admitted that answering OP repudiated the claim of complainant vide letter dated 23.03.2021. Moreover, it is stressed that answering OP has refunded the amount of Rs.22,323.69 in to the account of complainant under due intimation to her vide letter dated 26.03.2021. It is averred that complainant is not their

CC-119 of  2021

consumer and she has no locus standi to file the present complaint. However, on merits, OP has denied all the allegations of complainant being wrong and incorrect and asserted that policy in question has been procured after the death of life assured by concealing the material facts from them. It is reiterated that there is no deficiency in service on the part of answering OP and all the allegations levelled by complainant alongwith allegations for relief sought too are denied being wrong and incorrect and made prayer for dismissal of complaint with costs.

5                                    Parties were given proper opportunities to prove their respective case. Ld counsel for complainant tendered into evidence affidavit of complainant Ex C-1 and documents Ex C-2 to Ex C-6 and then, closed the evidence on behalf of complainant.

6                                    To controvert the allegations of complainant, ld counsel for OP tendered into evidence affidavit of Gurpreet Singh Ex OP-1 and documents Ex OP-2 to Ex OP-11 and then also closed the same on behalf of Opposite Party.

 

 

 

CC-119 of  2021

7                                     We have carefully perused and gone through the evidence and documents produced by complainant party.                          

8                                  From the careful perusal of record and going through the affidavits, evidence and pleadings of the complainant, it is observed that grievance of complainant is that her husband was insured with OP under the policy in question and during the validity of insurance period, he died and after his death, complainant submitted claim alongwith bills and documents to OP, but  OP did nothing needful in making payment of genuine insurance claim to her. On the other hand plea taken by OP is that DLA died on 14.04.2020 but his death was shown on 14.05.2020 and even policy in question was procured by concealing the health issues and by misrepresentation. As per OP, it rejected the claim of complainant vide letter dated 23.03.2021 and even OP has already made refund of Rs.22,323.69 in to the account of complainant and in this regard letter dated 26.03.2021 was duly sent to complainant.

9                                 It is well proved and clearly evident from the record made available by the complainant that deceased husband of complainant was insured with OP against policy in question and it

CC-119 of  2021

cannot be denied that insured died during the subsistence of said policy. It is evident from the record that OP has nothing to contradict                         the allegations of complainant that despite repeated requests by complainant, OP has not made payment of insurance claim on account of death of her husband to her. It is clear enough that complainant is duly entitled for the insurance claim as there is nothing on record to justify the repudiation of the genuine claim of the complainant.  

10                             It is sufficient for this Commission to hold in the present case that it was bounded duty of the Insurance Company to have verified information given in proposal form. Moreover, the OP neither brought any documents in evidence nor any witness before the Commission regarding the mandatory condition of disclosure of the earlier Insurance Policies taken by the Deceased Life Assured and about its effect. It is also evident that in the Insurance Policy, which is placed on file as Ex C-2, there were no terms and conditions according to which the insured was duty bound to disclose any insurance policy previously taken by him. In the absence of any such kind of evidence, the OP cannot escape from the their liability of

CC-119 of  2021

making payment of insurance claim. In the light of death certificate Ex C-5 that is issued by Registrar of Births & Deaths, there does not remain an iota of doubt that death of DLA occurred on 14.05.2020. Opposite party has nothing to challenge this document. In the absence of any authentic proof in respect of wrong date of death, plea taken by OP that deceased had died on 14.04.2020, has no legs to stand upon. It is observed that in the  absence of any cogent proof of wrong death date, it is hard to believe that the insured (now deceased) had died on 14.04.2020.

10                                It is further observed that policy in question commenced on 06.05.2020,  DLA died on 14.05.2020 it was  admitted to be repudiated by OP on 23.03.2021 on the ground that life assured had other insurance policies that were declined due to adverse findings on his health and misrepresentation of policy. As per OP date     of death of complainant falls prior to commencement of insurance policy i.e 14.04.2020  and Op refunded the amount of Rs.22,323.69 on 26.03.2021, meaning thereby, after a long period of about more than 10 months, taking sufficient time to find ways to decline the death claim of deceased life assured.

CC-119 of  2021

11                                It is clear enough that complainant is duly entitled for the insurance claim as there is nothing on record to justify the repudiation of the genuine claim of the complainant. In the absence of any authentic proof challenging the Death Certificate issued by Registrar of Births and Deaths, plea taken by OP that death certificate produced by complainant on account of death of her husband is manipulated and is not genuine, has no legs to stand upon. This is totally unrealistic reason for repudiating the claim as OP has failed to prove this. OP duly accepted the premium and on receipt of information regarding death of husband of complainant, OP intentionally refunded the premium amount after retaining the same for a long period of about 10 months to avoid making the payment of insurance claim on account of death of husband  of complainant. OP has raised unreasonable, meaningless objections. By repudiating the          claim of complainant on false grounds, OP cannot escape from their liability of making payment of genuine insurance claim to the complainant. Complainant has placed on record sufficient and cogent evidence to prove his pleadings and all documents placed on record by complainant are authentic and are beyond any doubt.

CC-119 of  2021

12                                  From the above discussion, it is made out that there is deficiency in service on the part of OP in repudiating the insurance claim to complainant on account of death of her husband, who was insured with OP against policy in question. Therefore, complaint filed by complainant stands hereby allowed with direction to OP to pay the death claim of Rs.14,40,000/-less Rs.22,323.69 (already paid by them to complainant) to the nominee of deceased. Opposite party is further directed to pay Rs.3,000/-to complainant as consolidated compensation for harassment and mental agony suffered by her and for litigation expenses incurred on present complaint.

13                             Compliance of this order be made within 45 days of the receipt of the copy of the order, failing which complainant shall be entitled to interest over aforementioned award amount at the rate of 6% from the date of filing the present complaint till final realization.

14                             Complaint could not be decided within stipulated period due to incomplete quorum and heavy pendency of work.

 

 

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15                             Copy of the order be supplied to complainant as well as opposite party free of cost as per rules.

16                              File be consigned to record room.

Announced in Commission

Dated : 24.01.2024

 

                  

                      Member                                         President

                      (Vishav Kant Garg)              (Kiranjit Kaur Arora)