Punjab

Ludhiana

CC/23/356

Pardeep Singh - Complainant(s)

Versus

HDFC Life Ins.Co.Ltd - Opp.Party(s)

Jyoti Sarup

07 Oct 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                             Consumer Complaint No: 356 dated 25.08.2023.                              Date of decision: 07.10.2024.

 

Pardeep Singh, Aged 28 years son of Late Dalwinder Singh son of Surjeet Singh, resident of VPO Malikpur Bet, Malikpur, Lludhiana.  

                                                                                      ..…Complainant

                                                Versus

1. HDFC Life Insurance, Ferozepur Road, SCO-41, 3^rd and 4^th Floor, Feroze Gandhi Market, Ludhiana through its Manager.
2. HDFC Standard Life Insurance Company Limited, Corporation and Registered Office: Lodha Excelus, 13^th Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai-400011.                                                                                                          …..Opposite parties 

Complaint Under Section 12 of the Consumer Protection Act.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

MS. MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. Jyoti Sarup, Advocate.

For OPs                          :         Sh. Nitin Kapila, Advocate.

 

ORDER

PER SANJEEV BATRA, PRESIDENT

 

1.                Briefly stated, the facts of the complaint are that in the month of May, 2016, father of the complainant Late Sh. Dalwinder Singh took life insurance policy No.18437321 from OP1 under HDFC Life Sanchay plan having UIN No.101N097V01 in which the complainant was a nominee. The policy was for a period of 15 years on premium of Rs.45,000/- per year, which the father of the paid in cash to the OPs. The complainant stated that at the time of issuing the policy, the OPs assured his father that there is no need of any medical test due to young age and his father was not medically examined. His father was having a good health at the time of getting the policy and even he was not suffering from any kind of ailment. Further the Ops assured his father that in case of any mis-happening, the company will pay the sum assured to the nominee of the policy holder. The complainant further stated that his father expired on 02.06.2016 at his residence at village Malikpur Bet. His death was natural and he was not suffering from any ailment. After death of his father, the complainant approached the OPs and gave intimation regarding death of his father. The complainant also submitted original policy, death certificate and other required documents as demanded by the OPs with assurance of passing of his claim very soon. However, when the complainant demanded  the return original policy, but OP1 refused to give the same.

                   The complainant further stated that on 08.10.2016, the OPs rejected his claim by mentioning that his father was suffering from cancer problem prior issuance of the policy. Even the OPs transferred Rs.43,424/- in his account without any intimation. According to the complainant, the OPs have rejected his claim without any reasonable cause and without giving any cogent reason. The complainant several times requested the OPs to pass his claim but they delayed the mater on one pretext or the other. Due to above said acts of the OPs, the complainant claimed to have suffered mental tension and agony. In the end, the complainant has prayed for issuing directions to the OPs to pay the claim of Rs.5,00,000/- and compensation of Rs.1,00,000/- and litigation expenses of Rs.25,000/-.

2.                The OPs appeared and filed joint written statement and assailed the complaint by taking preliminary objections on the ground of maintainability of the complaint; the complainant does not fall under definition of Consumer; lack of cause of action; the complainant has not come with clean hands; the complainant being estopped by his own act and conduct; concealment of material facts etc. The OPs stated that the policy No.18437321 was issued in favour of Dalwinder Singh and in the said policy, the deceased concealed the material facts from them at the time of issuing the policy. It was specifically asked that:

2	Have you ever suffered from or received treatment for, any symptoms or medical conditions for any of the following: Cancer, tumour, growth or cyst of any kind	No
4	Apart from minor ailments, such as cold and flu, have you received any treatment from any Doctor or specialist or been hospitalized or undergone hospital in the last 5 years?	No

The OPs further stated that the deceased denied of having suffered any such disease but after his death the claim was duly investigated and it was established  that the life assured was suffering from cancer buccal mucosa prior to the policy issuance and this was not disclosed in the policy dated 04.05.2016. The claim of the complainant was repudiated after due consideration vide letter dated 05.10.2016 and even the OPs refunded an amount of Rs.43,424/- in the account of the complainant.

                   On merits, the OPs reiterated the crux of averments made in the preliminary objections. The OPs have denied that there is any deficiency of service and has also prayed for dismissal of the complaint.

3.                In support of his claim, the complainant tendered his affidavit Ex. CA in which he reiterated the allegations and the claim of compensation as stated in the complaint as well as affidavit Ex. CB of Sh. Lakhvir Singh son of Ajit Singh, R/o. VPO Malikpur Bet, Malikpur, Ludhiana. The complainant also tendered documents i.e. Ex. C2 is the copy of death certificate of Dalwinder Singh, Ex. C3 is the copy of rejection letter dated 05.10.2016, Ex. C4 is the copy of welcome letter and policy documents and closed the evidence.

4.                On the other hand, the counsel for the OPs tendered affidavit Ex. RA of Sh. Arpit Higgins, Manager-Legal & Compliance of the OPs along with documents i.e. Ex. R1  is the copy of policy documents, Ex. R2 is the copy of repudiation letter dated 05.10.2016, Ex. R3 is the copy of final investigation report, Ex. R4 is the copy of death certificate of Dalwinder Singh, Ex. R5 is the copy of driving licence of Dalwinder Singh, Ex. R6 is the copy of Aadhar Card of the complainant, Ex. R7 is the copy of PAN Card of Dalwinder Singh, Ex. R8 is the copy of Aadhar Card of Dalwinder Singh, Ex R9 is the copy of account statement of the complainant, Ex. R10 is the copy of certificate of Sarpanch, Ex. R11 is the copy of authorization letter for obtaining documents, Ex. R12 is the copy of KYC details of the nominee/claimant, Ex. R13, Ex R14 are the copies of statements of Gurmit Kaur, Asha Worker, Village Malikpur, Ex. R15 is the copy of statement of the complainant, Ex. R16 and Ex. R17 are the copies of statements of Lakhvir Singh, Ex. R18 is the copy of test report of Mohandai Owsal Hospital, Ex. R19 is the copy of affidavit of Piyush Pandey, Investigator, Ex. R20 is the copy of authority letter in favour of Sh. Arpit Higgins and closed the evidence.

5.                The consumer complaint No.RBT/CC/828 of 2016, filed by the complainant was partly allowed by the Camp Court at Ludhiana vide its decision dated 16.06.2022. The complainant preferred First appeal No.1104 of 2022 as well as the OPs filed Misc. application  No.1183 of 2022 In/and First appeal No.762 of 2022 before the Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh which was allowed vide order dated 24.07.2023 vide which the order dated 16.06.2022  passed by the District Consumer Disputes Redressal Commission Kapurthala, Camp Court at Ludhiana was set aside. The Hon’ble State Commission further directed this Commission to decide the complaint a fresh on merits by taking into consideration the contents of the complaint and the reply of the OPs. The OPs were given liberty to file fresh application for additional evidence before the District Commission for producing the documents. The complainant was also granted liberty to produce any other evidence/documents by filing an application before the District Commission. The Hon’ble State Commission further directed this complainant to consider the documents so placed on record and thereafter, by affording adequate opportunity of hearing the parties, to decide the complaint afresh on merits. The parties were directed to appear before this Commission on 24.08.2023.

                   Accordingly, on 24.08.2023, Sh. Jyoti Sarup, Advocate appeared on behalf of the complainant and Sh. Nitin Kapila, Advocate also appeared on behalf of the OPs. The OPs filed an application for leading additional evidence, which was allowed vide order dated 24.11.2023 and the witness Dr. Harpreet Singh Saini, DMRD, DNB(Consultant Radiologist) was summoned with complete medical record file of patient Mr. Dalwinder Singh. The said witness Dr. Harpreet Singh Saini appeared on 20.03.2024 and recorded his statement before this Commission and produced copy of record as Ex. RW2/1 (containing pages 1 to 8). He was cross examined by the counsel for the complainant. Thereafter, the counsel for the OPs closed additional evidence after tendering document Ex. R21.

                   The complainant did not produce any rebuttal evidence and the counsel for the complainant suffered a statement not to adduce any rebuttal evidence.

6.                We have heard the arguments of the counsel for the parties and also gone through the complaint, affidavit and annexed documents and affidavit produced on record by both the parties.

7.                 Admittedly, on 04.05.2016, father of the complainant obtained HDFC Life Sanchay Policy Ex. C4 = Ex. R1 from the OPs by paying premium of Rs.45,000/- per annum for a sum assured of Rs.1,66,893/-. The coverage period of the policy was 15 years having premium paying term of 5 years. The relevant salient features of the policy Ex. C4 = Ex. R1, as derived from column Your Policy At A Glance, is reproduced as under:-

          “Policy Term (Years)      :                            15 to 25 years

Premiums

Frequency	Annual	Half Yearly	Quarterly	Monthly
Minimum Installment premium (exclusive of taxes)	₹30,000	₹15,000	₹7,500	₹2,500

 

          Guaranteed Additions (GA)

The plan offers guaranteed additions (GA) as percentage of Sum Assured on Maturity accrued at simple rate for each completed policy year and payable at maturity.

Policy Term (Years)	GA as % of Sum Assured on Maturity
15 to 19 years	8%
20 to 25 years	9%

 

          Maturity Benefit

On your survival, at end of the policy term, you will receive lump sum benefit as aggregate of :

1. Sum Assured on Maturity
2. Accrued Guaranteed Additions

Maturity benefit as percentage of Sum Assured on  Maturity as per term chosen is as follows:-

Policy Term	15	16	17	18	19	20	21	22	23	24	25
Maturity benefit as % of Sum Assured on Maturity	220%	228%	236%	244%	252%	280%	289%	298%	307%	316%	325%

On payment of the Maturity Benefit, the policy will terminate and no more benefits will be payable.

Death Benefit

On death during the policy term, provided all due premiums have been paid, we will pay Sum Assured on Death PLUS Accrued Guaranteed Additions to the nominee Where the Sum Assured on Death is higher of the following: Sum Assured on Maturity An absolute amount assured to be paid on death, which in this case is equal to the Sum Assured on Maturity 10 times the Annualized Premium 105% of the premiums paid till date On payment of the Death Benefit, the policy will terminate and no more benefits will be payable.

 

The policy in question was issued on the basis of proposal form and declaration submitted by the insured which is produced along with repudiation letter Ex. R2 at page 97 to 101, whereby the queries asked from the life insured in column Personal “Details of the Life to be Assured” were answered in negative by the life assured.

8.                However, father of the complainant i.e. life assured Dalwinder Singh died on 02.06.2016 regarding which the complainant lodged a death claim with the OPs along with death certificate of Dallwinder Singh and other documents. Upon receipt of the claim, the OPs appointed ProbeIndia, Investigator, who after recording statements of the complainant, his neighbours etc. prepared a final investigation report Ex. R3 vide which the investigator came to conclusion that “LA was suffering from mouth cancer due to which he was treated at Mohandai Oswal Hospital, Ludhiana. LA was expired on dated 02.06.2016 at his residence and cremation was done by the family members at Malikpur bet in the presence of relatives and neighbours. Hence pre-policy ailment found in this case and we also procured the document evidence to support the same.”

                   On the basis of said investigation report Ex. R3, the OPs repudiated the claim of the complainant vide repudiation letter dated 05.10.2016 Ex. R2. The operative part of the repudiation letter Ex. R2 is reproduced as under:-

“The policy was issued on the basis of the proposal dated May 04, 2016 made to HDFC Standard Life Insurance Company Limited (herein after referred to as the “Company”) for purchase of HDFC Life Sanchay (UIN: 101N097V01), for a Sum Assured of INR 1,66,893.

The proposal was accepted on the basis of information provided in the proposal form with the policy getting issued on May 05, 2016.

In this connection we refer to Section in the said Application, which deals with ‘Personal Details of Life to be Assured’. Under this section the following relevant questions had been answered as incorrectly.

2	Have you ever suffered from or received treatment for, any symptoms or medical conditions for any of the following: Cancer, tumour, growth or cyst of any kind	No
4	Apart from minor ailments, such as cold and flu, have you received any treatment from any Doctor or specialist or been hospitalized or undergone hospital in the last 5 years?	No

 

 From Investigations, it was established that the Life Assured was suffering from Cancer Buccal Mucosa prior to the policy issuance. This was not disclosed in the application date May 04, 2016. Had this information been provided to the Company at the time of applying for the insurance policy, we would have declined the application.

Also, we will be processing an amount of Rs.43,424/- (Rupees Forty Three Thousand Four Hundred Twenty Four Rupees Only) to your account no.XXXXXXXX0650 maintained with HDFC Bank Ltd. furnished to us by you towards the refund of premium payable under the above said policy.”

9.                Now the point of determination arises for consideration before this Commission is whether the OPs were justified in repudiation of the claim of the complainant or not?

10.              While leading additional evidence, statement of Dr. Harpreet Singh Saini was recorded who produced the patient medical record of the deceased Dalwinder Singh of Mohandai Oswal Hospital, Ludhiana. Perusal of this record shows that the deceased was examined on 15.04.2016 by Dr. Yogesh Arora, the then colleague of said witness Dr. Harpreet Singh Saini in the presence of complainant Pardeep Singh and observed swelling on the right side of mandibular which was having a history earlier to two years. He also referred dates in chronological order starting from 09.06.2014, 13.06.2014, 08.08.2014, 22.05.2014, 04.10.2014 deciphered from the old medical record produced by the complainant and his father before him regarding his pre-existing ailment. Perusal of these medical notes also refers to the histopathology report showing Carcinoma and receipt of treatment by the DLA at CMC Hospital, Ludhiana. After advising tests, Dr. Yogesh Arora also asked him for follow up along with old medical records. So it becomes crystal clear that the deceased life assured was suffering from this serious ailment since 2014 and the deceased as well as the complainant were fully aware of the existence of this dreaded disease and they have intentionally concealed the same at the time of obtaining the policy in question. It is also pertinent to mention that the policy in question was obtained on 04.05.2016 and death of the life assured took place on 02.06.2016 at Village Malikpur Bet, Ludhiana and the deceased died on the 26^th day of inception of the policy. It was the duty of the insured to make full disclosure and no information, substance or interest was required to be concealed or omitted. The pre-existing disease/ history of the insured Dalwinder Singh being a case of mouth cancer was a relevant and material fact which was required to be disclosed at the time of obtaining the policy in question by the insured. So there is a concealment and suppression of material facts which could have affected the decision of the OPs with regard to the terms and conditions of the policy.

                   Reference can be made to Branch Manager, Bajaj Allianz Life Insurance Company Ltd. and others Vs Dalbir Kaur in 2021 (217) AIC 50 whereby the Hon’ble Supreme Court of India has held that the contract of insurance is one of the utmost good faith and proposer who seeks to obtain policy of life insurance is duty bound to disclose all material facts bearing upon issue as to whether insurer would consider it appropriate to assume risk which is proposed. The Hon’ble Supreme Court has further held that the proposer failed to disclose vomiting of blood which had taken place barely month prior to issuance of policy of insurance and of hospitalization which had been occasioned as consequences. The assured was suffering from pre-existing ailment and judgment of NCDRC directing payment of sum insured was set aside.  

                   Further reference can be made to Reliance life Insurance Co. Ltd. and others Vs Rekhaben Nareshbhai Rathod in 2019 (2) R.C.R. (Civil) 909 whereby the Hon’ble Supreme Court of India has held 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.

11.              Further reference can also be made to the law laid down in Satwant Kaur Sandhu Vs New India Assurance Co. Ltd. Civil Appeal No.2776 of 2002 decided n 10.07.2009 whereby it has been 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. As such, in view of the above said facts and circumstances, we are of the considered view that the deceased life insured was guilty of concealment of material facts as he failed to disclose in the proposal form that he was suffering from mouth cancer prior to commencement of the policy. Therefore, in our considered view, the OPs were justified in repudiating the claim of the complainant.

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 the order be supplied to the parties free of costs as per rules. File be indexed and consigned to record room.     

 

(Monika Bhagat)                                 (Sanjeev Batra)        

                    Member                                              President 

 

Announced in Open Commission.

Dated:07.10.2024.

Gobind Ram.