Punjab

Ludhiana

CC/19/416

Deepak Panday - Complainant(s)

Versus

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

Shiv Pal Singh Adv.

24 Apr 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No:416 dated 30.08.2019.                                                         Date of decision: 24.04.2023.

 

Deepak Panday age about 33 years S/o. Sh. Shesh Nath Panday, R/o. New Model Town, behind Police Station, Sahnewal, Ludhiana (Mobile No.9988176019 and Email address- N.A.)                                                                                                                                                 ..…Complainant

                                                Versus

1. HDFC Life Insurance Co. Ltd., (Formerly Known as HDFC Standard Life Insurance Co. Ltd.), Through its authorized Signatory/Incharge/Manager Address: 11^th Floor, Lodha Excelus, Apollo Mills Compound, N.M. Joshi Road, Mahalaxmi, Mumbai-400011.
2. HDFC Life Insurance Co. Ltd., Communication Office, through its authorized Signatory/Incharge/Manager Address; HDFC Life, 5^th Floor IL & FS Financial Center, Plot C 22, G Block, Bandra Kurla Complex, Bandra East, Mumbai-400051.
3. HDFC Bank, Sahnewal Branch, Ludhiana through its Head/authorized Signatory/Incharge/Manager.
4. HDFC Standard Life Insurance Co. Ltd., Khanna Branch Office, Through its authorized Signatory/Incharge/Manager Address: 279, Ist Floor, near Gurudwara Kalgidhar, G.T. Road, Khanna-141401.

…..Opposite parties 

Complaint Under section 2, 12 and 14 of the Consumer Protection Act.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

SH. JASWINDER SINGH, MEMBER

MS. MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. Shiv Pal Singh, Advocate.

For OP1, OP2 and OP4 :         Sh. Nitin Kapila, Advocate.

For OP3                         :         Exparte.

 

ORDER

PER SANJEEV BATRA, PRESIDENT

1.                Briefly stated, the facts of the case are that father of the complainant namely Sh. Shesh Nath Panday  was having a bank account bearing No.13401000009365 at HDFC Bank, Sehnewal branch, Ludhiana since 25.01.2011 and was having sufficient balance in the said account. The complainant stated that in the year 2018, an official of opposite party No.3 branch induced his father to take a Life Insurance Policy namely HDFC SL Progrowth Flexi life Policy which was for the beneficial interest of its account holders. The official of opposite party No.3 assured father of the complainant that in case of sudden death of life assured, an assured sum of Rs.2,10,000/- will be given to the family of the deceased/assured as per policy and believing the assurance of official of opposite party No.3, the father of the complainant purchased the policy of opposite parties bearing No.20436985 and having UIN 1011103V01 issued on 5^th June 2018 for a period of 10 years on payment of annual premium of Rs.30,000/- and his life was assured for a sum of Rs.2,10,000/- with opportunity fund of 100 percent. The complainant further stated that his father suffered a heart attack and expired on 27.04.2019. The complainant approached opposite party No.3 for the sum assured under the policy who demanded some documents i.e. death certificate, Aadhar card, hospital admission card of deceased from complainant and directed him to submit the documents with opposite party No.4. The complainant submitted the demanded documents to opposite party No.4 and opposite party No.3 and 4 told the complainant to wait for some time and also assured that his claim will be passed. But the complainant was shocked to received letter dated 10.06.2019 from the opposite parties mentioning that in the proposal form some questions were answered incorrectly and it was also mentioned that from the investigations it was established that the life assured was suffering from Ischemic Heart Disease and Hypertension which was not disclosed in the application dated 04.06.2018. The claim of the complainant was refused on the above said reasons and the opposite parties credited an amount of Rs.26,239/- only in his bank account. The complainant many times visited the office of opposite parties for redressal of his grievances but they refused to pay the assured sum. The complainant further stated that his father had never been asked any questions alleged in the rejection letter and only his signatures were taken by official of opposite party No.3. His father was induced and assured by opposite party No.3 that in case of sudden death assured sum will be given to the family but now in case of heart attack of father of complainant, the opposite parties are declining the claim on the pretext that incorrect answers were given in the proposal form. Even no detail of investigation held by the opposite parties has been disclosed in the claim rejection letter nor it has been mentioned when these investigations were done by the opposite parties. The opposite parties have out rightly rejected the claim  of the complainant which amounts to malpractice, deficiency in service and misrepresentation on the part of the opposite parties. The complainant sent a legal notice dated 06.07.2019 through his counsel but no reply was given. Hence this complaint whereby the complainant has prayed for issuing direction to the opposite parties to pay the assured sum of Rs.2,10,000/- as per the policy terms and conditions  and also to pay compensation of Rs.2,00,000/- besides Rs.33,000/- as cost of litigation.   

2.                Notice was sent to opposite party No.3 through registered post on 19.09.2019 but none turned up for opposite party No.3 despite service and as such, opposite party No.3 was proceeded against exparte vide order dated 07.11.2019.

3.                Upon notice, opposite parties No.1, 2 and 4 filed  joint written statement and by taking preliminary objections, assailed the complaint on the ground of maintainability,  lack of jurisdiction of this Commission, The complaint is an abuse of process of law, no consumer dispute arise as per Consumer Protection Act.  The opposite parties stated that the policy is a contract entered into between the complainant and the opposite parties and the parties are bound by the terms and conditions of the contract. The opposite parties further stated that Mr. Shesh Nath Pandey (father of the complainant) had obtained HDFC SL Pro Growth – Felxi Policy bearing No.20436985 with a premium of Rs.30,000/- per annum and frequency of the premium term was 10 years with sum assured of Rs.2,10,000/-. The policy was issued on the basis of proposal made to the opposite parties which was accepted on the basis of information provided in the proposal form dated 04.06.2018 having risk commencement date as 05.06.2018. In the documents submitted by the proposer in the proposal form/electronic proposal form for single life which deals with the heath details of the life to be assured under short medical questionnaire in the member enrolment form, the relevant questions have been answered incorrect as “NO”, which is reproduced as under:-

13. Have you ever suffered from diabetes/high blood sugar/sugar in urine, high blood pressure/hypertension, heart disease, stroke?	NO
19. Are you currently suffering from any illness, impairment or taking any medication or pills or drugs?	NO
22. During last five year have undergone or been recommended to undergo hospitalization?	NO
24. During last five years have undergone or been recommended to undergo X-Ray, any other investigation (including checkups for employment/insurance/foreign visit)?	NO

 

The opposite parties further stated that from the investigations, it was established that the life assured was suffering from Ischemic Heart Disease and Hypertension which is prior to the issuance of the policy and he remained under treatment from Christian Medical College & Hospital, Ludhiana and in that regard, hospital record dated 14.04.2018 and 15.07.2011 was also collected from CMC Hospital by the surveyor of opposite parties showing that the proposer was fully aware of said disease and it was not disclosed in the application/proposal form dated 04.06.2018. The opposite parties stated that had this information been provided to the company at the time of applying for the insurance policy, they would have declined the application. The vital information was not provided to the opposite parties at the time of applying for the insurance policy and as such, the claim of the complainant could not be accepted and a sum of Rs.26,239.17 was processed to the account of the proposer maintained with Punjab National Bank, which was furnished by him with them towards the fund value payable under the policy.

                   On merits, opposite party No.1, 2 and 4 reiterated the crux of averments made in the preliminary objections. Opposite party No.1, 2 and 4 have denied that there is any deficiency of service and have also prayed for dismissal of the complaint.

4.                In support of his claim, the complainant tendered his 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 policy schedule, Ex. C2 is the index card of deceased of Mohandai Oswal Hospital, Ex. C3 is the copy of death notification form of deceased, Ex. C4 is the copy of death claim rejection letter dated 10.06.2019, Ex. C5 is the copy of online complaint submitted by the complainant to opposite party company, Ex. C6 is the copy of email dated 24.06.2019 sent by the complainant to Insurance Ombudsman, Ex. C7 is the copy of legal notice dated 06.07.2019, Ex. C8 to Ex. C11 are the copies of postal receipts and closed the evidence.

5.                On the other hand, counsel for opposite party No.1, 2 and 4 tendered affidavit Ex. RA of Sh. Gurpreet Singh, Deputy Manager Legal and Compliance of the opposite parties along with documents Ex. R1 is the affidavit of Md. Shahnawaz, investigator, Ex. R2 is the copy of rejection letter dated 10.06.2019, Ex. R3 is the copy of insurance policy, Ex. R4 is the copy of consumer consent document, Ex. C5 is the copy of investigation report, Ex. R6 is the copy of test reports/treatment record, Ex. R7 is the copy of authority letter and closed the evidence.

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

7.                Admittedly, Sh. Shesh Nath Panday, father of the complainant had obtained bearing No.20436985 Ex. C1=R3 with premium of Rs.30,000/- per annum for a premium term of 10 years having a sum assured of Rs.2,10,000/- . Unfortunately, Sh. Shesh Nath Panday died on 27.04.2019 and the “Statement of Death Claim” was submitted on 01.06.2019 which was declined by the opposite parties on 10.06.2019 vide letter Ex. C4/R2. The refusal was based upon the fact that the deceased was suffering from Ischemic Heart Disease and hypertension which was not disclosed in the application dated June 04 2018, the operative part of this letter is reproduced as under:-

“In this connection we refer to the “Personal Details of life to be Assured” in the said application. Under this section, the following relevant questions had been answered incorrectly: 

13	Have you ever suffered from diabetes/high blood sugar/sugar in urine, high blood pressure/hypertension, heart disease, stroke?	NO
19	Are you currently suffering from any illness, impairment or taking any medication or pills or drugs?	NO
22	During last five year have undergone or been recommended to undergo hospitalization?	NO
24	During last five years have undergone or been recommended to undergo X-Ray, any other investigation (including checkups for employment/insurance/foreign visit)?	NO

         

However, from investigations, it was established that the Life Assured was suffering from Ischemic Heart Disease and Hypertension which was not disclosed in the application dated June 04, 2018. Had this information been provided to the Company at the time of applying for the insurance policy, we would have declined the application.”

8.                The rejection letter Ex. C4/R2 has laid emphasis on the fact that the policy was issued on the basis of proposal dated 04.06.2018 and have also referred to its column Nos.13, 19, 22 and 24 “Personal Details of Life to be Assured” in the application dated 04.06.2018. The opposite parties have produced two paged customer consent form document Ex. R4 but no proposal form has been produced by the opposite parties. Even perusal of this customer consent document Ex. R4 shows that it is the official of opposite party No.3 who appears to have prevailed upon the deceased to obtain the policy in question. This document was also filled by Gurvarinder Singh, a bank employee whose evidence by way of affidavit was also material to establish that at the time of issuing the policy, the contents of documents were read over and explained to the deceased. In the absence of a duly signed and complete proposal form, it cannot be concluded that there was non-disclosure of any pre-existing disease by the deceased.

9.                Opposite parties No.1, 2 and 4 were not justified in declining the claim of the complainant and it would be just and appropriate if the opposite parties are directed to jointly and severally pay the balance claim of Rs.1,83,761/- (i.e. Rs.2,10,000- Rs.26,239 = Rs.1,83,761/-) to the complainant along with interest @8% per annum from the date of filing of complaint till its actual payment within 30 days from the date of receipt of copy of order along with composite costs of Rs.10,000/-.

10.              As a result of above discussion, the complaint is partly allowed with direction to the opposite parties to jointly and severally pay the balance claim of Rs.1,83,761/- (i.e. Rs.2,10,000 - Rs.26,239 = Rs.1,83,761/-) to the complainant along with interest @8% per annum from the date of filing of complaint till its actual payment within 30 days from the date of receipt of copy of order. The Opposite parties shall further jointly and severally pay composite cost of Rs.10,000/- (Rupees Ten Thousand only) to the complainant within 30 days from the date of receipt of copy of order. Copies of the order be supplied to the parties free of costs as per rules. File be indexed and consigned to record room.

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

 

(Monika Bhagat)          (Jaswinder Singh)                      (SanjeevBatra) Member                        Member                                       President         

 

Announced in Open Commission.

Dated:24.04.2023.

Gobind Ram.

 

 

Deepak Pandey Vs HDFC Life Insurance Co. Ltd.                             CC/19/416

Present:       Sh. Shiv Pal Singh, Advocate for complainant.

                   Sh. Nitin Kapila, Advocate for OP1, OP2 and OP4.

                   OP3 exparte.

 

                   Arguments heard. Vide separate detailed order of today, the complaint is partly allowed with direction to the opposite parties to jointly and severally pay the balance claim of Rs.1,83,761/- (i.e. Rs.2,10,000 - Rs.26,239 = Rs.1,83,761/-) to the complainant along with interest @8% per annum from the date of filing of complaint till its actual payment within 30 days from the date of receipt of copy of order. The Opposite parties shall further jointly and severally pay composite cost of Rs.10,000/- (Rupees Ten Thousand only) to the complainant within 30 days from the date of receipt of copy of order. 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)          (Jaswinder Singh)             (SanjeevBatra)

Member                         Member                            President

 

Announced in Open Commission.

Dated:24.04.2023.

Gobind Ram.