District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No.84/2020.
Date of Institution: 07.02.2020.
Date of Order: 16.06.2022.
Satyapal son of late Shri Kishan Singh, aged about 29 years, resident of village Milakpur, Mansa Chowk, Bhiwadi, Rajasthan – 301018 .
…….Complainant……..
Versus
1. HDFC Life Insurance Company Limited, HDFC Life , Faridabad NIT, Branch Ist floor, Block NO. 5R-1A, NIT B.K.Chowk, Above Bharti Gupta Eye Clinic, Faridabad – 121001 through its Manager.
2. Manoj Kumar (Agent No. 00778729), resident of village Narhawali Panhera Khurd, Faridabad (Licence No. HDF 00778729)
…Opposite parties……
Complaint under section-12 of Consumer Protection Act, 1986
Now amended Section 34 of Consumer protection Act 2019.
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
PRESENT: Sh. Amit Tyagi, counsel for the complainant.
Sh. Sagar Bhatia, counsel for opposite party No.1.
Shri Deva Nand Chauhan, counsel for opposite party No.2.
ORDER:
The facts in brief of the complaint are that opposite party No.2 father of the complainant namely Kishan Singh to take a life insurance policy of opposite party No.1 and on proposal of opposite party, father of the complainant namely Kishan Singh agreed to take a policy HDFC Life Progrowth Plus vide policy No. 21611116 and deposited the premium amount as per requirements of opposite parties upon which the complainant issued the said policy in favour of father of the complainant and the complainant was nominee of his father which clearly mentioned in the said policy. The opposite parties assured the complainant as well as his father on account of death of father of the complainant namely Kishan Singh, the opposite parties pay Rs.12,00,000/- as sum assured as per the terms and conditions of the said policy. Thereafter father of the complainant namely Kishan Singh was suffering from illness and due to said illness, father of the complainant namely Kishan Singh had been expired on 01.11.2019. Thereafter the complainant intimated the opposite parties within time and make request to pass the claim/sum assured of Rs.12,00,000/- in favour of the complainant but the opposite parties required related documents. Thereafter the complainant makes many requests to the opposite parties to pay the amount of Rs.12 lakhs on account of death of father of the complainant as per the terms and conditions of above said policy issued by the opposite parties and also deposited all required documents to the opposite parties but the opposite parties made one pretext to the other and did not pass the claim of the complainant. The complainant sent legal notice dated 03.01.2020 to the opposite party No.1 but all in vain. 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 the amount of Rs.12,00,000/- to the complainant on account of
death of father of the complainant as per the terms and conditions of the policy issued by the opposite parties.
b) pay Rs50,000/- as compensation for causing mental agony and harassment .
c) pay Rs. 21,000/- as litigation expenses .
2. Opposite party No.1 put in appearance through counsel and filed written statement wherein Opposite party No.1 refuted claim of the complainant and submitted that Shri Kishan Singh (hereinafter referred to as “Deceased Life Assured”) had applied for an Unit Liked Insurance Plan “HDFC Life ProGrowth Plus” vide Proposal form No. 1100053818607 on 20.06.2019 for total sum assured of Rs.12,00,000/- on his own life by paying Annual Premium of Rs.60,000/- under Half Yearly payment mode. The policy term and premium paying term opted was 15 years. Aongwith the proposal form, the deceased life assured had also submitted copies of authoritative document sin proof of the insured’s age, income, address and identification in support of the information provided in proposal form. The answering opposite party accepted the proposal at the standard rates by taking into consideration the facts disclosed by Deceased Life Assured in the proposal form as true and correct, thereafter policy No. 21611116 was issued to Deceased Life Assured with risk commencement form 05th July 2019. The policy bond alongwith Free Look Period Intimation and copy of proposal form was duly delivered to the insured. In Freelook period of 15 days, the insured had option to cancel the policy in case of any discrepancies in the terms and conditions of the policy including the details in the policy but the DLA did not raise any concern regarding the policy features and the terms and condition of said policy within the said period of 15 days. It was submitted that the complainant informed answering opposite party about the sad demise of Deceased Life Assured and death claim was lodged under the aforesaid insurance policy. In furtherance of the claim and in compliance of
statutory provisions, an investigation was conducted for the disposal of the claim lodged but in the course of investigation it was revealed that the Deceased Life Assured had obtained the said policy by misrepresenting, fraudulently and concealing his previous medical history. From investigations, it was established that the life assured was suffering from old Cerebrovascular accident, Hypertension, Advanced Renal Failure, chronic kidney disease, chronic liver disease with portal hypertension, thrombocytopenia and
Splenomegaly prior to the policy issuance. This was not disclosed in the proposal form/application dated 20.06.2019. had this information been provided to the company at the time of applying for the insurance policy, the answering opposite party would have declined the application. The answering opposite party had issued the said policy to the Deceased Life Assured on the basis of facts disclosed by him in the said proposal, thereby the contract stands vitiated at end of the answering opposite party on the grounds of fraudulent suppression of material information, as the policy in question was obtained by playing fraud upon his client as the Deceased Life Assured concealed the true and actual facts of her previous medical history and health thus, his client could not get a reasonable opportunity to assess the risk insuring the DLA. Since policy in question was obtained by concealing & misrepresenting the material facts with regards to medical history, his client in the light of aforementioned facts and circumstances, rightfully repudiated the claim of the complainant vide their letter dated 09.12.2019 which was just and reasonable as per the insurance laws as well as the terms and conditions of said policy. However, as per terms & conditions of the policy governing Benefits under the policy in case of death, his client released an amount of Rs.25,379.99 to the nominee of the LA i.e. the complainant as fund value of the policy on the date of death of L.A. Opposite party No.1 denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
3. Opposite party No.2 put in appearance through counsel and filed written statement wherein Opposite party No.2 refuted claim of the complainant and submitted that the complainant had no locus standi or cause of action to file the present complaint against the answering opposite party, because there was no relationship between the answering opposite party and the complainant as “Consumer” and Service Provider. The alleged policy was issued by the opposite party No.1 to the father of the complainant and if any dispute arose then the same between the complainant and opposite party No.1 Opposite party No.2 denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
4. The parties led evidence in support of their respective versions.
5. We have heard learned counsel for the parties and have gone through the record on the file.
6. In this case the complaint was filed by the complainant against opposite parties – HDFC Life Insurance Co. Ltd. & Ors. with the prayer to: a) the amount of Rs.12,00,000/- to the complainant on account of death of father of the complainant as per the terms and conditions of the policy issued by the opposite parties. b) pay Rs50,000/- as compensation for causing mental agony and harassment .c) pay Rs. 21,000/- as litigation expenses .
To establish his case the complainant has led in his evidenceEx.CW1/A – affidavit of Satyapal, Ex.C-1 – Insurance Policy Kit, Ex.C-2 – Death Claim Decision letter , Ex.C-3 – letter dated 22.11.2019, Ex.C-4 – legal notice, Ex.C-5 – postal receipt,, Ex.C-6 – Reply to legal notice, Ex.C-7 – Adhaar card.
On the other hand counsel for the opposite party No.1 strongly agitated and opposed. As per the evidence of the opposite partyNo.1 Ex. OP-1/A – affidavit of Shri Kunal Aurora, deputy Manager-Legal, HDFC Standard Life Insurance Co. Ltd., New Delhi, Ex.OP1/1 – proposal form/electronic proposal form for single life,, Ex.-OP1/2 – letter dated 6th July 2019,, Ex.OP1/3 – Discharge summary, Annexure R1-D – Death claim Decision letter, Annexure R1-E- letter dated Dec.06,2019 regarding processed his payment.
Counsel for opposite party No.2 has made a statement that the reply already filed on behalf of opposite party No.2 be read as evidence of opposite party No.2. Accordingly, evidence on behalf of opposite party No.2 has been closed vide order dated 10.03.2022.
7. In this case, Shri Kishan Singh (hereinafter referred to as Deceased Life Assured) had applied for an Unit Liked Insurance Plan “HDFC Life ProGrowth Plus vide proposal Form No. 1100053818607 on 20.06.2019 for total sum assured of Rs.12,00,000/- on his own life by paying annual premium of Rs.60,000/- under Half Yearly payment mode. The policy term and premium paying term opted was15 years. Alognwith the proposal form, the decease life assured had also submitted copies of authoritative documents in proof of the insured’s age, income, address and identification in support of the information provided in proposal Form. Opposite party No.1 accepted the proposal at the standard rates by taking into consideration the facts disclosed by deceased life assured in the proposal form, thereafter policy No. 21611116 was issued to the Deceased Life Assured with risk commencement form 05th July 2019. In Freelook period of 15 days, the insured had option to cancel the policy in case of any discrepancies in the terms and conditions of the policy including the details in the
policy but the DLA did not raise any concern regarding the policy features and the terms and conditions of said policy within the said period of 15 days. The Deceased Life Assured Shri Kishan Singh was admitted in Metro Manas Arogya Sadan heart Care & Multispeciality Hospital, Mansarovar, Jaipur on 17.05.2019 with case of altered sensorium, fever and SOB for 5 days, loss of apetite, weight loss, weakness for 60 days. The DLA/insured was discharged from the hospital on 23.05.2019 vide Ex.OP1/3. As per Ex.OP1/3 that “History and Course in Hospital – patient is k/c HTN OLD CVA on alternate medicines was presented to emergency of Metro MAS Hospital with c/o altered sensorium, fever and SOB for 5 days, loss of appetite, weight loss, weakness for 60 days, patient was admitted and found to have advanced renal failure, metabolic encephalopathy and fluid overload. HD was done. Appropriate IV Antibiotics were give, IV iron and Inj. Darbejoieten given for anaemia. Patient has spienomegaly and thrombocytopenia and possibility of chronic liver disease with portal HTN was considered. Patient improved with the treatment given, he was advised for AV fistula cre ation but was refused by family and is discharges with advice as follow.”
8. It is evident for Discharge Summary vide Ex.OP1/3 that the life assured was suffering from old Carebrovascular accident, Hypertension, Advanced Renal Failure, chronic kidney disease, chronic liver disease with portal hypertension, Thrombocytopenia and Splenomegaly before submitting proposal of policy. The DLA deliberately and knowingly did not disclose in proposal form about his admission in hospital, treatment and diseases while applying for the aforesaid policy. Had this information been provided in proposal form, the opposite party No.1 would had declined the proposal form/application. Since policy in question was obtained by concealing & misrepresenting the material facts with regard to medical history, health and admission in hospital, opposite party No.1 repudiated the claim of the complainant vide letter dated 09.12.2019 as per the insurance laws as well as the terms and conditions of the said policy. However,
as per terms and conditions of the policy governing benefits under the policy in case of death, opposite party No.1 released an amount of Rs.25,379.99 to the nominee of the DLA i.e the complainant as fund value of the policy on the date of death of L.A.
The counsel for the opposite party has citation in case titled Branch Manager, Bajaj Allianz Life Insurance Company Ltd. and Others (2021-1) 201 PLR 547 (SC) passed by the Hon’ble Supreme Court of India in Civil Appeal No. 3397 of 2020 (Arising out of SLP © NO. 10652 of 2020 in which it has held that “Insurance Act, 1938 (4 of 1938) Sector-45 – Contract – Proposal of insurance is one of utmost good faith – A proposer who seeks to obtain a policy of life insurane is duty bound to disclose all material facts bearing upon the issue as to whether the insurer would consider it appropriate to assume the risk which is proposed – It is with this principle in view that the proposal form requires a specific disclosure of pre-existing ailments, so as to enable the insurer to arrive at a considered decision based on the actuarial risk – In the present case, the proposer failed to disclose the vomiting of blood which had taken place barely a consequence – was suffering from Hepatitis-C – Death occurred within a period of one month and seven days from the insurance – claim repudiated – order upheld.”
Ratio of this authority is applicable to the facts of the present case.
9. After going through the evidence led by both the parties, no deficiency in service on behalf of the opposite parties has been proved. Hence, the complaint is dismissed. Copy of this order be sent to the parties concerned free of costs. File be consigned to the record room.
Announced on: 16.06.2022 (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharma)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
