Punjab

Ludhiana

CC/19/539

Gyan Singh - Complainant(s)

Versus

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

A.B.Sharma Adv.

20 Jul 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No:539 dated 22.11.2019.                                                         Date of decision: 20.07.2023.

 

1. Ghan Singh aged about 73 years S/o. Sucha Singh, R/o. Patti Mohri, Village Manuke, Jagraon, Distt. Ludhiana.
2. Parminder Singh Bhullar S/o. Late Balwant Singh, R/o. Village Patti Mohri, Village Manuke, Jagraon, Distt. Ludhiana.                                                                                                               ..…Complainants

                                                Versus

HDFC Life Insurance Company Ltd., SCO-41, 3^rd and 4^th Floor, Feroze Gandhi Market, Ludhiana through its Branch Manager.                                                                                                                                     …..Opposite party 

Complaint Under Section 12 of the Consumer Protection Act.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

SH. JASWINDER SINGH, MEMBER

MS. MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainants            :         Sh. A.B. Sharma, Advocate.

For OP                           :         Sh. Nitin Kapila, Advocate.

 

ORDER

PER SANJEEV BATRA, PRESIDENT

1.                Briefly stated, the facts of the complaint are that late Balwant Singh, who was son of complainant No.1 and father of complainant No.2, purchased two HDFC Life Insurance Policies bearing No.CP000046 on 03.10.2016 for a sum assured of Rs.3,23,498/- and policy bearing No.PP000151 on 27.10.2018 for a sum of Rs.1,06,806/- towards death benefits from the opposite party and was paying premium to the opposite party. According to the complainants, complainant No.1 Ghan Singh was nominee in insurance policy No.CP000046 and Parminder Singh was nominee in policy No.PP000151. The complainant stated that on 06.12.2018 in the morning, Late Balwant Singh suffered a paralytic attack and was admitted in Global Hospital, Jalandhar where he remained for four days and on 10.12.2018 he got expired. A sum of Rs.1,50,000/- approximately were spent on his treatment. After the death of Balwant Singh, the complainants lodged claim with the opposite party  but the same was declined vide letter dated 15.03.2019 and 12.04.2019 on the ground that Balwant Singh was suffering from coronary artery disease prior to issuance of the policy. However, Balwant Singh was not suffering from such problem or disease before his admission nor he taken any treatment for this disease but the opposite party at their own investigated the above said disease in Late Balwant Singh. Even on the death summary it was mentioned that Late Balwant Singh was on treatment for coronary artery disease since 4-5 years but no such thing was ever disclosed by the deceased or his family members to the doctors. The complainants further stated that the opposite party has wrongly repudiated their claim. They are entitled to Rs.3,23,498/- and Rs.1,06,806/-. The opposite party has acted negligently in denying their claim and committed malpractice as well as deficiency in service due to which they have suffered mental pain and harassment for which they are entitled to compensation. In the end, the complainants prayed for issuing direction to the opposite party Rs.3,23,498/- and Rs. 1,06,806/- of the insurance policies along with compensation of Rs.50,000/- and litigation expenses of Rs.11,000/-.

2.                Upon notice, the opposite party appeared and filed written statement by taking preliminary objections that the complaint is not maintainable, the complainants have not come to court with clean hands and have suppressed the material facts, this Commission has no jurisdiction to entertain and try the complaint etc. The opposite party stated that Mr. Balwant Singh had obtained two HDFC policies bearing No.CP000046 (HDFC Life Group Credit Protect) on 03.10.2016 for a sum assured of Rs.3,23,498/-  in which complainant No.1 was nominee and No.PP000151 (HDFC Life Group Credit Protect Plus Insurance Plan) on 27.10.2018 for a sum assured of Rs.1,06,806/- in which complainant No.2 was nominee. The policies were issued on the basis of proposal made to opposite party which was accepted at standard rates based on information provided in the member information form submitted on 29.09.2016 by the deceased and against which policy was issued on 03.10.2016. Similarly, the proposal case was accepted at the standard rates based on the information provided in the member information form submitted on 16.10.2018 by the deceased and against which policy was issued on 27.10.2018. The Member enrolment form deals with ‘Health Details of Life to be Assured’ and in the short medical questionnaire, the relevant questions were answered as “NO”, which are reproduced as under:-

 

1] Have you ever suffered of are currently suffering from: (a) Chest Pain or heart attack or any other heart disease (b) Cancer, tumour growth or cyst of any kind (c) Stroke, Paralysis, Epilepsy, any  psychiatric/mental disorder, disorder of brain/nervous system or any kind of physical disabilities (d) Asthma, tuberculosis or lung disorder (e) Disease or disorder of muscles, bones or joint, arthritis or blood disorder (anaemia) or any endocrine disorder (f) Disease of kidney, digestive system (stomach pancreas, gall bladder, intestine.

NO

6] Are you taking any medication or  has a doctor ever attended to you for any conditions, diseases of impairment not mentioned above (except for cough or cold)?

NO

According to the opposite party, from investigations, it was established that Balwant Singh was suffering from Coronary Artery Disease since last 4/5 years i.e. prior to issuance of the policy and he remained under treatment from Global Hospital, Ludhiana and was fully aware of the said diseases. This was not disclosed in the application/proposal form. The opposite party further stated that had this  information been provided to the company at the time of applying for the insurance policy, they would have called for further medical test/questionnaire based on the reports only, they would have decided to offer insurance cover. Since vital information was not provided at the time of applying for insurance policy and as such, claim of the complainants could not be accepted and the same was declined vide letters dated 15.03.2019 and 12.04.2019.

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

3.                In support of their claim, complainant No.1 Sh. Ghan Singh tendered his affidavit Ex. CA in which he reiterated the allegations and the claim of compensation as stated in the complaint. The complainant also tendered documents Ex. C1 is the copy repudiation letter dated 12.04.2019 of policy No.CP000046, Ex. C2 is the copy of insurance policy No.CP000046, Ex. C3 is the copy of repudiation letter dated 15.03.2016 of policy No.PP000151, Ex. C4 is the copy of death summary of Global Hospital, Ex. C5 is the copy of death certificate of Balwant Singh and closed the evidence.

4.                On the other hand, counsel for opposite party tendered affidavit Ex. RA of Sh. Gurpreet Singh, Deputy Manager Legal & Compliance, HDFC Life Insurance Co. Ltd., SCO 149-151, 1^st Floor, Sector 43-B, Chandigarh along with documents Ex. R1 is the copy of authority letter, Ex. R2 is the copy of repudiation letter dated 15.03.2019 of policy No.PP000151, Ex. R3 is the copy of Group Claim Form of policy No.PP000151, Ex. R4 is the copy of insurance policy No.PP000151, Ex. R5 is the copy of proposal form dated 16.10.2018, Ex. R6 and Ex. R16 are the copies of death certificate of Balwant Singh, Ex. R7 and Ex. R13 are the copies of death summary issued by Global Hospital, Ludhiana Ex. R8 is the copy of PAN card of Balwant Singh, Ex. R9 is the copy of PAN card of Parminder Singh, Ex. R10 is the copy of canceled cheque No.000522, Ex. R11 is the copy of  repudiation letter dated 12.04.2019 of policy No.CP000046, Ex. R12 is the copy of Group Claim Form of policy No.CP000046, Ex. R14 is the copy of Aadhar card of Ghan Singh, Ex. R15 is the copy of PAN card of Ghan Singh, Ex. R17 is the copy of cancelled cheque No.229338, Ex. R18 is the copy of proposal form dated 29.09.2016, Ex. R19 is the copy of authority letter, Ex. R20 is the copy of insurance policy No.CP000046 and closed the evidence.

5.                We have heard the arguments of the counsel for the parties 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.      

6.                 On the basis of proposal form dated 29.09.2016 Ex. R18, on 03.10.2016, the opposite party  issued HDFC Life Group Credit Protect Insurance Plan  Policy Ex. C2 having a sum assured of Rs.3,23,498/- to Balwant Singh now deceased (hereinafter called as insured). Complainant No.1 Ghan Singh is father and nominee of Balwant Singh in the said policy. Similarly, on the basis of proposal form dated 03.10.2016 Ex. R12, the opposite party  issued HDFC Life Group Credit Protect Insurance Plan Policy Ex. R4 having a sum assured of Rs.1,06,806/- to Balwant Singh in which complainant No.2 Parminder Singh son of the insured is the nominee of Balwant Singh in the said policy. On 06.12.2018, the insured Balwant Singh suffered paralytic attack and he was got admitted in Global Hospital, Jalandhar and remained admitted there till 10.12.2018 where he expired due to sudden cardiac arrest at about 01.00 PM. An expenditure of Rs.1,50,000/- were incurred by the complainants. The death summary is Ex. C4=R17. The complainants lodged claims under both policies vide claim forms Ex. R11/R12 and claim form Ex. R3. On 15.03.2019 and 12.04.2019 vide respective letters Ex. C1 and Ex. C3, the opposite party refused to accept the claim of the complainants on identical grounds. The common operative part in the both letters reads as under:-

“We would like to bring to your attention, the “Member Information Form” in the Member Information Form, which deals with ‘Health Details of Member’. In this connection under short Medical Questionnaire in the Member Information Form (which deals with ‘Health Details of Member), the following relevant question(s) was/were answered as “NO”

1] Have you ever suffered of are currently suffering from: (a) Chest Pain or heart attack or any other heart disease (b) Cancer, tumour growth or cyst of any kind (c) Stroke, Paralysis, Epilepsy, any  psychiatric/mental disorder, disorder of brain/nervous system or any kind of physical disabilities (d) Asthma, tuberculosis or lung disorder (e) Disease or disorder of muscles, bones or joint, arthritis or blood disorder (anaemia) or any endocrine disorder (f) Disease of kidney, digestive system (stomach pancreas, gall bladder, intestine.   6. Are you taking any medication or  has a doctor ever attended to you for any conditions, diseases of impairment not mentioned above (except for cough or cold)?

Yes                                                   NO NO

 

Our investigations have however established that the Life Assured was suffering from Coronary Artery Disease which is prior to issuance of the policy.

Had this information been provided to the Company at the time of applying for the insurance policy, we would have called for further medical tests/questionnaire. Based on the reports only, we would have decided to offer insurance cover.

Since this vital information was not provided to us at the time of applying for the policy, we are unable to accept your claim.”

7.       At the very outset, it has been noticed that neither in the written statement or in the affidavit nor in these respective letters, the opposite parties have not referred to any of the terms, conditions or clause which was invoked to deny the claims of the complainants. The recitals of these documents are general in nature and it has been only mentioned that the vital information was not provided with the opposite parties at the time of applying of the policies, so the claims of the complainants could not be accepted. The opposite parties have referred to the Health details of the life assured in “Member Information Form” where the answer to the relevant questions has been stated to be given “NO” by the insured Balwant Singh. Further, it has been mentioned in the written statement that Balwant Singh was suffering from Coronary Artery Disease since last 4-5 years prior to issuance of the policies and he remained under treatment from Global Hospital, Ludhiana. Neither the report nor the affidavit of the investigator nor medical record of Global Hospital, Ludhiana was produced by the opposite party to substantiate their claim with regard to treatment of Balwant Singh insured. These documents were material in nature and its non-production has certainly caused dent in the authenticity of investigation and legality of repudiation letters. In the given set of facts and circumstances, the repudiation of the claims of the complainants is not justified and it would be just and appropriate if the opposite party is directed to settle and reimburse the claims of the complainants regarding the insurance policies No. No.CP000046 and No.PP000151 along with composite costs of Rs.10,000/-. 

8.                As a sequel of above discussion, the complaint is partly allowed with direction to the opposite party to settle and reimburse the claims of the complainants regarding the insurance policies No. No.CP000046 and No.PP000151 strictly in accordance with terms of policy terms and conditions within 30 days from the date of receipt of copy of order. The complainants are entitled for a composite costs of compensation of Rs.10,000/- (Rupees Ten Thousand only). Payment of this amount be made within 30 days from the date of receipt of copy of order. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

9.                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:20.07.2023.

Gobind Ram.

 

 

Ghan Singh and another Vs HDFC LIC                                   CC/19/539

Present:       Sh. A.B. Sharma, Advocate for complainants.

                   Sh. Nitin Kapila, Advocate for OP.

 

                   Arguments heard. Vide separate detailed order of today, the complaint is partly allowed with direction to the opposite party to settle and reimburse the claims of the complainants regarding the insurance policies No. No.CP000046 and No.PP000151 strictly in accordance with terms of policy terms and conditions within 30 days from the date of receipt of copy of order. The complainants are entitled for a composite costs of compensation of Rs.10,000/- (Rupees Ten Thousand only). Payment of this amount be made within 30 days from the date of receipt of copy of order. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

 

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

 

Announced in Open Commission.

Dated:20.07.2023.

Gobind Ram.