Haryana

Karnal

CC/103/2020

Seema Devi - Complainant(s)

Versus

HDFC Life Insurance Company Limited - Opp.Party(s)

Amit Beniwal

01 May 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                        Complaint No. 103 of 2020

                                                        Date of instt.14.02.2020

                                                        Date of Decision:01.05.2023

 

Seema Devi widow of Pyara Lal age about 34 years, resident of village Rukanpur Uchana Karna Lake, Karnal, District Karnal.

 

                                               …….Complainant.

                                              Versus

 

1.     HDFC Life Insurance Company Limited, registered office-Lodha Excelus, 13^th floor, Apollo Mills compound, N.M. Joshi Marg, Mahalaxmi, Mumbai.

 

2.     HDFC Life Insurance Company Limited SCO 778, 779, 1^st floor, Narayan Plaza, Kunjpura Road-Karnal-132001 through its Branch Manager.

                                                                      …..Opposite Parties.

 

Complaint Under Section 12 of the Consumer Protection Act, 1986 and after amendment Under Section 35 of Consumer Protection Act, 2019.

 

Before   Shri Jaswant Singh……President.

              Shri Vineet Kaushik……Member

                   

Argued by: Shri Amit Beniwal, counsel for complainant

                   Shri Vikas Bakshi, counsel for the OPs.

 

                    (Jaswant Singh President)

ORDER:   

                

                The complainant has filed the present complaint Under Section 12 of the Consumer Protection Act, 1986 as after amendment under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that husband of complainant namely Pyara Lal (since deceased) has purchased a policy HDFC Life Super Income Plan from the OPs through signing a proposal form dated 23.03.2018 and on accepted the proposal form the authorized agent of OPs enquired full detail of insured Pyara Lal about his age, his family details, about disease, health in deeply and then issued the policy no.20285912 on 04.04.2018 through OPs and also paid a sum of Rs.25,000/- towards premium. The risk of life and policy was commenced w.e.f. 23.03.2018 as shown in non-ulip policy schedule. The husband of complainant was about 34 years (D.O.B 03.04.1984) as shown in PAN card, Aadhar card, school living certificate and he died on 23.04.2018 due to chest pain.  After the death of her husband, complainant duly informed the OPs in this regard. Complainant submitted all the required documents for settlement of the claim. At the time of issuance of the policy, complainant was got medically examined by approved medically officer of company but diagnosed no disease/symptom at that time which debarred the complainant from taking the policy and after considering all the relevant facts. The claim of the complainant was wrongly and illegally repudiated on 01.03.2019 on the false and frivolous grounds. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action; locus standi and concealment of true and material facts. On merits, it is pleaded that the claim made by the complainant was repudiated by the OPs on the ground of mis-representation and concealment of material facts by deceased life assured (DLA) at the time of making the proposal. It is further pleaded that the life assured late Pyare Lal after completely understanding the term and condition of the insurance product “HDFC Life Super Income Plan” had voluntarily applied for an insurance policy, vide voluntarily applied for an insurance policy vide proposal form bearing 1100046094602 alongwith customer consent document other channel signed on 23.03.2018. In the proposal form the DLA gave all relevant details and information in the prescribed form, a premium amounting to Rs.26,125/- was proposed to be paid annually for the period of 24 years (premium payment years 12 years)  for sum assured Rs.2,50,000/-. In the instant application form, the complainant i.e. wife of DLA was proposed to be nominee. As per the proposal form the deceased life insured (DLA) had declared that he was not suffering from any disease. The DLA had fully understood the terms and conditions of the policy and further agreed under the agreement therein that if any untrue statement be contained in the application, the policy contract shall be null and void and the money which have paid in respect thereof shall stands forfeited to OP. It is further pleaded that based on the information and declaration containing in application/proposal form and further believing the same to be true also upon receipt of the duly filled form alongwith the initial premium OPs had issued the policy bearing no.20285912 with the commencement date of 23.03.2018. Thereafter, policy documents alongwith the schedule and the terms and conditions thereto and a welcome letter were sent to the deceased policyholder which were duly delivered to the address of the deceased policy holder. Thereafter, on 17.12.2018 the OPs received death claim intimation alongwith the claimant’s statement and death certificate of the deceased policy holder whereby the OPs were given to understand that the deceased policyholder died suddenly on 23.04.2018 due to heart attack. It is further pleaded that during the course of the investigation, it was established deceased life assured was suffering from Tuberculosis prior to application of the insurance, it is also to be noted that DLA was taking treatment from PHC (Primary Health Care Centre) Kachwa and the said fact is also evident from the Medical Records obtained during the investigation. During the investigation and as well as vide medical reports it was also found out that DLA was suffering from T.B. since 14.01.2017 and DOT provider Chander Kanta (ANH) attend for drug since 29.12.2016.  Based on abovementioned observation it clearly reflects that these material details affecting the decision of the insurer for the acceptance or rejection of the contract of insurance were willfully suppressed by the DLA as the same was not disclosed by him at the time of signing the said application inspite of the specific question asked in the proposal form, therefore, the said claim was rightly repudiated and same was duly informed to the complainant, vide letter dated 01.03.2019. Further, an amount of Rs.25,000/- paid as premium was refunded and further credited in the saving account no.xxxxxxxxxx0297 of the complainant maintained with OBC. There is no deficiency in service and unfair trade practice on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of insurance policy Ex.C1, copy of death claim form Ex.C2, copy of death certificate Ex.C3, copy of Aadhar card of deceased life assured Ex.C4, copy of PAN card of Pyare Lal Ex.C5, copy of Aadhar card of complainant Ex.C6 and closed the evidence on 22.10.2021 by suffering separate statement.

5.             On the other hand, learned counsel for the OP has tendered into evidence affidavit of Gurpreet Singh, Manager Ex.RW1/A, copy of proposal form Ex.R1, copy of customer consent form Ex.R2, customer statement form Ex.R3, copy of insurance policy Ex.R4, copy of claim form Ex.R5, copy of death certificate Ex.R6, copy of investigation report Ex.R7, copy of medical record Ex.R8 to Ex.R11, copy of payment letter Ex.R12, copy of repudiation letter Ex.R13 and closed the evidence on 20.10.2022 by suffering separate statement.

6.             We have heard the learned counsel of the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that husband of complainant (since deceased) had purchased a policy HDFC Life Super Income Plan from the OPs. The policy was commenced from 23.03.2018. The husband of complainant died on 23.04.2018 due to chest pain.  After the death of her husband, complainant being nominee lodged the death claim with the OPs and submitted all the required documents for settlement of the claim. The claim of the complainant was wrongly and illegally repudiated by the OPs on 01.03.2019 on the false and frivolous grounds and lastly prayed for allowing the complaint. Learned counsel for complainant relied upon the judgments case titled as Gokal Chand (D) Thr. Lrs. Versus Axis Bank Ltd. and Anr., in civil appeal no.9237 of 2022, date of decision 15.12.2022 of Hon’ble Supreme Court; Maneti Rawat Versus Life Insurance Corporation of India and Others in complaint case no.C-215 of 1998, date of decision 24.09.2007 of Hon’ble State Commission, Delhi and Future Generali India Life Insurance Co. Ltd. Versus Harinder Udayarj Singh in Revision Petition no.3592 of 2016, date of decision 10.01.2020 of Hon’ble National Commission.

8.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that the claim of the complainant has been repudiated by the OPs on the ground of mis-representation and concealment of material facts by deceased life assured (DLA) at the time of making the proposal. As per the proposal form the deceased life insured (DLA) had declared that he was not suffering from any disease. Life assured died on 23.04.2018 due to heart attack. He further argued that during the investigation and as well as medical reports it was also found that DLA was suffering from Tuberculosis (T.B.) since 14.01.2017 and was taking treatment from PHC (Primary Health Care Centre) Kachwa, so the said claim was rightly repudiated by the OPs. He further argued that an amount of Rs.25,000/- paid as premium was refunded to the complainant and prayed for dismissal of the complaint.

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, the life assured was insured with the OPs for the sum assured of Rs.2,50,000/- and the policy in question was issued on 04.04.2018. It is also admitted that complainant is the nominee of the deceased life assured.

11.           The claim of the complainant has been repudiated by the OPs, vide repudiation letter Ex.R13 dated 01.03.2019, on the ground of concealment of true and material facts with regard to pre-existing disease at the time of filling the proposal form, as life assured Pyara Lal was suffering from pulmonary tuberculosis since 14.01.2017 which was not disclosed in the proposal form dated 23.03.2018, which was prior to the inception of this policy.

12.           The onus to prove that the life assured was having pre-existing disease, prior to commencement of the policy was relied upon the OPs. OPs have duly proved its version by leading cogent and convincing evidence. It is evident from treatment record Ex.R8 dated 29.12.2016 the deceased life assured got treatment for Tuberculosis under Revised National Tuberculosis Control Programme since the year 2016. This fact also proved from the medical record Ex.R9 to Ex.12. DLA had concealed these facts at the time of purchasing the policy. To rebut the said treatment record, complainant has miserably failed to produce any cogent and convincing evidence. Thus, it has been proved on record that deceased life assured was having pre-existing disease and had concealed the true and material facts regarding his health at the time of purchasing the insurance policy. Complainant has also failed to place on file any evidence or medical record to prove that deceased life assured had died due to heart attack. Cause of death also not proved. The policy was purchased on 04.04.2018 and life assured had died on 23.04.2018 i.e. within one month of purchase it. Thus, the possibility of death due to Tuberculosis cannot be ruled out.  Hence, it is proved on record, the deceased life assured was suffering from pre-existing disease and he concealed the said facts from the OPs at the time of obtaining the insurance policy.   In this regard, we are fortified with the observations of Hon’ble Supreme Court in case titled as Branch Manager, Bajaj Allianz Life Insurance Company Ltd. and others Vs. Dalbir Kaur in civil appeal no.3397 of 2020 decided on 09.10.2020 wherein Hon’ble Supreme Court held that a policy of insurance is governed by the principles of utmost good faith. The suppression of material facts by the insured/policyholder entitles the OP to repudiate the policy under section 45 of the Insurance Act. The said authority is fully applicable to the facts of the present case.

13.           It is settled principle of insurance law that contract of insurance is a contract uberrima fides and utmost faith must be observed by the contracting parties. Every material fact must be disclosed, otherwise there is good ground for rescission of contract. If, there are misstatements or suppression of material facts, the policy can be called into question. In this regard reference may be made to the judgment of the Hon’ble Supreme Court in case titled Satwant Kaur Sandhu Versus New India Assurance Co. IV( 2009) CPJ 8 (SC) and judgment of Hon’ble National Commission in case Life Insurance Corporation of India and another Versus Bimla Devi Revision Petition no.3806 of 2009 decided on 12.8.2015 and Sunita Rani Versus PNB Metlife India Insurance Company Limited in appeal no.1252/2015 dcided on 21.04.2017.

14.           In the present case deceased life assured has concealed the true and material facts regarding his health at the time of commencement of the policy in question.

15.           The case laws cited by the learned counsel for the complainant are not applicable to the facts of the present complaint.

16.           Thus, in view of the above, present complaint is devoid of any merits and same deserves to be dismissed and the same is hereby dismissed. No order as to costs.  The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Dated:01.05.2023                                                                       

                                                                  President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Rekha Chaudhary)

                    Member                         Member