Haryana

Karnal

CC/255/2015

Sucha Singh S/o Babu Ram - Complainant(s)

Versus

HDFC LIfe Insurance Company - Opp.Party(s)

Vikash Chauhan

22 Nov 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL. 

                                                     Complaint No. 255 of 2015

                                                    Date of instt.19.10.2015

                                                     Date of decision 22.11.2017

 

Sucha Singh son of Sh. Babu Ram aged about 67 years, resident of village Birthe-Bahri, Sub Tehsil Rajound, District Kaithal.

                                                                                 ……..Complainant.

                                        Versus.

1. The Head Branch Office, HDFC Life Insurance SL, Karnal Branch, Naryana Plaza, SCO 778-779, Kunjpura Road, opposite Mahavir Dal Karnal-132001.

2. The Head, Registered office Ramon House, HT Parekh Marg, 169 Backbay Reclamation, Church Gate, Mumbai-400020.

 

                                                                      ..…Opposite Parties.

 

 Complaint u/s 12  of the Consumer Protection Act 1986.

 

Before     Sh. Jagmal Singh……….President.

                Sh.Anil Sharma…….Member.

 

Present:   Sh. Vikash Chauhan Advocate for the complainant.

                 Sh. Vikas Bakshi Advocate for opposite parties.

                 

       

                (JAGMAL SINGH, PRESIDENT)

 

 ORDER:

 

                This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986, on the averments that his son namely Kuldeep Singh had purchased a Life Insurance Policy no.14547653 in the month of August, 2011 from the OPs and paid a premium amount of Rs.1,49,999/- and the insured amount of Rs.14,99,990/-. The premium was paid vide demand draft of Rs.15000/- dated 10.8.2011 and the proposal was duly accepted by the OPs, confirmation letter alongwith the policy details was sent to Kuldeep Singh son of the complainant, vide letter dated 27.8.2011. The date of maturity is 31.8.2021. The annual premium were paid regularly and a total sum of Rs.4,49,997/- was paid till 26.2.2014. His son was quite hale and hearty but unfortunately died on 25.3.2014 at Aparna Hospital Madhuban, Karnal because of illness. He being nominee of his son applied for death claim benefit and provide all the required documents to the OPs. He received a letter dated 17.3.2015 vide which OPs repudiated his claim on the false and fictitious grounds. The complainant was shocked to see his accounts statement and letter dated 23.3.2015 that the OPs have transferred a sum of Rs.4,99,421.16/- in his account towards death claim of his son whereas as per the policy a sum of Rs.14,99,990/- should be given to him towards death claim. He visited the office of OPs many times and requested to make the payment of the remaining payment of the claim, but OPs did not pay any heed to his request. Then, he sent a legal notice dated 6.8.2015 through his counsel to the OPs in that regard, but to no effect. In this way there was deficiency in service on the part of the OPs. Hence complainant filed the present complaint.

2.             Notice of the complaint was given to OPs, who appeared and filed written statement raising preliminary objections with regard to jurisdiction; intricate questions of law and facts are involved, which cannot be decided in summary proceedings; maintainability; locus standi and cause of action and concealments of material facts. On merits, it has been submitted that the deceased life assured (hereinafter referred as DLA) had purchased as Life Insurance Policy in the month of August 2011, vide policy no.14547653 and had paid the premium for the same. But the said policy was an act of fraud as the deceased has submitted the forged and fabricated income proof for obtaining the insurance policy. It has further been submitted that the complainant is not entitled to any claim as for the facts that the DLA was suffering from Mayo Clinic Alcoholic Liver Decease, HEP-B & HEP-C.  The OPs have rightly repudiated the claim of the complainant vide its letter dated 17.3.2015. It is admitted fact that due fund value of the policy was paid to the complainant and complainant is not entitled to any other relief/amount except the fund value as the policy in question was A Unit Linked Plan. Hence there was no deficiency in service on the part of the OPs and prayed for dismissal of the complaint.

3.             Complainant tendered into evidence his affidavit Ex.CW1/A and documents Ex.C1 to Ex.C4 and closed the evidence on 22.8.2016.

4.             On the other hand, OPs tendered into evidence affidavit of Amit Khanna Ex.OPW1/A and documents Ex.OP1 to OP14 and closed the evidence on 22.9.2017.

5.             We have heard the learned counsel for both the parties and perused the case file carefully and have also gone through the evidence led by the parties.

6.             It is admitted by the parties that the son of complainant had purchased a Life Insurance Policy no.14547653 for a sum assured of Rs.14,99,990/- and the date of maturity of policy is 31.8.2021. It is also admitted that DLA died on 25.3.2014 and complainant was the nominee in the abovesaid policy. Complainant lodged the claim with the OPs but OPs repudiated the claim of the complainant, vide letter dated 17.3.2015. It is also admitted that OPs have transferred a sum of Rs.4,99,421.16/-/- in the account of the complainant.

7.             The dispute between the parties is that according to the complainant, the OPs have repudiated his claim on fake and fictitious grounds whereas according to the OPs, they have rightly repudiated the same.

8.             According to repudiation letter dated 17.3.2015, while repudiating the claim of the complainant, it is mentioned as under:-     “However, our investigations have established that the Life Assured was suffering from Chronic Liver Disease prior to the policy issuance and also was Chronic Alcoholic, which was not disclosed in the application dated August 10, 2011. Further, the documents submitted as an income proof at proposal stage is found to be fake. Had this information been provided to the company at the time of applying for the issuance policy, we would have declined the application.”

9.             As the OPs have declined the claim in question, so the onus was upon the OPs to prove the allegations/grounds of repudiation. To prove their case, the OPs have tendered into their evidence documents Ex.OP-1 to Ex.OP-14 besides the affidavit Ex.OPW1/A. Ex.OP-2 is the investigation report vide which the investigator stated that insured Kuldeep Singh had liver disease from some time and he was on very regular treatment for his illness and he was a Handicapped man due to an accident in Italy, but the insured did not disclose his illness in his company proposal form when he took the insurance. To prove this fact, the OPs placed on the file medical record from Arpana Hospital, Madhuban, Karnal as Ex.OP-12 and Ex.OP-13. But this medical record pertained to the treatment taken by the insured from January, 2014 to March, 2014. As already stated above, the policy in question was taken by the insured in August, 2011. The OPs could not point out from the medical record Ex.OP-12 & Ex.O-13 that the insured for suffering from the illness before taking the policy. No history was given in the hospital record which lead to the contention/suggestion of the OPs that the insured was suffering and was aware about the disease pointed out by the investigator of the OPs. The report of the investigator of the OPs does not point out any evidence which may lead to the conclusion that at the time of submitting proposal form, the insured was aware that he was suffering from the liver disease. In these circumstances, it cannot be said that the insured obtained the insurance policy by concealing the material facts regarding his ailment. In this regard we can rely upon the authority cited in 2016 (2) CLT 322 (NC) tilted as Shanti Devi Versus TATA AIG Life Insurance Co. Ltd., the head note of this authority as under:-

        Hormonal disorder-Pre existing disease-Suppression of material fact-No history given in hospital which lead to the suggestion that the insured was aware about disease-Report of the investigator does not point out any evidence which may lead to the conclusion that at the time of submitting proposal form, the insured was aware that he was suffering from disease-Held-Thus, it cannot be said that the insured obtained the insurance policy by concealing material fact regarding his ailment as a result of Hormonal disorder. This authority is fully applicable to the facts of the case. The OPs have failed to prove on the file that the insured was having a pre-existing disease and was aware of the same.

 11.          The second contention of the OPs is that the documents submitted as an income proof at proposal stage were found to be fake. In this regard it is pertinent to mention here that the policy was taken by the insured in the year 2011 and the insured died in 2014 and all the due premiums were deposited regularly by the insured. Moreover, the investigator has mentioned in his investigation report that the insured became handicapped after a road accident in the year 2009 in Italy and the insured was departed to India as he became handicapped and the family of the insured got a huge amount of claim( because of this Accident) from Italy and that Amount was deposited in the Local Branch of HDFC Bank from where this insurance was sold out as all the Bank Employees of the HDFC Bank knew the Family of the Insured very well and they guided the Claimant to take this Insurance. Therefore, the insured had sufficient mean to pay the premium and accordingly the insured had paid the same without fail. Moreover, if the argument sake it is presumed that the documents submitted by the insured were fake, even then the same has not adverse effect on the claim of the complainant. However, it is pertinent to mention here that the OPs have failed to prove the same to be fake because neither any witness has been examined nor affidavit of the concerned person was tendered. In these circumstances, we are of the considered view that the OPs have wrongly repudiated the claim of the complainant.  Hence the OPS were deficient in providing services to the complainant.

12.           Thus, as a sequel to above discussions, we allow the complaint and direct the OPs to pay the insured amount to the complainant after deducting the amount already paid. We further direct the OPs to pay Rs.3300/- as cost on account of mental pain, agony, harassment and litigation charges. This order shall be complied with within 30 days from the date of receipt of copy of this order failing which the complainant is entitled interest @ 8% per annum from the date of announcement of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:22.11.2017

                                                                       

                                                                  President,

                                                         District Consumer Disputes

                                                           Redressal Forum, Karnal.

 

 

                       (Anil Sharma)

                            Member