Haryana

Fatehabad

CC/442/2019

Sukhbir - Complainant(s)

Versus

HDFC Life Insurance Company - Opp.Party(s)

Dayanand Siwach

08 Jan 2024

ORDER

BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION FATEHABAD.

                                      Sh.Rajbir Singh, President.                                               Dr.K.S.Nirania and Smt.Harisha Mehta, Members

 

                                                Complaint Case No.:442of 2019.

                                             Date of Institution:    08.11.2019.

                                                        Date of order:            08.01.2024.      

 

Sukhbir Singh son of Shri Ram Kishan resident of village Gorakhpur Tehsil & District Fatehabad

                                                                          ….. Complainant.

                                          Versus     

 

1.HDFC Life Insurance Company Limited, Regd. Office 13^th Floor, Lodha Excelus, Apollo Mill Compound N.M.Joshi Marg, Mahalaxmi, Mumbai-400001 through its authorized signatory.

2.HDFC Life Insurance Company SCO 57 of 60, First Floor, Kamala Place, Red Square Market, Hisar District Hisar  through its Manager/Authorised Signatory.

….Opposite parties.

 

Complaint U/s 12 of the Consumer Protection Act, 1986

                                                                                

Present:         Shri Dayanand Siwach, Advocate for the complainant.

                  Shri Yogesh Gupta, Advocate for the opposite parties.

 

ORDER

SH.RAJBIR SINGH, PRESIDENT

                   Brief facts of the present complaint are that father of the complainant namely Sh.Ram Kishan got insured his life with Ops through insurance policy No.20628635, by making insurance premium of Rs.95,000/-,  for sum assured of Rs.9 lac, commencing from 28.08.2018 with maturity date 18.08.2028; that the complainant has been nominated as nominee; that on 22.10.2018, the insured died due to electrocution while working in the field;  that the complainant submitted all the relevant documents with the Ops and requested for settlement of the complaint but the Ops vide letter dated 27.03.2019 wrongly and illegally repudiated the claim of the complainant;

that the aforesaid acts of omission and commission on the part of the OPs amount to deficiency in service and unfair trade practice. Hence, this complaint. 

2.                Averments of the complaint have been strongly opposed in the joint written statement filed on behalf of Ops wherein several preliminary objections such as maintainability, concealment of material facts, locus standi and estoppal etc. have been taken. It has been further submitted that the life assured at the time of making the proposal form had misrepresented about his health i.e. the deceased was suffering from taking treatment for the decease of lung cancer prior to issuance of the policy, therefore, the claim was rightly repudiated vide letter dated 27.03.2019; that in the proposal, the life assured had answered the following questions in negative:-

Have you never suffered from Epilepsy, any nervous disorder or mental condition, paralysis or multiple sclerosis, depression, or psychiatric disorder, cancer or a tumor?	No
Are you currently suffering from any illness, impairment or taking any medication or pills or drugs?	No
During the last five years have you have you undergone or being recommended to undergo hospitalization?	No
During the last five years have you undergone or being recommended to undergo X-ray any other investigation (including check-ups for employment/insurance/foreign visits?	No

 

It has been further submitted that the life assured has violated the terms and conditions of the policy in question, therefore, the ops have rightly repudiated the claim of the complainant as the policy in question was purchased with malafide intention. Other contentions have been controverted and in the end, a submission was made for dismissal of the complaint.

4.                The parties then led their respective evidence by way of affidavits and documents. The complainant has tendered in evidence his affidavits Ex.CW1/A, Ex.CW2/A, Ex.CW3/A and Ex.CW4/A alongwith documents Ex.C1 to Ex.C5. On the other hand, no evidence on behalf of Ops has been led despite availing ample opportunities and the same was closed by the order of the Commission on 12.05.2023.

5.                We have heard learned counsel for the parties and with their kind assistance, the material available on the case file, have been perused and examined.

6.                Undisputedly, the father of the complainant was insured with Ops for a sum assured of Rs.9 lac (Ex.C3). It is also not disputed that the life assured died during the currency of the policy on 22.10.2018 (Ex.C2).  Learned counsel for the complainant has argued that the life assured died due to electrocution, therefore, the death of the life assured being accidental death is covered under the policy.  Learned counsel for the complainant in support of his plea drew the attention of this Commission towards the duly sworn affidavits Ex.CW1/A (Ravinder Kumar son of Dalip), Ex.CW2/A (Parwinder son of Jogi) and Ex.CW3/A (Satyawan son of Bhag Chand) all are field neighbourers and inhabitants of same village, wherein they all have deposed that the life assured was not suffering from any disease and died due to electrocution. Ex.C5 i.e. certificate issued by the Member of Zila Parishad also depicts that the life assured died due to electrocution.

7.                          On the other hand the Ops have come with the plea that the life assured had concealed the material facts from the Ops before obtaining the policy in question as he was suffering from lung cancer but there is nothing on the case file to support this plea. The burden of proof was upon the OPs to prove that the insured was suffering from pre-existing diseases prior to taking the policy, but they have miserably failed to discharge this onus, by not leading any cogent and convincing evidence in the shape of medical evidence to prove this fact.  Moreover, the complainant has established his case that the death of life assured was accidental which is covered under the policy in question. Another strange factor, which this Commission has noticed that the premium amount is still retained by the insurance company.

9.                          After considering all the facts and going through the material available on the case file, we have no hitch to reach at a conclusion that the Ops are only trying to back out from the contract and it is a general observation that in a number of cases, the insurance companies are issuing policies keeping in view the statements made by the proposer in utmost good faith but when it comes to settlement of claims, they start examining the matter under the microscope.  Moreover, the Ops in their reply have specifically taken the plea that the life assured was patient of lung cancer but they have not produced any documents qua the ailment as well as taking treatment from any hospital by the life assured.  It is settled principle of law that mere pleadings without any concrete evidence does not have weight-age in the eyes of law.  

 9.                         Thus, as a sequel to our above discussion, we accept the present complaint and direct the Ops to pay the amount of Rs.9 lac (sum assured) to the complainant alongwith interest @ 6% per annum from the date of filing of present complaint till actual realization. We also direct the Ops to further pay a sum of Rs.11,000/- for mental agony and harassment including litigation expenses to the complainant.  The order be complied within a period of 45 days from today.

10.                        In default of compliance of this order, proceedings against respondents shall be initiated under Section 72 of Consumer Protection Act, 2019 as non-compliance of court order shall be punishable with imprisonment for a term which shall not be less than one month, but which may extend to three years, or with fine, which shall not be less than twenty five thousand rupees, but which may extend to one lakh rupees, or with both. A copy of this order be sent to the parties free of cost. This order be also uploaded forthwith on website of this Commission, as per rules, for perusal of parties herein. File be consigned to the record room after due compliance.     

Announced in open Commission.                                                            Dated: 08.01.2024

 

                                                                                                        

          (K.S.Nirania)                       (Harisha Mehta)                (Rajbir Singh)                              Member                               Member                                           President