Punjab

Ludhiana

CC/17/780

Amar Singh - Complainant(s)

Versus

HDFC Life Insurance - Opp.Party(s)

Kewal Preet Adv.

18 Oct 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, LUDHIANA         

 Complaint No.780 of 2017

Date of Instt. 27.10.2017

Date of Decision: 18.10.2019

Amar Singh aged 73 years Son of Sh. Kahen Singh resident of Village Malakpur Bet, Tehsil and District Ludhiana.

..........Complainant

Versus

1.       HDFC Life Insurance, SCO-41, 4^th Floor, Feroze Gandhi Market, Above Tanishq Showroom, Ludhiana (Punjab) through its Territory Manager.

2.       The Vice President/Claims HDFC Standard Life Insurance Co. Ltd. The IL&FC Finance Center, Fifth Floor, Plot No.C-22, G-Block Bandra Kurla, Complex, Bandra (E) Mumbai 40051

3.       HDFC Bank, Branch Malakpur Bet, Tehsil and District Ludhiana through its Branch Manager.

 

….….. Opposite Parties

Complaint Under the Consumer Protection Act.

 

Before:        Sh. G. K. Dhir               (President)

Smt. Jyotsna Thatai       (Member)

 

Present:       Sh. Kawalpreet Singh, Adv Counsel for the                                     Complainant.

OPs No.1 & 2 exparte.

Complaint against OP No.3 not admitted.

Order

Jyotsna Thatai (Member)

1.                This complaint has been filed by the complainant, wherein alleged that the complainant purchased a policy bearing policy No.18582520 plan HDFC Life Sanchay in the name of his son Chamkaur Singh son of Amar singh in the year 2016 for total insured sum of Rs.1,85,903/- from OPs through OPs and sum of Rs.50,000/- paid by complainant to OP, vide cheque No.000000000003 dated 25.07.2016 as a first premium of the above said policy. Unfortunately, Chamkaur Singh son of complainant suddenly suffered Heart Attack and admitted in the DMC Hospital, Ludhiana on 12.11.2016, but he was found dead, the doctor clearly mentioned the reason of death of Chamkaur Singh due to Cardioregpitaloy (Heart Attack).

2.                That after the death of Chamkaur Singh complainant being a father of the assured person put their claim to OPs along with relevant original document i.e. original policy in question, but same was rejected with the objection that the assured person was suffering from Tuberculosis prior to the policy issuance and same was not disclosed in the application dated 19.07.2016. Had this information been provided to the company at the time of applying for the insurance policy, insurer would have declined the application and OP also sent the amount of Rs.48,188/- to complainant which was paid by complainant as a first premium of the policy in question. In fact, as per terms and conditions of the policy in case of death, OPs are liable to pay the sum of Rs.5,00,000/- which is higher of the 10 time of annualized premium or sum assured on maturity i.e. Rs.1,85,903/- or 105% of premium paid as a death benefit to the petitioner being father and nominee of the insured person. After the receipt of letter dated 03.03.2017, complainant numerous time approached to OP in person and telephonically, but every times OP assured to complainant the amount in question paid by OPs as soon as possible, but all in vain. Thereafter, complainant again moved a letter on 05.05.2017 regarding the actual and factual position of the deceased of Tuberculosis and also submitted the medical certificate and death certificate of Chamkaur Singh and stated that at the time of death deceased Chamkaur Singh was not suffering from Tuberculosis and his son Chamkaur Singh already treated effectively and from last 9/10 years, he was fully cured from above said disease. Moreover, the reason of death is not Tuberculosis and same is due to heart attack to Cardioregpitaloy. But despite of that OP failed to pay the insured amount to the complainant as per terms and conditions of the policy in question and OPs are fully liable to pay the insured amount Rs.5,00,000/- along with interest. As such, the repudiation of claim of complainant by OPs are illegal, arbitrary, based on the conjectures and the surmises and OPs intentionally rejected the claim of the complainant and it is deficiency in service on their part and complainant suffered mental pain, agony and harassment on the account of rejection of claim by the OPs. The complainant also got served the OPs with a legal notice dated 08.09.2017 through his counsel, but the OPs neither sent any reply nor paid the amount in question to the complainant and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to pay the insured amount of Rs.5,00,000/- as a sum insured along with interest @ 18% per annum from the OP beside it Rs.1,00,000/- as mental harassment and Rs.50,000/- as deficiency in service and Rs.35,000/- as litigation expenses as claimed.

3.                Notice of the complaint was given to the OPs No.1 and 2, but despite service, they did not come present and ultimately, both were proceeded against exparte and OP No.3 was not summoned because complaint against OP No.3 not admitted.

4.                In order to prove his case, complainant himself tendered into evidence his own affidavit Ex.CW1/A along with some documents Ex.C-1 to Ex.C-10 and  Mark-CA & then closed the evidence.

5.                We bestowed our thoughtful consideration to the submissions made by learned counsel for the complainant and also gone through the case file very minutely.

6.                The factum of the complaint, in regard to purchase of insurance policy from the OPs by the complainant in the name of his son Chamkaur Singh, in the year 2016 for a total sum insured of Rs.1,85,903/-, is not disputed. It is also clear that after the death of insured Chamkaur Singh, the complainant father of Chamkaur Singh submitted an insurance claim, but the same was repudiated by the OP, vide letter dated March 3, 2017. The same is placed on the file by the complainant as Ex.C-5. The complainant has also placed on the record terms and conditions of HDFC Life Sanchay Policy Mark CA, which states that sum assured on death will be higher of the amount mentioned or 10 times the analyzed premium or 105% of the premium paid. Now question remains only to be considered and to decide whether there was any concealment of previous ailment of insured Chamkaur Singh or not. These allegations have been raised by the OPs in a letter dated March 3, 2017 Ex.C-5 and when any plea is taken by either of the party, then ball goes to the Courtyard of that party to prove that fact. So, accordingly, happened in this case and it was bounded duty of the OPs to prove the allegations as made in the repudiation letter that the deceased was having a disease of Tuberculosis prior to the policy issuance. The complainant also wrote a letter dated 05.05.2017 denying that the deceased Chamkaur Singh had the disease of Tuberculosis. Moreover, as per medical certificate of cause of death Ex.CW2/1, the reason of death of Chamkaur Singh is due to Cardioregpitaloy (Heart Attack) and not Tuberculosis. Despite notice OPs have chosen to be exparte which means they have nothing to say in this matter. So, with these observations, we come to conclusion that death claim of the deceased Chamkaur Singh has been wrongly repudiated by the OP, vide letter dated 3 March 2017 Ex.C-5, whereas complainant is entitled for the insured amount being father of the deceased Chamkaur Singh.

7.                As an upshot of our above detailed discussion, the complaint of the complainant succeeds and the same is partly accepted and OPs are directed to pay insured amount of Rs.5,00,000/- after deducting the already paid amount with interest 9% per annum from the date of repudiation i.e. 03.03.2017, till realization and further OPs are directed to pay compensation for harassment, deficiency in service and mental tension to the complainant, to the tune of Rs.25,000/- and litigation expenses of Rs.5000/-. The entire compliance be made within one month from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.

8.                Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

 

Dated                                       Jyotsna Thatai              G. K. Dhir

18.10.2019                                        Member                          President