BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 112 of 2016
Date of Institution : 5.5.2016
Date of Decision : 7.9.2017.
Baljit Singh son of Sh. Dara Singh, resident of village Bhuthan Khurd, Tehsil and District Fatehabad.
……Complainant.
Versus.
- HDFC Standard Life Insurance Company Ltd., Branch Office Sirsa, 1st Floor Classic Auto Care Sangwan Chowk, Opp. Sharma Petrol Pump Dabwali Road Sirsa- 125055, through its Branch Manager.
- HDFC Standard Life Insurance Company Limited, 11th Floor Lodha Excelus, Apollo Mills Compound NM Joshi Marg, Mahalaxmi, Mumbai 400011, through its Managing Director/ Authorized person.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. R.L.AHUJA…………………………PRESIDENT
SMT. RAJNI GOYAT ………………… MEMBER
SH. MOHINDER PAUL RATHEE …… MEMBER.
Present: Sh. P.S. Sokhal, Advocate for the complainant.
Sh. A.S. Kalra, Advocate for opposite parties.
ORDER
The case of the complainant in brief is that Dara Singh purchased two policies i.e. policy No.16893073 for a sum of Rs.8,22,116/- and policy No.16927625 for a sum of Rs.10,00,000/- from opposite party no.2 through op no.1and got his life insured by making premium to the opposite parties. Thus, the life insured got his life insured for a total sum of Rs.18,22,116/- from the opposite parties. During the life time period the insured himself and after the death of life insured, the nominee is entitled for the benefit of policies as per terms and conditions of the policies. The complainant is the son of the life insured and he is also the nominee of the life insured in both the policies. That the insured was hale and hearty at the time of taking insurance policies and there was no any kind of history of any disease prior to death and at the time of purchasing of both the policies. The insured was also checked up by the doctor on panel of company at the time of issuance of the policies. It is further averred that unfortunately the insured died suddenly on 25.7.2014 due to heart attack at his early age during the subsistence of the policies. The complainant who is the son and nominee of the insured intimated the ops regarding the death of insured and requested for death claim benefits under both the policies. The complainant also lodged claim with the opposite parties and completed all the formalities and submitted all the documents alongwith original policies with the ops. The officials of ops assured the complainant that claim will be disbursed within the short period. The complainant also requested the officials of ops many times for disbursement of claim but all in vain and the ops have not paid the claim. It is further averred that complainant received letters dated 18.5.2015 vide which the ops repudiated the claim of complainant regarding both the policies by stating that the life assured was suffering from seizures disorder and palpitation prior to the policy issuance, which was not disclosed in the application dated 5.6.2014. Had this information been provided to the company at the time of applying for the insurance policy, they would have declined the application. The version of the ops for repudiating the claim under the above said policies is false, concocted and fabricated only to repudiate the genuine claim of complainant. The life insured never suffered from any such type of alleged disease as alleged by the insurance company in their repudiation letters dated 18.5.2014 under both the policies. It is further averred that complainant is entitled to get the insured amount of Rs.18,22,116/- under both the policies alongwith interest @24% per annum from the date of death of life insured till actual realization. The ops have harassed and humiliated the complainant by not paying the claim. Hence, this complaint.
2. On notice, opposite parties appeared and filed written statement taking certain preliminary objections. It is submitted that it is vehemently denied that the deceased life insured was not having history of any disease prior to death and at the time of purchasing the policies. It is submitted that deceased life insured while applying for the policies gave wrong information pertaining to his heath. It is further submitted that after verifying, it was found by the answering ops that the deceased life insured was suffering from the pre-existing chronic disease of “Seizures Disorder & Palpitation” which the deceased had not disclosed and had withheld material information at the time of filing of the proposal form. The life insured did not die a natural death. The complainant lodged the claim with the ops. But the same was repudiated vide letter dated 18.5.2015 stating the reasons thereof. The ops never assured the complainant that the claim will be disbursed within short period. If any assurance given also (though denied) the same was subject to the investigation to be done by the ops. That on the basis of investigations conducted and the evidence gathered by the ops, the claim of complainant was rejected. The ops have conducted proper investigations before repudiating the said claims of the complainant. Remaining contents of complaint have also been denied.
3. The complainant produced his affidavit Ex.C1 and copies of repudiation letters Ex.C2 and Ex.C3. On the other hand, ops produced affidavit Ex.OPW1/A and copies of documents Ex.OP1 to Ex.OP8.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. The perusal of evidence of complainant reveals that complainant has furnished his affidavit Ex.C1 in support of his complaint in which he has reiterated all the contents of the complaint qua policies purchased by his father deceased Dara Singh and about his death on 25.7.2014. He has deposed that he lodged claim with the ops but both the claims were repudiated by the ops. The complainant has produced repudiation letters in this regard as Ex.C2 and Ex.C3. On the other hand, Sh. Amit Khanna, Executive Legal has furnished his affidavit on behalf of ops as Ex.OPW1/A in which he has reiterated the contents of the written statement filed by ops. The ops have also produced copy of investigation report as Ex.OP1, copy of certificate of doctor Ex.OP2, copy of application moved by complainant Ex.OP3, copy of certificate of complainant Ex.OP4 and copies of statements Ex.OP5 to Ex.OP8.
6. The perusal of the record reveal that both the parties have not placed on record the death certificate qua the factum of death of deceased Dara Singh allegedly took place on 25.7.2014. Similarly both the parties have not placed on record copies of the insurance policies and terms and conditions of the policies due to reason best known to them. The opposite parties have relied upon the report of the Investigator. The opposite parties have repudiated the claims of the complainant vide repudiation letters dated 18.3.2015 Ex.C2 and Ex.C3 on the ground that from investigations it was established that the life assured was suffering from Seizures disorder and Palpitation prior to the policy issuance, which was not disclosed in the application dated June 05, 2014. Had this information been provided to the company at the time of applying for the insurance policy, they would have declined the application.
7. The opposite parties have mainly relied upon investigation report Ex.OP1 in which it has been reported that in their investigation, it has been found that LA was taking treatment for fits with palpitation before taking policy whose information he did not describe on proposal form when he was taking policy for him. He put hide his illness and past medical treatment regarding to it with company. The opposite parties have also placed on record a certificate of doctor of Community Health Centre, Shri Kolayat (Rajasthan) as Ex.OP2 in which it is certified that Sh. Dara Singh son of Sh. Sunda Ram, aged 59 years, resident of Jhajhu came in the institution with complaints of fits with palpitation vide OPD No.33353 dated 18.5.2014 and after his check up on 18.5.2014 at 10.40 a.m. he was referred to PBM Hospital, Bikaner vide referral No.276/18.5.2014. The perusal of the investigation report reveals that it does not bear the signatures of any Investigator, nor it bears name of the Investigator who conducted this whole investigation. Moreover, this report is silent qua the cause of death of the deceased insured and whether there was any close proximity of the disease from which he was suffering with the heart attack by which he allegedly died. So, from the report it appears that investigator has not made his all best efforts to investigate the matter properly and to come to the right conclusion in order to settle the claim of the complainant qua the death of the deceased Dara Singh.
8. In view of our above discussion, we partly allow this complaint and direct the opposite parties to appoint some another Investigator with a direction to make thorough probe qua the date and cause of death of the deceased as well as the fact whether deceased Dara Singh was suffering from any pre-existing disease prior to the purchase of the policies and said disease had any close proximity with the cause of death and also to produce his detailed report to all the circumstances and the facts qua the death of deceased Dara Singh alongwith death certificate and further opposite parties are directed to reopen and re-examine the claim of the complainant within 45 days after receipt of investigation report and pay claim if same is payable under the terms and conditions of the policies. The parties are left to bear their own costs. A copy of this order be supplied to the parties free of costs. File be consigned to the record room.
Announced in open Forum. President,
Dated:07.09.2017. Member Member District Consumer Disputes
Redressal Forum, Sirsa.
