BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 110 of 2016
Date of Institution : 5.5.2016
Date of Decision : 15.11.2017.
Ram Chander son of Sh. Kala Ram, resident of village Patli Dabar, Tehsil and District Sirsa.
……Complainant.
Versus.
1. HDFC Standard 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.
2. 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. Prem Singh Sokhal, Advocate for the complainant.
Sh. Sandeep Kamboj, Advocate for opposite parties.
ORDER
The case of the complainant in brief is that son of complainant got his life insured with the opposite parties by purchasing insurance policy No.16843291 for insured amount of Rs.15,00,000/- commencing from 30th May, 2014 for a period of 30 years by making premium to the ops at Branch Sirsa. That during the life period of life insured himself and after the death of life assured the nominee is entitled for benefit of the policy as per terms and conditions of the policy. It is further averred that insured was hale and hearty at the time of taking insurance policy and there was no any history of any disease prior to death. The insured was also checked up by the doctor on panel of the company at the time of issuance of the policy. The complainant being father of life assured is nominee of the life assured as per the policy. It is further averred that life assured Sukhdev Singh died during the subsistence of the policy period. The complainant submitted claim form with the ops and also lodged claim with the ops and also submitted original policy to the ops. The complainant also completed all the formalities and requested for disbursement of claim amount and the officials of the ops assured the complainant for disbursement of claim amount within short period. The complainant also contacted the official of the ops many times but all in vain. It is further averred that complainant received a letter dated 27.5.2015 issued by the ops vide which the insurance company has repudiated the claim of the complainant by stating that life assured was suffering from coronary artery disease prior to issuance of policy, it was also noted that the life assured belongs to below poverty line and the income of the life assured was less than what has been disclosed in application dated 8.5.2014. Had this information provided to the company at the time of applying for insurance policy, they would have declined the application. The whole version of the company is fabricated and false only to decline the genuine claim of the complainant. The life assured had never such type of disease as alleged by the insurance company in the repudiation letter and he was having sufficient income to pay the premium and the life assured disclosed all the true and real facts in the application at the time of applying for insurance policy. That the ops have committed deficiency in service by repudiating the genuine claim of the complainant and have caused harassment and mental agony to the complainant. Hence, this complaint.
2. On notice, opposite parties appeared and filed reply taking certain preliminary objections. It is submitted that deceased life assured purchased the life insurance policy from the answering ops on 22.5.2014 and at the time of purchase of policy and filling up the proposal form, the deceased life assured intentionally and deliberately concealed the factum of his ailment as the deceased prior to his death met with an accident and due to accidental injuries, the backbone of the insured Sukhdev Singh was ruptured and he suffered injuries on his chest and lost his voice and rendered physically disabled person and also suffered from coronary artery disease but these facts have been knowingly concealed by the deceased. He knowingly answered the question regarding medically fitness of deceased life assured as OK whereas he was not physically able and fit person because of above said injuries sustained by him, hence the complainant is not entitled to claim any sum against the said policy. It is also submitted that no medical examination of the deceased life assured was got conducted by the ops rather the life assured had filed the declaration form with the ops’ company about his fitness on the basis of which the policy has been issued and as the answer in the declaration form has been found false, hence the op company is not liable for the payment of the compensation/ sum assured. It is further submitted that on the submission of the claim form, the matter has been thoroughly checked/ verified and it has been found that the deceased life assured has procured the life insurance policy by way of concealment of facts, hence the company has rightly repudiated the claim of complainant. The policy has been issued on 22.5.2014 whereas the life assured has died on 19.7.2014 just within two months from the date of policy. The repudiation of death claim under the said policy is in accordance with the law of insurance and on the lines of Section 45 of Insurance Act, 1938. Remaining contents of the complaint have also been denied and prayer for dismissal of complaint has been made.
3. The complainant produced his affidavit Ex.C1, repudiation letter Ex.C2 and policy Ex.C3. On the other hand, ops produced affidavit of Sh. Amit Khanna, Deputy Manager (Legal) Ex.RW1/A, copy of insurance policy Ex.R1, copy of investigation report Ex.R2, copy of repudiation letter Ex.R3, copy of ration card Ex.R4, copy of BPL card Ex.R5, copy of list of BPL Ex.R6, copy of certificate of Sarpanch Ex.R7 and copies of treatment record Ex.R8 and Ex.R9.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. Learned counsel for the complainant has strongly contended that it is proved case of the complainant that son of complainant namely Sukhdev Singh had purchased insurance policy bearing No.16843291 for sum assured of Rs.15,00,000/- and paid the requisite premium. It is also proved on record that after his death, the complainant being nominee lodged the claim alongwith all the documents with the ops but however, ops arbitrarily and illegally repudiated the claim of the complainant on the ground that life assured was suffering from coronary artery disease prior to the issuance of the policy and the life assured belongs to below poverty line and the income of the life assured was less than what has been disclosed in the application dated 8.5.2014.
6. On the other hand, learned counsel for opposite parties has contended that life assured had suppressed the material facts while making the declaration qua the fact of his ailment as prior to his death he met with an accident and due to accidental injuries, the backbone of the insured Sukhdev Singh had been ruptured and he also suffered injuries on chest and lost his voice and rendered physically disabled person but these facts have been knowingly concealed by the deceased. He was not physically able and fit person at the time of purchase of the policy and he got the policy by concealment of facts qua his accident, injuries and the disability and therefore, the ops have rightly repudiated the claim of the complainant.
7. The perusal of the record reveals that the complainant in order to prove his case has furnished his affidavit Ex.C1 in which he has deposed qua averments made in the complaint. He has specifically deposed qua purchase of the policy by his son for the sum assured of Rs.15,00,000/-. He has also deposed that insured was hale and hearty at the time of taking of insurance policy and there was no any kind of history of any disease prior to his death. He has further deposed that Sukhdev Singh died during the subsistence of the policy period. However, the ops arbitrarily repudiated the claim of complainant by stating that life assured was suffering from coronary artery disease prior to issuance of policy and insured belongs to below poverty line and his income was less than what has been disclosed in the application dated 8.5.2014. On the other hand, ops have furnished affidavit of Sh. AmitKhanna, Deputy Manager Legal as Ex.RW1/A in which he has reiterated the averments made in the written statement. He has deposed that deceased life assured purchased the policy on 22.5.2014 and he died on 19.7.2014 and during investigation it was found that deceased met with an accident prior to the purchase of the policy and suffered injuries on his chest and his backbone was ruptured. He lost his voice and rendered physically disabled person and all these facts were concealed by life assured at the time of making declaration. The ops have also tendered in evidence copy of insurance policy Ex.R1, copy of investigation report Ex.R2, copy of repudiation letter Ex.R3, copy of ration card Ex.R4, copy of BPL card Ex.R5, copy of list of BPL Ex.R6, copy of certificate of Sarpanch Ex.R7, copy of certificate of Dahiya Nursing Home, Fatehabad Ex.R8 and copy of prescription slip of Dahiya Nursing Home Ex.R9.
8. It appears from the evidence of the opposite parties that record of the medical treatment of the deceased relates to the year 2013 whereas the policy was purchased by the deceased life assured on 22.5.2014 and the ops have also not placed on record the affidavit of the Investigator who made investigation qua the facts which have been mentioned in the written statement as well as in the affidavit of Mr. Amit Khanna, Deputy Manager (Legal) of the ops, nor the name of the investigator has been disclosed by the ops due to the reason best known to them. Further more, the ops have not placed on record the full proof of the date and place of the accident, nor have placed on record any FIR, DDR or any other document from which it could be presumed that the deceased life assured had met with an accident and suffered injuries prior to issuance of the policy. Moreover, the ops have also not placed on record the terms and conditions which were allegedly settled between parties at the time of issuance of the policy under which they have repudiated the claim of the complainant.
9. In view of above discussion, we partly allow the present complaint and direct the opposite parties to re-open and re-examine the claim of the complainant and thereafter to settle and pay claim if same is payable under the terms and conditions of the policy after examining full record and after thorough investigation qua the alleged accident of the deceased life assured and the alleged injuries suffered by him and treatment which he got qua the alleged injuries if same co-relates with the cause of death. This order should be complied by the ops within a period of 45 days from the date of receipt of copy of this order. 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:15.11.2017. Member Member District Consumer Disputes
Redressal Forum, Sirsa.
