BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 224 of 2016
Date of Institution : 7.9.2016
Date of Decision : 20.9.2017.
Smt. Ranju Goel widow of Sh. Yogesh Kumar Goel, resident of H. No.167, C-Block, Sirsa, Tehsil & District Sirsa.
……Complainant.
Versus.
1. HDFC Standard Life Insurance Company Ltd., through its Managing Directir/ Authorized Signatory. Corporate & Registered Office : Lodha Excelus, 13th Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai- 400011.
2. HDFC Life, HDFC Bank, Near Sangwan Chowk, Sirsa through its Branch Manager.
...…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. A.K. Monga, Advocate for the complainant.
Sh. A.S. Kalra, Advocate for opposite parties.
ORDER
The case of the complainant in brief is that husband of complainant namely Sh. Yogesh Kumar Goel purchased a life insurance policy No.18116856 for Rs. Four lacs and paid the premium. Prior to purchase of this policy, he filed proposal form on 31.12.2015 and thereafter the officials of ops verified all the facts mentioned in the proposal form and after finding all information given in proposal as correct, the above said policy was issued on 4.2.2016 to Yogesh Kumar at Sirsa. This policy was under the plan of HDFC Youngstar super premium. Besides this, the premium amount for this policy was got deposited from Yogesh Kumar by op no.2 officials at Sirsa. It is further averred that Yogesh Kumar died on 3.4.2016 and complainant filed the claim papers in the office of ops at Sirsa but the claim has been rejected by the ops vide letter dated 14.6.2016 on the ground that the insurer concealed the factum of his disease on the date of filing of the proposal forms and date of issuing the above said policy but he was not suffering from any of the disease at the time of filing of proposal form and at the time of issuing the policy and he has not concealed any facts in this regard from the ops. The repudiation of the claim of the complainant by the ops is wrong, illegal and is liable to be set aside. The complainant also sent a representative cum legal notice on 13.7.2016 to the ops for recalling/ withdrawing the order of repudiation but to no effect. Hence, this complaint.
2. On notice, opposite parties appeared and filed written statement taking certain preliminary objections. It is admitted that the deceased life insured had purchased life insurance policy dated 4.2.2016 for sum of Rs.4,00,000/-. It is submitted that the life insured while applying for the policy gave wrong information pertaining to his health. That after submission of the documents by the complainant, the death claim of the complainant was investigated and it was found by the opposite parties that the deceased life insured was suffering from the pre-existing chronic disease of “Jaundice, Diabetes Mellitus & Liver disease’ which the deceased had not disclosed and had withheld material information at the time of filing of the proposal form. The proposal, the personal statement and the life insurance policy all contain a special clause putting the insured on notice that in case of any such deliberate misrepresentation, the contract of insurance would become void and the amounts paid there under shall be forfeited. So the death claim was rightly rejected by the answering ops vide letter dated 14.6.2016 and prayer for dismissal of complaint has been made.
3. The complainant produced her affidavit Ex.C1, copy of letter dated 14.6.2016 Ex.C2, copy of legal notice dated 13.7.2016 Ex.C3, postal receipts Ex.C4 and Ex.C5. On the other hand, ops produced affidavit Ex.R1 and copies of documents Ex.OP1 to Ex.OP5.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. The perusal of the complaint reveal that complainant has specifically mentioned in the complaint that husband of complainant namely Yogesh Kumar had purchased a life insurance policy No.18116856 of Rs.four lacs from the opposite parties. He was not suffering from any disease. He died on 3.4.2016. She lodged the claim with the ops but, however, the ops rejected the claim of the complainant vide repudiation letter dated 14.6.2016 without assigning any valid reason. On the other hand, there is specific plea of the opposite parties that after the death of deceased Yogesh Kumar, claim was lodged by his wife present complainant. That life insured while applying for the policy gave wrong information pertaining to his health. After verification, it was found that deceased life insured was suffering from pre-existing disease of Jaundice, Diabetes Mellitus and liver disease which the deceased had not disclosed and had withheld material information at the time of filing of proposal form.
6. The complainant in order to prove her case has furnished her affidavit Ex.C1 in which she has reiterated all the contents of her complaint and has also placed on record Ex.C2 copy of letter dated 14.6.2016 and Ex.C3 copy of legal notice. On the other hand, the ops have furnished Ex.R1 affidavit of Sh. Amit Khanna, Legal Manager who has also deposed on the lines of the plea taken in the written reply of the ops. The ops have also placed on record Ex.OP1 copy of letter dated 20.4.2016, Ex.OP2 copy of affidavit, copy of treatment record of Department of Emergency and Trauma Care dated 3.4.2016 Ex.OP3, copy of investigation report Ex.OP4 and copy of letter dated 14.6.2016 Ex.OP5.
7. During the course of arguments, learned counsel for the opposite parties has strongly contended that it is proved on record from the evidence of the opposite parties that the deceased life insured had given a wrong information to the ops while getting the policy and concealed the fact qua his health as he was suffering from pre-existing diseases like Jaundice, Diabetes Mellitus and liver disease. A thorough investigation was got conducted by the ops as a result of which the ops came to the conclusion that this policy was obtained by deceased insured after concealing of the fact qua his pre-existing diseases and the ops have rightly repudiated the claim of the complainant. Learned counsel for the ops has also insisted upon the treatment record of the deceased Yogesh Kumar in which Dr. Vivek has written history of the patient but perusal of this report reveals that said doctor has not mentioned even single word that the cause of death of the deceased Yogesh Kumar was due to his pre-existing diseases. In other way, he has no co-related the cause of death with the alleged pre-existing diseases of the deceased. The record further reveal that said doctor has not appeared in the witness box nor he furnished any affidavit to this effect that the deceased was suffering from any such pre-existing disease nor he has given any specific opinion on the medical record of the deceased that the death of the deceased was due to the effect of these diseases. So under these circumstances, reliance cannot be placed on the medical record of the deceased. Moreover, the ops have not placed on record any other medical evidence in order to prove that deceased Yogesh Kumar was suffering from any pre-existing diseases as alleged in the repudiation letter. Further, the ops have relied upon report of the Investigator. The perusal of the report reveal that name of the Investigator is not mentioned in the report and further more, the ops have relied upon affidavit Ex.OP2 which does not bear name of the deponent nor same bears signatures of the deponent. So, it deserves to be ignored while evaluating the evidentiary value of this document. Therefore, it appears from the evidence of the ops that ops have failed to prove their plea by leading cogent evidence.
8. On the other hand, the complainant has proved on record that she is widow of the deceased Yogesh Kumar who died in Medanta Hospital on 3.4.2016 due to cardiac arrest and further more she has also proved that she has lodged a valid and legal claim with the opposite parties which ops have repudiated illegally and wrongly. It appears from the record that ops have repudiated the claim of the complainant arbitrarily and same is liable to be set aside.
9. In view of the above, we allow this complaint, set aside repudiation letter and direct the opposite parties to settle and pay claim of the complainant as per terms and conditions of the policy within a period of 45 days from the date of receipt of copy of this order, failing which the complainant will be entitled to interest @9% per annum from the date of filing of present complaint till actual payment. We further direct the opposite parties to pay a sum of Rs.12,000/- as composite compensation and litigation expenses to the complainant. 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:20.09.2017. Member Member District Consumer Disputes
Redressal Forum, Sirsa.
