Order by:
Sh.Amrinder Singh Sidhu, President
1. The complainant has filed the instant complaint under section 12 of the Consumer Protection Act, 1986 (now under section 35 of the Consumer Protection Act, 2019) on the allegations that Gurpreet Singh son of the complainant was insured with Opposite Parties No.1 to 3-Insurance Company vide policy No.18856698 HDFC SL ProGrowth Plus December 24, 2016 for a sum of Rs.15 lakhs and he paid the premium of Rs.35,000/- half yearly. Further alleges that unfortunately, said Gurpreet Singh had died on 29.12.2016 leaving behind the complainant as his legal heir being his mother. In the month of January, 2017 the complainant visited Opposite Party No.4-Bank and office of Opposite Party No.3 for payment of insured amount, and they got filled various papers and forms etc. and also took original policy and assured to pay the insurance amount to her within 15 days, but to no affect. In the month of March, 2017, the complainant received a letter from the Opposite Parties regarding the discontinuance of policy on the ground of misrepresentation of income and occupation which is absolutely false and baseless, whereas the son of the complainant never concealed any fact from the Opposite Parties at the time of purchasing the policy and after verifying the proposal form, the Opposite Parties had issued the policy to the son of the complainant. The complainant made requests to the Opposite Parties to pay the insurance claim on the death of deceased life assured, but the Opposite Parties did not pay any heed to the request of the complainant and hence, there is deficiency in service on the part of the Opposite Parties. Vide instant complaint, the complainant has sought the following reliefs.
a) The Opposite Parties may be directed to pay the sum of Rs.15 lakhs in respect of the policy in question alongwith upto date interest and incentives etc. and also to pay Rs.2 lakhs on account of compensation for causing her mental tension and harassment alongwith interest @ 2% per annum till its actual realization or any other relief to which this District Consumer Commission may deem fit be also granted.
Hence, the Complainant has filed the present complaint for the redressal of her grievances.
2. Opposite Parties No.1 to 3-Insurance Company appeared through their counsel and contested the complaint by filing the written version taking preliminary objections therein inter alia that the present complaint is not maintainable and is liable to be dismissed as there is no deficiency in service on the part of the Opposite Parties. The intricate questions of law and facts are involved in the present complaint which requires voluminous documents and evidence for determination which is not possible in summary procedure under the Act and the appropriate remedy, if any, lies only in the civil Court. The complainant has concealed material facts and documents from this District Consumer Commission and the policy was issued on the basis of proposal dated 24.12.2016 and the same was accepted based on the information provided in the proposal form and policy was issued on 24.12.2016. Opposite Parties No.1 to 3-Insurance Company received the statement of death claim dated 24.02.2017 alleging the death of Gurpreet Singh life assured on 29.12.2016 wherein even a declaration was made that the statement made in the said form is true in each and every respect. However, the Opposite Parties No.1 to 3-Insurance Company deputed investigator who conducted detailed investigation, recorded the statements and thus an indisputable prove was provided to show that there was misrepresentation of income and occupation of deceased Gurpreet Singh as the income of deceased was shown at Rs.5 lakhs from agriculture and from the work of plumber, but from the investigation, the income of deceased is not as per the proposal form as he was not doing any plumber work or agriculture work as he was not owner of any agriculture land. Further the marital status of deceased was shown in the proposal form as married but from the investigation, it was found that he was unmarried. Hence, the policy of the deceased was cancelled vide letter dated 17.03.2017 and the Opposite Parties No.1 to 3-Insurance Company requested the complainant to return the original policy documents with cancelled cheque and duly filled NEFT form for refund of premium, but the complainant failed to submit the same. On merits, Opposite Parties No.1 to 3-Insurance Company took up almost the same and similar pleas as taken by them in the preliminary objections and it was prayed that the complaint may be dismissed with costs.
3. None has appeared on behalf of Opposite Party No.4-Bank, and hence, Opposite Party No.4-Bank was proceeded against exparte.
4. In order to prove her case, the complainant has tendered into evidence her affidavit Ex.C1/A alongwith copies of documents Ex.C1 to Ex.C7 and closed the evidence on behalf of the complainant.
5. On the other hand, Opposite Parties No.1 to 3-Insurance Company also tendered into evidence the copies of documents Ex.Ops1 to 3/1 to Ex.Ops1 to 3/5 and affidavit of Sh.Arpit Higgins, Manager Legal Ex.Ops1 to 3/6 alongwith document Ex.Ops1 to 3/7 and closed the evidence on behalf of Opposite Parties No.1 to 3-Insurance Company.
6. We have heard the ld.counsel for the parties, perused the written arguments of the Opposite Parties No.1 to 3-Insurance Company and also gone through the documents placed on record.
7. Ld.counsel for the Complainant has mainly reiterated the facts as narrated in the complaint and contended that Gurpreet Singh son of the complainant was insured with Opposite Parties No.1 to 3-Insurance Company vide policy No.18856698 HDFC SL ProGrowth Plus December 24, 2016 for a sum of Rs.15 lakhs and he paid the premium of Rs.35,000/- half yearly. Further alleges that unfortunately, said Gurpreet Singh had died on 29.12.2016 leaving behind the complainant as his legal heir being his mother. In the month of January, 2017 the complainant visited Opposite Party No.4-Bank and office of Opposite Party No.3 for payment of insured amount, and they got filled various papers and forms etc. and also took original policy and assured to pay the insurance amount to her within 15 days, but to no affect. In the month of March, 2017, the complainant received a letter from the Opposite Parties regarding the discontinuance of policy on the ground of misrepresentation of income and occupation which is absolutely false and baseless, whereas the son of the complainant never concealed any fact from the Opposite Parties at the time of purchasing the policy and after verifying the proposal form, the Opposite Parties had issued the policy to the son of the complainant and in this way, there is deficiency in service on the part of the Opposite Parties.
8. On the other hand, ld.counsel for Opposite Parties No.1 to 3-Insurance Company has repelled the aforesaid contention of the ld.counsel for the complainant and contended that the complainant has concealed material facts and documents from this District Consumer Commission and the policy was issued on the basis of proposal dated 24.12.2016 and the same was accepted based on the information provided in the proposal form and policy was issued on 24.12.2016. Opposite Parties No.1 to 3-Insurance Company received the statement of death claim dated 24.02.2017 alleging the death of Gurpreet Singh life assured on 29.12.2016 wherein even a declaration was made that the statement made in the said form is true in each and every respect. However, the Opposite Parties No.1 to 3-Insurance Company deputed investigator who conducted detailed investigation, recorded the statements and thus an indisputable prove was provided to show that there was misrepresentation of income and occupation of deceased Gurpreet Singh as the income of deceased was shown at Rs.5 lakhs from agriculture and from the work of plumber, but from the investigation, the income of deceased is not as per the proposal form as he was not doing any plumber work or agriculture work as he was not owner of any agriculture land. Further the marital status of deceased was shown in the proposal form as married but from the investigation, it was found that he was unmarried. Hence, the policy of the deceased was cancelled vide letter dated 17.03.2017 and the Opposite Parties No.1 to 3-Insurance Company requested the complainant to return the original policy documents with cancelled cheque and duly filled NEFT form for refund of premium, but the complainant failed to submit the same.
9. We have gone through the rival contentions of both the parties. It is not denied that Gurpreet Singh son of the complainant was insured with Opposite Parties No.1 to 3-Insurance Company vide policy No.18856698 HDFC SL ProGrowth Plus December 24, 2016 for a sum of Rs.15 lakhs and he paid the premium of Rs.35,000/- half yearly. It is also not denied that said Gurpreet Singh had died on 29.12.2016. After his death, the complainant being his legal heir and nominee lodged the claim for the insurance amount with the Opposite Parties. The main plea of the Opposite Parties is that at the time of purchasing the policy in question, the deceased life assured has suppressed the material facts about his income, occupation and marital status. Perusal of the column (Details of Life to be assured) and (personal details of life to be assured) of proposal form Ex.OPs1 to 3/2, said Gurpreet Singh, mentioned his marital status as ‘Married’ and also mentioned his gross yearly income as Rs.5 lakhs with workplace name and address: Agriculture &U Sanitary Plumber, sanitary, supervisory etc. which ifso facto comes to the route of making the claim of the complainant. On the basis of said proposal form, the Opposite Parties have issued him policy in good faith. In this regard, Hon’ble National Consumer Disputes Redressal Commission, New Delhi in Revision Petition No. 434 of 2017 titled as Shriram Life Insruance Company Limnited Vs. K.Viraja decided on 15th January, 2020 has held that the Insurance contracts are governed by the Principle of ‘UBERRIMA FIDE” and the proposer applying for insurance is expected to correctly furnish all the material information regarding his health, family history, personal medical history, income etc. Policyholder failed to disclose his pre-proposal health ailment of hypertension. According, the State Commission Order was set aside and the complaint dismissed. Furthermore, Hon’ble Supreme Court of India in Civil Appeal No.8701 of 1997 decided on 02.11.1999 titled as Ravneet Singh Bagga Vs. M/s.KLM Royal Dutch Airlines has held that a Bonafide decision in good faith and a bona fide dispute is not covered within the term of ‘deficiency in service and only inefficiency, lack of due c are, absence of bona fide, rashness, haste or omission like acts on the part of the agency rendering services under a contract may be held guilty of deficiency in rendering service. Further Section 45 of the Insurance Act permits an insurer to cancel a life insurance policy in case a material concealment is made even if it does not amount to fraud.
10. Keeping in view the aforesaid facts and circumstances and replying upon the judgements of Hon’ble Supreme Court of India as well as Hon’ble National Commission, New Delhi (supra), we are of the view that the complainant has failed to prove any deficiency in service on the part of the Opposite Parties.
11. In view of the above discussions, there is no merit in the complaint and the same stands dismissed. Keeping in view the aforesaid facts and circumstances, the parties are left to bear their own costs. Copies of the order be furnished to the parties free of cost. File be consigned to record room after compliance.
12. Reason for delay in deciding the complaint.
This complaint could not be decided within the prescribed period because the State Government has not appointed any of the Whole Time Members in this Commission for about 3 years i.e. w.e.f. 15.09.2018 till 27.08.2021 as well as due to pandemic of COVID-19.
Announced in Open Commission.
Dated:28.03.2022.
