Haryana

Ambala

CC/196/2017

Harjeet Kaur - Complainant(s)

Versus

HDFC SL - Opp.Party(s)

21 Dec 2018

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AMBALA

 

                                                          Complaint case no.        : 196 of 2017

                                                          Date of Institution         : 16.06.2017

                                                          Date of decision   : 21.12.2018

 

Harjeet Kaur w/o Sh. Amardeep Singh, Resident of H.No.100, Karan Puri, Near Kamal Almari, GP, Ambala Cantt, 133001 Haryana.

 

      ……. Complainant.

 

1. HDFC SL Chandigarh-Sec 43 Branch Ground 1^st & 2^nd floor, SCO-149-150-151, Sector-43-B, Chandigarh, 160022
2. HDFC Life, Nicholson Road, Punjab Mohalla, Ist Floor, Sudhershan Towers, Ambala Cantt, Haryana 133001.

 ….…. Opposite Parties.

 

 

BEFORE:   SH. D.N. ARORA, PRESIDENT              

                   DR. SUSHMA GARG, MEMBER  

 

Present:       Sh. Tarun Datta, counsel for complainant.

                   Sh. Rajeev Sachdeva, counsel for Ops.

 

Per Dr. Sushma Garg:  

         The brief facts of the present complaint are that Sh. Amardeep Singh, the  deceased husband of the complainant, purchased a life insurance policy plan namely HDFC SL Pro Growth Flexi bearing no. 18320580 for a term plan of 15 years with a basic sum assured of Rs. 1000000/- on 19^th march 2016 from the opposite parties. During the subsistence of the policy, in the months of May and June 2016, Sh. Amardeep Singh (Insured) was diagnosed with a liver problem and was admitted in the Max Super Speciality Hospital and was diagnoses with ‘liver Cirrhosis with sepsis’ and ultimately died on 27.7.2016. Neither the deceased assured nor the complainant was aware earlier that the assured was affected with any such illness.  A death insurance claim was lodged with the opposite parties, but the opposite parties repudiated the claim wrongly and illegally. Hence this complaint by the complainant being the legal heir and dependent of the deceased assured for directing the OPs to pay the sum assured of Rs. 10 lakhs along with interest @ 18% from the date of death till realization. Further a sum of Rs. 50,000/- has been claimed as compensation for day to day harassment, pain and mental agony. A sum of Rs. 15500/-has been claimed as litigation expenses. Hence, the present complaint.

2.                Notice of the complaint was given to the OPs who appeared and filed a common reply to the complaint wherein apart from certain legal objections regarding the maintainability of the complaint, no cause of action etc., it has been pleaded that the deceased assured at the time of obtaining the policy concealed material fact about his health from the Ops. He was suffering from chronic disease of ‘ Liver with Portal Hypertension’ prior to the issuance of the policy and had suppressed this material fact from the Ops at the time of filling and signing the proposal form. Therefore, the insurance claim has rightly been denied by the OPs. So, OPs no. 1 & 2 have prayed for dismissal of the present complaint.

 3.                The complainant in her evidence tendered her affidavit Ex CX and documents C1 to C7 and closed her evidence. The Ops in their evidence tendered affidavit of the Executive Legal Manager of the Ops as RX and document R1 and further examined  Sh Deepak kumar, Asstt. Medical record officer of the Max hospital, Patparganj, new Delhi along with medical record and closed the evidence.

 4.                    We have heard the rival contentions and have also gone through the record. As per the discharge summary, the insured’s case history suggests that he was a known case of chronic liver disease since January 2016. The policy, admittedly, was purchased in the month of March 2016. The plea of the Ops is that the assured suppressed material fact of having contracted of the above said Liver disease in the proposal form submitted to the Ops. But surprisingly, no copy of any such proposal form wherein the insured, allegedly, suppressed the material fact about his health has been placed on the file. The mere averments made in the reply about the suppression of fact about his health by the deceased assured, in the absence of any corroborating evidence, is not enough to hold that the deceased had suppressed any material fact about his health at the time of obtaining the policy. Even otherwise if the copy of proposal form placed on the file then this Forum can ascertain whether diseased have concealed any mentioned facts regarding his disease. The Ops neither have placed on the file any copy of the terms and conditions of the policy document which stipulates about the repudiation of claim in case the assured is found diagnosed with any pre existing disease nor any document to prove that the assured had suppressed this material fact about his health at the time of obtaining the policy. In view of the above, the repudiation of the claim cannot be held to be justified. The complaint of the complainant, is therefore, allowed and the OPs are directed to pay to the complainant the sum assured of Rs. 10 Lakhs along with interest @ 9% from the date which comes after two months from the date of lodging of the claim with the OP till realization. A sum of Rs. 11000/- is also awarded and thereby directed to be paid by the Ops to the complainant towards litigation expenses. Copy of the order be sent to the parties concerned, free of costs, as per rules. File after due compliance be consigned to record room.

 

Announced on :21.12.2018                                                  (D.N. ARORA)

                                                                                                 President

 

 

 

                                                                    (DR. SUSHMA GARG)

                                                                                                Member