Complaint No: 490 of 2018.
Date of Institution: 10.12.2018.
Date of order: 01.09.2023
Sarabjit Nominee Wd/o Late Sh.Pargat Masih S/o Ashak Masih, R/o House No. 28, Village Amargarh P.O Wadala Bangar, Tehsil Batala District Gurdaspur - 143505.
....Complainant.
VERSUS
- HDFC Standard Life Insurance Company Ltd. Batala, 2nd Floor Plot No. 23/500, Shastri Nagar, Jalandhar Road, Batala-143505 through its Branch Manager.
- Navdeep Balhotra, (Agent) Code No. 00615783 C/o HDFC Standard Life Insurance Company Ltd. Batala, 2nd Floor Plot No. 23/500, Shastri Nagar, Jalandhar Road, Batala-143505.
….Opposite Parties.
Complaint u/s 12 of the Consumer Protection Act.
Present: For the complainant: Sh.Munishwar Nagpal, Adv.
For the opposite party No.1: Sh.Sandeep Ohri, Adv.
Opposite party No.2: Given up.
Quorum: Sh.Lalit Mohan Dogra President, Sh.Bhagwan Singh Matharu, Member.
ORDER
Lalit Mohan Dogra, President.
Sarabjit, Complainant (here-in-after referred to as complainant) has filed this complaint under section 12 of the Consumer Protection Act, (here-in-after referred to as 'Act') against the HDFC Standard Life Ins. Co. Ltd. and others (here-in-after referred to as 'opposite parties).2. Briefly stated, the case of the complainant is that a Life Insurance Policy UNI HDFC SL Pro Growth Super-II was purchased by her husband from opposite party No.1 through their agent Sh.Navdeep Balhotra having Code No.00615783 and paid Rs.15,000/- as premium vide receipt dated 15.06.2017. It is alleged that on 16.06.2017 a policy No.193371042 was issued by opposite party No.1 which was valid for 10 years i.e. from 15.06.2017 to 15.06.2027 with its annual premium of Rs.15,000/- and this amount was to be invested in Units and opposite party No.1 also gave Unit Statement for the period of 15 June 2017 to 16 June 2017 in which it was mentioned that 763.44354 units for a value of Rs.14,217.38 were credited in the name of Pargat Masih insurer who as per schedule of benefits under the said policy was entitled for the benefits which is under;-
1. Maturity Benefit:- Unit Fund Value
2. Death Benefit:- Rs.1,50,000/-
Expiry date 15.06.2027
3. Extra Life Benefit:- Rs.1,50,000/-
Expiry Dated 15.06.2027
It is further alleged that on 16.03.2018 an accident took place in between 4.00/4.30 AM at National Highway No.15 near Village Mahajan Lunkarsar, District Bikaner, Rajasthan in which unfortunately husband of the complainant died, who was a heavy vehicle driver by profession and opposite party was intimated regarding it on 16.04.2018 by the complainant through registered letter as well as on the email address of the opposite party. Complainant many times visited the office of the opposite party at Batala and requested them to settle the claim as per the policy, as she is appointed as nominee by the deceased Pargat Masih in the proposal form. Complainant also requested the opposite party No.1 to pay the claim as per the schedule of benefits and value of the units as she is entitled for the benefits as per the standard policy provisions, Para no.2 definitions Sub Para (i) and Sub Para (ii) and Para no.7 Sub Para (a) defining Accidental Death and Extra Life Benefit. It is also further alleged that complainant was surprised when she received a letter dated November 09, 2018 vide which her genuine claim was repudiated which she claimed as per the policy on the pretext that;-
“However from investigations it was established that the occupation details disclosed in the application form are found to be inaccurate. Life assured was a heavy vehicle driver. Had this information been provided to the Company at the time of applying for the insurance policy? There would have been difference in risk assessment. By withholding this information, the company was not able to underwrite the risk in the appropriate manner. Since this vital information was not provided to us at the time of applying for insurance policy. We regret our inability to accept your claim under the policy.
Also we are processing an amount of Rs.13,694.43/- to your account No.xxxxx5169 maintained with Punjab and Sind Bank furnished to us by you towards the refund of the premium under above said policy”.
It is further alleged that opposite party No.2 instead of mentioning the actual particulars in the proposal form/electronic proposal form for single life filled wrong particulars by mentioning the qualification of the insured as HSC, Occupation as Agriculture, Gross Yearly Income as Rs.2,50,000/-, Workplace Name and Address as PM Farm Amargarh, India, Industry Type:- Agriculture, Exact nature of Work:- Supervisory, Nature of Occupation Agriculture Land Owner at his own just to achieve the target besides knowing the true facts, whereas on the other hand insurer was an illiterate person and was a heavy vehicle driver by profession and did not know/understand English Language. Complainant many times requested the opposite parties to settle the claim but they did pay any heed to the complainant. Due to this illegal act and conduct of the opposite parties the complainant has suffered great loss and also suffered mental agony and physical harassment and inconvenience. So, there is a clear cut deficiency on the part of the opposite parties.
On this backdrop of facts, the complainant has alleged deficiency in service and unfair trade practice on the part of the opposite parties and prayed that the opposite parties be directed to pay jointly or severally, the value of the Units and Rs.3,00,000/- i.e. Rs.1,50,000/- as Death Benefit and Rs.1,50,000/- as Extra Life Benefit along with interest @ 18% per annum from the date of death, till its actual realization by allowing this complaint. Complainant has also prayed that opposite parties be burdened with Rs.1,00,000/- for physical harassment and mental agony including Rs.30,000/- as cost of litigation, in the interest of justice.
3. Upon notice, opposite party no.1 appeared through counsel and filed their written reply by taking preliminary objections that the policy in the present case is Unit Linked Policy and this Learned Commission has no jurisdiction to entertain and try the present complaint, that the complainant has no cause of action and locus standi to file the present complaint. The matter of fact is that in the present complaint, the complainant is leveling allegations of fraud and is alleging that the opposite party no.2 has not mentioned the actual particulars in the proposal form. The said fact cannot be decided in a summary way. It needs lot of evidence. So the complaint is liable to be dismissed. It is pleaded that there is no deficiency in services on the part of the opposite party and the claim of the complainant has been repudiated as the complainant got the policy by giving wrong facts at the time of getting the policy. At the time of submitting the electronic proposal form the complainant gave wrong facts 
regarding his occupation and other particulars. It is further pleaded that the repudiation letter which is already on the file and duly produced by the complainant and in the said letter it has been duly mentioned that in the proposal form, the occupation has been shown as agriculture and the work place shown as P.M. Farm and the nature of occupation has been shown as agriculture land owner but during investigation it revealed out that the life assured was a heavy 
vehicle driver. So, he concealed the material facts at the time of getting the policy. Even the complainant herself in her complaint admitted that the deceased was a heavy vehicle driver by profession. So the claim has been repudiated and the amount of Rs.13,694/- has been processed in the account of insured maintained in Punjab and Sind Bank i.e. towards the refund of the premium under the said policy.
On merits, the opposite party no.1 have reiterated their stand as taken in legal objections and denied all the averments of the complaint and there is no deficiency in service on the part of the opposite parties. In the end, the opposite party prayed for dismissal of complaint with costs.
4. Opposite Party No.2 was given up vide order dated 28.05.2019.
5. Learned counsel for the complainant has tendered into evidence affidavits of Sarabjit (Complainant) as Ex.CW-1 and Kashmir Masih as CW-2 along with other documents as Ex.C-1 to Ex.C-10.
6. Learned counsel for the Opposite Party No.1 has tendered into evidence affidavit of Arpit Higgins (Manager Legal), Authorized Signatory, HDFC Standard Life Insurance Company Ltd, Chandigarh as Ex.OP-1/1/A along with other documents as Ex.OP-1/1 to Ex.OP-1/6.
7. Rejoinder filed by the complainant.
8. The counsel for the complainant has argued that a Life Insurance Policy UNI HDFC SL Pro Growth Super-II was purchased by her husband from opposite party No.1 through their agent Sh.Navdeep Balhotra having Code No.00615783 and paid Rs.15,000/- as premium vide receipt dated 15.06.2017. It is further argued that on 16.06.2017 a policy No.193371042 was issued by opposite party No.1 which was valid for 10 years i.e. from 15.06.2017 to 15.06.2027 with its annual premium of Rs.15,000/- and this amount was to be invested in Units and opposite party No.1 also gave Unit Statement for the period of 15 June 2017 to 16 June 2017 in which it was mentioned that 763.44354 units for a value of Rs.14,217.38 were credited in the name of Pargat Masih insurer who as per schedule of benefits. It is further argued that on 16.03.2018 an accident took place at National Highway No.15 near Village Mahajan Lunkarsar, District Bikaner, Rajasthan in which unfortunately husband of the complainant died, who was a heavy vehicle driver by profession and opposite party was intimated regarding it on 16.04.2018 by the complainant through registered letter as well as through email. Complainant many times visited the office of the opposite party at Batala and requested them to settle the claim as per the policy, as she has been appointed as nominee by the deceased Pargat Masih in the proposal form. The claim lodged by the complainant was repudiated by the opposite party No.1 vide letter Ex.OP-1 by mentioning that deceased had wrongly got his occupation mentioned as Agriculture instead of Truck Driver. But the ld counsel for the complainant has further argued that the entire fault is of the opposite party No.1 as instead of mentioning the actual particulars in the proposal form/electronic proposal form for single life filled wrong particulars by mentioning the qualification of the insured as HSC, Occupation as Agriculture, Gross Yearly Income as Rs.2,50,000/-, Workplace Name and Address as PM Farm Amargarh, India, Industry Type:- Agriculture, Exact nature of Work:- Supervisory, Nature of Occupation Agriculture Land Owner at his own only with motive to achieve the target besides knowing the true facts, the insured was an illiterate person and was a heavy vehicle driver by profession and did not know/understand English Language. As such there is a clear cut deficiency on the part of the opposite parties. The Ld. counsel for the complainant has also relied upon the order of Honáble State Commission Punjab Chandigarh in case titled as “Jassa Singh vs Max Bupa Health Insurance company decided on 6 July 2021.
9. On the other hand counsel for the opposite party No.1 has argued that the claim of the complainant has been repudiated, as the insured got the policy by giving wrong facts and at the time of submitting the electronic proposal form the complainant gave wrong facts regarding his occupation and other particulars. It is further argued that the repudiation letter copy of which is Ex.OP-1 it has been duly mentioned that in the proposal form, the occupation has been shown as agriculture and the work place shown as P.M. Farm and the nature of occupation has been shown as agriculture land owner but during investigation it revealed out that the life assured was a heavy vehicle driver and as such the claim has been repudiated and the amount of Rs.13,694/- has been processed in the account of insured maintained in Punjab and Sind Bank.
10. We have heard the both the counsels for the parties and have gone through the record.
11. It is admitted fact that the husband of the complainant purchased a Life Insurance Policy UNI HDFC SL Pro Growth Super-II from opposite party No.1 through their agent Sh.Navdeep Balhotra having Code No.00615783 and paid Rs.15,000/- as premium vide receipt dated 15.06.2017 copy of which is Ex C1. It is further admitted fact that on 16.06.2017 a policy No.193371042 was issued by opposite party No.1, copy of which is Ex C2 which was valid for 10 years i.e. from 15.06.2017 to 15.06.2027 with its annual premium of Rs.15,000/- and this amount was to be invested in Units and opposite party No.1 also gave Unit Statement for the period of 15 June 2017 to 16 June 2017 in which it was mentioned that 763.44354 units for a value of Rs.14,217.38 were credited in the name of Pargat Masih insurer who as per schedule of benefits under the said policy was entitled for the benefits which is under;-
1. Maturity Benefit:- Unit Fund Value
2. Death Benefit:- Rs.1,50,000/-
Expiry date 15.06.2027
3. Extra Life Benefit:- Rs.1,50,000/-
Expiry Dated 15.06.2027
It is further admitted fact that on 16.03.2018 an accident took place and husband of the complainant died. It is further admitted fact that husband of the complainant was a heavy vehicle driver by profession.
It is also further admitted fact that vide letter dated November 09, 2018 claim was repudiated with reasons :-
“However from investigations it was established that the occupation details disclosed in the application form are found to be inaccurate. Life assured was a heavy vehicle driver. Had this information been provided to the Company at the time of applying for the insurance policy? There would have been difference in risk assessment. By withholding this information, the company was not able to underwrite the risk in the appropriate manner. Since this vital information was not provided to us at the time of applying for insurance policy. We regret our inability to accept your claim under the policy.
Also we are processing an amount of Rs.13,694.43/- to your account No.xxxxx5169 maintained with Punjab and Sind Bank furnished to us by you towards the refund of the premium under above said policy”.
The only disputed question for adjudication before this commission is whether the insured intentionally or deliberately got mentioned wrong particulars in proposal form and his profession as Agriculturist instead of Driver and if the said particulars were filled by the Navdeep Balgotra Agent of opposite party No.1, its effect.
12. To prove his case complainant has place on record his duly sworn affidavit Ex. CW-1, copy of policy schedule Ex.C-2, Schedule of benefits Ex.C-4 and copy of legal notice Ex.C-5, copy of repudiation letter Ex.C-9.
13. On the other hand opposite party No.1 has mainly relied upon proposal form Ex.OP-1/4 as per which the qualification of the insured is mentioned as HSC, language of communication as English, Occupation Agriculture, annual income as Rs.2,50,000/-, nature of Job supervisory, agriculture land owner. We have carefully gone through the contents of the consent document Ex OP-1/3 and online proposal form Ex.OP-1/4. The consent form has been signed by the insured at five places in Punjabi language and the perusal of the signatures show that said person is illiterate and had hardly learnt to put his signatures in Punjabi language, the proposal form is filled online in English language in which wrong particulars are mentioned as claimed by the opposite party No.1, but fact is that when the said person has put his signatures on consent form in Punjabi language with great difficulty, how it can be expected of such person to have got the wrong particulars mentioned in proposal form in English language, meaning there by that said proposal form was filled by the Navdeep Balgotra Agent to procure the policy of insurance and the particulars were filled by the said agent to bring the insured within the para meters of the policy of insurance which was being forced upon the insured. More over the evidence regarding wrong particulars having been filled by agent Navdeep Balgotra has remained un rebutted as the opposite party has not dared to examine said agent Navdeep Balgotra to deny the assertions made by the complainant in her affidavit who was non else but their own agent and must be still in their employment.
14. From the aforesaid discussion, it transpires that the genuine claim of the complainant has been repudiated by the opposite parties without any reasonable excuse. It is usual with the insurance companies to show green pastures to the consumers when they are to sell their policies. But however when it comes to the payment for claim, they invent all sort of excuses to deny the claim. Reliance in this connection can be had on the decision of Hon'ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of the particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation. This 'take it or leave it', attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.
15. It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon'ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-
"It seems that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy. The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy, Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich".
16. From the above discussion and documents on record and by relying upon the order of the Hon'ble State Commission Punjab Chandigarh in case titled as “Jassa Singh Vs. Max Bupa Health Insurance company decided on 6 July 2021, we have no hesitation in holding that the consent form and online proposal form Ex OP1/3 and Ex OP1/4 were filled by Agent Navdeep Balgotra to procure policy of insurance from the deceased insured person and particulars were filled the agent to bring the insured in the para meters of the policy without disclosing about the same to the insured who is definitely a illiterate person as discussed above, as such it is held that the insurance companies are more interested in collecting business through their agents in all possible manner but when it comes to settle and pay the claim the insurance companies take shelter under clauses and such facts as are mentioned in the present repudiation letter Ex.OP1.
17. The complainant has fully proved deficiency in service and business malpractice on the part of opposite party No.1 for repudiating the claim of the complainant vide letter Ex.OP-1, as such the present compliant is partly allowed and opposite party No.1 is directed to pay Rs.3,00,000/- i.e Rs.1,50,000/- as death benefit and Rs.1,50,000/- as Extra life benefit payable as per schedule of benefits attached with policy document Ex. OP1/1 alongwith interest @ 9 % per annum from the date of filing of the present compliant till realization of entire amount.
18. The complainant is also held entitled receive Rs.10,000/- as compensation from the opposite party for mental tension, harassment and Rs.5,000/- cost of litigation.
19. The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.
20. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record room.
(Lalit Mohan Dogra)
President
Announced: (B.S.Matharu)
Sept. 01, 2023 Member
*YP*
