BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,FATEHABAD.
Complaint No.:53 of 2017. Date of Instt.: 27.02.2017.
Date of Order: 13.09.2018.
Inder Singh, aged about 65 years, son of Shri Hanuman, resident of village Salam Khera, Tehsil and District Fatehabad.
…Complainant.
Versus
- HDFC Standard Life Insurance Company Limited, Above ICICI Bank, Red Square Market, Hisar, District Hisar through its Branch/Divisional Manager.
- Managing Director/General Manager, HDFC Standard Life Insurance Company Limited, 13th Floor, Lodha Excelus, Apollo Mills Compound, N.M. Joshi Road, Mahalaxmi, Mumbai.
…Respondents/OPs
Complaint U/s 12 of the Consumer Protection Act,1986.
Before: Sh.Raghbir Singh, President.
Sh.M.K.Khurana, Member.
Present: Sh. Sandeep Sheoran, Adv. for the complainant.
Sh. Yogesh Gupta, Adv. for OPs.
ORDER
The present complaint under Section 12 of the Consumer Protection Act, 1986 has been filed by the complainant against the Opposite Parties (hereinafter to be referred as OPs) with the averments that Sharwan Kumar (now deceased) son of the complainant obtained a life insurance policy from the OPs for a sum assured of Rs. 14 lakhs. The said policy was commenced on 30th January 2014 and the maturity date of the same was 30th January 2023. An amount of Rs. 2281/- as premium was paid by the life assured to the OPs at the time of commencement of the policy. Since the life assured was unmarried as such the complainant was nominated as nominee in the abovesaid insurance policy. Therefore, after death of the life assured the complainant being nominee is lawfully entitled to receive the insurance claim.
2. It is further submitted that unfortunately the life assured died a natural death on 14.2.2014 and prior to the death the life assured was not suffering from any kind of disease and he was having a very good health. Thereafter, the complainant duly informed OP no. 1 regarding death of the life assured within time and submitted claim forms and fulfilled all the formalities for settlement of the insurance claim. However, the OPs initially kept the claim pending but ultimately refused to accept the claim and repudiated the same on false and frivolous allegations vide repudiation letter dated 25.2.2015 on the ground that income of the life assured was less than what he had disclosed in the proposal form. It is further submitted that the ground taken by the OPs for refusing the claim of the complainant is totally wrong, false and without any basis whereas there is no concealment of any fact by the life assured while obtaining the said policy. Moreover, the ground taken by the OPs in repudiating the genuine claim of the complainant is no ground in the eyes of law.
3. It is further submitted that thereafter the complainant made a number of representations to the OPs for reconsideration of its illegal decision but to no avail. The non-payment of insurance claim of the complainant by the OPs amounts to deficiency on their part in rendering service to the complainant. The complainant has further prayed that the OPs may be directed for making a payment of Rs. 14 lakhs to the complainant as insurance claim of the abovesaid insurance policy along-with interest at the rate of 24% per annum from the date the amount became due till its realization. The complainant has also further prayed that the OPs may be directed for making a payment of compensation to the tune of Rs. 1 lakh to the complainant on account of mental agony and physical harassment.
4. On being served the OPs appeared and filed written statement, wherein various preliminary objections with regard to maintainability, cause of action, locus standi, mis-joinder and non-joinder of necessary parties and concealment of material facts and jurisdiction etc. have been raised.
5. In reply on merits, it is submitted that the life assured late Shri Sharwan Kumar had submitted proposal form to the OPs for purchase of life insurance policy. The said proposal was accepted and the life insurance policy was issued to him and the date of commencement was 30.1.2014. Thereafter, intimation of the death of life assured and insurance claim was received. The said claim was repudiated by the OPs vide repudiation letter dated 25.2.2015 on the ground that the life assured had committed fraud with the OPs as the documents submitted at the time of purchasing the policy as well as at the time of submitting the proposal form with regard to income of life assured were manipulated and fake. The proof of income given by the life assured was fabricated and manipulated. Therefore, the death claim of the life assured was repudiated. It is further submitted that repudiation of the insurance claim of the complainant by the OPs is perfectly in accordance with the terms and conditions of the insurance policy and the same is sustainable in eyes of law. There is no deficiency on the part of OPs in rendering service to the complainant and as such the present complaint is liable to be dismissed.
6. The learned counsel for the complainant tendered in evidence affidavit of the complainant as Annexure CW1/A and the documents Annexure C-1 to Annexure C-9. On the other hand, the learned counsel for the OPs tendered in evidence affidavit of Arpit Higgins Legal Manager as Annexure RW1/A along-with documents as Annexure R-1 to Annexure R-3 and closed the evidence of the OPs.
7. The learned counsel for the complainant in his arguments reiterated the averments made in the complaint and further contended that his genuine claim has been repudiated by the OPs illegally and without any basis ground. The learned counsel further contended that there was no concealment of any fact by the life assured at the time of filing of the proposal form. The information furnished by the life assured in the proposal form was absolutely correct and the same was verified by the OPs before issuance of the insurance policy. The learned counsel further contended that the present complaint may be allowed and the OPs may be directed for making a payment of Rs. 14 lakh as the insurance claim along-with compensation. The learned counsel in support of his case has relied upon the judgment dated 14.12.2017 rendered by the Hon’ble State Commission, Haryana in case titled as HDFC Standard Life Insurance Company Limited Vs. Vinod Kumar son of Megha Ram and the judgment dated 1.12.2017 rendered by Hon’ble State Commission, Haryana in case titled as Exide Life Insurance Company Vs. Smt. Gomti Devi. The learned counsel for the complainant also contended that the District Consumer Forum, Hisar in a case wherein the same issue of income proof was involved has allowed the complaint in favour of the complainant, and a compensation of Rs. 30,000/- was awarded against the OPs for adducing false evidence.
8. On the other hand, the learned counsel for the OPs vehemently rebutted the arguments advanced by learned counsel for the complainant and further contended that the life assured while obtaining the insurance policy concealed the material fact regarding his income and submitted a fake and forged document in support of his income. The learned counsel further contended that the insurance policy is a contract of utmost good faith and therefore it was obligatory on the part of proposer/life assured to disclose all the material information correctly regarding his health, age and financial position. The learned counsel further contended that repudiation of the insurance claim of the complainant is perfectly in accordance with the terms and conditions of the insurance policy and the same is sustainable in the eyes of law. In support of his contention, the learned counsel relied upon the judgments rendered by Hon’ble National Commission in case titled as Life Insurance Company of India Vs. Shamim and cited as 2010 (1) CLT decided on 1st of July 2009 and the judgment titled as Neetaben Mukund Shah & another Vs. Birla Sun Life Insurance Company Limited decided on 20.5.2015.
9. We have duly considered the arguments advanced by learned counsel for the parties and have also perused the entire material placed on record. It is not disputed that the impugned insurance policy was issued by the OPs to the life assured i.e. late Shri Sharwan Kumar son of the complainant for an amount of Rs. 14 lakh and the date of commencement of the policy was 30th January 2014. It is also not disputed that the life assured had expired on 14.2.2014 i.e. within the validity period of the abovesaid insurance policy. It is also not disputed that the complainant was nominated as nominee of the life assured in the abovesaid policy. It is also not disputed that on the date of death of the life assured the installment of premium of the abovesaid policy had been paid by the life assured to the OPs. In the present case, the insurance claim of the complainant has been repudiated by the OPs vide letter dated 25.2.2015 only on the ground that the life assured at the time of filing the proposal form had submitted a fake document regarding proof of his income. It is the case of the OPs that the Form J (Annexure R-2) submitted by the life assured at the time of obtaining of the abovesaid policy was fabricated and manipulated as the firm which has been issued the abovesaid J Form does not exist. However, the OPs have failed to produce any evidence or document to prove that the abovesaid J Form was submitted by the life assured to the OPs at the time of obtaining the insurance policy in question. Moreover, the Form J (Annexure R-2) does not bear the signatures of the life assured. A perusal of abovesaid J Form reveals that the same has been issued in the name of one Shri Anil Kumar whereas the name of the life assured was Sharwan Kumar. Therefore, we are of the considered opinion that the OPs have failed to prove that the Form J (Annexure R-2) was submitted by the life assured at the time of purchasing of the abovesaid policy. It is also pertinent to discuss here that the amount of premium in the abovesaid policy was just Rs. 2281/- per annum and it is a very small amount and even a workman/daily wager can afford to pay the same on yearly basis. Therefore, we are of the opinion that the amount of premium in the present case is not a material fact. Reliance is placed on the judgment rendered by Hon’ble State Commission, Haryana in case titled as Exide Life Insurance Company Vs. Mrs. Gomati Devi decided on 1.12.2017.
10. In view of the aforesaid discussion, the repudiation of insurance claim of the complainant by the Ops vide order dated 25.2.2015 is hereby set aside. The present complaint is accordingly allowed and the OPs are directed for making a payment of Rs. 14 lakhs as insurance claim to the complainant along-with interest at the rate of 7% per annum from the date of filing of the present complaint till realization. The OPs are further directed for making a payment of Rs. 5100/- as compensation and litigation charges to the complainant. The present order be complied with within a period of 30 days from the date of copy of the present order, otherwise the abovesaid amount will carry an interest at the rate of 9% per annum. A copy of this order be furnished to both the parties free of cost as provided in the rules. File be consigned to record room after due compliance.
Announced in open Forum:
Dt.13.09.2018.
(M.K.Khurana) (Raghbir Singh)
Member President DCDRF, Fatehabad.
