Punjab

Sangrur

CC/68/2015

Kulwinder Kaur - Complainant(s)

Versus

HDFC Standard Life Ins. - Opp.Party(s)

Shri Sonam Mohinder

14 Jul 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

.                                                              

 

                                                Complaint No.  68

                                                Instituted on:    09.02.2015

                                                Decided on:       14.07.2015

 

Kulwinder Kaur wife of Binder Singh, resident of Village Satoj, Tehsil Sunam, Distt. Sangrur.

                                                        ..Complainant

                                        Versus

1.             HDFC Standard Life Insurance Company Ltd. Lodha Excelus, 13^th Floor, Lodha Excelus Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai -400 011 (Regd. Office) through its Managing Director.

2.             HDFC Standard Life Insurance Company, Nabha Gate, Sangrur 148 001 through its Branch Manager..

                                                        ..Opposite parties

 

For the complainant  :       Shri Sonam Mohinder, Adv.

For opposite parties  :       Shri Sumir Fatta, Advocate.

 

 

Quorum:   Sukhpal Singh Gill, President

                K.C.Sharma, Member

                Sarita Garg, Member

 

 

Order by : Sukhpal Singh Gill, President.

 

1.             Smt. Kulwinder Kaur,  complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the mother-in-law of the complainant i.e. Smt. Hamir Kaur obtained the services of the OPs by getting herself insured under policy number 16374311 (HDFC Children’s Plan Met Benefits) on 21.10.2013 for Rs.2,27,380- towards death benefits and the complainant was the nominee under the policy. It is further averred that the Ops charged an amount of Rs.24,250/- towards the premium.  It is further averred that the OPs issued the policy only after getting the insured checked by the doctor of the OPs and after due satisfaction of the OPs.  It is further averred that on the intervening night of 5.2.2014/6.2.2014, the mother of the complainant died at home at the age of 59 years. It is further averred that after the death of the mother of the complainant, the complainant lodged the claim with the Ops and submitted all the relevant documents for releasing the claim, but the Ops put off the matter on one pretext or the other.  Ultimately on 23.6.2014, the OPs illegally and arbitrarily repudiated the claim of the complainant. It is further stated that the complainant also got served a legal notice upon the OPs on 28.1.2015, but all in vain.  Thus, alleging deficiency in service on the part of the OPs, the complainant has prayed that the OPs be directed to pay to the complainant an amount of Rs.2,27,380/- along with interest @ 18% per annum from the date of death i.e. 5.2.2014 till realisation and further claimed compensation and litigation expenses.

 

2.             In reply, legal objections are taken up on the grounds that the complainant has no cause of action and locus standi to file the present complaint, that the complainant has not come to the Forum with clean hands and that this complaint is not maintainable and that this Forum has no jurisdiction to try and entertain the present complaint. On merits, it is admitted that Smt. Hamir Kaur got insured herself from the Ops vide policy number 16374311 and the complainant is the nominee under the policy.  But, it has been denied by the OPs that the insured was ever checked by any doctor of the Ops prior to issuance of the policy in question.  It is however stated that the policy was issued to Hamir Kaur on the basis of her application dated 21.10.2013 submitted to the Ops for purchase of the HDFC Children Plan Met Benefit and the case of the applicant was accepted on the basis of information provided in the application form. But, it is stated that the insured gave wrong answers to the questions number 32, 38 and 41 of the application.  It is further stated that after the death of the insured, the complainant lodged the claim with the Ops and upon investigations, it was established that Hamir Kaur was suffering from cancer of lower alveolus prior to the issuance of the policy in question and this fact was not disclosed by her at the time of taking the policy.  It is further averred that had the insured provided the correct answers to the questions, the OPs would have called for further medical tests and only then the policy could have been issued.  It is however admitted that the complainant lodged the claim with the OPs regarding death of his mother. It is stated that the claim of the complainant was rightly repudiated vide letter dated 23.6.2014 as the claim was got investigated from Sakshi Investigation and Detective Agency and found that Mrs. Hamir Kaur was suffering from cancer disease from the last 2/3 years and was taking treatment from Acharya Tulsi Hospital, Bikaner (Raj).  As such, any deficiency in service on the part of the OPs has been denied.

 

3.             The learned counsel for the complainant has produced Ex.C-1 affidavit, Ex.C-2 copy of repudiation letter, Ex.C-3 copy of death certificate, Ex.C-4 copy of detail of life insured, Ex.C-5 postal receipt, Ex.C-6 copy of application, Ex.C-7 postal receipt, Ex.C-8 of legal notice, Ex.C-9 postal receipt, Ex.C-10 copy of legal notice, Ex.C-11 to Ex.C-13 affidavits, Ex.C-14 to Ex.C-16 copies of voter list, Ex.C-17 and Ex.C-18 copies of policy schedule and closed evidence. On the other hand, the learned counsel for the Ops has produced Ex.OP-1 copy of policy number 16374311, Ex.oP-2 copy of policy number 16224962, Ex.OP-3 copy of policy number 16330851, Ex.OP-4 copy of death claim form, Ex.OP-5 copy of death certificate, Ex.OP-6 and Ex.OP-7 copies of letters, Ex.OP-8 copy of investigation report, Ex.OP-9 copy of affidavit, Ex.OP-10 copy of medical history, Ex.OP-11 copy of diagnosis report, Ex.OP-12 copy of repudiation letter, Ex.OP-13 and Ex.OP-14 copies of letters, Ex.OP-15 affidavit, Ex.OP-16 copy of order dated 17.4.2015 and Ex.OP-17 affidavit and closed evidence.

 

4.             We have very carefully perused the pleadings of the parties and heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits dismissal, for these reasons.

 

5.             It is an admitted fact that Smt. Hamir Kaur (referred to as DLA in short) got insured herself for Rs.2,27,380/- from the OPs by paying the requisite premium of Rs.24,250/- w.e.f. 21.10.2013 as is evident from the copy of policy, which is on record as Ex.Op-1.  It is also an admitted fact that the complainant was the nominee under the policy in question.  It is also an admitted fact that the DLA died during the subsistence of the insurance policy on the night of 5/6.2.2014.  It is further not in dispute between the parties that after the death of the DLA, the complainant submitted the claim along with documents to the Ops and the repudiation of the claim by the OPs is also admitted one.  In the present case, the complainant has alleged that the Ops have wrongly and illegally repudiated the rightful claim of the complainant.   It is worth mentioning here that the Ops have repudiated the claim on the ground that the DLA was suffering from cancer disease prior to taking of the insurance policy in question from the OPs and was also getting treatment from the Acharya Tulsi Hospital, Bikaner (Rajasthan).  Now, the only question which arises for determination before us is whether the Ops have rightly repudiated the claim of the complainant on the ground that the DLA was suffering from the cancer prior to taking of the insurance policy or not.

 

6.             The learned counsel for the Ops has contended vehemently that on 21.10.2013 the DLA took the policy in question by giving wrong answers in negative to the questions numbers 32, 38 and 41 of the application form.  Question number 32 relates to that ‘have you ever suffered from epilepsy, any nervous disorder or mental condition, paralysis or multiple slerosis, depression or psychiatric disorder, cancer or a tumor, but the DLA replied ‘No’.   But, the learned counsel for the OPs has contended vehemently that the claim of the complainant has been rightly repudiated as the claim was got investigated from Sakshi Investigation and Detective Agency, Patiala, whose report is on record as Ex.OP/8, wherein it has been clearly mentioned that the insured took the treatment in Acharya Tulsi Hospital, Bikaner, Rajasthan. It is further stated that the investigator visited this hospital and procured all the IPD papers of the insured.  The insured started taking treatment from very long time and in these all treatment record the insured was a patient of cancer and she was on very regular treatment from this hospital which falls prior to this policy. Ex.OP-10 and Ex.OP-11 are the documents relating to the mother of the complainant Smt. Hamir Kaur, which clearly shows that the DLA was admitted in that hospital on 15.10.2012 under registration number 5625/12 and took treatment on regular basis there.  The learned counsel for the complainant has contended vehemently that the copies of treatment record Ex.OP-10 and Ex.OP-11 do not relate to the DLA as the village of the DLA was ‘Satoj’ and not ‘Satao’ as mentioned in the above said documents.  But, we are unable to accept such a contention of the learned counsel for the complainant as it seems that there is spelling mistake in the name of village, but, the other particulars such as name of DLA, name of the husband of DLA, Tehsil, District and State are the same.  As such, we are of the considered opinion that the DLA took treatment for cancer disease as is evident from the documents Ex.OP-10 and Ex.OP-11. Further to support the investigation report, Ex.OP-15 is the affidavit of Dr. Kavinder Sharma of Sakshi Investigation and Detective Agency, wherein it has been clearly mentioned that the insured Hamir Kaur had cancer disease from the last 2-3 years and she was taking regular treatment from Acharya Hospital, Bikaner for her illness.  On the other hand, the complainant has not produced any evidence to rebut such a contention of the OPs that the DLA was not the patient of cancer and that she never took treatment from Acharya Hospital Bikaner.  Under the circumstances, we find it to be a clear cut case of pre-existing disease at the time of taking of the insurance policy by the DLA by suppressing the material fact that she was taking treatment from Acharya Tulsi Hospital, Bikaner (Rajasthan).  The learned counsel for the OPs has further contended that a person who suppresses the material facts at the time of taking the insurance policy is not entitled to any relief.  To support such a contention, the learned counsel for the complainant has cited Dineshbhai Chandarana and another versus Life Insurance Corporation of India 2010(4) CLT 563 (NC).

 

7.             In view of our above discussion, we find no case made out for any deficiency in service on the part of the Ops, as such, the complaint is dismissed. However, the parties are left to bear their own costs. A copy of this order be supplied to the parties free of cost. File be consigned to records.

                Pronounced.

                July 14, 2015.

                                                        (Sukhpal Singh Gill)

                                                           President

 

 

                                                              (K.C.Sharma)

                                                                Member

 

 

                                                                (Sarita Garg)

                                                                   Member