Punjab

Ludhiana

CC/14/228

Bhagwanti Singh - Complainant(s)

Versus

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

31 Mar 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, LUDHIANA.

                                                          C.C.No. 228 of 05.03.2014

                                                          Date of Decision: 31.03.2015

1.Bhagwant Singh son of Ram Singh, resident of House No.172, Kartar Nagar, Amloh Road, Khanna, Tehsil Khanna, District Ludhiana.

2.Parminder Singh son of Sh.Ram Singh resident of House No.172, Kartar Nagar, Amloh Road, Khanna, Tehsil Khanna, District Ludhiana, through Special Power of Attorney Sh.Bhagwant Singh.

                                                                                      … Complainants

                                             Versus            

                                                         

1.HDFC Standard Life Insurance Company Limited, 11^th, 12^th and 13^th Floor, Lodha Excelus Apollo Mills Compound, N.M.Joshi Marg, Mahalaxmi, Mumbai-400011.

2.HDFC Standard Life Insurance Company Limited, Khanna, Tehsil Khanna, District Ludhiana.                                                                                                                                                           …Opposite Parties

          Complaint under section 12 of the Consumer Protection Act,1986

 

Quorum     Sh. R.L. Ahuja, President.

                   Sh.Sat Paul Garg, Member. 

                   Ms.Babita, Member.

                                               

Present       Sh.G.S.Sekhon, Adv. for complainants.

Sh.Ajay Chawla, Adv. for OPs.

 

                                                ORDER

R.L. AHUJA, PRESIDENT

1.                Present complaint u/s 12 of the Consumer Protection Act, 1986, has been filed by Sh.Bhagwant Singh through his Special Power of attorney Sh.Parminder Singh(hereinafter in short to be referred as ‘complainants’) against HDFC Standard Life Insurance Company Limited and others (herein-after in short to be referred as ‘OPs’)- directing them to pay the claim amount of insurance policy of Ram Singh alongwith Rs.10 lakh on account of financial loss suffered by the complainants and Rs.25,000/- for causing mental agony and harassment besides Rs.1 lakh for deficiency in service and Rs.11,000/- as litigation expenses to the complainants.

2.                Brief facts of the complaint are that the complainants are only the legal heirs of deceased Ram Singh. The father of the complainant Ram Singh during his life time, got a life insurance policy bearing No.15529855 of HDFC Life Insurance Company after completing all the formalities of Insurance Company and after the verification, the Ops issued the policy to the father of the complainants, who was working as Electrician in various private companies and lastly, he was working at Gobind Steel Industries, G.T.Road, Sirhind Side, Mandi Gobindgarh as he was skilled labourer. Unfortunately, the father of the complainants Ram Singh died on 22.2.2013 at Khanna, Tehsil Khanna, District Ludhiana due to natural death. After his death, the complainants and his brother informed the concerned officials of HDFC Life Insurance Company to make the payment of the policy, but the officials of HDFC Life Insurance Company sent a rejecting letter to the complainants with the reason that the deceased has travelled to overseas which was not disclosed on lame excuse. Sh.Ram Singh deceased was living with his family members including the complainants and he has not visited overseas after obtaining the insurance policy. Thus, the reason mentioned above is not satisfied. The complainants have already sent an application on 14.10.2013 to the Ombudsman, Chandigarh but till now, no reply has been received by the complainants. The complainants many times approached to the Ops and requested them to accept the abovesaid requests of the complainants, but to no effect. Due to abovesaid illegalities of the Ops, the complainants suffered great money loss, mental agony and harassment. Hence, this complaint.

3.                Upon notice of the complaint, OPs were duly served and appeared through their counsel Sh.Ajay Chawla, Advocate and filed their written reply, in which, it has been submitted in the preliminary objections that the complaint under the reply is not maintainable as the complainants have attempted to misguide and mislead this Hon’ble Forum. No cause of action has ever been arisen in favour of the complainants and against the answering OPs to file the present complaint as the complainants have created a false story in their complaint to mislead this Hon’ble Forum by concocting and distorting the facts and circumstances of the present case. It has been submitted that online proposal form in the present case was filled by the complainant on 22.10.2012 for purchasing “HDFC SL Progrowth Super-II Policy” and the policy in question i.e. Policy No.15529855 dated 25.10.2012 was issued and it commenced on the even date. The aforesaid policy is unit linked policy whereby the investment is made through Share Market/Speculative transactions and main motive for investment is for profit and gains. Further, it is submitted that the deceased “Life Assured”(hereinafter referred to as DLA) i.e. Sh.Ram Singh had submitted to the answering Ops, a proposal/application dated 22.10.2012 for the purchase of HDFC SL Progrowth Super-II Insurance Plan, the proposal was accepted on the standard rates based on the information provided by the LA and consequently a policy was issued bearing policy No.15529855 dated 25.10.2012 and it commenced on the even date. The present complaint is an afterthought and has only been filed with the ulterior motive to harass and humiliate the answering Ops. Before, acceptance of the proposal by the answering Ops, the contents of the proposal/application, illustrations and addendum forms were read and understood by the DLA. On the basis of the information furnished in the application/proposal form, the proposal was processed by the answering Ops and thereafter the aforesaid policy was issued to the DLA. As per the terms of the policy, where the policy holder has affixed his/her thumb impression or policy holder has signed in vernacular or policy holder has not filled the application form, then a third person has to make a declaration to the effect that the contents of the application form have been explained to the proposed policy holder in the language known and understood by him/her in his presence. In the present case, the said declaration was given by a third party to the satisfaction of the answering Ops. Unfortunately, on 22.2.2013, Sh.Ram Singh i.e. Life Assured died and after his death, the complainant had intimated the answering Ops about the death of the life assured and completed all the requisite formalities as directed by Ops for the purpose of getting the benefits of the insurance policy. Copy of death claim statement dated 15.4.2013 which was received by the Ops on 17.4.2013.  On receiving of the death claim statement, the answering Ops conducted the investigation with regard to the death claim of the complainant through the investigating agency i.e. A-One Investigation Services and after investigation, the said agency submitted his Death Investigation Report dated 7.5.2013 alongwith the documents on the basis of which the investigation report was made. On perusing the report, it was transpired that the deceased life assured travelled to overseas which was not disclosed in the application dated 22.10.2012. In this connection, the answering Ops refer to Section (C) i.e. personal history of the life to be assured. In the said application under this Section, the following relevant questions had been answered incorrectly:-

6.Have you resided overseas for more than 6 months continuously during the last five years or do you intend to travel overseas in the next six months?

[  ] Yes  [√ ] NO

If you have answered “Yes” to the above question, please give the names of the countries and duration of stay:

	Name of Countries	Duration
Past Travel
Future Travel

 

However, from the investigation, it was established that DLA travelled to overseas which was not disclosed in the application dated 22.10.2012. From the documents procured by the investigation agency, it is established that the life assured was employed in some universal mining company as Electrician whereas, in the proposal form, he had mentioned that he is working in Govind Steel Industries, G.T.Road, Sirhind Mandi Gobindgarh, Punjab. Moreover, the documents procured from Sidhu Hospital Pvt.Ltd., it is revealed that deceased life assured was suffering from HIV Positive and was diagnosed as HIV +VE. From the investigation report, it was also revealed that the DLA was a chronic alcoholic and used to consume liquor in large quantity and his liver had been damaged and most of the treatment was done as Zambia. The DLA had come to India for two months leave and had become sick in India and his health starting deteriorating steadily and he was taken to Sidhu Hospital Pvt. Ltd., Doraha on 15.11.2012 and prior to this, he had his check-up on 24.10.2012 and 4.11.2012. Further, it is submitted that not only the DLA concealed the material facts regarding his health from the answering Ops but also concealed the place of work. The deceased life assured concealed the material fact that he was working in Universal Mining and Chemical Industries in Lusaka-Zambia as an Electrician. Had the said information been correctly disclosed at the time of applying for the insurance policy, the answering Ops would not have offered life insurance cover to the DLA on the existing terms and conditions. Further, it is submitted that the answering Ops had already paid a sum of Rs.89,465.06P as fund value to the complainants as has been explained in the repudiation letter but the complainants have concealed the said information from this Hon’ble Forum. Since, the deceased life assured concealed the material facts qua the pre-existing disease from the answering Ops, therefore, the answering Ops had rightly repudiated the claim of the complainants after taking into consideration the provisions of Section 45 of the Insurance Contract Act, 1938. On merits, it is submitted that the documents produced by the answering Ops clearly indicate that the DLA was working at Zambia in South Africa and he came to India on leave for two months and had to return on 7.12.2012 but could not return due to this deteriorating health. It is admitted to the extent that the DLA died on 22.2.2013 but the death was not a natural death but due to pre-existing disease. The answering Ops are not liable to pay the claim, compensation and interest to the complainants because the DLA had obtained the policy from the answering Ops by concealment of material facts the disclosure of which could have changed the mind of the answering Ops to issue the insurance policy in question. Hence, the answering Ops had rightly repudiated the claim of the complainant being based on mis-representation and fraud. Otherwise, similar pleas were taken as mentioned in the preliminary objections. At the end, denying any deficiency in service on the part of answering OPs and denying all other allegations of the complainants being wrong and incorrect, answering OPs prayed for dismissal of the complaint with costs.

4.                Learned counsel for the complainant in order to prove the case of the complainants, tendered into evidence affidavit of complainant no.1 as Ex.CA, in which, he has reiterated all the contents of the complaint. Further, learned counsel for the complainants has proved on record documents Ex.C1 to Ex.C6.

5.                On the other hand, in order to refute the case of the complainants, learned counsel for the Ops adduced evidence by placing on record affidavit Ex.RA of Sh.Amit Khanna, its Associate Manager, in which, he has reiterated all the contents of the written reply filed by the Ops and refuted the case of the complainants. Further, learned counsel for the Ops has proved on record documents Ex.R1 to Ex.R13.

6.                We have heard the learned counsel for the parties.

7.                Learned counsel for the complainants has filed the written arguments, in which, he has submitted that the complainants are the only legal heirs of the deceased Sh.Ram Singh as he had obtained during his life time, insurance policy of HDFC Life Insurance Company Limited bearing NO.15529855 on 22.10.2012 in which, the complainant no.2 was appointed his nominee, whereas, the policy was of Rs.7 lakh and the installment of the amount of Rs.1 lakh was paid by Sh.Ram Singh to the HDFC Standard Life Ins.Company. The father of the complainants was working as private electrician at private firm Mandi Gobindgarh who had unfortunately died on 22.2.2013 at Khanna leaving behind the complainants as his legal heirs. After the death of the father of the complainants, a claim has been filed to pay the amount under the policy, but the Ops has not paid the entire amount and has paid a small amount and has dismissed the claim of the complainants on the pretext that Sh.Ram Singh, father of the complainants during his life time, had not disclosed that whether he had gone to overseas. As per the life insurance policy and at the time of issuing the policy to late Sh.Ram Singh, it was told that Rs.7 lakh would be paid alongwith the other benefits to his legal heirs, if untimely Sh.Ram Singh died before the completion of the policy period, but the Ops have refused the death claim on the lame excuses which are not acceptable under the law. The Ops are now taking objections that the amount was put of the life insurance of deceased Ram Singh in a pro growth super two policy which was not disclosed to the deceased Ram Singh prior to the obtaining the policy. The version put forward by the Ops is a wrong and is not acceptable and they are liable to pay the entire amount as per the policy obtained by the deceased Ram Singh.

8.                On the other hand, learned counsel for the Ops has contended that it is proved fact that the deceased Sh.Ram Singh while obtaining the insurance policy in question, had concealed the material facts that he had not travelled/resided overseas for more than 6 months continuously during the last five years or he intended to travel overseas in the next six months. Further, deceased Sh.Ram Singh has not disclosed that he was suffering from pre-existing disease and he was settled in foreign country and as per record of Sidhu Hospital Pvt. Ltd, Doraha, he was suffering from disease i.e. HIV +Ve and thereafter, he had purchased the policy in question by mis-representating the facts and as such, Ops had rightly repudiated the claim of the complainants. Further, learned counsel for the Ops has relied upon judgments titled as Aviva Life Insurance Co.India Ltd. vs. Mrs.Sween Goyal-Revision Petition NO.3053 of 2009, decided on 21.11.2014(N.C.); Darshana Garg vs. Tata AIG Life Insurance Co.Ltd. and others-First Appeal No.1294 of 2010, decided on 10.3.2014(State Commission); ICICI Prudential Life Insurance Company Limited and others vs. Naresh Kumar-First Appeal No.242 of 2011, decided on 23.1.2014(State Commission); Divisional Manager, LIC of India and others vs. Smt.Anupama and others-Revision Petition Nos.3794-3796 of 2007, decided on 17.4.2012(N.C.); Sushil Kanta Narulla vs. Birla Sun Life Insurance Co.Ltd.-First Appeal No.209 of 2010 decided on 20.1.2014(State Commission) and Oriental Insurance Co.Ltd. vs. Munimahesh Patel-2006(4)CIVCC 203: 2006(7)SCC-655.

9.                We have gone through the written arguments filed by the leanred counsel for the complainants and have also considered the rival contention of learned counsel for the Ops alongwith judgments placed on record during the course of arguments and have also gone through the record on the file very carefully.

10.               Perusal of the record reveals that it is an admitted fact between the parties that deceased Sh.Ram Singh, who was the father of the present complainants, had obtained the policy in question from the Ops on payment of premium. As per the averments of the complainants that the deceased Sh.Ram Singh died due to natural death and after his death, death claim was lodged with the Ops by the complainants which was registered and processed. Perusal of the record reveals that Ops had appointed A-One Investigating Agency for the investigation of the case of the complainants, who after his thorough probe and investigation qua the death of the deceased Sh.Ram Singh, had submitted his detailed Claim Investigation Report dated 7.5.2013 Ex.R5 and after perusing the report and statements of the witnesses and going through the medical record of the deceased Sh.Ram Singh pertaining to Sidhu Hospital Pvt. Ltd.Doraha, the Ops had repudiated the claim of the complainants vide their letter Ex.R11 on the ground that vital information was not provided to them at the time of applying for the insurance policy.

11.              It is apparently clear from the statement recorded by Mr.Parminder Singh(LA’s son) i.e. complainant no.2 during the meeting with the investigator reveals that he had got recorded his statement that the LA was his father, who died at home on 22.2.2013 all of a sudden. The LA was working in Lusaka, Zambia as an electrician and had come to home on 2 months leave and he had to return Zambia on 7.12.2012 and further, this fact was also find corroboration from the statements of other witnesses namely Mr.Sant Singh MC, Mrs.Jyoti, Mr.Asha Rani, Mr.Cap.Jaswant Singh, who are the neighbourers, Mr.Rajesh Hair Dresser and Mr.Pankaj. Further, perusal of the passport of the deceased Sh.Ram Singh, it is apparently clear that he came to India in 6.10.2012 and had to return on 7.12.2012 but could not return due to his deteriorating health and died in February 22,2013.

12.              Perusal of the proposal form  Ex.R2 reveals that deceased Sh.Ram Singh had denied this fact that he had gone/resided abroad/overseas for more than 6 months continuously during the last five years or he was intended to travel overseas in the next six months. So, it appears that deceased Sh.Ram Singh, i.e. father of the complainants, who had obtained the insurance policy in question from the Ops, had concealed the material facts and information from the Ops and further, we find force from the judgment relied upon by the Ops titled as Darshana Garg vs. Tata AIG Life Insurance Co.Ltd.-First Appeal No.1294 of 2010-decided on 10.3.2014(State Commission), in which, it has been observed by the Hon’ble State Commission that the appellant/complainant was suffering from that pain on the day she filled up the proposal form and she was noticing the discolouration of the figner tips for the last two-three years. She was bound to disclose that abnormaility in the proposal form and withholding of that information was a valid ground for repudiating her claim. Further, we find force from the judgment titled as Aviva Life Insurance Co.India Ltd. vs. Mrs.Sween Goyal-Revision Petition No.3053 of 2009, decided on 21.11.2014(N.C.), in which, it has been observed by the Hon’ble National Commission that the answers given by the insured in the proposal form were untrue ot his knowledge. There was clear suppression of “material facts” in regard to the health/habits of the insured. It was not for the insured to determine whether the information sought for in the aforesaid questionnaries was material for the purpose of life insurance policy. At any rate, the statements made in the proposal form were untrue and incorrect. Thus, it was observed that the insruance company was justified in repudiating the claim of the compalinant. So, in our view, there does not appear to be any deficiency in service on the part of the Ops while repudiating the claim of the complainants.  

13.              In view of the above discussion, we are of the opinion that the complainants have failed to prove their case against the Ops by leading cogent and convincing evidence on record. As such, we hereby dismiss the complaint being devoid of any merits. Copy of this order be made available to the parties free of costs. File be completed and consigned to record room.

 

   (Babita)                       (Sat Paul Garg)              (R.L.Ahuja)

     Member                     Member                        President.   

Announced in Open Forum

Dated:31.03.2015

Gurpreet Sharma.