Punjab

Ludhiana

CC/19/30

Jasbir Kaur - Complainant(s)

Versus

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

Naresh Yadav Adv.

05 Apr 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No: 30 dated 09.01.2019.                                                         Date of decision: 05.04.2023. 

 

Jasbir Kaur wife of Sukhjit Singh, House No.B-11-1735, Brown Road, Ludhiana.                                                                                                                                                                                             ..…Complainant

                                      Versus

1. HDFC Standard Life Insurance Company Limited, communication Address at HDFC Life, 5^th Floor, ILFS Financial Centre, Plot C-22, G Block, Bandra Kurla Complex, Bandra East, Mumbai-400051 and
2.  HDFC Standard Life Insurance Company Limited, Feroze Gandhi Market, Ludhiana.                                                                                                                                                                   …..Opposite parties 

Complaint Under Section 12 of the Consumer Protection Act, 1986.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

SH. JASWINDER SINGH, MEMBER

MS. MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant            :         Sh. Naresh Yadav, Advocate

For OPs                         :         Sh. Nitin Kapila, Advocate.

 

ORDER

PER SANJEEV BATRA, PRESIDENT

1.                In brief, the facts of the case are that Bobby Singh, brother of the complainant was holder of insurance policy No.17587979 dated 20.05.2015 of the opposite parties having maturity amount of Rs.9,90,000/-. He had been paying the premium of policy regularly without any fault and paid three installments to the opposite parties. On 30.01.2018, said Bobby Singh died due to heart attack at home. The complainant stated that the heart failure of deceased Bobby Singh may have resulted all of a sudden and it was not a chronic disease. The complainant stated that her parents have already died and only she being the nominee was entitled to get insurance amount. After the death of Bobby Singh, the complainant lodged the claim with the opposite parties by completing all the requisite formalities but the opposite parties made lame excuses that it was not disclosed at the time of policy that Bobby Singh was alcoholic which is not a valid ground to reject the claim. No documentary evidence has been shown by the opposite parties to this effect. Bobby Singh has not died due to alcohol rather he has died due to heart attack and he was not alcoholic. The opposite parties are legally bound to pay maturity amount of Rs.9,90,000/- to the complainant but in a clandestine manner, the opposites parties paid a sum of Rs.3,34,492.43 vide letter dated 23.07.2018. The complainant further stated that she several times approached the opposite parties to pay the entire amount but they failed to do the needful and their act and conduct amounts to deficiency in service due to which the complainant has suffered mental tension, agony and harassment for which the opposite parties are liable to pay damages and compensation to the tune of Rs.1,00,000/- to the complainant. The complainant got served a legal notice dated 20.08.2018 upon the opposite parties but to no avail. Hence this complaint whereby the complainant has prayed for issuing direction to the opposite party to pay the claim amount/insured amount of Bobby Singh i.e. Rs.9,90,000/- minus the amount already paid along with compensation of Rs.1,00,000/-

2.                Upon notice, the opposite party appeared and filed written statement by taking preliminary objections and assailed the complaint on the ground of maintainability of the complaint; suppression of material facts by the complainant and lack of jurisdiction. The opposite party alleged that the policy in question is a contract entered into between the complainant and the opposite parties. Thus the parties are bound by the terms and conditions of the contract. The opposite parties stated that Mr. Bobby Singh, brother of the complainant had obtained policy No.17587979 which was issued on the basis of proposal dated 08.04.2015 made to the opposite parties for purchase of HDFC Youngstars Super Premium for a sum assured of Rs.9,90,000/- and the proposal was accepted on the basis of information provided in the proposal form in which the relevant questions have been answered as “NO” which is reproduced as under:-

2] Live problem (excluding Jaundis) or hepatitis B or C	NO
4] Apart from minor ailments such as cold and flu, have you received any treatment from any Doctor?	NO

However, from the investigations, it was established that the life assured was alcoholic and this fact clearly finds mention in the discharge summary issued by Dayanand Medical College & Hospital, Ludhiana. This was not disclosed in the application dated 08.04.2015. Had this information been provided to the company at the time of applying for the insurance policy, we would have declined the application. The opposite parties further stated that since the vital information was not provided to them as such, the claim of the complainant could not be accepted and the opposite parties had processed an amount of Rs.3,34,492/- in account of the complainant towards the fund value payable under the policy in question and same was duly accepted by the complainant. Now the complainant cannot re-agitate the matter by filing the complaint.

                   On merits, the opposite parties have reiterated the crux mentioned in the preliminary objections and controverted the facts made in the complaint. The opposite parties have denied the fact that the deceased died due to heart attack. The opposite parties stated that the deceased was habitual alcoholic and was undergoing treatment from Dayanand Medical College & Hospital, Ludhiana and he had concealed the vital information from the opposite parties while making application for obtaining policy in question.  The opposite parties has denied any deficiency in service on their part. In the end, a prayer for dismissal of the complaint has been made.

3.                In evidence, complainant tendered her affidavit as Ex. CA and reiterated her averments of the complaint. The complainant also placed on record documents i.e. Ex. C1 is the copy of her Adhar card, Ex. C2 is the copy of PAN card of the complainant, Ex. C3 is the copy of driving license of Bobby Singh, Ex. C4 is the copy of PAN card of Bobby Singh, Ex. C5 is the copy of death certificate of Bobby Singh, Ex. C6 is the copy of indemnity bond, Ex. C7 is the copy of individual death claim form, Ex. C8 is the copy of account statement of the complainant, Ex. C9 is the copy of account statement of Bobby Singh, Ex. C10 is the copy of death claim, Ex. C11 is the copy of legal notice dated 13.08.2018, Ex. C12 is the copy of postal receipt and closed the evidence.

4.                On the other hand, the counsel for the opposite parties tendered affidavit Ex. RA of Sh. Gurpreet Singh, Deputy Manager (Legal & Compliance) of the opposite parties as well as affidavit Ex. RB of Mr. Kumar Jay, Investigator of M/s. Transparent World along with documents i.e. Ex. R1 is the copy of authority letter dated 30.01.2019, Ex. R2 is the copy of policy documents, Ex. R3 is the copy of proposal form, Ex. R4 is the copy of death claim, Ex. R5 is the copy of insurance policy details, Ex. R6 is the copy of proposal form, Ex. R7 is the copy of investigation report, Ex. R8 is the copy of discharge summary of DMC Hospital from 27.02.2017 to 09.03.2017, Ex. R9 is the copy of discharge summary of DMC Hospital from 30.07.2017 to 07.08.2017, Ex. R10 is the copy of radiodiagnosis and imaging report, Ex. R11 is the copy of patient notes of DMC Hospital, Ex. R12 is the copy of ragiodiagnosis report, Ex. R13 is the copy of upper GI endoscopy report, Ex. R14 is the copy of discharge summary of DMC Hospital from 26.03.2017 to 01.04.2017 and closed the evidence.

5.                We have heard the arguments of the counsel for the parties and also gone through the complaint, affidavit and annexed documents and written statement produced on record by both the parties.   We have also gone through the written arguments submitted by the complainant.

6.                In this case, Bobby Singh, the brother of the complainant obtained policy No.17587979 on 20.05.2015 on the basis of proposal form Ex. R6 as per which the insured Bobby Singh stated that he is not suffering from any pre-existing disease and the relevant questions were answered as “NO” which is reproduced as under:-

2] Live problem (excluding Jaundis) or hepatitis B or C	NO
4] Apart from minor ailments such as cold and flu, have you received any treatment from any Doctor?	NO

 

As per policy Ex. R2 dated 21.05.2015, the relevant clause 17 of which is as under:-

          17.     Incorrect information and non-disclosure

          (1)     Your policy is based on the application and declaration which you   have made to us and other information provided by you/on your         behalf. In case of fraud or misrepresentation including non-       disclosure of any material facts, the policy shall be cancelled     immediately and the surrender value shall be payable, subject to       the fraud or misrepresentation being established in accordance    with Section 45 of the Insurance Act, 1938.

7.                Perusal of the discharge summary Ex. R8, Ex. R9, Ex. R14  shows that Bobby Singh was addicted to alcohol for the last 20 years. As per affidavit Ex. RB of investigator Sh. Kumar Jay the insured was having habitual of liquor due to which his liver was bad and he died due to same reason. He was also suffering from CLD (Chronic Liver Disease), Cirrhosis with portal Hypertension, Ascites, BP & DM, The life assured was taking regular treatment at Dayanand Medical College & Hospital. In the said affidavit, it is also mentioned that the life assured was doing business of shoes and his income was apprx. 3 Lack. Family member of life assured did not provide his income proof. As per medical paper of LA provided by his family members that LA was alcoholic and he was suffering from CLD (Chronic Liver Disease), Cirrhosis with portal hypertension, Ascites, BP & DM but duration is not mentioned.

8.                It is not disputed that relying upon the pre-existing disease of insured Bobby Singh, net amount of Rs.3,34,492/- as per Ex. C1 was given to the complainant which was accepted by her without any protest. The complainant contended that her whole claim was not processed by the opposite parties as the insured was not suffering from any pre-existing disease and was died due to heart attack and he was not alcoholic. On the other hand, the counsel for the opposite parties contended that as there was concealment of facts regarding preexisting ailment on the part of the life insured Bobby Singh and as such, the insurance company has rightly repudiated the claim of the complainant. In this regard reference can be made to 2010 (1) ICC 9 in Satwant Kaur Sandhu Vs New India Assurance Company Ltd. whereby the Hon’ble Supreme Court of India has been held at the time of taking the policy, the deceased was suffering from Diabetic Nephropathy/Chronic Renal Failure and he did not disclose the fact of ailment while taking the policy which was within his knowledge and he was required to disclose it under the terms of policy. Death of the deceased took place after 7 months of taking the policy and his wife claimed compensation which was repudiated by the insurance company. It amounts to suppression of material facts and there is no deficiency in service and insurance company is justified in repudiating the claim. Material fact means any fact which would influence the judgment of a prudent insurer in fixing insurer the premium or determining whether to accept the risk or not.

10.              The policy in question was obtained in the year 2015 i.e. on 20.05.2015 and the waiting period for pre-existing disease was three years but unfortunately Bobby Singh died on 30.01.2018 i.e. during the waiting period of three years. As such, considering the concealment of facts of pre-existing disease on the part of life assured and as per clause 17(1) of the policy terms and conditions, the complainant was given Rs.3,34,492/- as surrender value according to section 45 of the Insurance Act, 1938. The complainant accepted and received the said amount without any protest. In the given set of facts and circumstances, the opposite parties were justified in repudiating the claim of the complainant and as such, it would be just and appropriate if the complaint is dismissed.

11.              As a result of above discussion, the complaint fails and the same is hereby dismissed. However, there shall be no order as to costs. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

12.              Due to huge pendency of cases, the complaint could not be decided within statutory period.

 

(Monika Bhagat)          (Jaswinder Singh)                      (Sanjeev Batra)                          Member                            Member                                      President         

 

Announced in Open Commission.

Dated:05.04.2023.

Gobind Ram.

 

 

Jasbir Kaur Vs HDFC Standard Life Insurance Co.                CC/19/30

Present:       Sh. Naresh Yadav, Advocate for complainant.

                   Sh. Nitin Kapila, Advocate for OPs.

 

                   Arguments heard. Vide separate detailed order of today, the complaint fails and the same is hereby dismissed. However, there shall be no order as to costs. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

 

(Monika Bhagat)          (Jaswinder Singh)                      (Sanjeev Batra)                          Member                            Member                                      President         

 

Announced in Open Commission.

Dated:05.04.2023.

Gobind Ram.