BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM:
AMBALA
Complaint Case No. : 75 of 2017.
Date of Institution : 08.03.2017.
Date of Decision : 10.08.2018.
Surjit Kaur aged about 50 years wife of Amrik Singh son of Sh.Shyam Singh r/o village Jagoli, Tehsil & District.
………….Complainant.
Versus
1.HDFC Standard Life Insurance Company Ltd. 11th Floor, Lodha Excelus, Apollo Mills Compound, N.M.Joshi Marg, Mahalaxmi, Mumbai, 400011.
2.HDFC Standard Life Insurance Company Ltd. Regd.Office Lodha Excelus, 13th Floor, Apollo Mills Compound, N.M.Joshi Marg, Mahalaxmi Mumbai 400011.
3.HDFC Bank Ltd. Rasoolpur, Tehsil & District Ambala through its Manager.
…………Opposite Parties.
Complaint Under Section 12 of the Consumer Protection Act.
CORAM: SH. DINA NATH ARORA, PRESIDENT
MS. PUSHPENDER KUMAR, MEMBER
Present: - Sh. M.S.Malhotra, Adv, for complainant.
Sh. Rajiv Sachdeva, Adv. for the OP Nos.1 & 2. Sh.Ashok Goel, Adv. for OP No.3.
ORDER
Brief facts of the present complaint are that Amrik (husband of the complainant) had purchased an insurance policy bearing No.17003522 on 09.08.2014 from OPs for a sum of Rs.3,50,000/- and all the formalities were completed by the deceased at the time of purchasing the policy in question. The husband of the complainant was hale and hearty at the time of obtaining the policy. He felt sick and was diagnosed as a patient of cancer. On 18.03.2015 he died due to cancer and after his death claim was lodged but the same was repudiated vide letter dated 31.07.2015 with remarks that Our investigations have established that the life assured was suffering from Testicular Seminoma prior to policy issuance, which was not disclosed in the application. The repudiation made by the OPs on false and flimsy grounds, therefore, the act and conduct of the OPs clearly amounts to deficiency in service and unfair trade practice on their part. In evidence, the complainant has tendered affidavit Annexure CX and document Annexure C1 to Annexure C8.
2. On notice OPs appeared. OP Nos. 1 & 2 filed their joint reply wherein several preliminary objections such as maintainability, concealment of material facts from this Forum. In the present case, deceased Amrik Singh LA at the time of making the proposal form had misrepresented about the condition of his health as he was suffering from Chronic disease called Testicular Seminoma as form of Cancer as is evident through the medical record. The life assured was suffering from pre-existing disease before issuance of the policy in question and had concealed the material information from this Forum. The policy contract would be null and void in case the life assured had obtained the policy by misrepresenting and concealing of material facts. The policy of life insurance is a contract where observance of utmost good faith is enjoyed by both the parties and if the insurer misled about the risk covered then the purpose of the policy would vitiate. Other contentions have been controverted and prayer for dismissal of the complaint has been made. In evidence, the OPs have tendered affidavit Annexure RW1/A and documents Annexure R1 to Annexure R10.
Learned counsel for the OP No.3 in a separate statement dated 06.09.2017 admitted the reply filed by Op Nos.1 & 2.
3. We have heard learned counsel for the parties and gone through the case file very carefully minutely and carefully.
4. Undisputedly, the husband of the complainant had obtained an insurance policy from the Ops. The grouse of the complainant is that her husband died during the period of insurance policy but the OPs have repudiated the claim despite the fact that it was the duty of the insurance company to indemnify the same.
5. On the other hand learned counsel for the OPs argued that the policy in question has been obtained by concealment of the material facts because at the time of obtaining the policy in question the life insured was having pre-existing disease.
6. In the present case the policy in question was issued to the life assured on 09.08.2014 (Annexure C3) by the OPs and in this very document the date of application has been mentioned as 02.08.2014. In the repudiation letter Annexure C2 the OPs have mentioned as under:
33 | Have you ever suffered from Epilepsy, Any nervous disorder or mental condition, paralysis or multiple sclerosis depression or psychiatric disorder, cancer or a tumor | No |
35 | Are you currently suffering any illness, impairment or taking any medication or pills or drugs | No |
36 | During last 5 years have you undergone or been recommended to undergo hospitalization. | No |
7. The proposal form Annexure R1 on the basis of the policy in question has been issued does no co-relate the grounds as mentioned in the repudiation letter because no such type of disease in the form of Question and Answer has been mentioned. However, this document is not clearly visible but in this document it can be easily seen that some point on the Yes column has been marked whereas in the repudiation letter the answer has been mentioned as NO which shows that the insurance company has not come to this Forum with clean hands. Moreover, in Annexure C4 i.e. case summary it has been mentioned that the patient was admitted on 29.09.2014 and was discharged on 04.10.2014 in a satisfactory condition. From this one thing is very much clear that after obtaining the policy in question the life assured was hospitalized and that too after around 50 days. There is every possibility that the life assured might not have the knowledge for the disease for which he was hospitalized on 29.09.2014. The Ops have placed case file investigation report Annexure R6 on the case file wherein it has been mentioned that during investigation we visited to locality met with the local residents and inquired about LA they revealed that LA had cancer from last 2 years, he was under treatment in Ludhiana and died due to same. In this very document the investigator has mentioned the cause of death as Cancer but the OPs have neither produced any person from whom the investigator had confirmed that the life assured was actually suffering from Cancer and died due to same except a certificate Annexure R5 allegedly issued by Angan Worker wherein it has been mentioned that Amrik Singh has died due to cancer. This document does not caries evidentiary value because there is not mentioned that under which Office/Tehsil/District said worker was working and even there is no dispatch number on this document. In the investigation report the investigator has mentioned that the life assured was suffering from cancer for the last 2 years there is nothing on the case file that the life assured was ever admitted in the hospital before inception of the policy rather Annexure C4 Case summary authenticated that he was admitted in the hospital only on 29.09.2014. Therefore, it appears the findings recorded by the investigator are just vague and based on the basis of conjectures and surmises and, thus, patently illegal and perverse. In general it is known that, many times the healthy persons are unaware of such silent aliments of diabetes and hypertension, which come to their knowledge first time during health checkup camps or in any emergent situation. Thus, OPs can not apply a hard and fast rule to presume that, the complainant was suffering for long duration i.e. before taking the policy. Therefore, we are not convinced with this argument that the life assured was having pre-existing disease. It was just a hypothetical presumption of OPs to repudiate the claim of complainant. Such argument is bereft of any merit and has no medical basis. The OPs failed to prove their contention; accordingly the repudiation of claim by OP is unjustified, it’s a deficiency in service.
8. Keeping in view the above said facts and circumstances we are of the view that present complaint deserves acceptance. Accordingly, we allow the present complaint with costs which is assessed at Rs.5000/- and the repudiation letter Annexure C2 is quashed being issued wrongly and illegally. The Ops are directed to comply with the following orders, within a period of 30 days from the date of receiving of copy of this order:
- To pay Rs. 3,50,000 being sum assured failing which the awarded amount would carry interest @ 9 % per annum till its realization.
A copy of this order be supplied to both the parties free of cost. File be consigned after due compliance.
Announced on: 10.08.2018
(Pushpender Kumar) (D.N.Arora)
Member President
District Consumer Disputes Redressal Forum, Ambala.
