Haryana

Ambala

CC/55/2018

Raj Kumar - Complainant(s)

Versus

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

14 Aug 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA.

 

                                                          Complaint Case No.:  55 of 2018.

                                                          Date of Institution         :   09.02.2018.

                                                          Date of decision   :   14.08.2019.

 

Raj Kumar s/o Shri Mani Ram, r/o Ward No.2, Durjana, District Hanumangarh.

                                                                                       …. Complainant.                                                    Versus

1. HDFC Standard Life Insurance Company Ltd., 13^th Floor, Lodha Excelus, Apollo Mils Compound N.M. Joshi Road, Mahalaxmi, Mumbai-400011.
2. HDFC Standard Life Insurance Company, Ambala Nicholson Road, Branch 1^st Floor, Sudarshan Towers Cross Road No.1, Nicholson Road, Ambala Road, Cantt 133001.

               ..…. Opposite Parties.

         

Before:        Smt. Neena Sandhu, President.

                   Smt. Ruby Sharma, Member,

Shri Vinod Kumar Sharma, Member.                 

                            

Present:       Shri Abhishek Sharma, Advocate, counsel for complainant.

Shri Rajiv Sachdeva, Advocate, counsel for the OPs.

         

Order:        Smt. Neena Sandhu, President.

Complainant has filed this complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’), praying for issuance of following direction to them:-

1. To make the payment of Rs.3,35,000/- alongwith interest @18% and other benefits under the policy.
   382.  

Any other relief which this Hon’ble Forum may deem fit.

 

Brief facts of the case are that during his lifetime, Shri Mani Ram s/o Shri Manphool, r/o Ward No.2, Durjana, District Hanumangarh (hereinafter referred to as “DLA”) had obtained life insurance policy No.19293494 dated 05.05.2017 under HDFC Life Sampooran Samridhi Plus plan from the OP No.2 at Ambala. In case of death of the policy holder, his nominee will receive sum of Rs.3,35,000/-. The complainant being real son of DLA, was the nominee/legal heir of the DLA. During his lifetime, DLA had paid the annual premium of Rs.34,045/- dated 12.05.2017 under Client ID No.1774516. Before granting the policies, the panel doctors of OP company had checked the health condition of DLA and after satisfying from the same, the OP company issued the said insurance policy. The official of OP company had suo-moto filed the Proposal Form without taking the signature on the proposal form. Unfortunately, on 27.05.2017, DLA died at his home due to heart failure and the complainant had informed the OPs in this regard, which demanded certain documents to issue the death claim. The complainant supplied all the documents regarding death of his father within stipulated period, but the OPs prolonged the matter on one pretext or other and ultimately, issued a letter dated 19.12.2017 and declined the death claim with the reason “Life Assured had multiple insurance from other insurance companies”. The aforesaid reason for declining the claim was totally wrong and illegal as the OPs never disclose the facts before the deceased which was mentioned in the proposal form nor the agent of the company had taken any signature in the proposal form. By not paying the death claim amount, the OPs have committed deficiency in service. Hence, the present complaint.

2.                Upon notice, OPs appeared through counsel and have filed written version raising preliminary objections regarding maintainability and cause of action. On merits, it is stated that the DLA had concealed the fact that he had obtained various policies from different insurance companies before the issuance of the life insurance policy by the OPs. That as per the Proposal Form of the deceased DLA vide Column NO.2 to 7 of the Personal Details of life assured, which is reproduced as under, whereby, he had declared that he does not have any insurance cover:-

2.	Do you have any existing insurance cover of premium paying and/or paid up policies.	NO
3.	Have you submitted any simultaneous application for the life insurance to any other life insurance company, which is still pending or are likely to revive lapse policies.	NO
4.	Has any application for insurance on your life has been postponed?	NO
5.	Has any application for insurance on your life has been accepted with extra premium?	NO
6.	Has any application for insurance on your life has been accepted on other special terms?	NO
7.	Has any application for insurance on your life has been declined?	NO

 

                   In the proposal form dated 05.05.2017, the DLA concealed about having previous/existing insurance cover from the OPs at the time of applying for the insurance policy in question. By concealing the vital information with regards to the previous insurance cover, the DLA has violated the basic principle of “Utmost Good Faith” and has obtained the insurance policy by keeping the OPs in dark, thus, the claim was rightly repudiated vide letter dated 19.12.2017. There is no deficiency on the part of the OPs and the present complaint may be dismissed with heavy costs.

3.                The ld. counsel for the complainant tendered affidavit of complainant as Annexure CA alongwith documents as Annexure C-1 to C-7 and closed the evidence on behalf of complainant. On the other hand, learned counsel for the OPs tendered affidavit of Shri Arpit Higgins, Legal Manager, HDFC Standard Life Insurance Company Ltd. as Annexure OP-A alongwith documents Annexure OP1 to OP3 and closed the evidence on behalf of OPs.

4.                We have heard the learned counsel for parties and carefully gone through the case file.

5.                Admittedly, DLA had taken insurance policy from the OPs for a sum assured of Rs.3,35,000/- vide policy document Annexure C-1. From the First Premium Receipt (Annexure C-2), it is evident that Shri Raj Kumar, complainant was appointed as nominee in the said policy. Complainant being the nominee of the DLA, had lodged the claim with the OPs, which was repudiated vide letter dated 19.12.2017 (Annexure OP-2) on the ground that Life Assured had concealed the factum of having multiple insurance from other insurance companies. The learned counsel for the complainant has submitted that the Proposal Form, on the basis of which the OPs had repudiated the claim of the complainant, had not been signed by the DLA. Thus, the OPs were not justified in repudiating the claim of the complainant. On the contrary, the learned counsel for the OPs has argued that from the Email Annexure OP-3, it is quite clear that DLA had taken a policy from Birla Sun Life Insurance Company, but while taking the policy in question from the OPs, in the Proposal Form, the DLA did not disclose the said fact and therefore, violated the terms & conditions of the policy and thus, nothing is payable to the complainant under the policy and the claim was rightly repudiated. In support of his contention, he has referred a case law titled Reliance Life Insurance Co. Ltd. & Anr. Vs. Rekhaben Nareshbhai Rathod, Civil Appeal No.4261 of 2019, date of decision 24.04.2019, passed by the Hon’ble Supreme Court of India. From the perusal of Proposal Form Annexure OP-1, it is evident that the same has not been signed by the DLA. As such, the said Proposal Form cannot be taken into consideration to arrive at a conclusion that DLA did not disclose about the insurance policies taken from the other insurance companies. The case law titled Reliance Life Insurance Co. Ltd. & Anr. Vs. Rekhaben Nareshbhai Rathod (Supra), relied upon by the learned counsel for the OPs, is not applicable in the present case, because, in this case, the Proposal Form on the basis of which the OPs had repudiated the claim, has not been signed by the DLA. Even no other document has been placed on record by the OPs to prove their above-said contention. Facing with this situation, we are of the view that the insurance company cannot be said to be right in repudiating the claim of the complainant merely by placing reliance on the Proposal Form, which is not signed by the DLA and are thus liable to pay the death claim amount to the complainant, as per the policy. From the policy document Annexure C-1, it is clear the DLA was insured for a sum of Rs.3,35,000/-. Therefore, the OPs are liable to pay the said amount to the complainant being nominee alongwith interest. The OPs are further liable to compensate the complainant for the mental agony and physical harassment caused to him alongwith the litigation expenses.

6.                In view of the aforesaid discussion, we allow the present complaint and direct the OPs to pay the claim amount of Rs.3,35,000/- to the complainant alongwith interest @7% per annum w.e.f. 19.12.2017 i.e. the date of repudiation of claim, till its realization. The OPs are also directed to pay Rs.3,000/- as litigation charges. The OPs are further directed to comply with the order within the period of thirty days from the date of receipt of certified copy of this order. Certified copies of this order be sent to the parties concerned, free of costs, as per rules. File be indexed and consigned to the Record Room.

Announced on :14.08.2019.

 

          (Vinod Kumar Sharma)           (Ruby Sharma)     (Neena Sandhu)

              Member                                  Member             President