BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, JALANDHAR.
RBT/CC No.104 of 2021
Date of Inst. 08.03.2021
Date of Decision: 09.08.2022
Rupinder Singh S/o Rattan Singh R/o Village Surakhpur, District Kapurthala.
..........Complainant
Versus
1. HDFC Standard Life Insurance Co. Ltd. through its Branch Manager, 1st & 2nd Flr, Gupta Chambers, Civil Lines, Jalandhar, Punjab 144001.
2. HDFC Standard Life Insurance Co. Ltd., through its Managing Director, 11th Floor, Lodha Excelus, Apollo Mills Compound, N. M. Joshi Road, Mahalaxmi, Maharashtra, Mumbai-400011.
3. HDFC Bank Ltd., Near Narinder Cinema, G. T. Road, Jalandhar through its Manager.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Dr. Harveen Bhardwaj (President)
Smt. Jyotsna (Member)
Sh. Jaswant Singh Dhillon (Member)
Present: Sh. Nitish Arora, Adv. Counsel for the Complainant.
Sh. Rajat Chopra, Adv. Counsel for the OPs No.1 & 2.
Sh. V. K. Gupta, Adv. Counsel for the OP No.3.
Order
Dr. Harveen Bhardwaj (President)
1. The instant complaint has been remanded back by the Hon’ble State Commission, vide order dated 28.01.2021, whereby the order of this Commission dated 10.12.2019 was set-aside and the District Commission was directed to give an opportunity to the appellants-company to place on record the documents as prayed in the applications in additional evidence before the District Commission and also give to the complainant an opportunity to rebut the same and thereafter the District Commission shall record a specific finding. After remand of the case, in compliance of the order of Hon’ble State Commission, the OP was granted an opportunity to file the additional evidence. The documents were filed by the company/OP and thereafter an application was moved by the complainant for allowing the expert for taking photographs of the original loan agreement produced by the OP No.3 for comparing the same with the photocopy of the loan agreement produced by OPs No.1 & 2 and the application was allowed without issuing any notice of the application to the OPs and without calling reply of the OPs. This order was challenged by the OP and the order was set-aside by the Hon’ble State Commission with the direction to decide the same in accordance with the law by following the principles of natural justice by giving an opportunity to the OPs to file reply to the application, if any.
2. In compliance with the order of Hon’ble State Commission dated 15.11.2021, the application dated 10.08.2021 already moved by the complainant for allowing the expert for taking photographs of the original loan agreement for comparing the same with the signatures of deceased Rattan Singh, was decided by this Commission on 29.12.2021.
3. Brief facts of the complaint are that the complainant is the son of deceased policy holder Rattan Singh. The OP No.1 the branch office of OP No.2, who had issued insurance policy in favour of deceased father of the complainant Rattan Singh. The OP No.3 had financed the vehicle make Tata Prima 4023 for a sum of Rs.10,20,217/-, against which the life insurance policy was issued by OP No.1. The said vehicle was purchased by the deceased father of the complainant from Tata Motors Jalandhar. The complainant is also nominee of the said policy, therefore is a consumer within the ambit of the Consumer Protection Act. The insurance policy in question is under scheme of membership insurance and having policy No.CP000046 and Scheme Member Code 82487889 for assured amount of Rs.10,00,000/-, commencing from 06.03.2017 to 05.03.2019 stands in the name of the father of the complainant deceased Rattan Singh and wherein the complainant Rupinder Singh is a nominee.
4. That only the Policy Schedule was provided to the complainant at the time of issuance of policy of insurance and no terms and conditions of the policy of insurance including any hidden exclusion clauses were not provided to the complainant and as such, any hidden exclusion clause in the policy of insurance is not binding upon the complainant.
5. That the father of the complainant, insured Rattan Singh was gone to Dubai for his personal work and fell ill over there and was admitted on 19.07.2017 till 01.08.2017 in the Thumbay Hospital, Ajman UAE, as his condition was then diagnosed stable and normal and then he was discharged and was advised medical treatment at home. Thereafter, the insured came back to India and took treatment at Premier Gastroenterology Institute at Jalandhar from 01.08.2017 to 06.08.2017, where he was advised to consult the higher centre for his treatment. Thereafter, he took treatment at Mannat Super Specialty Hospital and was discharged on 11.08.2017 and his condition was termed as ‘Hemodynamically Stable’. The discharge summary was issued by the said hospital. The father of the complainant was not satisfied with the treatment at Jalandhar and therefore, he got himself admitted at PGIMER, Chandigarh on 12.08.2017 and was diagnosed with condition ‘Abdominal Distension and Jaundice’. He was given treatment and was discharged on 25.08.2017 and his condition was stated as ‘Hemodynamically Stable’. Thereafter, the father of the complainant came back home at Kapurthala in a healthy state and was under medication as advised by the doctors at PGIMER, Chandigarh. The father of the complainant enjoyed good health from 25.08.2017 to 03.09.2017. However, father of the complainant complained of high fever on 04.09.2017 and on the same day, he was taken to PGIMER, Chandigarh for his treatment. The father of the complainant continued his treatment at PGIMER, Chandigarh from 04.09.2017. He was shifted to ICU and while undergoing treatment in ICU, he took his last breath on 21.09.2017. The Liver Clinic File issued by PGIMER, Chandigarh on 04.09.2017 and Death Certificate of Rattan Singh was also placed on the file.
6. That the complainant being nominee of the Life Insured Rattan Singh, had lodged death claim of his father with OP No.1. To the utmost shock of the complainant, the said claim was rejected by the OPs No.1 & 2, vide letter dated 24.03.2018 after lapse of five months on the ground as stated therein as under:-
“Life insured was suffering from Diabetes for 6 years and Chronic Liver Disease prior to issuance of policy and the said information was not provided to the OPs No.1 and 2 by the father of the complainant at the time of taking of policy.”
7. It is further submitted that the questionnaire was filled by the agents of OPs No.1 and 2 on their own without inquiring the same from the deceased. As such, the rights of the legal heirs of the deceased cannot be waived off on the basis of this wrongly filled questionnaire. However, the father of the complainant was not suffering from any Chronic Liver Disease with Portal Hypertension, Diabetes Mellitus at the time of taking of insurance policy from the OPs. The OPs No.1 and 2 has rejected the claim of the complainant on false and flimsy grounds in order to avoid their liability. The said life insurance was done at the instance of OP No.3, who assured the father of the complainant that in case of any mis-happening, the amount of the loan shall be adjusted from the insurance money received from OPs No.1 and 2. The family of the deceased father of the complainant was immensely dependent on the earnings of the deceased and after his death is unable to maintain themselves and also not in a financial position to repay the loan. Taking benefit of the said fact, the OP No.3 is threatening the family of the deceased Rattan Singh to repay the outstanding loan amount or they will take the possession of the vehicle forcibly. The act and conduct of the OPs is tantamount to deficiency in service, which caused mental tension and agony to the complainant and accordingly, the instant complaint filed with the prayer that the complaint of the complainant may be accepted and OPs No.1 and 2 be directed to make the payment of Rs.10,00,000/- to the complainant being the amount of insurance policy and further, OP No.3 may kindly be restrained from taking possession of the loaned vehicle till the time the present dispute is decided by the Forum and further, OPs No.1 and 2 be directed to pay interest @ 18% per annum upon the awarded amount and further, OPs No.1 and 2 be directed to pay litigation expenses of Rs.20,000/-.
8. Notice of the complaint was given to the OPs and accordingly, OPs No.1 and 2 appeared through its counsel and filed joint written reply, whereby contested the complaint by taking preliminary objections that at the very outset the answering OPs No.1 and 2 deny all the allegations, facts and averments stated in the complaint filed by the complainant except to the extent they are expressly admitted therein and further averred that the complaint under reply is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead the Forum and as such, the complaint is liable to be dismissed on this ground. It is further alleged that no cause of action has ever accrued in favour of the complainant to file the present complaint and thus, the same is liable to be dismissed and further submitted that the complainant has concealed the material facts. It is further averred that the deceased life insured i.e. Rattan Singh had submitted to the OP No.3 a proposal/application for the purchase of Group Insurance Policy bearing No.CP000046 i.e. “HDFC Life Group Credit Protect Insurance Plan” and deceased insured was accepted and policy was issued on 06.03.2017 by issuing a Member No.82487889. It is further alleged that the deceased Rattan Singh insured at the time of making the said proposal had misrepresented about his health i.e. the deceased was suffering from Diabetes Mellitus for the last six years & Chronic Liver disease with Portal Hypertension prior to issuance of the policy and the suppression of this material facts at the time of filling and signing the proposal form based on which the said policy was issued amounts to suppression of true facts. This very fact is very much evident from the medical records obtained by the OPs No.1 and 2 in which the deceased life insured was diagnosed with aforesaid disease. So, it is established that the deceased life assured has suppressed and concealed the very material facts of the suffering from chronic pre-existing disease at the time of issuance of the policy. Thus, the complaint is liable to be dismissed and as such, the claim of the complainant has been rightly repudiated, vide letter dated 24.03.2018 on the ground of suppression of material facts by the insured at the time of filling up the proposal form. On merits, it is admitted that the policy in question was obtained by the father of the complainant and who took a treatment and died in the hospital, thereafter insurance claim was filed by the complainant, the same was repudiated rightly. The other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
9. Replication to the written reply of the OPs No.1 and 2 filed, whereby reasserted the entire facts as detailed in the complaint and denied those of the written statement.
10. OP No.3 filed its separate reply and contested the complainant by taking preliminary objections that the instant complaint is not maintainable against the answering OP No.3 and is liable to be dismissed with heavy cost. The OP No.3 is unnecessarily dragged in the instant complaint because there is an inter-se dispute between the complainant and the OPs No.1 and 2 and as such, the instant complaint qua OP No.3 is liable to be dismissed. It is further averred that there is no deficiency in service or negligence alleged on the part of the answering OP and further submitted that the father of the complainant Sh. Rattan Singh availed credit/loan facility from the OP No.3 for the purchase of the commercial vehicle under the loan account No.82487889. However, the said loan account presently running highly irregular. It is submitted that the complainant himself stood as guarantor for the repayment of the above said dues, but he and other LRs are of late Sh. Rattan Singh are not making the payment of the same and further submitted that the bank has first charge over the amount any received from the insurance company. On merits, the factum as narrated in the complaint are controverted and lastly submitted that the complaint of the complainant qua answering OP is without merits, the same may be dismissed.
11. Replication to the written reply of the OP No.3 not filed.
12. In order to prove the case of the complainant, the counsel for the complainant tendered into evidence affidavits of the complainant Ex.CA and Ex.CB alongwith some documents Ex.C-1 to Ex.C-12 and closed the evidence.
13. Similarly, counsel for the OPs No.1 and 2 tendered into evidence affidavit Ex.OPA alongwith some documents Ex.OP-1 to Ex.OP-6 and closed the evidence and then counsel for the OP No.3 tendered into evidence affidavit Ex.R3/A alongwith some documents Ex.R-1 and Ex.R-2 and closed the evidence
14. We have heard the learned counsel for the respective parties and have also gone through the case file as well as written arguments submitted by counsel for complainant and counsel for the OPs No.1 & 2 very minutely.
15. It is admitted that the OP No.3 financed the vehicle make Tata Prima 4023 for a sum of Rs.10,20,217/- and the copy of the RC has been proved as Ex.C-1 and copy of the invoice Ex.C-2 and the life of the father of the complainant was insured by the OPs No.1 and 2 through OP No.3. The father of the complainant remained admitted in hospital in Thumbay Hospital, Ajman UAE from 19.02.2017 to 01.08.2017. The complainant has proved on record the discharge summary and medical report of his father as Ex.C-4 and Ex.C-5. The complainant has also proved on record that after coming back to India, the father of the complainant took treatment at Premier Gastroentology Institute at Jalandhar from 01.08.2017 to 06.08.2017 where he was advised to consult the higher centre for his treatment and then he took treatment from Mannat Super Speciality Hospital and was discharged on 11.08.2017. His condition was termed as Hemodynamically Stable. The complainant has proved on record the discharge summary from Premier Gastroentology Institute Ex.C-6 and the letter issued by Mannat Hospital, Ex.C-7. Thereafter uptil 04.09.2017, he remained fine and he was again admitted in PGIMER, Chandigarh on 04.09.2017 and he took his last breath on 21.09.2017. He has proved on record medical record and discharge summary Ex.C-9 & Ex.C10 and death certificate has been proved as Ex.C-11. The death claim was lodged with the OPs No.1 & 2, which was rejected on the ground that life insured was suffering from Diabetes for 6 years and Chronic Liver Disease prior to issuance of policy and the said information was not provided to the OPs No.1 and 2 by the father of the complainant at the time of taking of policy. On this ground only, the claim was rejected. The repudiation letter has been proved as Ex.C-12.
16 The contention of the OP is that the father of the complainant has concealed the material fact of pre-existing diseases from OPs No.1 and 2. The questionnaire was given to the complainant to which the answers were given by the father of the complainant and those were wrong answers. He has concealed the fact that he was suffering from diabetes mellitus for the last six years and the chronic liver disease with Portal Hypertension prior to issuance of policy. The counsel for the OP has further stated that the father of the complainant was alcoholic and due to consumption of alcohol, he had suffered liver cirrhosis and this is evident from the discharge summary of the father of the complainant. To support that the consumption of alcohol leads to cirrhosis, he has relied upon 2012 (63) R.C.R. Civil 815 and 2014 (80) R.C.R Civil 55. It is well settled law that the insurance company is to prove that there is a nexus between the cause of death and the disease. To prove that he was suffering from liver disease, it was incumbent upon the OPs to prove that he died because of the pre-existing liver disease and diabetes. The policy was taken by the complainant on 06.03.2017. The complainant was admitted in Thumbay Hospital, Ajman UAE on 19.07.2013 i.e. after the issuance of the policy. The complaint of the complainant at the time of admission was diabetic mellitus and alcohol drinking since the previous day i.e. yesterday and his condition was improved when he was discharged from the hospital. Ex.C-6 is the discharge summary dated 06.08.2017. Though, in this document, it has been mentioned that chronic alcoholic since 8 years and last alcohol intake was 17.07.2017. This itself shows that there was no intake of alcohol since 17.07.2017 till 01.08.2017, when he was admitted in Premier Gastroentology Institute, Jalandhar. Ex.C-8 is the discharge summary of Department of Hepatology PGIMER, Chandigarh, where he was admitted on 12.08.2017 with the complaint of Abdominal distension since 1 month, Yellowish discoloration of eyes since 1 month and he was having jaundice and altered sensorium. In this discharge summary, there is no reference of the fact that he was having liver cirrhosis as mentioned in Ex.C-6, the basis, on which the claim of the complainant has been repudiated. The OP has produced on record the affidavit of the surveyor, who has proved the document Ex.OP-6 which has been proved by the complainant as Ex.C-6 also in which there is a reference of liver cirrhosis. All these documents pertain to the period after the policy was issued to the complainant and not prior to the inception of policy of insurance. The OP has not proved on record any document to show that he was ever admitted in the hospital prior to the issuance of the insurance for the illness of diabetes or liver cirrhosis. Though it has been held by the Hon'ble National Commission is that cirrhosis of liver does not develop over night and one of the most common causes of this disease is alcoholism and similar view has been taken by the Hon’ble State Commission in 2014 (80) R. C. R. (Civil) 55 and Hon'ble National Commission in 2012 (63) R.C.R. Civil 815, but the OPs have failed to prove that he was habitual alcoholic and prior to the issuance of the policy, he used to have alcohol. It has been held by the Hon'ble National Commission in 2005 (2) CPJ 78 and 2007 (10) RCR Civil 133 that “simple allegations made by the petitioner that the deceased was alcoholic, was suffering from diabetes mellitus, and jaundice, etc. would not be sufficient. The unproved case history recorded by some person on the date of admission of Shri Bachan Singh, the deceased would not be cogent and convincing evidence to repudiate the claim unless it was coupled with medical report for the treatment prior to submission of the proposal form.” Therefore, in the present case also mere on the allegations that the father of the complainant was alcoholic, without any evidence, does not prove that due to the alcoholism the father of the complainant suffered cirrhosis. 17. The deceased was about 55 years old at the time of his death i.e. on 04.09.2017. It was the duty of the panel doctor to medically examine the insured Rattan Singh before issuing the policy. It has been held by the Hon'ble National Commission in case titled as “Senior Divisional manager, Life Insurance Corporation of India Vs. Smt. J. Vinaya (N.C.D.R.C.) 2003 (1) C. P. J. 50”, wherein it is held that "Before us, apart from the certificate of hospital treatment dated 19.1.1990 which we have referred to have there has not been any evidence led by the LIC to prove that the case fell with the Second Part of Section 45 of the Insurance Act. Doctors of the L.I.C. would have also examined the deceased before his proposal was accepted. Nothing has been alleged as observed by the Supreme Court in the case of Smt. G.M. Channabasamma, that those doctors were either an incompetent lot or were won over by the complainant. In the present case also the panel doctors have not examined the insured prior to acceptance of proposal form. The OPs had moved the application for summoning the medical record regarding the disease of the father of the complainant and this record was pertaining to the period 12.08.2017 to 25.08.2017. The documents have already been produced on record by the complainant. There are mere references of the fact that the he was suffering from diabetes mellitus and liver cirrhosis, but there is no evidence on the record to shows that he ever took the treatment from any of the hospital or doctor or ever remained admitted in the hospital for the above said diseases prior to the policy. It has been held by Hon’ble State Consumer Disputed Redressal Commission Chandigarh, in a case titled as “Life Insurance Corporation of India Vs Sarabjit Kaur”, that contention, raised by OP that material information suppressed by insured - False answers given in proposal form-Contention untenable-Ultimate cause of death, aspiration pneumonia-No mention that diabetes has direct nexus with the ultimate cause of death-Fact that insured taking medicine for diabetes for 10 years or had taken treatment for stroke suffered in 1993 not established - Diabetes, Hypertension not serious diseases-Part of ordinary strain , stress of life - Repudiation of claim not proper-Insurer liable under policy-Appeal Dismissed. Thus, as per above law, merely having diabetes is no ground to repudiate the claim.
18. The law referred by the Ld. Counsel for the OPs, titled as “Branch Manager, Bajaj Allianz Life Insurance Company Ltd and Others Vs. Dalbir Kaur” and “Life Insurance Corporation of India Vs. Manish Gupta, of Hon’ble Supreme Court, is not applicable to the facts of the present case as at the relevant time i.e. at the time of issuance of policy, the complainant himself was not aware of the fact that he is suffering from the diabetes as well as liver cirrhosis as he was not taking any medicine at that time nor this fact has been proved by the OPs. Proposition of law is not disputed that the contract of insurance is one of the utmost good faith and proposer who seeks to obtain policy of life insurance is duty bound to disclose all material facts bearing upon issue as to whether insurer would consider it appropriate to assume risk which is proposed, but it is the duty of the OPs to prove that the complainant has concealed the material facts from the OPs at the time of filling the proposal form. Similarly, the law relied upon by the Ld. Counsel for the OPs, titled as “Reliance Life Insurance Co. Ltd. & Others Vs. Rekhaben Nareshbhai Rathod” and “Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd.” is not applicable to the facts of the present case.
19. It has been held by the Hon'ble National Commission in a case titled as “Sushil Kumar Jain Vs. United India Insurance Co. Ltd.” in 2012 (1) C.P.J. 204 that:-
“Respondent Insurance Company has not been able to produce any credible evidence including documentary evidence or medical record to show that Petitioner had been treated for pre-existing diseases. If the Petitioner did indeed suffer from serious diseases like diabetes and hypertension, he would have, no doubt, taken treatment for the same.”
In the present case also the certificate of the doctor in Ex.C-6 and Ex.C-7 is not based on any document or any tests, therefore it cannot be said that the deceased had concealed the material facts. Even otherwise, the diabetes and hypertension are not such disease which can be said pre-existing disease or serious disease. It has been held by the Hon’ble Supreme Court, in a case titled as “P. Vankat Naidu Vs. Life Insurance Corporation of India (SC), in 2011 (4) C. P. J. 6 that:-
“Since the respondents had come out with the case that the deceased did not disclose correct facts relating to his illness, it was for them to produce cogent evidence to prove the allegation. However, as found by the District Forum and the State Commission, the respondents did not produce any tangible evidence to prove that the deceased had withheld information about his hospitalization and treatment. Therefore, the National Commission was not justified in interfering with the concurrent finding recorded by the District Forum and the State Commission by making a wild guesswork that the deceased had suppressed the facts relating to his illness."
20. The OPs have relied upon the report of the Surveyor, who has produced the documents to show that the deceased was suffering from the pre-existing diseases of diabetes and liver cirrhosis and he was alcoholism, but the OPs have not produced on record any medical record of deceased pertaining to the diseases prior to the issuance of the policy. It has been held by the Hon'ble National Commission, in a case titled as “Shanti Devi Vs. Tata AIG Life Insurance Co. Ltd.” (N.C.D.R.C.N.D.) 2016 (2) C.P.R. 265:2016 (2) CLT 322 that:- “On perusal of medical record we find that insured remained under treatment at Pandit Bhagwat Dayal Sharma, PGIMS Rohtak, initially as an OPD patient and thereafter as an inpatient during the period 17.03.2010 till the date of his death on 02.04.2010. There is nothing in the medical record to show that the insured or his family member gave any history which would lead to the suggestion that the insured was aware that he was suffering from Cushing disease and which is a hormonal disorder and he concealed this fact by giving a wrong answer to question no.5(c) of the proposal form in the negative. Even the report of the investigator does not point out any evidence which may lead to the conclusion that at the time of submitting proposal form, the insured was aware that he was suffering from Cushing disease. Thus, it cannot be said that the insured obtained the insurance policy by concealing material fact regarding his ailment as a result of hormonal disorder. Thus, in our view the State Commission has committed a grave error in appreciating the facts which has resulted in injustice to the petitioner.”
21. The Ld. Counsel for the OP No.3 has submitted that their loan has already been settled. Since, no relief has been claimed against the OP No.3 and the loan has already been settled, therefore, complaint qua OP No.3 is dismissed. So, in view of the documents filed on record by the complainant and law relied upon by the complainant as well as OP and the discussion, it is concluded that the insurance claim of the complainant has wrongly been repudiated by the OPs No.1 and 2 for which the complainant being the nominee as well as LR of the deceased insured Rattan Singh is entitled for the relief and accordingly, the complaint of the complainant is partly allowed and OPs No.1 and 2 are directed to pay death insurance claim of insured Rattan Singh of Rs.10,00,000/- to the complainant alongwith interest @ 9% per annum from the date of repudiation i.e. 24.03.2018, till realization and further, OPs No.1 and 2 are directed to pay a compensation including litigation expenses of Rs.20,000/- to the complainant. The entire compliance be made within one month from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.
22. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jaswant Singh Dhillon Jyotsna Dr. Harveen Bhardwaj
09.08.2022 Member Member President
