BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, JALANDHAR
Complaint No.158 of 2017
Date of Instt. 19.05.2017
Date of Decision: 20.04.2021
Mankaran Gill, d/o Late Manminder Singh, resident of House No.9, Cantt, Road, Atwal Colony, Jalandhar.
..........Complainant
Versus
1. HDFC Standard Life Insurance Co. Ltd., 1st and 2nd Floor, Gupta Chambers, Opposite Commissioner Office, Tehsil Road, Jalandhar 144001 through its Manager/Branch Manager.
2. HDFC Standard Life Insurance Co. Ltd., Corporate and Registered Office: Lodha Excelus, 13th Floor, Apollo Mills Compound, NM Joshi Marg, Mahalaxmi, Mumbai 400011 through its Manager/Authorized Signatory.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Sh. Kuljit Singh (President)
Smt. Jyotsna (Member)
Present: Sh. Rakesh Dhir, Advocate Counsel for complainant.
Sh. A.K. Gandhi, Advocate Counsel for OPs.
Order
Kuljit Singh (President)
1. The instant complaint has been filed by the complainant, against OPs on the averments that her father had taken the policy namely HDFC SL ProGrowth Super II No.17887121 with client ID 88126672 and the risk commenced from 26.09.2015 of sum assured of Rs.7,00,000/- and annual premium paid by the insurer was Rs.1,00,000/- and term was of 15 years. All the formalities of the insurance company were fulfilled by the insurance company i.e. OPs prior to issuance of the policy in favour of late Manminder Singh. Unfortunately, Manminder Singh died on 23.07.2016 and after his death complainant filed claim with OPs with death certificate on 02.09.2016 confirming the death of the life assured. OPs instead of approving the claim of Rs.7 lac in favour of complainant without giving opportunity of hearing had not accepted the complete claim and only processed an amount of Rs.1,06,979,97/- to the account of the complainant maintained with HDFC Bank vide letter dated 3.11.2016 which is highly inhuman and unreasonable. Due to above said act and conduct of OPs, she has filed the present complaint and prayed that OPs be directed to pay Rs.7 lakh a sum assured in case of death of insurer with interest @18% per w.e.f. date of lodging the claim till its realization, besides to pay Rs.2,00,000/- as compensation for mental harassment and Rs.22,000/- as cost of litigation. ,
2. Upon notice, OPs appeared and filed written reply and contested the complaint of the complainant by averring that the complaint is false and vexatious. The complaint is not maintainable. The OPs have rightly denial the payment of the death claim of the deceased Manminder Singh as present case is a clear cut case of concealment of material facts and misrepresentation. As per investigation, the deceased Manminder Singh was known patient of Hypertension and Hypercholestria with Coronary disease, this was pre-existing one, which was not disclosed by the deceased at the time of inception of the insurance policy. The policy was purchased by the deceased with his free will and terms and conditions of the policy were duly explained to the deceased at the time of execution of the policy. Rest of the averments of the complainant were denied by OPs and they prayed for dismissal of the complaint.
3. The complainant has tendered in evidence his affidavit Ex.C-A along with copies of documents Ex.C-1 to Ex.C-6. On the other hand, OPs tendered in evidence affidavit of Amit Khanna Deputy Legal Manager HDFC Standard Life Insurance Co. Ltd as Ex.OP-A along with copies of documents Ex.OP1&2/2 to Ex.OP1&2/9.
4. We have heard learned counsel for the parties and have also gone through the record of the case very carefully.
5. The glance at evidence is required by us to settle the controversy in this case. The complainant has tendered in evidence her affidavit Ex.C-A in support of her case. She alleged deficiency in service and unfair trade practice on the part of OPs. Ex.C-1 is copy of additional requirement –Gentle Reminder 3. Ex.C-2 is coy of additional requirement. Ex.C-3 is copy of death claim policy. Ex.C-4 is copy of death claim policy dated 03.11.2016. Ex.C-5 is copy of policy document.
6. To refute this evidence of the complainant, OPs tendered in evidence affidavit of Amit Khanna Deputy Legal Manager HDFC as Ex.OP-A. Ex.OP1&2/2 is copy of proposal form. Ex.OP-1&2/3 is copy of document. Ex.OP1&2/3 is copy of declaration form. Ex.OP1&2/5 is copy of death certificate.
7. This fact is admitted that father of the complainant taken the policy namely HDFC SL Pro Growth Super II no.17887121 with claim ID 88126672 and the risk commenced from 26.09.2015 with sum assured of Rs.7,00,000/- and annual premium paid by the insurer was Rs.1,00,000/- and policy term was of 15 years. This fact is clear from policy schedule Ex.C-5 placed on the record. The complainant completed all the formalities of the policy, which were demanded by OPs from time to time, which is proved from Ex.C-2 to Ex.C-3 on the record. OPs rejected the claim of the complainant on the ground that he concealed the material fact about his health at the time of inception of the policy. But it was duty of the insurer/OPs to check the insured before giving the policy. In the proposal form, there is no mention of any chronic disease. OPs alleged that deceased Manminder Singh was suffering from Hypertension and Hypercholestria with coronary disease and this was pre-existing one. OPs have not produced any vital evidence on the record, from which it is clear that deceased Manminder Singh suffering from chronic disease before taking the policy in question. The complainant admitted in para no.4 of his complaint that OPs only processed an amount of Rs.1,06,979.97 to the account of the complainant maintained with HDFC Bnak but not accepted the complete claim. The risk commenced of the policy in question from 26.09.2015 and insured/father (since deceased) of the complainant expired on 23.07.2016 during currency period of the policy. The complainant is nominee of her deceased father, as such, she is entitle for death claim of her father. Ex.OP-1&2/2 is copy of proposal form. From perusal of this proposal form, it has transpired that some columns of this form are blank. It presumes that it filled up by the agent of the OPs himself without consent of the complainant. Various documents placed on record by OPs but not exhibited, from perusal of these documents i.e. certificate of attending physician, death summary, consent form, in these documents, nowhere it is mentioned that the complainant was suffering from the above mentioned disease from the last so many years. So, we do not agree with the submissions of the OPs, that complainant (since deceased) was suffering from any chronic disease at the time of taking the policy in question.
8. The Hon’ble Punjab and Haryana High Court at Chandigarh in case titled as New India Assurance Company Limited versus Smt. Usha Yadav and others reported in 2008(3) RCR (Civil) Page 111 held as under:-
“It seems that the insurance companies are only interested in earning the premiums and find ways and means to decline the claims. All conditions which generally are easily understood by a person at the time of buying any policy. The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay cost of Rs.5000/- for luxury litigation being rich.”
Further, Hon’ble National Commission, New Delhi decided the matter in case titled as Branch Manager Life Insurance Company versus Krishna Devi and others reported in 2016(4) CPR 523, wherein it has been held that “Insurance – Death of Insured – LIC settled the claim under one policy only. LIC refused to pay death claim for remaining policies on ground that deceased suppressed the factum of obtaining first policy while filling up the proposal form for obtaining subsequent policies. District Forum directed to pay 16 lakh plus bonus along with interest. LIC filed appeal before State Commission. State Commission partly allowed the appeal and set aside the direction for payment of interest on the amount awarded. Present revision petition filed against the same. Keeping in view the fact that there is no justification for non-payment of claim under the policy. It has not been shown anywhere that deceased was suffering from any disease. There is no question of concealment of any material information about status of health of deceased. Revision petition dismissed. “
9. In the case in hand, it is not proved anywhere that policyholder was suffering from any disease and he had not disclosed any material fact regarding his health condition. Therefore, repudiation of death claim of the complainant by OPs is unjustified and baseless. The above view of ours stands fortified by Hon’ble National Commission New Delhi in PNB Metlife India Insurance Company Limited and another versus Sunita Goyal and others reported in Revision Petition no.1729 of 2016 decided on 26.08.2016. This citation proves that the onus was upon the insurer to prove the misrepresentation alleged to have been made by the insured, meaning thereby that it was for the insurer to prove that he was suffering from pre-existing disease at the time when proposal was suffering. Further Hon’ble National Consumer Disputes Redressal Commission New Delhi in case titled as Life Insurance Corporation of India versus Charanjit Kaur reported in 2011(4) CPR 459 , wherein it has been held that “ claim repudiated on the ground of concealment of fact of pre-existing disease. Forum allowed complaint. Appeal against - Dismissed – Revision Petition against – Contention, deceased suppressed material facts that he was suffering from diabetic mellitus and was chronic alcoholic. Not tenable. Failure on part of Insurance Company to prove allegations of fraudulent concealment pertaining to health of deceased. Revision petition dismissed with costs.
10. Form perusal of above facts and circumstances of the case and plethora of judgments, we are of the considered opinion, we allow the complaint of the complainant and OPs are directed to pay Rs.5,93,021/- with interest @ 6% per annum from the date of lodging the claim till its realization. Rs.1,06,979.97 has already been paid by OPs to complainant out of claim amount of Rs.7,00,000/-. The complainant is also entitled Rs.7000/- as compensation for mental harassment as well as cost of litigation. The opposite parties are also directed to deposit Rs. 3000/- as costs in the Consumer Legal Aid Account maintained by this Commission.
11. The compliance of the order be made within 45 days from receipt of copy of this order. The complaint could not be decided within stipulated period due to rush of work and spread of Covid-19.
12. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Announced in open Commission
20th of April 2021
Kuljit Singh
(President)
Jyotsna
(Member)
