Chandigarh

DF-II

CC/422/2014

Seema Garg - Complainant(s)

Versus

HDFC Standard Life Insurance Company Limited - Opp.Party(s)

Abhineet Tanjea, Adv.

07 Oct 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II, U.T. CHANDIGARH

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Consumer Complaint  No	:	422 of 2014
Date  of  Institution	:	14.8.2014
Date   of   Decision	:	07.10.2016

 

 

 

 

 

Seema Garg w/o late Sh. Jai Bhagwan R/o House No.1218, Sector 10, Panchkula.

                …..Complainant

Versus

 

1. HDFC Standard Life Insurance Co. Ltd. through its Managing Director, 11^th floor, Lodha Excelus, Apollo Mills Compound, N. M. Joshi Marg, Mahalaxmi, Mumbai.
2. The Regional Manager, HDFC Standard Life Insurance Co. Ltd. Madhya Marg, SCO No.50-51, Sector 9D, Second floor, Chandigarh.
3. HDFC Ltd. through its Branch Manager, SCO 153-155, Sector 8-C, Near Sindhi Sweets, Chandigarh.

….. Opposite Parties

 

BEFORE:  SH.RAJAN DEWAN                 PRESIDENT

         MRS.PRITI MALHOTRA             MEMBER

 

 

For complainant(s)      :     Sh. Abhineet Taneja, Adv. For the                     complainant.

 

For OP No.1&2           :     Sh. Nitin Thatai, Adv.

 

For OP No.3             :     Ms. Rupali Verma, Adv. For OP No.3.

 

 

PER PRITI MALHOTRA, MEMBER

 

 

          As per the case, the husband of the complainant availed loan from the OP No.3 and paid the premium regularly without any default. The husband of the complainant got the loan insured from OP No.1 to secure the complainant and other family members from repayment of loan. A sum of Rs.8705/- was paid towards the premium of the said policy and the policy was issued on 30.10.2013 valid upto 30.10.2032. As per terms and conditions of the policy the OP No.1 was liable to repay the loan upto the sum of Rs.15.00 lac in case of death of the person insured. Unfortunately the husband of the complainant (insured) expired on 14.11.2013 due to heart attack.  On 30.12.2013,  the complainant applied for death claim with OP No.1 but it illegally repudiated the same vide its letter dated 31.1.2014 on the ground that it was established from the investigation that the insured was suffering from chronic liver failure, alcohol dependence and insulin dependent diabetes mellitus which was not disclosed while obtaining the policy.  It is stated that it was also the liability of the OP No.1 which accepted the premium and entered into the contract to get insured medically examined before issuing policy  and after accepting the premium and after entering into an agreement without verifying the facts the insurance company cannot wriggle out its liability on the ground that some facts were concealed. It is alleged that despite numerous requests to settle the death claim of the husband of the complainant the OP No.1 did not settle her claim. Alleging the said act of OPs as deficiency in service, this compliant has been filed.

 

2]       The Opposite Parties No.1&2 have filed reply and while admitting the factual matrix of the case stated that on 1.1.2014 the answering OPs received a statement of death claim pertaining of deceased life assured who unfortunately expired on 14.11.2013. The said form was filled up by HDFC Ltd. being the assignee/claimant in the said policy.  The complainant also gave an affidavit to the effect that the deceased Life Assured (DLA) expired on 14.11.2013 and he had no medical history. But on investigation with regard to the death claim of the assignee/claimant, it was transpired that the deceased life assured was a chronic alcoholic and was suffering from K/C/O (known case of) DM-II (diabetes mellitus-II) and CLD (Chronic Liver Disease) and Acute/severe alcoholic hepatitis much prior to the filing of the proposal form and issuance of insurance policy. The deceased life assured had taken treatment from PGIMER and General Hospital Sector 6, Panchkula. As such the deceased life assured had concealed the material information regarding his health in the proposal form submitted by him. Therefore, the answering OPs have rightly repudiated the claim of the complainant. Pleading no deficiency in service and denying rest of the allegations, it is prayed that the complaint be dismissed.

         OP No.3 in its short reply admitted that the complainant availed loan from it and stated that no claim has been made against OP No.3 in the complaint, therefore, the same be dismissed qua it.

 

3]       Parties led evidence in support of their contentions.

 

4]       We have heard the ld.Counsel for the parties, and have also perused the record.

 

5]       Admitted facts are that the husband of the complainant namely Sh.Jai Bhagwan availed the house loan facility to the tune of Rs.15.00 lacs from Opposite Party NO.3 and also got an insurance from OPs No.1 & 2 vide policy ‘HDFC Life Click 2 Protect Policy’ dated 30.10.2013 (Ann.C-1) thereby secured himself and his family members from repayment of the loan in case of his death.

 

6]      Unfortunately, the husband of the complainant (the policyholder) expired on 14.11.2013 and her wife i.e. complainant lodged a claim with the OPs, which was repudiated. Challenging the said repudiation, the present complaint has been filed.  The Opposite Parties vehemently opposed the complaint stating that they have rightly repudiated the claim as the policy obtained by the husband of the complainant, now deceased, was based on concealment of material facts as from the investigations it was established that the Life Assured was suffering from Chronic Liver Failure, Alcohol Dependence and Insulin Dependent Diabetes Mellitus, which was not disclosed while obtaining the policy. 

 

7]       In the present complaint, the complainant has failed to contradict the repudiation of the claim, done by the OPs on the basis of suppression of material facts by the life assured i.e. husband of the complainant at the time of obtaining the policy in question, by placing on record any convincing evidence. However, the OPs No.1 & 2 have placed on record cogent evidence showing that the life insured i.e. husband of the complainant (now deceased) before obtaining the loan as well as the policy in question, was a Chronic Alcoholic and was suffering from K/C/O (Known case of) DM-II (Diabetes Mellitus-II) and CLD (Chronic Liver Disease) and Acute/severe Alcoholic hepatitis much prior to the filling of the proposal form and issuance of the insurance policy.  The Opposite Parties No.1 & 2 have also placed on record the medical record of the life assured pertaining to the illness suffered by him & treatment taken before taking loan as well as the policy in question and also the copy of the proposal form wherein the complainant suppressed/not disclosed the factum of his previous ailment and treatment taken.  It is also proved that the complainant availed treatment and remained admitted in PGIMER, Chandigarh from 3.9.2013 to 7.9.2013 and also in General Hospital, Sector 6, Panchkula, prior to obtaining the policy in question as well as the loan (Ann.R-9 to R-11), from 1.10.2013 to 4.10.2013. 

 

8]       The cogent evidence placed on record by the OPs No.1 & 2 proves that the life assured i.e. husband of the complainant had suppressed the material facts about his health and treatment taken by him while taking the policy in question, thus not entitled for any benefit thereof. 

 

9]       The complainant has also claimed that there is no nexus between the previous treatment taken by the life assured and the cause of death of the life assured, which occurred on account of cardiac arrest/heart attack.  On this, the OPs have placed on record the latest judgment of Hon’ble Chandigarh State Consumer Disputes Redressal Commission, UT, Chandigarh i.e. FA No.404 of 2014 – Surinder Kaur Vs. ICICI Prudential Life Insurance Company Ltd. & Others, decided on 2.1.2014, wherein it has been held that “Nexus or no nexus of the disease hardly matter – The question was of suppression of material facts and not, as to whether, the disease, on account of whereof the life assured died, had any nexus with his death or not – Claim rightly repudiated.”  Further, the Hon’ble National Commission, New Delhi in R.P.No.1061 of 2011 – LIC of India & Ors. Vs. Ramamani Patra & Anr., decided on 3.8.2015, has held that “Repudiation of claim on ground of pre-existing non-disclosure of disease – Insured not disclosed the pre-existing disease in proposal form – Death of insured – Plea raised by complainant that there is no nexus between the accidental death and disease suppressed – Held, that the duty of the Consumer For a under obligation not to find out whether there is a nexus between the accidental death and disease suppressed by the insured – No connection with the grant of compensation – The nexus point has to be eschewed out of consideration otherwise the uberrimae fides shall stand violated.”  We find favour with the above cited case law and held the repudiation done by the OPs as justified. 

 

10]      However, the case law cited by the complainant i.e. LIC of India & Anr. Vs. Mercy Masih – I(2010) CPJ 167 – Chhattishgarh State Commission & Life Insurance Corporation of India Vs. Vijendra Singh Yadav- IV(2011) CPJ 130 – Rajasthan State Commission, cannot be relied upon in view of the latest law settled by the Hon’ble National Commission, New Delhi in LIC of India & Ors. Vs. Ramamani Patra & Anr. (Supra).  

          

11]      In view of the above discussion, we are of the opinion that no case of deficiency in service is made out against the OPs.  Hence, the complaint is dismissed with no order as to costs.

         The certified copy of this order be sent to the parties free of charge, after which the file be consigned.

Announced

07^th October, 2016                 

                                                                                       Sd/-

 (RAJAN DEWAN)

PRESIDENT

 

 

Sd/-

(PRITI MALHOTRA)

MEMBER