Punjab

Rupnagar

CC/15/22

Chanchal Singh - Complainant(s)

Versus

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

Sh. Satish Kumar, Adv

18 Sep 2015

ORDER

ORDER

                                       MRS. NEENA SANDHU, PRESIDENT

                   Sh. Chanchal Singh 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 ‘the O.Ps.’) praying for issuance of the following directions to them:-

i)       To release the death claim/compensation of Rs.5,00,000/- along with interest @ 16% P.A. from the date of death of Jaswinder Kaur, policy holder, till realization,

ii)      To pay Rs.20,000/- as litigation costs,

iii)     To grant any other relief, which this Forum may deem fit, in the interest of justice.

 

 

2.                In brief, the case of the complainant is that Smt. Jaswinder Kaur, wife of the complainant, had obtained policy bearing No.15624788, known as “ HDFC Life Sampuran Sarmidhi Plan”  from the O.P. No.1, which commenced w.e.f. 04.12.2014. The said policy was for a period of ten years and the premium of Rs.29,101/- was to be paid yearly. The ID Number 59936236 was issued to said Jaswinder Kaur. He was appointed as nominee in the said policy. Said Jaswinder Kaur had been paying the premium of the said policy regularly, but unfortunately, she passed away, suddenly, on 02.10.2014.  Her death was a natural death, which had occurred due to heart failure. He being husband, legal heir and nominee under the said policy, applied for the death claim. Sh. Santosh Kumar Singh i.e. O.P. No.3, who alleged himself to be investigator appointed by O.Ps. No.1 & 2, visited his house and had taken all the necessary documents from him for processing the claim case.  Said Santosh Kumar Singh had also given his mobile No.95074-72623 and also bank account No.403502010014672 of one Ajit Kumar, Union Bank, Delhi for making payment in the said account for getting the claim cleared. Said Santosh Kumar Singh had claimed 10% in advance of the actual claim likely to be passed in his favour. However, he had paid him Rs.12,000/- because at that time, he was having only Rs.12,000/-. The O.P.  No. 3 had taken undue advantage & benefit of his innocence & compulsion. He was entitled to the death claim of Rs.5,00,000/-, which had accrued due to the natural death of the insured i.e. his wife, Jaswinder Kaur, under the above mentioned policy. On 25.01.2015, he had also made a written representation to the O.P. No. 1 requesting for making payment of the claim amount, but instead of making payment of the claim amount, on 05.02.2015,  the O.Ps. No. 1 & 2 have wrongly & illegally repudiated the claim on flimsy grounds. Hence, this complaint.

 

3.                On being put to notice, the O.P. No.1 filed written version in the shape of affidavit of Sh. Amit Khanna, Associate Manager (Legal & Compliance), HDFC Standard Life Insurance Company Limited, taking preliminary objections; that the complainant has filed a false, frivolous & vexatious complaint with the malafide intention of abusing the process of this  Forum, as such, the same deserves to be dismissed; that this Forum has no jurisdiction to try & decide the dispute involved in this case because the intricate questions of law & facts are involved in this case, which require documents and evidence, which is not possible in the summary procedure under the Act and the appropriate remedy, if any, lies in the Civil court, only; that the life assured had concealed the material facts regarding her illness, as such, she had played fraud with the answering insurance company and the complaint is liable to be dismissed on this ground also. On merits, the fact regarding issuance of the policy in question and payment of the requisite premium by the life assured is admitted, but it is stated that the same was issued on the basis of the statements made by the life assured, who had obtained the same by concealing the facts regarding her illness because she was already suffering from hyper tension and was having blood pressure problems for 4-5 years prior to the issuance of the said policy. At the time of filing the proposal form, she concealed the facts regarding her illness and medical treatment taken by her from the hospital. The policy was, thus, got issued fraudulently, by making misstatement of facts. It is further stated that after the death of the life assured, the complainant had lodged claim and matter was got inquired/investigated by the answering O.P. through Maddox Advisory and Consultancy Private Limited, who submitted its report, after investigating the case. As per the said report, during investigation , it was found that the life assured was having high B.P., and she was hypertension patient since long, i.e. years back and had been taking treatment for the same. She used to be unconscious, frequently, due to hypertension and on the fateful day, her condition became serious, due to which she died. The said investigating agency had also inquired from the ASHA worker and Sarpanch of the village regarding the cause of death, whon also confirmed that the life assured was suffering from BP problem and hypertension. The investigating team had also met the family members of the life assured to know the cause of death and it was further revealed that the life assured had taken treatment for BP and hypertension from Dr. Vishal Jagota and also from Swastik Hospital. The medical reports were also obtained by the said investigating agency. The investigating team had also inquired from the neighbour, chemist shop, Swastik Arogya Nursing Home, Nangal, Baweja Hospital, Rupnagar, Sangha Hospital, Rupnagar, Paras Nursing Home and Hospital, Rupnagar, Vishal Hospital, Rupnagar and Savitra Hospital Rupnagar. After due investigation, it was concluded by the investigating team that the life assured was a patient of hypertension since 4-5 years prior to her death and had taken treatment for the same from the hospitals, stated above. The claim lodged by the complainant after death of the life assured had been repudiated vide letter dated 05.02.2015, in the light of the report of investigating agency, referred to above, who had investigated the matter thoroughly & honestly. It is denied that any of the officials of the answering O.P.  had ever demanded any bribe from the complainant. Rest of the allegations made in the complaint have also been denied and a prayer has been made for dismissal thereof, with costs.

 

4.                The O.P. No. 2 filed separate written version taking preliminary objections; that the complaint is not maintainable in the present form & it does not lie and is liable to be dismissed; that the complainant has no cause of action to file the present complaint against the answering O.P.; that it is bad in the eyes of law on account of mis-joinder of parties; that the complainant has not approached this Forum with clean hands, as he has concealed the true state of facts and has suppressed the material facts from this Forum, as such, he is not entitled for any relief from this Forum; that the relief claimed by the complainant is in respect of the insurance policy purchased from the O.P. No. 1, as such, in case of any grievance relating to the said insurance policy, he is required to approach the O.P. No. 1 for redressal of the same  and it is the O.P. No.1, who is to accept or reject the claim under the insurance policy in question, as per its terms & conditions and that the issue relates to settlement of death claim by the O.P. No. 1 under the insurance policy, as such, there is no question of any deficiency in service or adoption of any unfair trade practice on the part of the answering O.P. No. 2. On merits, it is stated that the answering O.P. had not sold any insurance policy, however, the complainant and his wife had opted to invest in the insurance policy in question at their own, after fully understanding the features of the same. Neither any representation was made by the complainant to the answering O.P. nor the claim has been repudiated by it. It is reiterated that the death claim, if any, is to be decided by the O.P. No. 1 and the answering O.P. has no role to play in acceptance or rejection of the death claim in question. Rest of the allegations made in the complaint have also been denied and a prayer has been made for dismissal thereof, with costs.

 

5.                So far as the complaint filed against the O.P. No. 3 i.e. Sh. Santosh Kumar Singh, is concerned, it is pertinent to mention here that the complaint against the said O.P. No. 3 was dismissed as withdrawn vide order dated 08.05.2015.

 

6.                On being called upon to do so, the learned counsel for the complainant tendered affidavit of the complainant, Ex. C1, affidavit of Smt. Amarjeet Kaur Ex.C2, affidavit of Smt. Sheena Sharma Ex.C3, photocopies of documents Ex.C4 to C20 and closed the evidence. On the other hand, the learned counsel for the O.P. No. 1 tendered affidavit of Sh. Amit Khanna, Manager Legal Ex.OP-1/A, photocopies of documents Ex.OP-1/B to OP-1/N, whereas the learned counsel for the O.P. No. 2 tendered affidavit of Sh. Sumit Narang, Manager, Ex.OP-2/A and closed their respective evidence.

 

7.                We have heard the learned counsel for the complainant and the contesting O.Ps. and gone through the record of the file, carefully.

 

8.                The learned counsel for the complainant submitted that Smt. Jaswinder Kaur, wife the complainant, had purchased an insurance policy, namely, “HDFC Life Sampuran Smridhi Plan” on 4.12.2012, under which the complainant was appointed as nominee and she had paid the premium regularly. However, on 2.10.2014, she suddenly died, due to heart failure, as such, it was a natural death. Being nominee under the policy, the complainant lodged the claim with the insurance company alongwith the requisite documents, but the O.P. on 5.2.2015 repudiated his genuine claim, arbitrarily, on flimsy grounds, therefore, the relief as sought in the complaint be granted to him.

 

9.                The learned counsel for the O.P. No.1 submitted that the insurance company has rightly repudiated the claim as the life assured had concealed the material facts relating to her health, at the time of taking the insurance policy in question, because she was suffering from hypertension and was having the said problem since 4-5 years prior to the inception of the said policy, as has been found by the investigator appointed by the insurance company, who had submitted his report Ex. OP1/C. Even from the certificate dated 24.11.2014, issued by Dr. Vishal Jagota, it is proved that Smt. Jaswinder Kaur, life assured was suffering from hypertension, and was taking treatment regularly. Therefore, the complaint being without any merit be dismissed.

 

10.              The learned counsel for the O.P. No.2 submitted that since the relief claimed by the complainant is in respect of the insurance policy purchased from the O.P. No.1, therefore, it is the O.P. No.1, who is to accept or reject the claim under the insurance policy in question, as per its terms & conditions and there is no question of any deficiency in service or adoption of any unfair trade practice on the part of the O.P. No.2, as it has nothing to do in settlement of the claim lodged by the complainant. As such, the complaint filed against the O.P. No.2 be dismissed with costs.

 

11.              Admittedly, Smt. Jaswinder Kaur got herself insured vide “HDFC Life Sampuran Smridhi Plan” on 4.12.2012, under which the complainant was appointed as nominee. However, after her death, the claim lodged by the complainant has been repudiated by the O.P. No. 1 on the ground of non-disclosure of health as is evident from the email dated 5.12.2015, Ex. C5. Thus, the question for determination is as to whether the life assured had concealed any material fact relating to her health at the time of inception of the policy in question?

 

                   On perusal of the policy documents, Ex. OP1/M, it is evident that the proposal form, contained specific questions, and in reply to the questions as to whether she was suffering or suffered from High Blood Pressure & heart disease, the life assured had ticked ‘No’ in the relevant columns, whereas during the investigation, as is evident from the investigation report dated 30.11.2014 (Ex.OP-1/C), it was found that the LA was patient of hypertension around 4-5 years prior to her death. The said fact stands corroborated from the certificates, Ex. OP1/J & Ex. OP1/K issued by Dr. Vishal Jagota of Swastik Arogya Nursing Home. In the certificate dated 24.11.2014 (Ex. OP1/J), the said doctor has certified that late Smt. Jaswinder Kaur wife of S. Chanchal Singh was a known case of hypertension and was on regular treatment and was on Amlokind 4 T since 4 years. The other Certificate (Ex. OP1/K) issued by the said doctor on 25.11.2014, is also to the same effect. The law has already been laid down by the Hon’ble Supreme Court in ‘Satwant Kaur Sandhu vs. New India Assurance Company Limited’ (2009) 8 SCC 316 that a certificate of Hospital Treatment is admissible and sufficient for proving the pre-existing disease. Even our own Hon’ble State Commission in ‘Life Insurance Corporation of India vs. Jeevan Lata’ FA No. 1127 of 2014 decided on 11.05.2015, by relying upon the case of ‘Satwant Kaur Sandhu vs. New India Assurance Company Limited’ (supra) and by making reference to the observations made by it in—‘Life Insurance Corporation of India and others vs. Darshna Devi and another’ FA No. 63 of 2010 decided on 20.12.2013, has held that such a certificate is admissible in evidence without any affidavit of the concerned signatory. From the above said certificates, it is apparent that the life assured was suffering from hypertension and was taking treatment for the said ailment, prior to the inception of the policy i.e. 4.12.2012, but she did not disclose the said fact in the proposal form at the time of taking the insurance policy in question. Therefore, as per Term No. 10 of the terms & conditions of the policy, which reads as under:-

“Your policy is based on application and declaration which you have made to us and other information provided by you/on your behalf. However, if any of the information provided is incomplete or incorrect, we reserve the right to vary the benefits, which may be payable and, further, if there has been non-disclosure of a material fact, then we may treat your policy as void from inception”.

 

the policy has become void from its inception. In this view of the matter  the insurer has rightly repudiated the claim and the complaint filed qua the O.P. No.1 is liable to be dismissed. Even the complaint filed against the O.P. No.2 is also liable to be dismissed because the complainant has also failed to prove any deficiency in service on its part.

 

12.              In view of the aforesaid discussion, we dismiss the complaint, the same being without any merit. The parties are left to bear costs of their own.

 

                   The certified copies of this order be supplied to the parties forthwith, free of costs, as permissible under the rules and the file be indexed & consigned to the Record Room.

ANNOUNCED                                                                       (NEENA SANDHU)

Dated 18.09.2015                                       PRESIDENT

 

 

                                                (SHAVINDER KAUR)

                                                                     MEMBER.