Punjab

Sangrur

CC/216/2018

Karamjit Kaur - Complainant(s)

Versus

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

Sh.S.S.Dhindsa

15 Apr 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

 

 

                                                               

                                                Complaint No.  216

                                                Instituted on:    01.05.2018

                                                Decided on:       15.04.2019

 

 

Karamjit Kaur wife of Mika Khan @ Amrik Khan son of Gian Chand, resident of Village Khadial, Tehsil Sunam, District Sangrur.

                                                        …Complainant

                                Versus

 

1.     HDFC Standard Life Insurance Company Limited, Lodha Excelus 13^th Floor, Apollo Mills Compound, NM Joshi Marg, Mahalaxmi, Mumbai 400 011 through its Managing Director.

2.     HDFC Standard Life Insurance Company Limited, HDFC SL Patiala, Leela Bhawan, 1^st and 2^nd Floor, SCO 114-115, New Leela Bhawan Market, Above Domino Pizza, Patiala through its Branch Manager.

3.     HDFC Bank Branch Khadial Tehsil Sunam, District Sangrur through its Branch Manager.

                                                        ..Opposite parties

 

 

 

For the complainant          :       Shri S.S.Dhindsa, Adv.

For Opp.parties1&2          :       Shri Amit Goyal, Adv.

For OP No.3                     :       Shri S.S.Punia, Adv.

 

 

 

Quorum:   Vinod Kumar Gulati, Presiding Member

                Manisha, Member

       

 

 

Order by : Vinod Kumar Gulati, Member.

 

1.             Smt. Karamjit Kaur, complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the husband of the complainant Shri Mika Khan obtained one insurance policy, namely, HDFC Pro Growth Plus vide policy number 19551892 from the OPs through OP number 3 at Village Khadial on 19.8.2017 by paying the requisite premium of Rs.49,000/- against which the husband of the complainant was insured for Rs.3,43,000/- for the period from 19.8.2017 to 24.8.2017.  It is further stated that the premium was paid on 19.8.2017 vide DD through OP number 3 and the complainant was the nominee under the policy.  Further case of the complainant is that during the subsistence of the insurance policy, Shri Mika Khan died on 24.8.2017 and after his death all the documents were submitted to the OPs number 1 and 2 for payment of the insurance claim, but the grievance of the complainant is that the Ops paid only an amount of Rs.48945.22 against the insurance amount, when the complainant approached the OPs for remaining payment, no satisfactory reply was given by the Ops. Thus, alleging deficiency in service on the part of the OPs, the complainant has prayed that the OPs be directed to pay to the complainant the insurance claim of Rs.3,43,000/-  along with other benefits with interest @ 18% per annum from the date of death of Mika Khan till realisation and further claimed compensation and litigation expenses.

 

2.             In reply of the complaint filed by the OPs number 1 and 2, preliminary objections have been taken up on the grounds that the complaint is not maintainable, that the complainant has no cause of action to file the present complaint, that the complainant has created a false story and that the complainant has not come to the Forum with clean hands. It is stated further that an investigation was got conducted and it was found that the deceased had concealed material information about his state of health at the time of taking the said policy, which was material in nature and was in the knowledge of the deceased and he knowingly concealed the same.  The deceased was a chronic alcoholic and was not keeping good health since 2014 and was remained admitted in Vishwashish Hospital on 21.11.2014 and also collected medical evidence containing clear evidence of admission and got operated on 19.5.2016 for ‘repair of large epigastric hernia” from Sharma Hospital and Endosurgery Centre, Bathinda.  All this evidence is pre proposal for the policy in question i.e. the life assured was suffering from health issues the same was in his knowledge at the time of applying for policy on 19.8.2017 and the deceased died on 24.8.2017. It is stated further that the deceased obtained the policy by concealing the material facts about the status of his health. It is stated further that after repudiation of the claim, a fund value of Rs.48,945.22 has been refunded to the complainant and the same is admitted by the complainant in her complaint.    But, the other allegations levelled in the complaint have been denied in toto.

 

3.             In reply filed by OP number 3, legal objections are taken up on the grounds that the complaint is not maintainable, that the complainant has unnecessarily dragged the OPs into uncalled litigation and that the complainant has got no locus standi and cause of action to file the present complaint.  On merits, it is stated that Mika Khan was having a saving account with the OP number 3 and he got insurance policy namely HDFC Pro Growth Plus vide policy number 19551892. It is admitted that demand draft of Rs.49,000/- was made on the name of HDFC Standard Life Insurance from the account of Mikka Khan on his instructions. It is stated that it is matter of record that Mikka Khan died on 24.8.2017.

 

4.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-13 copies of documents and closed evidence. On the other hand, the learned counsel for the OPs number 1 and 2 has produced Ex.OP1&2/1 to Ex.OP1&2/10 and closed evidence. The learned counsel for OP number 3 has produced Ex.OP/3 affidavit and closed evidence.

 

5.             We have carefully perused the complaint, version of the opposite parties and evidence produced on the file and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits dismissal, for these reasons.

 

6.             It is admitted fact between the parties that the policy number 19551892 was issued to Mika Khan which was applied by him by filling the proposal form. The date of commencement of the policy was 19.8.2017 and the term was of 10 years and the sum insured was Rs.3,43,000/-. The first/initial premium of Rs.49,000/- was paid by the deceased. Mika Khan was expired on 24.8.2017 and the claim of the deceased was repudiated by the insurance company on account that the life assured was suffering from low HB with episodes of hypoglycaemic shock with chronic alcoholism and hernia, which was not disclosed in the application dated 19.8.2017.

 

7.             We have carefully gone through the documents submitted by the complainant as well as the OPs and as per information provided in the death claim from Annexure R-2 (Personal details of the life to be assured), reply to the question number 14,23,24,25 and 30 have been given in the negative (No). On this, the complainant has not rebutted the claim of the OPs.  Further the OPs have placed on record the discharge certificate of Vishwas Hospital, Sunam, Punjab with date of admission as 21.11.2014 and date of discharge as 22.11.2014 and the treatment     taken by the deceased worth diagnosis as hypoglycaemic shock with anaemia.  Also the OPs have placed on record the discharge summary dated 21.5.2016 of Sharma Hospital and Endosurgery Center Bathinda showing that the deceased was admitted in the above hospital on 19.5.2016, operated on 19.5.2016 and discharged on 21.5.2016 with the operative procedures of open INLAY Mesh Repair of Epig. Hernia. From the above, it is clear that the deceased concealed the material information about his state of health at the time of taking the said policy, which was material in nature and was in the knowledge of the deceased and knowing concealed the same. But again the complainant has not rebutted the contention of the OPs.  It is pertinent to mention here that the complainant in her affidavit dated 19.1.2018 has stated that Mika Khan/Amrik Khan is the same person.

 

8.             From the sequel of the above discussion, the repudiation of the claim made by the OPs is legal and as per the terms and conditions of the policy As such, the complaint is dismissed. A copy of this order be issued to the parties free of cost. File be consigned to records.

                        Pronounced.

                        April 15, 2019.

                                       

               

 

                                                        (Vinod Kumar Gulati)

                                                                     Member

 

 

 

                                                                (Manisha)

                                                                  Member