BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 319 of 2016
Date of Institution : 22.12.2016
Date of Decision : 21.11.2017.
Anguri wife of late Sh. Jagdish, resident of village Doulatpur, Tehsil Uklana and District Hisar.
……Complainant.
Versus.
1. HDFC Standard Life Insurance Company Ltd., 11th Floor Lodha Excelus, Apollo Mills Compound NM Joshi Marg, Mahalaxmi, Mumbai 400011, through its Director/ authorized person.
2. HDFC SL Sirsa, 1st floor, Classic Auto Care Shop, Dabwali Road, Sangwan Chowk, opposite Sharma Petrol Pump Sirsa, Tehsil and Distt. Sirsa 125055, through its Branch Manager.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. R.L.AHUJA…………………………PRESIDENT
SMT. RAJNI GOYAT ………………… MEMBER
SH. MOHINDER PAUL RATHEE …… MEMBER.
Present: Sh. Prem Singh Sokhal, Advocate for the complainant.
Sh. Sandeep Kamboj, Advocate for opposite parties.
ORDER
The case of the complainant in brief is that the official of the opposite parties approached the husband of the complainant namely Jagdish and told him about the benefits of the life insurance and at that time the husband of complainant was admitted in the hospital and was under treatment. The husband of complainant also disclosed about his disease to the official of the ops and keeping in view of the health condition of the husband of the complainant, the official of the ops insured the life of husband of complainant vide policy no.17029804 for sum assured of Rs.3,45,355/- by taking premium from him. It is further averred that official of the ops came to the life assured in the hospital and obtained the signature of the life assured on the printed papers (forms) and nothing was written or filled in, in the presence of life assured at the time of signing of the proposal form. That unfortunately the life assured died on 14.8.2014 in the hospital during his hospitalization and during the policy period. It is further averred that during the life time of the life assured, he was entitled for the benefits of the policy and after his death, the nominee is entitled for the benefits of the policy. The complainant is the nominee of the life assured as per policy. Hence the complainant lodged claim for death benefits of the policy i.e. sum assured of the policy. It is further averred that complainant submitted all the documents alongwith original policy with the ops while claiming the sum assured of the policy. But the op no.1 repudiated the claim of complainant vide letter dated 2.2.2016 on the ground that the relevant questions had been answered as incorrectly by the life assured in his personal details and that investigation by ops has established that the life assured was hospitalized with history hepatizes with right side paralyses with brain stock and was diagnosed with Brain Tumor which is prior to the policy issuance which was not disclosed in the application dated 13.8.2014. Had this information been provided to the company at the time of applying the insurance policy, they would have declined the application. This version of ops is wrong and false as the life assured was already hospitalized and life of Jagdish life assured was insured by the official of the company keeping in view his health condition. It is further averred that life assured did not answer in negative of the question no.32 and question 37 of the personal detail of life assured. The official of the insurance company obtained the signature on the blank papers and the life assured never suffered from the disease as mentioned in the question no.32. The life assured died his natural death during hospitalization. Thus, the opposite party no.1 has wrongly repudiated the claim of the complainant. It is further averred that ops have committed deficiency in services by denying the genuine claim of the complainant and complainant has been harassed and humiliated by the ops. Hence, this complaint.
2. On notice, opposite parties appeared and filed reply taking certain preliminary objections that complaint is not maintainable in the present form and that complainant has suppressed the material facts from this Forum as the deceased life assured purchased the life insurance policy from the answering ops on 20.8.2014 and at the time of purchase of policy and filling up the proposal form, the deceased life assured intentionally and deliberately concealed the factum of his ailment because even according to the papers detected by the ops regarding the health condition of the deceased, he was suffering from viral hepatitis with CVA with PVO with left side hemi paresis and was treated in Maharaja Aggarsain Medical College, Agroha prior to issuance of policy and died due to the above said aliment on 14.8.2014 but this fact has been concealed by the deceased knowingly. It is further submitted that the question regarding medically fitness of deceased life assured was answered as OK, while the fact remains that at that time he was not physically able and fit person because of abovesaid disease, hence the complainant is not entitled to claim any sum against the said policy. It is further submitted that the Hon’ble Supreme Court of India in its several judgments have clearly laid down that the relationship between the insured and the insurer is of utmost good faith and is based on the Latin Maxim “Uberrima Fides” and it is the duty of the insured to show all Uberrima Fides i.e. to disclose every material fact before the contract is made. The policy under question bearing number 17029804 was issued by the ops company on the basis of the information provided by the life assured in the proposal form. Since the information provided by the life assured in the proposal form was established to be incorrect by the ops’ company, hence the company was well within its rights to repudiate the said claim of the complainant. Since the answering ops have acted within the four corners of the statutory provisions, no case of deficiency in services can be said to have arisen. It is further submitted that death of life assured had occurred due to the previous ailment/ disease suffered by him. On merits, the pleas taken in the preliminary objections have been reiterated, contents of the complaint have been denied and prayer for dismissal of the complaint has been made.
3. The complainant produced her affidavit Ex.C1, copy of repudiation letter dated 2.2.2016 Ex.C2, copy of letter dated 21.8.2014 Ex.C3. On the other hand, ops produced affidavit of Sh. Amit Khanna, Deputy Manager Legal Ex.RW1/A, copy of policy details Ex.R1, copy of receipt of premium Ex.R2, copy of proposal form Ex.R3, copy of voter identity card Ex.R4, copy of adhar card Ex.R5, copy of affidavit of Mr. Mahesh Singh, Investigator Ex.R6, copy of investigation report Ex.R7, copy of treatment record Ex.R8, copy of repudiation letter Ex.R9 and copy of ration card Ex.R10.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. The perusal of the record reveals that complainant in order to prove her case has furnished her affidavit Ex.C1, copy of repudiation letter Ex.C2 and copy of letter dated 21.8.2014. On the other hand, opposite parties have tendered affidavit of Sh. Amit Khanna, Deputy Manager Legal Ex.RW1/A and copy of policy details Ex.R1, copy of receipt of premium Ex.R2, copy of proposal form Ex.R3, copy of voter identity card Ex.R4, copy of adhar card Ex.R5, copy of affidavit of Mr. Mahesh Singh, Investigator Ex.R6, copy of investigation report Ex.R7, copy of treatment record Ex.R8, copy of repudiation letter Ex.R9 and copy of ration card Ex.R10.
6. The perusal of the affidavit Ex.C1 of the complainant reveals that complainant has reiterated all the contents of her complaint. She has deposed that the official of the ops approached the husband of the complainant Jagdish and told him about the benefits of the life insurance and at that time her husband was admitted in the hospital and was under treatment and the husband of the complainant also disclosed about his disease to the official of the ops. The ops insured the life of husband of the complainant vide policy no.17029804 for Rs.3,45,355/- by taking premium. She has further deposed that unfortunately the life assured die don 14.8.2014 in the hospital during his hospitalization. After the death of her husband, she lodged claim with the ops but ops repudiated the claim of the complainant vide letter dated 2.2.2016 on the ground that the relevant questions had been answered as incorrectly by the life assured in his personal details. The investigation by the ops has established that the life assured was hospitalized with history of hepatitis with right side paralyses with brain stock and was diagnosed with Brain Tumor which is prior to the policy issuance, which was not disclosed in the application dated 13.8.2014. It has also been submitted in the repudiation letter that the life assured did not answer in negative of the questions no.32 and 37 of the personal detail of the life assured.
7. On the other hand, the ops have relied upon affidavit of Sh. Amit Khanna, Deputy Manager Legal Ex.RW1/A who has also deposed and reiterated the averments made in the written statement. He has specifically deposed that the deceased life assured had intentionally and deliberately concealed the factum of his ailment because even according to the papers detected by the ops regarding the health condition of the deceased, he was suffering from viral hepatitis with CVA with PVO with left side hemi paresis and was treated at Maharaj Aggarsain Medical College, Agroha prior to issuance of policy and died due to the abovesaid ailment on 14.8.2014, but this material fact had been concealed by the deceased knowingly. He has further deposed that question regarding medically fitness of deceased life assured was answered as OK, while the fact remains that at that time he was not physically able and fit person because of above said disease sustained by him. Moreover, the deceased knowingly stated his false income as Rs.2,50,000/- per annum while actually the life assured belongs to below poverty line. The opposite parties have also relied upon documents copy of policy details Ex.R1, copy of receipt of premium Ex.R2, copy of proposal form Ex.R3, copy of voter identity card Ex.R4, copy of adhar card Ex.R5, copy of affidavit of Mr. Mahesh Singh, Investigator Ex.R6, copy of investigation report Ex.R7, copy of treatment record Ex.R8, copy of repudiation letter Ex.R9 and copy of ration card Ex.R10.
8. The perusal of the investigation report Ex.R7 reveals that it was reported by the investigating agency that as per the statement of the complainant Anguri wife of the deceased LA, LA expired on 14.8.2014 at Medical College at Hisar while taking the treatment. She further told that LA was a healthy man. Though the evidence collected by the ops is quite different from the statement of the complainant. The complainant in her complaint has stated that at the time of filling the proposal form, her husband Jagdish was admitted in the hospital and he was getting treatment on 13.8.2014 and he died on 14.8.2014, whereas the record of the ops reveal that policy was issued on 21.8.2014 which is evident from the copy of the policy document Ex.C3. The column No.32 and 37 of the proposal form Ex.R2 reveal that it was declared by the deceased LA that he was not suffering from any disease whereas per the record he was admitted in the hospital on the day of filling of the proposal form. Though, the complainant has taken the plea that the official of the ops obtained the signatures of the deceased LA when he was already admitted in the hospital and issued the policy at their own but this plea of the complainant does not find any corroboration from any other quarter, nor any other cogent and convincing evidence has been led by the complainant in order to prove her plea taken in her complaint. The perusal of the medical record of Jagdish Ex.R8 reveals that the deceased LA was admitted in the hospital on 8.8.2014 and he was suffering from viral hepatitis with CVA with PVO with left side hemi paresis and died on 14.8.2014. So, it cannot be presumed that at the time of filling the proposal form, deceased LA was hale and hearty and was not suffering from any disease rather before issuance of the policy he died on 14.8.2014. So, it appears from the evidence of the opposite parties that ops have rightly repudiated the claim of the complainant.
9. In view of the above discussion, we do not find any merit in the present complaint and same stands dismissed, but keeping in view the facts and circumstances of the present case with no order as to costs. A copy of this order be supplied to the parties free of costs. File be consigned to the record room.
Announced in open Forum. President,
Dated:21.11.2017. Member Member District Consumer Disputes
Redressal Forum, Sirsa.
