BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 292 of 2017
Date of Institution : 06.11.2017
Date of Decision : 27.02.2018
Liladhar Soni son of Shri Milkhi Ram, resident of Ward No.12, Harizan Mohalla, Rania, Tehsil Rania, District Sirsa.
……Complainant.
Versus.
- HDFC Standard Life Insurance Company Limited, Lodha Excelus, 13th Floor, Appollo Mills Compound, N.M. Joshi Marg, Mahaluxmi, Mumbai,400011.
- Branch Manager, HDFC Standard Life Insurance Company Limited, Sangwan Chowk, near Axis Bank, Sirsa.
- Branch Manager, HDFC Bank, Sirsa Road, near Punjab National Bank Rania, Tehsil Rania, District Sirsa.
..…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SHRI R.L. AHUJA…………….. PRESIDENT
SHRI MOHINDER PAUL RATHEE……MEMBER.
Present: Sh.Ajay Bansal, Advocate for the complainant.
Sh. M.K. Singla, Advocate for the opposite parties no.1&2.
Opposite party no.3 exparte.
ORDER
In brief, the case of complainant is that complainant’s brother namely Shri Sohan Lal during his life time purchased a insurance policy of the opposite parties under HDFC Life Sampoorn Samiridhi Plus Plan through op no.3 from the Branch Office of op no.1 i.e. HDFC Standard Insurance Company Limited Sirsa Branch. The policy bears number 19249899. Under this policy total sum assured on maturity is Rs.6,09,152/- with first premium installment of Rs.98000/- including taxes applicable. The policy has its different slabs in case of death of the assured. In case of death of the life assured before maturity date within one year Rs.7,00,738/- is shown to have been payable. Accordingly the first installment of Rs.98000/- was paid by the brother of the complainant as premium which was accounted by the ops towards first premium payable w.e.f 19.04.2017. It is further averred that complainant was appointed as Nominee by said Shri Sohan Lal. On 08.05.2017, the brother of the complainant died all of sudden. He died his natural death and not due to any ailment or otherwise. After his death, the complainant applied for insured amount. The complainant approached the office of ops Nos. 2 and 3 on different occasions but to his surprise, he was handed over a letter/order dated 28.9.2017 vide which the claim has been repudiated on the grounds of concealment of facts and a sum of Rs.94449/- has been deposited as final payment in the account no.50100191925056 of the complainant maintained with op no.3. The action of the ops in repudiating the insurance claim of the complainant on account of death of his brother is illegal, null and void and the order dated 28.9.2017 is liable to be set aside. The ops have acted in a most arbitrary manner. No opportunity of hearing has been afforded to the complainant before repudiating the claim on flimsy grounds by the ops nos. 1 and 2. Thus the principles of natural justice have been grossly violated. It is further averred that at the time of purchasing policy, no information was concealed from the ops. Whatever documents or information demanded by the ops were supplied to them. Thus, the ops are bound by the doctrine of promissory estoppel. Before the purchase of policy by the brother of complainant, it was the duty of the ops to make full verification of the facts. It is further averred that at the time of death, the brother of the complainant was hale and hearty. He was never treated upon for any ailment or excessive alcoholism. He died naturally and not due to any disease or ailment or any other unnatural reason. The repudiation of claim under the policy is an arbitrary action of the ops and amounts to a sheer abuse of process and great deficiency in service, for which the complainant has been suffering mental pain and agony. Hence, this complaint.
2. On notice, opposite parties no.1 and 2 appeared and filed written statement taking certain preliminary objections. It is submitted that the true facts of the present case are that upon being approached by one Sohan Lal and after in receipt of duly proposal form and as per the information supplied by the life assured true in its entirety, the ops had issued the policy bearing No.19249889 having a sum assured amount of Rs. 609152/- against the proposal received on dated 19.4.2017. At the time of submitting the proposal form, the life assured represented himself to be a owner of Jeweller shop having an annual income of Rs.3 lacs and further represented himself to be single and further declared that he was not enrolled with any other life insurance company and the op company considering all the declarations as made by the life assured true, issued the policy in question. It is further submitted that within a very short span of 20 days, the op company were in receipt of death claim intimation from the complainant, where by the complainant represented to the ops qua passing away of life assured on dated 8.5.2017. The answering ops after in receipt of a death claim had proceeded the case for conducting necessary investigation being an early claim i.e. within 20 days from the date of commencement of policy and during the course of investigation, it has been revealed to the ops’ company that the policy in question has been obtained by the life assured in collusion with the present complaint fraudulently and the life assured misrepresented himself to be a jeweler with an annual income of Rs.3 Lacs despite the fact that as per the declaration made by the complainant, the life assured was working at his shop on salaried basis having annual income of Rs.1.5 lacs and apart from the same during the course of investigation, it has also been revealed that the life assured was a chronic alcoholic, which fact the life assured has intentionally concealed and the life assured at the time of entering into the proposal form, was enrolled with other life insurance company availing maximum sum assured and apart from the same, the life assured intentionally declared himself as single despite the fact that on the date of applying for a policy he was having a Marital Status. During the course of investigation, it has also been revealed that the life assured at the time of applying for a policy was on death bed and prior to applying for a policy he already met with an accident and owing to the same, his bones crashed and the complainant very well knew this fact that the life assured will not sustain for a long time and the complainant with a view to encash the situation, has got procured the policy in question. Therefore, the ops company looking into the material concealment of the facts so committed by the life assured in collusion with the complainant and on the basis of evidence collected during the course of investigation, had repudiated the claim so put forth by the complainant vide repudiation order dated 28.9.2017. However as per the terms and conditions of the policy contract in the present scenario the liability of the op company is restricted to refund of premium amount and the op company in discharge of its legal liability under the policy contract, has disbursed an amount of Rs.94,449/- towards full and final settlement and the complainant after in receipt of the above said amount has not raised any sort of protest which shows the implied consent of the complainant. It is further submitted that the insurance is a contract between the parties and is governed by Insurance Act, 1938 and both the parties to the contract were bound to provide true information to the other party and it is the op company who considering the information contained in the proposal form true had issued the policy in question. Had the life assured apprised the ops about his true and correct financials at the time of entering into the proposal form, then the ops will not have issued a policy in favour of the life assured with such a heavy sum assured. It is further submitted that it is well settled that the contract of life insurance is a concluded contract between the parties to the contract and no addition or subtraction is admissible to any of the terms and conditions of the life insurance contract. As per the life insurance contract, the proposer have to make the truth full disclosure while purchasing the policy and the insurance company do not have any access qua the information supplied by their customer and they have to rely upon the information supplied by their consumer. On merits, it is submitted that the policy in question has been procured by the life assured by misrepresenting the material facts and as such the contract entered into by the life assured with that of the ops is void in nature and the same cannot be enforced through any legal mechanism. It is further submitted that the sum assured amount under the policy is Rs.609152/- and not Rs. 700738/-. It is submitted that the death of the life assured is not sudden rather the same is accountable to the accident which the life assured met few days back prior to taking of a policy and since fraudulent intention of the life assured behind purchase of a policy has been Lime Light during the course of investigation, so the op company rightly repudiated the claim and has refunded the premium amount to the complainant towards full and final settlement towards all claims under the policy. The complainant is not entitled to any compensation as claimed by him and prayer for dismissal of complaint has been made.
3. Opposite party no.3 did not appear despite notice and was proceeded against exparte.
4. The parties then led their respective evidence in the form of affidavits and documents. The complainant has tendered his affidavit Ex.CW1/A, copy of letter dated 20.4.2017 Ex.C1, copy of first premium receipt Ex.C2, copy of death certificate Ex.C3, copy of repudiation letter dated 28.9.2017 Ex.C4, copy of aadhar card Ex.C5, copy of statement of account Ex.C6 and copy of aadhar card of Sohan Lal Ex.C7. On the other hand, ops produced affidavit of Sh. Rohit Manager Operation Ex.R1, copy of proposal form Ex.R2, copy of repudiation letter Ex.R3, copy of aadhar card of Seema Rani Ex.R4, copy of email Ex.R5, copy of affidavit of Liladhar Ex.R6, copy of death claim Ex.R7 alongwith Ex.R8, copy of death certificate Ex.R9, copy of verification of aadhar Ex.R10, copy of application moved by Seema Rani Ex.R11, copy of pass book of Seema Rani Ex.R12 and copy of investigation report Ex.R13.
5. We have heard learned counsel for the parties and have perused the case file carefully.
6. Learned counsel for complainant has contended that complainant has proved on record that brother of complainant namely Sohan Lal had purchased an insurance policy bearing No.19249899 from opposite parties and total sum assured on maturity was Rs.6,09,152/- with first premium installment of Rs.98,000/-. The policy has its different slabs in case of death of the assured. In case of death of the life assured before maturity date within one year, Rs.7,00,738/- was shown to have been payable. Accordingly, first installment of Rs.98,000/- was paid by brother of complainant as premium which was accounted by the ops towards first premium payable w.e.f. 19.4.2017. The complainant was appointed as nominee by his brother Sohan Lal. It has also been contended that on 8.5.2017, brother of complainant died all of sudden. Claim was lodged by the complainant with all the required documents but however same has been repudiated by ops vide letter dated 28.9.2017 on the grounds of concealment of facts and a sum of Rs.94,449/- has been deposited as final payment in the account of the complainant maintained with op no.3. The ops have arbitrarily and illegally repudiated the claim of complainant though they were under legal obligation to pay the same. The complainant or his brother had not concealed anything from ops while getting the policy. Learned counsel for complainant has also relied upon judgments reported as 2000(1) CPC 358 titled as LIC vs. Suresh Kumar (minor) (HSCDRC, Chandigarh) and 2008(3) CPJ 279 titled as LIC Vs. Satinder Kaur (SCDRC Punjab).
7. On the other hand, learned counsel for opposite parties has strongly contended that claim of complainant has been rightly repudiated on the ground of concealment of material facts regarding occupation and annual income of life assured, marital status of deceased, his habit of taking alcohol and purchase of another policy by the deceased life assured.
8. We have considered the rival contentions of the learned counsel for the parties and have also gone through the record as well as judgments relied upon by learned counsel for complainant.
9. It is undisputed fact between the parties that brother of complainant namely Sohan Lal had taken a policy bearing number 19249899 from opposite parties and before purchasing this policy, he had submitted a proposal form. After going through all the blanks of the proposal form and filling the same to the best of his knowledge, the life assured put his signatures on the proposal form. The opposite parties after considering the contents of the proposal form to be correct had issued this policy on 19.4.2017. It is also admitted fact that said Sohan Lal died on 8.5.2017. Claim was lodged by the complainant who is brother of deceased LA being nominee and submitted all the relevant documents to the ops but however, ops have repudiated the claim of complainant vide letter dated 28.9.2017, copy of which is Ex.C4.
10. The perusal of the evidence of complainant reveals that complainant in order to prove his case has furnished his affidavit Ex.CW1/A in which he has reiterated all the averments made in the complaint and has also deposed that he is legally entitled to get insurance amount of Rsa,7,00,738/- after deducting a sum of Rs.94,449/- already paid alongwith interest at the rate of 18% per annum from due date till payment. The complainant has also produced on record documents Ex.C1 to Ex.C7 as detailed above.
11. On the other hand, the perusal of the evidence of opposite parties reveals that ops have furnished affidavit of Sh. Rohit Manager as Ex.R1 in which he has also reiterated the averments made in the written statement. He has specifically deposed that insurance is a contract between the parties and is governed by Insurance Act, 1938 and both the parties to the contract were bound to provide true information to the other party and it is the op company who considering the information contained in the proposal form true had issued the policy in question. He has further deposed that life assured by misrepresenting the material facts procured the policy in question and as such the contract entered into by the life assured with that of ops is void in nature and same cannot be enforced through any legal mechanism. The death of life assured is not sudden rather the same is accountable to the accident which the life assured met few days back prior to taking of the policy and since fraudulent intention of the life assured behind purchase of a policy has been lime light during the course of investigation, so the ops have rightly repudiated the claim and have refunded the premium amount to the complainant towards full and final settlement towards all claims under the policy. The ops have also tendered documents Ex.R2 to Ex.R13 as detailed above.
12. From the evidence of the parties, it is apparently clear that ops have revoked the contract of insurance due to false information submitted in the proposal form by the deceased life assured, as a result of which the ops have paid an amount of Rs.94,449/- towards full and final settlement and transferred same in the account of complainant maintained with op no.3 and this fact has not been denied by learned counsel for complainant during the course of arguments. As per proposal form submitted by the life assured, his annual income was of Rs.3,00,000/- per month and he was running his own business whereas the perusal of affidavit of complainant Ex.R6 reveals that complainant has specifically deposed that late Sohan Lal was his elder brother who was working on his shoip and income of his brother was about Rs.1,50,000/- per annum. His brother Sohan Lal had expired on 8.5.2017. So the complainant himself has falsified the income shown in the proposal form by deceased life assured by executing this Ex.R6.
13. Secondly, the deceased LA had shown himself as single in the proposal form whereas ops have furnished writing/ application Ex.R11 on file which is of Seema wife of Sohan Lal. She has stated in this writing which was addressed to HDFC Bank, HDFC Life, Rania that she is wife of Sohan Lal and Liladhar is her brother-in-law (Devar). Some time ago, her husband was hit by a bull, as a result of which his bones were fractured and in connivance with the officials of the HDFC, her brother in law got the policy issued in the name of her husband fraudulently and it has been wrongly mentioned that Sohan Lal was a bachelor. He met with an accident due to the reason that he was under influence of alcohol. The ops have also placed on record copy of the bank account statement of Seema Rani as Ex.R12 and also placed on record copy of aadhar card of Seema Rani as Ex.R4 which also shows the home address of the deceased LA.
14. Thirdly, the deceased LA had shown in the proposal form that he is not having policy of another companies but from the evidence of ops, it is proved fact that he had purchased number of policies prior to his death within short period. Further more, he has declared that he was not suffering from any disease and he was not having alcohol but from the evidence of ops, it is proved fact that he was taking alcohol and as per letter of his wife Seema, he suffered injuries on his person under the influence of liquor when he was hit by a bull.
15. So, it is apparently clear from the evidence of ops that deceased life assured Sohan Lal had furnished wrong information deliberately in order to get the benefit of the policy with fraudulent intention by concealing material facts which he was under legal obligation to disclose to the ops. So, it appears from the evidence of ops that deceased life assured had concealed material facts from the ops. Moreover, we find force from the judgment of the Hon’ble State Consumer Disputes Redressal Commission, Punjab in case titled as LIC Vs. Lakhbir Kaur etc. FA No.1696 of 2009 decided on 14.1.2014. The judgments relied upon by learned counsel for complainant are of no help to the case of complainant.
16. In view of the above, the present complaint is devoid of any merit and same is hereby dismissed but 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 after due compliance.
Announced in open Forum. President,
Dated:27.2.2018. Member District Consumer Disputes
Redressal Forum, Sirsa.
