Complaint No: 189 of 2022.
Date of Institution: 13.09.2022.
Date of order: 26.02.2024.
Mr. Nitin Tuli Son of Late Radha Krishan, resident of near Post Office, Mohalla Pathana, Kalanaur, District Gurdaspur. Pin Code – 143512.
…........Complainant.
VERSUS
1. The Branch Manager, HDFC Standard Life Insurance Co. Ltd., S.L. Batala Branch, 1st Floor 23/500, Shashtri Nagar, Jalandhar Road, Batala, Tehsil Batala District Gurdaspur, Punjab. Pin Code – 143505.
2. HDFC Life Insurance Co. Ltd., 5th Floor, ILFS Building, Plot No. C-22 G Block Bandra, Kurla Complex, Bandra (E), Mumbai – 400051.
3. HDFC Bank Branch Kalanaur Tehsil and District Gurdaspur, through its Manager. Pin Code – 143512.
….Opposite parties.
Complaint U/S 35 of Consumer Protection Act, 2019.
Present: For the Complainant: Sh.Rohan Kumar Sharma, Advocate.
For the Opposite Parties No.1 & 2: Sh.Sandeep Ohri, Advocate.
Opposite Party No.3: Exparte.
Quorum: Sh.Lalit Mohan Dogra, President, Sh.Bhagwan Singh Matharu, Member.
ORDER
Lalit Mohan Dogra, President.
Nitin Tuli, Complainant (here-in-after referred to as complainant) has filed this complaint under section 35 of the Consumer Protection Act, 2019 (here-in-after referred to as 'Act') against HDFC Standard Life Ins. Co. Ltd. Etc. (here-in-after referred to as 'opposite parties).
2. Briefly stated, the case of the complainant is that the father of the complainant namely Radha Krishan was holding savings account with the opposite party No. 3 with A/c No. 22081930000415 and under the preferred banking relationship as part of relationship enhancement, the opposite party No. 3 advised the complainant to obtain a Life Insurance Policy and on the advice and proposal of the opposite party No. 3 i.e. bank, the father of the complainant opted Insurance Policy Plan of the opposite parties No. 1 and 2 under “HDFC Life Sanchay Par Advantage Plan” bearing Policy No. 22524251 as per proposal form dated 25.04.2020. It is further pleaded that the policy was issued on dated 28.04.2020 and Sh. Radha Krishan i.e. father of the complainant had paid a sum of Rs.1 Lac as policy premium. The term period of the policy is of 43 years. As per the policy, the insured Radha Krishan had to pay every year Rs.1 Lac for 10 years and the Policy term is of 43 years. The father of the complainant was also insured for a sum of Rs.10,15,000/- in case of death of the policy holder. The complainant is the nominee in the said policy. However, the policy was not delivered to the complainant or his father Late Sh. Radha Krishan due to negligent and ignorant services of the opposite parties. It is further pleaded that unfortunately, Sh. Radha Krishan died on dated 27.08.2020 and an intimation regarding the death of his father was duly given by the complainant to the opposite parties, but on dated 11.11.2020, the complainant received a death claim decision letter through the opposite party No. 1, in which the death claim of the life assured was repudiated on the ground that “Life assured was suffering from physical disability prior to the policy issuance”. However, the opposite parties No. 1 and 2 transferred the amount of Rs.1 Lac to the account of the complainant i.e. Nitin Tuli bearing A/c No. 50100359020420. It is further pleaded that as a matter of fact the plan was advised by the opposite party No. 3 and their executives and proposal form was filled on dated 25.04.2020 with prior advice and consultation with the opposite party No. 3 and on dated 25.04.2020, the executives of the HDFC Bank visited the house of the deceased Radha Krishan. The officials of the opposite party No. 3 namely Nidhi Bhatia and Ankush Malhotra remained present in the house of life assured for more than 2 hours. It is further pleaded that the mark of physical injury on the right arm elbow was quite appearable as it was the month of April 2020, the life assured worn half sleeves shirt and it was the executive members who filled the proposal form and the Executive members namely Nidhi Bhatia and Ankush Malhotra did not consider necessary to mention the said mark of physical injury on right arm elbow of life assured and they also said that it is just mark of physical injury and not a disability and same is not affecting the daily activities of the deceased as deceased was well physically active and used to ride motor bike and had also worked on his own petrol pump and performed his daily routine work and therefore, it is wrong to say that disability effects the daily activities. It is further pleaded that as far as the mark of physical injury on the right arm elbow of the life assured/deceased Radha Krishan is concerned, which was way back in 1989. Hence, the question of non-disclosing of the disability of the life assured decreased Radha Krishan does not arise as the executives and the opposite party No. 3 were full aware about the facts. As such, nothing has been kept concealed / hidden by the deceased as alleged by the opposite party No. 1 in their Death Claim Decision Letter. It is further pleaded that the life assured deceased Radha Krishan was an illiterate and was not able to read and write "English Language" at all. Even to validate this fact, his signatures may be verified on his PAN Card which is in local Punjabi Language and deceased Radha Krishan had a bank account with the opposite party No. 3, his signature can be validate by so. Since, the mark of the said physical injury was a dated and was quite apparently visible, how was it ignored by the employee while selling / filling the application form for life assured. Moreover, the opposite parties did not conduct any medical checkup of the deceased life assured, at the time of issuing the insurance policy. It is further pleaded that no material fact has ever been concealed by the deceased life assured at the time of getting policy. By repudiating the genuine claim of the complainant, the opposite parties intend to get wrongful gain and wrongful loss to the complainant. The opposite parties are making false excuses only to avoid their liability as it was the duty of the opposite parties to satisfy all the terms and conditions of the policy and now by repudiating the genuine claim of the life assured / complainant, the opposite parties are committing gross negligence. It is further pleaded that the repudiating the claim of deceased life assured is clearly against the legal right of the individual / complainant / claimant and the opposite parties are entirely responsible to pay the death claim of the life assured to the complainant jointly and severally. Therefore, the opposite parties were unable to fulfill the responsibility of supplying fair services to their customers and committed the unfair trade practices. It is further pleaded that the complainant served a Legal Notice dated 12.08.2022 to the opposite parties calling upon them to pay the legal and genuine claim of the deceased life assured, but the opposite parties did not reply the legal notice. It is further pleaded that due to this illegal act and conduct of the opposite parties the complainant has suffered great loss and also suffered mental agony, Physical harassment and inconvenience. It is further pleaded that there is a clear cut deficiency in service on the part of the opposite parties.
On this backdrop of facts, the complainant has alleged deficiency and negligence in service and unfair trade practice on the part of the opposite parties and prayed that necessary directions may kindly be issued to the opposite parties to pay the death claim amounting to Rs.9,15,000/- of the deceased life assured to the complainant (Nominee) alongwith interest @ 12% per annum from the date of its due till actual realization. The opposite parties may also be burdened with compensatory costs to tune of Rs.50,000/- on account of causing mental and physical harassment and deficiency in services to the complainant, in the interest of justice.
3. Upon notice, the opposite parties No.1 and 2 appeared through counsel and contested the complaint and filing their written reply by taking the preliminary objections that the complainant has no cause of action to file the present complaint against the answering opposite parties No. 1 & 2 and the complainant has no locus standi to file the present complaint against the answering opposite parties No. 1 and 2. It is pleaded that the insurance is a contract based upon utmost good faith and the insured breached the said good faith and concealed the material facts at the time of getting insurance policy and as such the present complaint is liable to be dismissed. It is further pleaded that the policy has been issued on the basis of electronic proposal form and the question No. 6 of the said proposal form is given below:-
“Do you have any physical disability which is affecting your day to day activities? The insured gave its answer as “NO”, but when the claim has been filed and the documents has been submitted it has been come out that the life assured was suffering from physical disability prior to the policy issuance and this was not disclosed in the application dated 25.04.2020. So, the claim has been rejected and there is no deficiency in services on the part of the answering OP’s insurance company and the claim has rightly been repudiated. Moreover, the answering OP’s insurance company has also paid an amount of Rs.1,00,000/- to the account of the complainant as refund of premium payable under the above said policy. It is further pleaded that there is no deficiency on the part of the answering OP’s insurance company. The matter of fact is that the claim has been repudiated by the answering opposite parties No. 1 and 2 on the ground that the complainant kept concealed about his physical disability prior to the policy issuance. This was not disclosed in the application dated 25.04.2020. So, the present complaint is deserves to dismissed on this score alone.
On merits, the opposite parties No.1 and 2 have reiterated their stand as taken in legal objections and denied all the averments of the complaint and there is no deficiency in service on the part of the opposite parties. In the end, the opposite parties prayed for dismissal of complaint with costs.
4. Opposite party No.3 did not appear despite the service of notice and was proceeded against exparte vide order dated 24.11.2022.
5. Learned counsel for the complainant has placed on file affidavits of Nitin Tuli, (Complainant) as Ex.CW-1/A and Ms. Sunita Tuli w/o Late Radha Krishan Tuli as Ex.CW-2/A alongwith other documents as Ex.C-1 to Ex.C-6 alongwith complaint.
6. Learned counsel for the opposite parties No.1 and 2 has placed on file affidavit of Sh. Gurpreet Singh, (Authorized Signatory, HDFC Life Gen. Ins. Co. Ltd., Chandigarh) as Ex.OPW-1,2/A alongwith other documents as Ex.OP-1,2/1 to Ex.OP-1,2/10 alongwith reply.
7. Rejoinder filed by the complainant.
8. Written arguments filed by the complainant but not filed by the opposite parties no.1 and 2.
9. Counsel for the complainant has argued that father of the complainant had purchased life insurance policy from opposite parties No.1 and 2 on payment of premium of Rs.1 Lakh for 10 years and term of policy was 43 years. It is further argued that father of the complainant was insured for a sum of Rs.10,15,000/- in case of death of the policy holder. It is further argued that father of the complainant died on 27.08.2020 and on intimation to the opposite parties the claim lodged by the complainant was repudiated on 11.11.2020. It is further argued that the claim was repudiated on the ground of disability of father of the complainant. However, officials of opposite party No.3 namely Nidhi Bhatia and Ankush Malhotra were present in the house of the complainant when policy was sold to the father of the complainant and were aware about the said disability. It is further argued that father of the complainant has not died due to the disability and disability was in no way effecting the daily activities of his father. It is further argued that father of the complainant was not disclosed about any terms and conditions of the policy and was only made to sign proposal form by Nidhi Bhatia and Ankush Malhotra. It is further argued that repudiation of the claim is totally unjustified and it was the duty of the opposite parties to get the father of the complainant medical examined before selling the policy.
10. On the other hand counsel for the opposite parties No.1 and 2 has argued that father of the complainant had mentioned wrong answers regarding physical disability and as such on perusal of documents it came out that life assured was suffering from physical disability prior to the policy of insurance which was not disclosed in the application dated 25.04.2020. The said fact is fully proved from disability certificate Ex.OP-9 and as such claim was rightly repudiated by the opposite parties No.1 and 2.
11. Opposite party No.3 remained exparte.
12. To prove his case complainant has placed on record his self declaration Ex.CW-1/A, self declaration of Sunita Tuli Ex.CW-2 copy of death claim decision letter Ex.C1, copies of statement of account Ex.C2, copy of pan card Ex.C3, copy of legal notice Ex.C4, postal receipts Ex.C5 and one document Ex.C6 whereas opposite party No.1 and 2 have placed on record affidavit of Gurpreet Singh Ex.OPW-1,2/A, copy of proposal form Ex.OP-1,2/1, copy of death claim decision letter Ex.OP-1,2/2, copy of application/electoral form Ex.OP-1,2/3, copy of inside track services Ex.OP-1,2/4, copy of nominee statement Ex.OP-1,2/5, copy of certificate issued by Dr.Sukhdeep Singh Bhagowalia Ex.OP-1,2/6, copy of Covid 19 Questionnarie Ex.OP-1,2/7, copy of letter dated 23.04.2020 Ex.OP-1,2/8, copy of identity card for disable person Ex.OP-1,2/9 including copies of policy's terms and conditions Ex.OP-1,2/10 (Additional Evidence).
13. Perusal of policy Ex.OP-1,2/1 shows that in the personal detail column in column No.6 there is query i.e. Do you have any physical disability which is affecting your day to day activities. The answer mentioned is 'No' but it has not come on record as to who filled the details of said proposal form. Complainant has specifically alleged the role of Nidhi Bhatia and Ankush Malhotra in filling the details of proposal form but opposite parties No.1 and 2 have not placed on record affidavit of Nidhi Bhatia and Ankush Malhotra to prove this fact that the said details were explained to the life assured while filing the details. Perusal of identity card for disabled persons Ex.OP-1,2/9 shows that the father of the complainant was having disabiliy of right arm upto 60% but there is no record in the shape of opinion of any medical expert that a person with 60% disable of right arm cannot perform his day to day activities. Moreover, opposite parties No.1 and 2 have not taken this plea that the death of the life assured took place due to the said disability. Moreover, perusal of file shows that identity card for disabled person Ex.OP-1,2/9 has been issued on 14.08.1995 and the death of life assured took place on 27.08.2020 i.e. after a gap of 25 years which proves that the life assured was living a normal life and was performing his day to day activities for a long period of 25 years inspite of the alleged disability. As such repudiation of the claim by taking shelter of query No.6 in the proposal form is totally unjustified. We are further of the view that it is not the case of the opposite parties No.1 and 2 that before issuance of the policy the opposite parties No.1 and 2 tried to get the life assured medically examined or that the life assured had refused to undergo medical examination. We are of the view that failure to get the life assured medically examined before issuance of the policy and thereafter taking the plea regarding physical disability to repudiate the is totally unjustified.
14. This Commission has placed reliance on judgment of Hon'ble Supreme Court of India 2023(2) Law Herald (SC) 1560 titled as Om Parkash Ahuja Vs. Reliance General Insurance Co. Ltd. Etc. wherein it was held by the Hon'ble Supreme Court of India as under:-
"Consumer-Insurance-Health Insurance-Non-mentioning of disease from which the deceased suffered at the time of purchasing the policy was not material, as the death was caused from a different disease all together-Both had no relation with each other-Insurance Company directed to pay".
15. We have placed reliance upon the judgment of Hon'ble Supreme Court of India in case titled as Om Parkash Ahuja Vs. Reliance General Insurance Co. Ltd. etc. reported in Law Herald (SC) 2023(2) Page 1560 wherein in it has held as under:-
"Insurance-Health Insurance-Complainant had taken health insurance for his family which was renewed time to time-His wife suffered from cancer of ovary and took treatment-Claim for reimbursement of medical expenses was repudiated on the ground that wife of complainant was suffering from heart disease and it was not disclosed at the initial time of taking policy-Medical Certificate establishes that rheumatic heart disease and carcinoma ovary are not related to each other-Thus, non-mentioning of disease from which the wife of appellant suffered at the time of purchasing the policy was not material, as the death was cause from a different disease all together- Both had no relation with each other-Insurance Company directed to pay the claim amount with interest".
As per which it has been held that the disease in respect of which the claim has been lodged and the alleged pre-existing disease have no connection with each other. As such we are of the view that repudiation of the claim on the ground of pre-existing disease is totally unjustified.
16. We have further placed reliance upon judgment of Hon'ble Punjab State Consumer Dispute Redressal Commission, Chandigarh reported in 2014(3) C.P.J. 13 : 2014(87) R.C.R.(Civil) 264 wherein it was held as under:-
"Insurance Company failed to produce any evidence to show that appellant was suffering from said disease at the time of taking policy - No affidavit of any doctor or person who recorded history of patient".
17. We also placed reliance upon judgment of Hon'ble Supreme Court of India reported in 2022 LiveLaw (SC) 506 wherein it was held by the Hon'ble Supreme Court of India as under:-
"Insurance - Insurance companies refusing claim on flimsy grounds and/or technical grounds - While settling the claims, the insurance company should not be too technical and ask for the documents, which the insured is not in a position to produce due to circumstances beyond his control. (Para 4.1)".
We are of the view that the opposite parties cannot refuse to settle the claim of the complainant by referring to the record of previous disability with which the death of life insured has no connection or nexus. Moreover, the opposite parties have issued the policy of insurance after having received premium, as such opposite parties cannot refuse to settle the clam by referring to previous disability with which the death of insured has no concern. We are of the view that insurance companies are only interested in procuring business this way or the other but at the time of the settlement they find one excuse or the other some of which are totally ignorable.
18. From the evidence on record and case laws cited above the deficiency in service is fully proved on the part of opposite parties No.1 and 2 and since it has come on record that opposite parties No.1 and 2 have already refunded Rs.1 Lakh to the complainant.
19. Accordingly, present complaint is partly allowed and opposite parties No.1 and 2 are directed to pay Rs.9,15,000/- to the complainant alongwith interest @ 9% P.A. from the date of filing of the present complaint till realization within 30 days from the date of receipt of copy of this order.
20. The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases.
21. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record room.
(Lalit Mohan Dogra)
President
Announced: (B.S.Matharu)
Feb. 26, 2024 Member
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