BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 154 of 2017
Date of Institution : 10.7.2017
Date of Decision : 10.01.2018.
Smt. Sunder Devi wife of Late Shri Krishan Kumar, resident of 79/2, village Tajiakhera, Sahuwala-II (53), Tehsil and District Sirsa.
……Complainant.
Versus.
1. HDFC Standard Life Insurance Co. Ltd. Lodha Excelus, 13th Floor, Apollo Mills Compound, NM Joshi Marg, Mahalaxmi Mumbai- 400011.
2. HDFC Standard Life Insurance Co. Ltd., Branch Office situated at 1st Floor, Classic Auto Care Shop, Dabwali Road, Sangwan Chowk, Sirsa.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. R.L.AHUJA…………………………PRESIDENT
SMT. RAJNI GOYAT …………………. MEMBER.
Present: Sh. Parveen Godara, Advocate for the complainant.
Sh. Sandeep Kamboj, Advocate for opposite parties.
ORDER
The case of the complainant in brief is that complainant is widow of late Shri Krishan Kumar. The husband of the complainant namely Krishan Kumar had purchased an insurance policy HDFC Life Super Saving Plan (UIN:101N090V01) from opposite party on 3.3.2016 for a sum assured of Rs.6,11,919/-. The policy was issued on 5.3.2016 to the policy holder with policy No.18278954. It is further averred that at the time of proposal for the above said policy, the policy holder filled in the policy form and had submitted his PAN card, migration certificate of school, aadhar card for the age and address proof. That the policy holder had paid first premium of Rs.50,000/- in the above said policy. It is further averred that policy holder expired on 29.3.2016 and the ops were informed regarding this fact and a duly signed death claim statement was sent to the ops. That after receiving the statement of death claim, the ops had transferred an amount of Rs.48,150/- to the account number of nominee in the above said policy on 6.4.2017. That on 5.5.2017, the complainant had sent an email to the ops regarding the claim of the above said policy. In reply of the email, the ops had sent a repudiation letter in which it is mentioned that the policy holder had concealed his correct age and due to this fact the policy holder is not eligible for the payment of sum assured. It is further averred that at the time of proposal for the above said policy, the policy holder had not concealed any fact regarding the age as alleged by the ops, in fact the policy holder had submitted PAN card, aadhar card and migration certificate which shows the correct date of birth of policy holder as 30th June, 1972 and the policy holder was of age of 44 years at the time of death. That the act and conduct of the ops comes under the ambit of deficiency in service as well as unfair trade practice due to which the complainant being a widow is suffering recurring loss till today and also suffering serious harassment. Therefore, the complainant is entitled to the payment of sum assured of the policy holder i.e. Rs.6,11,919/- alongwith interest @18% from 29.3.2016 and a sum of Rs.1,00,000/- as compensation from the ops on account of mental agony besides Rs.33,000/- as litigation expenses. That the complainant approached the op no.2 regarding the above said claim but op no.2 did not entertain the grievance of the complainant and asked the complainant to approach the Head Office of HDFC Standard Life Insurance Company Ltd. situated at Mumbai. Thereafter, the complainant had sent a legal notice to the head office on 27.5.2017 through registered post and the same was received by the company by the above said head office on 5.6.2017 but to no effect. Hence, this complaint.
2. On notice, opposite parties appeared and filed reply taking certain preliminary objections. It is submitted 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 5.3.2016 and at the time of purchase of policy and filling up the proposal form, the deceased life assured had intentionally and deliberately concealed the factum of his age as at the time of proposal form, the deceased had stated his age as of 44 years whereas as per documentary proof, his age was found as of 51 years but this material 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 and the fact remains that the insured has died just after 24 days of the policy and is not a co-incident rather this thing shows that the policy has been procured by presenting the false facts and the fact remains that the premium amount paid by the life insured had already been refunded to the insured and premium amount had been disbursed to the account of the nominee, hence the complainant is not entitled to claim any sum against the said policy. Apart from above, the deceased life assured also furnished other wrong information in the proposal form on which ground also company can and has rightly repudiated the claim of complainant. The complainant has filed the delayed claim form on 23.3.2017 i.e. after the lapse of about one year from the death of life assured and the delayed form has been filed just after destroy of the material connected with the death of the life assured. Further more, the deceased knowingly stated his false income while actually the life assured belongs to below poverty line and the income of the life assured was much less than the income as disclosed in the proposal form. It is further submitted that under the provisions of Section 45 of the Insurance Act, 1938, it is envisaged that “the insurer is entitled to repudiate policy on the ground that statement made in the proposal or in any report of a medical officer or referee or a friend of the insured or any other document leading to issue of the policy was inaccurate or false, before the expiry of two years from the effective date of the policy, and thereafter that if such false or inaccurate statement was on a material matter or suppressed facts were material to disclose and it was fraudulently made and the policy holder knew that the statement was false or was material to disclose. On merits, the pleas taken in the preliminary objections are reiterated, the contents of the complaint are denied and prayer for dismissal of complaint has been made.
3. The parties then led their respective evidence by way of affidavits and documents.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. The perusal of the record reveals that it is an undisputed fact between the parties that the husband of the complainant namely Krishan Kumar had purchased policy no.18278954 by filing a proposal form on 3.3.2016 for a sum assured of Rs.6,11,919/-. The policy was issued on 5.3.2016. It is also an admitted fact between the parties that said Krishan Kumar died on 29.3.2016 within a short span of 24 days and the death claim was lodged by present complainant Sunder Devi qua death of her husband. The claim of complainant was repudiated and an amount of Rs.48,150/- was sent in the account of the complainant being nominee of the deceased Krishan Kumar.
6. The bone of contention between the parties is qua the age of deceased Krishan Kumar. As per the contention of the complainant, the date of birth of deceased Krishan Kumar was 30.1.1972 and he mentioned same in the proposal form and he was of about 44 years old at the time of his death, but however, as per the contention of the opposite parties, the deceased Krishan Kumar was of 51 years of age at the time of purchase of the policy and he had concealed this fact from the ops by misrepresenting the fact about his age and obtained the policy. He died within a short span of 24 days and after investigation it was found that he was more than 51 years old at the time of purchasing the policy. The insurance contract is a contract of good faith. Since he had cheated the ops by making false declaration qua his age, as such the contract was void, abinitio and an amount of Rs.48.150/- received by ops on account of premium was refunded to the nominee.
7. The perusal of the record reveals that complainant in order to prove her complaint has furnished her affidavit Ex.C1 in which she has specifically deposed that date of birth of policy holder is 30.1.1972 and he was aged about 44 years at the time of his death. She has proved documents Ex.C6 copy of driving licence of Krishan Kumar, Ex.C7 copy of aadhar card of Krishan Kumar, Ex.C8 copy of pan card of Krishan Kumar and certificate issued by Principal, G.S.S.S. Sahuwala Ex.C11. All these documents find mention the date of birth of deceased Krishan Kumar as 30.1.1972. On the other hand, ops have furnished affidavit of Sh. Amit Khanna, Deputy Manager Legal as Ex.RW1/A who has reiterated all the averments made in the written statement of the opposite parties. The opposite parties have also placed on file copy of policy Ex.R1, copy of voter identity card of Krishan Kumar as Ex.R2 which finds mentions the age of Krishan Kumar on 1.1.1994 as 33 years. The ops have also placed on file voter identity card of Smt. Sunder complainant as Ex.R3 which finds mention her age as 31 years on 1.1.1994. Ex.R5 is the affidavit of Beacon Minar-e-Noor Consultants Pvt. Ltd. Luckhnow by which the ops have tried to prove the investigation report submitted by the investigator and also filed the copy of the voter list for the year 2015 in which the age of the deceased as well as his wife has been shown. From the evidence of the complainant, it is proved fact on record that date of birth of the deceased Krishan Kumar is 30.1.1972 and he had mentioned same date in his proposal form. Though, the ops have insisted upon the report of the Investigator but unfortunately the ops have not mentioned the name of the investigator in the affidavit Ex.R5, nor the affidavit has been furnished by the investigator who conducted the investigation qua the claim of the complainant. Further more, as per version of the ops, the claim was lodged on 23.3.2017 but however, the perusal of Ex.R5 affidavit reveals that stamp paper for furnishing affidavit alongwith investigation report was purchased on 18.1.2017 which itself falsifies the version of the ops. Further more, the ops have relied upon the investigation report which is attached with the affidavit but same does not bear date, month and year of the investigation, nor it bears the signatures of any investigator though name of the investigator mentioned in this report is Balam Khan but name of this Balam Khan does not find mention even in the written statement as well as in the affidavit of Sh. Amit Khanna who represented the ops, nor it finds mention in the affidavit Ex.R5. The ops have hidden the name of the investigator in their defence plea due to reason best known to the ops. Moreover, the report of the investigator reveals that the investigator has found the death certificate of the deceased as genuine and he concluded his report with the remarks that summary of the details shared by the persons namely Ummed Singh, Subhas Kumar, Prehlad and Mahendra as listed individuals and neighbors and they all narrated that LA was farmer and his health condition was good. He got heart attack and died. So there is nothing in the report which contradicts the claim of the complainant. Further more, the ops have taken the plea that deceased Krishan Kumar was a BPL card holder and his financial position was not so good in order to purchase the policy in question but however as per report of the investigator they visited the residence of the deceased and came to know that nominee was out of station, so they met other family members and inquired and they also told the same as others and new house is under construction, it shows their sound financial condition. So, it appears from this report of the investigator on which the ops have fully relied upon that the deceased Krishan Kumar was having sound financial condition and died due to heart attack as narrated by the neighbors, individuals to the investigator. So there remains no doubt that complainant is not entitled to the death claim of her husband as per the terms and conditions of the policy.
8. In view of the above, we allow the present complaint and direct the opposite parties to pay the death claim i.e. sum assured of Rs.6,11,919/- to the complainant within a period of one month from the date of receipt of copy of this order, failing which the complainant will be entitled to interest @9% per annum from the date of this order till actual payment. We also direct the ops to further pay a sum of Rs.10,000/- as composite compensation and litigation expenses to the complainant. 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:10.1.2018. Member District Consumer Disputes
Redressal Forum, Sirsa.
