BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SIRSA.
Consumer Complaint no. 107 of 2020
Date of Institution : 25.02.2020
Date of Decision : 22.05.2024
Amit Kumar (aged about 23 years) son of Late Sh. Kuldeep son of Sh. Rati Ram, resident of House No. 366, Ward No.7, VPO Bushan, Tehsil Tosham, District Bhiwani.
……Complainant.
Versus.
1. HDFC Standard Life Insurance Company Ltd. Branch Office, HDFC SL, Sirsa Branch, Ist Floor Classic Auto Care Shop, Dabwali Roaad, Sangwan Chowk, Opposite Sharma Petrol Pump, Sirsa, through its Branch Manager.
2. HDFC Standard Life Insurance Company Ltd. Registered Office : Lodha Execlus, 13th Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai- 400011 through its Chief Manager/ Authorized Signatory.
…….Opposite Parties.
Complaint under Section 12 of the Consumer Protection Act, 1986.
Before: SH. PADAM SINGH THAKUR……. PRESIDENT
MRS.SUKHDEEP KAUR……………MEMBER.
SH. OM PARKASH TUTEJA………MEMBER
Present: Sh. Sandeep Sharma, Advocate for the complainant.
Sh. Puneet Narang, Advocate for opposite parties.
ORDER
The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 (after amendment u/s 35 of the Consumer Protection Act, 2019) against the opposite parties (hereinafter referred as Ops).
2. In brief, the case of complainant is that father of complainant namely Sh. Kuldeep got insured himself from the ops under HDFC Life Sampoorn Samridhi Plus policy and purchased said policy bearing No. 21067667 from op no.1 at Sirsa and risk of commencement of said policy was with effect from 12.01.2019 and premium of said policy was Rs.19,139/- half yearly. The premium paying term was for 15 years and policy term was 20 years and the detail of the policy is given in policy schedule which is well within knowledge of ops. That at the time of purchasing said policy, his father was hale and hearty and was not suffering from any disease. It is further averred that father of complainant paid first installment of Rs.19,139/- and second premium was to be paid in the month of July, 2019, but before depositing of second premium, his father suddenly died on 14.05.2019 and it was untimely and sudden death. That as per aforesaid policy, the complainant was appointed as nominee by his father and thus complainant is entitled to get the claim on account of death of his father as per policy. It is further averred that ops were immediately intimated by him about death of his father and he approached to op no.1 and requested to pay Rs.4,26,400/- as sum assured amount but op no.1 put off the matter with one pretext or the other. The complainant made several rounds to the office of op no.1 and requested to pay the claim amount but now a few days back the ops have refused to pay the sum assured amount as per policy without any reasonable cause. The complainant also got served a legal notice to the ops on 06.01.2020 but to no effect and the act and conduct of the ops amounts to gross deficiency in service and unfair trade practice due to which complainant has suffered unnecessary harassment. Hence, this complaint.
3. On notice, ops appeared and filed written version raising certain preliminary objections. It is submitted that life insured deceased had purchased the life insurance policy bearing no. 1067667 for a sum assured of Rs.4,26,400/- and had paid a premium of Rs.19,139/-. The deceased had submitted forged documents with respect to the Income & Occupation at the proposal stage before issuance of the life insurance policy by the answering ops. It is further submitted that it was disclosed by the DLA that he was a shop owner and doing business of sales and marketing at Bhiwani whereas as per investigation the deceased life insured was a driver. That it was further concealed that the wife of deceased was under the government scheme of MNREGA as daily wager/ labourer and had no source of income to pay the premium for purchasing life insurance policy. The deceased life assured was not owner of any shop and nor was doing business of sales and marketing at Bhiwani as disclosed by the deceased life insured in the proposal form. That by concealing the vital information with regards to the pre existing disease as well submitting of the forged income and occupation documents, the LA deceased has violated the basic principle of “Utmost Good Faith” and has obtained the insurance policy by keeping the ops in dark about the risks that he is transferring to the ops. It is further submitted that considering the concealment of vital information, while filling the proposal form and after thorough investigation done by the ops, the life insurance policy was terminated and discontinued and an intimation to this effect was also sent vide letter dated 30.09.2019. It is further submitted that complainant is not entitled to any amount under the policy as the said policy was discontinued and cancelled. The policy has been cancelled and discontinued as the same was procured by submission of forged and manipulated income and occupation documents at the proposal stage by the deceased life insured. The premium paid at the time of issuance of policy has been refunded and a letter to the said effect was also sent vide letter dated 17.10.2019. It is further submitted that cancellation and discontinuance of the policy by answering ops vide letter dated 30.09.2019 is perfectly legal in consonance with the provisions of the law as laid down under the Insurance Act and guidelines laid down by the IRDAI, the Insurance Regulatory Body of the Insurance Companies. The complainant is not entitled to any death claim or compensation amount as alleged by complainant. It is further submitted that mere serving of legal notice does not make entitle to the complainant to relief as claimed in the complaint against the terms and conditions of the policy and the policy agreement. The terms and conditions of the policy agreement are binding upon both the parties i.e. insurer, insured and their legal representatives. Remaining contents of complaint are also denied to be wrong and prayer for dismissal of complaint made.
4. The complainant in evidence has tendered his affidavit Ex. CW1/A and documents Ex.C1 to Ex.C8.
5. On the other hand, ops have tendered affidavit of Sh. Gurpreet Singh, Manager as Ex. RW1/A and documents Ex.R1 to Ex.R7.
6. We have heard learned counsel for the parties and have gone through the case file.
7. From the policy documents Ex.C4, it is evident that father of complainant namely Sh. Kuldeep purchased life insurance policy in question from ops for the sum insured amount of R.4,26,400/- by paying half yearly premium amount of Rs.19,139/-. The annual premium was of Rs.38,278/- and date of risk commencement was 12.01.2019 and policy was issued by ops on 16.01.2019. The premium paying term was for 15 years and policy term was for 20 years as is also evident from policy schedule. The complainant was nominee in the said policy. According to the complainant father of complainant suddenly died on 14.05.2019 i.e. before the date of second premium which was to be paid in the month of July, 2019 and complainant being nominee and son of deceased insured lodged his claim with the ops but the ops have not paid genuine claim of complainant. The ops instead of paying death benefits of his father to the complainant have only refunded premium amount as is evident from their letter dated 17.10.2019 Ex.R6. The ops have taken the plea that it was disclosed by deceased life assured that he was a shop owner and doing business of sales and marketing at Bhiwani whereas as per the investigation the deceased life insured was a driver and that his wife was a daily labourer under the scheme of Government namely MNREGA, therefore, they were not in financial position to pay such huge amount of premium and deceased concealed these facts from the insurance company at the time of availing life insurance policy from the ops. In this regard, ops have also placed on file detail investigation report as Ex.R3 and job card of Smt. Sheela wife of Kuldeep deceased/ insured under MNREGA as Ex.R4. However, ops are estopped from taking these pleas by their own act and conduct as only after death insured/ father of complainant ops have started investigation of his financial status which were required to be conducted prior to issuance of policy in question. Since insured has died and policy was in force at the time of his death, therefore, rejection of claim of complainant on the above said grounds of his financial capacity is not justified. The ops could verify about his financial position to pay the premium and about his job etc. before issuance of policy in question but they have failed to do so. Moreover, it cannot be said that a driver cannot run a side business i.e. shop and he can run his subsidiary business for earning his livelihood. Moreover, from the copy of jamabandi of year 2016-2017 placed on file by ops themselves, it is evident that said Kuldeep insured was also having agricultural land in his name and he might be a shop keeper as well as part time driver of the school bus. Moreover, it cannot be said that a driver who has also agricultural land cannot pay half yearly premium amount of Rs.19139/- i.e. about just Rs.3190/- in one month. Even if it is assumed that deceased was a driver then also he could pay the premium amount being agriculturist also and his wife was also helping hand as she was also an earning member of the family as per own version of ops. The ops have not verified the said fact that either Kuldeep singh was a driver or shop keeper and now after his death they are estopped from taking the above said plea and therefore, cancellation of policy in question by paying premium amount only to the complainant is not justified. Moreover, anyone cannot question about financial position of others without knowing about his actual financial position and it cannot be said that only poor persons are in the job of driving rather sound person can also do driving. Moreover, the concern of the ops is about premium and not about work of the insured and it was only concern of the insured to pay premium either through driving work or through running of shop etc. So, the ops at very later and belated stage have wrongly and illegally taken the above said baseless grounds for termination of the policy in question after death of deceased insured. The complainant is entitled to sum insured amount of Rs.4,26,400/- as well as other benefits as per policy on account of death of his father insured from the ops.
8. In view of our above discussion, we allow the present complaint and direct the opposite parties to pay the sum insured amount of Rs.4,26,400/- to the complainant after deducting premium amount refunded to the complainant and also to pay guaranteed additions as per policy within a period of 45 days from the date of receipt of copy of this order, failing which complainant will be entitled to receive the above said claim amount of Rs.4,26,400/- alongwith other benefits alongwith interest at the rate of @6% per annum from the date of this order till actual realization. We also direct the ops to further pay a sum of Rs.10,000/- as composite compensation for harassment and litigation expenses to the complainant within above said period. A copy of this order be supplied to the parties as per rules. File be consigned to the record room.
Announced. Member Member President,
Dated: 22.05.2024. District Consumer Disputes
Redressal Commission, Sirsa.
