Haryana

Kurukshetra

123/2018

Parminder Kaur - Complainant(s)

Versus

HDFC Standered - Opp.Party(s)

O.P.Paruthi

09 Mar 2021

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION KURUKSHETRA.

 

Consumer Complaint No.123 of 2018.

Date of instt.:01.06.2018. 

                                                                       Date of Decision:09.03.2021.

 

Parminder Kaur w/o late Shri Jagjit Singh, r/o House No.107/05-A, Bhagwan Nagar Colony, Pipli, Kurukshetra, Tehsil Thanesar, District Kurukshetra. 

                                                                                      …….Complainant.                                                 Versus

 

1. HDFC Standard Life Insurance Co. Ltd., Registered office: Lodha Excelus, 13^th Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai-400011, through its Managing Director.
2. The Branch Manager, HDFC Standard Life Insurance Co. Ltd., Kurukshetra, SCO No.66, 2^nd Floor, Sector-17 Branch, near IBP Petrol Pump, Kurukshetra.

                   ….…Opposite parties.

 

Complaint under Section 12 of Consumer Protection Act.

 

Before        Smt. Neelam Kashyap, President.    

                   Ms. Neelam, Member. 

                   Shri Issam Singh Sagwal, Member.                                                       

Present:      Shri O.P. Paruthi, Advocate for the complainant.   

Shri Vikas Bakshi, Advocate for the opposite parties.

             

ORDER

                                                                         

                    This is a complaint under Section 12 of the Consumer Protection Act, 1986 moved by complainant Parminder Kaur against HDFC Standard Life Insurance and other, the opposite parties.

 

P2.              The brief facts of the complaint are that the OP No.1 is a company who is doing business of General Insurance after taking premium and OP No.2 is a branch at Kurukshetra. The husband of the complainant had purchased insurance policy HDFC SL Youngster Super Premium vide policy No.16957858 dated 15.07.2014 for a sum insured of Rs.2,50,000/- for the period from 15.07.2014 to 15.7.2024 by paying a premium of Rs.25,000/- each on 15.7.2014 and 25.7.2015. Her husband was admitted to Nagpal Nursing Home, Kurukshetra as he was suffering from loose motion and bloody stool at the time of admission. His condition was serious and he had died during the treatment on 08.5.2016 leaving behind the complainant and his minor son Gurjaswinder Singh. After her death, she approached the OPs for insured amount and submitted all the requisite documents with them, but the OPs repudiated the claim vide letter dated 02.8.2016. It is pertinent to mention here that the OPs had credited Rs.47,746.02 without any detail or communication. Her husband was not the patient of Ulcerative Colitis prior to insurance policy. According to the death certificate issued by the Sub Registrar, Birth and Death, Kurukshetra, her husband was died due to illness, which proves that her husband was not died due to Ulcerative Colitis. By not paying her genuine claim, the OPs are deficient in services. Hence, this complaint.

3.                Upon notice, the opposite parties appeared and filed written statement raising preliminary objections regarding maintainability and cause of action. It is stated that in the present case, the deceased LA Shri Jagjit Singh was suffering from Ulcerative Colitis prior to issuance of the policy in question and at the time of making the proposal he had had misrepresented about his health. This very fact is very much evident from the medical records obtained by the OPs, in which, the deceased was diagnosed with Ulcerative Colitis prior to issuance of the policy. The LA had suppressed and concealed the very factum of suffering from chronic pre-existing disease at the time of issuance of the policy and thus, his death claim was rightly repudiated vide letter dated 02.8.2016 and an amount of Rs.47,748.02 has also been paid to the complainant towards the fund value paid under the said policy. The LA while applying for the policy gave wrong information pertaining to his health. There is no deficiency on the part of the OPs. On merits, the rest of the contents of the complaint are denied and prayed for dismissal the same.

4.                The complainant tendered affidavit Ex.CW1/A alongwith documents Ex.C-1 to Ex.C-9 and closed the evidence. On the other hand, learned counsel for OPs tendered affidavit Ex.RW1/A alongwith documents Ex.OP-1 to Ex.OP-5 and closed the evidence.

5.                Learned counsel for the OPs has filed affidavit Ex.RW1/A and tendered documents Ex.R-1  to Ex.R-9 in his evidence and closed the evidence of the OPs.

6.                We have heard the learned counsel of the parties and carefully gone through material available on the file.

7.                The learned counsel for the complainant has argued the husband of the complainant had purchased insurance policy HDFC SL Youngster Super Premium vide policy No.16957858 dated 15.07.2014 for a sum insured of Rs.2,50,000/- for the period from 15.07.2014 to 15.7.2024 by paying a premium of Rs.25,000/- each on 15.7.2014 and 25.7.2015. It is argued that husband  of the complainant was admitted to Nagpal Nursing Home, Kurukshetra as he was suffering from loose motion and bloody stool at the time of admission. His condition was serious and he had died during the treatment on 08.5.2016 leaving behind the complainant and his minor son Gurjaswinder Singh. After her death, she approached the OPs for insured amount and submitted all the requisite documents with them, but the OPs repudiated the claim vide letter dated 02.8.2016. It is also argued that the OPs had credited Rs.47,746.02 without any detail or communication. Her husband was not the patient of Ulcerative Colitis prior to insurance policy. The OPs have  not paid the claim of the complainant which amounts to deficiency in services on their part. Reliance has been placed on the law laid down in case Ratna Vs. LIC of India and others , Revision petition no. 1151 of 2017( Against the order dated 20.01.2017 in Appeal No.2184/2005 of the State Commission, Maharashtra, decided by the Hon’ble National Commission.

8.                On the other hand learned counsel for the OPs while reiterating the contentions made in the written statement has argued that deceased LA Shri Jagjit Singh was suffering from Ulcerative Colitis prior to issuance of the policy in question and at the time of making the proposal he had had misrepresented about his health. He has argued that this fact is clear from the investigation report Ex.OP-3 that the deceased was a known case of resistant Ulcerative Colitis since 8-10 years. The learned counsel for the OPs has further argued that vide Ex.OP-4, husband of the complainant was admitted  in Guru Nanak Hospital, Sham Nagar, Rajpura and  he was taking treatment  8-10 years before from the said hospital  for Ulcerative Colitis, which is chronic disease and the deceased has concealed this fact from the OPs in the proposal form while taking the present insurance policy and as such the  his death claim was rightly repudiated vide letter dated 02.8.2016. Learned counsel for the OP has placed reliance on the law laid down in case LIC of India and another Vs. Deep Chand Sood and others first appeal No.318 of 2008 decided on 17.3.2020 by the Hon’ble National Commission.

9.                After hearing the learned counsel for the parties, we are of the view that the claim of the complainant has wrongly been repudiated by the OPs vide repudiation letter dated 2.08.2016. The learned counsel for the OPs has laid much emphasis on the document Exd.OP-4 and argued that the LA was  a known case of resistant Ulcerative  colitis since 8-10 years. To prove this fact reliance has been placed on Ex. OP-4 a certificate issued by the doctor of Guru Nanak Hospital, Rajpura. But perusal of document Ex.OP-4 shows that the said doctor has not mentioned in the said document as to from what date to which date the LA remained admitted and what treatment has been given to him. He has not  attached any medical treatment record with the Ex.OPO-4. Moreover, neither affidavit of the doctor  who issued document Ex.OP-4 has been placed on the file nor the said doctor has been examined. Therefore, the document Ex.OP-4 cannot be believed. Further, the investigation report Ex.OP-3 is also not supported with any documentary evidence. The investigator who prepared the said report has not been examined nor his affidavit has come forward on record  in support of the investigation report.  On the other hand, from Ex.C-7 issued by Nagpal Hospital  and Maternity Home, Kurukshetra, the stand of the complainant that her husband suffered  loose motion and bloody stools and was admitted in  Nagpal Nursing Home on 5.05.2016 and died on 8.5.2016 is duly proved and it is held that husband of the complainant died on 8.5.2016 due to loose motion and bloody stools and not due to any pre existing disease as alleged by the OPs. Therefore, in such circumstances, it cannot be said that the LA-deceased was suffering  from  resistant Ulcerative  colitis since 8-10 years or at the time of obtaining of the present insurance policy and the claim of the complainant has wrongly been repudiated and there was deficiency in services on the part of the OPs. The authority given on behalf of OPs is not applicable to the facts of the present case.

 

10.              In this case, the OPs have credited the amount of Rs.47,746/- in the account of the complainant, the amount of premiums so paid by the life assured.  As discussed above, now the complainant is found entitled to sum assured, therefore, the OPs shall pay the complainant the sum assured minus Rs.47,746/-refunded by the OPs to the complainant.

 

11.              In view of our above discussion, we accept the present complaint and direct the OPs jointly and severally  to make the payment of the sum assured under the policy minus the amount of Rs.47,746/-  to the complainant on account death of her husband life assured Sh.Jagjit Singh. The OPs shall also pay Rs.5000/- to the complainant as litigation expenses.  The OPs are further directed to make the compliance of this order within a period of  45 days from the date of preparation of certified copy of this order, failing which the  complainants will be also at liberty to initiate proceedings under Section 25/27 of the Act against the OPs. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the record-room, after due compliance.

 

Announced in open commission:

Dt.: 9.03.2021.                                                        (Neelam Kashyap)                                                                                          President.

 

 

(Issam Singh Sagwal),              (Neelam)         

     Member                                 Member.