IN THE CONSUMER DISPUTES REDRESSAL FORUM, PATHANAMTHITTA. Dated this the 20th day of September, 2010. Present:- Sri. Jacob Stephen (President) Smt. C. Lathika Bhai (Member) Sri. N. Premkumar (Member) C.C. No. 96/2009 (Filed on 17.07.2009)Between: Mrs. Baby George, Pulimoottil Divya Darshan, Thiruvalla – 689 101, Pathanamthitta Dist. (By Adv. R. Gopikrishnan) .... Complainant. And: 1. HDFC Standard Life Insurance Co. Ltd., Ramon House, H.T. Parekh Marg, Backbay Reclamation Church Gate, Mumbai – 400 020, represented by its Chief Execute- Manager. 2. HDFC Standard Life Insurance Co. Ltd., 4th Floor, Deepa Tower, Deepa Junction, M.C. Road, Thiruvalla – 689 101, represented by its Branch Manager. (By Adv. Roy Thomas) .... Opposite parties: ORDER Sri. Jacob Stephen (President): The complainant has filed this complaint against the opposite parties for getting a relief from the Forum. 2. The case of the complainant in brief is as follows: The complainant is the mother of deceased Thomas George who took a Life Insurance Policy under the plan name ‘HDFC Unit Linked Endowment Plan’ from the opposite parties vide Policy No. 10605198 commenced from 26.05.2006 by paying ` 50,000 as its first premium. Later, he had paid two more instalments of ` 50,000 each. Thus the policy holder paid a total amount of `1,50,000 to the opposite parties. As per the terms and conditions of the policy, the said Unit Linked Endowment Plan is growth oriented and it covers medical benefit with life coverage to the policy holder to the tune of the deposited amount. The complainant is the nominee of the policy holder. The said policy was issued to the policy holder after medical examination by the experts appointed by the opposite parties. 3. The policy holder Mr. Thomas George died on 24.07.2008. Thereafter, the complainant being the nominee of the policy holder approached second opposite party more than once for the policy benefits of the deceased. The second opposite party collected all the relevant records under pretext that all documents are necessary for processing the claim. But they have not given the policy benefits so far and instead issued a repudiation letter dated 22.05.2009 to the complainant raising frivolous and untenable contentions. The repudiation of the claim is unjust and unfair which caused financial loss and mental agony to the complainant. The complainant is entitled to get the policy benefits. The non-payment of the policy benefits to the complainant is a clear deficiency in service and the opposite parties are liable to the complainant. The deceased Thomas George had some other policies of the same nature from other insurance companies and after his death; his legal heirs received all policy benefits from other companies. Hence this complaint for the realisation of ` 3,00,000 with growth benefits along with ` 50,000 as compensation from the opposite parties. The complainant also prays for allowing the cost of this proceedings. 4. The opposite parties filed their version with the following contentions: The opposite parties admitted the issuance of the policy to the complainant’s son and the repudiation of the claim submitted by the complainant. According to the opposite parties, the life insurance contract is based on principle of utmost good faith. The policy was issued in favour of the complainant’s son on the basis of the information provided by him in the proposal form. In the proposal form, the complainant has suppressed certain facts in respect of his health conditions. As per the medical certificate dated 05.02.2005, issued from Thiruvalla Medical Mission Hospital, it is clearly revealed that the policy holder was suffering from certain serious diseases. The said vital information was purposefully suppressed by the deceased policy holder at the time of application for the said policy, otherwise the policy should not have been issued. Since the policy holder had suppressed about the existing diseases, opposite parties are not liable to the complainant and hence the repudiation was legal and they have not committed any deficiency in service. With the above contentions, opposite parties pray for the dismissal of the complaint. 5. On the basis of the pleadings of the parties, the only question to be decided is whether this complaint can be allowed or not? 6. The evidence of this case consists of the proof affidavit in lieu of chief examination of the complainant and the proof affidavit of opposite party in lieu of their chief examination and Exts.A1 to A4. After closure of evidence, both sides were heard. 7. The Point: The complainant’s allegation against the opposite parties is that his son was a policy holder of the opposite parties and she is the nominee in the policy. The policy holder died. As per the terms and conditions of the policy, she is entitled to get the policy benefits offered by the opposite parties. But they have repudiated the claim of the complainant. The opposite parties are liable for giving all policy benefits as per the terms and conditions of the policy. 8. In order to prove the complainant’s case, the complainant had filed a proof affidavit in lieu of chief examination narrating her case along with 4 documents. The documents produced were marked as Exts.A1 to A4 on the basis of the proof affidavit. Ext.A1 is the Premium Receipt dated 26.05.2006 issued by the opposite parties to the policy holder for the receipt of the first premium amount of ` 50,000. Ext.A2 is the repudiation letter dated 22.05.2009 issued to the complainant. Ext.A3 is the letter-dated 15.07.2009 issued by Bajaj Allianz Life Insurance Company Ltd. showing the death claim payment under another policy of the deceased. Ext.A4 is the true copy of the payment details issued by HDFC Bank to the legal heir of the deceased in respect of another policy held by the deceased. 9. Opposite parties’ contention is that as per the terms and conditions of the policy in question, the policy holder has to disclose the pre-existing diseases in the proposal form at the time of taking the policy. The deceased in this case had certain ailments at the time of taking the policy and he had not disclosed the said ailments in his proposal form. According to the opposite parties, suppression of material facts disentitles the policy holder from getting the policy benefits. On getting the claim form from the complainant, the opposite parties made an enquiry and revealed that the deceased was admitted at Thiruvalla Medical Mission Hospital from 01.02.2005 to 05.02.2005 for severe portal gastropathy, liver cirrhosis, spleenomegaly/ascites & portal hypertension. This fact was revealed from the Medical Certificate issued by Dr. P.C. Cheriyan, Medical Superintendent of Thiruvalla Medical Mission. Since the deceased was suffering from the above said diseases at the time of taking the policy, he is not entitled to get policy benefits as per the terms and conditions of the policy. So they argued that they have not committed any deficiency in service in repudiating the complainant’s claim. 10. In order to prove the contentions of the opposite parties, the Zonal Manager of the first and second opposite parties filed a proof affidavit. But they have not adduced any documentary or oral evidence supporting their contentions. 11. On the basis of the contentions of the parties, we have perused the materials on record. There is no dispute regarding the issuance of the policy and the validity of the policy. The only dispute is that the deceased is not entitled to get the policy benefits as he had suppressed the information regarding the pre-existing diseases. But in this case, the opposite parties have not adduced any documentary evidence for substantiating the alleged pre-existing diseases and the terms and conditions of the policy in support of their contentions. So the contentions regarding the suppression of facts by the policy holder is not sustainable. At the same time, the opposite parties have no case against the contention of the complainant that all the relevant documents were with the opposite parties and the complainant had remitted ` 1,50,000 as premium amount and the policy holder is entitled to get life coverage to the tune of the deposited amount and the deposited amount with its accrued growth amount offered by the opposite parties. In the circumstances, this complaint is allowable and the non-payment of the policy benefits by the opposite parties is a clear deficiency in service and the opposite parties are liable for the same. 12. In the result, this complaint is allowed, thereby the opposite parties are directed to pay the deposited amount of ` 1,50,000 (Rupees One lakh fifty thousand only) with its accrued growth amount and ` 1,50,000 (Rupees One lakh fifty thousand only) the amount covered for the life of the depositor with its interest at the rate of 9% per annum from the date of filing of this complaint till this date along with compensation of ` 10,000 (Rupees Ten thousand only) and cost of ` 1,000 (Rupees One thousand only) to the legal heirs of the deceased as per the Succession Law applicable to the complainant within 30 days from the date of receipt of this order, failing which the legal heirs are allowed to realise the whole amount ordered herein above at the rate of 12% interest per annum from today till the whole realisation. Pronounced in the Open Forum on this the 20th day of September, 2010. (Sd/-) Jacob Stephen, (President) Smt. C. Lathika Bhai (Member) : (Sd/-) Sri. N. Premkumar (Member) : (Sd/-) Appendix: Witness examined on the side of the complainant : Nil. Exhibits marked on the side of the complainant: A1 : First premium receipt dated 26.05.2006 issued by the opposite parties to deceased Thomas George. A2 : Repudiation letter dated 22.05.2009 issued by the opposite parties to the complainant. A3 : Letter dated 15.07.2009 issued by Bajaj Allianz Life Insurance Company to the complainant. A4 : True copy of the payment details issued by HDFC Bank. Witness examined on the side of the opposite parties : Nil. Exhibits marked on the side of the opposite parties : Nil. (By Order) Copy to:- (1) Mrs. Baby George, Pulimoottil Divya Darshan, Thiruvalla – 689 101, Pathanamthitta Dist. (2) Chief Executive Manager, HDFC Standard Life Insurance Co. Ltd., Ramon House, H.T. Parekh Marg, Backbay Reclamation Church Gate, Mumbai – 400 020, (3) Branch Manager, HDFC Standard Life Insurance Co. Ltd., 4th Floor, Deepa Tower, Deepa Junction, M.C. Road, Thiruvalla – 689 101. (4) The Stock File.
| | HONORABLE LathikaBhai, Member | HONORABLE Jacob Stephen, PRESIDENT | HONORABLE N.PremKumar, Member | | 
