BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 65 of 2015
Date of Institution: 27.3.2015
Date of Decision : 23.12.2016
Reshmi widow of Shyonath Meghwal, resident of village Jaton Ka Bas Devasar, Tehsil Sardarshahar, District Churu (Rajasthan).
…Complainant.
Versus.
1. HDFC Standard Insurance Company Limited, Branch Office Sirsa, 1st floor, Classic Auto Care Sangwan chowk, Opp. Sharma Petrol Pump, Dabwali Road, Sirsa-125055, through its Branch Manager.
2. HDFC Standard Life Insurance Company Limited, 11th floor, Lodha Excelus, Apollo Mill Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai 400011, through its Managing Director / Authorized person.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SHRI S.B.Lohia …………………PRESIDENT
SHRI RANBIR SINGH PANGHAL ……MEMBER.
Present: Sh. Ravinder Singh, Advocate for the complainant.
Sh. Ashish Goel, Advocate for opposite parties.
ORDER
In brief, the case of the complainant is that her husband, since deceased had purchased a life insurance policy No.16343794 for the sum of Rs.5,50,000/- from the opposite parties commencing from 3.10.2013 by making payment of premium to the ops. The insured Shyonath died on 6.12.2013 due to heart failure during the policy period and as per terms and condition of policy, the nominee is entitled for death claim benefits i.e. insured amount. Being nominee and legal heir, complainant lodged her claim with the ops for the benefit of the policy but the ops have not paid the claim till today. The complainant made enquiry about claim and came to know that her claim has been repudiated on false grounds that the insured was having BPL card whereas the insured was an agriculturist and was not holding any BPL card. Even the complainant has not received any repudiation letter from ops. The ops repudiated the claim of complainant on false grounds. Hence, this complaint.
2. On notice, ops appeared and replied that at the time of submitting the proposal form and as per the information supplied by life assured, he disclosed that his financial position is very sound and he had declared his annual income to be Rs.four lacs from agriculture and ops considering the information as true had issued the policy on a premium of Rs.11,958/- on semi annual mode. Then within a very short span of two months, the ops were in receipt of death claim intimation from the complainant regarding death of life assured on 6.12.2013. During the course of investigation, it has been revealed to the ops that the life assured was a member of BPL category and was not having so much sound financial position to purchase a policy on an annual premium of Rs.20,000/- and had concealed the actual position of his financial status at the time of entering into the proposal form. Therefore, keeping in view the fact that life assured concealed material fact from ops, the have repudiated the claim vide repudiation letter dated 3.12.2015. As such complaint is liable to be dismissed.
3. By way of evidence, complainant filed her affidavit Ex.C1, copy of letter dated 1.11.2013 Ex.C2, copy of policy Ex.C3, copy of application Ex.C4, copy of claim form Ex.C5, copy of death certificate Ex.C6. On the other hand, ops produced affidavit of Sh. Amit Khanna, Deputy Legal Manager Ex.RW1/A, copy of policy with proposal form Ex.R1, premium and benefit details Ex.R2, copy of death certificate Ex.R3, copy of application Ex.R4, copy of claim form Ex.R5, copy of affidavit Ex.R6, copy of repudiation letter Ex.R7, copy of ration card Ex.R8
4. We have heard learned counsel for the parties and have gone through the case file carefully. Written argument submitted on behalf of ops also perused.
5. All the averments of the complaint have been admitted. However, from the perusal of policy documents Ex.R2, it is evident that sum assured is Rs.4,55,911/- and not Rs.5,50,000/- as alleged by the complainant. The only question to decide the present complaint is whether non acceptance of the claim of the complainant on the ground of insured BPL card holder is wrong or not? In our view, the sole ground for not accepting the death claim of complainant on the ground of BPL card holder is not acceptable because there is no nexus between the BPL card holder’s death claim or insurance claim of any other person who is not holding the BPL card. When the opposite parties accepted the premium after proposal of the life assured and issued life insurance policy to the insured, they are bound to pay the sum assured. There is no reason to accept the contention of the ops that on the basis of source of income of Rs.four lacs declared by the insured, they issued the policy. In our view, when insured paid the higher side premium to the ops and agreed to pay the premium of more than Rs.20,000/- per year, then it was the burden of life insured to pay the premium to the ops. Moreover, it was the duty of the opposite parties to obtain the necessary documents showing the income of the insured. It is no where alleged that insured specifically denied that he was not BPL card holder. As such, we are of the considered opinion that ops have wrongly withheld the sum assured and complainant is entitled to the sum assured for the death of her husband. The authorities cited by learned counsel for ops in cases titled as Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. (2009) 8 Supreme Court Cases 316 and Lakhbir Kaur & Others Vs. LIC, RP No.1840 of 2014 decided on 16.12.2014 (NC) and ICI Prudential Life Ins. Co. Vs. Yashika @ Meera and others, RP No.470 of 2015 decided on 4.11.2015 are not applicable in this case being on differing footings.
6. Thus, as a sequel to our above discussion, we allow the present complaint and direct the opposite parties to pay the sum assured i.e. Rs.4,55,911/- to the complainant within a period of one month from the date of receipt of copy of this order, failing which complainant will be entitled to interest @9% per annum from the date of filing of present complaint i.e. 27.3.2015 till actual realization. A copy of this order be supplied to the parties as per rules. File be consigned to the record room after due compliance.
Announced in open Forum. President,
Dated:23.12.2016. District Consumer Disputes
Member Redressal Forum, Sirsa.
