Haryana

Ambala

CC/243/2017

Parveen Kumar - Complainant(s)

Versus

HDFC Standard Life Inss Co Ltd. - Opp.Party(s)

Prem Sagar Sharma

03 Oct 2018

ORDER

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AMBALA

 

                                                                      Complaint case no.        : 243 of 2017

                                                          Date of Institution         : 17.07.2017

                                                          Date of decision    :  03.10.2018

 

 

 Parveen Kumar s/o Sh. Azad Singh, r/o VPO Jhandwala Bagar, District  Fatehabad.

    ……. Complainant.

 

 

1.  HDFC Standard Life Insurance Company Ltd, 13^th Floor, Lodha Excelus, Appolo Mils  Compound N.M.Joshi Road, Mahalaxmi, Mumbai-400011.

 

2.  HDFC Standard Life Insurance Company, Ambala Nicholson Road, Branch, Ist Floor Sudarshan Towers Cross Road No.1, Nicholson Road, Ambala Road, Cantt-133001.

 

 ….…. Opposite Parties.

 

Before:        Sh. D.N.Arora, President.

                   Sh. Pushpender Kumar,  Member

                   Dr. Sushma Garg, Member.

 

                  

Present:        Sh. P.S.Sharma, counsel for complainant.

 Sh. Rajeev Sachdeva,  counsel for OPs.

 

 

ORDER:

                   In nutshell, brief facts of the present complaint is that Sh. Ravinder Kumar s/o Sh. Azad Singh during his lifetime obtained life insurance policy no.18068724 dated 26.12.2015 from the OP No.2 at Ambala. Name of the policy is HDFC Life Super Samridhi plus plan and in case of death of the policy holder his nominee will received sum of Rs. 2,34,610/-. The complainant being his real brother was the nominee/legal heir of the deceased Ravinder. Ravinder during his life time has paid the annual premium of Rs. 14,703/- under Client ID No.95347440 dated 14.12.2015 at the time of getting the insurance policy. Before granting the policy the penal doctor’s on the penal of OP Company has checked the health condition of deceased Maan Singh and after satisfying from the same, the O company issued the above said insurance policy. Unfortunately on 15.08.2016 Sh. Ravinder died at his home due to heart failure. However before his death Sh. Ravinder was very fit and he was not suffering any kind of illness or disorder. He is about 19 years of age. After the death of Sh. Ravinder complainant has informed the OP Nos. 1 & 2 regarding death of his brother and requested for the clearance of death claim in his favour but the OP demanded certain documents to issue the death claim. On this the complainant supplied all document relating to death of his father within the stipulated period but eh OP prolong  the matter on one pretext  or other and ultimately the Ops issued a letter on 07.03.2017 and decline the death claim under aforesaid policy with the reason “Non disclosure of previous insurance application and mismatch the profile detail”. The aforesaid reason for decline death claim by the OP Nos.1 & 2 is totally wrong and illegal. The aforesaid reason for declining the claim of the deceased is totally deficiency on the part of Ops because the OP never discloses the facts before the deceased which is mentioned in the proposal form nor the agent of the company has taken any signature in the proposal form. Hence, the present complaint. 

2.               Upon notice, OP Nos.1 & 2 appeared through counsel and filed written statement submitting that the policy  in question was cancelled by the Ops after internal  investigation conducted by the Ops for non-disclosure of the previous policies  from the other insurance companies as well as mis match in the profile details vide letter dated 07.03.2017 sent the life insured.  It is further pertinent to mention here that the life insured was duty bound as per the IRDA guidelines to disclose the factum of the obtaining of previous insurance covers from the other insurance companies in the proposal form, which  the life insured had not disclose in the proposal form that had the life insured disclosed or inform the Ops of the earlier proposals or the insurance cover from the other insurance companies that decision of the Ops with regards to the acceptance and issuance of the insurance policy in question would have been different. Thus, there is no deficiency of the service on the part of the Ops and prayed for dismissal of the present complaint.

3                 To prove his version complainant tendered his affidavit as Annexure C-A along with documents as annexure C-1 and C-5 and close his evidence. On the other hand, Counsel for the OP tendered affidavit as Annexure R-X alongwith documents as Annexure R-1 to R-8 and close their evidence.

4.                We have heard both the counsel of the parties and carefully gone through the case file.

5.                It is proved on the file that the real brother of the complainant Ravinder Kumar has obtained HDFC life Sampuran Samridhi+ policy No. 18068724 as Annexure C-1. The complainant being a nominee has filed this complaint. It is clear from the policy in question in case of death policy holder complainant/nominee is entitled the insured amount Rs. 2,34,610/-. It is not disputed that the deceased has paid the annual premium of Rs. 14,703/- on 14.12.2015 at the time of getting the policy. The life insured has duly filled the proposal form Annexure R-3. It is proved on the file that the deceased died on 15.08.2016 as per Annexure C-5 (death certificate). The claimant has filed the claim before the Ops for claiming the insured amount Rs.2,34,610/-.  but Ops have declined the claim amount on the ground that “Non disclosure of previous insurance application and mismatch the profile detail” and issued repudiation letter Annexure C-4.

                   We have firstly gone through the claim form Annexure R-3. The above said proposal form is not a visible copy. So, the above said proposal form cannot look into consideration. However, the OP has place on record copy of e-mail Annexure R-7 it is clear that the deceased has obtained the one policy No.160514680448 from the IDBI Federal Life Insured Company Ltd.  and complainant has also purchased the another policy from SBI Life Insurance Co. Ltd. vide policy no.007054237 and insured amount shown Rs.15,60,000/-. The Ops have repudiated the claim of the complainant on the ground as per Annexure C-4 i.e. “We  refer to the confirmation of Policy Discontinuance-Policy No.18068724 and wish to inform you that the policy has been cancelled on account of “Non disclosure  of  previous insurance application and mis match in profile details with other insurance company at proposal stage”.

6.                From the above said documents i.e. description of policies, it is clear that the deceased has purchased two policies from the different insurance company. However, the counsel for the complainant is relied upon the law laid down the National Commission 2014 (3) CPJ 582 Sahara India Life Insurance Corporation Limited Vs. Rayani Raman Jani Yulu has clearly held that non declaration of previous policy is not a material fact and not a ground which could justified  repudiation of claim. It was held that insured and his legal representative cannot be left suffered on the part of agent. In case of Satwant Kaur Sandhu Vs. New India Assurance Company (Civil Appeal No.2776 of 2002) decided on 10.07.2009 by Hon’ble Supreme Court of India has held that the upshot of the entire  discussion is that in a contract of insurance, any fact which would influence the mind of a prudent insurer in deciding whether to accept or not to accept  the risk is a material fact. If the proposer has knowledge of such fact, he is obliged to disclose it particularly while answering questions in the proposal form. Needless to emphasize that any inaccurate answer will entitle the insurer to repudiate his liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a contract of insurance.

7.                In view of the law laid down Hon’ble Supreme Court as well as Hon’ble National Commission “non disclosure of the previous policy” is not a material facts and not a ground which could justified the repudiation of claim. The above referred judgments are identical to the facts of the present case.  Hence, the insurance company has wrongly repudiated the claim that the deceased has obtained two policies from Shriram Life Insurance and SBI Life Insurance and Ops have sought information from the above insurance companies.

8.                Keeping in view the above said facts and circumstances as well as law laid down above it is clear that the OP has wrongly and illegally  repudiated  the claim of the complainant on the ground of concealment regarding suppression of previous policy. Hence, the repudiation letter Annexure C-4 is hereby quashed. The present complaint is hereby allowed with cost which is assessed at Rs. 5,000/- and the Op Nos.1 & 2 are directed to pay the insured amount i.e. Rs.2,34,610/- as per Annexure C-3 i.e. proposal form alongwith interest @ 9% from the date of filing of the present complaint till its realization. Copy of this order be supplied to both the parties free of cost. File be consigned to record room after due compliance.

Announced on :03.10.2018

 

 

 

      (Pushpender Kumar)        (Dr. Sushma Garg)         (D.N. ARORA)

          Member                            Member                     President