BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA.
Complaint No. 137 of 2014
Instituted On: 19.11.2014
Decided On: 10.03.2015
Gurdeep Kaur wife of Late Surinderpal Singh son of Gurdial Singh resident of Near Baba Isshar Singh College, Dharamkot Road, Kot Ise Khan, Tehsil Dharamkot, District Moga.
Complainant
Versus
1. HDFC Standard Life Insurance Company Limited, GT Road, Moga, through its Branch Manager.
2. HDFC Standard Life Insurance Company Limited, 11th Floor, Lodha Excelus, Appolo Mills, Compound N M Joshi Marg, Mahalaxmi, Mumbai, registered office at Ramon House, HT Parekh Marg, 169, Backbay Reclamation, Churchgate, Mumbai-400020.
Opposite Parties
Complaint under Section 12 of the
Consumer Protection Act, 1986.
Coram: Sh.S.S.Panesar, President
Smt Vinod Bala, Member
Smt.Bhupinder Kaur, Member
Present: For the complainant : Sh.Gopal Krishan Bansal Advocate
For the opposite parties : Sh Vishal Jain Advocate Cl.
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ORDER
(S.S.Panesar, President)
The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 (herein-after referred to as ‘Act’) against HDFC Standard Life Insurance Company Limited, GT Road, Moga, through its Branch Manager and another (herein-after referred to as ‘opposite parties) -OPs directing them to pay Rs.1,50,000/- plus interest @24% per annum on account of sum assured towards death benefit of deceased Surinderpal Singh, to pay Rs.50,000/- as compensation for causing mental tension and harassment besides Rs.11,000/- as costs of litigation.
2. Briefly stated, Surinderpal Singh, who was husband of complainant got himself insured by depositing Rs.15,000/- as insurance charges through cheque No.030018 dated 30.11.2012 with the opposite parties vide policy No.15617102. At the time of issuance of the policy, the agent of the opposite parties assured the deceased Surinderpal Singh that this policy was for Rs.1,50,000/-, in case anything happened, the opposite parties will pay Rs.1,50,000/- to the nominee of the policy holder. During the continuation of the policy, in the month of March-April 2013, the husband of the complainant fell ill and he was under treatment of various doctors and ultimately Surinderpal Singh had died on 17.10.2013 in Deep Hospital, Ludhiana. The complainant, who is the nominee of Surinderpal Singh deceased, approached the office of opposite parties at Moga and
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submitted all the relevant documents for the settlement of the claim under the policy. After receiving the requisite documents, the opposite parties assured the complainant that the claim amount will be released as early as possible. Thereafter, the complainant approached the opposite parties a number of times and requested them to release the claim amount. But instead of releasing the claim amount, the opposite parties vide letter dated 06.01.2014 refused to release the claim of the complainant on the ground that deceased Surinderpal Singh had concealed about his health problem. In the above said letter, the opposite parties had returned only Rs.13,960.90 directly in the account of the complainant. Non releasing the claim amount of the complainant, amounts to deficiency in service on the part of the opposite parties Hence this complaint.
3. Notice of the complaint was given to the opposite parties, who have appeared through their counsel namely Sh. Vishal Jain Advocate and filed joint written reply contesting the same. They took up preliminary objections that a complicated question of law and facts are involved in the present complaint, which requires voluminous documents and evidence for determination; that the complainant has concealed the material facts from this Forum as well as the opposite parties, therefore, the complainant is not entitled to any relief; that the deceased Surinderpal Singh insured was having pre-existing disease at the time of taking the insurance policy. The complainant had past medical history of Chronic Renal Failure prior to policy insurance, which was not disclosed in the application dated
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29.11.2012; that the complainant is not a consumer of the opposite parties; that the complainant has no locus standi to file the present complaint and that the opposite parties have rightly been repudiated the claim of the complainant vide letter dated 06.01.2014. On merits, the preliminary objections have been reiterated and the allegations of the complaint have been denied and a prayer for dismissal of the complaint with costs has been made.
4. In order to prove his case, the complainant tendered in evidence his affidavit Ex.C1, copies of documents Ex.C2 to C-6 and closed his evidence.
5. To rebut the evidence of the complainant, the opposite parties tendered in evidence affidavit of Amit Kumar Manager Ex. O.P.No.1 &2/11 and copies of documents Ex.OP1 &2/1 to Ex. OP 1 & 2/10 and the evidence of the opposite parties closed by order vide order dated 02.03.2015.
6. We have heard the learned counsel for the parties and have also carefully gone through the record.
7. The learned counsel for the complainant has vehemently contended that there is no dispute that Surinderpal Singh, husband of the complainant, got himself insured by depositing Rs.15,000/- as premium with the opposite parties vide policy No.15617102 dated 13.12.2012. Copy whereof is Ex.C-2 with insurance value to the tune of Rs.1,50,000/-. It is also not denied that Surinderpal Singh fell ill in the month of March 2013
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and as ultimately died on 17.10.2013 in Deep Hospital, Ludhiana. Copy of death certificate accounts for Ex.C-4 on record. The complainant submitted all the relevant documents for the settlement of the claim, being nomine of her husband. But, however, the opposite parties refused to release the claim vide letter dated 06.01.2014, copy whereof is Ex. C-2. The opposite parties have returned Rs.13,960.90 Paise directly in the account of the complainant, but they did not release the full insurance amount in her favour. The opposite parties are deficient in service and it is contended that the complaint is liable to be allowed as prayed for.
8. On the other hand, the learned counsel for the opposite parties has vehemently contended that Surinderpal Singh insured was suffering from pre-existing disease at the time of getting the insurance policy. The complainant had past medical history of Chronic Renal Failure prior to get the insurance cover and the insured did not disclose his disease while filling performa of insurance policy besides that it is contended that instant insurance policy was a Unit Linked policy and the complainant cannot claim herself to be a consumer in relation to the opposite parties. There is no deficiency in service on the part of the opposite parties. Due amount, payable under the insurance cover, has already been remitted back directly in the account of the complainant. Instant complaint as framed is not maintainable and it is contended that complaint is liable to be dismissed.
9. We have given thoughtful consideration to rival contentions.
10. A perusal of the insurance policy Ex.C-3 would reveal that it
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is a Unit Linked policy and in such like policies, the insured/complainant does not become consumer as defined under Section 2 (1)(d) of the Consumer Protection Act. It is commercial transaction. There is also no denying the fact that the policy in question was a Unit Linked Policy and as such, the claim made thereunder is not cognizable by the Foras under the Act. In support of the contention, reliance can be placed upon III (2013) CPJ 203 (NC) Ram Lal Aggarwalla Vs. Bajaj Allianz Life Insurance Co. Ltd & Anr.
11. In the above noted judgement, the dispute was regarding Unit Linked Insurance Policy and the claim made thereunder policy was disallowed by the District Forum by making the following observations:
“The investment made by the petitioner/complainant was to gain profit. Hence it was invested for commercial purposes and, therefore, the petitioner/complainant is not a consumer under the opposite parties. The State Commission Odisha in First Appeal No.162 of 2010 in the case of Smt.Abanti Kumari Sahoo v. Bajaj Allianz Life Insurance Company Ltd., have held that the money of the petitioner/complainant invested in the share market is no doubt a speculative gain and the speculative investment matter does not come under the Consumer
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Protection Act and accordingly, the State Commission dismissed the appeal.”
On the basis of the findings so recorded by the District Forum it came to the conclusion that the complaint was not maintainable under the Act and it was dismissed accordingly. Against the order of the District Consumer Forum, the complainant filed an appeal before the State Commission, which also did not find any reason to differ with the finding recorded by the District Forum and accordingly rejected the appeal memo at the admission stage. Not satisfied with the order, the petitioner filed a revision before the Hon’ble National Commission. The Hon’ble National Commission was pleased to hold that there was no jurisdictional error, illegality or infirmity in the order passed by the State Commission warranting inference and the revision was dismissed. Similar proposition of law has been echoed by our Hon’ble State Commission in Smt. Paramjit Kaur complainant Vs. Aviva Life Insurance Company India Limited opposite party decided on 04.07.2014.
12. Secondly there is evidence on record that Surinderpal Singh was suffering from Chronic Renal Failure since 2012 and the opposite parties collected evidence regarding the disease suffered by Surinderpal Singh now deceased, which is Ex.O.P.1&2/9 on record. However, at the time of filling the performa Surinderpal Singh knowingly concealed the pre-existing disease from the insurer and due to mis-representation of facts regarding pre-existing disease, the insured got the insurance policy. Had
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the opposite parties knew about the pre-existing disease of Surinderpal Singh now deceased, they must not have issued any insurance cover for him. Since the insured has himself violated the terms and conditions of the insurance policy by non-disclosing pre-existing disease suffered by him. As such the opposite parties were justified in declining the claim of the complainant. The complaint has no force. The opposite parties are not guilty of any deficiency in service. Consequently, instant complaint fails and the same is ordered to be dismissed. Copies of the order be sent to the parties free of cost immediately and thereafter the file be consigned to the record room.
Announced in Open Forum.
Dated:10.03.2015.
