Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 428.
Instituted on : 25.07.2017.
Decided on : 14.05.2019.
1. Smt. Kamla Devi w/o Late Sh. Wazir Singh son of Sh. Hira Singh, age 28 years.
2. Arju daughter of Late Wazir Singh, age 14 years,
3. Yash son of Late Wazir Singh, age 9 years,
Minor sons through their mother Smt. Kamla Devi w/o late Wazir Singh being their next friend & natural guardian of the minors,
All residents of VPO Ghuskani, District Rohtak. ………..Complainant.
Vs.
1. HDFC Standard Life Insurance Company Ltd., through its Managing Director.
Corporate & Registered Office-Lodha Exclus, 13th Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai 400011 (Maharashtra).
2. Branch Office-HDFC SL Rohtak Branch, through its Branch Manager, 2nd Floor, Ashoka Building, Ashoka Chowk, Delhi Road, Opp. Myna Tourist Complex, Rohtak. District Rohtak. (Service to Respondent/OP No. 1, is to be effected through respondent No. 2).
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
SH. VED PAL, MEMBER.
DR. RENU CHAUDHARY, MEMBER.
Present: Sh. R.S. Rajain, Advocate for the complainant.
Sh. Kunal Juneja, Advocate for opposite parties.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that the complainant’s husband had got his life insured with respondent for a sum of Rs. 6,01,115/- vide policy No.17545272 dated 25.03.2015. That said policy having term for 25 years with yearly installment/premium of Rs.29,100/-. That the complainant has been nominated in the said policy after death claim. That the husband of complainant had taken the policy from the Agent of the respondent on his advice. The husband of the complainant was medically examined by the experienced doctors from the Insurance Company who had given clearance certificate of fitness. That the yearly installment of Rs. 29,100/- was paid on 25.03.2015 and the next premium was due on 25.03.2016. That unfortunately, the policy holder died on 02.06.2015 in the ordinary course of nature at his residence. That the complainant applied for insurance claim after death of her husband and submitted the entire relevant documents to the respondent. But, the respondent has repudiated the claim vide letter dated 11.04.2016 on the ground that “The vital information was not provided to the respondent at the time of applying for the said policy”. That the act of opposite parties of not paying the alleged death claim amount is illegal amounts to deficiency in service. As such, it is prayed that opposite parties may kindly be directed to pay Rs.6,01,115/- as death claim alongwith interest @ 18% per annum from the date of death till realization and Rs.50,000/- as compensation and Rs.10,000 as litigation expenses as explained in relief clause.
2. After registration of complaint, notice was issued to the opposite parties. Opposite parties in their reply has submitted that the deceased Wazir Singh LA, at the time of making the said proposal, had misrepresented about his health i.e. the deceased was suffering from Liver Failure and was under the treatment at PGI Rohtak prior to issuance of the policy and further had also suppressed that the life insured deceased had taken another life insurance policy from other life insurance company. It is further submitted that life assured was examined by the penal doctor, but it does not exonerate the life assured not to disclose the true facts which were well within the knowledge of the deceased life insured and the relevant questions were answered in negative. That the life assured deceased did not die naturally rather died due to the chronic kidney disease from which the life insured deceased was suffering. All the other contents of the complaint were stated to be wrong and denied and opposite parties prayed for dismissal of complaint with cost qua the opposite parties.
3. Ld. counsel for the complainant in his evidence has tendered affidavits Ex.CW1/A and Ex.CW1/B, documents Ex.C1 to Ex.C9 and has closed his evidence on dated 14.08.2018. Ld. counsel for the opposite parties has stated that reply already filed on behalf of opposite parties be read in evidence and close the evidence on 07.01.2019.
4. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
5. In the present case the claim of the complainant has been repudiated by the opposite parties on the ground that the life assured was suffering from kidney disease and occupation and income details disclosed by the deceased LA in his proposal form were also found false. The insurance company further made an objection that the life assured had previously having insurance policy from some other insurance company and the details of the said policy has not been disclosed by the deceased L.A. On the other hand, contention of ld. counsel for the complainant is that the deceased LA has not disclosed any fact from the opposite parties and he was duly examined by the doctor of the opposite party. Moreover the burden to prove the facts is on the insurer. Ld. counsel for the complainant has also placed reliance upon the judgment of Hon’ble Supreme Court, AIR 2001Supreme Court 549 in case titled as Life Insurance Corporation of India and other, 2005(1)CCC 128(Rajasthan) of Rajasthan High Court in case titled as Life Insurance Corporation of India Vs. District Permanent Lok Adalat & Anr. and 2018(2)CLT459 of Hon’ble NCDRC in case titled as M/s Royal Sunderam Alliance Insurance Co. Ltd. and other Vs. Malanie Das.
6. After going through the file and hearing the parties it is observed that the first objection taken by the respondent is that deceased was suffering from kidney disease and regarding this fact the respondent officials has only filed detailed reply. The perusal of this reply itself shows that the respondent insurance company changed his stand as submitted in the written statement that the deceased LA was suffering from liver disease and he died due to liver failure. The deceased LA was taking treatment from PGIMS Rohtak prior to the issuance of the insurance policy and he had not disclosed the material fact before the respondent officials. To prove this fact the respondents have not placed on record any evidence. The respondent has only filed a detailed reply which was not supported with affidavit. Moreover, the respondent insurance company also admitted the fact in para no.5 of the reply that : “life assured was examined by the penal doctor, but it does not exonerate the life assured not to disclose the true facts……”. Perusal of this para itself shows that the respondent officials themselves have admitted this fact that the deceased LA was examined by the penal doctor of the respondent insurance company. Hence the plea taken by the respondent that complainant has misrepresented about his health in the proposal form is turned down. Moreover, no evidence is placed on record by the OPs to falsify the occupation and income details of deceased LA.
7. Secondly, the respondent officials have not placed on record any document to prove that the deceased LA was having another policy from other insurance company. To prove this fact they have not placed on record any detail of the insurance company or policy number and the same is also not mentioned in the written statement filed by the respondents. Hence this objection is also turned town. In this regard the law cited above by ld. counsel for the complainant are also fully applicable on the facts and circumstances of the case. As such opposite parties are liable to pay the insurance claim to the complainants. Initially the present complaint was filed by Smt. Kamla Devi as nominee but as per copy of ration card placed on record as Ex.C8, the deceased have two another LRs. namely Arju and Yash and they are also entitled for the insurance claim equally.
8. In view of the facts and circumstances of the case, complaint is allowed and it is directed that the opposite parties shall pay the claim of policy no.17545272 amounting to Rs.601115/-(Rupees six lac one thousand one hundred and fifteen only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 25.07.2017 till its actual realization and shall also pay a sum of Rs.5000/-(Rupees five thousand only) as compensation and litigation expenses to the complainants Smt. Kamla Devi, Arju and Yash in equal share within one month from the date of decision. It is also made clear that the amount after disbursement on account of complainant no.2 of minor daughter Arju and complainant no.3 Yash should be deposited in any nationalized bank till their majority and will be paid to them on attaining the age of majority.
9. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
14.05.2019.
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Nagender Singh Kadian, President
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Ved Pal Hooda, Member.
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Renu Chaudhary, Member.
