District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No. 259/2022.
Date of Institution:12.05.2022.
Date of Order:07.06.2023.
1. Lalita Garg aged 54 years W/o Late Shri Vinod Kumar Garg, R/o House NO. 186, Sector-31, Faridabad (Haryana) Mobile Card No. 6313 8234 3912.
2. Shubham Garg, aged 31 years S/o late Shri Vinod Kumar Garg, r/o House No. 186, Sector-31, Faridabad (Haryana), Mobile No. 9910301310 Aadhaar card No. 5175 0675 3317.
…….Complainants……..
Versus
1. IDBI Bank Ltd., 5C/3, Railway Road, NIT, Faridabad.
2. Manager, IDBI Bank, Ltd., 5C/3, Railway Road, NIT Faridabad.
3. Ageas Fedral Life Insurance Company ltd., (Formerly known as IDBI Fedral Life Insurance company Ltd.) 22nd floor, A wing Marathron Futures, NM, Joshi Marg, Lower Pavel (East) Mumbai – 400 013.
4. Shri Sudhir Singh, Senior Relationship Manager, Ageas Fedral Life Insurance Company ltd. (Formerly known as IDBI Fedral Life Insurance Company Ltd.) 22nd floor, A Wing Marathron Futures, NM, Joshi Marg, Lower Pavel (East), Mumbai – 400 013, Mobile NO. 9716276608 E-mail: sudhir.singh@idbifedral.com
…Opposite parties
Complaint under section-12 of Consumer Protection Act, 1986
Now amended Section 34 of Consumer protection Act 2019.
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
Indira Bhadana………….Member.
PRESENT: Sh. Jatinder Singh , counsel for the complainant.
Opposite parties Nos.1 & 2 ex-parte vide order dated 07.09.2022.
Sh. Rakesh Dabaas, counsel for opposite parties Nos.3 & 4.
ORDER:
The facts in brief of the complaint are that husband of the complainant No.1 namely Shri Vinod Kumar Garg took Housing loan of Rs.66,00,000/- from opposite parties Nos.1 & 2 and the interest thereon was settled @ 8.85% pa. The complainant NO.2 was co-applicant, in the above mentioned housing loan. The husband of the complainant NO.1 deposited the title deed of the house No. 186, Sector-31, Faridabad measuring 358.8 sq. yards i.e 300 sq. meters with opposite parties Nos.1 & 2. The Housing loan was to be returned to the opposite parties within a period of 20 years as per the loan agreement. The housing loan amount of Rs.66,00,000/- was disbursed on 29.06.2019, in the loan account No. 1929675100000 of the husband of the complainant No.1, being maintained with the IDBI Bank Ltd., Railway Road, NIT, Faridabad. As per the terms and conditions of the loan agreement, the husband of the complainant No.1, late Shri Vinod Kumar Garg was to pay the housing loan to the opposite parties Nos.1 & 2 through monthly installment @ Rs..58,747/- each. Unfortunately the husband of the complainant No.1 died on 23.11.2020. The loan installments were regularly paid by the husband of the complainant till Nov. 2020. Even as on date the due amounts of loan installments were being paid by the son of the complainant NO.1, who was co-applicant of the housing loan and the real son of the late Shri Vinod Kumar Garg. When the husband of the complainant No.1 took the housing loan from the opposite parties Nos.1 & 2, the officials of the opposite parties Nos.1 & 2 advised the husband of the complainant No.1 that the husband of the complainant NO.1 should get the housing loan amount secured under Group Loan Secure Plan from opposite parties Nos.3 & 4 by making the payment towards insurance premium, mentioning the benefits of getting the housing loan secured under group loan secure plan.
As per the advise of the Loan Manager and the officials of the opposite parties Nos.1 & 2, the husband of the complainant No.1 and the father of the complainant No.2, asked the procedure of securing the loan amount through LIC policy, whereby the Loan Manager and the officials of the opposite parties Nos.1 & 2 told the husband of the complainant No.1 that the husband of the complainant No.1 would be required to take a Life Insurance Policy form the opposite parties Nos. 3 & 4 for which the husband of the complainant No.1 would require to undergo Medical Check up by the Panel doctor of the opposite parties Nos.3 & 4. Accordingly the husband of the complainant NO.1 opted for the Life Insurance policy No. 4001332731 in his name from the opposite parties Nos.3 & 4. The husband of the complainant No.1 was medically examined by the panel doctor of the opposite partesNos.3 & 4, whereby the husband of the complainant NO.1 was found hale and hearty and accordingly the husband of the complainant NO.1 paid an amount of Rs.7,09,323.95 paise towards the time insurance premium and the husband of the complainant NO.1 namely Shri Vinod Kumar Garg was made insured under IDBI Fedral Life Insurance Group Loan Secure Plan. It was submitted that late Shri Vinod Kumar Garg paid an amount of Rs.2,11,772/- vide cheque No. 073377 dated 01.07.2019 and cheque No. 073378 dated 06.07.2019 for an amount of Rs.17,552/- both drawn on Punjab National Bank, whereas, an amount of Rs.4,80,000/- was paid after raising loan from IDBI Bank Ltd., the opposite party No.1 towards insurance premium. The total insurance premium of Rs.7,09,323.95 paise was paid to the opposite parties Nos.3 & 4 and hired their insurance services. Shri Vinod Kumar Garg, since deceased the husband of the complainant No.1 and the father of the complainant NO.2 was a hale and hearty person aged 58years. The husband of the complainant No.1 and the father of the complainant No.2 namely Shri Vinod Kumar Garg suffered severe respiratory problem on 23.11.2020 and was taken to Asian Institute of Medical Sciences, Sector-21, Faridabad during the Covid-19 Pandemic period and was attended by Dr. Rishi Gupta. Shri Vinod Kumar Garg reached hospital at about 7.40 p. pm 23.11.2020 and was shifted to CCU, immediately. Despite best efforts of the attending doctors and putting Shri Vinod Kumar Garg on ventilator Support, the attending doctors could not save the patient Vinod Kumar Garg and died sue to sudden Cardiac arrest and was declared dead at 8.45 p.m. Upon the death of late Shri Vinod Kumar Garg, the complainants approached the opposite parties Nos.1 & 2 intimating them with regard to the death of late Shri Vinod Kumar Garg, with a request that the death benefits accrued upon the death of deceased under insurance policy NO 4001332731 issued by opposite parties Nos.3 & 4 be adjusted with the Housing Loan of the deceased as the sum insured was of Rs.69,83,091.72 paise which was equal to the housing loan amount and the amount of loan raised for taking the LIC policy under Group Loan Secure Plan. It was worth mentioning that the death risk commencement date was 09.07.2019 to 08.07.2028. The complainant No.2 approached the opposite parties with the request that since Shri Vinod Kumar Garg had died and as such the opposite parties Nos.1 & 2 should not raise any demand of the loan installments from the complainants and the complainant Nos.1 & 2 should get the entire loan amount from the opposite parties Nos.1 & 2 which was duly insured under the Group Loan Secure Plan, for which Shri Vinod Kumar Garg, since deceased paid a amount of Rs.7,09,323.95 paise as insurance premium covering the risk of the loan amount. Infact upon getting the intimation regarding the death of Shri Vinod Kumar Garg, the opposite parties Nos.1 & 2 would had stopped the receipt of the loan installment sand the entire loan amount would have adjusted with the insured amount after collecting the insured amount from the opposite parties Nos.3 &4 and or the opposite parties Nos.1 & 2 should have recovered the insured amount form opposite parties Nos.3 & 4. The opposite party No.3 sent a letter dated 27.03.2021, whereby the death claim of late Shri Vinod Kumar Garg under policy No. 4001332731 was repudiated taking a frivolous and baseless and that the insured declarant had not disclosed the alleged ailments at the time of enrolment as insured with opposite party No.3. Had there been any such alleged ailment present with the deceased Shri Vinod Kumar Garg, he same would have noted by the Panel doctor of the opposite party No.3 who medically examined and checked up Shri Vinod Kumar Garg, since deceased prior to insuring Shri Vinod Kumar Garg mentioned above. If any ailment was found by the panel doctor of the opposite party No.3 the opposite party No.3 would had denied issuing the Life Insurance Policy to the husband of the complaint NO.1 and the father of the complaint No.2. Opposite parties Nos. 3 & 4 playing smart had no one hand had taken Rs.7,09,323.95 paise from the husband of the complainant No.1 namely Shri Vinod Kumar Garg, since deceased and now the opposite parties Nos.3 & 4 had denied the genuine claim of the complainant vide letter dated 27.4.2021.The aforesaid act of opposite party amounts to deficiency of service and hence the complaint. The complainant has prayed for directions to the opposite parties Nos. 3 & 4 to:
a) make the payment of the assured amount to opposite parties Nos.1 & 2 accrued upon the death of late Shri Vinod Kumar be passed on to the opposite parties Nos.3 & 4 for squaring up the housing loan amount raised from the opposite parties Nos.1 & 2
b) pay Rs. 5,00,000/- as compensation for causing mental agony and harassment .
c) pay Rs. 55,000 /-as litigation expenses.
2. Notice was sent to opposite parties Nos.1 & 2. Shri Rajesh Sharma, counsel for opposite parties Nos.1 & 2 appeared but did not file the written statement. Case called several times since morning but none appeared on behalf of opposite parties Nos.1 & 2. Therefore, opposite parties Nos.1 & 2 were proceeded against exparte vide order dated 07.09.2022.
3. Opposite parties Nos.3 & 4 put in appearance through counsel and filed written statement wherein Opposite parties Nos.3 & 4 refuted claim of the complainant and submitted that the complainant had duly signed and submitted the application form NO. 124508922 dated 28.06.2019 on which, a policy bearing NO 4001332731 was issued to the complainant and the said policy documents was dispatched to the complainant on 11.07.2019. It was also submitted that the answering opposite had issued a Master policy to IDBI Bank vide policy bearing No. 2000000259, which was group insurance plan and DLA had made an application for enrolling his name as member under the said policy and issuance of insurance cover under the policy and on the basis of duly signed member enrollment from received from the DLA and answering opposite party had issued the policy namely IDBI Federal Life Insurance Group Loan Secure Plan, bearing policy No. 4001332731. The answering opposite party had received a premium of Rs.7,09,323.95 as one time premium.. On 38.23.3030, the answering opposite party received a death claim form from the complainant intimating the death of life assured, the DLA had died on 23.11.2020 i.e. within one year four month and fourteen days from the very first inception of the policy in question and after that the answering opposite party as per the rules and regulations of the Insurance Act conducted an investigation and after investigation some facts had been revealed and during investigation some documents pertains to the serious medical history of the DLA had been received and as per the medical records from AIIMS hospital dated 08.07.2019 the facts confirmed that the DLA was known case of Coronary Artery Disease (CAD) in 2018 Acute Myocardial Infarction in 2008 and further fact came into light that DLA had frequent admission with shortness of breath for twice in last 6 months and all these above said facts were not disclosed to the answering opposite party during proposal stage and if the above said information would revealed by the DLA to the answering opposite party then opposite party would have declined/cancelled the proposal form submitted by the DLA, therefore, the present false complaint of the complainant may kindly be dismissed on this score alone. The above said investigation was conducted as per the rules and regulations of the Insurance Act and above said non-disclosure of such material facts fully and truthfully had direct impact and impaired the answering opposite party from assessing the risk and affected the underwriting decision and present contract of insurance was based on utmost good faith and as such DLA was under legal obligation to disclose the above said facts with all material particulars without any concealment and suppression, therefore, the present complaint of the complainant was a perfect example and case of concealment of the true and material information from the answering opposite parties. The DLA and his family members including complainant and his son were fully known to the serious pre-existing medical condition of DLA and same had not been willfully disclosed to the answering opposite party and the above said facts came into existence only after the death claim of the deceased in investigation duly conducted by the answering opposite party as per rules and regulations, therefore the illegal and false claim of the complainant and her son was rightly repudiated vide letter dated 27.03.2022 and an intimation in this regards had been duly sent to the complainants and the same had been duly received by the complainants. In view of the aforesaid fact and circumstances the present complaint was perfect example of suppression of material fact about his serious pre-existing medical condition and the answering opposite part had rightfully repudiated the death claim of the complainant vide its letter dated 27.03.2022. Opposite parties Nos.3 & 4 denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
4. The parties led evidence in support of their respective versions.
5. We have heard learned counsel for the parties and have gone through the record on the file.
6. In this case the complaint was filed by the complainant against opposite parties–IDBI Bank with the prayer to: a) make the payment of the assured amount to opposite parties Nos.1 & 2 accrued upon the death of late Shri Vinod Kumar be passed on to the opposite parties Nos.3 & 4 for squaring up the housing loan amount raised from the opposite parties Nos.1 & 2. b) pay Rs. 5,00,000/- as compensation for causing mental agony and harassment . c) pay Rs. 55,000 /-as litigation expenses.
To establish his case the complainant has led in his evidence, Ex.CW-1/A – affidavit of Lalita Garg, Ex.C-1 – Death summary, Ex.C-2 – IDBI Federal Life Insurance Group Loan Secure Plan, Ex.C-3 – Terms and conditions, Ex.C-4 (colly) – email dated 23.04.2021, Ex.C-5 - repudiation letter dated 27.03.2021.
On the other hand counsel for the opposite parties Nos. 3& 4 strongly agitated and opposed. As per the evidence of the opposite parties Nos.3 & 4 Ex.RW3/A1 – affidavit of Sony George,, Ex.R-1 – Member Enrollment Form, Ex.R-2 – Proposal Amendment Form, Ex.R-3 – letter dated July 9,2019, Ex.R-4 – letter dated 26.04.2021, Ex.R-5 – Option 1 (Regular Counter offer), Ex.R-6 – Death Benefit Claim Form, Ex.R-7 – death certificate, Ex.R-8 – Names of Ombudsman and addresses of Ombudsman Centres , Ex.R-9 – repudiation letter dated 27.03.2021, Ex.R-10(colly) – Claim investigation report, Ex.R-11 – Death summary, Ex.R-12 - email.
7. In this case, the husband of the complainant No.1 namely Shri Vinod Kumar Garg took Housing loan of Rs.66,00,000/- from opposite parties Nos.1 & 2 and the interest thereon was settled @ 8.85% pa. The husband of the complainant No.1 deposited the title deed of the house No. 186, Sector-31, Faridabad measuring 358.8 sq. yards i.e 300 sq. meters with opposite parties Nos.1 & 2. The Housing loan was to be returned to the opposite parties within a period of 20 years as per the loan agreement. The housing loan amount of Rs.66,00,000/- was disbursed on 29.06.2019, in the loan account No. 1929675100000 of the husband of the complainant No.1, being maintained with the IDBI Bank Ltd., Railway Road, NIT, Faridabad. The complainant No.1 paid an amount of Rs.7,09,323.95 paise towards the time insurance premium. The husband of the complainant No.1 namely Shri Vinod Kumar Garg was made insured under IDBI Fedral Life Insurance Group Loan Secure Plan . After a span of 1-1/2 years borrower died due to cardio arrest the case was repudiated by the opposite party on the ground that the patient was having PED.
8. After going through the evidence led by the parties, the complainant/borrower took the loan before 1-1/2 year back and paying the installment continuously and he has paid the premium of the insurance of the claim too and the age of the complainant was 58 years. The complainant has also paid for the medical as per the record. He was medically examined before taking the loan. Opposite party should not issued the insurance policy incase of any doubt. Opposite party have took huge amount of the premium from the complainant. They cannot repudiate the insured amount when they are taking premium.
9. Moreover, when the insured is above 58 years then the Insurance Company was at liberty to get the complainant medically examined prior to issuance of the policy in question. Insurance Company cannot take advantage of its act of omission and commission as it is under obligation to ensure before issuing the policy in question whether a person is fit to be insured or not. It was the duty of the opposite party to get the complainant immediately examined before issuing the policy as per IRDA guidelines.
10. The ground of rejection of claim does not stand to the test of scrutiny because opposite party has not placed on record any credible evidence to prove that the complainant had pre existing disease which was not disclosed by him at the time of obtaining said policy.
11. Keeping in view of the above submissions, the Commission is of the opinion that the complaint is allowed. Opposite parties Nos.3 & 4 are directed to refund the EMI taken by the opposite parties after the date of death of the borrower as well as the insured amount to the complainant as per T & C of the policy. Opposite parties Nos.3 & 4 are also directed to pay the remaining loan amount to the complainant. Opposite parties Nos.3 & 4 are also directed to pay Rs.5500/- as compensation for causing mental agony & harassment alognwith Rs.5500/- as litigation expenses to the complainant. Compliance of this order be made within 30 days from the date of receipt of copy of this order. Copy of this order be sent to the parties concerned free of costs. File be consigned to the record room.
Announced on: 07.06.2023 (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharma)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
(Indira Bhadana)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
