BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMRITSAR.

Consumer Complaint No. 445 of 2014

Date of Institution: 14-08-2014

Date of Decision: 20-08-2015

Sharanjit Singh, aged about 60 years, son of Sh.Niranjan Singh, resident of H.No. 1032, Gali No.6, Dashmesh Nagar, Tarn Taran Road, Near Vicky Palace, Amritsar. 

Complainant

Versus

1. India First Life Insurance Company Limited, 301, B Wing, The Qube, Infinity Park, Dindoshi-Film City Road, Malad (East) Mumbai-400097, through its Manager/ Director/ Principal Officer/ Person Over all Incharge.
2. India First Life Insurance Company Limited, Upper Ground Floor, Surya Plaza, Opposite Namdhari Kanda, Tarn Taran Road, Amritsar, through is Manager/ Person Over all Incharge.
3. The Muthoot Finance Limited, Upper Ground Floor, Surya Plaza, Opposite Namdhari Kanda, Tarn Taran Road, Amritsar, through its Manager/ Person Over All Incharge. 

Opposite Parties

Complaint under section 11 and 12 of the Consumer Protection Act, 1986 as amended upto date.

Present: For the Complainant: Sh.  Vikas Mahajan, Advocate.

              For the Opposite Parties: Sh. Sahil Sharma, Advocate.

Quorum:

Sh.Bhupinder Singh, President

Ms.Kulwant Kaur Bajwa, Member

Mr.Anoop Sharma, Member  

Order dictated by:

Sh.Bhupinder Singh, President.

1. Present complaint has been filed by Sh.Sharanjit Singh under the provisions of the Consumer Protection Act alleging therein that Sarabjit Kaur wife of the complainant obtained life insurance policy from Opposite Parties No.1 and 2 through Opposite Party No.3, bearing policy No. G0000253 commenced w.e.f. 17.7.2013 having value of Rs.3 lacs by paying a premium of Rs. 5226/-  and the complainant Sharanjit Singh being husband of policy holder Smt.Sarabjit Kaur was appointed as nominee of the said policy. It is important to mention here that only cover note or schedule of the insurance were supplied, but the Opposite Parties No.1 and 2 never supplied any terms and conditions of the policy in question to the complainant much less the alleged terms and conditions every formed part of the contract between Smt.Sarabjit Kaur and Opposite Parties. Complainant alleges that during the validity period of the said policy, Smt.Sarabjit Kaur suddenly fell ill and she was got admitted in Shri Guru Nanak Dev Hospital, Amritsar in unconscious stage and where she ultimately died on 12.2.2014. After the death of Smt.Sarabjit Kaur (herein-after referred as ‘DLA’), the complainant immediately intimated the Opposite Parties regarding the death of her wife and complainant lodged the claim as per the policy to Opposite Parties No.1 and 2 and also supplied all the requisite documents i.e entire medical record, copy of policy cover note, death certificate  of DLA Smt.Sarabjit Kaur alongwith other relevant record as demanded by the Opposite Parties and all the requisite formalities were fulfilled by the complainant. But the Opposite Parties No.1 and 2 repudiated the claim of the complainant on 9.6.2014 on the flimsy ground that the insured has not given the true facts at the time of obtaining the policy and she had  concealed the facts. This plea raised by the Opposite Parties No.1 and 2 in  the impugned repudiation letter is totally vague, baseless and concocted one.  Alleging the same to be deficiency in service, complaint was filed seeking directions to the Opposite Parties to pay the insured amount of Rs.3 lacs alongwith interest @ 18% per annum. Compensation and litigation expenses were also demanded.
2. On notice, Opposite Parties No.1 and 2 appeared and filed written version in which it was submitted that the present complaint is not maintainable. The contract of the insurance is based on a foundation of utmost good faith i.e.Principle of Uberrimae  Fide.  The DLA Smt.Sarabjit Kaur was suffering from Diabetes (Type-2), Hypertension & Chronic Renal Failure and was under treatment for the same, prior to signing the proposal form for obtaining the policy. If the DLA Smt.Sarabjit Kaur would have disclosed her past medical history, the Opposite Parties No.1 and 2 would not have issued the subject policy and she had not disclosed these material facts about her past illness and admission in the hospital. It is submitted that the Opposite Parties No.1 and 2 are under no liability to approve the death claim since the insurance contract became void due to intentional non disclosure and rendering of wrong and misguiding statements by the DLA Smt.Sarabjit Kaur  on material facts which have a vital impact on the medical underwriting of the proposal. But inspite of having complete knowledge of the medical condition suffered, the DLA Smt.Sarabjit Kaur intentionally withheld the material information from Opposite Parties No.1 and 2 and chose not to disclose the true and correct facts. The DLA Smt.Sarabjit Kaur had fraudulent intentions from the very beginning to defraud the Opposite Parties No.1 and 2 and to extract undue benefit. As per the claim intimation documents, DLA Smt.Sarabjit Kaur has passed away at Guru Nanak Dev Hospital on 12.2.2014, but during investigation it was found  that the DLA Smt.Sarabjit Kaur was suffering from Diabetes (Type-2), Hypertension & Chronic Renal Failure and was under treatment for the same in Smt.Parvati Devi Hospital for the period 29.5.2013 to 2.6.2013 which is prior to signing the proposal form for obtaining the policy. So, the repudiation of the claim of the complainant is just, proper, legal, valid and made on the grounds of non –disclosure of material facts.              While denying and controverting other allegations, dismissal of complaint was prayed.
3. Opposite Party No.3  appeared and filed written version in which it was submitted that the present complaint is bad for mis-joinder of parties as the answering Opposite Party  is unnecessarily arrayed as party to the present complaint. As far as obtaining policy in the name of DLA Smt.Sarabjit Kaur is concerned, the same is matter of record and terms and conditions of the policy may be perused and will prevail. However, in case any act done against terms and conditions of policy and due to contravention of terms and conditions of the policy, Opposite Party No.3 is not liable for any claim.   While denying and controverting other allegations, dismissal of complaint was prayed.
4. Complainant tendered into evidence his affidavit Ex.C1 alongwith documents Ex.C2 to Ex.C15 and closed the evidence on behalf of the complainant.
5. Opposite Parties No. 1 and 2 tendered into evidence affidavit of Sh.K.R.Vishwanarayan Ex.OP1,2/1 alongwith power of  attorney Ex.OP1,2/A, affidavit of Sanjay Kumar Ex.OP1/3 alongwith documents Ex.OP1,4 to Ex.Op1/10.
6. Opposite Party No.3 tendered into evidence the affidavit of Sh.G.S.Pahwa, Manager Ex.OP3/1.
7. We have carefully gone through the pleadings of the parties; arguments advanced by the ld.counsel for the parties and have appreciated the evidence produced on record by both the parties with the valuable assistance of the ld.counsel for both the parties.
8. From the record i.e. pleadings of the parties and the evidence produced on record by the parties, it is clear that Sarabjit Kaur wife of the complainant obtained life insurance policy bearing  No. G0000253 from Opposite Party No.1 through Opposite Party No.3, commenced w.e.f. 17.7.2013 having value of Rs.3 lacs. The complainant Sharanjit Singh being husband of policy holder Smt.Sarabjit Kaur was the  nominee under the said policy. Smt.Sarabjit Kaur insured, suddenly fell ill and was admitted in Shri Guru Nanak Dev Hospital, Amritsar where she died on 12.2.2014. Medical certificates to this respect are Ex.C8 and Ex.C9 and  death certificate is Ex.C6. The complainant being the nominee under the policy and husband of DLA Smt.Sarabjit Kaur lodged claim with Opposite Parties No.1 and 2 alongwith entire medical record  and relevant documents, but the Opposite Parties No.1 and 2 repudiated the claim of the complainant on 9.6.2014 vide letter Ex.C7 on the ground that the insured had not given the true facts at the time of obtaining the policy and she had  concealed the material facts. Ld.counsel for the complainant submitted that the insured has not concealed any material facts and all this amounts to deficiency of service on the part of the Opposite Parties. 
9. Whereas the case of the Opposite Parties No.1 and 2 is that the contract of the insurance is based on a foundation of utmost good faith i.e.Principle of Uberrimae Fide. The DLA Smt.Sarabjit Kaur had not disclosed the true facts to the insurer while obtaining the policy. She has given declaration Ex.C11 in which she has categorically stated that she did not suffer from any physical/ mental ailment/ disorder nor suffered from any disease nor remained admitted in any hospital whereas DLA Smt.Sarabjit Kaur remained admitted in Smt.Parvati Devi Hospital, Amritsar from 29.5.2013 to 2.6.213 as is evident from the discharge summary of that hospital Ex.OP1/5 where she was diagnosed as suffering from Type-2 Diabetes Mellitus/ hypertension, DKD, CRF (Chronic Renal Failure). The DLA Smt.Sarabjit Kaur has concealed these material facts from the Opposite Parties No.1 and 2 at the time of obtaining the insurance policy in question.  Had the DLA Smt.Sarabjit Kaur disclosed the true facts regarding her pre-existing disease and the fact that she remained admitted in Smt.Parvati Devi Hospital, Amritsar, the Opposite Parties No.1 and 2 would not have issued the policy in question i.e. insurance cover to the DLA Smt.Sarabjit Kaur. Ld.counsel for the Opposite Parties No.1 and 2 submitted that Opposite Parties No.1 and 2 have rightly repudiated the claim of the complainant vide letter dated 9.6.2014 Ex.C7. Ld.counsel for the Opposite Parties No.1 and 2 submitted that there is no deficiency of service on the part of the Opposite Parties No.1 and 2.
10. From the entire above discussion, we have come to the conclusion that  DLA Smt.Sarabjit Kaur got Master Life Insurance Policy in question from Opposite Parties No.1 and 2 through Opposite Party No.3  bearing  No. G0000253 commenced w.e.f. 17.7.2013 having value of Rs.3 lacs. At the time of taking the policy, DLA Smt.Sarabjit Kaur had given declaration i.e. declaration of good health Ex.C11 duly produced and proved by the complainant himself in which DLA Smt.Sarabjit Kaur herself has declared that she did not suffer from any physical/ mental ailment/ disorder nor suffered from any disease nor she remained admitted in any hospital/ clinic . This declaration was made by DLA Smt.Sarabjit Kaur on 17.7.2013 under her own signatures whereas the Opposite Parties No.1 and 2 have produced the medical treatment record  of DLA Smt.Sarabjit Kaur from Smt.Parvati Devi Hospital, Amritsar Ex.OP1/5 i.e. patient discharge summary and other relevant documents i.e. lab reports, etc. DLA Smt.Sarabjit Kaur remained admitted  in Smt.Parvati Devi Hospital, Amritsar from 29.5.2013 to 2.6.2013   and she was diagnosed a case of  Type-2 Diabetes Mellitus/ hypertension, DKD, CRF (Chronic Renal Failure). Not only this, she had already undergone cholecystectomy and hysterectomy. No doubt, the age of the patient on the record has been written as 35 years, but the complainant could not rebut these documents nor she ever denied that she did not remain admitted in Smt.Parvati Devi Hospital, Amritsar for the aforesaid disease. DLA Smt.Sarabjit Kaur remained admitted in Smt.Parvati Devi Hospital, Amritsar from 29.5.2013 to 2.6.2013 and she gave declaration Ex.C11 on 17.7.2013 i.e after about 2 months, where she was admitted for the aforesaid diseases in Smt. Parvati Devi Hospital, Amritsar. All this shows that DLA Smt.Sarabjit Kaur had intentionally concealed the material facts while giving this declaration Ex.C11 on the basis of which, the insurance policy was issued by Opposite Parties No.1 and 2 to DLA Smt.Sarabjit Kaur under the group Master Life Insurance Policy  through Opposite Party No.3. DLA Smt.Sarabjit Kaur has obtained the insurance policy from Opposite Parties No.1 and 2 by concealment of material facts. As such, the policy is void  abinitio and the complainant is not entitled to any relief under the policy in question for the death of DLA Smt.Sarabjit Kaur.
11.  Consequently, we hold that complaint is without merit and the same is hereby dismissed with no order as to cost. Copies of the order be furnished to the parties free of cost. File is ordered to be consigned to the record room. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum.

Dated: 20-08-2015.                                                   (Bhupinder Singh)                                                                                               President

hrg                                                (Anoop Sharma)     (Kulwant Kaur Bajwa)   

              Member                         Member