Chandigarh

StateCommission

A/142/2023

TATA AIA LIFE INSURANCE COMPANY LTD, - Complainant(s)

Versus

JEEV SHARMA & ORS - Opp.Party(s)

NITIN THATAI ADV.

31 Oct 2023

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, U.T. CHANDIGARH

[Additional Bench]

Appeal No.	:	A/142/2023
Date  of  Institution	:	27/06/2023
Date   of   Decision	:	31/10/2023

 

 

 

 

 

Tata AIA Life Insurance Company Limited, through its CEO & Managing Director, 14^th Floor, Tower-A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai – 400013.

 

The present Appeal is being filed through Sh. Harsimran Singh, Assistant Vice President (Legal), Tata AIA Life Insurance Company Limited, SCO 2939-2940, 2^nd Floor, Sector 22-C, Chandigarh.

….Appellant

 

Versus

 

1.     Jeeva Sharma wife of Late Hari Singh, Resident of Village Gumma Taksal, 951 Parwanoo, Solan, Himachal Pradesh – 173220.

…. Contesting Respondent

 

2.     IndusInd Bank Limited, Branch SCO 359-360, Sector 35-B, Chandigarh – 160035.

 

3.     Anuj Bhardwaj, Relationship Manager (SRM), IndusInd Bank Limited, SCO 359-30, Sector 35-B, Chandigarh.

…. Performa Respondents

 

BEFORE: MRS. PADMA PANDEY   PRESIDING MEMBER

                PREETINDER SINGH     MEMBER

 

PRESENT	:	Sh. Nitin Thatai, Advocate (on Video Conferencing) and Ms. Monika Thatai, Advocate for the Appellant.
		Sh. Samrit Gill, Advocate proxy for Sh. Samuel Gill, Advocate for Respondent No.1/Complainant.
		Respondent Nos. 2 & 3 ex-parte vide order dated 31.08.2023

PER PADMA PANDEY, PRESIDING MEMBER

 

 

1.         This appeal is directed against the order dated 10.05.2023, rendered by the District Consumer Disputes Redressal Commission-I, U.T. Chandigarh (for brevity hereinafter to be referred as “the Ld. Lower Commission”), vide which, it allowed the Consumer Complaint bearing no.CC/553/2022, in the following terms:-

13]     In view of the above discussion, the present consumer complaint succeeds and the same is accordingly allowed. OP No.1 is directed as under:-

i.       to pay insured amount of ₹12,60,000/- to the Complainant, along with interest @ 9% per annum from the date of repudiating the claim till realization.

ii.      to pay an amount of ₹1,00,000/- to the complainant as compensation for causing mental agony and harassment to her.

iii.     to pay an amount of 20,000/- to the complainant as costs of litigation.

14]     This order be complied with by the OP No.1 within thirty days from the date of receipt of its certified copy, failing which, it shall make the payment of the amounts mentioned at Sr.No.(i) & (ii) above, with interest @12% per annum from the date of this order, till realization, apart from compliance of direction at Sr.No. (iii) above.

2.         For the convenience, the parties are being referred to, in the instant Appeal, as position held in Consumer Complaint before the Ld. Lower Commission.
3.         Before the Ld. Lower Commission, it was the case of the Complainant (Respondent No.1 herein) that her husband had purchased one TATA AIA Life Insurance Fortune Guarantee Plus Policy from OP No.1.  The said Policy was valid from 10.11.2021 to 10.11.2031 with maturity benefit death benefit.  The sum insured under the said Policy was ₹12,60,000/-. In case of death of life insured, during policy term, the benefit payable were highest as per terms and & of the policy. The husband of the complainant was under treatment from 13.01.2022 to 24.01.2022 at Frank Institute of Medical Sciences at Bahalgarh Sonipat, Haryana and died due to cardio resp failure as per progress report. The complainant approached OPs with the claim, but the OP No.1 denied the same vide letter  Annexure C-9 on the ground of disparity related to the medical condition of the insured  i.e. hypertension and COVID history  though the cause of death of the husband of the complainant was cardio resp failure. Hence, the aforesaid Consumer Complaint was filed before the Ld. Lower Commission, alleging deficiency in service and unfair trade practice on the part of the Opposite Parties.

 

4.         In the reply filed before the Ld. Lower Commission, while admitting the factual matrix of the case, OP No.1 (Appellant herein) pleaded that at the time of taking the policy the insured had to fill one COVID 19 exposure questionnaire form in which he was asked about the exposure of COVID 19 wherein he had mentioned that he had never been tested positive for COVID-19. The Insured with a malafide intention did not disclose his history of COVID 19. In the medical record placed on file it is clearly mentioned that the insured had been tested positive for COVID 19 before the issuance of policy. It is alleged that the insured had a history of COVID-19 and hypertension and these facts were deliberately and fraudulently suppressed in the proposal form as well as COVID 19 questionnaire form by the insured from the answering OP. Thus, there was no illegality in repudiating the claim of the complainant and a prayer has been made for dismissal of the Complaint.

 

5.         Opposite Party No.2 (Respondent No.2 herein) contested the consumer complaint pleading that the Policy in question was issued by OP No.1 which has no concern with the answering OP. The role of OP bank was only that of an intermediary and thus, it cannot be held liable for deficiency in service or unfair fair trade practice if any on the part of OP No.1. On these lines, the cause was sought to be defended and a prayer for dismissal of the Complaint was made.

 

6.         Since OP No.3 (Respondent No.3 herein) did not file reply within the stipulated period, despite affording ample opportunities, his defence was ordered to be struck off by the Ld. Lower Commission, vide order dated 16.12.2022.

 

7.         On appraisal of the pleadings of the parties and the evidence adduced on the record, Ld. Lower Commission accepted the Complaint and issued directions to the OP No.1 as noticed in the opening para of this order.  

 

8.         Aggrieved against the aforesaid order passed by the Ld. Lower Commission, the instant Appeal has been filed by the Appellant/OP No.1.

 

9.         Pertinently, in the present proceedings, notice of the appeal was sent to Respondents No.2 & 3. However, nobody appeared on their behalf despite service, therefore, they were proceeded ex-parte on 31.08.2023.

 

10.         We have heard Learned Counsel for the contesting parties and have gone through the evidence and record of the case with utmost care, along with the written arguments advanced on behalf of Respondent No.1/ Complainant.

 

11.         It is the case of the Complainant that the Ld. Lower Commission while passing the impugned order has failed to appreciate the documentary evidence available on record, which resulted into perverse finding, as the Ld. Lower Commission allowed the Complaint wrongly interpreting the law on the point and also ignoring the fact that there was concealment of material facts and information.  

 

12.         The consumer complaint has its genesis in the policy purchased online by the late husband of the Complainant on 08.11.2021 for which the Appellant/OP No.1 took his consent under the provisions of IRDAI (issuance of e-insurance policies) (First Amendment) Regulations, 2016. While submitting the proposal form, one form was to be filled by the deceased life assured (for short hereinafter to be referred as ‘the DLA’) i.e. COVID-19 Exposure Questionnaire, wherein the DLA stated that he had never tested positive for Corona Virus. Based on the information furnished in the proposal form and COVID-19 Questionnaire by the DLA, subject policy was issued with sum assured of ₹12,60,000/-. 
13.         Learned Counsel for the Appellant/OP No.1 argued that the Ld. Lower Commission failed to appreciate that the husband of Complainant/Respondent No.1 died due to cardio-respiratory failure and that he had been suffering from Hypertension and had also been tested positive for Corona Virus before the issuance of the policy which vital fact he withheld while submitting COVID-19 questionnaire.  Per material available on record, we find sufficient force in the above argument, in as much as, although the Ld. Lower Commission by placing reliance on Neelam Chopra Vs. Life Insurance Corporation of India, (decided on 0^th Oct. 2018) has taken due cognizance of the fact that the DLA was suffering from Hypertension and that the same being a life style disease the claim of the insured cannot be rejected, yet there was not even an iota of discussion with regard to the COVID History of the DLA, much less about the statement made in the COVID-19 questionnaire at the time of taking the subject policy. The Ld. Lower Commission has also misconstrued & misapplied the law laid down by the Hon’ble Apex Court in Manmohan Nanda Vs. United India Assurance Co. Ltd. & Anr., 2022 (1) RCR (Civil) 449, inasmuch as, one of the principles laid down by the Hon’ble Supreme Court stipulates that if specific queries are made in a proposal form then it is expected that specific answers are given by the insured who is bound by the duty to disclose all material facts. Thus, it is an obligation on the part of the DLA to disclose all the facts about his health condition. As a natural corollary to above, the aforesaid aspects were required to be dealt with by the Ld. Lower Commission threadbare in the light of material available on record.  However, the Ld. Lower Commission failed to notice the same and proceeded to record its findings on surmises and conjectures, which to our mind, amounts to miscarriage of justice and is against the principles of natural justice. The cogent evidences which were on record and speaking the truth had been ignored and not taken into consideration by the Ld. Lower Commission.

 

14.         To our mind, the Ld. Lower Commission has taken a somewhat inclement view of the matter without entirely appreciating the facts & circumstances in the right perspective as a result of which the complaint remained unadjudicated on its merits. This Bench feels, that in the peculiar circumstances and facts of this case it would result in something less than justice if the cause of the lis be not allowed adjudication upon merits. The door of justice ought to have been kept ajar and the matter ought to have been better adjudicated on merits.   

 

15.         In the wake of above, it is evident that the Ld. Lower Commission was, thus, wrong, in accepting the complaint. The findings of the Ld. Lower Commission, in this regard, being illegal, therefore, deserve to be reversed.

 

16.         No other point, was urged, by the Counsel for the Parties.

 

17.         For the reasons recorded above, the appeals are accepted, with no order as to costs. The order of the Ld. Lower Commission is set aside. The cases are remanded back to the Ld. Lower Commission, with a direction to decide the same afresh, on merits, expeditiously, in accordance with the provisions of law.

 

18.         Pending application(s), if any, also stand disposed off as having been rendered infructuous.     

 

19.         The parties are directed to appear before the Ld. District Consumer Disputes Redressal Commission-I, U.T., Chandigarh, on 10.11.2023 at 10.30 A.M. for further proceedings.

 

20.         The record of the Ld. Lower Commission, alongwith a certified copy of the order, be sent back immediately, so as to reach there, well before the date and time fixed.

 

21.         Certified copy of this order be placed on the records of the connected appeal.

 

22.         Certified Copies of this order, be sent to the parties, free of charge. 

 

23.         The appeal file be consigned to the Record Room, after due completion.

Pronounced

31^st October, 2023                                                                     

                                         Sd/-                         

                                                                (PADMA PANDEY)

PRESIDING MEMBER

 

 

Sd/-

(PREETINDER SINGH)

MEMBER

“Dutt”