Haryana

Bhiwani

CC/574/2019

chhoto devi - Complainant(s)

Versus

kotak insurance - Opp.Party(s)

r.l ranga

09 Nov 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BHIWANI.

 

                                                                  Consumer Complaint No. : 574 of 2019

                                                      Date of Institution             : 23.07.2019

                                                                  Date of order                     : 09.11.2023

 

Smt. Chhoto Devi wife of Shri Diwan Singh R/o village Dhanana-III, Tehsil and District Bhiwani.

  

             ……Complainant.

 

Versus

 

1.         Kotak Life Insurance Co. Ltd. Regd. Office 2^nd Floor, Plot No.C-12, G-Block, BKC Bandra (E), Mumbai (Maharashtra)-400051 through its M.D./Authorized signatory.

 

2.         The Branch Manager, Kotak Life Insurance Co. Ltd. Near Basia Bhawan, Hansi Road, Bhiwani, Tehsil and District Bhiwani.

 

…… Opposite Parties.

 

COMPLAINT U/S 12 OF CONSUMER PROECTION ACT, 1986.

 

BEFORE:          Hon’ble Mrs. Saroj Bala Bohra, Presiding Member.

  Ms. Shashi Kiran Panwar, Member.

 

Present:-          Sh. Devender Singh, Advocate for complainant.

             Sh. Kapil Shrama, Advocate for OPs.

 

ORDER:

 

Saroj Bala Bohra, Presiding Member.

 

1.                     Brief facts of this case are that Sh. Himmat Singh (since deceased), son of complainant, date of birth 10.10.1982, had purchased a life insurance policy from OP No.2 vide policy No.03884521 and complainant is nominee in the policy. The said policy was commenced from 30.06.2017 with date of maturity as 30.06.2032 for sum assured Rs.4,20,000/-. As per complainant, the policy was covering all risk i.e. normal and accidental death from the commencement of the policy.  Complainant has alleged that the policy was commenced from 03.06.2017 and one receipt has also issued in favour of son of complainant and schedule part A receipt also issued in his favour and this receipt showing commencement of rider from 30.06.2017 i.e. after 27 days of issuance of the receipt. Complainant paid premium Rs.24014.31p. vide cheque no.692278 for the said policy.  It has submitted that life assured expired, so complainant, being nominee, lodged a claim with OPs completing all formalities for due benefit under the policy but the OPs closed it as No Claim vide letter dated 09.03.2018 alongwith cheque of Rs.24014.31p.  Complainant get served a legal notice dated 26.10.2018 upon the OPs but of no avail which, as per complainant, amounts to deficiency in service, causing monetary loss as well as mental and physical harassment to her.  Hence,  the present complaint has been preferred seeking directions against the OPs to pay Rs.4,20,000/- alongwith interest @18% per annum alongwith premium amount till final realization, further to pay Rs.50,000/- on account of mental and physical harassment. Any other relief to which this Commission deems fit has also been sought.

2.                     Upon notice, OPs appeared and filed written statement submitting therein that on receiving proposal form from complainant dated 05.06.2017 alongwith auto debit instruction from Mr. Himmat Singh (Deceased Life Assured) for an insurance policy on 05.06.2017. The DLA opted for Kotak Premium Endowment Plan with a policy term of 15 years and annual premium of was Rs.25,091/-.  Thereafter, OP raised a requirement on 09.06.2017 for providing confirmation for mismatch in modal premium mentioned Proposal form and Benefit Illustration and also a fresh proposal form filled alongwith all necessary details. As such, OP received a fresh proposal dated 13.06.2017. Accordingly, a policy was issued on this proposal form for a sum assured of Rs.4,20,000/- and policy was commenced from 30.06.2017.   It has been submitted that OP received a death claim intimation dated 31.10.2017 and 06.11.2017 alongwith all other necessary documents that life assured passed away on 07.06.2017 i.e. 2 days after signing of first proposal form dated 05.06.2017.  During evaluation of the claim, OP noticed that DLA died on 07.06.2017 and policy contract commenced on 30.06.2017, as such, on the date of commencement of the policy, life assured was not alive and hence the contract was rendered void, invalid, fraud hence policy was cancelled from inception as per clause 8 of the policy contract.  In the end, prayer for dismissal of complaint with costs has been made.

4.                     In evidence of complainant, evidence affidavit of complainant Ex. CW1/A alongwith documents Annexure C-1 to Annexure C-8 has been filed and closed the evidence.

5.                     On the other hand, evidence affidavit Ex.RW1/A of Sh. Aditya Singh, AVP, Legal alongwith documents Annexure R-1 to Annexure R-8 and closed the evidence.

6.                     We have heard learned counsel for the parties and perused the record minutely. Complainant to prove her case has placed reliance on a  schedule pertaining to policy (Annexure C-1), it reveals that the policy in question was to be commenced from 30.06.2017 and perusal of proposal deposit receipt (Annexure C-3) reveals that OP had received Rs.25090/- as premium in the name of deceased life assured on 05.06.2017. As per death certificate (Annexure C-7) it is clear that Himmat Singh (DLA) died on 07.06.2017 and Annexure C-8 reveals that deceased life assured had singed a part of proposal form on 03.06.2017.  Thus learned counsel for complainant has argued that the life assured, on his date of death, was duly covered for the benefit of insurance under the policy and prayed for acceptance of the complaint.

7.                     On the other side, OPs placed reliance on the proposal form dated 05.06.2017 (Annexure R-1) which reveals that it was signed by life assured on 03.06.2017. The second proposal form dated 13.06.2017 has also been placed on record as (Annexure R-3). A careful perusal of policy document Annexure R-4 reveals that the date of commencement of policy & risk was from 30.06.2017.  A careful perusal of record shows that Ops have placed on record two proposal forms dated 05.06.2017 & 13.06.2017 (Annexure R-1 & R-2) respectively.  These both the proposal forms have been signed by life assured Himmat Singh.  It is not in dispute that life assured died on 07.06.2017 and the second proposal form has been filled up after the date of his death. Thus the story so put forth by the Ops to level their case, creates doubt and thereby assumed that both these forms were purportedly got signed by the OPs /their agent from life assured during subsistence of his life and now have used these documents as a tool to bring the case in their favour.

8.                     Deceased life assured paid the premium amount on 05.06.2017 as is clear from premium receipt Annexure C-3 and complainant expired on 07.06.2017. Thus the risk cover on the life of insured person commence from 05.06.2017  and not from 30.06.2017 as alleged by the OPs. Thus the deceased life assured comes under the umbrella of insurance risk cover under the policy in question.  To substantiate its case, no satisfactory evidence has been filed on record on behalf of Ops, either oral or documentary, to satisfy this Commission that there was justified ground on the part of Ops to repudiate the genuine claim of the complainant after death of her son. Admittedly, the complainant is nominee in the policy and the policy is having sum assured Rs.4,20,000/-. Further, complainant side admits that a sum of Rs.25090/- has already been received by them qua the policy in question. Here, we may place reliance on case law delivered by Hon’ble Punjab & Haryana High Court in CWP No.26178 of 2016 titled as National Insurance Co.Ltd. Vs. Sandeep & others reported in 2017 (1) RCR (Civil) Page 621 wherein it has been  held that “Insurance companies give lucrative offers to attract customers-However, the moment any insured puts even the most genuine claim, seldom said claim would be accepted by any insurance company.”

9.              For the abovementioned reasons, we are of the considered opinion that there was deficiency in service and unfair trade practice on the part of both the Ops by not allowing the genuine claim of the complainant qua sum assured under the policy taken by the insured/son of complainant. Hence, this complaint is allowed and the OPs, jointly and severally, are directed to comply with the following directions within 40 days from the date of order:-

(i)        To pay a sum of Rs.3,94,910/- (Rs.Three lac ninety four thousand nine hundred ten) to the complainant being nominee in the policy alongwith simple interest @ 9% per annum from the date of filing of complaint till the actual realization.

(ii)       To pay Rs.10,000/- (Rs. Ten thousand) as compensation  on account of mental agony and physical harassment. 

3. To pay Rs.5500/- (Rs. Five thousand five hundred) as litigation expenses.

                        In case of default, the Ops shall liable to pay simple interest @ 12% per annum on the aforesaid all the amounts for the period of default. Certified copies of the order be sent to parties, free of costs, as per rules. File be consigned to the record room, after due compliance.

Announced.

Dated:09.11.2023.