Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 559.
Instituted on : 22.09.2017.
Decided on : 07.01.2019.
Smt. Prem w/o Rai Singh s/o Sh. Hira Singh aged 68 years, r/o VPO Behlba, Pana Khas, Teh. Meham, Distt. Rohtak.
………..Complainant.
Vs.
- Kotak Mahindra Life Insurance Co. Ltd., through its Managing Director. Registered office- Plot C-12, G-block, BKC Bandra(E),. Mumbai-400051(Maharashtra).
Corporate office-Kotak Mahindra Life Insurance Co. Ltd., Kotak Infiniti, 7th Floor, Zone-1, Building no.21, Infiniti Park, Off Western Express Highway,Goregaon Mulund Link Road, General A K Vaidya Marg, Malad(E) Mumbai-400097.
- Branch Office-Kotak Mahindra Life Insurance Co. Ltd., Through its Branch Manager, JMD Regent Square, 2nd Floor, MG Road, Opp. Sahara Mall, Gurgaon(Haryana).
- Branch Office-Kotak Mahindra Insurance Co. Ltd., through its branch Manager, 1st Floor, No.5, Scheme No.19, Subhash Road, Subhash Park Rohtak-124001.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
SH. VED PAL, MEMBER.
SMT. SAROJ BALA BOHRA, MEMBER.
Present: Sh. R.S.Rajain, Advocate for the complainant.
Sh.Gulshan Chawla, Advocate for the opposite parties.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that late son of claimant namely Devender s/o Rai Singh had got his life insured with respondent/OPs for a sum of Rs.378000/- vide policy No.03555503 dated 19.10.2016. That the policy term was for 20 years having date of maturity 19.10.2036. That claimant has been nominated as nominee in the policy. That the half yearly premium of Rs.19981/- was paid on 19.10.2016 and the next premium was due on dated 10.04.2017. That unfortunately the policy holder Sh. Devender had died on 26.10.2018 in the ordinary course of nature in his village Behlba, District Rohtak. That the complainant applied for death claim of her son and submitted the entire relevant documents but the OP has illegally repudiated the claim of the complainant vide its letter dated 24.03.2017 on the ground that “The life insured intentionally withheld the material information from the company at the time of applying for the said policy”. That the son of the complainant had not withheld any information from the respondents in any manner. That the act of opposite parties of repudiating the genuine claim of the complainant is illegal and amounts to deficiency in service. Hence this complaint and the complainant has prayed for directing the OPs to pay a sum of Rs.378000/- alongwith interest, compensation and litigation expenses as explained in relief clause.
2. Notice of the complaint was issued to the opposite parties. Opposite parties in their written reply has submitted that the opposite party received a duly filled and signed proposal form dated 13.10.2016 from the complainant’s son (DLA) and on the basis of details and declaration mentioned in the proposal form and believing the same to be true and correct, the subject policy bearing no.03555503 was issued to the DLA by the opposite party. That on receipt of death claim intimation from the complainant, the answering opposite party initiated the process of claim investigation and during the said process; the answering opposite party became privy to the fact that the DLA already had an existing life insurance cover of about Rs.2073500/- much prior to availing the subject policy from the answering opposite party. That DLA had intentionally withheld the said material information from the OP and fraudulently procured the subject policy from the opposite party. That a cover of Rs.925000/- was also applied from Bajaj Allianz Life Insurance Co. whereby the same was declined as the LA died before issuance of the said cover. That the claim of the complainant was rightly repudiated on the grounds of non-disclosure of material facts, untrue statements contained in the said proposal form, which forms the basis for the issuance of the subject policy. That there is no deficiency in service on the part of opposite parties and dismissal of complaint has been sought.
3. Both the parties led evidence in support of their case.
4. Ld. Counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A & Ex.CW2/A, documents Ex.C1 to Ex.C8 and closed his evidence. On the other hand ld. Counsel for the opposite parties has tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R7(including R4(A) to Ex.R4(D) and has closed his evidence.
5. We have heard ld. counsel for the parties and have gone through the material aspects of the case carefully.
6. The perusal of the documents itself shows that the Life Insured Devender had taken the policy of Rs.378000/- from the opposite parties and after his death the complainant being nominee has filed the death claim. During the pendency of complaint, an affidavit was filed by the mother of the complainant and it was submitted that Smt. Prem w/o Rai Singh is the nominee and only legal heir of the late son namely Devender s/o Sh. Rai Singh. She also deposed that deceased Devender was unmarried and never taken any child in adoption till his death and in this way she is sole L.R. of deceased Devender. In the present case, the claim of the complainant was repudiated by the respondent officials vide letter dated 24.03.2017. As per the letter, the claim of the complainant was repudiated on the ground that the material information has been suppressed by the deceased and he had not disclosed the true and correct facts in his proposal form. As per the letter dated 24.03.2017 the life assured had applied for a total cover of more than Rs.2073000/- with other insurance companies prior to issuance of the present policy no.03555503 issued by the respondent officials. In this way, the material information has not been disclosed. So the claim of the complainant was repudiated as per the terms and conditions of the policy. In support of their case, ld. counsel for the opposite party has placed reliance upon the law of Hon’ble Supreme Court in Civil Appeal No.2776 of 2002, decided on 10.07.2009 tilted as Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. and law of Hon’ble National Commission in Revision Petition No.1573 of 2012 decided on 14.12.2017 titled as Sanjay Atmaram Patel Vs. LIC of India. On the other hand, ld. counsel for the complainant has also placed reliance upon the law AIR 2001 Supreme Court 549 titled as Life Insurance Corporation of India Vs. Smt. Asha Goel, 2005(1)CLT 494(NC) titled as LIC vs. P.S.Aggarwal, 2017(2)CLT 332(NC) titled as Baleshwar Singh Vs. LIC & Ors., order dated 12.04.2017 of Hon’ble National Commission in Aviva Life Insurance Co. vs. Rekhaben Ramjibhai Parmar, III(2011) CPJ373(NC) titled as LIC Vs. Shahida Begum and 2016(4)CPR 400:2017(2)CPJ497(NC) titled as IDBI Federal Life Insurance Co. Vs. Ramesh Parsad Jain.
7. After going through the above referred cases, it is observed that the respondent placed on record the judgment of Hon’ble Supreme Court tilted as Satwant Kaur(Supra). The perusal of this judgment shows that “Material fact” means any fact which would influence the judgment of a prudent insurer in fixing the premium or determining whether to accept the risk or not- if the proposer has knowledge of such fact, he is obliged to disclose the same-Failure to do so entitled the insurer to repudiate his liability under the policy”. In the alleged case the deceased purchased a mediclaim policy from the respondent and he has not disclosed in his proposal form that the LA/deceased was suffering from chronic renal failure/Diabetic Nephropathy. So the claim of the complainant was not paid and final appeal was dismissed in the Apex Court. In the present case the facts are different as in the case in hand, the deceased LA purchased life insurance policy and he gave all the relevant information in his claim form except the other health policies purchased from the other life insurance companies. Except this information, he had filled all the correct information before the OPs. In favour of his contention ld. counsel for the complainant placed on record case titled Aviva Life Insurance Co.Vs. Rekhaben Ramjibhi Armar decided by Hon’ble National commission on 12.04.2017, in which Apex Court in CEO Sahara India Life Insurance Co. Ltd. and another Vs. Rayani Ramayanjneyulu in SPL(c ) No.30740 of 2014 dated 21.11.2014 has held that “The main question involved in Sahara India case(Supra) was that the insured did not mention about the previous insurance policies. The Hon’ble Apex Court upheld the view of this commission that by no stretch of imagination the information about any previous insurance policies could be held to be material. The court has observed that it was difficult to fathom as to why these facts would influence the judgment of a prudent insurer in fixing premium of determining the cover or whether he would like to take the risk.”
8. After considering the above mentioned case, we came to the conclusion that the repudiation made by the insurance company on the false and fabricated ground is not legally justified. On the other hand, after considering the facts and documents placed on record by the respondent we came to the conclusion that in the repudiation letter the respondent insurance company took a plea that the deceased had already applied for total cover of more than Rs.2073000/- prior to issuance of the policy in dispute. We have perused the affidavit filed by the insurance company and at page no.6 of the affidavit the detail of 3 previous insurance companies has been mentioned. As per this affidavit, the deceased LA purchased the policy No.6806146 on dated 30.06.2015 from the Birla Sun Life Insurance Co. Ltd. having sum assured Rs.853500/-. The second policy was issued by Bajaj Allianz Insurance Co. having policy no.323469413 dated 31.08.2016 having sum assured Rs.400000/- and lastly a policy no.52261318 was issued by the Reliance Nippon Life Insurance Co. and date of proposal is not mentioned and the sum assured is Rs.820000/-.The total comes to Rs.2073500/-. After perusal of the documents placed on record as Ex.R4(A), four policies has been mentioned in this document. As per document Ex.R4(C) it has been established that the Bajaj Allianz Insurance company had approved the claim against the policy no.323469413 which was arisen against the death of deceased LA. In this way one insurance company had already paid the claim of the complainant which has been proved itself from the documents placed on record by the respondent officials. Moreover, the another claim arisen against the policy no.6806146, Birla Sun Life Insurance Co. having proposal dated 30.06.2015 was also settled down by the company which is proved with the document Ex.R4(D) placed on record by the respondent itself. Now coming upon third insurance cover, which is issued by the Reliance Nippon Life Insurance Co. having policy no.52261318, we have perused Ex.R7 a proposal form of one Devender s/o Udey Ram, resident of village Dhigtana, District, Hissar, Haryana. Perusal of this document shows that this policy does not pertain to the deceased LA because the father name and residential address of the DLA was different and this policy was issued in the name of some other Devender. So the respondent officials advanced that the deceased LA had not disclosed another cover notes/policies amounting to Rs.2073500/-, from which Rs.820000/- is falsely mentioned in the name of DLA. Payment of another two policies had already been paid by the insurance companies to the complainant. Hence the OPs have repudiated the claim of the complainant on false and fabricated grounds which is established from the documents placed on record by the OPs itself.
9. 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.03555503 amounting to Rs.378000/-(Rupees three lac seventy eight thousand only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 22.09.2017 till its actual realization and shall also pay a sum of Rs.5000/-(Rupees five thousand only) as compensation and litigation expenses to the complainant within one month from the date of decision.
10. Copy of this order be supplied to both the parties free of costs.
11. File be consigned to the record room after due compliance.
Announced in open court:
07.01.2019.
................................................
Nagender Singh Kadian, President
..........................................
Ved Pal Hooda, Member.
…………………………..
Saroj Bala Bohra, Member.
