Haryana

Kaithal

214/19

Krishana - Complainant(s)

Versus

Kotak Mahindra Life Insurance Co.Ltd - Opp.Party(s)

Sh.Gurdev Singh

08 Aug 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KAITHAL.

                                                     Complaint Case No.214/2019.

                                                     Date of institution: 30.07.2019.

                                                     Date of decision:08.08.2023.

Krishna aged 52 years wife of Soran, resident of Kalapatti Village Kailram, Tehsil Kalayat, Distt. Kaithal.

                                                                        …Complainant.

                        Versus

1. Kotak Mahindra Life Insurance Company Ltd., Regd. Office, 2^nd Floor, Plot C-12 G Block BKC, Bandra (E), Mumbai-400051 through its Zonal Manager.
2. Kotak Mahindra Life Insurance Company Ltd., Dhand Road, Kaithal through its Branch Manager.
3. John Deere Agency, New Grain Market Road, Kalayat, Distt. Kaithal now shifted at Kaithal in the name of A.C.Agency, Ambala Road Bye pass near Maruti and Toyota Agency, Kaithal through its partners namely Goldy and Dilbag Singh.
4. Vijender son of Ram Niwas, resident of Village Songal, Tehsil and Distt. Kaithal, agent of the Kotak Mahindra Life Insurance Company Ltd., Kaithal.

….OPs.

        Complaint under Section 12 of the Consumer Protection Act

CORAM:     SMT. NEELAM KASHYAP, PRESIDENT.

                SMT. SUMAN RANA, MEMBER.

                SH. SUNIL MOHAN TRIKHA, MEMBER.

       

Present:     Sh. Gurdev Singh, Advocate, for the complainant.   

                Sh. Manoj Ichhpilani, Advocate for the OPs.No.1 & 2.

                Sh. Shamsher Singh, Adv. for the OP No.3.

                OP No.4 exparte.

               

ORDER

NEELAM KASHYAP, PRESIDENT

        Krishna-Complainant has filed this complaint under Section 12 of Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the OPs.

2.             In nutshell, the facts of present case are that Lakhbir Singh son of Soran Singh was the son of the complainant, borrowed a loan for tractor from the OPs and the OPs had issued the policy against the said loan of tractor.  The son of complainant got his life insured with the OPs vide policy No.CC000014 (loan account No.TEE6033163) for the insured amount of Rs.4,00,000/-.  The son of complainant died on 26.05.2018 and the complainant being nominee of her son lodged the claim with the OPs and submitted all the necessary documents but the Ops repudiated the claim of complainant vide letter dt. 12.11.2018.  The said repudiation of claim is stated to be wrong and illegal.  So, it is a clear cut case of deficiency in service on the part of OPs and prayed for acceptance of complaint.     

3.         Upon notice, the OPs No.1 to 3 appeared before this Commission, whereas OP No.4 did not appear and opted to proceed against exparte vide order dt. 03.01.2020 passed by this Commission.  OPs No.1 & 2 contested the complaint by filing their joint written version raising preliminary objections that the claim of complainant was repudiated by the answering Ops on the ground that the life assured has not disclosed correct information and suppressed material facts in the Membership Form-cum-Declaration  of Good Health (hereinafter referred to as ‘DOGH’) with regards to his pre-existing illness.  The DLA was suffering from Human Immunodeficiency Virus (HIV+) prior to applying for the subject policy and the said fact was suppressed by the deceased life assured.  The discharge summary dt. 03.04.2018 from CHC/PHC/UHC/UPHC-KTL confirms that the life assured had a history of HIV+two years ago.  The DOGH was signed by the member on 25.05.2018 and the said fact was not disclosed by the member at the time of signing the DOGH.  There is no deficiency in service on the part of OPs.  On merits, the objections raised in the preliminary objections are rebutted and so, prayed for dismissal of complaint.

4.             OP No.3 filed the written version raising preliminary objections with regard to maintainability; locus-standi; cause of action and evasively denied all the facts so contained in the complaint and so, prayed for dismissal of complaint.  

5.             To prove his case, the complainant tendered into evidence affidavit Ex.CW1/A alongwith documents Annexure-C1 to Annexure-C11 and thereafter, closed the evidence.

6.             On the other hand, the OPs No.1 & 2 tendered into evidence affidavit Ex.RW1/A alongwith documents Annexure-R1 to Annexure-R6, OP No.3 tendered into evidence affidavit Ex.RW3/A and thereafter, closed the evidence.

7.             We have heard the learned Counsel for both the parties and perused the record carefully.

8.             Ld. counsel for the complainant has argued that Lakhbir Singh son of Soran Singh was the son of the complainant, borrowed a loan for tractor from the OPs and the OPs had issued the policy against the said loan of tractor.  It is further argued that the son of complainant got his life insured with the OPs vide policy No.CC000014 (loan account No.TEE6033163) for the insured amount of Rs.4,00,000/-.  The son of complainant died on 26.05.2018 and the complainant being nominee of her son lodged the claim with the OPs and submitted all the necessary documents but the Ops repudiated the claim of complainant vide letter dt. 12.11.2018.  It is further argued that the said repudiation of claim is wrong and illegal.  So, it is a clear cut case of deficiency in service on the part of OPs.

9.             On the other hand, ld. counsel for the Ops No.1 & 2 has argued that the claim of complainant was repudiated by the Ops No.1 & 2 on the ground that the life assured has not disclosed correct information and suppressed material facts in the Membership Form-cum-Declaration  of Good Health (hereinafter referred to as ‘DOGH’) with regards to his pre-existing illness.  It is further argued that the DLA was suffering from Human Immunodeficiency Virus (HIV+) prior to applying for the subject policy and the said fact was suppressed by the deceased life assured.  The discharge summary dt. 03.04.2018 from CHC/PHC/UHC/UPHC-KTL confirms that the life assured had a history of HIV+two years ago.  The DOGH was signed by the member on 25.05.2018 and the said fact was not disclosed by the member at the time of signing the DOGH.

10.            Ld. counsel for the OP No.3 has argued that the complainant never intimated the OP No.3 regarding the death of her son and moreover, the OP No.3 has no concern with the complainant and her son.

11.            We have considered the rival contentions of both the parties.  The OPs No.1 & 2 have repudiated the claim of complainant vide letter dt. 12.11.2018 as per Annexure-C1/R6 on the ground that the life assured was suffering from Human Immunodeficiency virus prior to the date of signing the DOGH.  We have perused the Membership Form-cum-Declaration of Good Health as per Anneuxre-R1, wherein the life assured namely Lakhbir Singh (since deceased) son of complainant has mentioned as under:-

        “I hereby declare that:

        I am in good health”

        Ld. counsel for the OPs No.1 & 2 has placed on file the discharge summary dt. 03.04.2018 from CHC/PHC/UHC/UPHC-KTL as per Annexure-R4 which confirms that the life assured had a history of HIV+two years ago.  The aforesaid DOGH was duly filled-up and signed by the life assured on 25.05.2018 and the said fact was not disclosed by the member at the time of signing the DOGH.  Ld. counsel for the OPs No.1 & 2 has placed reliance upon the case law titled as Kaleshwati Bai Vs. LIC decided by Hon’ble National Commission on 12.11.2014 bearing Revision Petition No.1313 of 2014, wherein in para No.8 of said judgment, it is mentioned that “The deceased while replying to the questions contained in the proposal form, misrepresented by saying that he had not consulted any doctor in connection with treatment of an illness which lasted for more than one week.  Similarly he also made a false representation that he had never suffered from any kidney related disease.  Misrepresentation made by the deceased true state of his health to the corporation it is quite likely that either the proposal submitted by him would not have been accepted or the corporation might have asked for a higher premium considering the state of his health and the past history of his ailment.  The LIC, therefore, was fully justified in repudiating the claim.  We, therefore, find no merit in the revision petition and the same is hereby dismissed.  No order as to costs.”

        The said authority is fully applicable to the facts of instant case.  From the facts and circumstances of the case, it is clear that the life assured deceased has concealed the material information regarding his disease Human Immunodeficiency Virus (HIV+) in the DOGH Form. So,  we are of the considered view that the OPs No.1 & 2 have committed no mistake in repudiating the claim of the complainant.  Hence, we found no deficiency on the part of the OPs.       

12.            Thus, as a sequel of aforesaid discussion, we find no merit in the present complaint and accordingly, the same is hereby dismissed.  There is no order as to costs.  A copy of this order be sent to both the parties free of cost.  File be consigned to the record room after due compliance.     

Announced in open court:

Dt.:08.08.2023.

                                                                (Neelam Kashyap)

                                                                President.

 

(Sunil Mohan Trikha),           (Suman Rana),          

Member.                            Member.

 

Typed by: Sanjay Kumar, S.G.