Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. : 428.
Instituted on : 10.09.2018.
Decided on : 22.06.2022.
- Khajani mother of Late Sh. Jagat Singh s/o Late Sube Singh, resident of village Farmana Badshapur Tehsil Meham Distt. Rohtak.
- Muskan minor daughter of Late Sh. Jagat Singh, through her grandmother being natural guardian and next friend, resident of village Farmana Badshapur Tehsil Meham Distt. Rohtak.
.......................Complainants.
Vs.
- Kotak Mahindra Life Insurance Company Ltd., registered office 2nd Floor, Plot no. C-12, G-Block, BKG, Bamdra, (E) Mumbai-400051, through its Divisional Manager office at opposite All India Radio, Subhas Road, Rohtak.
- Kotak Mahindra Life insurance Company Ltd., through its Divisional Manager, Opposite All India Radio, Subhas Road, Rohtak.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
DR. SHYAM LAL, MEMBER.
Present: Sh.Sanjay Saharan Advocate for complainant.
Sh.Gulshan Chawla Advocate for opposite parties.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that son of complainant namely Jagat Singh son of Sube Singh had obtained one life insurance policy bearing no.03914772 issued on 06.11.2017 for the sum assured Rs.600000/- from the opposite parties. Before availing the said policy Jagat Singh had disclosed all the required facts/quarries regarding his health to the concerned authorized official who had filled up the proposal form etc. and after fully satisfying with the same, the respondents had issued the aforesaid policy. Complainant was nominated as nominee for the said policy. Life assured Jagat Singh has died on 23.11.2017 due to chest pain. Complainant being nominee for the said policy and being legal heir of Jagat Singh submitted her claim for the said policy and completed all the required formalities as required by respondents. Complainant visited the office of the respondents many a times to get the genuine claim amount but despite her repeated requests, no claim amount has been disbursed to the complainant. The respondents have issued a letter dated 31.03.2018 mentioning therein illegal and arbitrary facts “non disclosure and suppression of material facts” and repudiated the genuine claim of complainant and did not supply any copy of document in support of their version. The act of opposite parties is illegal and amounts to deficiency in service. Hence this complaint and it is prayed that opposite parties may kindly be directed to pay the claim amount of policy amounting to Rs.600000/- alongwith interest, compensation and litigation to the complainant expenses as explained in relief clause.
2. After registration of complaint, notice was issued to the opposite parties. Opposite parties filed their written reply submitting therein that the respondents, upon receiving the application form in the name of life assured namely Jagat Singh and believing the details to be true and correct had issued policy bearing no.03914772 on 06.11.2017 having sum assured of Rs.600000/-. It is submitted that the DLA/policyholder had specifically been asked under clause No.11.1(d) of the proposal form about his previous ailments including any respiratory diseases/disorders like asthma, bronchitis, pulmonary TB, lung ailments etc. The questions have been answered in the negative by the DLA and the same is reflected in the proposal form. Thereafter opposite parties received death claim intimation from the complainant on 23.01.2018 informing the answering opposite party that the policyholder expired on 23.11.2017 i.e. within 17 days from the date of issuance of the policy. Opposite party carried out investigation and found that the life assured had intentionally concealed certain material facts pertaining to his health at the time of issuance of policy. It was discovered that the deceased life assured had been suffering from TB since 2014 and had been taking treatment for the same upto 2015. The same is evident from the details of the DLA procured from the Treatment Card of Revised National Tuberculosis Programme. Furthermore, it was also observed that the DLA had applied for Insurance cover from other insurer immediately after the present insurance policy with the respondent company. The subject policy was issued to the DLA on 06.11.2017. DLA had applied for other policy within 4 days of the policy with the opposite party. Thereafter DLA was died on 23.11.2017 i.e. within 17 days . The DLA had procured multiple policies before his death which is highly suspicious to say the least and is evident of the malafide intention of the DLA to procure the said covers. Respondent company had received confirmations over email from other Insurance companies of existing covers with them i.e. Kotak life on 06.11.2017 for sum assured Rs.600000/- and Aditya Birla Sun Life on 14.11.2017 for Sum assured Rs.1000000/-. Thereafter, it was discovered that the complainant had applied for insurance policies exceeding Rs.16 lacs within 17 days of death. Said act of LA itself reveals the ill motive to procure the subject policy. In the light of same, the respondent company vide its letter dated 31.03.2018 had rightly rejected the claim and as such no harassment had been caused to the complainant. All the other contents of the complaint were stated to be wrong and denied and opposite parties prayed for dismissal of complaint with costs.
3. Ld. Counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.CW2 to Ex.CW6 and closed his evidence on dated 04.04.2019. Ld. counsel for opposite party has tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R6 and closed his evidence on 19.09.2019.
4. We have heard ld. counsel for the parties and have gone through the material aspects of the case very carefully.
5. In the present case, the claim of the complainant has been repudiated by the opposite party on the ground that life assured had intentionally concealed certain material facts pertaining to his health at the time of issuance of policy. It was discovered that the deceased life assured had been suffering from TB since 2014 and had been taking treatment for the same upto 2015. To prove the same, opposite parties have placed on record document Ex.R4 which is a treatment Card of Revised National Tuberculosis Programme. It is further contended that the DLA had applied for Insurance cover from other insurer immediately after the present insurance policy with the respondent company. The subject policy was issued to the DLA on 06.11.2017. DLA had applied for other policy within 4 days of the policy with the opposite party. Thereafter DLA was died on 23.11.2017 i.e. within 17 days . The DLA had procured multiple policies before his death which is highly suspicious to say the least and is evident of the malafide intention of the DLA to procure the said covers. Ld. counsel has also placed reliance upon the law of Hon’ble Supreme Court of India in Civil Appeal no.4261 of 2019 titled as Reliance Life Insurance Co. Ltd. Vs. Rekhaben Nareshbhai Rathod whereby Hon’ble Supreme Court has held that : “Failure of insured to disclose policy of insurance entitled insurer to repudiate claim”. Ld. counsel has also placed reliance upon the judgment dated 20.10.2009 of Hon’ble Supreme Court titled as Grasim industries Ltd. and another Vs. Agarwal Steel.
6. After going through the file and hearing the parties it is observed that in fact the respondents have pleaded that complainant has concealed some material fact from the respondent insurance company regarding his health and some other insurance policies taken from other insurance companies. Regarding the health of life assured, it is observed that he was suffering from TB since 2014 and had been taking treatment for the same upto 2015. But he has taken the present insurance policy on 11/2017. Meaning thereby he was not suffering from TB at the time of issuance of present policy. So he did not disclose this fact at the time of proposal for the policy. No doubt as per the proposal form Ex.R1, the answer to the question that : “Have you ever suffered from, received/receiving treatment or advice for any respiratory disease/disorder like asthma, bronchitis, pulmonary TB, lung ailment etc.?”, is given in negative. But it is not proved that the life assured himself has filled the proposal form. It is the general practice of the insurance companies that the proposal form is filled by the agent/officials of the companies and then it is got signed by the insurer. Moreover, it was the duty of the opposite parties to make investigation about the declaration of the health given by life insured after issuance of the policy. But the same has been done after the death of life insured. Hence concealment regarding health is not proved. Regarding the other plea that some other insurance policies had been taken by the life assured from other insurance companies and he has concealed the same from the opposite party. In this regard it is observed that complainant had taken the policy from the opposite party on 06.11.2017 and from the Aditya Birla Company on 14.11.2017. When a policy has been taken after 8 days of the purchase of present policy, how the same can be disclosed at the time of purchase of present policy. Hence the repudiation of claim by the opposite party is illegal and amounts to deficiency in service and opposite parties are liable to pay the sum assured to the L.Rs of deceased Jagat Singh. As such the law cited above by ld. counsel for the opposite parties are not fully applicable on the facts and circumstances of the case.
7. In the present complaint initially the complainant has pleaded that she is sole legal heir of the deceased Jagat Singh but lateron an application has been moved by the complainant’s counsel on dated 22.04.2022 for filing an amended title and also submitted that the deceased Jagat Singh was married and he has minor daughter namely Muskan and he also placed on record the death certificate of Sube Singh as ‘Annexure JN-A’, death certificate of Smt. Usha Devi wife of Jagat Singh as ‘Annexure JN-B’, birth certificate of Muskan as ‘Annexure JN-C’ and Aadhar card of Muskan as ‘Annexure JN-D’. In this way in the present case, there are two legal heirs of deceased Jagat Singh i.e. Khajani Devi mother of deceased Jagat Singh and Muskan daughter of deceased Jagat Singh.
8. In view of the facts and circumstances of the case we hereby allow the complaint and direct the opposite parties to pay the claim amount of Rs.600000/-(Rupees six lacs only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 10.09.2018 till its realization and shall also pay a sum of Rs.5000/-(Rupees five thousand only) as compensation on account of deficiency in service and Rs.5000/-(Rupees five thousand only) as litigation expenses to the complainants i.e. L.Rs of deceased Jagat Singh. It is made clear that out of the total awarded amount, 25% amount will be given to the mother of deceased Jagat Singh i.e. Khajani(complainant no.1) and remaining 75% amount will be given to the daughter of the deceased i.e. Muskan(complainant no.2), which shall be deposited in any nationalized bank in the shape of FDR and will be disbursed to her on attaining the age of majority. Order shall be complied within one month from the date of decision.
9. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
22.06.2022.
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Nagender Singh Kadian, President
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Tripti Pannu, Member.
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Shyam Lal, Member.
