Haryana

Fatehabad

CC/207/2018

Rameshwar - Complainant(s)

Versus

Kotak Mahindra life Insurance - Opp.Party(s)

Sukhbir Dhaka

15 Mar 2021

ORDER

 

BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, FATEHABAD.

 

                                                                Complaint No.: 207 of 2018

                                                                   Date of Institution: 30.07.2018

                                                            Date of order:  15.03.2021.

 

Rameshwar son of Amar Singh resident of Agroha District Hisar.

 

                                                                          ….. Complainant.

                                          Versus                   

 

1. Kotak Mahindra Old Mutual Life Insurance Limited, Registered Office : 2^nd Floor, Plot No.C-12, G-Block, BKC, Bandra (E), Mumbai through its Chairman-cum-Managing Director/Authorized Person.
2. Kotak Mahindera Old Mutual Life Insurance Company Limited, Branch Office, Ist Floor, Meet Complex situated at New Bus Stand Road, Near Nehru Park, Plot No.87/8 and 88/8, Narwana (Haryana) 126116 through its Branch Manager.
3. Rajender Kumar son of Aad Ram resident of Ward no.10, Village Pirthala Tehsil Tohana District Fatehabad.

 

….Opposite parties.

 

Complaint U/s 12 of the Consumer Protection Act

                                                                                                    

Before:                      Sh.Raghbir Singh, President.

                                   Smt.Sukhdeep Kaur, Member.

 

           

Present:                      Sh.Sukhbir Dhaka, counsel for the complainant.

Sh.Yogesh Gupta, counsel for the OPs No.1 & 2.

Sh.Suraj Kiran, counsel for OP No.3.                      

 

ORDER:

 

                        The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against the opposite parties with the averments that wife of the complainant namely, Sursati got herself insured with the OPs vide insurance policy no.361213 valid from 07.02.20-17 to 05.02.2031 for a sum assured of Rs.4 lakh and a payment of insurance premium amounting to Rs.35996/- was also made.  The complainant was nominated as nominee in the abovesaid policy.

2.                     It is further submitted that the life assured died on 25.07.2017 and intimation regarding her death was given to the OPs by the complainant and claim was also submitted after completion of all the formalities and the complainant was assured by the OPs that the insurance claim would be released to him very soon.  However, the OPs instead of settling the insurance claim of the complainant repudiated the genuine claim of the complainant wrongly and illegally and verbally informed the complainant.  It is further submitted that the abovesaid act on the part of OPs amounts to deficiency in rendering service to the complainant.  Hence, the present complaint. In evidence, the complainant has tendered affidavit Annexure C1/A and documents Annexure C1 to Annexure C3.

3.                     On being served OPs appeared and filed their respective replies.  The OP Nos.1 & 2 in their joint reply have taken preliminary objections such as maintainability, jurisdiction and cause of action etc. It has been submitted that the insurance company had received duly signed proposal form and on the basis of same policy bearing No.03612130 was issued on 07.02.2017.  Since the information provided by the Life Assured in the proposal form was established to be untrue and false, therefore, the answering Ops were well within their right to repudiate the said claim, therefore, no deficiency in service can be fasten against them.  It has been further submitted that the life assured passed away within 6 months from the date of commencement of the subject policy, therefore, the claim was rightly repudiated and the present complaint is devoid of material particulars and has been filed merely to harass and gain undue advantage and unjustified money from the answering Ops.  The complainant has not acted in good faith with respect to the subject of this complaint and has approached to this Commission with unclean hands. It has been further submitted that during the assessment of the claim, it was revealed that the life assured had availed multiple life insurance policies from other insurance companies and the said fact was not disclosed to the answering OPs in the proposal form.  It is further submitted that the life assured had already availed insurance policies from other insurance companies for account of Rs.13.20 lakhs before applying for the subject insurance policy. Therefore, the fraudulent action of the life assured is evident from the details of the total cover which is mentioned in the chart as below:-

Sr. No.	Company Name	Policy No.	Proposal Date	Sum Assured
1.	Birla Sun Life	007132601	06/10/2016	7,20,000
2.	Aviva Life Insurance Company	10301382	18/10/2016	6,00,000
3.	ICICI Prudential Life Insurance Company	20695977	07/02/2017	5,00,000
Policy No.3 was obtained as additional cover after issuance of cover in question
4.	Kotak Mahindra Life Insurance Co. Ltd.			4,00,000/-

 

4.                     It is further submitted that the deliberate and intentional non-disclosure of necessary material information by the life assured amounts to fraud committed upon the OPs.  The life assured with malafide intention did not disclose the relevant information which is an essential requisite of Life Insurance Contracts as Life Insurance Contracts are based on the principle of Utmost Good Faith.  It is further submitted that the insurance claim in the present case has been repudiated by the answering OPs in accordance with the terms and conditions of the insurance policy and the same is sustainable in the eyes of law.  There is no deficiency on the part of answering OPs in rendering service to the complainant and as such the present complaint is liable to be dismissed being devoid of merits.

5.                     OP No.3 in its reply has submitted that an amount of Rs.35,996/- was collected by the answering Op from the insured and the same was deposited with the Op Nos. 1 & 2.  Other contentions have been controverted and prayer for dismissal of the complaint has been made.  In evidence, the Ops have tendered affidavit Annexure RW1/A and documents Annexure OP1/1 to OP1/5

6.                     We have duly considered the arguments advanced by learned counsel for the parties and have also perused the entire material placed on record.  The core issue involved in the present complaint is as to whether repudiation of the insurance claim of the complainant by the OPs is in accordance with the terms and conditions of the policy and sustainable in the eyes of law.

7.                     Undisputedly, the policy in question was issued by the OPs to the life assured on receiving of payment of premium to the tune of Rs.35,996/-. It is also not disputed that the life assured had expired during the subsistence of the policy in question.   The ground for the repudiation of the present claim is that the life assured had concealed the material information qua purchasing of other policies from other insurance companies.  As per the written statement filed by Op No.1 and Op NO.2, the insurance claim in the present case has been repudiated on the ground that the life assured had concealed the material facts in the proposal form filed for obtaining the present insurance policy i.e. the DLA had availed various other policies which was not disclosed in the proposal form. In para No.7 of facts of the case of written statement the insurance company has also given a table of the various insurance policies availed by the DLA. As per the details given in para 7 of the DLA had availed an insurance policy No.007132601 on 06.10.2016 for a sum of Rs.7,20,000/- from Birla Sun Life Insurance Company. However, a perusal of Annexure C3 (documents issued by Aditya Birla Insurance Company) reveals that the above said insurance policy was not issued in the name of Sursati (DLA) wife of the complainant. A document (Annexure-4) placed on file by the learned counsel for the insurance company during arguments further reveals that the above said policy was not issued by the Aditya Birla Insurance Company and the application was cancelled on the request of the life assured. Regarding the IInd policy of the table the Aviva Life Insurance Company vide Annexure R4 has intimated that the said policy was declined at the proposal stage. The IIIrd policy as mentioned in the table was issued by ICICI Prudential Life Insurance Company on 07.02.2017 whereas in the present case the proposal was signed by the DLA on 01.01.2017 i.e. prior to the issuance of the policy by ICICI Prudential Life Insurance Company on 07.02.2017 whereas in the present case the proposal was signed by the DLA on 01.01.2017 i.e. prior to the issuance of the policy by the ICICI insurance company. Therefore, the question of concealment  of the policy dated 07.02.2017 by the DLA does not arise as she had already signed the proposal form on 01.01.2017.

8.                     In view of the aforesaid discussion the insurance company has failed to produce any evidence to prove that before the date of filing of the proposal form the DLA had availed other insurance policy. Therefore, the plea taken by the insurance company in the written statement that insurance claim of the complainant has been repudiated on the ground that the DLA had availed various other insurance policies before the date of filing the proposal and the same was not disclosed in the proposal form is not correct. We are of the considered opinion that no material information has been concealed by the DLA while obtaining the insruacne policy in question. Perusal of the proposal form Annexure OP1/1 reveals that all the columns have been filled with English Language except the signature of the life assured in Hindi. If we read this document with the written statement submitted by the Op No.3, wherein it has been submitted that OP No.3 he had visited the village of insured at Pirthala and collected the amount of premium, therefore, there is every possibility that the proposal form was filled in by the agent/Op No.3 without disclosing all the material information to be supplied by the insured because the complainant and his wife/life assured are rustic villagers, therefore, the plea regarding concealment of the material fact from the insurance company does not survive anymore.  Being an agent it was the duty of the Op No.3 to make the life assured and her husband understood all the pros and cons of the insurance policy but in the present complaint it has not been done because there is nothing on the record to show that the agent/official of the insurance company had ever made the life assured understood regarding the terms and conditions of the policy. It was the duty of the insurance company to verify all the facts before issuance of the policy. In the present complaint the insurance company is trying to usurp the premium amount of the life assured by taking the advantage of rustic-ness of the life assured. Undisputedly, the insurance contract is based on utmost good faith but the terms and conditions of the contract are binding on both the parties. In the present complaint, the complainant had paid premium amount of Rs.35,996/- to the insurance company and when she had died within six months of the issuance of the policy the insurance company has repudiated the claim on the ground of concealment.  In the present complaint had there been any doubt that the life assured and her husband are telling lie or gave the wrong information in the proposal in that eventuality it was upon the insurance company either to reject the proposal form or to inform the life assured to provide complete and accurate information. The policy in question was valid from 07.02.2017 to 05.02.2031 and the life insured was died on 25.07.2017 within the subsistence of the policy. It was not supposed for the insurance company to keep the heavy premium to the tune of Rs.35,996/- for a longer period and when the life assured had died and claim had been submitted for compensation, then the insurance company has come with the plea of concealment which shows that the insurance company is trying to shift the burden of its wrong on the shoulder of the complainant/life assured for usurping the premium amount, which cannot be allowed to do so. The repudiation of the claim of the complainant by the opposite parties is not justified.

8.                         Thus, as a sequel to our above discussion, we allow the present complaint and the repudiation of the claim of the complainant is set aside and the opposite parties are directed to make payment of claim/insured amount of Rs.4,00,000/- to the complainant alongwith interest @ 9% per annum from the date of filing of present complaint till actual realization within a period of one month, failing which the complainant will be at liberty to initiate legal proceedings against the opposite parties. A copy of this order be supplied to both the parties free of costs.  File be consigned after due compliance.

 

Announced in open Commission.                                                              Dated:15.03.2021

                                                            (Raghbir Singh)                                                                                                            President                                  (Sukhdeep Kaur)                                           District Consumer Dispute

Member                                        Redressal Commission, Fatehabad.