Haryana

Fatehabad

CC/163/2018

Saroj - Complainant(s)

Versus

Kotak Mahindra life Insurance - Opp.Party(s)

Jitender Thakkar

01 Jun 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL COMMISSION, FATEHABAD.

Complaint no.163/2018.

Date of instt.29.05.2018. 

                                                          Date of Decision: 01.06.2023

 

Smt.Saroj widow of Bhup Singh son of Dalip Singh resident of House No.8/1 Village Jandwala Bagar, Sub Tehsil Bhattu Kalan Tehsil & District Fatehabad.

 

                                                                             ..Complainant.

                                      Versus

 

1. Kotak Mahindra Life Insurance Company Limited Registered Office 2^nd Floor Plot No.C-12, G-Block, BKC, Bandra (E) Mumbai-400051 through its Chairman-cum-Managing Director/Managing Director.
2. Kotak Mahindra Life Insurance Company Limited Branch Office, First Floor, SCO 91, Sector Police Line Area, Urban Estate, Hisar (Haryana) 125001 through its Divisional/Branch Manager.

.. OPs. 

    

      Complaint under Section 12 of Consumer Protection Act, 1986

                                                                                                                  

 

Before:                   Sh.Rajbir Singh, President.

                              Smt.Harisha Mehta, Member.

 

Argued by:         Sh. Jitender Thakker, Advocate for the complainant.

    Sh. Yogesh Gupta, Advocate for the OPs.

 

ORDER

SH.RAJBIR SINGH, PRESIDENT

 

Brief facts of the present complaint are that Sh.Bhup Singh husband of the complainant during his lifetime had obtained life insurance policy bearing no.03554898 for basic sum assured of Rs.2,89,594/- (guaranteed Maturity Benefits of Rs.5,54,571.57/-) valid upto 15.10.2016 to 15.10.2031 and regarding this an amount of Rs.20,000/- was paid a premium to Ops; that the complainant was appointed as nominee in the said insurance policy; that the life insured died on 23.01.2018 and regarding this claim alongwith requisite documents was submitted to the Ops for insurance benefit but the Ops vide letter dated 31.03.2018 repudiated the insurance claim of the complainant on the ground of non-disclosure and suppression of material facts. The act and conduct of the Ops clearly amounts to deficiency in service on their part.  Hence, this complaint.

2.                On notices, Ops and filed their joint written statement wherein various preliminary objections with regard to maintainability, jurisdiction, concealment of true and correct facts, locus standi, estoppel and cause of action etc., have been raised. It has been further submitted that the DLA himself had  concealed the material information from the Ops; that the present policy was obtained with malafide intention as the claim intimation was received on 08.03.2018 whereas the DLA had expired on 23.01.2018; that after receiving the claim, statutory investigation was made which revealed that the DLA had an existing life cover amounting to Rs.12.43 lakhs from other insurance companies and this fact had not been disclosed in the proposal form;  that after availing the subject policy, the DLA availed further policies for total sum assured of Rs.16.6 lakhs; that the DLA had violated the clause 9.1 of proposal form by not disclosing the other insurance policies; that 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 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 OPs in rendering service to the complainant and as such the present complaint is liable to be dismissed being devoid of merits.

3.                Learned counsel for the complainant tendered in evidence affidavit of the complainant as Annexure C1 along-with the documents Annexure C2 to Annexure C6.  On the other hand, Sh.Shakil Ahmad working as AVP Legal tendered in evidence his affidavit as Annexure RW1/A along-with the documents as Annexure R1 to Annexure R5. 

4.                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.

5.                Perusal of the proposal form submitted by the life assured on 12.10.2016 shows that he was asked to disclose all the insurance policies held/applied with the Kotak Mahindra Life Insurance Company or any other insurance companies. The above said question was answered by the life assured in negative thereby representing that neither he held nor he had applied for any life insurance cover either with the company of the OPs or any other insurance company.  From perusal of the Annexure R5 placed on record, it is revealed that the life assured had applied for total cover of more than 12.42 lakhs with other companies prior to the subject policy.  Therefore, the said aforesaid information given by the life assured in the proposal form was false.  Vide declaration and authorization contained in the proposal form and signed by the insured he agreed that in case of any mis-statement or suppression of material information, the company had the right to repudiate the claim under the policy.  Therefore, if the information withheld by the insured is found to be material, no amount is payable by the insurance company to the complainant. In the proposal form (Annexure R1), the income of the life assured has been shown as Rs.3 lakh per annum. Had the DLA disclosed the information regarding applying for/obtaining of other policies having value of more than 12 lakhs, the Ops would not have issued the subject policy.

6.                          The present complaint was filed on 29.05.2018 and the written statement was filed by the Ops on 13.08.2018. The complainant was having ample opportunities to rebut the pleas taken by the Ops with regard to the alleged allegations of obtaining the subject policy by concealing the material information qua existing/applied for other polices but the complainant has failed to lead any clinching and authentic evidence either by way of an affidavit or by way of documentary evidence to satisfy this Commission that the Ops have wrongly and illegally repudiate the claim in question. It is settled law that insurance is a contract of utmost good faith and that the contract of insurance is based on doctrine of uberrima fide and even if any due diligence is done by the insurance company, it does not change the basic element of an insurance contract. On this point, reliance can be taken from case law titled as Reliance Life Insurance Company Ltd. & Anr Vs.Rekhaban Naresh Bhai Rathod Civil Appeal No.4261 of 2019 decided by Hon’ble Apex Court on 24.04.2019.  So in nutshell, we are of the considered opinion that the husband of the complainant had obtained the insurance policy in question with mala-fide intention  by suppressing the material information with regard to other policies, therefore, the Ops are well within their right to repudiate the claim of the complainant.

7.                          On the basis of above mentioned discussion, we are of the considered opinion that there was no deficiency in service at all or any unfair trade practice, on the part of any of the Ops, as alleged, so as to make any of them liable to any extent in this matter. Hence, the complaint is dismissed in view of the facts and circumstances stated above.  All the parties are left to bear their own costs. A copy of this order be supplied to both the parties free of cost as per rules.  This order be uploaded, forthwith, on the website of this Commission as per rules for the perusal of the parties. File be consigned to record room, as per rules, after due compliance.

 

Announced in open Commission.                                                            Dated:01.06.2023

 

                                                                                                        

                                                  (Harisha Mehta)                           (Rajbir Singh)                                                                             Member                                        President