Haryana

Kurukshetra

21/13-3-18

Gurnam Kaur - Complainant(s)

Versus

Kotak Mahindra - Opp.Party(s)

Amit Gupta

02 Jan 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KURUKSHETRA.

Complaint Case No.21 of 2013/Remanded Case.

Date of instt:10.1.2013. 

                                Date of Decision:02.01.2019.

Gurnam Kaur wife of kehar Singh, resident of village Kheri Dabdalan, House No.186, Near Government Middle School, Ladwa, District Kurukshetra.

 

                                                                ……….Complainant.      

                        Vs.

 

1. Meena Kumari, resident of House No.258/1, village Gobindpuri, agent of Kotak Mahindra Life Insurance Company, Ladwa, District Kurukshetra. (Given up vide order dated 17.10.2014)
2. Managing Director of Kotak Mahindra Old Mutal Life Insurance Ltd. Central Processing Centre, 8^th Floor, Godrej Coliseum, Behind everared Nagar, Sieon (East) Mumbai-400022.
3. Branch Manager of Kotak Mahindra Life Insurance at Kurukshetra.

……Opposite parties.

 

       Complaint under section 12 of Consumer Protection Act.            

 

Before:      Smt. Neelam Kashyap, President.

                Ms. Neelam, Member.

                Sh. Sunil Mohan Trikha, Member.

Present :    Sh. Amit Gupta, Advocate for complainant.

                 OP No.1 given up vide order dated 17.10.2014.

 Sh. Mohit Tayal, Advocate for Ops No.2 & 3.

 

ORDER

                   This is a complaint under Section 12 of the Consumer Protection Act, 1986 moved by complainant Gurnam Kaur against Kotak Mahindra and others, the opposite parties.

2.             Brief facts of the present complaint are that the complainant is the wife of Kehar Singh, resident of House No.186, Near Govt. Middle School, Ladwa and her husband had obtained a policy through OP No.1 vide policy No.02186562 for a sum of Rs.10,00,000/- and the name/basic product is Kotak Health Insurance and the said policy commenced on 31.12.2010 issued on 4.1.2011 and the first premium of Rs.1,00,000/- was paid on 31.12.2011. After completing all the formalities, the Ops issued the above said policy to her husband and as per terms of the policy, the husband of the complainant deposited the premium regularly. On 17.4.2012 the husband of the complainant suffered a severe heart attack suddenly and died at the same time. The husband of the complainant was taken to Bansal Hospital, Ladwa but he was dead at that time and was declared by the doctor. The complainant moved the claim in respect of the said policy of her husband and also completed all the requirements as per directions of the Ops but the Ops have illegally repudiated her claim on false, illegal and unjustified grounds vide letter dated 24.11.2012. The Ops are legally bound to pay the entire insured amount as per terms and conditions of the policy because at the time of insuring the husband of the complainant, all the necessary documents i.e. copy of ration card, earning proof were also submitted and on considering the said documents to be correct, the Ops insured her husband.  The complainant approached the Ops time and again and requested to pay the insured amount but they did not pay any heed. Thus, it amounts to deficiency in service on the part of Ops. Hence, in such like circumstances, this complaint was moved by the complainant.

3.            OP No.1 was given up vide order dated 17.4.2014 on the statement of complainant.

4.            Ops No.2 & 3 appeared and contested the complaint by filing written statement and taking preliminary objections that complaint is false, frivolous and vexatious and is gross misuse of process of law and as such, the same is liable to be dismissed; that the present complaint does not raise any consumer dispute as defined under the Consumer Protection Act; that this Forum has no jurisdiction to entertain the present complaint and the complainant has failed to demonstrate any deficiency in service on the part of answering Ops; that the claim of the complainant was repudiated on the basis of concealment of material facts by the life assured. The Life Assured had concealed his true age and income at the time of submitting the Proposal Form. The fact regarding one’s age is a material fact, having a direct bearing upon the insurability of the Life assured and risk covered by the insurance company. The concealment of material fact by the life assured goes to the very root of the mater, consequently, vitiating the subject policy.  The proposer/life assured has to maintain and observe a complete good faith in entering into a insurance contract with the insurer. The Life assured/proposer is under solemn obligation to make full, complete, true and correct discloser of the material facts which may be relevant for the insurer to take in to account while deciding whether the proposal should be accepted. If the life assured/proposer failed to disclose the true and correct material facts to the insurer then the policy obtained by the life assured/proposer stand vitiated and the life assured or any person claiming under him, is not entitled for any benefits under the policy. In the present case, it was revealed that the life assured had understood his age at the time of issuance of the subject policy. Further, the income proof submitted by the life assured was also found to be fake and forged.  On merits, the contents of the complaint were denied. Preliminary objections were repeated. Prayer for dismissal of the complaint was made.

5.             The complainant in her evidence proved on records her affidavit as Ex.CW1/A, photo stat copies of documents as Annexure C-A to Annexure C-R. The Ops placed on file the documents Annexure R-1 to R-45.

6.             We have heard learned counsel for the parties and have gone through the record carefully.

7.             It is pertinent to mention here that earlier the present complaint was dismissed by this Forum vide order dt. 23.02.2016.  Aggrieved with the said order of this Forum, the complainant filed the appeal before Hon’ble State Commission, Haryana and Hon’ble State Commission, Haryana vide order dt. 17.07.2017 allowed the appeal filed by the complainant and set-aside the order of this Forum.  Thereafter, the Ops-M/s. Kotak Mahindra filed the appeal before Hon’ble National Commission and Hon’ble National Commission vide its order dt. 22.01.2018 set-aside the order of Hon’ble State Commission, Haryana and remanded this case to this Forum with the directions to decide the complaint afresh after summoning the record from Food & Supplies Department, Ladwa, District Kurukshetra, Haryana in order to verify the documents in terms of this order as also after examining the proprietor of Jai Bhagwan Subhash Chand, Ladwa with respect to the documents purporting to have been issued by the said firm. 

8.             After receiving the order of the Hon’ble National Commission, two witnesses were summoned to prove the record as per directions given by Hon’ble National Commission.  One witness did not appear before this Forum.  The only one witness namely Ishwar Singh, Inspector, Food & Supplies Department, Distt. Kurukshetra appeared before this Forum and examined.

9.             Learned counsel for the complainant contended that the life assured Kehar Singh (since deceased) had taken the policy in question on 31.12.2010.  His age at the time of taking the policy was 56 years as mentioned in the ration card, Annexure-CM.  The Ops had taken premium of Rs.1,00,000/- per year from the date of issuance of policy from the husband of complainant.  The husband of complainant was paying premium regularly.  The next point contended by the counsel of complainant that the life assured had sufficient source of income to take the policy.  The life assured had 83 marla land in his name, which is Annexure CL and also other land in the name of his wife and son, copy of jamabandi of that land Annexure CJ, Annexure CK and Annexure CN are also on the file.  The counsel of complainant further contended that the life assured Kehar Singh (since deceased) had sufficient income to pay the installments of policy.  The next point contended by the counsel of complainant that the insurance company has 15 days time to accept the proposal form of the person after verification and to issue the policy in the name of insured.  The insurance company may reject the proposal form within 15 days.  In this case, the Ops have taken installments from the life assured Kehar Singh (since deceased) but after the death of insured, the Ops had repudiated the claim of complainant on the wrong facts regarding age.  The counsel of complainant further contended that the ration card issued by the Food & Supplies Department i.e. Annexure CM in the year 2007 in which the age of Kehar Singh is shown as 52 years and at the time of issuance of the policy, he was 56 years old.  The next point contended by the counsel that in Annexure R-40 which was given by the counsel of Ops, it is mentioned that J-form 7 and 8 was not issued by M/s. Jai Bhagwan Subhash Chand but no person appeared before this Forum to prove Annexure R-40.  So, this document has not been proved on the file.  There is no document on the file regarding J-form as mentioned in Annexure R-40 dt. 08.11.2010 and 16.11.2010.  The counsel of complainant further contended that the husband of complainant had other source of income from the land which is on the file i.e. Annexure CI, Annexure CJ, Annexure CK (sale deeds) and Annexure CN, jamabandi which shows the name of deceased Kehar Singh.  Moreover, he has drawn our attention towards Annexure CN, jamabandi in which the name of Gurnam Kaur, the wife of Kehar Singh is mentioned as owner which shows that the life assured Kehar Singh (since deceased) and his family members have sufficient capacity to pay the installment of Rs.1,00,000/- per year.  The next point contended by the counsel that regarding Annexure CM, ration card, it was admitted by the witness Ishwar Singh, who appeared before this Forum that the ration card number 344690 was issued on the basis of proposal form Ex.RZ, which means that the ration card Annexure CM was issued by the department of Food & Supplies.  The age of life assured was 52 years at the time of taking the ration as on 15.11.2007.  The husband of complainant has taken the policy in the year of 2010.  So, at the time of taking the policy, the age of husband of complainant was 56 years.  The Ops have wrongly repudiated the claim of complainant without any reason.  So, the claim of complainant may please be accepted.

10.            On the other hand, learned counsel for the Ops No.2 & 3 contended that the age of Kehar Singh (since deceased) at the time of taking the policy was 66 years because as per document Annexure RZ, proposal form, his age was 60 years at the time of issuance of ration card.  Ishwar Singh, Inspector, Food & Supplies Department also admitted this fact that the ration card proposal form DI is issued by his department.  The next point contended by the counsel of Ops No.2 & 3 that according to Section 45 of Insurance Act, the Insurance Company has power to repudiated the claim if there is some concealment of fact by the insured at any time.  So, the complaint of complainant may please be dismissed.

11.            We have seen the record available on the file.  It is admitted fact that the insurance policy was provided by the Ops to life assured Kehar Singh (since deceased) on 31.12.2010 mentioning the basic sum insured as Rs.10,00,000/-.  The life assured suffered from severe attack on 17.04.2012 and died on his way i.e. evident from Annexure-CD, death certificate Annexure CE, proposal form is Annexure R1 and the insurance policy Annexure R9 (CB).  It is also admitted fact that the life assured told his age as 56 years at the time of issuance of policy by submitting copy of ration card Annexure-CM.  In the photo-copy of ration card, Annexure CM, the age of insured is mentioned as 52 years on 15.11.2007 i.e. date of issuance of ration card.  The above-mentioned documents shows that the life assured was 56 years at the time of issuance of policy on 31.12.2010.  The witness appeared before this Forum namely Ishwar Singh also admitted this fact that the ration card number 344690 has been issued from the Food & Supplies Department.  So, it clearly shows that the ration card is genuine and original ration card was also produced before this Forum which shows the age of deceased at the time of taking the policy as 56 years.  Regarding Annexure CG which shows that the proprietor of M/s. Jai Bhagwan Subhash Chand had written that they had not issued any J-form dated 08.11.2010 and 16.11.2010, there is no document on the file which proves that J-form was given to the Ops or not.  Moreover, before this Forum, no witness appeared before this Forum to prove this document.  The other document which are placed on the file regarding the ownership of land in the name of deceased Kehar Singh and his wife and his son are on the file which shows that the life assured Kehar Singh have sufficient capacity to pay the installments of insurance policy.  The Ops No.2 & 3 have wrongly repudiated the claim of complainant.  The Ops No.2 & 3 have taken two installments from the life assured, which are of huge amount of Rs.1,00,000/- per year.  At the time of issuance of policy, the Ops No.2 & 3 have 15 days time to accept the proposal form and to issue the policy in the name of insured i.e. mentioned in Mark-A which are guidelines regarding issuance of policy after verification.  Hence, in the facts and circumstances of the case, we are of the considered view that the Ops No.2 & 3 have wrongly repudiated the claim of complainant and there is gross deficiency in service on the part of Ops No.2 & 3.          

12.            Thus, as a sequel of above discussion, we allow the complaint against Ops No.2 & 3 and direct the Ops No.2 & 3 to pay the total sum assured of Rs.10,00,000/- to the complainant and further to pay Rs.20,000/- as lump sum compensation on account of harassment, mental agony including the litigation charges.  Let the order be complied with within 30 days from the date of preparation of copy of this order, failing which, the complainant shall be entitled interest @ 9% p.a. from the date of order till its realization.  A copy of said order be supplied to the parties free of cost.  File be consigned to record-room after due compliance.     

Announced in open court:

Dt.:02.01.2019.  

                                                                        (Neelam Kashyap)

                                                                        President.

 

 

(Sunil Mohan Trikha),           (Neelam)       

Member                             Member.