Haryana

Kurukshetra

24/2018

Ishu gupta - Complainant(s)

Versus

Kotak Mahindra - Opp.Party(s)

Virender Garg

04 Dec 2018

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KURUKSHETRA.

                                                     Complaint Case No.24 of 2018.

                                                     Date of institution: 25.01.2018.

                                                     Date of decision:04.12.2018.

Ishu Gupta S/o Sanjiv Kumar, R/o H.No.86, Ward No.16, Anaj Mandi, Pehowa, Distt. Kurukshetra.

                                                                        …Complainant.

                        Versus

1. The Managing Director, Kotak Mahindra Life Insurance Co. Ltd., 7^th Floor, Zone-4, Kotak Infiniti, Building No.21, Infinity Part, Off Western Express Highway, General A.K.Vaidya Marg, Malad (E), Mumbai-400097.
2. The Branch Manager, Kotak Mahindra Life Insurance Co. Ltd., Sector-17, near Virk Hospital, Kurukshetra. 

….Respondents.

BEFORE     Smt. Neelam Kashyap, President.

                Ms. Neelam, Member.

                Sh. Sunil Mohan Trikha, Member.

Present:     Sh. Gaurav Gupta, Advocate, for the complainant.   

                Sh. J.P.Gupta, Advocate for the OPs.

               

ORDER

                This is a complaint under Section 12 of the Consumer Protection Act, 1986 moved by complainant Ishu Gupta against Kotak Mahindra Life Insurance, the opposite parties.

2.            Brief facts of the present complaint are that the father of complainant namely Sh. Sanjeev Kumar purchased an insurance policy bearing No.03431877 from the Ops for the sum of Rs.8,50,000/- and paid the premium regularly to the Ops.  It is alleged that the father of complainant died on 22.08.2017.  The complainant being nominee of his father lodged the claim with the Ops and submitted all the necessary documents but the Ops did not settle the claim of complainant.  So, it is a clear cut case of deficiency in service on the part of Ops and prayed for acceptance of complaint with the direction to Ops to pay the claim amount of Rs.8,50,000/- to the complainant alongwith interest @ 15% p.a. and further to pay Rs.1,00,000/- as compensation for harassment and mental agony as-well-as Rs.22,000/- as litigation charges.   

3.            Upon notice, the OPs appeared before this Forum and contested the complaint by filing their reply raising preliminary objections with regard to locus-standi; maintainability; cause of action; that the claim of complainant was not payable and hence repudiated on the basis of intentional non-disclosure of material facts and false declarations made in the proposal form by the deceased life assured.  The life assured was suffering from diabetes mellitus, hypertension and was a chronic smoker and alcoholic for 30 years i.e. prior to signing of the proposal form on 23.03.2016.  Despite the same, the life assured intentionally gave a false declaration to the Ops regarding his health.  Thus, the Ops have repudiated the claim of complainant in a fair and just manner.  There is no deficiency in service on the part of Ops.  On merits, the objections raised in the preliminary objections are reiterated and so, prayed for dismissal of complaint.

4.             In support of his case, learned Counsel for the complainant tendered into evidence affidavit, Ex.PW1/A, copies of aadhar card as Ex.P1 & Ex.P2, copy of death certificate as Ex.P3, copy of letter dt. 31.03.2016 as Ex.P4, copy of first premium certificate as Ex.P5, copy of schedule of policy as Ex.P6 and copy of letter dt. 20.12.2017 as Ex.P7 and thereafter, closed the evidence.

5.           On the other hand, learned Counsel for the Ops tendered into evidence affidavit, Ex.RW1/A, copy of proposal form as Annexure-R1, copy of letter dt. 31.03.2016 as Annexure-R2, copy of death claim intimation form as Annexure-R3, copy of treatment record as Annexure-R4, copy of investigation report as Annexure-R5 and copy of letter dt. 20.12.2017 as Annexure-R6 and thereafter, closed the evidence on behalf of Ops. 

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

7.             Learned counsel for the complainant contended that the father of complainant Sh. Sanjiv Kumar son of Tara Chand had purchased an insurance policy from the Ops for a sum of Rs.8,50,000/- on 31.03.2016.  The counsel of complainant also contended that prior to issuance of policy, the Ops had done complete medical examination of Sanjiv Kumar from the penal of doctors.  He further contended that the father of complainant was hale and fit at the time of taking the policy.  Unfortunately, on 22.08.2017, the father of complainant had died due to natural death.  After the death of father of complainant, the complainant lodged the claim with the Ops for a sum of Rs.8,50,000/- but the Ops have repudiated the claim of complainant vide letter dt. 20.12.2017, Ex.P7 on the ground that the life assured was suffering from Diabetes Mellitus with Hypertension and also was a Chronic Smoker and Alcoholic since much prior to the date of signing the proposal.  He further contended that the said repudiation of claim is wrong and illegal.  The counsel of complainant placed reliance upon the case law cited in 2011(4) CPJ page 6, Civil Appeal No.7437 of 2011, date of decision: 26.08.2011 titled as P.Vankat Naidu Vs. LIC (SC); 2011(3) CPJ page 198, revision petition No.427 of 2007, date of decision: 05.07.2011 titled as NIA Vs. Murari Lal Bhusri (NC); 2012(4) CPJ page 646, revision petition Nos.2615 and 2616 of 2011, date of decision: 02.11.2012 titled as LIC Vs. Priya Sharma & others (NC); 2018(3) CLT page 208 titled as Bharti Axa Life Insurance Co. Ltd. and others Vs. Mamta Kumari (SC UT Chandigarh) and 2018(3) CLT page 187 titled as Rajinder Singh Vs. NIA (SC Haryana, Panchkula). 

8.             On the other hand, learned counsel for the Ops contended that the father of complainant had taken the policy without disclosing the pre-existing illness at the time of taking the policy.  The other point contended by the counsel of Ops that the proposal form duly signed by Sanjiv Kumar is Ex.R3 and in the columns he denied about his illness.  In the said proposal form, the father of complainant did not disclose his illness at the time of taking the medical policy.  The counsel of complainant has drawn our attention towards the treatment record of Fortis Hospital, Mohali relating to father of complainant, wherein it is mentioned in the history at the time of admission of father of complaiant that “He is known chronic alcoholic with h/o alcohol abuse for past 30 years.  He is abstinent for last 4 months and is on deaddiction for alcohol dependence.  He was being treated with haloperidol, lorazepam, tramadol, risperidone and bexol at mayo hospital.  He is a k/c/o of DMIL and HTN.  K/c/o ALD, PITM and esophageal varices. 

Patient presented with c/o fever, loose stools and altered sensorium for last 3-6 days”.

             He further contended that Ex.R5 is investigator report, which shows that Sanjiv Kumar was suffering from diabetes mellitus, hypertension and was a chronic smoker and alcoholic for 30 years.  He has drawn our attention towards the summary of the illness mentioned by the investigator in his report, Ex.R5 are as follows:-

“1. As per the common feedback confirming LA died dated August 22, 2017 due to chronic Liver Disease at his Residence.

2. All of them confirmed LA was chronic alcoholic from last 30 years and was suffering from ailment prior to his death.

3.LA had undergone treatment for his ailment from Fortis Hospital, Chandigarh, Mayo Hospital, Chandigarh & PGI Hospital, Chandigarh.

4. We have informed that LA runs Jindal Rice Mill”.

Moreover, the claim of complainant was repudiated on the ground that the life assured was suffering from diabetes.  He further contended that the policy in question was cancelled by the department because due to fraud and misrepresentation read with Section 45 of Insurance Act.  So, the complaint of complainant may please be dismissed.

9.             We have gone through the record available on the file which shows the intention of the complainant.  The complainant has not placed on record any treatment record relating to father of complainant which shows that the complainant has concealed the true and material information from this Forum.  So, in the facts and circumstances of the case, it is clear that at the time of taking the policy, the complainant was suffering from a diabetes mellitus, hypertension and was a chronic smoker and alcoholic for 30 years and the said pre-existing disease was suppressed by the complainant.  Hence, we are of the considered view that the Ops have rightly repudiated the claim of complainant.  The authorities submitted by the counsel of complainant are not disputed but the same are not applicable to the facts of instant case. 

10.            Thus, as a sequel of above discussion, we find no merit in the present complaint and accordingly, the same is hereby dismissed.  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.:04.12.2018.  

                                                                        (Neelam Kashyap)

                                                                        President.

 

 

(Sunil Mohan Trikha),           (Neelam)       

Member                             Member.