Before the District Consumer Disputes Redressal Commission, Room No. 208 2^nd Floor, District Administrative Complex, Tarn Taran

Consumer Complaint No   :          60 of 2019

Date of Institution                      :         19.08.2019

Date of Decision               :         24.01.2023

Sarabjeet Kaur aged about 43 years, wife of Kulwinder Singh son of  Pooran Singh, resident of village Walipur, Tehsil and Districdt Tarn Taran Adhar No. 3842-8418-9562, Mobile No. 96463-33924

                                                                             …..Complainant

Versus

1. Kotak Mahindra Life Insurance Company Limited (IRDAI Regn. 107) 7^th Floor, Building No. 21, Infinity Park, Off Western Express Highway, General A.K. Vadya Marg, Malad (E) Mumbai-400097 through its claims Manager,
2. Kotak Mahindra Bank Ltd. Bath Road, Vilalge Pandori Gola, Tehsil Tarn Taran Punjab, through its Branch Manager.

                                                                             …Opposite Parties

Complaint Under Section  10, 11, 12 and 13 of the Consumer Protection Act.

Quorum:               Sh. Charanjit Singh, President

Ms. Nidhi Verma Member

Sh. Varinder Pal Singh Saini, Member

For Complainant                     Sh. A.S. Dhillon Advocate

For Opposite party No. 1                 Sh. Nitin Sharma Advocate

For Opposite Party        No. 2                   Sh. Surinder Pal Singh Advocate

PER:

Sh. Charanjit Singh, President

1        The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 10, 11 12 and 13 against the opposite parties on the allegations that the Kulwinder Singh son of  Pooran Singh resident of village Walipur, Tehsil and District Tarn Taran has purchased a life insurance policy under Kotak Group Shield # bearing policy No. GS000280(Loan ID 9613064416) from the opposite parties on 9.7.2018. Kulwinder Singh son of Puran Singh husband of the complainant died on 28.9.2018. The complainant who is nominee of the deceased policy holder namely Kulwinder Singh is defined as consumer and has a right to file the present complaint against the opposite parties in the matter. Kulwinder Singh son of  Pooran Singh has purchased the above mentioned life insurance policy from the opposite parties by insuring his life with the opposite parties for a sum of Rs. 16,00,000/-. Kulwinder Singh son of  Pooran Singh was hail and healthy person at the time of purchasing of the above mentioned life insurance policy in question from the opposite parties. The premium of the policy was to the tune of Rs. 87,122.13 Paise and the mode of payment of premium was single premium. The policy holder Kulwinder Singh died on 28.9.2018 after got insured his life for the period from 9.7.2018 to 8.7.2023. As per terms and conditions of the above mentioned life insurance policy, the opposite parties are legally bound to make the full and final death claim of the above mentioned policy to the nominee of the deceased policy holder i.e. complainant. The complainant is widow as well as nominee of the deceased policy holder, as such, the complainant is legally entitled to receive and recover the full and final amount of death claim of the policy from the opposite parties. After the death of Kulwinder Singh the complainant submitted her death claim file to the opposite parties to get the death claim of the deceased Kulwinder Singh from the opposite parties but the opposite parties were deliberately lingering on the matter either one or the other false pretext and lame excuses. Now the opposite party instead of settling the death claim of the deceased has played a cruel joke with the complainant by rejecting the death claim on flimsy grounds vide their letter dated 31.3.2019 which are not tenable or sustainable in the eyes of law. The opposite parties in letter dated 31.3.2019 while rejecting the death claim of the complainant alleged that the deceased policy holder was suffering from cirrhosis of liver, portal hypertension, Alcoholic liver deceased hepatitis C while the deceased policy holder was not suffering from any such ailment as alleged by the opposite party. The opposite parties did not get conducted any medical test of deceased policy holder namely Kulwinder Singh at the time of issuing the above said policy despite of clear directions of insurance Regulatory and Development Authority, India, despite of the fact that the deceased policy holder Kulwinder Singh was 51 years of age at the time of commencement of the policy. The complainant has approached pillar to post in this regard to redress her grievances but in vain as the opposite parties finally refused to settle the death claim pertaining to the above mentioned life insurance policy and refused to make the full and final amount of death claim pertaining to the above mentioned life insurance policy to the complainant and prayed that the present complaint may be allowed by directing the opposite parties to settle the death claim of deceased Kulwinder Singh pertaining life insurance policy by making full and final of death claim i.e. Rs. 16,00,000/- to the complainant and prayed Rs. 20,000/- on account of mental and physical harassment caused to the complainant and Rs. 50,000/- on account of deficiency in service alongwith interest at the rate of 18% per annum from the date of filing of complaint till the actual realization of the amount of death claim. Alongwith complaint, the complainant has placed on record her affidavit Ex. C-1, Self attested copy of death certificate of deceased Kulwinder Singh Ex.C-2, Self attested copy of Insurance Policy bearing No. GS000280 Ex. C-3, Self attested copy of claim repudiation letter dated 31.3.2019 Ex. C-4, Self attested copy of Adhar Card of deceased Kulwinder Singh Ex. C-5, Self attested copy of Adhar Card of complainant Sarabjeet Kaur Ex. C-6.

2        Notice of this complaint was sent to the opposite parties and opposite party No. 1 appeared through counsel and filed written version inter alia pleadings that the complaint is not maintainable and is liable to be dismissed. The complainant has suppressed material facts from this Commission. The opposite party No. 1 has an arrangement with Kotak Mahindra Bank Ltd. whereby any person taking a loan from Kotak Mahindra Bank Ltd. can be covered under the group policy i.e. Kotak Group Shield plan and Kotak Mahindra Bank Ltd. becomes the Master Policy Holder and the Life to be assured becomes the member. In group insurance policies as per the said policy contract, as group members as specified by the master policy holder availing any loan from the policy holder for specific purposes as specified in the schedule of the policy contract may be covered by the opposite party No. 1 under the group insurance policy for the period and amount as specified in the certificate of insurance (COI) issued to every such specified member subject to the terms and conditions of the Master Policy. The opposite party No. 1 shall receive a premium amount from the Master Policyholder on behalf of the members seeking subscription to the said cover for the specified period for the specific No of members. The member has to provide a duty signed declaration of Good Health (DOGH) thereby assuring the insurer that the member is medically fit for availing the said insurance cover. In accordance to the terms and to join the pool of members, the Deceased Life Insured Mr. Kulwinder Singh provided a DOGH, thereby assuring the opposite party No. 1 that he was medically fit to avail the said policy and was not suffering from any ailments  / diseases. Since the information provided by the Life Assured in the form was established to be incorrect by the Medical records obtain by the company, hence the company was well within its rights to repudiate the said claim of the complainant. Since the opposite party No. 1 has acted within the four corners of the statutory provisions, no case of deficiency in services can be said to have arisen, and as such, the present complaint is not maintainable before this Commission. Repudiation of death claim under the subject policy was on the grounds of not disclosing true, correct and complete information in the said DOGH. The member, at the time of signing the DOGH, did not disclose the correct information about his health, and he deliberately failed to disclose that he was suffering from Cirrhosis of Liver, Portal Hypertension Alocholic Liver disease, Hepatitis C prior to the insurance of the policy and he was under treatment for the same. The medical records issued from Sri Guru Ram Das Charitable Hospital, Sri Amritsar dated 18.4.2017, 5.6.2018 and 24.6.2018 and the USG Abdomen issued from Sri Guru Ram Das Institute of Medical Science & Research, Sri Amritsar dated 25.07.2018 and the Medical cause of death issued from Sri Guru Ram Dass Charitable Hospital, Amritsar dated 28.9.2018 received during the assessment of claim procured during the assessment of claim substantiates the claim of the company. The said medical history was prior to the issuance of the cover which was not disclosed to the opposite parties by the member. From the stated circumstances, it is evident that the member had intentionally suppressed material facts pertaining to his health condition from the opposite party No.1 and fraudulently had obtained the said cover. The member passed away within 3 months from the date of commencement of the policy and as such, company has rightly repudiated the claim preferred by the complainant. Insurance contracts are contracts based on ‘Utmost Good Faith’ As per the contract, the insurer is bound to honour the claim under the policy, provided that the member at the time of signing the DOGH, had correctly disclosed all relevant information which are the basis on which the insurer decides to cover the said life. Since the member did not perform his duty to disclose all material information truthfully and correctly, the contract of insurance between the company and the life assured is a void contract. Life insurance claim payouts are made from the pool of funds of several policy holders / consumers of the services of an insurance company. Hence, to honour an illegitimate claim, would mean doing injustice to other genuine members. Hence, even entertaining the said case would be against the principles of natural justice and this would not be in the interest of a life insurance company. The complaint is devoid of any material particulars, and has been filed merely to harass and gain undue advantage and unjustified monies from the opposite parties and hence the complaint deserves to be dismissed in limine. The complaint has been filed with ulterior motive and malafide intention to cause harassment and prejudice to the opposite party No.1 which is a company of long standing and high repute, and to extract money from it without just cause or valid reason. The DOGH/Proposal Form is not merely a document to be signed and submitted for formality. It is the basis for the contract of insurance. It is the mode of providing information to the insurer so as to enable them to exercise a lawful right to evaluate the life before providing its services by covering the said life. A reference is most respectfully made here to Regulation 4(8) of the IRDA (Protection of Policyholder’s interests) Regulations, 2017 which provides that ‘Proposal form’ means a form to be filled in by the prospect in written or electronic or any other format as approved by the authority, for furnishing all material information as required by the insurer in respect of a risk, in order to enable the insurer to take information decision in the context of  underwriting the risk, and in the event of acceptance of the risk, to determine the rates, advantages, terms and conditions of the cover to be granted; Explanation: ‘Material information’ for the purpose of these regulations shall mean all important, essential and relevant information sought by insurer in the proposal form and other connected documents to enable him to take informed decision in the context of underwriting the risk. The company has been induced to issue the said cover on the life of member on the ground of suppression of material facts which is otherwise necessary for the issuance of the cover. Thus the subject matter for the above said cover itself is proved to be initiated by a fraudulent act, and therefore, the said policy is declared void by the company, and consequently, no benefit or amount under the said policy becomes payable, as the Life Assured was guilty of suggestion vari supresso falsi. The complainant has not acted in good faith with respect to the subject of this complaint and has approached the commission with unclean hands, whereas it is settled legal preposition that ‘One who seeks equity must come with clean hands. In accordance to policy terms and to join the pool of members, Mr. Kulwinder Singh (deceased) who had taken a loan facility from opposite party No.2 i.e. Kotak Mahindra Bank Ltd. in the capacity of his being a borrower of Master policyholder, he had submitted his application-cum declaration of Good health (DOGH) for loan ID-9613064416 to become a member under the Master Policy. Accordingly, certificate of insurance with flat cover was issued to Mr. Kulwinder Singh (deceased) as token to his life cover.   

          The DOGH is a pre requisite for availing a group insurance cover, thereby assuring the opposite parties that he was medically fit to avail the said policy and was not suffering from any ailments/ disease.. The opposite party No. 1 crave leave to refer to said declaration in DOGH:-

          I hereby declare that

1. I am in good health
2. I perform all my routine activities independently
3. I have never had any physical defect, deformity or disability affecting my day to day activities.
4. I have never suffered and am not currently suffering from:-

1. High Blood Pressure, Heart Attack or any other Heart disease.
2. Stroke, Paralysis in any form or any other Cerebrovascular Disease.
3. Diabetes or any other Endocrinal Disease, Kidney Disease
4. Any chronic Liver disease.
5. Any lung Disease
6. Blood Disorders, Gastro Intestinal Diseases or any other disorder of the bones, spine and muscle
7. Any Cancer or Cancerous Growth
8. Any Mental or psychiatric Condition, and Genetic Disease or any disease related to central nervous system
9. HIV/AIDS or AIDS Related complications

5. I have never undergone nor have been advised to undergo any major surgical procedure
6. In the last 2 years,. I have not-
   1. Been continuously hospitalized for more than 7 days (other than fractures of leg and arm)
   2. Undergone any investigation (including basic cardiological and blood tests) other than normal health check ups and insurance medicals …..
   3. Had Adverse result for any blood test X-Rays, ECG Stress Test, Biopsies, CT Scan, MRI….

As an acknowledgement of extending insurance cover to the member, a certificate of insurance was issued to him which clearly stated the prime features of the said insurance cover. The certificate of insurance (COI) was duly received as admitted by the complainant. Further certificate of insurance states that if Mr. Kulwinder Singh (deceased) not satisfied with policy he may cancel the policy in free look period. The company has not received the free look cancellation request in captioned policy hence it is deemed that Mr. Kulwinder Singh (deceased) has read and agreed upon the COI. Thereafter, the opposite parties received death claim intimation on 23.11.2018 alongwith the death certificate and other requisite documents from the policy holder stating that the member had expired on 28.9.2018 i.e. within 3 months from the date of issuance of insurance cover. On receipt of the death claim intimation, the opposite party No. 1 immediately initiated Regulatory and Development Authority (Protection of Policy Holder’s interest) Regulations, 2017 in order to verify the authenticity of the claim. From the investigation, it was found that the member, at the time of signing the DOGH, did not disclose the correct information about his health and he deliberately failed to disclose that he suffering from ‘Cirrhosis of Liver, Portal Hypertension Alcoholic Liver disease, Hepatitis C’ much prior to the issuance of the policy and he was under treatment for the same. The following documents came out from the investigation which revealed that the Life Assured was suffering from the above mentioned ailments prior to the policy issuance.

A                The medical records issued from Sri Guru Ram Dass Charitable Hospital, Sri Amritsar dated 18.4.2017, 5.6.2018 and 24.6.2018 procured during the assessment of claim.

B                 The USG Abdomen issued from Sri Guru Ram Das institute of Medical Science & Research, Sri Amritsar dated 25.6.2018 procured during the assessment of claim.

C                 The Medical cause of death issued from Sri Guru Ram Das Charitable Hospital, Sri Amritsar dated 28.9.2018 received during assessment of claim.

Had the company/ opposite party No. 1 known that the Life assured/ member had not disclosed his correct health and lifestyle details in the proposal form, then the opposite party No. 1 would have declined the proposal unfront. In view of the above the company had, vide its letter dated 31.3.2019 repudiated the claim of the complainant by explaining the reason behind the same. The same was also intimated to the policyholder vide its letter dated 31.3.2019. The complaint has not raised any objection on the decision made by the opposite party No. 1 company as the opposite party company has not received any written objection pertaining to claim repudiation letter dated 31.3.2019. The deceased member had also put his signature on the declaration of good health stating that he has understood the nature of questions and importance of disclosing all material information. Despite this the member suppressed the material fact which is nothing but fraud in order to gain unlawfully at the expense of the opposite parties. The liability of the opposite party No. 1 is only limited to the cover granted to the member. The amount of cover granted is mentioned in the certificate of insurance issued to the member. Thus, the opposite party No. 1 is not liable for any amount beyond the cover amount and the said amount was payable to the master policy holder i.e. Kotak Mahindra Bank Ltd. if the claim was admissible. Since the claim has been repudiated on the basis of fraudulent concealment of material facts. The opposite party No. 1 has denied the other contents of the complaint and prayed for dismissal of the same. Alongwith the written version, the opposite party has placed on record Declaration of Good Health Ex. OP1/1, Certificate of Insurance Ex. OP1/2, Copy of Claim intimation Form and Medical Record Ex. OP1/3 and Ex. OP1/4, Copy of letter dated 31.3.2019 Ex. OP1/5. 

3        The opposite party No. 2 appeared through counsel and filed written version by inter alia pleadings that the present complaint is wholly misconceived, baseless and unsustainable in law and is liable to be dismissed. The complainant is not the consumer of the opposite party No. 2 for the purpose of this complaint. Hence, the present complaint filed by the complainant is beyond the purview of the Consumer Protection Act, 1996. Hence, the present complaint is liable to be dismissed with exemplary cost. This commission has got no jurisdiction to try and entertain the present complaint. The present complaint is not maintainable against the opposite party No. 2 as there is no deficiency on its part. The present complainant has no prima facie case against the opposite party No.2. The opposite party No. 2 possesses goodwill and has an established market and has assumed a good reputation in respect of its business. The opposite party No. 2 has neither rendered any kind of service to the complainant/ her deceased husband nor has charged any amount for rendering any service to the complainant/ her husband. Both the parties are having separate legal entities registered separately under the Indian Companies Act, 1956 as companies distinct from each other. Even the scope of business of both the opposite parties is different from that of each other. The opposite party No. 2 is not involved in insurance business. Hence, issuing of insurance policy to the complainant’s husband does not arise at all. None of the document filed by the complainant suggests that opposite party No. 2 has ever issued any policy to the complainant’s husband. The opposite party No. 2 in capacity of corporate agent of OP No. 1 only facilitates its customer to execute documents for taking insurance policies. The opposite party No. 2 has no role to play either in issuance of the policy, collection of premium and allowing or repudiating any claim arising out of the insurance policy. It is the prerogative of the opposite party No. 1 to issue any policy, collect premium, allow or repudiate the claim of the customer on any ground. It is purely a business between the opposite party No. 1 and its customers with limited role of the opposite party No. 2 as a corporate agent i.e. to explain the terms and conditions of the policy and to assist the customer is executing the policy documents. The complainant has miserably failed to show any damage on account of the opposite party No. 2’s alleged actions and has also failed to establish any case for having suffered any loss due to the act of the opposite party No.2. Irrespective of the fact that the opposite party No. 2 cannot be held liable for any action that is outside the ambit and control of the opposite party No.2. The complainant has no locus standi to initiate the present proceedings against the opposite party No. 2. The opposite parties state that from all the above, it is apparent that the allegations leveled by the complainant against the opposite party No. 2 are patently false and tricky, besides being vague, evasive, cryptic and lacking in material particulars, clearly by way of an afterthought and as such, liable to be ignored/ rejected outright, and liable to be dismissed forthwith. The present complainant has filed the present complaint against the opposite party No. 2 with ulterior and oblique motives and designs, interalia, to harass the opposite party No.2. The acceptance or rejection of the claim under insurance policy is matter between complainant and the insurance company, the opposite party No. 2 has no role whatsoever in rejecting the claim. The opposite party No. 2 has denied the other contents of the complaint and prayed for dismissal of the same. Alongwith the written version, the opposite party no. 2 has placed on record affidavit of Nidhi Mahotra Ex. OP2/1, self attested copy of letter of authority Ex. OP2/2

4        The complainant has filed the replications to the written versions filed by the opposite party No. 1 and opposite party No.2 and denied all the contents of the written version and reiterated the stand as taken in the complaint and prayed that the present complaint may be allowed.

5        We have heard the Ld. counsel for complainant and have also carefully gone through the documents on the file.

6        In the present complaint, the complainant’s husband kulwinder Singh Purchased a life insurance policy under kotak Group Shield  bearing policy number GS 000280 (loan ID 9613064416) From the opposite parties on dated 9^th July 2018.  Kulwinder Singh died on 28^th September 2018.  After the death of Kulwinder Singh the complainant submitted her complete death claim file to the opposite parties to get the death claim but the opposite parties were deliberately lingering on the matter either on one or the other false pretext and lame excuses. On dated 31^st March 2019 opposite parties rejected the death claim of the complainant alleged that the deceased policy holder was suffering from cirrhosis of liver, portal hypertension, alcoholic liver disease, hepatitis C but the deceased policy holder was not suffering from any such alignment as alleged by the Ops.

7        Opposite party No.1 stated in their written version that Opposite party 1 had an arrangement with Kotak Mahindra Bank whereby any person taking a loan from Kotak Mahindra Bank can be covered under the group policy i.e. Kotak group shield plan and Kotak Mahindra Bank becomes the master policy holder and the life to be assured becomes the member.  It is also submitted that the member has to provide a duly signed declaration of good health thereby assuring the insurer that the member is medically fit for availing the said insurance cover.  Since the information provided by the life assured in the form was established to be incorrect by the medical records obtained by the company hence the company was well within it's right to repudiate the said claim of the complainant.  The repudiation of the death claim under the subject policy was on the grounds of not disclosing true, correct and complete information in the said DOGH. Furthermore, the medical records issued from Shri Guru Ram Das Charitable hospital, Amritsar dated 18^th April 2017, 6^th June 2018 and 24^th June 2018 and the USG Abdomen issued from Shri Guru Ram Das Institute of Medical Science & Research, Shri Amritsar dated 25^th June 2018 and the medical cause of death issued from Shri Guru Ramdas Charitable hospital Amritsar dated 28^th September 2018 received during the assessment of claim procured. The said medical history was prior to the insurance of the cover which was not disclosed to the respondent by the member. From the above stated circumstances it is evident that the member had intentionally suppressed material facts pertaining to his health condition from the answering respondent and fraudulently obtained the said cover.

8        The OP No. 2 stated in their written version that the OP 2 has neither rendered any kind of service to the complainant nor has charged any amount for rendering any service to the complainant.  It is submitted that both the opposite parties are having separate legal entities registered separately under the Indian Companies Act 1956.  It is submitted that the OP 2 is not involved in insurance business . Hence, issuing of insurance policy to the complainant’s husband does not arise at all moreover none of the document filed by the complainant suggests that the replying OP 2 has ever issued any policy to the complainant’s husband . However,  it is submitted that the OP 2 is capacity of corporate agent of OP 1 only facilitate its customer to execute documents for taking insurance policies. It is further submitted that the OP has no role to play either in insurance of policy collection of premium and allow or repudiating any claim arising out of the insurance policy.

9        We have gone through pleading of the parties, perused the record and heard the argument of the learned counsel for the parties. The OP 1 stated in their written version that the complainant’s husband Kulwinder Singh suppressed material facts pertaining to his health condition from the insurance company and fraudulently had obtained the said cover and to prove their point OP1 as an evidence placed on record :–

• The medical records issued from the Sri Guru Ram Das Charitable Hospital, Amritsar .
• The USG Abdomen issued from Shri Guru Ramdas Institute of Medical Science & Research, Amritsar
• The Medical cause of death issued from Shri Guru Ram Das Charitable Hospital, Amritsar.

The opposite party No. 1 relied upon the report of ultrasound Ex. OP1/4 which show the name i.e. Kulwinder Singh father name in this report as well as age is missing. As such, the same could not be considered the report of Kulwinder Singh as an evidence that he is suffering from disease mentioned in the said report. In some of the record of Guru Ram Dass Charitable Hospital, the age of Kulwinder Singh is 50 years and in some other documents the age is 53 years. There is contradiction in the age also. The medical record dated 27.9.2018 in which the previously registered column is blank which is clear that the patient has never visited the hospital earlier.  It is pertinent to mention here that the policy in question was commenced on 09.07.2018 as mentioned in insurance policy (Ex Op 1/2  ) and on the other hand the alleged DOGH (EX.OP 1/1 ) was allegedly signed on dated 23.07.2018 i.e. after the insurance/ commencement of the policy, hence the OP No.1 cannot say that the deceased husband of the complainant namely Kulwinder Singh had intentionally suppressed the material facts pertaining to his health condition and fraudulently obtained the policy. Further, it is important to mention here that the date of commencement of the policy is 09.07.2018 and same is valid till 08.07.2023 and the insured was died on 28.09.2018 and hence if the insured has been died within 3 months from the date of commencement of the policy, same is no ground to repudiate the claim of the policy. Moreover, OP 1 stated in their written version that the policy is under the NMG ( Non-Medical) category and the OPs did not get conducted any medical test of deceased policyholder namely Kulwinder Singh at the time of issuing the above policy despite of clear directions of insurance Regulatory and development authority, India despite of the fact that deceased policy holder Kulwinder Singh was above 51years of age at the time of commencement of the policy. The DLA was above 45 years of age and what prevented the opposite party to conduct the detail medical examination before the inception of policy.   Reliance in this connection has been placed upon Bajaj Allianz Life Insu.Co.Ltd. & Ors Vs. Raj Kumar III(2014) CPJ 221 (NC) wherein it was held that usually the authorized doctor of the Insurance Company examines the insured to assess the fitness and after complete satisfaction, the policy is issued. Thus the repudiation of the claim on the ground of preexisting disease was held to be invalid. To prove the contention that the complainant was suffering from pre existing disease before taking the policy in question, the opposite parties have not placed on record affidavit of treating doctor of the life assured. In this regard, a reference can be made to the judgment of the Hon'ble National Commission in Revision Petition No. 200 of 2007 "Mr. Satinder Singh versus National Insurance Co. Ltd." decided on 24.1.2011 wherein it has been observed that "recording of history of patient in the above stated manner does not become a substantiate piece of evidence and convincing evidence be brought on record that complainant was aware of preexisting disease." Further, it has been observed by the Hon'ble National Commission in the III 2014 CPJ 340 (NC) "New India Assurance Company Limited through its duly Constituted Attorney, Manager versus Rakesh Kumar" that people can live months/years without knowing the disease and it is diagnosed accidentally after routine checkup and on that ground repudiation is not justified. Further it has been observed by the Hon'ble National Commission in its judgment IV (2008) CPJ 89 (NC) "Life Insurance Corporation of India & Ors. Versus Kunari Devi" that history recorded in the hospital bed head ticket is not to be taken as evidence as Doctor recording history not examined and suppression of disease not proved.  Furthermore, It is usual with the insurance company to show all types of green pastures to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of DharmendraGoel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation.  This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.  It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.UshaYadav& Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-

“It seams that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.        The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.

10      In light of the above discussion, the complaint succeeds and the same is hereby allowed with costs in favour of the complainant. The opposite Parties are directed to make the insurance claim to the complainant. The complainant has been harassed by the opposite parties unnecessarily for a long time. The complainant is also entitled to Rs.25,000/- as compensation on account of harassment and mental agony and 11000/- as litigation expenses. Opposite Parties are directed to comply with the order within one month from the date of receipt of copy of the order, failing which the complainant is entitled to interest @ 9% per annum, on the awarded amount, from the date of complaint till its realisation.  Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Commission and due to COVID-19. Copies of the order be furnished to the parties as per rules. File is ordered to be consigned to the record room.

Announced in Open Commission

24.01.2023

 (Charanjit Singh)

       President

(Nidhi Verma)                        (V.P.S. Saini)        

                                        Member                                  Member