BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 143 of 2015
Date of Institution : 18.8.2015
Date of Decision : 30.1.2017.
Sita Ram aged about 28 years son of Shri Mohan Lal son of Shri Ganpat, resident of village Ratta Khera, Tehsil Dabwali, District Sirsa.
….Complainant.
Versus
1. Kotak Mahindra Old Mutual Life Insurance Company Limited, 4th Floor, Vinay Bhavya Complex, 159-A, CST Road, Kalina, Santacruz (East) Mumbai- 400 098 through its Regional Manager.
2. Kotak Mahindra Old Mutual Life Insurance Company Limited, 7th Floor, Kotak Infiniti, Bldg. No.21, Infinity Park, Off W.E. Highway, General A.K. Vaidya Marg, Malad (E) Mumbai- 400 097 through its Managing Director.
3. Kotak Mahindra Old Mutual Life Insurance Company Limited, Sangwan Chowk, Sirsa, District Sirsa, through its Branch Manager.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SHRI S.B.LOHIA. ……………………..PRESIDENT.
SHRI RANBIR SIGH PANGHAL……..MEMBER.
Present: Sh. B.C. Bhatiwal, Advocate for the complainant.
Sh. Sandeep Kamboj, Advocate for the opposite parties.
ORDER
In brief, the complainant’s case is that his father Mohan Lal had purchased one policy No.02634401 for sum assured of Rs.4,05,000/- under Basic Product Kotak Endowment Plan (UIN-107N002V01) on 16.11.2012 from opposite parties through their agent Pawan Kumar having agent code No.60147811. The said policy was commenced from 16.11.2012 for 20 years and the insurance premium of rs.19,489/- per annum was to be paid by his father to the ops for 20 years. His father had paid amount of Rs.20,092/- (Rs.19489 premium plus service and education cess) to the ops during his life time as per the terms and conditions of ops. The complainant has been appointed as nominee in the said policy. During the period of insurance, Mohan Lal died on 13.8.2013 and after his death, the complainant being his son and nominee under the policy is entitled to get claim amount of his father. The complainant submitted his claim to the ops alongwith all required documents and approached and requested them on many occasions to pay the amount of insurance policy alongwith interest and other benefits but all in vain and ops are not ready to pay anything to him rather they have postponed the matter intentionally and malafidely. The complainant also got served a legal notice upon ops on 19.2.2014 but to no effect. Hence, this complaint.
2. On notice, opposite parties appeared and filed reply submitting therein that repudiation of claim under the subject policy was on the grounds of misstatement of information, suppression of material information and furnishing of false information in the proposal form. The life assured at the time of filling up the proposal form, did not disclose the correct information about his health and he deliberately failed to disclose that he was suffering from thrombus in left bronchial artery prior to the date of signing the proposal form. The attested true copy of admission and discharge record produced from S.M.S. Medical College and Hospital, Jaipur dated 10.4.2011 clearly states that life assured was a known case of suffering from thrombus in left bronchial artery. The said medical history was prior to the issuance of the policy which was not disclosed in the proposal form. The complainant submitted a claim within nine months from the date of commencement of policy and as such the ops have rightly repudiated the claim. Insurance contracts are based on “Utmost Good Faith”. As per the contract, the insurer is bound to honour the claim under the policy, provided that the life assured at the time of applying for the policy had disclosed all relevant information with regard to his health, habits and employment etc. which are the basis of insurance. The life assured despite specific questions asked in the proposal form under clause 11.1 and 11.2 (b) regarding his health and disease intentionally withheld the material information from the ops and chose not to disclose true and correct facts in the proposal form and the above said fact of disease of life assured came to the notice of ops during investigation of claim. With these averments, prayer for dismissal of complaint has been made.
3. The complainant has tendered his affidavit Ex.C1, letter datged 20.11.2012 Ex.C2, legal notice Ex.C3, copies of postal receipts Ex.C4 to Ex.C6 and copy of acknowledgment Ex.C7. On the other hand, the opposite parties have tendered copy of proposal form Ex.R1, delivery report Ex.R2, copy of letter dated 20.11.2012 Ex.R3, copy of claim form Ex.R4, copy of admission and discharge card Ex.R5, copy of repudiation letter dated 26.11.2013 Ex.R6 and copy of reply to legal notice Ex.R7.
4. We have heard learned counsel for the parties and have gone through the case file carefully.
5. There is no dispute that the father of the complainant namely Mohan Lal obtained a life insurance policy from the opposite parties on 16.11.2012 for sum assured of Rs.4,05,000/-. The complainant was made nominee in the said policy. The father of the complainant has died on 13.8.2013 but the death claim submitted by the complainant to the ops has been repudiated by the ops vide their repudiation letter dated 26.11.2013 and copy of the same has been placed on file by the ops as Ex.R6. The ground for repudiation of the claim of the complainant is that deceased life assured Mohan Lal had made false declaration regarding his health in the proposal form at the time of taking policy in question. In the proposal form Ex.R1, to specific questions regarding his health that whether he suffered from, received/ receiving treatment of diseases as mentioned in clause 11.1 and to the specific question as mentioned in clause 11.2 (b) that have he been treated or are currently undergoing to have been advised treatment from a doctor or specialist or undergone any cardiological, radiological or pathological tests, the life assured answered in ‘No’. The opposite parties to support their version that deceased had given wrong answers/ declaration regarding status of his health at the time of filling of proposal form and to justify the repudiation of claim has placed on file copy of admission and discharge record of S.M.S. Medical College & Hospital, Jaipur Ex.R5 which shows that Mohan Lal life assured was admitted in the said hospital on 10.4.2011 and thrombus in left bronchial artery was diagnosed and he was discharged on 13.4.2011. The said document which is attested by Medical Officer of said hospital was received by the Investigator after death claim submitted by the complainant. So, from the said document, it is proved that deceased life assured was suffering from thrombus in left bronchial artery in the year 2011 i.e. prior to taking of the insurance policy and he had concealed the said material fact of his health from the ops in the proposal form. The complainant has not been able to submit any credible evidence to rebut the facts in the documents/ records produced from above said hospital. Therefore, we are of the considered view that the repudiation of the claim of the complainant on the ground of suppression of material fact regarding pre-existing disease is justified and ops have rightly repudiated the claim of the complainant.
6. Thus, as a sequel to our above discussion, we find no merit in the present complaint and same is hereby dismissed with no order as to costs. Copy of this order be given to the parties as per rules. File be consigned to record room after due compliance.
Announced in open Forum. President,
Dated: 30.1.2017. Member. District Consumer Disputes
Redressal Forum, Sirsa.
