Haryana

Karnal

CC/51/2020

Dhir Singh - Complainant(s)

Versus

Life Insurance Corporation Of India - Opp.Party(s)

Ramakant Sharma

29 Mar 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 51 of 2020

                                                        Date of instt.22.01.2020

                                                        Date of Decision:29.03.2023

 

Dhir Singh husband of late Smt. Pooja Rani (deceased), resident of village Bir Badalwa, Post Office and Sub Tehsil Nigdhu, District Karnal.

 

                                               …….Complainant.

                                              Versus

 

1.     Life Insurance Corporation of India, through its Branch Manager, Sector-12, Karnal.

 

2.     LIC of India, through its Manager,  489, Jeevan Parkash Building, Model town, Karnal.

 

3.     The Zonal Manager, LIC of India, Jeevan Bharti, towr-11, 124, Cannaught Circus, P.B. No.630, New Delhi 110001.

 

                                                                   …..Opposite Parties.

 

Complaint under Section 12 of the Consumer Protection Act, 1986 as amended under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary….Member

 

 Argued by: Shri Brij Bhushan, counsel for the complainant.

                    Ms. Shakuntla Dagar, counsel for the OPs.

 

                    (Jaswant Singh President)

ORDER:   

                

                The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 as after amendment under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant got purchased a policy bearing no.178179385 on the life of his wife Smt. Pooja Rani, sum assured of Rs.1,00,000/-T&T 820-20, Branch Office, Karnal-2 on 02.03.2018, for a period of 20 years and the name of the policy was money back policy. As per the terms and conditions of the policy, the installment of this policy was Rs.3943/- plus GST and the same was half yearly installment. This policy was purchased through Gianeshwar Dass agent of OPs. Unfortunately, Pooja Rani died on 01.07.2019. After the death of Pooja Rani, complainant visited the OP no.1, alongwith necessary documents in this regard and handed over the documents to Gineshwar Dass, Agent of OPs, who handed over the same to the OP no.1, through proper channel. As per terms and conditions of the policy, OPs are liable to pay Rs.1,00,000/- as insured amount but OPs paid only Rs.11,829/- i.e. the amount of three installments. At the time of purchasing the policy Smt. Pooja Rani was hale and hearty but OPs intentionally an deliberately repudiated the claim of complainant under the policy in question by making one excuse or the other and without any speaking order repudiated the claim of complainant under the policy in question. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action and concealment of true and material facts. On merits, it is pleaded that the policy in question was taken by Smt. Pooja Rani (since deceased-life assured) wife of complainant for sum assured of Rs.1,00,000/- under plan/term/premium paying term 820/20/15 with premium amounting to Rs.3943/- plus GST payable half yearly by OP no.1 with date of commencement of policy 28.03.2018 and the risk cover commencement being 31.03.2018. The complainant is the nominee in the said policy. As per death certificate, the life assured had died on 01.07.2019. The death intimation and claim forms were submitted by complainant, nominee husband. The claim was duly examined and it was observed that the duration of policy was only one year 3 months from the date of commencement of risk, hence the claim was examined under section 45 of Insurance Act 1938 and during investigation it was revealed that the life assured was pregnant at the time of filling the proposal form as she gave birth to male child on 27.09.2018 in Surya Hospital, Karnal. The policy was taken on 31.03.2018 on the basis of proposal form dated 02.03.2018, but in the said form she had not disclosed the fact that she was pregnant. Had she disclosed that the she was pregnant the insurance on her life could not have been granted as per rule of Corporation. As per Corporation’s guidelines vide circular no.Ref: Acturial/2088/4 dated 30.10.2006 and circular ref:NB&R/154/2016 dated 10.12.2016 insurance to pregnant women failing under category (iii) was not allowed and the deceased life assured was falling under category (iii). Hence she was not insurable as per provisions of Corporation and the death claim has been repudiated and decision has been conveyed to complainant, vide letter dated 22.11.2019. The life assured had not disclosed the fact of her pregnancy in proposal form dated 02.03.2018. Instead she concealed this material information and did not give any answer to the following question:

Q.no.13(a) “Are you pregnant now?

The life assured had not mentioned anything in reply to above question which means that it was done intentionally to get herself insured, hence conveying the meaning “No”. Thus, by leaving the above column blank she intentionally concealed the material information in the proposal form which would have affected the decision on granting the insurance on her life as insurance was not allowable in this case because the life assured was pregnant and failing under category (III) of female lives. There is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of insurance policy Ex.C1, copy of death certificate Ex.C2, copy of Aadhar card Ex.C3, copy of repudiation letter dated 22.11.2019 Ex.C4, copy of receipt of claim Ex.C5, copy of letter of insurance Ex.C6 and closed the evidence on 20.01.2022 by suffering separate statement.

5.             On the other hand, learned counsel for the OP has tendered into evidence affidavit of Puneet Kumar, Manager Ex.OP1/A, copy of status report of policy no.178179385 Ex.OP1, copy of status report of policy no.178163765 Ex.OP2, copy of letter dated 10.12.2016 Ex.OP3, copy of letter/circular dated 24.11.2016 Ex.OP4, copy of letters dated 30.10.2006 and 03.30.2017 Ex.OP5 and Ex.OP6, copy of proposal form Ex.OP7, copy of cancelled policy no. 178179385 Ex.OP8, copy of claimant’s statement Ex.OP9, copy of report of agent Ex.OP10, copy of identification and cremation certificate Ex.OP11, copy of death certificate of life assured Ex.OP12, copy of repudiation letter dated 22.11.2019 Ex.OP13, copy of status report on which calculation has been done Ex.OP14, copy of receipt of premium receipt Ex.OP15, copy of birth certificate of male child to Pooja Rani Ex.OP16, copy of NB opinion in respect of Death Claim under policy no. 178179385 Ex.OP17 and closed the evidence on16.12.2022 by suffering separate statement.

6.             We have heard the learned counsel for the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that wife of complainant purchased a money back policy from the OPs, sum assured of Rs.1,00,000/-, for a period of 20 years. Complainant is the nominee in the said policy. Unfortunately, Pooja Rani the wife of complainant died on 01.07.2019. After the death of Pooja Rani, complainant being nominee visited the OP no.1 and requested to release the death claim of his wife but OPs did not settle the claim and paid only Rs.11,829/- and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that policy in question was taken by Smt. Pooja Rani, the wife of complainant during her life time. The life assured had died on 01.07.2019. The death intimation was given by complainant and on receipt of death intimation, the claim was duly examined and observed that at the time of obtaining the policy, life assured had not disclosed the fact that she was pregnant. Thus, the claim of complainant has rightly been repudiated by the OPs, vide letter dated 22.11.2019 and lastly prayed for dismissal of the complaint. Learned counsel for OPs relied upon the case law titled as Reliance Life Insurance Co. Ltd. and Anr. Versus Rekhaben Nareshbhai Rathod in civil appeal no.4261 of 2019, decided on 24.04.2019.

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, wife of complainant had purchased a money back insurance policy from the OPs on 02.03.2018  and the date of commencement of the policy was 28.03.2018, for the period of 20 years and the sum assured of Rs.1,00,000/-. It is also admitted that complainant is the nominee in the said policy. It is also admitted that life assured had expired on 01.07.2019.

11.           The claim of the complainant has been repudiated by the OPs, vide repudiation letter Ex.C4/Ex.OP13 dated 22.11.2019 on the ground that deceased life assured was pregnant at the time of obtaining the insurance policy and this fact has not been disclosed by her in her proposal form and suppressed this material facts by the decease life assured.

12.           The policy in question had been purchased on 02.03.2018, she gave birth to a male child on 27.09.2018 in Surya Hospital, Karnal. The life assured expired on 01.07.2019.

13.           As per the version of the OPs, during the investigation it was found that life assured was pregnant at the time of filling the proposal form and this fact had not been disclosed by the life assured. Had she disclosed that she was pregnant, the insurance on her life could not have been granted as per rules of Corporation.

14.           Life assured had not expired due to pregnancy. She had already given birth to a male child on 27.09.2018 and expired on 01.07.2019. In claim form Ex.OP9 the reason of death has been mentioned as chest pain. Thus, there is no nexus between the cause of death and pregnancy of life assured.

15.           In reply of legal notice Ex.OP13 dated 22.11.2019, the OPs have put question no.13(a)  from life assured, which is reproduced as under:

Q.13(a) Are you pregnant now?                   Answer

                                                                 No

 

But in its written version filed on 22.10.2020, OPs have specifically mentioned that the life assured had not mentioned anything in reply to the above question in proposal form Ex.OP7. This fact also proved from column 13(a) of the proposal form Ex.OP7. It appears that OPs do not stand on their own legs. It was the duty of the OPs to check the proposal form thoroughly at the time of issuing the insurance policy. It appears OPs themselves had ignored the said column as “blank” just to get the premium amount from the life assured and also to complete their targets.

16. Hon’ble Punjab and Haryana High Court in case titled as New India Assurance Company Ltd. Versus Smt. Usha Yadav & others 2008 (3) RCR (Civil) 111, has held as under:-

                It seems that the Insurance Companies are only interested in earning the premiums which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance companies make the effected people to fight for getting their genuine claims. The Insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy.

 

 17.          Keeping in view the ratio of the law laid down in the abovesaid judgments, facts and circumstances of the complaint, we are of the considered view that act of the OPs amounts to deficiency in service and unfair trade practice. 

18.           The authority cited by the OPs is not applicable to the facts of the present case.  

19.           As per insurance policy Ex.C1, the sum insured is Rs.1,00,000/-. OPs have already transferred Rs.11829/- in the account of complainant.  Hence, complainant is entitled for remaining amount of 88171/-(1,00,000-11829) alongwith interest, compensation for mental harassment and litigation expenses etc.

20.           Thus, as a sequel to abovesaid discussion, we allow the present complaint and direct the OPs to pay Rs.88171/- (Rs. eighty eight thousand one hundred seventy one only) to the complainant alongwith interest @ 9% per annum from the date of repudiation of claim till its realization. We further direct the OPs to pay Rs.10,000/- to the complainant on account of mental agony and harassment and Rs.5500/- towards the litigation expenses. This order shall be complied with within 45 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 29.03.2023

                                                                President,

                                                      District Consumer Disputes

                                                      Redressal Commission, Karnal.

 

             (Vineet Kaushik)     (Dr. Rekha Chaudhary) 

                   Member                  Member