Punjab

Sangrur

CC/147/2016

Makhan Singh - Complainant(s)

Versus

Managing Director/Auth.Sign. - Opp.Party(s)

Shri Ritesh Jindal

23 Sep 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                         

                                                Complaint No.  147

                                                Instituted on:    14.01.2016

                                                Decided on:       23.09.2016

 

Makhan Singh son of Tilak Ram, resident of House No.2, Village Jakhepal Vas, Tehsil Sunam, Distt. Sangrur.

                                                                ..Complainant

                                Versus

1.     HDFC Standard Life Insurance Company Limited, Registered Office: Ramon House H.T. Park Marg, 169, Blackbay Reclamation, Church Gate, Mumbai through its Managing Director/Authorised Signatory.

2.     HDFC Standard Life Insurance Company Limited, First Floor, Adjoining Sanatan Dharam Mandir, Ward No.3, Nabha Gate, Sangrur through its Branch Manager/Authorised signatory.

                                                        …Opposite parties

For the complainant  :       Shri Ritesh Jindal, Advocate.

For OPs                    :       Shri Sumir Fatta, Advocate.

 

Quorum:   Sukhpal Singh Gill, President

                K.C.Sharma, Member

                Sarita Garg, Member

 

Order by : Sukhpal Singh Gill, President

 

1.             Shri Makhan Singh, complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the wife of the complainant, Smt. Shalu Sharma obtained two insurance policies i.e. one in the year 2005 and another in the year 2013 bearing number 10538240 and 16195188 for Rs.1,02,321/- and Rs.6,00,000/- respectively by paying the requisite premium.  The case of the complainant is that Smt. Shalu Sharma (referred to as DLA in short) died on 21.10.2013 and as such the complainant lodged the claim with the OPs against these two policies with the OPs. The OPs sent letter dated 12.09.2015 to the complainant regarding policy number 16195188 that the payment of death claim amounting to Rs.70,494.25 instead of Rs.6,00,000/- has been credited in the bank account of the complainant with State Bank of India, Branch Sunam, but the Ops did not pay any amount under policy number 10538240 without any reason.  The Ops did nothing despite serving of legal notice dated 21.12.2015 upon the OPs. Thus, alleging deficiency in service on the part of the Ops, the complainant has prayed that the Ops be directed to pay to the complainant the claim amount of Rs.5,29,505.75 and Rs.1,02,321/- along with interest @ 18% per annum and further claimed compensation and litigation expenses.

 

2.             In reply filed by the Ops, legal objections have been taken up on the grounds that the complaint of the complainant is not maintainable, that the complainant has not come to the Forum with clean hands, that the complainant has distorted and twisted picture and that the complaint is not maintainable.  On merits, it is admitted that the DLA Shalu Sharma obtained two policies bearing number 10538240 and 16195188 and the complainant was the nominee under the policies. It is stated further that the policies were issued to the DLA on the basis of her applications dated 6.3.2003 and 24.7.2013.  It is stated further that at the time of getting the policies the DLA gave wrong answers to the questions. It is further averred that after the death of the DLA, the claim was got investigated and it was found that the DLA was suffering from cancer disease prior to the issuance of the insurance policy number 16195188, as such the amount of Rs.70494/- has already been credited in the account of the complainant.  Further regarding the policy bearing number 10538240 it is stated that the complainant is not entitled to get any claim as the policy had became paid up on 6.3.2012 due to non payment of renewal premium.  It is stated that though the DLA contacted the OPs for revival of the policy on 1.4.2013, but she was asked to get conducted some health tests and to submit certain documents, but she failed to do so.  As such, a cheque for Rs.11,110/- was sent to the complainant, which he refused to accept the same.   As such, it is stated that nothing more is payable to the complainant.

 

3.             The learned counsel for the complainant has produced Ex.C-1 affidavit, Ex.C-2 copy of policy, Ex.C-3 copy of letter dated 3.8.2013, Ex.C-4 copy of claim form, Ex.C-5 copy of intimation, Ex.C-6 copy of letter dated 12.9.2015, Ex.C-7 copy of ration card, Ex.C-8 copy of death certificate, Ex.C-9 copy of legal notice and Ex.C-10 & Ex.C-11 postal receipts and closed evidence. On the other hand, the learned counsel for the Ops have produced Ex.OPs1 and Ex.Ops2 copies of insurance policies, Ex.OPs-3 to Ex.OPs-5 copies of letters, Ex.OPs-6 copy of investigation report, Ex.OPs-7 affidavit and closed evidence.

 

4.             We have carefully perused the complaint, version of the opposite parties and heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.

 

5.             It is an admitted fact of the parties that the wife of the  complainant was insured with the OPs under policy number 10538240 and 16195188 for Rs.1,02,321/- and Rs.6,00,000/- respectively.  w.e.f. 08.03.2013 for Rs.10,00,000/-.  It is also an admitted fact that the DLA died on 21.10.2013.  It is also an admitted fact that the complainant being the nominee under the policies in question lodged the claim with the OPs and submitted all the relevant documents, but the OPs repudiated the claim of the complainant vide letter dated 02.09.2015, a copy of which on record is Ex.OPs/5 on the ground that  the DLA was suffering from cancer at the time of obtaining the policy bearing number 16195188 for Rs.6,00,000/-.  Further it is stated that the OPs have already paid the due amount of Rs.70494.25 against this policy by transferring the same in the account of the complainant through NEFT.  But, regarding policy bearing number 10538240, no claim is payable as the policy has been in lapsed state.  Whereas, on the other hand, the learned counsel for the complainant has contended vehemently that the DLA did not conceal any material information at the time of getting the insurance policy, as she was not suffering from any ailment at that time.

 

6.             Further the learned counsel for OPs has drawn our attention towards the death claim investigation report, which is on record as Ex.OPs-6 and a bare perusal of it shows that the patient died due to suffering from cancer.   We feel that this report is not at all helpful to the case of the Ops, as the Ops have not produced any documentary evidence whatsoever to show that whether the DLA ever remained admitted in the Dayanand Medical College and Hospital, Ludhiana and for what period.  Further no bed head ticket, patient summary or any other documents is also on record to show that the DLA died due to cancer.  Further this report is not even signed by any one nor the affidavit of the investigator who conducted the investigation is on the record, as such, we are unable to go with the contention that the DLA was suffering from cancer at the time of getting the insurance policy or she obtained the policy in question by concealing the material facts of cancer disease from the OPs. The Ops have not produced on record any treatment record of the DLA to show that she ever got treatment from any hospital. 

 

7.             It is further worth mentioning here that before issuing the policy to the DLA, the OPs would have medically examined from their empanelled doctor, but the Ops are silent on this point and nothing has been produced on record.  There is no explanation from the side of the Ops that why they did not produce such investigation report of the empanelled doctor. It is obvious that if any disease could have been detected, then the Ops would not have issued any insurance policy to the deceased, but the OPs issued the policy in question to the DLA. To support such a contention the learned counsel for the complainant has cited Life Insurance Corporation of India and another versus Nirmla Devi III (2003) CPJ 18, wherein the Life Insurance Corporation of India repudiated the claim of the complainant on the ground that he has suppressed material facts and had got conducted surgery prior to the policy. But, the Life Insurance Corporation did not produce any medical documents/relevant proof regarding surgery conducted on the complainant, as such the claim was allowed along with interest @ 12% per annum.   Similar is the position in the present case, as the OPs have not produced any documentary evidence/relevant proof regarding the pre existing disease of the DLA, hence, this arguments of the OPs falls flat that the DLA was suffering from cancer disease at the time of taking the policy in question.

 

8.             A bare perusal of the written reply of the OPs reveals that the OPs have taken the stand that the DLA was suffering from cancer at the time of getting the insurance policy, but again the OPs have not produced any documentary evidence to support such a contention that the DLA was suffering from any such disease as mentioned above. Another contention of the learned counsel for the OPs that the DLA took the policy at the fag end of his life for Rs.6,00,000/-  and she died within three months of taking the policy is also not tenable, as it is open for any one to take the insurance policy at any time and there is no age fixed by the OPs for taking the insurance policy.  The learned counsel for the OPs has further contended that the DLA had concealed material information regarding pre existing disease, as such, the complainant is not entitled to get any insurance claim and it is stated that the claim has been rightly repudiated. But, in the present case, there is no such situation nor the Ops have proved on record that the DLA was suffering from any of disease at the time of taking the insurance policy.  

 

9.             On the other hand, the learned counsel for the complainant has contended vehemently that the DLA was not suffering from any ailment at the time of getting the insurance nor she suppressed any material information nor gave any false reply to the answers of the OPs.  The learned counsel for the complainant has cited Life Insurance Corporation of India versus Smt. G.M. Channabasemma 1991 AIR (SC) 392, wherein it has been held that burden of proof that the insured made false representation is on the Corporation.  But, in the present case, the OPs have miserably failed to do so.   The learned counsel for the complainant has further contended that the OPs have not produced any cogent and reliable evidence to show that the DLA ever took any treatment from any hospital prior to taking of the insurance policy in question.  To support such a contention, he has also cited a ruling of the Apex Court of India in P. Vankat Naidu versus Life Insurance Corporation of India and another IV(2011) CPJ 6 (SC), wherein the allegations of the Life Insurance Corporation of India that the life assured suppressed material information relating to his illness were not accepted, as the Corporation did not produce any tangible evidence to prove that the deceased withheld information about his hospitalization and treatment.  In the present case also, the Ops have not produced any such evidence to support the contention of the OPs. 

 

10.           Moreover, the empanelled/authorised doctor of the OPs must have diagnosed and examined the DLA before issuance of the policy, assessed his fitness and after complete satisfaction policy was issued, as such, it cannot be said that the DLA was having pre existing disease of cancer before issuance of the policy.   The same view has been taken by the Hon’ble National Commission in case Bajaj Allianz Life Insurance Co. Ltd. and others versus Raj Kumar III(2014) CPJ 221 (NC).    

 

11.           In the present case, since the OPs have miserably failed to prove his allegations about the concealment of material information/ailment by the DLA at the time of getting the insurance policy in question and have repudiated the rightful claim of the complainant, we feel that the Ops are not only deficient in rendering service , but also are negligent for the same.  As such, we are of the considered opinion that it is a clear cut case of deficiency in service on the part of the OPs.

 

12.           The insurance companies are in the habit to take these type of projections to save themselves from paying the insurance claim. The insurance companies are only interested in earning the premiums and find ways and means to decline claims. The above said view was taken by the Hon’ble Justice Ranjit Singh of Punjab and Haryana High Court in case titled as New India Assurance Company Limited versus Smt. Usha Yadav and others 2008(3) R.C.R. 9 Civil) 111.

 

13.           Accordingly, in view of our above discussion, we allow the complaint and direct the Ops to pay to the complainant an amount of Rs.5,29,505.75 under policy number 16195188 and an amount of Rs.1,02,321/- under policy number 10538240 along with interest @ 9% per annum from the date of repudiation of the claim i.e. 02.09.2015 till realisation in full.  The OPs are further directed to pay to the complainant an amount of Rs.20,000/- as compensation for mental tension, agony and harassment and further an amount of Rs.11,000/-  in lieu of litigation expenses.

 

14.           This order of ours be complied with within a period of thirty days of its communication.   A copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                September 23, 2016.

                                                        (Sukhpal Singh Gill)

                                                           President

 

 

                                                              (K.C.Sharma)

                                                                Member

 

 

                                                              (Sarita Garg)

                                                                   Member