Chandigarh

StateCommission

A/64/2023

DHFL PRAMERICA LIFEINSURANCE CO. LTD. - Complainant(s)

Versus

MANJU BALA - Opp.Party(s)

RAJ KUMAR, THE YOUNG JURIST

02 Jan 2024

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

[ADDL. BENCH]

 

 

Appeal No.	:	64 of 2023
Date of Institution	:	03.04.2023
Date of Decision	:	02.01.2024

 

 

Pramerica Life Insurance Ltd. [erstwhile DHFL Pramerica Life Insurance Co. Ltd.], through its Senior Manager – Legal, Regd. Office at 4^th Floor, Building No. 9, Cyber City, DLF Phase-III, Gurgaon, Haryana – 122002.

Branch Office at: SCO 2941-42, 1^st and 2^nd Floor, Sector 22-C, Chandigarh.

….Appellant

Versus

[1]      Manju Bala wife of Late Sh. Naresh Kumar, Resident of House No. 2438, Sector 20-C, Chandigarh.

Now Residing at: H.No.204, Rosewood GBP Enclave, Phase-I, Derabassi, District Mohali, Punjab.

[2]      HDFC Bank Limited, through its Regional/General Manager, having its office at SCO 153-154-155, Sector 8-C, Madhya Marg, Chandigarh.

….Respondents

 

BEFORE:

MRS. PADMA PANDEY, PRESIDING MEMBER PREETINDER SINGH, MEMBER

 

ARGUED BY:    Sh. Raj Kumar, Advocate for Appellant.

Ms. Jyoti Mehta, Advocate for Respondent No.1.

Ms. Neetu Singh, Advocate for Respondent No.2.    

 

PER PADMA PANDEY,  PRESIDING MEMBER

 

1]                This appeal is directed against the order dated 13.01.2023, rendered by the District Consumer Disputes Redressal Commission-I, U.T. Chandigarh (for brevity hereinafter to be referred as “the Ld. Lower Commission”), vide which, it allowed the Consumer Complaint bearing no.CC/222/2021, in the following terms: -

“4.       In the light of the aforesaid discussion, the present consumer complaint succeeds, the same is hereby partly allowed and OP-2 is directed as under:-

(i)         To pay to the complainant ₹10,07,168.16, as mentioned above, alongwith interest @ 9% per annum w.e.f. the date of death of the insured i.e. 18.8.2019, till its realisation.  However, OP-2 is further directed first to pay an amount of ₹7,88,754/-  to OP-1, out of the aforesaid amount, towards the outstanding amount in the home loan account, who will issue the NOC to the complainant on receipt of the said amount, and the remaining amount shall be paid to the complainant since OP-1 has already deducted some amount towards the loan account after the demise of her husband in order to discharge the liability of the deceased.

(ii)        to pay an amount of ₹50,000/- to the complainant as compensation for causing mental agony and harassment to her;

(iii)       to pay ₹10,000/- to the complainant as costs of litigation.

5.         This order be complied with by OP-2 within thirty days from the date of receipt of its certified copy, failing which, it shall make the payment of the amounts mentioned at Sr.No.(i) & (ii) above, with interest @ 12% per annum from the date of this order, till realization, apart from compliance of direction at Sr.No.(iii) above.

6.         Since no deficiency in service or unfair trade practice has been proved against OP-1, therefore, the consumer complaint qua it stands dismissed with no order as to costs.”

 

2]             For the convenience, the parties are being referred to, in the instant Appeal, as position held in Consumer Complaint before the Ld. Lower Commission.

 

3]                Before the Ld. Lower Commission, it was the case of the Complainant/Respondent No.1 that her husband namely Sh. Naresh Kumar had applied for home loan to Opposite Party No.1/Respondent No.2 which was sanctioned by it for the sum of ₹9,50,000/- vide acceptance letter dated 25.04.2019.  Thereafter, a Group Credit Life Insurance Policy was purchased by the husband of the complainant from Opposite Party No.2/Appellant through Opposite Party No.1 in order to secure the home loan of ₹9,75,708/- and the premium amount of the same was also paid by the husband of the complainant by obtaining another loan from Opposite Party No.1.  It was agreed through the policy that in case the installment of the home loan is not paid by the husband of the complainant in time, then Opposite Party No.2 (Insurance Company) shall be liable to pay the same.  In addition to this, it was also assured that in case of any casualty to the insured, the entire loan amount shall be borne by Opposite Party No.2.  During his life time, husband of the complainant had paid the installments of Opposite Party No.1, but, later on he fell ill and was admitted in the hospital and ultimately died on 18.08.2019.  On the demise of her husband, complainant had submitted insurance claim with Opposite Party No.2, but, the same was repudiated vide letter dated 24.01.2020, on the ground that the cause of death of Sh. Naresh Kumar was due to heart disease prior to the date of purchase of the policy and the said fact was concealed by him to Opposite Party No.2.  A complaint was also filed before the Ombudsman, but, nothing has been done. Opposite Parties were requested several times to admit the claim, but, with no result. Hence, the aforesaid Consumer Complaint was filed before the District Commission, alleging deficiency in service and unfair trade practice on the part of Opposite Parties.

 

4]                In the reply filed before the Ld. Lower Commission, while admitting the factual matrix of the case, Opposite Party No.1 pleaded that the husband of the complainant and the complainant had availed two loans i.e. home loan and loan to fund insurance premium, the consumer complaint is not maintainable against Opposite Party No.1.  It was asserted that till date, an amount of ₹8,65,610/- and ₹82,488/- is due towards the total disbursed amount to the complainant and her husband.  It was further alleged that the parties are bound by the terms and conditions of the loan agreement. Denying all other allegations and pleading no deficiency in service, the Opposite Party No.1 prayed for dismissal of the Complaint.

 

5]                Opposite Party No.2 contested the claim of the Complainant by filing its separate written reply, inter alia, pleading that the deceased/life insured had availed a loan from Opposite Party No.1 and based on the said loan, deceased had purchased the policy in question from it (Opposite Party No.2) and at the time of purchase of the policy, all the terms & conditions of the same were explained to the deceased who, after admitting the same, had accepted the policy. The said policy was w.e.f. 30.04.2019 for 11 years and the premium of ₹96,214.42 was paid by the insured for the sum insured of ₹10,20,505/-.  It was asserted that the deceased under the head of medical questionnaire in the proposal form dated 30.04.2019 had declared that he was neither suffering from any disease or disorder or he had suffered from such disease in the past.  It was further asserted that in fact the deceased was diagnosed with blood cancer and body ache which fact has also been reflected in the medical records (Annexure 4), but, the said fact was never disclosed by the deceased in the proposal form as well as while filling the health declaration of the proposal form. Even during investigation, investigator had discovered that the deceased died on account of chronic kidney disease, chronic liver disease and sugar from which the deceased was suffering since the last many years.  It was submitted that the claim of the complainant was decided in accordance with the terms and conditions of the policy. The cause of action set up by the complainant was denied and a prayer for dismissal of the complaint was made.

 

6]                After hearing the counsel for the parties and going through the record, the Ld. Lower Commission allowed the complaint, in the manner, as stated above.

 

7]                Aggrieved against the aforesaid order passed by the Ld. Lower Commission, the instant Appeal has been filed by the Appellant/ Opposite Party No.2.

 

8]                We have heard Learned Counsel for the parties and have also gone through the evidence and record of the case, with utmost care and circumspection.

 

9]                The core question that falls for consideration before us is as to whether the Ld. Lower Commission has rightly passed the impugned order by appreciating the entire material placed before it. 

 

10]              After giving our thoughtful consideration, to the contentions raised and material on record, we are of the considered opinion, that the instant Appeal is liable to be dismissed for the reasons to be recorded hereinafter.

 

11]              Record transpires, the policy in question was purchased by the deceased Sh. Naresh Kumar and his wife on 30.04.2019 and the disease from which the deceased was suffering i.e. multiple myeloma, P\W\C\O LBA X 3 months came to light only in the month of August, 2019, though he was diagnosed with back ache sometime in the month of June 2019, that too after the issuance of the policy. The Ld. Lower Commission after going the terms & conditions and benefits of the policy attached with the welcome letter (Annexure C-5) in pith & substance, recorded a categorical finding that nothing has been contained therein that in case of any pre-existing disease of the insured, he will not be entitled for the insurance claim, rather it contains if an insured member dies when his insurance coverage under the policy is in force, the coverage in force will be payable to the claimant and similarly the exclusion clause does not contain that in case the insured dies due to some pre-existing disease after the purchase of the policy, he shall not be entitled for any claim. This leads to an irresistible conclusion that Appellant/Opposite Party No.2 was unjustified in repudiating the claim of the complainant on the ground of concealment of facts, especially when it has come on record that there is no iota of any evidence on record showing that prior to the issuance of the policy, deceased was suffering from the ailment which resulted in causing his death. Furthermore, it was the bounden duty of Appellant/ Opposite Party No.2 to get the insured/deceased medically examined, as it had already received expenses from the deceased for his medical examination, and the same was not done by it. It is a settled proposition of law that where the insurance clause provided that the condition precedent for acceptance of the premium was the medical examination, it would be logical for an underwriter to accept the premium based on the medical examination and not otherwise and by the very fact that the insurer accepted the premium, waived the condition precedent of medical examination. To our mind, he Appellant/ Opposite Party No.2 thus cannot escape from its liability on the ground that the deceased had concealed facts about his pre-existing disease. No case is made for any interference in the well reasoned findings recorded by the Ld. Lower Commission.

 

12]              No other point was urged, by the Learned Counsel for the parties.

 

13]              It is demonstrable from a reading of the impugned Order of the Ld. Lower Commission that it is certainly not an order passed without reasons or without applying the judicious mind. The facts and circumstances of the case have been gone into, weighed and considered, and due analysis of the same has been made. It also does not appear to be an order passed without taking into account the available evidence.

 

14]              In the wake of the position, as sketched out above, we are dissuaded to interfere with the impugned order rendered by the Ld. Lower Commission. The appeal being bereft of merit is accordingly dismissed and the order of the Ld. Lower Commission is upheld.

 

15]              The pending application(s), if any, stand disposed off in terms of the aforesaid order.

 

16]              Certified copies of this order be sent to the parties free of charge.

 

17]              The file be consigned to Record Room, after completion.

 

Pronounced

02.01.2024.

                                                                                                  Sd/-

[PADMA PANDEY]

PRESIDING MEMBER

 

 

Sd/-

 (PREETINDER SINGH)

MEMBER

“Dutt”