Haryana

Karnal

CC/95/2018

Sundri Devi - Complainant(s)

Versus

Max Life Insurance Company Ltd - Opp.Party(s)

S.N Bhardwaj

22 Apr 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

 

                                                          Complaint No. 95 of 2018

                                                          Date of instt. 23.04.2018

                                                          Date of Decision 22.04.2019

 

 

Sundri Devi @ Sundri Bai aged about 57 years widow of Shri Ramesh Kumar resident of House no.88/3, Ram Nagar, Karnal.

                                                                         …….Complainant

                                                        Versus

 

1. Max Life Insurance Company Ltd., office 2^nd floor, Pathak Hospital, Sector-12, Karnal through its Branch Manager.

2.  Max Life Insurance Company Ltd., office plot no.90-A, Sector-18, Gurgugram-122015, Haryana through its Manager.

 

                                                                        …..Opposite Parties.

 

           Complaint u/s 12 of the Consumer Protection Act. 

 

Before    Sh. Jaswant Singh……President. 

      Sh.Vineet Kaushik ………..Member

                Dr. Rekha Chaudhary…….Member

 

 Present:  Shri S.N. Bhardwaj Advocate for complainant.

                   Shri Ashwani Popli Advocate for opposite parties.

 

                    (Jaswant Singh President)

ORDER:                    

 

                        This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986 on the averments that Mohit Kumar son of Shri Ramesh Kumar real son of complainant was the policy holder/life insured of the OP, vide policy no.122935935. The proposal form of the policy was accepted by the OPs on 21.07.2016 and policy was issued on 30.07.2016 after confirming/verifying requisite terms and conditions of the policy. The coverage term of the policy was 10 years. The son of complainant Mohit Kumar used to do the work of Furniture/Carpenter who had deposited Rs.27087/- as premium with the OPs. The complainant is the nominee as well as real mother of deceased Mohit Kumar. In case of untimely death of the policy holder, the sum assured was fixed as Rs.6,00,000/- as per the policy. The son of complainant untimely died on 7.4.2017 due to fever. The complainant being nominee had intimated the OPs regarding the death of her and applied for claim and completed all the formalities, vide claim reference no.201712401020 in the month of May, 2017. The OP sent a letter dated 31.07.2017 to the complainant, vide which the OPs refused to pass the claim on the ground that “there is misrepresentation of occupation and income of late Mohit Kumar in the proposal form.” The said objection of the OP is quite wrong and illegal. The claim form fill-up by the agent of the OPs and thereafter spot verification was done by the other officers of the OPs. There is no any kind of misrepresentation. The complainant requested the OPs so many times to release the claim but OPs always postponed the matter on one pretext or the other. In this way there was deficiency in service on the part of the OPs. Hence complainant filed the present complaint.

2.             Notice of the complaint was given to the OPs, who appeared and filed written version raising preliminary objections with regard to maintainability; jurisdiction; locus standi; cause of action; complainant is estopped by her own act and conduct from filing the present complaint and concealment of true and material facts. On merits, it is pleaded that the deceased life assured approached the OP and chosen the “Max Life Life Gain Premier 20 years 10 pay” Plan and the complainant purchased the policy and submitted the proposal form dated 21.07.2016 and in the proposal form, the deceased life assured has submitted the wrong detail of material information which was very much necessary at the time of determination of the annual premium under the policy of insurance because, the life assured disclosed in the proposal form that he is having business of furniture and he is earning Rs.2 lakhs. The OPs have investigated the matter and it was found during the investigation that he was not having business of furniture rather he is only and doing the work on daily wages. Moreover, in the investigation, it also came to know that the life assured was the member of family living Below Poverty line (BPL) and if the life assured had told the said information then the sum assured of Rs.3,05,981/- had not been assessed/determined by the insurance company and it might have very less. So, the information mentioned by the life assured was based on false and frivolous facts, which is criminal breach of trust on the part of the life assured. In the proposal form, the deceased life assured had given declaration to the effect that he had made complete, true and accurate disclosure of all the facts and circumstances, it is evident that material representation as required in the proposal form was not made by the deceased. So, on the basis of misrepresentation and concealment of material information the claim of complainant was declined/repudiated on 31.07.2017 and due intimation of the same was sent to the complainant. So, 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.             Complainant tendered into evidence her affidavit Ex.CW1/A, affidavit of Ganga Ram Ex.CW2/A and documents Ex.C1 to Ex.C6 and closed the evidence on 30.11.2018.

4.             On the other hand, OPs tendered into evidence affidavit of Dhiraj Malik Ex.RW1/A and documents Ex.R1 to Ex.R3 and closed the evidence on 26.03.2019.

5.             We have appraised the evidence on record, the material circumstances of the case and the arguments advanced by the learned counsel for the parties.

6.             The case of the complainant, in nutshell, is that her son Mohit Kumar was policy holder/life insured with the policy dated 30.07.2016 issued by the OPS. The coverage terms of the policy was 10 years. The son of complainant was used to do the work of Carpenter. The sum assured was Rs.6,00,000/- The son of the complainant demise untimely on 7.4.2017 due to fever. The complainant being nominee/real mother of her unmarried son named Mohit Kumar applied for death claim of her son but OPS refused to pass the claim on the ground that “there is misrepresentation of occupation and income of late Mohit Kumar in the proposal form.”

7.             On the other hand, the case of the OPs is that the complainant approached the OPs for releasing the death claim of her son namely Mohit Kumar. The deceased Mohit Kumar submitted the proposal form on 21.07.2016 and in the proposal form, the deceased life assured has submitted the wrong detail of material information which was very much necessary at the time of determination of the annual premium under the policy of insurance because the life assured disclosed in the proposal form that he is having business of furniture and he is earning Rs.2,00,000/-. But during the investigation, it was found he was not having business of furniture rather he is only doing the work on daily wages. Moreover, in the investigation, it also came to know that the life assured was the member of family living Below Poverty line (BPL) and if the life assured had told the said information then the sum assured of Rs.3,05,981/- had not been assessed/determined by the insurance company and it might have very less. So, on the basis of misrepresentation and concealment of material information the claim of complainant was declined/repudiation on 31.07.2017.

8.             Admittedly, the life assured was died during the subsistence of the policy. The claim of the complainant was repudiated by the OPs, on the ground of misrepresentation and concealment of material information. Main plea of OP is that, in the proposal form, the deceased life assured has submitted the wrong detail i.e. he is having business of furniture. We have gone through the proposal form Ex.C2, in column no.12 occupation has been shown, in column no.13, nature of job has been shown and in column no.14 name of the employer has been shown. As per Ex.C2 deceased life assured was doing the furniture works on the salary basis and his income was 2 lakh at that time. There is nothing mention in proposal form Ex.C2 that the deceased life assured was having the business of furniture. Moreover, he was doing the work on salary basis.

9.             It is not a case of OP that life insured was having any pre-existing disease. The plea taken by the OP regarding the family status of life insured is not acceptable, when he has already paid the premium of the first installment then why he cannot paid the premium further. Thus, in our view the act of the OPs is amounts to deficiency in service and unfair trade practice.

10.            Thus, as a sequel to abovesaid discussion, we allow the present complaint and direct the OPs to pay the insured amount to the complainant with interest @ 9% per annum from the date of repudiation till its realization. We further direct the OP to pay Rs.20,000/- to the complainant on account of mental agony and harassment suffered by her and for the litigation expense. This order shall be complied within 30 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:22.04.2019                                                                       

                                                                      President,

                                                              District Consumer Disputes

                                                               Redressal Forum, Karnal.      

 

        (Vineet Kaushik)          (Dr. Rekha Chaudhary)

            Member                           Member