Haryana

Charkhi Dadri

CC/158/2022

Mukesh Devi - Complainant(s)

Versus

MD/CEO, PNB Metlife Insurance Company Ltd - Opp.Party(s)

Sh. Manjeet Chahar

13 Dec 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL

COMMISSION, CHARKHI DADRI.     

 

                                                           Complaint No.         158 of 2022.                                                                          Date of Institution:  08.06.2022

                                                           Date of order:                  13.12.2023

 

Mukesh Devi wife of Kishore Kumar, aged about 40 years and permanent resident of village and post office Nauragabass Jattan, Tehsil & Distt. Charkhi Dadri.

..Complainant.

                                                VERSUS

1.PNB Metlife Insurance Company Ltd through its MD/CEO, Regd. Office Unit No. 701 to 703, 7^th Floor, west wing, Raheja Tower, MG Road, Banglore-560001.

2.Director (Operation & Services), PNB Metlife Insurance Company Ltd. 1^st Floor, Techniples-1, Techniples Complex, Off Veer Sarvarkar Flyover, Goregaon (West), Mumbai-400062.

3.Manager/Sale rep, PNB Metlife Insurance Co Ltd, PNM(PNB) Kharkhara(Akoda), Tehsil & Distt. Mahendergarh.

                                                                 ..Opposite parties.

                   COMPLAINT UNDER THE CONSUMER                                                PROTECTION ACT,

Before: -   Hon’ble Sh. Manjit Singh Naryal, President

                Hon’ble Sh. Dharam Pal Rauhilla, Member.

 

Argued by: Sh. Manjeet Chahar,Adv. for complainant.

                   Sh. Rajender Verma, Adv. for OP no.1&2.

                    OP no.3 exparte vide order dt.26.08.2022

 

O R D E R

1.                 Brief facts of this case are that Sh. Kishore Kumar (since deceased), husband of complainant, had purchased a life insurance policy No.23128901 on 16.12.2019 for a basic sum assured Rs.28,00,000/-.  It has averred that husband of complainant died on 23.04.2021, after that, complainant lodged a claim with OPs, being nominee, but claim was not passed by OPs. So, complainant made requests as well as visited the office of OPs many times but of no avail despite issuance of a legal notice dated 14.02.2022. Complainant has averred that due to non-release of the claim, she has suffered monetary loss as well as mental and physical harassment. Hence, the present complaint has been preferred seeking directions against the OPs to pay the balance amount of death claim amounting to Rs. 24,00,000/- alongwith interest to the complainant, further to pay Rs.1,00,000/- on account of mental and physical harassment and a sum of Rs.21,000/- towards litigation expenses.

2.                     Upon notice, OPs appeared and filed written statement submitting therein that during the course of investigation of claim, it revealed that life assured was suffering from diabetic, liver disease, COPD and his leg also started to swell he had undergone treatment since prior to issuance of the policy. Thus the deceased life assured while filing proposal form concealed this material fact despite having a specific question with respect to the same. It has been submitted that the life assured expired only within a short span from issuance of the policy. Thus any non-closure of material medical facts or misrepresentation in the proposal forms would render the contract voidable at the option of insurer. Thus the claim of complainant was rightly repudiated vide letter dated 03.09.2021. In the end, prayer for dismissal of complaint with costs was made.

3.                     Notice was sent to the opposite party no.3 through registered post, but when none has appeared on behalf of the opposite party no.3, the opposite party  no.3 was proceeded against ex-parte vide order dated 26.08.2022.

4.                     To prove its complaint, the counsel for complainant has tendered in evidence affidavit of complainant as Exhibit CW1/A and documents Ex. C-1 to Ex.C-5 and closed the evidence vide order dt. 15.11.2022

5.                     On the other hand, the counsel for the OPs have filed affidavit Ex.RW1/A and tendered documents Ex.R1 to Ex.R6 and closed  the evidence vide order dt. 10.01.2023.

6.                We have heard the arguments advanced by learned counsel for both the parties and gone through the entire material available on record thoroughly and carefully.

7.                At the outset, the insurance policy taken from OPs for basic sum assured to the extent of Rs.28 lac vide Ex.C-1 & Ex R-3, is not in dispute. Death of the insured during the period of the insurance policy has also not been disputed. The complainant herein is nominee of the insured is also admitted. The payment of premium on due date by and on behalf of insured is also not in dispute. Date of commencement of policy is 16.12.2019 and its date of maturity is 14.12.2076 and such fact also not disputed by the OPs. The main opposition of the OPs is that at the time of filing the proposal form, the insured did not provide information qua disease before commencement of the policy period.   Hence, the columns filled up by the insured at the time of taking the insurance policy and particularly to the effect that the insured was not suffering  from any serious/old disease i.e. diabetic, liver disease, COPD and other disease cannot be treated as misrepresentation of material facts or concealment of old disease by insured or by his nominee, as the case may be. In our further considered opinion, it was also the duty of the OPs to have got verified about any disease being suffered by the insured at the time of issuing insurance policy in his favour. No satisfactory evidence has been filed on record on behalf of OPs, either oral or documentary, to satisfy this Commission that there was justified ground on the part of OPs to repudiate the genuine claim of the complainant after death of her husband/insured. To avoid liability the OPs have refunded premium of Rs. 4,00,000/- paid by the deceased  for the said life insurance.

8.                    For the abovementioned reasons, we are of the considered opinion that there was deficiency in service and unfair trade practice on the part of both the OPs by not allowing the genuine claim of the complainant qua sum assured under the policy taken by the insured/husband of complainant. Hence, this complaint is allowed and the OPs viz. PNB Met Life Insurance Company, are directed to comply with the following directions within 45 days from the date of order:-

(i)        To pay  balance amount of death claim Rs.24,00,000/- (Rs. Twenty Four lakh only) to the complainant being nominee in the policy alongwith simple interest @ 9% per annum from the date of filing of complaint till the actual realization.

(ii)       To pay Rs.10,000/- (Rs. Ten thousand) as compensation  on account of mental agony and physical harassment. 

(iii)    To pay Rs.5500/- (Rs. Five thousand five hundred) as litigation expenses.

                        In case of default, the OPs shall liable to pay simple interest @ 12% per annum on the aforesaid all the amounts for the period of default. Certified copies of the order be sent to parties, free of costs, as per rules. File be consigned to the record room, after due compliance

Announced:                                                         

Dated:13.12.2023