District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No. 690/2022.
Date of Institution:23.12.2022.
Date of Order:.17.08.2023.
Mr. Sunny Arora S/o Late Shri Bansidhar Arora r/o H.No. 189, Sector-10, Housing Board Colony, Faridabad.
…….Complainant……..
Versus
1. M/s. Tata AIA Life Insurance Co. Ltd. Through its Directors.
2. Mr. Rishi Srivastava CEO & Managing Director, M/s. Tata AIA AIA Life Insurance Co. Ltd..
3. Regional Head (Delhi Region) M/s. Tata AIA Life Insurance Co. Ltd. Regd. Off. At 14th floor, Tower a, Penincula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai – 400 013.
Also at: First floor, 16th Community Centre, New Friends Colony, New Delhi.
Also at: BP-47, Second floor, Bhadana Complex, Neelam Bata Road, NIT, Faridabad – 121001.
…Opposite parties
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
Indira Bhadana………….Member.
PRESENT: Sh. Vikas Yadav alongwith Shri Deepak, counsel for the complainant.
Sh. Ravi Nagar, counsel for opposite parties Nos.1 to 3.
ORDER:
The facts in brief of the complaint are that the deceased father of the complainant in consultation with complainant had obtained the life insurance policy from the opposite parties on 18th March 2020 after satisfying from al the benefits to be provided from the opposite parties in furtherance of which the complainant paid a total premium of Rs.1,13,988/- p.a. The policy in question was issued with subject to the policy’s conditions such as medical examination and other parameters which were considered by the opposite parties after having been satisfied with all the covenants of the Tata AIA Life Insurance Sampoorna Raksha Plan after that the opposite parties issued a policy No. C281282003 on the name of insured late Mr. Bansidhar Arora (deceased father of the complainant). On 08.02.2022, the father of the complainant died due to cardiac arrest which was duly informed by the complainant to the opposite parties vide his letter dated 23.02.2022 alongwith submission of original documents bearing its ref. NO.CC22091050 whereas there was no impediment while submission of the claim. Reference to the claim, the opposite parties replied with a letter dated 31.03.2022, which was astonishing and distressing reply with the repudiation of complainant’s legitimate claim on erroneous reason that the father of “the complainant had not disclosed the information regarding the previous insurance application. The complainant wanted to put in the kind notice of this Hon’ble Commission that the opposite parties did not bothered to check the credentials w.e.f. the case documents of late Shri Bansidhar Aroar, which was evident from the contents of letter dated 31.03.2022, where a template reply was addressed to the complainant, where the heartfelt condolences were paid to one Mr. Birendra Kumar Surana on 18th Feb.2022, whereas, the name of the deceased father of the complainant was Bansidhar Arora, therefore, the alleged rejection was without applying the mind
with deliberate intention to avoid their liability. At the very outset the complainant submitted that he or his deceased father had not given any misstatement neither had suppressed the material facts from the opposite parties in fact all the questions asked from him were correctly answered by the complainant’s deceased father at the time of filing of the application form. The proposal form was correctly answered by the complainant but kindly note that the same was filled by the opposite parties through their authorized representative. The opposite parties seeming to be acting in a malicious manner, the opposite parties despite having been satisfied from the complete body checkup conducted by them from their designated authorized lab, on the basis of which, the complainant’s deceased father issued above policy upto their satisfaction. The opposite party not only issued the policy in question out of their own pre will and as per their terms and conditions in lieu of which they had taken first premium of Rs.1,13,988/- vide receipt No ID2926014 on 18.03.2020 and further for the period of 2nd year received an amount of Rs.1,13,988/- having its receipt No. V1826108 on 16.3.2021 and raised the demand of 3rd year premium vide their email dated 28.02.20222, therefore, it was evident from the above acts of them that the opposite parties had mischievously repudiated the claim of the complainant and acting against the principles of natural justice as well as against the directions of policy norms. The complainant sent legal notice dated 06.09.2022 to the opposite party through registered post but all in vain. The aforesaid act of opposite party amounts to deficiency of service and hence the complaint. The complainant has prayed for directions to the opposite parties to:
a) pay the total amount as mentioned in the policy NO. C281282003 alongwith interest @ 18% p.a. till its realization.
b) pay Rs. 5,00,000/- as compensation for causing mental agony and harassment .
c) pay Rs. 55,000 /-as litigation expenses.
2. Opposite parties put in appearance through counsel and filed written statement wherein Opposite parties refuted claim of the complainant and submitted that the present consumer complaint had been filed without any cause of action as the insurance claim of the complainant had been rightly repudiated on the ground of concealment of material facts. In the present matter, the proposal form dated 18.03.2020 and filled by the complainant’s father sought details pertaining to previous insurance policies, if any, in Part B: Health and Personal Details.: the following question was asked:
S.No. | Health details | Reply |
1. | Has any of your insurance application or reinstatement application on life, accident, medical or health, critical illness, or disability ever been decline, postponed, or accepted at extra premium or modified terms? | No. |
The answer provided by the DLA to question NO.1 was a categorical “NO”. however, at the time of investigating the claim of the complainant, it was revealed to the opposite parties that the DLA had, in fact, applied for a policy with another insurance company which was postponed in view of the reported medical findings of elevated blood sugar levels and abnormal treadmill test reports. This was clearly indicative of the fact that the DLA had suppressed material fact sin the proposal form and was not honest in his intention. Based on this revelation, the opposite party No.1 rightly repudiated the claim of the complainant. In the present case, the DLA had failed to make full disclosure of the material fact that a previous insurance policy was postponed because the DLA was diagnosed with elevated
blood sugar levels. In fact, the DLA had maliciously lied to the opposite parties by not honestly answering the straightforward questions posed in the proposal form. It was categorically asked to the DLA if any previous policy was declined, postponed or accepted on modified terms, however the DLA had intentionally answered in the negative and concealed the actual fact from the opposite parties. Since it was revealed to the opposite parties that the DLA had concealed material facts and had breached the contract of insurance, the opposite party No.1 was well within its rights to repudiate the claim of the complainant. Opposite parties denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
3. The parties led evidence in support of their respective versions.
4. We have heard learned counsel for the parties and have gone through the record on the file.
5. In this case the complaint was filed by the complainant against opposite parties–Tata AIA Life Insurance and Ors. with the prayer to: a) pay the total amount as mentioned in the policy NO. C281282003 alongwith interest @ 18% p.a. till its realization. b) pay Rs. 5,00,000/- as compensation for causing mental agony and harassment . c) pay Rs. 55,000 /-as litigation expenses.
To establish his case the complainant has led in his evidence, Ex.CW1/A – affidavit of Sunny Arora, Ex.C-1 – death certificate,Ex.C-2- insurance bond, Ex.C-3 – repudiation letter dated 31.03.2022, Ex.C-4 – proposal form, Ex.C-5 – First premium receipt, Ex.C-6 – email dated 18.08.2022, Ex.C-7 to C-9 – postal receipts, Ex.C-10 – legal notice,, Ex.C-11 – reply to legal notice,
On the other hand counsel for the opposite parties strongly agitated and opposed. As per the evidence of the opposite parties Ex. OP-1/A – affidavit of
Shri Aviraaj Singh, Authorized Signatory, Tata AIA Life Insurance Co. Ltd., 14th floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai,, Ex. OP-1 – proposal form,, Ex.OP-2 – Policy schedule, Ex.OP-3 – HO summary, Ex.OP-4 - repudiation letter dated 31.03.2022. Opposite party also submitted the written arguments as well as citations.
6. In this case, complaint was filed by the complainant with the prayer of pay the total amount as mentioned in the policy No. C281282003 alongwith interest @ 18% p.a. till its realization. The complainant has also submitted the written submissions.
7. It is evident from the perusal of policy schedule Vide Ex.C-5, the age of the deceased Bansi Dhar Arora is 59 years. When the insured is above 45 years then the Insurance Company was at liberty to get the complainant medically examined prior to issuance of the policy in question. Insurance Company cannot take advantage of its act of omission and commission as it is under obligation to ensure before issuing the policy in question whether a person is fit to be insured or not. It was the duty of the opposite party to get the complainant immediately examined before issuing the policy as per IRDA guidelines.
8. During the course of arguments, the counsel for the complainant has placed on reliance Medical Insurance – Once Insurer Accepts that concealment of disease was not material, reimbursement & renewal can’t be refused passed by the Hon’ble Supreme Court of India on 6th July 2023.
Ratio of this authority is applicable to the facts of the present case
9. After going through the evidence led by the parties, the Commission is of the opinion that the complaint is allowed. Opposite parties are directed to process the claim of the complainant within 30 days from the date of receipt of the copy of order and pay the sum insured amount to the complainant alongwith interest @ 9% p.a. from the date of filing of complaint till its realization.
Opposite parties are also directed to pay Rs.5500/- as compensation for causing mental agony & harassment alongwith Rs.5500/- as litigation expenses to the complainant. Compliance of this order be made within 30 days from the date of receipt of copy of this order. File be consigned to the record room.
Announced on: 17.08.2023 (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharma)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
(Indira Bhadana)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
