Punjab

Moga

CC/16/82

Malkiat Kaur - Complainant(s)

Versus

P.N.B. Metlife India Insurance Co. Ltd. - Opp.Party(s)

Sh. Sahil Goyal

31 Aug 2016

ORDER

THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA.

 

                                                                                      CC No. 82 of 2016

                                                                                      Instituted on: 29.03.2016

                                                                                      Decided on: 31.08.2016

 

Malkiat Kaur, aged 58 years, wife of Satnam Singh son of Major Singh, resident of Village Rauke Kalan, Tehsil Nihal Singh Wala, District Moga.

                                                                          ……… Complainant

 

Versus

1.       P.N.B. Metlife India Insurance Company Limited (Formerly known as Metlife India Insurance Company Limited) registered office at Birgaid, Seshamehal, 5, Vani Vilas Road, Basavanagudi, Bangalore-560004, through

          (i)      Managing Director/Deputy Director.

          (ii)     Marketing Manager, Circle Officer, Marketing Department, Ferozepur

Road, Ludhiana.  

(iii)    Mrs. Seema V.Pasneja, Corporate Agent/Sales Manager, Punjab National Bank, Badhni Kalan, Tehsil Nihal Singh Wala.

 

2.       Punjab National Bank, Badhni Kalan, through its Manager Badhni Kalan, Tehsil Nihal Singh Wala, District Moga.

 

3.       Punjab National Bank, Village Rauke Kalan, through its Manager Rauke Kalan, Tehsil Nihal Singh Wala, District Moga.

                                                                           ……….. Opposite Parties

 

Complaint U/s 12 of the Consumer Protection Act, 1986.

 

 

Quorum:    Sh. Ajit Aggarwal,  President,

                   Smt. Vinod Bala, Member,

                   Smt. Bhupinder Kaur, Member.

 

Present:       Sh. Sahil Goyal, Advocate Cl. for complainant.

                    Sh. Armaandeep Singh Virdi, Advocate Cl. for opposite party nos.1 (i) & (ii).

                     Opposite party no.1 (iii) ex-parte.

                     Sh. Vinay Kashyap, Advocate Cl. for opposite party nos. 2 & 3.

 

ORDER :

(Per Ajit Aggarwal,  President)

1.                Complainant has filed the instant complaint under Section 12 of the Consumer Protection Act, 1986 ( hereinafter referred to as the "Act") against P.N.B. Metlife India Insurance Company Limited (Formerly known as Metlife India Insurance Company Limited) registered office at Birgaid, Seshamehal, 5, Vani Vilas Road, Basavanagudi, Bangalore-560004, through Managing Director/Deputy Director and others (hereinafter referred to as the opposite parties) directing them to pay Rs.14,20,000/- as basic sum assured with all profit and bonus upto date against the policy no.21513303 date of commencement 06.03.2015 issued by opposite parties in the name of Satnam Singh son of Major Singh, Patti Gurdas, Rau Ke Kalan, District Moga. Further opposite parties may be directed to pay Rs.1,00,000/- on account of mental tension, agony, harassment to the complainant and deficiency in services alongwith interest at the rate of 12% p.a. from the date of death till actual realization of the entire amount to the complainant or any other relief which this court may deem fit and proper be also granted.

2.                Briefly stated the facts of the case are that Satnam Singh son of Major Singh was the husband of the complainant and he was having a saving bank account no.0545000108153970 and also one Crop Limited Account with opposite party no.2 bank at Badhni Kalan. The PNB Metlife India Insurance Company Limited was previously known as Metlife India Insurance Company Ltd and after collaboration with Punjab National Bank, it has changed its name and is dealing in business of insurance etc. to the people. The opposite party no.1 (iii) is corporate agent/sales manager of the opposite party company and is working at Punjab National Bank, Badhni Kalan and has her office in the said bank. Being customer of opposite party no.1 (iii) and 2, the said Satnam Singh used to visit the bank and was visiting terms with them and they advised them to purchase insurance policy and accordingly the said Satnam Singh purchased one policy no.21513303 under Met Family Income Protector Plus Plan on 04.03.2015. Basic sum assured Rs.14,20,000/- premium payable half yearly of Rs.36,761.56 plus service charges Rs.1135.94 = Rs.37893. Annual premium Rs.73524/- date of commencement on 06.03.2015 for 10 years i.e. completion date of policy was 06.03.2025 at Badhni Kalan and said Satnam Singh paid first premium on 04.03.2015 from his saving account0545000108153970 with Punjab National Bank, Badhni Kalan on 02.03.2015 and first premium payment receipt and above said policy was issued to Satnam Singh. The said Satnam Singh has died on 08.07.2015 at Village Rauke Kalan at his home due to sudden heart attack. The complainant is nominee in the said policy and is entitled to get all the benefits of the said policy after the death of Satnam Singh. After the death of her husband Satnam Singh, the complainant informed the opposite parties and they provided claim application for death claim and other papers and accordingly on 19.08.2015, Manager of opposite party no.3 bank got signatures of complainant on those claim papers and completed the same and received the same and sent to opposite party no.1 and 2 for doing the needful and to release the insurance/claim amount to complainant alongwith all the benefits against the said policy being nominee. After receiving the said claim papers, the opposite party no.1 (iii), 2 and 3 alongwith some officials visited the house of complainant and recorded the statements of complainant and his family members and other neighbourers that Satnam Singh died all of sudden due to heart attack at home on 08.07.2015 and he was not suffering from any disease or was not having any health problem and was hale and healthy and at that time, they assured the complainant that they would send the complete papers to the higher authority and the complainant will receive amount of basic sum assured of Rs.14,20,000/- alongwith all benefits and the same will be credited into the account of the complainant and she will be informed on her mobile number, through SMS. After that the complainant many a times met opposite party no.1 (iii), 2 & 3 and inquired about claim, then opposite party no.1 (iii) and 2 demanded 10% of the sum assured from the complainant to get sanctioned the claim on the pretext that by paying this amount to higher authority, the complainant will get the claim amount at the earliest and they have to pay 5% out of that 10% to opposite party nos.1 (i, ii), but the complainant refused to accept this illegal amount of the opposite parties. Due to non-accepting of this illegal demand by the complainant, the opposite parties in collusion with each other have rejected the claim of the complainant vide letter dated 02.03.2016. The complainant requested the opposite parties to reconsider her claim, but they again rejected the same vide letter dated 11.03.2016. Due to sudden death of her husband Satnam Singh, complainant has suffered huge loss who is having two daughters and she has no son. Now complainant has no male member in the family and instead of releasing the claim amount to the complainant, the opposite parties are unnecessarily harassing the complainant and in spite of receipt of claim forms, the opposite parties have again issued letter dated 20.02.2016 for deposit the due premium of March, 2016 and due to this illegal act of opposite parties, the complainant has suffered great loss, mental tension and agony for which opposite parties are jointly and severally liable to pay the said claim amount alongwith all benefits and interest. The opposite parties were requested many a times to admit the rightful claim of the complainant, but they refused to do so. Hence this complaint.

3.                Upon notice, opposite party nos.1 (i) & 1 (ii) appeared through their counsel and filed written reply taking certain preliminary objections that the instant complaint is false, malicious, incorrect and with malafide intent and is nothing but an abuse of the process of law and it is an attempt to waste the precious time of this Forum, as the same has been filed by the complainant just to avail undue advantage and the same is liable to be dismissed under section 26 of the Consumer Protection Act, 1986; that the averments made therein, are vague, baseless and with malafide intent; that the complaint filed by the complainant does not fall within the definition of a 'consumer dispute' under the Consumer Protection Act, 1986 as there is neither any unfair trade practice adopted by this opposite party nor any deficiency in services being established against the opposite party. Further submitted that Late Mr. Satnam Singh (herein referred to as 'Deceased Life Insured/DLI") after completely understanding the terms and conditions of their product 'Met Family Income Protector Plus' had submitted the duly signed Proposal Form no.207118073 on 04.03.2015 and offered to pay Rs.37,897/- half yearly towards the initial premium against the Sum Assured of Rs.14,20,000/-. It is submitted that the contents of the Proposal Form were explained to the DLI and he had given a Declaration stating that he has furnished the information after fully understanding the contents thereof and also after understanding the terms and conditions of the plan he had applied for and has made true and accurate disclose of all the facts and has not withheld any information. It is submitted that in the proposal form at Page 2, there was a column wherein the DLI was required to provide answers with respect to his Medical History and the DLI replied that he was not suffering from any disease neither he was taking any medical treatment. The relevant details is reproduced below for the kind perusal of this Forum.

2.	Seizures, Stroke, Paralysis, Epilepsy, Parkinson's, Multiple Sclerosis or any other Disorder of the Brain or Nervous System?	No
5.	Any Kidney, Liver Bladder disorder or Prostate Disease, Blood/Protein in Urine?	No
14. (a)     (b)   (c)	During the Past Five Years Have you consulted any doctor or health practitioner for illness lasting for more than 4 days except for fever, common cold or cough? Have you undergone ECG, X-rays, blood test or other tests? Have been admitted/advised to be admitted to any hospital or any other medical facility?	No     No   No

 

                   Upon receipt of the dully filled up Proposal Form and believing the information provided by the DLI to be true and correct alongwith the initial Premium, the opposite party evaluated and processed the Proposal Form on the basis of the information furnished by Deceased Life Insured and issued policy bearing no.21513303 with Risk Commencement date of 06.03.2015. The complainant was made the nominee under the said policy. Thereafter, the policy Documents alongwith the Schedule and the standard terms and conditions thereto and a Welcome letter were dispatched at the address of Deceased Life Insured which were duly delivered. It is submitted that the said policy was issued by opposite party relying upon the information provided in the Proposal Form regarding the various aspects including the personal, professional and other details. Further the proposal form which was duly signed by the DLI clearly had a provision for a declaration by the DLI. For the sake of brevity the same are reproduced herein below:-

          "Declaration, Agreement and Authorization:

I have read this Application or got read/explained the Application and furnished the information, after fully understanding the contents thereof, and also understood the terms and conditions of the plan that I have applied for. I have made complete true and accurate disclosure of all the facts to the best of my knowledge and belief and that I have not withheld any information."

 

                   Thus, the DLI in this case had fully understood the terms and conditions of the policy and further agreed under  the Agreement therein that if any untrue statement be contained in the application /Proposal Form, the policy contract shall be null  and void and the moneys which have paid in respect thereof shall stands forfeited to PNB Metlife. Further submitted that the Deceased Life Insured has just paid one premium. Thereafter, on 24.08.2015 the opposite party received the Death Claim Intimation from the complainant thereby intimating us that the Person Insured died on 08.07.2015 due to Heart Attack, which was duly acknowledged by opposite party vide letter dated 25.08.2015. The claim being an early claim, as the person insured died within a short span of only 4 months, the opposite party as per the procedure, carried out an investigation to settle the claim of the complainant. During the course of investigation and assessment of the claim, it was revealed to the opposite party that the DLI did not provide true and correct information while filling up the proposal form with respect to his medical history. It was revealed that the DLI was suffering from Alcohol induces Liver Cirrhosis, Right Frontal Intracranial Hemorrhage and underwent Craniotomy and was suffering from Hypertension prior to issuance of the said policy. The reports of Dayanand Medical College & Hospital, Ludhiana clearly establishes this fact that the DLI was suffering from chronic disease, much prior to the signing of the proposal form. It is pertinent to mention that in the proposal form there was a Question wherein the DLI was asked whether he has undergone any ECG, X-ray or have been admitted in the hospital in the past 5 years and the DLI replied in the negative. It is submitted that the documents of Dayanand Medical College & Hospital, Ludhiana states that the DLI underwent ECG, X-rays and various other tests on dated 28.10.2012 and thereafter the DLI was admitted in the ICU on dated 25.06.2013. It is to be noted that the DLI filled up and signed the proposal form on dated 04.03.2015 and despite the specific questions in the proposal form, the DLI concealed and suppressed the material facts with respect to his past medical history, thus inducing the opposite party to issue the said policy in his favour. It is also to be noted that the DLI expired only within a short span of 4 months from the date of issuance of the policy. Even after being aware that he was suffering from such a deadly disease, he opted for the policy to get the undue advantage out of the same and provided false information in the proposal form. Based on the abovementioned observations, it clearly reflects that these material details affecting the decision of the Insurer for the acceptance or rejection of the contract of insurance were wilfully misrepresented by the DLI as the same was wrongly mentioned by him in the Proposal Form at the time of availing the said policy, in spite of their specific questions in the Proposal Form. It is most humbly submitted that the DLI after understating the contents of the Proposal Form was duty bound to answer the questions with regard to his health/Occupation/Habits conditions of which he alone had personal knowledge and was aware of. Thus, the contract of insurance being of utmost good faith, DLI was obliged to give full and correct information on all matters which would influence the judgment of a prudent insurer in determining whether he will accept the risk and if he would, at what rate of premium and subject to what conditions. The material facts bearing on the risk in life insurance contracts viz., the state of health or illness (present & past), occupation and habits, particulars of previous insurance etc. are only within the knowledge of the proposer/insured. The insurer, therefore, has to reply entirely on the information, which the proposer gives at the time of proposal. If a material fact is suppressed, the insurer will be misled about the risk covered and hence the same will vitiate the contract. The insurer will then be well within its right to treat the contract as void as per the terms and conditions of the policy document. Thus, the opposite party has rightly repudiated the claim of the complainant on the ground of providing false information as to material facts with respect to his medical history, at the time of filling up of the Proposal Form, based on which the said policy was issued by opposite party to him. The said fact and grounds for repudiation was duly communicated by the opposite party to complainant vide its letter dated 28.10.2015. The complainant again sent a letter to opposite party requesting for the re-evaluation of the claim of the complainant vide letter dated 27.01.2016. The Independent Claim Committee of the opposite party reviewed the claim decision and upheld the same on the ground that the Policy was taken by concealing the material facts. The said decision was communicated to the complainant vide letter dated 02.03.2016. Further submitted that the fact that the Deceased Life Insured was suffering from Cancer was a material facts for the opposite party for arriving at a decision whether to issue the said policy or not and if yes, at what premium etc. Further submitted that there has been no negligence, deficiency of service and unfair trade practice on the part of opposite party; that the instant complaint lacks a cause of action. Therefore, this complaint is liable to be dismissed for want of the cause of action; that the present complaint is neither maintainable in law nor on facts and the same is liable to be dismissed in limine.

                   In Para-wise reply, all other allegations made in the complaint have been denied and a prayer for dismissal of the complaint with costs has been made.

4.                 Upon notice, despite due service, none appeared on behalf of opposite party no.1 (iii). As such, opposite party no.1 (iii) was ordered to be proceeded against ex-parte.

 5.               Opposite party nos. 2 & 3 filed their written reply, taking certain preliminary objections that the present complaint against opposite party nos.2 & 3 is legally not maintainable as no cause of action arose to the complainant against answering opposite parties; that there is no privity of contract between the complainant and answering opposite parties of any kind. So, the present complaint against answering opposite parties is without any cause of action and the same is liable to be dismissed with heavy costs; that the answering opposite parties have been unnecessarily impleaded in the present complaint without any cause of action and they have been dragged into false and frivolous litigation. It is pertinent to mention here that earlier some other parties also arrayed the bank as party in the insurance claim case, but this Forum as well as Hon'ble State Commission, Punjab, Chandigarh dismissed the complaints against the bank being not maintainable. So, in the light of the earlier decision, the present complaint is also liable to be rejected out rightly with special exemplary costs, as the Nationalized Bank has been unnecessarily dragged into false and frivolous litigation. So, the answering opposite parties are entitled to the compensation for filing such type of complaint; that this Forum has no jurisdiction to try and entertain the present complaint in light of the decision of Hon'ble National Commission in Revision Petition no.658 of 2012 in case Ram Lal Agarwalla Vs Bajaj Allianz decided on 23.04.2013 as the present alleged policy was purchased by deceased from opposite party no.1 which was ULIP Policy as per the pleadings. So, the Consumer Fora have no jurisdiction to entertain the present complaint and the same is liable to be rejected; that the present complaint is bad for mis-joinder of necessary parties. On this score also, the same is liable to be rejected against answering opposite parties. On merits, it is admitted correct that Satnam Singh deceased having saving bank account and crop loan account with opposite party no.2. Opposite party no.3 has no concern whatsoever with the complaint and opposite party no.3 has been wrongly impleaded in the present complaint. Further opposite party nos.2 & 3 never advised anyone to purchase any insurance policy nor it is the duty of the answering opposite party nos.2& 3 to indulge the insurance business as the answering opposite parties are doing the bank business as prescribed under the law and as per the Reserve Bank of India guidelines. The amount of the premium is debited in the account as per the instruction of Satnam Singh and according to the bank rules. Further the answering opposite parties have no concern regarding the claim of the complainant after the death of Satnam Singh. The answering opposite parties are not liable to pay any amount as alleged. It is the duty of opposite party no.1 to deal with grievances of Malkiat Kaur. Further submitted that Legal heirs or any other person never approached answering opposite parties nor they have any concern whatsoever with the complainant. The answering opposite parties never demanded any 10% as alleged. The all other allegations made in the complaint have been denied and a prayer for dismissal of the complaint with costs has been made.  

6.                In order to prove the case, complainant Malkiat Kaur tendered in evidence her duly sworn affidavits Ex. C-1 and Ex.C-2, affidavit of Sh.Nirmal Singh Ex.C-3, affidavit of Sh.Lakhvir Singh Ex.C-4, affidavit of Karamjit Singh Ex.C-5 and copies of documents Ex. C-6 to Ex.C-15 and closed the evidence. 

7.                In rebuttal, opposite party nos.1 (i) & 1 (ii) tendered in evidence duly sworn affidavit of Sh.Motty John, General Manager Legal of PNB Metlife India Insurance Company India Limited Ex.OP-1(i), (ii)/1 and copies of documents Ex.OP-1(i), (ii)/2 to Ex.OP-1(i), (ii)/46 and closed the evidence. Whereas, opposite party nos.2 & 3 tendered in evidence duly sworn affidavit of Sh.Jagdish Nehra, Senior Manager, Punjab National Bank Ex.OP2,3/1 and closed the evidence.        

8.                We have heard the learned counsel for the parties and have very carefully gone through record placed on file.

9.                Ld Counsel for complainant vehemently argued that husband of complainant was having a saving bank account and crop loan account with OP-2 and on advise of agent of OP-2, he purchased an insurance policy of OP-1 on 4.03.2015 and insured himself for ten years for sum assured of Rs.14,20,000/-. Annual premium was Rs.73,524/-and said policy commenced on 6.03.2015 and he paid the first premium on 4.03.2015. Unfortunately, husband of complainant died on 8.07.2015 due to sudden heart attack and thereafter, complainant submitted all claim forms to Op-3, who further submitted the documents to OP-1 and 2 for processing the claim, but after receiving the same, OP-1 (iii), 2 and 3 alongwith some officials visited the house of complainant and got recorded the statement of complainant and her family members that her husband died due to heart attack and got signatures of complainant on various forms and documents and also assured her that her claim would be processed shortly, but thereafter, they did not do anything and when complainant met them with request to process her genuine insurance claim, OP-1(iii), 2 and 3 demanded 10% from sum assured to process the claim and when complainant refused to accept their demand, they in connivance with each other repudiated the claim of complainant vide letter dated 2.03.2016. Complainant made many requests to OPs to admit her claim, but they again rejected her claim vide letter dt. 11.03.2016. Action of OPs in repudiating the claim of complainant amounts to deficiency in service and has caused harassment and mental agony to her and her family as after death of her husband, there is no male member in their family to win the bread for them. Complainant has humbly prayed for accepting the present complaint alongwith compensation and litigation expenses.

10.              To controvert the allegations of complainant counsel, ld counsel for OP-1 argued that on 24.08.2015, they received Death Claim Intimation from complainant informing that her husband died on 8.07.2015 due to heart attack and as the claim submitted was an early one, so they carried out investigation to settle the claim and during investigation it was found that husband of complainant concealed material facts regarding his health from OPs at the time of purchasing the insurance policy in question. Documents of DMC, Ludhiana clearly reveal that DLI underwent ECG, X-rays and various other tests on 28.10.2012 and thereafter, he was admitted in ICU on 25.06.2013. It is revealed that husband of complainant was suffering from Alcohol induces Liver Cirrhosis, Right Frontal Intracranial Haemorrhage and underwent Craniotomy and was suffering from Hypertension prior to issuance of the said policy. Reports of DMC, Ludhiana establish that prior to signing the proposal form, DLI was suffering from chronic disease. It is further submitted that in proposal form in answers to queries regarding any illness, DLI/husband of complainant has replied in negative, but reports of Dayanand Medical Hospital clearly state that DLI/husband of complainant underwent ECG, X-rays and various other tests on 28.10.2012 and he was admitted in ICU on 25.06.2013. Though DLI was fully aware of his illness, but he intentionally concealed the material facts regarding his chronic medical history from Ops and gave misrepresentation of facts about his health in proposal form. He died within short span of 4 months from the date of issuance of policy and though being aware of deadly disease, he willingly wanted to obtain undue monitory benefit from OPs by opting to purchase the said policy. Thus, there is non-disclosure of material facts or misrepresentation of material facts in the proposal form and as per terms and conditions of the policy, by doing so, DLI has rendered the contract of insurance voidable at the option of Insurer. OPs have rightly repudiated the insurance claim of complainant on the ground of providing false information and for concealing the material facts from OPs. It is reiterated that there is no deficiency in service on the part of Ops and has prayed for dismissal of present complaint.

11.              Ld Counsel for OP-2 and 3 argued that all allegations levelled by complainant upon them are totally wrong and false. It is asserted that they never advised complainant  to purchase the said policy nor they indulge in insurance business as they do their banking business as per rules. Amount of premium was debited from the account of husband of complainant as per bank rules.  It is further averred that they have no concern with the claim of complainant and they are not liable to pay the same and it is the duty of OP-1 to deal with the grievance of complainant. All the other allegations have been denied and counsel for OP-2 and 3 has prayed for dismissing the present complaint against them.

12.              It is admitted case of the parties that deceased Satnam Singh purchased insurance policy from OP-1 through OP-2 securing his life on 04.03.2015, it is further admitted that said Satnam Singh died on 08.07.2015 at his house and complainant lodged claim with OPs stating the cause of death of said Satnam Singh as sudden heart attack. The OP-1 repudiate the claim on the ground that as the claim was lodged in very short period, so they appoint investigator and in investigation it reveals that Late Satnam Singh was suffering from Alcohol induces Live Cirrhosis, right frontal intracranial haemorrhage underwent Craniotomy and Hypertension prior to the issuance of the policy in dispute and take treatment of his these disease from DMC Hospital Ludhiana, they relied their case on the investigation report Ex  OP-1 (i) (ii) /15 and record of DMC hospital as Ex OP-1 (i) (ii) /24 to OP-1(i) (ii)/42. They argued that at the time of purchasing the insurance policy. The complainant did not disclose about his prior ailment and concealed material facts from the OPs. The Counsel for the Complainant argued that said Satnam Singh was never suffering from any such disease, he was hale and healthy and died due to sudden heart attack in his house. In his support he produced affidavits of person of neighbourhood and of village doctor who stated that the Satnam Singh was never suffering from any disease and he died due to sudden heart attack, even in the investigation report. The investigator also mentioned that he take statement of authorized person but no one states regarding any prior ailment of life insured. The investigator visited the local hospital of the area to check the medical record of DLI and he found no medical record regarding the said Satnam Singh. Moreover in his investigation report in conclusion he mentioned that LA was patient of epilepsy and suffering from diabetes HTN, BA and ACD and was treated at DMC Ludhiana whereas in the repudiation letter dated 28.10.2015 Ex OP-1(i) (ii)/43. The OP-1 mentioned that Satnam Singh was suffering from Alcohol induces Live Cirrhosis, right frontal intracranial haemorrhage underwent Craniotomy and Hypertension and there is contradiction between their own investigation and alleged medical record produced by the OPs and cause stated by them for repudiation of claim. Moreover, the medical record of Dayanand Medical College and Hospital,  Ludhiana produced by the OPs as OP-1 (i) (ii)/24 to OP-1(i) (ii)/42 on which the OP relied upon their case, there is only the name of patient is written as Satnam Singh the parentage of said Satnam Singh and his address is nowhere mentioned in these medical record, so how they relate this medical record with deceased life insured Satnam Singh, they have not produced any record or evidence which shows that the alleged medical record relates to same Satnam Singh. Even the treating doctor is also not produced to prove the medical record. If the deceased was suffering from the ailment as alleged by the Ops, then he must be take treatment for his ailment regularly in the hospital in the local veracity but in their investigation the Ops failed to found any medical record of the said Satnam Singh in the hospital of local area. Furthermore it is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims.  The Hon’ble Punjab and Haryana High Court in case titled New India Assurance Company Ltd. Vs Smt. Usha Yadav & Ors 2008 (3) RCR (Civil) page 111 has held to the following effect:

“It seems that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.

The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining  policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.

                  Hon’ble Punjab & Haryana High Court in a similar case titled National Insurance Company Limited, Gurgaon Vs Ravi Dutt Sharma and another, 2011 (3) RCR (Civil) page 631, has held that the Insurance Companies are not acting fairly in all such matters after charging huge premium and intention is always to repudiate the claim on one ground or the other. The Hon’ble Apex Court in case titled as Dharmendra Goel Vs Oriental Insurance  Co. Ltd. III (2008) CPJ 63 (SC) held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the values of a particular insured goods, disowns the same on one pretext or the other, when they are called upon to pay compensation. The “take it or leave it”, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.

                   With regard to rude behaviour of Insurance Companies, Hon’ble Punjab State Commission, Chandigarh in First Appeal No.622 of 2007 decided on 20.04.2012 titled as Meena Rani Vs The Oriental Insurance Co. Ltd. Has also held to the following effect:

“There is no denying the fact that the insurers while selling the insurance policy proclaim all sorts of benefits and facilities for the insured to trap him in purchasing their policy. However, when time comes to stand to the said promise and to pay the amount of compensation, then every effort is made to reject the claim and even false pleas are invented, report of the surveyor is delayed, the assessment of compensation is reduced and the insured is cornered to accept a lesser amount.”

          The OPs wrongly and illegally repudiate the claim of the complainant.

13.              From the above discussion, we are come to the conclusion that the OP-1 have failed to prove that Satnam Singh was suffering from any prior disease, there is contradiction between the investigation report submitted by the investigator of OP-1 and repudiation letter dated 28.10.2015 issued by OP-1, in both these investigation report and repudiation letter, they allege different disease from which are suffered by said Satnam Singh. The medical record of DMC hospital is also cannot relied upon as there is only the name of patient is written as Satnam Singh and nowhere is parentage and address is mentioned to link it with deceased Satnam Singh.

14.              We are fully convinced with the arguments of Counsel for the Complainant and case law produced by them. The opposite party no.1 wrongly and illegally repudiate the claim of the complainant on flimsy ground which amounts to deficiency in service and trade mal practice on their part. The present complaint in hand is hereby allowed against opposite party no.1. However there is no deficiency in service on the part of opposite party nos.2 & 3 and complaint against opposite party nos.2 & 3 is dismissed. The opposite party no.1 is directed to pay the insurance claim of complainant amounting of Rs.14,20,000/- along with interest @ 9% PA from 28.10.2015 when they repudiate the claim of the complainant vide their letter Ex. OP (i) (ii)/43 till final realization.  Opposite party no.1 further directed to pay Rs.10,000/- (Ten thousand only) to complainant for harassment and mental agony suffered by her besides Rs.3,000/-(Three thousand only) as litigation expenses within one month of receipt of the copy of the order failing which, complainant shall be entitled to proceed under Section 25 and 27 of the Consumer Protection Act. Copy of order be given to parties free of cost under rules. File be consigned to record room.

Announced in Open Forum.

Dated: 31.08.2016.

 

                        (Bupinder Kaur)                 (Vinod Bala)              (Ajit Aggarwal)

                                 Member                        Member                     President