Haryana

Bhiwani

CC/80/2017

Sudesh - Complainant(s)

Versus

PNB LIFE - Opp.Party(s)

Ranvijaypal

09 Nov 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BHIWANI.

 

                                                                  Consumer Complaint No. : 80 of 2017

                                                      Date of Institution             : 05.06.2017

                                                                  Date of order                     : 09.11.2023

 

Smt. Sudesh Tanwar wife of late Shri Vijay Singh R/o village Nawa Rajgarh, Tehsil and District Bhiwani, at present resident at Near Ram Gopal School, Uttam Nagar, Bhiwani.

  

             ……Complainant.

 

Versus

 

1.         PNB Metlife India Insurance Company Limited, 1^st Floor, SCF-50, Sec-11, HUDA, Panipat.

 

2.         Punjab National Bank, through its Branch Manager, Bhiwani.

 

…… Opposite Parties.

 

COMPLAINT U/S 12 OF CONSUMER PROECTION ACT, 1986.

 

BEFORE:          Hon’ble Mrs. Saroj Bala Bohra, Presiding Member.

  Ms. Shashi Kiran Panwar, Member.

 

Present:-          Sh. Ranvijay Pal, Advocate for complainant.

             Sh. Gagandeep Makkar, Advocate for OP No.1.

             Defence of OP No.2 struck off vide order dated 20.09.2018.

 

ORDER:

 

Saroj Bala Bohra, Presiding Member.

 

1.                     Brief facts of this case are that Sh. Vijay Singh (since deceased), husband of complainant, had purchased a life insurance policy No.21203317 on 08.11.2014 from OP No.2 for a basic sum assured Rs.2,00,000/-.  It has averred that husband of complainant died on 05.06.2015, after that, complainant lodged a claim with OPs, being nominee, but claim was not passed by OPs. So, complainant made two representations dated 12.10.2015 and 25.11.2015 as well as visited the office of OPs many times but of no avail despite issuance of a legal notice dated 26.02.2016. Complainant has averred that due to non-release of the claim, she has suffered monetary loss as well as mental and physical harassment. Complainant has averred that earlier a consumer complaint qua this matter was filed but the same was dismissed vide order datd 09.05.2017 due to non-appearance of complainant. Hence, the present complaint has been preferred seeking directions against the OPs to pay the entire claim under the insurance policy alongwith interest to the complainant, further to pay Rs.50,000/- on account of mental and physical harassment and a sum of Rs.10,000/- towards litigation expenses.

2.                     Upon notice, OP No.1 appeared and filed written statement submitting therein that during the course of investigation of claim, it revealed that life assured was suffering from Tuberculosis since prior to issuance of the policy.  Life assured was taking treatment from DOT center of Bhiwani since 25.07.2005. 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 of 19 months 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 and this communication was made to complainant vide letter dated 12.10.2015 alongwith fund value of Rs.37,465.56p. In the end, prayer for dismissal of complaint with costs was made.

3.                     Since, the OP No.2 failed to file written statement to the complaint despite availing sufficient opportunities, therefore, its defence was struck off vide order dated 20.09.2018.

4.                     To prove its complaint, the counsel for complainant has tendered in evidence affidavit of complainant as Exhibit CW1/A and documents Annexure C-1 to Annexure C-6 and closed the evidence.

5.                     On the other hand, evidence affidavit Ex.RW1/A of Sh. Rajeev Sharma, Senior Manager (Legal) alongwith documents Annexure R-1 to Annexure R-4 and closed the evidence.

6.                     We have heard learned counsel for the contesting parties and perused the record minutely.

7.              At the outset, the insurance policy taken from OPs for basic sum assured to the extent of Rs.2.00 lac vide Annexure C-1 & Annexure R-1, is not in dispute. However, it is admitted by complainant side that a sum of Rs.37,465/- have already been received by her qua the benefit of the policy. Death of the insured on the due date 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 08.11.2013 and its date of maturity is 08.11.2028 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 his eight years prior Tuberculosis disease before commencement of the policy period (Annexure R-2). In our considered opinion, if a person suffers from Tuberculosis at a particular point of time, which too about eight years prior to commencement of policy, it cannot be treated as serious so as to repudiate the genuine claim of the insured/his nominee in the case like under discussion, especially when the disease referred above is completely curable. 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 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.

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, jointly and severally, are directed to comply with the following directions within 40 days from the date of order:-

(i)        To pay a sum of Rs.1,62,535/- (Rs. one lac sixty two thousand five hundred thirty five) 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. 

3. 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:09.11.2023.

 

                                    (Shashi Kiran Panwar)                    (Saroj Bala Bohra)

                                                       Member                           Presiding Member

District Consumer

Disputes Redressal

Commission, Bhiwani. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Present:-          Sh. Ranvijay Pal, Advocate for complainant.

             Sh. Gagandeep Makkar, Advocate for OP No.1.

             Defence of OP No.2 struck off vide order dated 20.09.2018.

 

                        Arguments heard. Vide our separate order of even date, the complaint has been allowed. File after due compliance be consigned to the record room.

Dated:09.11.2023.

 

                                    (Shashi Kiran Panwar)                    (Saroj Bala Bohra)

                                                       Member                           Presiding Member

District Consumer

Disputes Redressal

Commission, Bhiwani.