Karnataka

Chitradurga

CC/9/2020

Smt.Shoba w/o late Ashoka T - Complainant(s)

Versus

Pnb Met Life India Insurance co ltd, - Opp.Party(s)

Sri.K.B.Chandrappa

19 Aug 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, CHITRADURGA.

CC.NO:9/2020

DATED:19^th AUGUST 2022

PRESENT: -     Sri. M.I.SHIGLI. B.A., LL.M.,  PRESIDENT

 

                        Smt. B.H. YASHODA.    B.A., LL.B., LADY MEMBER

                    

…COMPLAINANT/S	Smt. Shoba w/o late Ashok T, Aged about 37 years, House Hold R/o Opp Maruthi complex, Cholgudda, Chitradurga town. (Rep by Advocate Sri.K.B. Chandrappa)
V/S
...OPPOSITE PARTY/S	1 . PNB Met Life India Insurance co. ltd., Unit No.701,702,703, 7th  floor, West Wing, Raheja tower, 26/27,MG Road, Bangalore-01     2 . PNB Met Life India Insurance co ltd, Unit 101,Techniplex, Complex No.1,1st  Floor, Opp Veerasavarkar playover, Goregoan (west), Mumbai-400062 ( OP No.1 & 2 Rep by Advocate Sri. B.S. Shivamurthy)   3 . Incharge PNB Met life Insurance (Punjab National Bank co ltd., D no.32, near Umapathi conventional Hall, VP Extension, Chitradurga.   ( OP No.3 Rep by Advocate Sri. C.J. Lakshminarasimha)

:ORDER:

 

Sri. M.I.SHIGLI. B.A., LL.M., PRESIDENT

 

       This complaint is filed by the complainant U/s 12 of CP Act 1986, against the OPs, claiming relief of settlement of Insurance Claim of Rs.19,50,670/- and other compensation by way of damages for inconvenience, pain, mental agony and costs of proceedings.

 

 

BRIEF FACTS OF CASE:

        2. The complainant being the legal hair of one Ashok T, who had obtained Life Insurance Policy issued by the OPs which is being marketed in the name and style of “MetLife Mera Plan”

        The policy was for the assured sum of Rs.19,50,000/- in case of natural death and in case death due to accident was for a sum of Rs.50,00,000/-. The policy premium was Rs.4,426/- of yearly rest and for a period of 20 years commencing from 24/03/2017 to 24/03/2032. And the complainant was the nominee. It is stated that the OPs had issued policy after due verification and perusal of documents and on obtaining necessary information.

        3. It’s further stated that, the policy holder Ashok T, died on 05/09/2017 at his house due to heart attack (chest pain). And as

stated by the complainant on the date of death, the policy was in force and it covered the risk. The complainant states that, the deceased Ashok T, left behind the complainant as surviving nominee.

        4. As stated by the complainant, after the death of her husband the policy holder, she approached, the OPs for settlement of her claim and sought for issuance of claim, from the OPs who went on postponing the same.

        5. As stated by the complainant, she received a letter on 29/01/2018 from OPs stating that the OPs have already issued letter dated 26/12/2017 intimating that the OPs have cancelled the policy as the insured had not furnished the necessary document, and policy premium shall stand forfeited to OPs

        6. The complainant claims that, this act of OPs is intentional act of cheating, unfair trade practice and rendering their service deficient.

        The complainant further asserts that, she got issued a legal notice to OPs and sought for the settlement of her claim. And OP No.3 only responded to the same, denying the contents of the notice.

 

        7. Hence the cropping up of this complaint on accrual of cause of action.  On registering this complaint, this commission has issued notice to OPs who have appeared through their respective counsel and filed their versions.

        The OP No.1 and 2 have filed their version jointly whereas
OP No.3 has filed its version separately. However, the OP No.1 and 2 in their version have stated that… “there is no conflict of interest between Respondent No.1, 2 and 3 hence, a common written version is being filed’’.

        8. The crux of the defense, is in the following lines that, the deceased Life Assured (LA) had obtained the subject policy by way of fraud… who had obtained other insurance policies from other insurance companies, and he had failed to disclose the same in the proposal form which amount material suppression of fact under subject policy. Further the OPs have submitted catena of cases to defend their case in para No. 8 to 23 of its version which shall be discussed later.

        9. As the case was set for recording evidence, the complainant got examined herself as PW-1 and got documents marked as Ex.A-1 to
A-8. And on their turn the OPs 1 to 3 lead their evidence through their Relationship Manager as DW-1 and got marked documents at Ex.B-1 to B-6. Though DW-1 has deposed that he deposed on behalf of OP No1 to 3, the OP No.3, has separately examined another witness as DW-2, but has not got marked any documents on its behalf.

        10. After closure of evidence of both sides, either parties have submitted their written, as well as oral arguments.

        Having heard the arguments of both sides, the following points arise for our consideration viz…    

1. Whether the complainant proves that she is the consumer of the Complainant?
2. Whether the complainant further prove deficiency of service on the part of OPs.
3. What order?

11. Our findings on the above points.

1. Point No.1: In the affirmative
2. Point No.2: In the affirmative
3. Point No.3: As per the final order for the following.
4.  

        12. It’s an undisputed fact that, the deceased husband of the complainant had purchased the policy in question from OP No.3, where the Life of the (L.A) Assured with Rs.19,50,000/- in case of natural death.

         It’s also undisputed fact that the death of L.A was natural death. The OPs in their version at para No.27 on page No.9, have specifically admitted the policy particulars and coverage of the policy. However the defense of the OPs is disclosed at para 37 and 38 of their version.

        13. The OPs have contended at para 6 on page 2 that,

“…The contract of Insurance is a contract based on “UBERRIMAEFIDEI” i.e. utmost good faith”. But this principle, according to us is reciprocal, and it could be conveniently inferred that, the OPs are equally bound by the same principle.

        14. It is to be noticed that, the OPs have seriously contended in para 7 on page No.2 of its version that,

“… During said investigation it was revealed that LA had obtained the subject policy by way of fraud as there was active concealment of a fact by the LA as to his other insurance policies applied/obtained from other insurance companies…”

        15. This portion of version of OPs amount to tainting the claims of the complainant/L.A. with criminal liability. This compells us to draw an inference that, the OPs shall prove their stand with the standard of proof  requires  to  prove  in  criminal  allegation.   In other

words, this has to be proved beyond reasonable doubts. It is to be noticed that the insured is an agriculturist, and as a proposer must not be aware of the legal jugglery found in the proposal form. It is also to be noticed that, the omission of the insured to disclose a previous policy of insurance would not influence the mind of a prudent insurer. Hence the stand of the OPs stigmatizing the L.A requires, best possible proofs. Hence the onus to prove fraud is on the insurer. 

        16. Though the OPs in order to sustain their grounds of defense have relied upon certain authorities, but, have not made little efforts to supply the photo copies of the above citation, which in our view, is unwarranted on the part of OPs.

Referring back to Point No.1 for consideration, it is to be noticed that, the OPs have not disputed the locus of the complainant as nominee of the insured. And hence it could be conveniently answered that the complainant is the consumer of the OPs. And hence
Point No.1 is answered in affirmative.

        And turning our attention to Point No.2 as noted above, to the nature of deficiency of the OPs.

        17. The claimant/complainant has been informed of the repudiation of the claim as per Ex.A-1, the letter dated January 29^th 2018. It is pertinent to note that, the letter in question at Ex.A-1 is addressed to the insured, almost 4 months later to his death. And counsel for complainant vehemently argued that, this Ex.A-1 refers to an earlier letter dated 26^th December 2017, which is obviously addressed to the insured prior to Ex.A-1. The counsel for complainant submits that, nothing is placed on record by the OPs to substantiate their claim that such letter dated 26^th December 2017 was delivered to the assured during his Life time. It is also to be noticed that as per Ex.A-2, the first yearly premium is paid by the insured on 24^th March 2017 and next premium was due by 24^th March 2018. Ex.A-8 discloses the fact that, premium amount of Rs.4,426.50./- is received by OPs where the present complainant is shown as nominee of the assured.

18. The policy particulars at page 39 of the policy, denotes that, the insured is guaranteed with Rs.19,50,000/- in the first year of the policy.

        And in order to prove, its case the OPs have produced document at Ex.B-3 of another policy of HDFC. But no effort is made by the OPs by examining any witness/s to that effect.

        The counsel for the complainant, has drawn our attention that though the OPs have produced Ex.B-6 of HDFC insurance claim, by the complainant, but there is no reference of this Ex.B-6 in Ex.B-3.

        19. The counsel for the complainant draws our attention to the copy of the authority in the matter of Aviva Life Insurance Co. Ltd. V/s Rekhasen Ramajibhai Parmar in Rev.Petition No.4204/2011, rendered by the NCDRC dated 12/04/2017 where it is held that,

“…..Keeping in view the facts and circumstances of this case, in our opinion, the non-disclosure of the other insurance policies does not fall within the ambit of Section 45 of the Insurance Act, as the concealment was neither wilful nor fraudulent. To reiterate, the Agent himself admitted that it is the normal practice that in non medi-claim policies, the question regarding   existence of other insurance policies is not asked and that he himself had filled the proposal form. By no stretch of imagination it can be held to be a material fact fraudulently suppressed, entitling the Insurance Company to repudiate the claim on the stated ground…..”

        Similarly the counsels for the complainant produced authority of Rajastan State Commission ruling in the matter of Aviva Life Insurance V/s Shri Ramashwar Prasad Jain (First Appeal No.46/2017) dated 13/06/2017.

       

 

 

20. On the contrary as stated above, the OPs have made not made little effort to furnish the copies of the authorities they rely upon and have not been able to convince this commission, as to their stand. However the principle of those cases, cannot made applicable to the facts and circumstances of the case in hand.   

In the backdrop of the above detailed facts and circumstances narrated, we opine that, the OPs are not justified in repudiating the claim of the complainant, and we answer Point No.2 in affirmative.

        By the analysis of the our findings on Point No.1 and Point No.2, we proceed to pass the following…

:ORDER::

        The complaint filed by the complainant U/s.12 of Consumer Protection Act, 1986 is Partly allowed.

It is ordered that, the OPs shall settle the claim of the complainant to the tune of Rs.19,50,000/-.

The OPs shall pay Rs.20,000/- towards pain and suffering and mental agony.

The OPs shall also liable to pay Rs.10,000/- towards litigation expenses.

The same shall be complied within a period of 30 days from the date of this order, failure to which, the aggregate amount shall carry interest at the rate of 12% p.a. till its realization.

        Communicate the order to parties.

 

(Typed directly on the computer to the dictation given to stenographer, the transcript corrected, revised and then pronounced by us on 19^th August 2022.)

 

 

       LADY MEMBER                                          PRESIDENT

 

-:ANNEXURES:-

Witnesses examined on behalf of Complainant:

 

PW-1:- Smt. Shoba w/o late Ashok T,

 

Witnesses  examined on behalf of opponents:

DW-1&2 :-Sri. Rudra Muni S/o Thippeswamy

DW-3:- Sri D. Ahobhalesh S/o D. Anjaneyalu

 

Documents marked on behalf of Complainant:

01	Ex-A-1:-	Letter dated January 29th 2018.
02	Ex-A-2:-	First Premium Receipt dated 01/04/2017
03	Ex-A-3:-	Death certificate
04	Ex-A-4:-	Legal Notice dated 07/03/2018
05	Ex-A-5:-	Postal Window receipt dated 07/03/2018
06	Ex-A-6:-	Aadhar Card Xerox copy of late Ashok T
07	Ex-A-7:-	Aadhar Card Xerox copy of M. Shobha
08	Ex-A-8:-	Policy document dated 01/04/2017

 

 

Documents marked on behalf of opponents:

 

01	Ex-B-1:-	Letter of Authority copy
02	Ex-B-2:-	Addendum to electronic proposal form
03	Ex-B-3:-	Investigation Report copy
04	Ex-B-4:-	HDFC Life Super Savings Plan Policy dated 26/03/2017
05	Ex-B-5:-	First Premium Receipt dated 25/03/2017
06	Ex-B-6:-	Death Claim Letter copy

 

 

 

     LADY MEMBER                                    PRESIDENT

 

 

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