Complaint No: 429 of 2018.

                                                                    Date of Institution: 09.10.2018.

                                                                            Date of order: 16.10.2023

Mohan Singh Son of Charan Singh, resident of VPO. Sohal, Tehsil and District Gurdaspur. Pin Code – 143520

                                      ....Complainant

                                  VERSUS

1.       PNB Met Life India Insurance Company Ltd. Regd. Office Brigade Seshamahal, 5 Vani Vilas Road, Basavanagudi, Bangalore, through its Managing Director. Pin Code – 560063.

2.       The Chairman, Claims Committee, PNB Met Life India insurance Company Ltd., 1st  Floor, Techniplex Complex, Off Veer Sawarkar Flyover, Goregaon, West Mumbai – 400062.

3.       Punjab National Bank Branch Sohal, Tehsil and District Gurdaspur, through its Manager. Pin Code – 143521.

4.       Smt. Navjot Sharma w/o Sonu Village Mann, Tehsil and District Gurdaspur. Pin Code – 143521.

                                                                                                                                     ….Opposite Parties.

                                  Complaint U/S 12 of the Consumer Protection Act.

Present: For the Complainant: Smt.B.K.Bajwa, Advocate.

   For the Opposite Parties No.1 to 3: Sh.Vikas Sharma, Advocate.

   Opposite Party No.4 exparte.

Quorum: Sh.Lalit Mohan Dogra, President, Sh.Bhagwan Singh Matharu, Member.

ORDER

Lalit Mohan Dogra, President.

          Mohan Singh, Complainant (here-in-after referred to as complainant) has filed this complaint under section 12 of the Consumer Protection Act, (here-in-after referred to as 'Act') against PNB Met Life India Insurance Co. Ltd. Etc. (here-in-after referred to as 'opposite parties).

2.       Briefly stated the case of the complainant is that the complainant obtained an insurance policy bearing Policy No. 21533532 dated 23.03.2015 in the name of his son namely Karamjit Singh. It is submitted that son of the complainant was insured for a sum of Rs.5,00,000/-. It is further pleaded that complainant deposited two premiums of Rs.50,000/- with the OP’s and the date of maturity of the above mentioned policy was 23.3.2030 and mode of payment of premium was yearly. It is further pleaded that above said policy was obtained by the complainant at the instance of OP No. 3 who instigated the complainant to obtain this insurance policy and the same will give a very good return. It is further submitted that all the formalities were also completed by the OP No. 3 in his office as the representatives of the OP’s No.1 and 2 were sitting in the office of OP No. 3. It is further submitted that unfortunately son of the complainant died on 5.1.2016 as natural death all of sudden and the information regarding death of the son of the complainant was duly given to the OP’s by the complainant. It is further pleaded that OP’s sent letter dated 13.05.2016 to the complainant condoling death of his son and also directed the complainant to send necessary documents in this regard. It is further submitted that thereafter, the complainant submitted claim for payment of the insured amount alongwith all vested benefits to the OP’s. It is alleged that the OP No. 2 vide letter dated 29.06.2016 repudiated the claim of the complainant on false and flimsy grounds and fake observations that the deceased was suffering from liver disease and ALD Cirrhosis, portal HTN, Hepatitis prior to policy insurance. It is further alleged that the observations raised by the OP’s are totally false, imaginary and lie day dreaming, which has no legs to stand. It is further submitted that son of the complainant was hale and hearty and he died a natural death all of sudden. It is further pleaded that moreover, son of the complainant was got medically examined by the representative / agent of the OP’s before issuance of insurance policy. It is further submitted that the son of the complainant was insured by the OP’s when he was found fit from all corners. It is further pleaded that complainant never concealed any fact regarding health of the insured from the OP’s at the time of obtaining insurance policy. It is further alleged that the OP’s by not making payment of the insured amount on account of untimely death of the son of complainant on baseless observations are trying to back out from its pious obligation of making payment of the insured amount on account of demise of the policy holder with malafide intention and ulterior motive without any reason or rhyme. It is further pleaded that this decision of the OP’s is liable to be set aside and the complainant is entitled to receive the amount of insurance policy. It is further alleged that it is a case of clear cut deficiency gross negligence in service and unfair trade practice on the part of the OP’s who did not pay the insured amount to the complainant on false and flimsy grounds and without any reason or rhyme. It is further pleaded that due to this illegal act and conduct of the opposite parties the complainant has suffered great loss and also suffered mental agony, Physical harassment and inconvenience. It is further pleaded that there is a clear cut deficiency in service on the part of the opposite parties.

          On this backdrop of facts, the complainant has alleged deficiency and unfair trade practice on the part of the opposite parties and prayed that necessary directions may kindly be issued to the opposite parties to honor the claim of the complainant and make the payment of insured amount qua the claim of the complainant immediately in terms of the insurance policy may also be awarded to the complainant besides the amount in question on account of mental agony, physical harassment and deficiency in service on the part of the opposite parties, in the interest of justice.

3.       Upon notice, the opposite parties No.1 and 2 appeared through counsel and contested the complaint and filing their written reply by taking the preliminary objections that the Complaint filed by the Complainant is not maintainable and is liable to be dismissed as the Complainant has attempted to misguide and mislead the Hon'ble Court. It is further pleaded that the Complainant has suppressed material facts from this Hon'ble Court and as such the Complaint is liable to be dismissed and insurance contracts are contracts based on "Utmost Good Faith" and that the Life Assured/Proposer being a party to the contract is bound to disclose all material facts known to him at the time of proposal. It is further pleaded that the complainant has concealed and has suppressed the material and relevant facts of the case. It is further pleaded that complaint has been filed with malafide and dishonest intention and has not only concealed the material facts from the Hon'ble Court but has also twisted and distorted the same to suit their own convenience and to mislead this Hon'ble Court. It is further pleaded that the complicated question of law & facts are involved in the present complaint, which requires voluminous evidence i.e. examination and cross examination of witness which is not possible in the summary proceeding of consumer protection Act, 1986. It is further pleaded that therefore, only the civil court has the jurisdiction to try & decide the present complaint and therefore, the present complaint is liable to be dismissed. It is further pleaded that the complainant has filed the captioned complaint with the sole motive to gain illegally at the cost of OP’s. It is further pleaded that complaint is therefore liable to be dismissed in limine and the complainant has unnecessarily dragged the OP’s into uncalled litigation under the garb of Consumer Protection Act and as such the complaint is liable to be dismissed with heavy costs. It is further pleaded that the present complaint is not maintainable for want of cause of action as from a simple perusal of the whole complaint it is clear that there no cause of action has arisen in favour of the complainant and against the answering opposite parties. It is pleaded that the policy under question Met Easy Super bearing No. 21533532 was issued by the OP’s Company on the basis of the information provided by the Deceased Life Assured ("DLA") in the online proposal form No. 207277720 dated 19.03.2015 and since the information provided by DLA in the proposal form was established to be incorrect by the OP’s Company and hence the OP’s Company was well within its right to repudiate the said claim of the Complainant. It is further pleaded that as per the process of the OP’s the claim was investigated under section 45 of the Insurance Act, 1956 to verify the veracity of the claim. "Section 45 In accordance to the Section 45 of the Insurance Act, 1938 no policy of life insurance shall after the expiry of two years from the date on which it was effected, be called in question by an insurer of the Policy, was inaccurate of false, unless the insurer shows that statement was on material to disclose and that it was fraudulently made by the Policy holder and that the policy holder knew at the time of making it that the statement was false or that it was material to disclose". It is further pleaded that during the investigation & claim evaluation process it was found that the Deceased Life Assured at the time of filling up the proposal form, did not disclose the correct information about his health and from the medical documents procured during investigation it was found that late Mr. Karamjit Singh was suffering from Liver disease and ALD Cirrhosis, portal HTN, Hepatitis & was chronic Alcoholic prior to the issuance of policy. It is further pleaded that however the relevant question in the application form dated 19.03.2015 seeking insurance cover under this policy was answered as "NO" by late Mr. Karamjit Singh and proposer Mohan Singh (Complainant). It is further pleaded that from the medical record it was found that the complainant got admitted in Fortis Hospital Mohali on 28.10.2014 and 21.11.2014 vide patient ID No. 504436 and further admitted in Fortis Hospital, Amritsar on 13.02.2015 vide patient ID No. 144596 and discharged on 17.02.2015. It is further pleaded that the insured further got the treatment in the Fortis Hospital Amritsar on 24.02.2015, 07.03.2015, 28.03.2015, 18.04.2015, 09.05.2015 and died on 05.01.2016 due to the previous ailment. It is further pleaded that as per the discharge summary dated 17.02.2015 the insured was admitted in emergency with complaint of Generalize body weakness since 10 days and was diagnosed with "DECOMPANSATED CIRRHOSIS of  LIVER WITH HEPATIC ENCEPHALOPATHY SEPTICEMIA" and the history recorded in the said discharge summary was "EXCESSIVE ALCOHOLIC - LEFT FROM LAST 6 MONTHS". It is further pleaded that the answering opposite parties paid the amount of Rs.88,286.13/- including the premium amount of Rs.50,000/- which was received after the death of life assured through direct debit. It is further pleaded that from the stated circumstances, it is evident that the Life Assured had given wrong information and suppressed material facts in order to wrongfully obtain the subject policy from the OP’s company. It is further pleaded that therefore, the present complaint is liable to be dismissed.

          On merits, the opposite parties No.1 and 2 have reiterated their stand as taken in legal objections and denied all the averments of the complaint and there is no deficiency in service on the part of the opposite parties. In the end, the opposite parties prayed for dismissal of complaint with costs.

4.       Upon notice, the opposite party No.3 appeared through counsel and contested the complaint and filing their written reply by taking the preliminary objections that the complaint is not maintainable in the present form and no cause of action has accrued to the complainant against the opposite party No. 3 for filing the present complaint. It is further pleaded that the complainant has filed the present false complainant by concocting a false story, and dragged the opposite party No. 3 in false litigation, as such the complainant is liable to be burdened with special costs. It is pleaded that it is wrong that the insurance policy in question was obtained by the complainant at the instance of the opposite party No. 3. It is further pleaded that opposite party No. 3 never asked the complainant to obtain insurance policy in question, nor the complainant is having any account with the opposite party No. 3 Bank. It is further pleaded that the complainant has impleaded the opposite party No. 3 in this case unnecessarily. As submitted above, the opposite party No. 3 has nothing to do with the Insurance of the son of complainant. It is further pleaded that complainant has dragged the opposite party No. 3 in unwanted and false litigation.

          On merits, the opposite party No.3 have reiterated their stand as taken in legal objections and denied all the averments of the complaint and there is no deficiency in service on the part of the opposite party. In the end, the opposite party prayed for dismissal of complaint with costs.

5.       Opposite party No.4 did not appear despite the service of notice and was proceeded against exparte vide order date 17.12.2018.

6.       Learned counsel for the complainant has tendered into evidence affidavit of Mohan Singh, (Complainant) as Ex.CW-1/A alongwith other documents as Ex.C-1 to Ex.C-2.

7.       Learned counsel for the opposite parties No.1 and 2 has tendered into evidence affidavit of Sh. Rajeev Sharma, (Senior Manager - Legal, PNB MetLife India Insurance Co. Ltd, Gurgaon) as Ex.OP-1,2/A alongwith other documents as Ex.OP-1,2/B to Ex.OP-1,2/E.

8.       Learned counsel for the opposite party No.3 has filed affidavit of Sh. Hitash Kumar Mahajan, (Manager of PNB, Branch Sohal, Gurdaspur) alongwith reply.

9.       Rejoinder not filed by the complainant.

10.     Written arguments not filed by both the parties.

11.     Counsel for the complainant has argued that complainant had purchased policy of insurance on 23.03.2015 in the name of his son namely Karamjit Singh. It is further argued that the sum assured was Rs.5,00,000/- and the complainant had deposited Rs.50,000/- as premium for two times. It is further argued that during the continuation of insurance policy the insured i.e. Karamjit Singh died on 05.01.2016 all of sudden and on intimation having been given to the opposite parties. The claim was repudiated by the opposite parties vide letter dated 29.06.2016 with the excuse that deceased was suffering from liver disease and ALD Cirrhosis, portal HTN, Hepatitis prior to the policy. It is further argued that the deceased was not suffering from any such disease and the repudiation of regular payable claim amounts to deficiency in service.

12.     On the other hand counsel for the opposite parties No.1 and 2 has argued that since the insured Karamjit Singh was suffering from liver disease and ALD Cirrhosis, portal HTN, Hepatitis prior to issuance of policy and since at the time of seeking insurance cover the insured had given wrong answers and as such the claim was rightly repudiated by the opposite parties No.1 and 2 and there is no deficiency in service on the part of the opposite parties No.1 and 2.

13.     Counsel for the opposite party No.3 has argued that opposite party No.3 has been unnecessarily impleaded as party in the present complaint and the complaint is liable to be dismissed.

14.     Opposite party No.4 remained exparte.

15.     We have heard the Ld. counsels for the parties and gone through the record. It is admitted fact that complainant had purchased Met Easy Super Policy from opposite parties No.1 and 2. It is further admitted fact that the insured Karamjit Singh expired on 05.01.2016 and the claim lodged by the complainant has been repudiated by the opposite party No.1 on the ground of concealment diseases i.e. liver disease and ALD Cirrhosis, portal HTN, Hepatitis.

16.     To prove his case complainant has placed on record copy of application form Ex.C1 and copy of death certificate Ex.C2 whereas opposite parties No.1 and 2 have placed on record copy of letter dated 08.06.20216 Ex.OP-1,2/B and copy of treatment record Ex.OP-1,2/C. Perusal of Ex.OP-1,2/B and Ex.OP-1,2/C shows that in the year 2014, the insured was suffering from liver disease and remained under treatment of various hospitals and on account of concealment of previous ailments the claim was repudiated vide letter Ex.OP-1,2/D and total amount of Rs.88,286.13 was refunded to the complainant. Although opposite parties No.1 and 2 have not examined any doctor or medical expert to prove the previous ailments from which the deceased was suffering but we are of the view that the policy in question has been obtained with malafide intention to get insurance claim by concealment of severe liver disease from which the insured was suffering. As such we are of the view that complainant has not been able to prove deficiency in service. Moreover, the insured was admittedly a teacher and educated person and had given all the answers

of 18 questions in negative intentionally as the insured was aware about the treatment which he was undergoing.

17.     As such we do not find any merit in the present complaint and accordingly complaint is ordered to be dismissed.                

18.     The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.

19.     Copy of the order be communicated to the parties free of charges. File be consigned.                                                                                                                                                               

            (Lalit Mohan Dogra)

                                                                                        President.  

Announced:                                                   (B.S.Matharu)

Oct. 16, 2023                                                        Member.

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