Haryana

Karnal

CC/343/2017

Kamlesh - Complainant(s)

Versus

PNB Met Life Insurance Company Limited - Opp.Party(s)

Anand Kumar Garg

16 May 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

 

                                                          Complaint No. 343 of 2017

                                                          Date of instt. 13.10.2017

                                                          Date of Decision 16.05.2019

 

Kamlesh widow of late Shri Krishan Lal son of Shri Chander Singh resident of 1174, Tandiya Rana, village Gangana, Sonepat-131302, Haryana.

 

                                                                       …….Complainant

                                        Versus

 

1. PNB Metlife Insurance Company Limited, office at Second Floor, SCO-223, Sector-12, Karnal-132001, through authorized signatory.

2. PNB Metlife Insurance Company limited head office at 1^st floor, Techniplex-1, Techniplex Complex, off Veersavarkar Flyover, Goregaon(West), Mumbai-400062, through authorized signatory.

                                                                                                                                                                             …..Opposite Parties.

 

           Complaint u/s 12 of the Consumer Protection Act. 

 

Before    Sh. Jaswant Singh……President. 

      Sh.Vineet Kaushik ………..Member

            

 

 Present:  Shri Amit Munjal Advocate for complainant.

                  Shri Naveen Sharma Advocate for OPs.

 

                   (Jaswant Singh President)

ORDER:                    

 

                        This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986 on the averments that the husband of complainant has purchased a life insurance plan during his life time, vide policy bearing no.22125229 and same was commenced from 2^nd of March, 2017 for the terms of 20 years and also premium of Rs.55,000/- was also duly paid and the same was duly received by the Opposite parties (OPs) as per the policy the sum assured is Rs.9.58,453/- alongwith other benefits as per the policy terms and conditions supplied to the insured /policy holder. The complainant was nominee in the said policy. The policy holder was expired due to heart attack on 21.04.2017 in Civil Hospital, Gohana, Haryana. After the death of the policy holder, complainant intimated the OPs in this regard and lodges the claim with the OPs. OPs have illegally sent a letter dated 16.05.2017, vide which OPs illegally cancelled the policy since inception and flatly refused to entertain the genuine claim of complainant, however, complainant is legally entitled for the amount insured as per the policy. Complainant was regularly demanded the genuine claim of the policy holder but after many request OPs handover the policy cancellation letter dated 16.05.2017. Then complainant sent a legal notice dated 7.7.2017 to the OPs in this regard but it also did not yield any result. In this way there was deficiency in service on the part of the OPs. Hence complainant filed the present complaint.

2.             Notice of the complaint was given to the OPs, who appeared and filed written version stating therein that OPs was in receipt of a duly filled and signed proposal form from one Mr. Krishan wherein Deceased Life Insured (DLI) expressed his willingness to obtain a policy of Life Insurance from the OPs. On the basis of the information provided by the DLI in the proposal form and believing the same to be true and correct, the OPs issued the policy bearing no.22125229 on 26.02.2017. It is pertinent to mention that the said policy was issued relying upon the information provided by the DLI in the Proposal Form and that the DLI had duly signed a declaration form stating that the information provided in the proposal form were true and correct, and any false information shall entitle the OPs to declare the policy as void ab-nitio and to forfeit the premium amount, paid under the said policy.

3.             Further, upon internal investigation it was found that the DLI has suppressed & concealed the material facts and provided false information in the proposal form, which were material with respect to the issuance of the policy. The OP directed the DLI to provide some additional documents, for proper verification of the information provided in the Proposal Form. However, the DLI failed to provide the requisite documents and resultantly, the OPs declared the policy as void ab-initio. Hence the policy bearing no.22125229 was declared as void ab initio by the OP, and hence no benefits are payable under the said policy. Since the policy has been declared as void ab initio by the OP, the complainant is not entitled to claim any relief under the said policy. Hence there is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

4.             Complainant tendered into evidence his affidavit Ex.CW1/A and documents Ex.C1 to Ex.C12 and closed the evidence on 29.10.2018.

5.             On the other hand, OPs tendered into evidence affidavit of Rajeev Sharma Ex.OP1/A and documents Ex.R1 to Ex.R4 and closed the evidence on 30.04.2019.

6.             We have appraised the evidence on record, the material circumstances of the case and the arguments advanced by the learned counsel for the parties.

7.             The case of the complainant is that her husband had purchased a life insurance plan and on 2^nd of March, 2017 for the Terms as 20 years. The sum assured was Rs.9,58,453/- alongwith other benefits. The policyholder was expired due to heart attack on 21.04.2017 in Civil Hospital, Gohana, District Sonepat, Haryana. After the death of the policyholder, complainant intimated the OPs and lodged the death claim with the OPs. But OPs have repudiated the claim of the complainant, vide letter dated 16.05.2017 in illegal manner. The complainant is legally entitled for the insured amount as per policy.

8.             On the other hand, the case of the OPs is that after receiving the information of death of policyholder, the matter was investigated, upon internal investigation it was found that the DLI has suppressed and  concealed the material facts and provided false information in the proposal form, which were material with respect to the issuance of the policy. The DLI failed to provide the requisite documents and resultantly, the OPs declared the policy as void ab-initio. There is no deficiency in service on the part of the OPs.

9.             Admittedly, the DLI had purchased a life insurance plan policy in the year 2017. It is also admitted the DLI has expired during the subsistence of the policy. As per version of the complainant her husband expired due to heart attack. But there is no document on the file to prove that DLI expired due to heart attack. Complainant failed to prove that cause of death of the DLI. The policy in question was issued on 26.02.2017 and DLI was expired on 21.04.2017 within short period i.e. 53 days.

10.            The claim of the complainant was repudiated by the OPs on the ground that during the investigation, it was found that the DLI has suppressed and concealed the material facts and provided false information in the proposal form. DLI failed to provide some additional documents for the purpose of verification of the information provided in the proposal form. In this regard OP relied upon the letter Ex.R1. The OPs also relied upon the treatment record i.e. OPD slip of DLI Ex.R2. As per OPD slip Ex.R2 DLI was under the treatment of O.P.Jindal Institute of Cancer and Cardiac Research N.C.Jindal Institute of Medical Care and Research since 21^st September, 2016. Moreover, as per photographs Ex.R4 of the DLI, it is crystal clear that DLI was suffering from pre-existing disease. Thus, there is no deficiency in service on the part of the OPs in repudiating the claim of the complainant.

11.            It is settled principle of insurance law that contract of insurance is a contract uberrima fides and utmost faith must be observed by the contracting parties. Every material fact must be disclosed, otherwise there is good ground for rescission of contract. If, there are misstatements or suppression of material facts, the policy can be called into question. In this regard reference may be made to the judgment of the Hon’ble Supreme Court in case titled Satwant Kaur Sandhu Versus New India Assurance Co. IV( 2009) CPJ 8 (SC) and judgment of Hon’ble National Commission in case Life Insurance Corporation of India and another Versus Bimla Devi Revision Petition no.3806 of 2009 decided on 12.8.2015.

12.            Thus, as a sequel to abovesaid discussion and in view of law cited above, we do not find any merits in the complaint and the same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:16.05.2019                                                                       

                                                                      President,

                                                              District Consumer Disputes

                                                               Redressal Forum, Karnal.      

 

                (Vineet Kaushik) 

                 Member