BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SIRSA.
Consumer Complaint no. 153 of 2020
Date of Institution : 16.07.2020
Date of Decision : 08.08.2024.
Mrs. Salochna Goyal, aged about 60 years widow of Shri Krishan Kumar Goyal, resident of New Aggarsain Colony, 7-A, Near Tirkona Park, Hisar now residing at 12/202, Backside Gali Poonia Hospital Wali, Aggarsain School, Sirsa, Tehsil and District Sirsa.
……Complainant.
Versus.
1. PNB Metlife India Insurance Company Limited, Operation Deptt. PNB Bank, Rori Bazar, Sirsa through its Circle Officer/ Branch Officer.
2. PNB Metlife India Insurance Company Limited, Operation Deptt. PNB Bank, Dabra Chowk, Hisar through its Branch Manager.
3. PNB Metlife India Insurance Company Limited, Goregaon West, Mumbai- 400062 through its Branch Manager/ Principal Officer.
4. PNB, Nagori Gate, Hisar through its Branch Manager.
5. PNB (Head Office) (Loan Department), 1st Floor, Rori Bazar, Gali PNB Wali, Sirsa, through its Senior Officer.
…….Opposite Parties
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. PADAM SINGH THAKUR……. PRESIDENT
SH. OM PARKASH TUTEJA ……… MEMBER
Present: Sh. Manoj Narula, Advocate for the complainant.
Sh. R.N. Kulhria, Advocate for opposite parties no.1 to 3.
Sh. Ravinder Kumar, Advocate for opposite parties no.4 and 5.
ORDER
The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 (after amendment u/s 35 of C.P. Act, 2019) against the opposite parties (hereinafter referred as Ops).
2. In brief, the case of complainant is that earlier she was residing at Hisar. The complainant is owner in possession of a Plot No. 21, H. No. 209, Vishwakarma Colony, Hisar also known as Aggarsain Colony, Hisar vide sale deed No. 10054 dated 16.02.2018. That husband of complainant namely Shri Krishan Kumar Goyal obtained home loan of Rs.8,49,000/- from Punjab National Bank which was disbursed to him on 28.09.2018 and on 8.10.2018. That at that time, PNB purchased insurance policy against the above said loan amount with motive to secure the above said loan from PNB Metlife vide group policy number 00000299 for the period 09.10.2018 to 09.10.2028 under loan safety insurance plan. It is further averred that husband of complainant had paid Rs.48,999.50 to the insurance company to secure the loan amount of Rs.8,29,340/- and this insurance policy is called as Group Policy Holder Punjab National Bank/ PNB Metlife Family Policy against home loan and complainant has been shown as nominee under the above said loan as well as policy. That it was assured by insurance company as well as PNB Bank to the husband of complainant that in case of death of insured, the remaining installment of loan shall be payable by the insurance company to the PNB and bank will not claim any installments from the husband of complainant or from complainant or from legal heirs of deceased. It is further averred that husband of complainant died on 18.09.2019 and complainant has submitted death certificate and also submitted her claim alongwith original policy and all other requisite documents to the company with the request to pay the remaining loan amount to the bank and all these documents were given by her to Mr. Suresh bank employee who assured that bank will not recover anything from the complainant at any point of time. It is further averred that later on vide letter dated 27.01.2020 ops no.1 to 3 have repudiated the claim of complainant on the ground of non disclosure of health condition i.e. coronary artery disease and cerebro vascular accident whereas in fact husband of complainant was not suffering from any such disease. At the time of getting insurance policy, he was medico-legally examined by the medical staff of the insurance company and he was found to be fit and after completing all legal requirements and formalities, the above said policy was issued to him but now the company has taken totally false and frivolous ground only for the purpose of non payment of any claim on totally false, frivolous, flimsy and imaginary grounds. It is further averred that in this manner, the said repudiation letter dated 27.01.2020 is wrong, incorrect against law and facts and against terms and conditions of policy and the act and conduct of ops comes under the ambit of deficiency in service as well as unfair trade practice due to which complainant is suffering recurring financial losses till today and also suffering serious harassment and mental tension. Hence, this complaint.
3. On notice, ops appeared. Ops no.1 to 3 filed written statement taking certain preliminary objections regarding cause of action, locus standi, maintainability, mis joinder and non joinder of necessary parties, estoppal and suppression of true and material facts etc. On merits, it is submitted that contract of insurance is based on “uberrimaefide” i.e. utmost good faith. The person seeking insurance knows all the facts, which materially affect the risk. The insurance company cannot have any information or knowledge. The person seeking insurance is the only person having full knowledge and he is under an obligation to make a full and honest disclosure of the facts and materials to the insurer at the time of proposal and is expected to maintain a higher and rigorous standard of good faith. It is further submitted that in the instant case late Shri Krishan Kumar Goyal after completely understanding the terms and conditions of product “Met Loan and Life Suraksha-RC S” had voluntarily applied for a policy by filling up the proposal form dated 09.10.2018 and offered to pay an annual premium of Rs.48,999/- to be paid annually for a proposed sum assured amounting to Rs.8,29,340/-. That upon receipt of the dully filled up proposal form alongwith initial premium, the answering ops evaluated and processed the proposal form on the basis of information provided by him and issued policy bearing No. 22690291 on 09.10.2018 to Shri Krishan Kumar i.e. husband of complainant for the term of 10 years. It is further submitted that insurance company received death claim intimation on 30.11.2019 under subject policy informing that DLA died on 18.09.2019. The death of life assured under subject policy occurred within 11 months from the date of issuance of subject policy, thus claim was duly covered under early claim as per Section 45 of the Insurance Act, hence, discrete investigation was conducted. That it seems that husband of complainant has misguided the company and had not provided the true and correct facts. As per the company’s records, the deceased life insured applied for an insurance cover wherein he did not disclose that he was suffering from Hypertension, coronary artery disease and Cerebrovascular accident before the policy issuance. However, concerned question in the proposal form dated 28.09.2018 seeking insurance cover under this policy was answered as “NO” by late Mr. Krishan Kumar Goyal which was a material non disclosure of the fact. It is further submitted that said non disclosure is a material concealment on the part of deceased life assured which is a sheer and gross negligence on the part of the complainant and her deceased husband and as such the said claim of complainant was rightly and legally repudiated as No Claim and as such on this score alone the instant complaint deserves to be dismissed with special costs. Remaining contents of complaint are also denied to be wrong and prayer for dismissal of complaint made.
4. Ops no.4 and 5 also filed written statement taking certain preliminary objections. It is submitted that true facts are that op no.4 and op no.2 were having tie-up. The husband of complainant was having an account no. 194600NC00003239 with op no.4. He himself approached to op no.2 for issuing a insurance policy, for that Rs.49,000/- (through DD) has been debited from account on 28.09.2018. Op no.4 has never put any pressure for taking the insurance policy from op no.2. As per account statement, Rs.49,000/- was debited from the account of husband of complainant for insurance of PNB Met Life with op no.2. The answering ops do not know terms and condition decided by insured and op no.2 and answering ops are not beneficiary in any manner. Remaining contents of complaint are also denied to be wrong and prayer for dismissal of complaint qua ops no. 4 and 5 made.
5. The complainant in evidence has tendered her affidavit Ex. CW1/A and copies of documents Annexures C1 to C24.
6. On the other hand, ops no.1 to 3 have tendered affidavit of Sh. Arijit Basu, Senior Manager as Ex. RW1/A and documents Ex.R1/1 to Ex. R1/7. Ops no.4 and 5 have tendered affidavit of Sh. Vikas Yadav, Branch Manager as Ex.RW4/A and documents Ex.RW4/1 and Ex. RW4/2.
7. We have heard learned counsel for the parties and have gone through the case file.
8. Admittedly the husband of complainant namely Krishan Kumar Goyal now deceased during his life time had obtained home loan of Rs.8,49,000/- from ops no.4 and 5 which was disbursed to him in installments on 28.09.2018 and on 8.10.2018. As the op no.4 and op no.2 insurance company were having tie up, therefore, in order to secure said home loan amount, said Krishan Kumar Goyal purchased PNB Metlife Loan and Life Suraksha insurance policy the period 09.10.2018 to 09.10.2028 from ops no.1 to 3 for sum assured amount of Rs.8,29,340/- i.e. coverage of loan amount to the extent of Rs.8,29,340/- as is evident from certificate of insurance Annexure C11. The premium amount of Rs.49,000/- was paid to ops no.1 to 3 as is evident from statement of account Annexure C14. The husband of complainant Krishan Kumar Goyal died on 18.09.2019 and as such complainant lodged claim with death certificate of her husband, but the claim of complainant has been repudiated by the ops no.1 to 3 vide repudiation letter dated 27.01.2020 Annexure C9 on the ground of non disclosure of health for Coronary artery disease and Cerebro vascular accident. However, we are of the considered opinion that ops no.1 to 3 have wrongly and illegally repudiated the claim of complainant because prior to issuance of policy in question, the husband of complainant was got medically examined by the ops no.1 to 3 from panel of the doctors as averred by complainant and ops no.1 to 3 have not denied this fact. Although ops no.1 to 3 have placed on file investigation report Ex. R1/2 to prove that deceased was suffering from disease of HTN, CVA since 2012 and presently with disease of tongue cancer and have also placed on file treatment records of various hospital in this regard but it cannot be said that deceased himself denied the fact to the ops no.1 to 3 that he was not suffering from any disease. In the proposal form Ex.R1/4, the answers against the questions that whether insured was suffering from any of the disease have been marked in negative i.e. “NO” but it is not proved on record by ops no.1 to 3 through any cogent and convincing evidence that actually questions about any pre existing disease were put to the insured now deceased and he himself denied the fact that he was not suffering from any disease. The ops have not furnished the affidavit of the person/ agent who filled up the proposal form to prove the fact that deceased himself denied about having any disease. Rather it appears from the proposal form itself that the person who filled the proposal form himself tick marked the answers as NO in the proposal form. It is also a general practice that at the time of selling of insurance policies to the customers, the agent of the insurance company himself fills proposal form and at that time no care is taken that person to whom they are selling insurance policies is suffering from any disease or not and insurance is done without knowing actual disease of the insured. So, in this case it cannot be said at all that deceased life assured voluntarily and intentionally concealed the factum of his pre-existing disease from the ops no.1 to 3 at the time of issuance of the policy in question. Although insured may be suffering from disease of coronary artery and cerebro vascular accident in the year 2012 but said disease had no relevance at the time of issuance of policy in question by ops no.1 to 3 which was issued in the year 2018. Moreover, Hon’ble Punjab and Haryana High Court in case titled as New India Assurance Company Ltd. Versus Smt. Usha Yadav & others 2008 (3) RCR (Civil) 111, has held as under:-
“It seems that the Insurance Companies are only interested in earning the premiums which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance companies make the effected people to fight for getting their genuine claims. The Insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy.”
9. The above said authority is also fully applicable to the facts and circumstances of the present case. In the present case also, the ops got investigated the matter after the death of insured deceased i.e. after about one year of issuance of the policy in question whereas they were required to know about any pre existing disease of insured before issuance of the policy in question. As such ops no.1 to 3 cannot repudiate the claim of complainant on above said ground. Learned counsel for complainant during the course of arguments has stated that outstanding loan amount of Rs.8,53,448.38 has been repaid by complainant to ops no.4 and 5 and NOC has been issued by the bank and has placed on file statement of account in this regard. The loan amount was to be repaid in monthly installments and on the date of death of insured, the outstanding loan amount would have been Rs.7,85,318.52 as per chart enclosed with policy documents. So, the complainant is entitled to an amount of Rs.7,85,318.52 from the ops no.1 to 3 and complainant will also be entitled to interest on the said amount besides compensation for harassment.
10. In view of our above discussion, we allow the present complaint qua opposite parties no.1 to 3 and direct them to pay claim amount of Rs.7,58,318.52/- ( in round figure Rs.,7,58,300/-) to the complainant alongwith interest @6% per annum from the date of filing of present complaint i.e. 16.07.2020 till actual realization within a period of 45 days from the date of receipt of copy of this order. We also direct the ops no.1 to 3 to pay a sum of Rs.10,000/- as composite compensation for harassment and litigation expenses to the complainant within above said stipulated period. However, complaint qua ops no.4 and 5 stands dismissed. A copy of this order be supplied to the parties as per rules. File be consigned to the record room after due compliance.
Announced. Member President,
Dated: 08.08.2024. District Consumer Disputes
Redressal Commission, Sirsa.
