BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SIRSA.
Consumer Complaint no. 483 of 2019
Date of Institution : 16.08.2019
Date of Decision : 12.06.2023
Kuldeep Singh son of Sh. Krishan, resident of VPO Barasari, Tehsil and Distt. Sirsa.
……Complainant.
Versus.
1. PNB Metalife India Insurance Company Ltd., Sirsa through its Divisional Manager.
2. PNB Metalife India Insurance Company Ltd., 1st Floor, Techniplex 1, Techniplex Complex, Off Veer Sawarkar Flyover, Goregaon, West Mumbai- 400062 (Maharashtra), through its Chairman.
…….Opposite Parties.
Complaint under Section 12 of the Consumer Protection Act, 1986.
Before: SH. PADAM SINGH THAKUR……. PRESIDENT
MRS.SUKHDEEP KAUR……………MEMBER.
SH. OM PARKASH TUTEJA……….MEMBER
Present: Sh. Ashish Vashisht, Advocate for the complainant.
Sh. Amit Goyal, Advocate for opposite parties.
ORDER
In brief, the case of complainant is that Sh. Krishan Kumar father of complainant had purchased a life insurance policy No. 22581202 on 04.07.2018 from the ops and paid an amount of Rs.51205/- as premium to the ops and complainant was made nominee in the said policy. That later on the father of complainant expired on 10.12.2018 at Sirsa. It is further averred that thereafter complainant informed the ops and submitted all the relevant documents to the ops and requested to pay the death benefit of the father of complainant as mentioned in the policy i.e. (i) 10 times the annualized premium (ii) sum assured on maturity (iii) basic sum assured but the ops started to put the matter off with one pretext or the other and since then complainant is visiting the office of op no.1 and requesting to pay the above said death benefit of father of complainant. It is further averred that ops are not paying any heed on the requests of complainant and in this way they are unnecessarily harassing and humiliating the complainant and the act and conduct of the ops amounts to deficiency in service as well as unfair trade practice. Hence, this complaint.
2. On notice, ops appeared and filed written version taking certain preliminary objections. It is submitted inter-alia that ops received duly filled and signed death claim intimation form dated 10.01.2019 under subject policy informing that life assured died on 10.12.2018 due to “Heart Attack”. That as death of DLA occurred within six months from date of issuance of first subject policy dated 04.07.2018, insurance company conducted investigation as per the mandate of Section 45 of the Insurance Act through independent investigation agency in order to check the veracity of the claim. It is further submitted that after careful evaluation of the records obtained by insurance company through investigation, it was revealed that life assured had provided incorrect information and suppressed material fact that he was suffering from Chronic Liver Disease, HBs Ag positive, Diabetes Mellitus Type 2 and portal hypertension prior to issuance of subject policy which amounts to material suppression of fact. That during investigation, authorized investigator was apprised by neighbours of DLA that he was suffering from liver disease and died due to the same. Accordingly investigator visited S.M. S. Hospital, Jaipur wherein DLA was found to be admitted on 30.11.2018 and discharged as LAMA (Leave against medical advice) on 04.12.2018 during which he was diagnosed with CLD (Chronic Liver Disease), HBs Ag+ (Hepatitis B Positive), Diabetes Mellitus Type 2 and portal hypertension. It is further submitted that it was further informed that DLA also took treatment at Medicity Hospital, Sirsa Haryana where from also medical documents were procured which stated that DLA was admitted in said hospital on 18.05.2018 during which he was diagnosed with above said disease and it was further mentioned that DLA was chronic alcoholic and smoker. That said medical documents prove beyond any doubt that DLA was not only suffering from liver disorder but also underwent treatment for the same thereby implying that he was well aware of the same but chose to suppress the same and rendered the subject contract of insurance void ab initio. As such the claim of complainant has been rightly repudiated as per terms and conditions of the policy on the ground that contract of insurance is a contract based on utmost good faith and prayer for dismissal of complaint made.
3. The complainant in evidence has tendered his affidavit Ex.CW1/A, affidavit of Sh. Rajesh son of Sh. Manphool, resident of VPO Barasari Ex. CW2/A, affidavit of Sh. Vinod son of Sh. Shishpal, resident of VPO Barasari Ex. CW3/A and copies of documents i.e. repudiation letter Ex. C1, welcome letter dated 9.7.2018 Ex.C2 and death certificate of his father Krishan Kumar Ex.C3.
4. On the other hand, ops have tendered affidavit of Sh. Rajeev Sharma Senior Manager Ex. RW1/A and copies of documents Ex. R1 to Ex.R5.
5. We have heard learned counsel for the parties and have gone through the case file carefully.
6. Admittedly on 04.07.2018 the father of complainant namely Krishan Kumar purchased insurance policy from the ops by paying premium amount of Rs.51205.20 and complainant was made as nominee of insured in the said policy. However, the insured Krishan Kumar died on 10.12.2018 i.e. after about five months of the purchasing of the policy in question from ops and complainant has also placed on file death certificate of his father as Ex.C3. The complainant being nominee and son of deceased Krishan Kumar has claimed death benefit of his father i.e. ten times annualized premium, sum assured amount on maturity and basic sum assured amount as per policy. However, the claim of the complainant has been repudiated by the ops on the ground that deceased concealed the material information regarding his ill health from the ops at the time of purchase of insurance policy in question as specific questions about any disease of liver and kidney were put to the insured but he denied the same that he is not suffering from such type of disease. The ops in order to prove that insured Krishan Kumar was suffering from liver disease prior to the purchase of policy in question has placed on file treatment records of Medicity Hospital, Sirsa ( page no.11 to 43 of Ex.R4), the perusal of which reveals that Krishan Kumar was admitted in the said hospital on 18.05.2018 for liver disease and was discharged on 22.05.2018. The ops have also placed on file treatment record of S.M.S. Hospital, Jaipur (page no.1 to 4 of Ex.R4) which also reveals that said Krishan Kumar remained admitted in the said hospital from 30.11.2018 to 04.12.2018 as he was suffering from chronic liver disease and ultimately he died on 10.12.2018 just after about five months of purchase of policy in question. So, it is proved on record that Krishan Kumar now deceased was already under treatment of chronic liver disease prior to the availing of insurance policy in question from ops but he concealed the said material information from ops at the time of purchasing the insurance policy and filling of proposal form. So, the complainant is not entitled to the death benefit of deceased Krishan Kumar as per clause 6.7 and exclusions clause 6.9 of the policy in question. The authority relied upon by learned counsel for complainant in case titled as Sunil Kumar Sharma Versus Tata AIG Life Insurance Company and anr. 2021 NCJ 353 (NC) is not applicable to the facts of the present case because in that case insured was suffering from life style disease of diabetes whereas in the present case it is proved on record that deceased was having liver disease prior to the purchasing of the policy. However, as the policy in question was issued by the ops without verifying about the ill health of Krishan Kumar and ops could verify the said fact before issuance of the policy in question but only verified the said fact after his death and ops have not shown anything regarding forfeiture of premium amount, therefore, complainant is entitled to refund of the premium amount of Rs.51205/- paid by father of complainant to the ops alongwith interest besides compensation for harassment in this regard as ops have not refunded the premium amount to the complainant after termination of policy in question.
7. In view of our above discussion, we partly allow the present complaint against the ops and direct the ops to make refund of the premium amount of Rs.51,205/- to the complainant alongwith interest @6% per annum from the date of filing of present complaint i.e. 16.08.2019 till actual realization. We also direct the ops to further pay a sum of Rs.15,000/- as composite compensation for harassment and litigation expenses to the complainant. The ops are liable to comply with this order within a period of 30 days from the date of receipt of copy of this order, failing which ops will be liable to pay the above said amount of Rs.51,205/- alongwith interest @9% per annum for the defaulted period. A copy of this order be supplied to the parties as per rules. File be consigned to the record room.
Announced. Member Member President,
Dated: 12.06.2023. District Consumer Disputes
Redressal Commission, Sirsa.
JK
