Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. : 314
Instituted on : 13.07.2018
Decided on : 15.01.2024
Sarita d/o Samunder Singh, R/o VPO, Titoli Tehsil & District Rohtak.
………..Complainant.
Vs.
- PNB Metlife Insurance Company, registered office at “Bridge Seshamahl” 5’ Vani Vilas Road, Basavanagudi, Bangalore-560004 through its Chief Executive/Incharge.
- PNB Metlife, Near Inox and SBI Bank and Community Center office-Ram Ropal Colony, Sonepat Road, Rohtak.
…….Respondents/Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
DR.VIJENDER SINGH, MEMBER
Present: Sh.N.P.Sharma Advocate for the complainant.
Sh. Naveen Chaudhary, Advocate for the opposite parties.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case as per complainant are that maternal uncle of complainant obtained MetlifeFamily Income Protector Plus(non linked non participating terms assurance plan) vide policy no.21904371 on 06.06,.2016 for basic sum assured of Rs.1420000/- or guaranteed monthly regular income of Rs.10000/- for 240 monthsw.e.f. 21.05.2016. The maternal uncle of the complainant had died on 09.01.2017. At the time of obtaining policy, the maternal uncle of the complainant has appointed the complainant as nominee. Therefore, the complainant had applied for death claim of Rs.1420000/- by completing all the formalities including filling of forms and submission of relevant documents. But despite repeated requests of the complainant, the amount of death claim has not been released to the complainant. The act and conduct of the opposite parties is illegal and amounts to deficiency in service. Hence this complaint and it is prayed that respondents/opposite parties may kindly be directed to pay the death claim of Rs.1420000/- alongwith interest @ 18% p.a. from the date of withholding till realisation and alternatively to pay Rs.10000/- per month to the complainant for 240 months alongwith interest for delaying period. Respondents may also be directed to pay compensation of Rs.150000/- andlitigation expenses to the complainant.
2. After registration of complaint, notice was issued to the respondent/opposite parties. Opposite parties in their reply has submitted that on 05.04.2017 the opposite party received the intimation regarding the death of DLA on 09.01.2017 at home due to sudden chest pain. Since the DLA died in a very short period of just 7 months from the date of proposing the policy, therefore the opposite party appointed Prefecture an investigating agency to investigate the genuineness of the claim of the complainant. During investigation it was found that before proposing the policy, the DLA was suffering from the disease tuberculosis and for which he was taking the treatment fromCHC Dighal(Jhajjar) and remained under treatment from 11.03.2016 to 08.10.2016 vide TB Card no.84. In this regard the Medical Officer of CHC Dighal issued the certificate. From the investigation it was also came to know that the deceased also taken the treatment from PGI Hospital Rohtak but the hospital authorities refused to provide any medical record to the investigator. Thereafter the investigator submitted his report dated 21.04.2017 with the opposite party and after getting the report, the complainant was asked to provide the Attending Physician Statement(Form-B) and family physician statement(Form-C) and the complainant vide letter dated 01.08.2017 submitted that the DLA died suddenly at home and no treatment was taken at any hospital. The opposite party also wrote letters to theSuptd. PGI Rohtak for providing the medical documents of DLA but no reply was received. However on the basis of certificate issued by CHC Medical Officer Dighal, it is duly proved that at the time of proposing the policy, the deceased was under the treatment of tuberculosis and the said fact was not disclosed in the proposal form. Therefore the insured has misrepresented the fact about his health. Thereafter the claim of the complainant was repudiated vide letter dated 18.10.2017 as per terms and conditions of the policy. There is no deficiency in service on the part of opposite parties and dismissal of complaint has been sought.
3. Ld. counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C6and thereafter failed to conclude his evidence despite availing sufficient opportunities including last opportunity and as such evidence of complainant was closed by the Court order dated 18.08.2021. On the other hand, Ld. counsel for opposite parties has tendered affidavit Ex. RW1/A, documents Ex.R1 to Ex.R9 and closed his evidence on 07.02.2022.
4. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
5. We have perused the documents placed on record by both the parties. As per respondent the DLA was suffering from the disease tuberculosis before proposing the policy and for which he was taking the treatment from CHC Dighal(Jhajjhar) and remained under treatment from 11.03.2016 to 08.10.2016 vide TB Card no.84. To prove this fact, opposite parties have placed on record copy of medical certificate Ex.R3 issued by Medical officer CHC Dighal(Jhajjar). As per this document the patient Vijay s/o Kanval R/o Dighal(Haryana) taken the TB treatment from dated 11.03.2016 to 08.10.2016 vide T.B.Card No.84. Whereas as per the proposal form attached with the document Ex.R9, at page no.28, DLA has answered the question no.3 in negative that whether he was suffering from the disease of tuberculosis and other diseases mentioned in that column.The alleged proposal form was submitted by the deceased LA on 18.05.2016. Whereas on that date he was under treatment from CHC Jhajjar(11.03.2016 to 08.10.2016) which is proved through the document Ex.C3. The deceased Life Assured had concealed the material fact about his health at the time of obtaining the insurance policy.On the other hand, law cited by ld. Counsel for the complainant titled as Birla Sun Life Insurance Co. Ltd. and Anr. Vs. Permanent LokAdalat and Anr.in CWP No.15137 of 2014 decided on 04.05.2019 by Hon’ble Punjab & Haryana High Court, SushmaSareen Vs. Insurance ombudsman and anothers,CWP no.1743 of 2018(O & M) decided on 04.08.2023, as HDFC Standard Life Insurance Co. Ltd. Vs. Guru Kirtan Singh in FA No.356 of 2018 decided on 31.10.2022(N.C), Bajaj Allianz Insurance Company Vs.KanduruGangadhar Rao in Revision Petition no.1054 of 2022 decided on 07.10.2021(N.C.) and Start Health Allied Insurance Co. Vs. AnantRam &Ors. in CWP No.11522/2023 decided on 16.10.2023 are not fully applicable on the facts and circumstances of the case as in the present case, the deceased LA died due to the disease from which he was suffering at the time of filling proposal form .
6. In view of the fact and circumstances of the case it is observed that there is no deficiency in service on the part of opposite parties and the opposite parties have rightly repudiated the claim of the complainant. As such present complaint stands dismissed with no order as to costs.
7. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
15.01.2024.
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Nagender Singh Kadian, President
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TriptiPannu, Member.
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Vijender Singh, Member.
