Punjab

Patiala

CC/17/52

Ranjit Singh - Complainant(s)

Versus

PNB Metlife India INsurance - Opp.Party(s)

Sh K S Thind

19 Apr 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

PATIALA.

 

                                     

Consumer Complaint No.	:	CC/ 52/2017
Date of Institution	:	21.2.2017
Date of Decision	:	19.4.2023

 

 

Ranjeet Singh, aged about 48 years, son of Jaswant Singh, resident of village Bhateri Kalan, PO Daun Kalan , Tehsil and District Patiala.

 

                                                                   …………...Complainant

                                      Versus

 

1. PNB Met Life India Insurance Co. Ltd.Registered office Unit No.701, 702 and 703, 7^th Floor, West Wing, Raheja Tower, 26/27, M.G.Road, Banglore-560001 (Karnataka) through its M.D.
2. Claims Committee, PNB Met Life India Insurance Co. Ltd. 1^st Floor, Techniplex, 1, Technicplex complex, Off Veer Sawarkar Flyover, Gogegoan West, Mumbai-400062 (Maharashtra) through its Chairman.
3. PNB Met Life India Insurance Co. Ltd. SCO 68-69, 3^rd Floor,Sector 17-B,Chandigarh through its Branch Manager.
4. PNB Met Life India Insurance Co. Ltd. Punjab National Bank Complex, inside Sheranwala Gate, Patiala through its Branch Manager.

                                                                   …………Opposite Parties

 

Complaint under the Consumer Protection Act

 

QUORUM

                                      Hon’ble Mr.S.K.Aggarwal, President

                                      Hon’ble Mr.G.S.Nagi,Member         

 

 

PRESENT:                   Sh.K.S.Thind, counsel for complainant.

                             Sh.Gagandeep Singh, counsel for OPs.

                                     

 ORDER                                          

1. The instant complaint is filed by Ranjeet Singh (hereinafter referred to as the complainant) against PNB Met Life India Insurance Co. Ltd. (hereinafter referred to as the OP/s) under the Consumer Protection Act ( for short the Act).
2. The averments of the complainant are as follows:
3. That complainant is holding Health Insurance Policy No.21792153 under the plan Met Life Major Illness Prem Cover, commencing from 21.1.2016, for a period of 10 years. The same was issued in the name of complainant on 5.2.2016. An amount of Rs.27243-29P, as annual premium was payable on or before 21^st of January of every year. Complainant paid the first premium before issuing said policy. Smt.Darshan Kaur, wife of the complainant is the nominee, in the said policy. At the time of issuing the policy, medical examination of complainant was conducted by the concerned doctor of OPs and at that time complainant was not suffering from any ailment. It is averred that no medical report was provided to the complainant.
4. After some time of issuance of policy, complainant suffered from kidney problem. He got himself examined from Max Super Specialty Hospital, Mohali and he was suggested for kidney transplant. After conducting various medical tests, complainant was admitted in Max Super Specialty Hospital, Mohali on 16.6.2016, where kidney transplantation was conducted on 18.6.2016.He was discharged from the hospital on  25.6.2016. An amount of Rs.7 Lakh, approximately was spent on his treatment, medicine and medical tests etc.
5. Thereafter, vide letter dated 4.8.2016, complainant submitted medical claim to the OPs. The OPs vide letter dated 31.8.2016 showed their inability to admit the claim and refused to pay the same on the ground of non disclosure of material facts. Complainant sent legal notices dated 3.10.2016 and 10.10.2016 to the OPs but to no effect.There is thus, deficiency in service and unfair trade practice on the part of OPs. The act and conduct of OPs also caused mental agony and harassment to the complainant. Consequently, prayer has, thus, been made for acceptance of complaint.
6. Upon notice, OPs appeared through their counsel and filed written statement having contested the complaint and raised certain preliminary objections. In the pleadings it is submitted by the OPs that in the proposal form there was a column wherein the complainant was required to provide answers with respect to his medical history and he replied that he was neither suffering from any disease nor he was taking any medical treatment. Accordingly upon receipt of duly filled up proposal form and believing the information provided by the complainant to be true and correct, alongwith initial premium, OPs evaluated and processed the proposal form and issued policy bearing No.21792153 on 4.2.2016.
7. During the course of investigation and assessment of claim, it was revealed that complainant did not provide true and correct information, as he was suffering from hypertension with chronic kidney disease prior to the issuance of policy having concealed material information with respect to his medical history. Thus, the insurer is well within its right to treat the contract as void as per the terms and conditions of the policy and have rightly repudiated the claim of complainant vide letter dated 31.8.2016.
8. On merits, it is submitted that routine checkups are conducted only on the basis of information provided by the complainant and until & unless complainant discloses correct medical history, the same could not be ascertained during normal health checkups. Further, OPs have made submissions as are taken in their pleadings, so the same are not required to be repeated for the sake of brevity.Ultimately, after denying all other averments of the complainant, OPs prayed for dismissal of complaint.
9. In evidence, complainant with his counsel tendered his affidavit, Ex.CA, letter dated 31.8.2016,Ex.C1, letter dated 4.8.2016,Ex.C2, discharge summary,Ex.C3, Metlife Major Illness premium back cover,Ex.C4, legal notice dated 3.10.2016,Ex.C5, postal receipts,Exs.C6 to C9, copies of medical bills,Exs.C10 to C50 and closed evidence.
10. On the other hand, ld. counsel for OPs has tendered in evidence, Ex.OPA affidavit of Sh.Rajeev Sharma, Sr.Manager-Legal of OPs alongwith documents, Exs.OP1 to OP3 and closed evidence.
11. We have heard ld. counsel for the parties and have also gone through the record of the case, carefully.
12. Ex.OP1 is the copy of proposal form filled up by the complainant on 19.1.2016 for purchasing the insurance policy in question. In the said proposal form there was a column wherein the complainant was required to provide answers with respect to his medical history. In the said columns, complainant had replied ‘No’ i.e. he was not suffering from any disease nor he was taking any treatment.
13.  We have gone through the discharge summary, Ex.C3, produced on record by the complainant himself,  wherein , in the PRESENTING COMPLAINTS, it is written, “MR RANJEET SINGH 48 YEARS OLD MALE K/C/O HTN WITH CKD ON MAINTAIN HD ADMITTED HERE AT MSSH FOR RENAL ALLOGRAFT TRANSPLANT. DONOR SISTER. HE IS ON MHD SINCE OCT 2015.
14. Thus, from the above, it is clear that complainant was  k/c/o i.e. known case of HTN with  CKD i.e. hypertension with chronic kidney disease, prior to filling up of proposal form and issuance of policy, which was issued in his name on 5.2.2016. Complainant was on dialysis from October,2015 and this fact was known to him. Complainant intentionally and willfully did not disclose this material information while submitting the proposal form. It is well settled that if any person knocks the doors of any Court/Commission or Tribunal whatsoever by concealing the true facts, he is not entitled to get any relief. Since in the present case complainant has suppressed material information about his health from the OPs at the time of filling up the proposal form which was known to him, therefore, he is not entitled for any claim and the same has been rightly repudiated by the OPs. Similar view has been taken by the Hon’ble Supreme Court of India in the case titled as Satwant Kaur Sandhu Vs. UIIC, in civil appeal No.2776 of 2002 decided on 15.7.2009.  Thus, there is no deficiency of service or unfair trade practice on the part of OPs in repudiating the claim.
15. In view of above discussion, we are of the opinion that complaint is without any merit and the same is dismissed accordingly.  Parties are to bear their own costs.        
16. The instant complaint could not be disposed of within stipulated period due to Covid protocol and for want of Quorum from long time.
85109252238716.  
85109252238717.  

                                              G.S.Nagi                           S.K.AGGARWAL

                                              Member                          President