Haryana

Fatehabad

CC/299/2019

Suresh Kumar - Complainant(s)

Versus

PNB Metlife Insurance - Opp.Party(s)

Subhash Dhaka

15 Mar 2021

ORDER

BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL COMMISSION, FATEHABAD.

Complaint no. 299/2019.

Date of Instt. 30.07.2019                      Date of Decision: 15.03.2021

 

Suresh Kumar son of Ram Swaroop resident of village Banawali Tehsil & District Fatehabad.

                                                                             ..Complainant.

                                          Versus

1. PNB Metlife India Insurance Company Limited, Regd. Office 1^st Floor, Techniplex Complex, Off. Veer Sawarkar Flyover, Goregaon West : Mumbai through its Chairman-cum-Managing Director/Sr. Manager –Claims.
2. PNB Metlife India Insurance Company Limited, Branch Office in Punjab National Bank, Fatehabad through its Branch Manager.

                                                                               ..Respondents/OPs.      

              Complaint under Section 12 of Consumer Protection Act, 1986.      

Before:            Sh. Raghbir Singh, President.                                                                            Smt.Sukhdeep Kaur, Member.

Argued by: Sh. Sukhbir Dhaka, Advocate for complainant.                            

 Sh. V.K.Mahiya, Advocate for OPs.

 

ORDER:-

          The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant against the OPs with the averments that he had taken an insurance policy No.22694258 from Ops for a period of 22 years for sum assured of Rs.7,56,028/- by making a premium amount of Rs.38,665/- to the OPs.  At the time of obtaining  the policy nothing was concealed by the complainant but it was utter shock for him that vide letter/memo dated 24.01.2019 the OPs had cancelled the insurance policy of the complainant without assigning any reason and remained mum qua the premium amount received for  issuance of the policy in question.  The complainant requested the OPs number of times for refund of the premium amount but to no avail. The act and conduct of the Ops clearly amounts to deficiency in service on their part. Hence, this complaint.  In evidence, the complainant has tendered affidavit and documents Annexure C1 to Annexure C3.

2.                On notice, OPs appeared and filed their joint reply, wherein it has been submitted that insurance is a contract based on utmost good faith and the person seeking insurance should know all the facts, which materially affect the risk as the person seeking insurance is the only person having full information and knowledge and he is under the obligation to make a full and honest disclosure of the facts. In the present case the complainant has suppressed the material fact from the insurance company that he was suffering from HIV prior to issuance of subject policy but he had failed to disclose the same in the proposal form which is a material suppression from the insurance company.  It is further submitted that the subject insurance policy was issued and all decision were taken in conformity of insurance terms and conditions which is concluded contract between insurance company and life assured. There is no deficiency in service on the part of the insurance company as there is no breach of terms and condition on their part.  In the present complaint since the consent of insurance company has been obtained through fraud and misrepresentation which includes concealment of material facts with malafide intention to deceive respondent to issue policy in the name of LA who was suffering from HIV by misrepresenting himself to be hale and healthy, subject contract of insurance is voidable at the option of the Ops.  Thus, the OPs have rightly declared the subject policy null and void.  The complaint is devoid of material particulars and has been filed merely to harass and gain undue. Other contents of the complaint have been cotroverted and prayer for dismissal of the complaint has been made.  In evidence, the Ops have tendered affidavit Annexure  RW1/A and documents Annexure R1 to Annexure R5.

3.                We have heard learned counsel of the parties and have gone through the written arguments submitted on behalf of Ops besides going through the documents submitted on behalf of the parties.

4.                The grievance of the complainant is that he had purchased policy from OPs by paying its premium to the tune of Rs.38665/- and at the time of purchasing of policy nothing was concealed from the OPs but despite that the Ops have cancelled the policy without assigning any reason and even did not refund the premium amount to the tune of Rs.38665/- to him.

                   Per contra, it is the case of the Ops that the complainant has obtained the policy in question by misrepresenting himself fit and healthy despite the fact that he was suffering from HIV and he has not disclosed the material information in the proposal form and this fact came into the knowledge of OPs during pre-claims investigations that the complainant had obtained the policy in question by playing fraud and by concealing the material fact qua his health, therefore, the OPs have rightly cancelled the policy and has rightly withheld the amount in question.

5.                Perusal of the case file reveals that the policy No.22694258 was issued on 15.10.2018 on receipt of premium amount of Rs.38665/- from the complainant but the said policy was cancelled on 14.02.2019 and the amount was forfeited.  Though the Ops have stressed hard that the complainant himself has violated the terms and conditions of the policy because he had concealed the material information qua his health from the insurance company because he was already suffering from HIV before the issuance of the insurance policy but this plea appears to be plausible on one side but there is nothing on the case file to show that the terms and conditions were ever supplied to the complainant and even the Ops have failed to disclose as to what loss the insurance company had suffered because the policy was cancelled by the insurance company within 4 months of its issuance. Though the OPs have placed on case file letter dated 24.01.2019 Annexure C3 and letter dated 14.02.2019 but failed to prove on the case file the mode through which these letters were ever conveyed to the complainant. In general, if some one purchases a life policy and he/she dies within a period of six months, in that eventuality, the insurance company leave the insurer high and dry without making the payment of insured amount to the insurer and now  in the present case the insurance company has shown another method to forfeit the premium amount. It is not forgettable that the pre-emption of Consumer Protection Act is benevolent in nature and it protects the customers from being cheated/ causing damage from the service provider. In the present case the insurance company is at a dominate position because the complainant has paid the premium amount and the same is lying with the insurance company. In such like cases where the policy got cancelled within a short span,  the insurance company should return the premium amount without any deduction and without entangling the customer/insurer in technicalities.  It is strange that even the OPs have not placed on record any documents showing that the complainant was suffering from HIV at the time of filing the proposal farm and even not brought on the case file any enquiry proceedings/investigations which have been made as basis for the cancellation of the policy allegedly issued to the complainant after receiving the premium amount of Rs.38665/-.

6.                In view of the above said discussion, we are of the considered opinion that the complainant has been able to prove deficiency on the part of OPs. The present complaint is accordingly allowed and the OPs are directed to refund the amount of Rs. 38665/- to the complainant which was received as premium alongwith interest at the rate of 8% per annum from the date of filing of the present complaint till its realisation. The OPs are further directed to make a payment of Rs.3,000/- to the complainant as compensation on account of mental agony and physical harassment and litigation charges. Order be complied within a period of 45 days from the date of preparation of copy of order. Copy of this order be supplied to the parties free of costs as per rules. File be consigned to the record after due compliance.

Announced.                                     

Dt. 15.03.2021              (Sukhdeep Kaur)                   (Raghbir Singh)

                                      Member                         President

                                                                   District Consumer Disputes                                                                                Redressal Commission, Fatehabad