Haryana

Kurukshetra

201/2018

Charanjit Kaur - Complainant(s)

Versus

PNB Metlife - Opp.Party(s)

A.K.Mehla

27 Jan 2020

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KURUKSHETRA.

 

                                        Consumer Complaint No.201 of 2018.

                                        Date of instt.:20.09.2018. 

                                        Date of Decision:27.01.2020.

 

 

Charanjit Kaur, aged 35 years, widow of Shri Sandeep Kumar, r/o village Sunarian, Post Office Babain, District Kurukshetra. 

                                                                        …….Complainant.                                             

 Versus

 

1. PNB Metlife India Insurance Co. Ltd., 1^st Floor, Techniplex 1, Techniplex Complex, Off Veer Sawakar Flyover, Goregaon West, Mumbai-400062, through its Chairman/Authorized Signatory.
2. PNB Metlife India Insurance Co. Ltd., 2^nd & 3^rd Floor, SCO 68-69, Sector-17B, Chandigarh through its Manager.
3. Punjab National Bank, Babain (Kurukshetra) through its Branch Manager.

                ….…Opposite parties.

 

Complaint under Section 12 of Consumer Protection Act.

 

Before       Smt. Neelam Kashyap, President.    

                   Ms. Neelam, Member.       

                   Shri Issam Singh Sagwal, Member.                                                 

Present:     Shri A.K. Mehla, Advocate for the complainant.               

                Shri Hitesh Walia, Advocate for the Opposite Parties No.1 & 2

Shri Lovekash Machhal, Advocate for opposite party No.3.

           

ORDER

                                                                         

                    This is a complaint under Section 12 of the Consumer Protection Act, 1986 moved by complainant Charanjit Singh against PNB Metlife and another, the opposite parties.

2.             The brief facts of the complaint are that on the allurement of the OP No.3, Shri Sandeep Kumar (since deceased) husband of the complainant had purchased/obtained a PNB Metlife Insurance Policy bearing No.21124235 having plan of Insurance Met Money Back, Policy Term 10 years for a sum assured of Rs.3,00,000/- from the OPs on 22.07.2013 and paying the regular installment. Her husband had also purchased another policy No.21912316, Policy Term 15 years, from OPs on 02.06.2016 for a sum assured of Rs.12,00,000/-. During the continuation of above said policies, her husband suffered heart attack and died on 15.6.2016. She being nominee and legal heirs of Sandeep Kumar in both the policies lodged a claim alongwith all the relevant papers and at that time, the OPs assured to pay the claim amount in both the policies. After that, a surveyor appointed by the OPs, who visited her house and made inquire about the death of Sandeep Kumar and recorded statement of her as well as Brij Bhan, Numberdar of the village. That after waiting sufficient time, she was shocked to receive the letters dated 23.9.2017 in which the OPs mentioned that Late Mr. Sandeep Kumar was suffering from Liver and Kidney problem and took treatment from PGI, Rohtak prior to policy issuance. However, the concerned question in the application form, seeking insurance cover under this policy was answered as “No” by late Mr. Sandeep Kumar. We approached PGI Rohtak and requested to share the medical records of the treatment of Sandeep Kumar, in response, they sent a letter dated 08.8.2017 seeking consent to share the CR no. and date of admission with us for further action. However, her husband was quite hale and hearty and was not suffering from any disease as alleged in the letters. Neither he was admitted in PGI Rohtak nor taken any treatment from there. She sent a legal notice dated 07.8.2018 through her counsel Shri Anil Kumar Mehla ask the OPs to pay the claim amount but the OPs failed to do so. By not paying the genuine claim, the OPs are deficient in services. Hence, this complaint.

3.             Upon notice, the opposite parties No.1 & 2 appeared and filed written statement stating therein that the policies in question were issued by the OPs on the basis of information provided by the deceased LA in the proposal form dated 16.07.2013 and 01.06.2016 respectively. Since the information provided by the DLA in the respective proposal forms were established to be incorrect by the OP. Hence the OPs repudiated the said claim of the complainant. The policy bearing No.21912316 was commenced on 02.06.2016 and the DLA was died on 15.09.2016 just within 13 days from the date of commencing the policy. The early death of insured clearly proves that the policy in question was taken by the DLA with the malafide intention to play fraud with the OPs. During the investigation and claim evaluation process, it was found that DLA was suffering from Liver and Kidney problem before the date of proposing the policies in question. He was getting treatment from BBC Hospital Shahabad, PGI Chandigarh and also at Singhal Nursing Home. So, it is evident that the LA had given wrong information and suppressed the material facts from the OPs. On merits, the rest of the contents of the complaint are denied and prayed for dismissal the same against the OPs No.1 & 2.

                Upon notice, the opposite party No.3 appeared and filed written statement raising preliminary objections regarding maintainability; cause of action; jurisdiction. The complainant has not come with clean hands and has suppressed the true & material facts from this Hon’ble Forum. The true & material facts are that deceased Sandeep Kumar himself with his free consent had purchased the insurance policy from the OPs No.1 & 2. The OP No.3 has no role in the present complaint but inspite of that the complainant has involved the OP No.3 in the present complaint without any ca of reasons. Hence the present complaint may be dismissed against the OP No.3 with special costs.

4.             The complainant has tendered affidavit Ex.CW1/A alongwith documents Ex.C-1 to Ex.C-12. On the other hand, the OPs No.1 & 2 has tendered affidavit Ex.RW1/A alongwith documents Ex.R-1 to Ex.R-8. The OP No.3 has tendered affidavit Ex.D-3/A.

5.             We have heard the learned counsel of the parties and carefully gone through the case carefully.

6.             The learned counsel for the complainant has reiterated all the averments mentioned in the complaint. He argued that husband of the complainant Shri Sandeep Kumar had purchased/obtained a PNB Metlife Insurance Policy bearing No.21124235 having plan of Insurance Met Money Back, Policy Term 10 years for a sum assured of Rs.3,00,000/- from the OPs on 22.07.2013. The husband of complainant had also purchased another policy No.21912316, Policy Term 15 years, from OPs on 02.06.2016 for a sum assured of Rs.12,00,000/-. During the continuation of above said policies, husband of complainant suffered heart attack and died on 15.6.2016. The complainant being nominee and legal heirs of Sandeep Kumar in both the policies lodged a claim alongwith all the relevant papers. After that, a surveyor appointed by the OPs. He further argued that after waiting sufficient time, the OPs denied the claim vide letters dated 23.9.2017 mentioning therein that Late Mr. Sandeep Kumar was suffering from Liver and Kidney problem and took treatment from PGI, Rohtak prior to policy issuance. However, her husband was quite hale and hearty and was not suffering from any disease as alleged in the letters. Neither he was admitted in PGI Rohtak nor taken any treatment from there. By not paying the genuine claim, the OPs are deficient in services.

7.             Contrary to it, the learned counsel for the OPs No.1 & 2 has reiterated all the averments mentioned in the reply. He argued that the policy bearing No.21912316 was commenced on 02.06.2016 and the DLA was died on 15.09.2016 just within 13 days from the date of commencing the policy. The early death of insured clearly proves that the policy in question was taken by the DLA with the malafide intention to play fraud with the OPs. He further argued that during the investigation and claim evaluation process, it was found that DLA was suffering from Liver and Kidney problem before the date of proposing the policies in question. He was getting treatment from BBC Hospital Shahabad, PGI Chandigarh and also at Singhal Nursing Home. So, it is evident that the LA had given wrong information and suppressed the material facts from the OPs and prayed for dismissal the same against the OPs No.1 & 2. In support to their contention, he placed reliance upon case laws titled LIC of India & Anr. Vs. Balbir Kaur I (2009) 212 (NC); LIC of India Vs. Radhika Devi, III (2008) CPJ 226; LIC of India Vs. Rukma, 2012 (II) CPJ 44 (NC); LIC of India Vs. Premlata Aggarwal, 2012 (2) CLT 182 (NC); Sandanand Bag Vs. LIC & Anr., 2012 (III), CPJ 398 (NC); Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd., 2009 (IV) CPJ 8 (SC); Life Insurance Corporation of India Vs. Smt. Asha Goel & Anr., 2001, ACJ, 806; Dineshbhai Chandrana Vs. LIC, First Appeal No.242/2006, dod 27.7.2006 and Vikram Greentech (I) Ltd. and another Vs. New India Assurance Co. Ltd., 2009 (4), CLT, 313.

8.             The learned counsel for the OP No.3 has also reiterated all the averments mentioned in its respective reply.

9.             At the outset, the learned counsel for the OPs No.1 & 2 has contended that this Forum has no jurisdiction to entertain the complaint as the OPs No.1 & 2 belongs to outside District Kurukshetra. From the record, we found that the complainant purchased the policy in question from the OPs No.1 & 2 and the premium of those policies was paid through OP No.3. The OP No.3 is sisters concern of OPs No.1& 2. Since the complainant impleaded the OP No.3 as party in the present case who belongs to District Kurukshetra, therefore, in view of the above, this Forum at Kurukshetra has jurisdiction to entertain and try the present complaint.

10.            There is no dispute that Shri Sandeep Kumar (hereinafter called as “DLA”) purchased one PNB Metlife Insurance Policy bearing No.21124235 having plan of Met Money Back, Term 10 years for a sum assured of Rs.3,00,000/- on 22.07.2013 and after that, purchased another policy bearing No.21912316, Term 15 years, from OPs on 02.06.2016 for a sum assured of Rs.12,00,000/- vide Welcome Letters Ex.C4 and Ex.C5 respectively. There is also no dispute that said DLA was died on 15.06.2016 vide Death Certificate Ex.C-8 and after his death, the complainant ‘being nominee and legal heirs of DLA, submitted the claims against both the policies with the OPs, who refused to pay the claims in both the policies, vide their letters dated 23.09.2017 Ex.C-6/Ex.C-7/Ex.R1/Ex.R5 respectively on the ground that late Mr. Sandeep Kumar was suffering from Liver Kidney problem and taking treatment from PGI Chandigarh prior to issuance of policies in question. The Ops No.1 & 2 further contended that DLA provided the incorrect information about his health in respective proposal forms and drawn attention of this Forum towards Ex.R2 and Ex.R6 (page No.20), wherein the DLA had given answers in negative. But it is pertinent to mention here that it is the duty of the OPs to verify all the facts mentioned in the proposal form by the LA and in the present too, the OPs No.1 & 2 has provided the policy in question after verifying those facts mentioned in the respective Proposal Forms and now they cannot deny to release the claim on this very ground. Hence, this contention of the Ops No.1 & 2 has no force, hence rejected.  

11.            Now coming to the next contention of the OPs No.1 & 2 that DLA was suffering from Liver and Kidney problem and took the treatment from PGI, Rohtak prior to policy issuance. But it is pertinent to mention here that the OPs No.1 & 2 have failed to produce any documentary evidence in this regard that the DLA was suffering from above mentioned disease prior to taking the policies in question. Contrary to it, to support her contention, the complainant has produced Undertaking given by one Brijbhan, Numberdar of village of the DLA, wherein he clearly stated that Sandeep Kumar, DLA was died incidentally due to heart attack. The OPs No.1 & 2 further contended that they demanded the treatment record of DLA from the PGI, Rohtak through RTI Mark-A dated 06.07.2017, but the said hospital showed their inability to provide the same and asked for CR number/admission number of the patient. However, it is pertinent to mention here that if the PGI, Rohtak had not provided the requisite information to the OPs No.1 & 2 through RTI, then they can file any complaint/appeal in this regard with higher authorities, but no such document in this regard is produced on record by the OPs. Moreover, during the pendency of this complaint, the OPs No.1 & 2 moved an application for summoning the medical record from the BBC Hospital, Shahabad and PGI Chandigarh in respect of the treatment taken by DLA, without mentioning any detail of his treatment, as such, the said application has also been dismissed. It may be stated here that mere allegations are not sufficient, those are necessary to be proved by cogent evidence. In the present case, the insurance company i.e. OPs No.1 & 2 has not been able to prove the allegations, on the basis of which, they had refused to pay the claims to the complainant. Thus, the refusal of the claim done by the OPs No.1 & 2 is held to be unjustified and amounts to deficiency in services on their part. Hence, the OPs are liable to pay the insured amount of Rs.2,11,000/- against policy No.21124235 and Rs.12,00,000/- against policy No.21912316, total amounting Rs.14,11,000/-, alongwith compensation and litigations expenses, to the complainant. The case laws produced by the OPs No.1 & 2 are not disputed, but the same are not helpful to the case of the OPs No.1 & 2, being rested on different footings. Since there are no specific allegations against the OP No.3 and even it has no role to play in the dispute in question, therefore, complaint qua OP No.3 is liable to be dismissed.

12.            In view of the aforesaid discussion, we hereby dismiss the present complaint against the OP No.3 and allow the same against the OPs No.1 & 2 and direct them in the following manner:-

1. To pay the total insured amount of Rs.14,11,000/- (Rs.2,11,000/- + Rs.12,00,000/-) in both policies, to the complainant alongwith interest @ 6% per annum w.e.f. 20.09.2018 i.e. the date of filing the present complaint, till its realization.
2. To pay Rs.10,000/- as compensation for mental agony and physical harassment suffered by the complainant.
3. To pay Rs.5,000/- as litigation expenses.

 

                The OPs No.1 & 2 are further directed to comply with the aforesaid directions jointly and severally within the period of 30 days from the date of preparation of certified copy of this order, failing which, the complainants will be at liberty to initiate proceedings under Section 25/27 of the Act against the OPs No.1 & 2. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the record-room, after due compliance.

Announced in open Forum:

Dt.:27.01.2020.                                                   (Neelam Kashyap)

                                                                        President.

 

 

(Issam Singh Sagwal),         (Neelam)       

Member                             Member.