Haryana

Bhiwani

CC/210/2022

Promila - Complainant(s)

Versus

PNB MetLife - Opp.Party(s)

Ajit Singh

26 Apr 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BHIWANI.

 

                                                             Consumer Complaint No. : 210 of 2022

                                                        Date of Institution            : 27.09.2022

                                                                  Date of order                    : 26.04.2024

 

1. Promila wife of late Sh. Ravinder S/o Surajbhan,

 

2. Deepti Gill-minor daughter of late Sh. Ravinder,

 

3. Darpan Gill-minor son of late Sh. Ravinder,

 

4. Marman-mother of late Sh. Ravinder,

 

All residents of VPO Neemriwali, Tehsil and DistrictBhiwani (Haryana).

  

           ……Complainants.

 

Versus

 

1. The Chairman, Claims Committee, PNB Metlife India Insurance Company Ltd., 1^st Floor,  Techniplex 1, Techniplex Complex, Office Veer Savarkar Flyover, Goregaon West, Mumbai-400062, Maharashtra.

 

2. The Managing Director, PNB Metlife India Insurance Company Ltd., Unit No.701,702,703, 7^th Floor, West Wing, Raheja Tower, 26/27 M.G. Road, Banglore-560001 Karnatka.

 

3. The Concerned Officer, PNB Metlife India Insurance Company Ltd., New Anaj Mandi, Loharu Road, Bhiwani, 127021, Haryana.

 

4. The Chief Manager, PNB Metlife India Insurance Company Ltd., Near Jindal Hospital, N.H.10, Tosham Road, Mahabir Colony, Near Model Town Ext. Model Town, Hisar.

…… Opposite Parties.

 

COMPLAINT U/S 35 OF CONSUMER PROECTION ACT, 2019.

 

BEFORE:     Mrs. Saroj Bala Bohra, Presiding Member.

Ms. Shashi Kiran Panwar, Member.

 

Present:-       Sh. Ajit Singh, Advocate for complainant.

                    Sh. Rajender Verma, Advocate for OPs No.1 & 2.

                    OP No.3 given up vide order dated 02.08.2023.

                    OP No.4 exparte vide order dated 26.05.2023.

 

ORDER:

 

Saroj Bala Bohra, Presiding Member.

 

1.                 Brief facts of this case are that husband of complainant-Ravinder Kumar had taken an insurance policy ‘Mera Jeewan Surksha Plan-117N102V02’  from OP No.3 on 28.02.2020 for a sum assured of Rs.50.00 lacs by paying premium Rs.23,330/-  and the date of maturity was 28.02.2050.  Complainant is nominee in the said policy. Second installment of premium was paid on 09.03.2021. It is submitted that her husband died on 20.04.2021 due to Covid-19. So, complainant to get claim submitted all relevant documents with OP No.4 but despite various visits to the OPs and information sought under RTI, claim was not released. Legal notice dated 22.07.2022 was served upon the OPs but of no use.  Hence, the present complaint has been preferred alleging deficiency in service thereby causing monetary loss as well as mental and physical harassment. In the end, prayer has been made seeking directions against the OPs to pay Rs.50.00 lac to the complainant alongwith interest.

2.                 Notices were sent to the OPs. OP No.1 & 2 filed written statement raising preliminary objections qua maintainability of complaint and concealment of true facts.  On merits, it is admitted that the alleged policy on the life of Mr. Ravinder Kumar was issued subject to certain terms and conditions of the policy. The date of commencement of policy was 28.02.2020 and date of premium paying term for 30 years, and Darpan Gill is nominee and Mr. Promila is appointee in the policy.  It is submitted that upon intimation of death of life assured, surveyor was appointed, who known from the neighbour of complainant that life assured was suffering from heart disease and was taking treatment from Jindal Hospital, Haryana. Thus this material fact was concealed by the life assured at the time of taking policy which is violation of terms and conditions of policy and thus the claim of complainant was repudiated vide letter dated 09.11.2021.  In the end, denied for any deficiency in service or harassment to complainant and prayed for dismissal of complaint with costs.

3.                 OP No.4 did not bother to appear despite registered notice to him, as such, it was proceeded against exparte vide order dated 26.05.2023.

4.                 OP No.3 was given by vide statement dated 02.08.2023 by learned counsel for complainant.

5.                 In evidence of complainant, affidavit of complainant Ex.CW1/A alongwith documents Ex. C-1 to Ex. C-16 have been filed and closed the evidence.

6.                 On the other hand, affidavit of Mr. Devender Verma, Manager, Legal Ex. RW1/A alongwith documents Annexure R-1 to Annexure R-6 have been filed and closed the evidence.

7.                 We have heard learned counsel for the contesting parties and perused the record minutely. Written arguments on behalf of OPs No. 1& 2 filed supported by case laws delivered by Hon’ble Supreme Court of India, and Hon’ble National Consumer Disputes Redressal Commission, New Delhi. OPs placed reliance on case law titled Reliance Life Insurance Co. Ltd. and ors. Vs. Rekhaben Nareshbhai Rathod,  Civil Appeal No.4261 of 2019 (arising out of SLP (C) No.14312 of 2015, decided on 24.04.2019 (SC), and a case law titled Aviva Life Insurance Company Ltd. &Anr. Vs. Naresh Kumar First Appeal No.339 of 2017 (against order dated 21.07.2016 in Complaint No.112 of 2014 of the State Commission Haryana) (NCDRC) decided on 22.01.2024. We have gone through the written arguments and the case laws.

8.                 Learned counsel for complainant has argued that the OP insurance company has arbitrarily and illegally repudiated the genuine claim of complainant on the ground of suppression of previous ailment by life assured while taking the insurance policy. The counsel has vehemently argued that in fact, the life assured was not suffering from any disease and he was died due to Covid-19. The counsel, to support of his case, has placed reliance on a case law delivered by Hon’ble Punjab & Haryana High Court in CWP No.26178 of 2016 titled as National Insurance Co.Ltd. Vs. Sandeep & others reported in 2017 (1) RCR (Civil) Page 621 wherein it has been  held that “Insurance companies give lucrative offers to attract customers-However, the moment any insured puts even the most genuine claim, seldom said claim would be accepted by any insurance company.”

9.                 On the other hand, learned counsel for OPs has argued that there was suppression of previous ailment which is violation of terms and conditions of insurance policy, therefore, the claim of complainant was righty repudiated within the meaning of the Insurance Act, 1938 wherein at point 45(2) it is written that ‘A policy of the life insurance may be called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider of the policy, whichever is later, on the ground of fraud.’

10.               After hearing learned counsel for the parties and going through the record put-forth by both the sides, it is clear from policy document (Annexure R-3) that the policy was for sum assured of Rs.50,00,000/- (Fifty lacs), and that the life assured died during subsistence of the policy.  As per document(s) Annexure R-2, life assured had gone under medical examination at the time of issuing of the policy and no alleged heart disease was found in the life assured. Therefore, it cannot be alleged by OPs that Insured/Life assured had concealed the fact of his previous ailment or breached the terms & conditions of the insurance policy, whereas document (Ex. C-5 & C-6) reveal that the life assured died due to disease of Covid-19 and direct cause of death as per this medical report was ‘cardiopulmonary arrest’. The OP insurance company has repudiated the claim of complainant (Annexure R-6) on the ground that the life assured was having pre-existing disease before commencement of the insurance policy and answer to this question in the proposal form was answered as ‘no’  by Mr. Ravinder which is violation of terms & conditions of the policy. Further, Rs.39,543/- towards policy premium was refunded in the bank account of life assured/complainant, such amount  has not been agitated by the complainants.  

11.               In view of the above, we have observed that repudiation of the claim of complainants is not tenable on the basis of documents on file especially the medical examination of life assured before issuance of the policy. Thus , it is concluded the claim of complainants has been repudiated by the OPs in a casual manner without mentioning any cogent and convincing reason thereof which shows that the OP insurance company has adopted a trend not to release claim of the poor persons rather compel them to knock the doors of the Consumer Commission. It is worthwhile to mention here that the OP(s) are not settling even genuine claims of consumers/complainants which is illegal and amounts to indulgence into unfair trade practice/malpractice resulting into monetary loss as well as mental and physical harassment to complainants.  Hence, the complaint is allowed and complainants are entitled to the sum assured under the policy minus Rs.39,543/- refunded to them by Ops. So, the OPs No.1, 2 & 4, jointly and severally, are directed to comply with the directions within 40 days from the date of order:-

(i)       To pay a sum of Rs.49,60,457/- (Rs. Fourty nine lacs sixty thousand four hundred fifty seven) to the complainants alongwith simple interest @ 6% per annum from the date of filing of complaint till actual realization. Out of the said amount, Rs.5,00,000/- (Rs. Five lacs) be given to Smt. Marman- complainant no.4.  Rest of the amount be given to complainants No. 1 to 3 in equal shares. The shares of complainant Nos. 2 & 3 (minors) be deposited in any nationalized bank till the period they attain majority.  

(ii)      Further, to pay Rs.50,000/- (Rs. Fifty thousand) as compensation  on account of mental agony and physical harassment. 

3. To pay Rs.11,000/- (Rs.Eleven thousand) as litigation expenses.

                    If this order is not complied with, then the complainant shall be entitled to the execution petition under section 71 of Consumer Protection Act, 2019 and in that eventuality, the opposite party may also be liable for prosecution under Section 72 of the said Act which envisages punishment of imprisonment, which may extend to three years or fine upto rupees one lac or with both.  Certified copies of the order be sent to parties, free of costs, as per rules. File be consigned to the record room, after due compliance.

Announced.

Dated:26.04.2024