Haryana

Kurukshetra

249/2018

Babita - Complainant(s)

Versus

PNB - Opp.Party(s)

Raj Singh

18 Feb 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL  COMMISSION, KURUKSHETRA.

                                                               Complaint Case No.249 of 2018

                                                               Date of institution: 21.11.2018                                                                        

                                                                Date of decision:18.02.2022

                              

Smt.Babita Rani aged about 43 years, widow of Labh Singh resident of village Dewana Tehsil Pehowa, District Kurukshetra now at house No.108/3, Ward No.2, Gau Charan Pehowa, Tehsil Pehowa District Kurukshetra.

                                                                …Complainant.

                             Versus

1.PNB Metlife India Insurance Co.Limited, SCO No.223, 2^nd Floor, Sector 12, Karnal through its Manager.

2.The Chairman, PNB Metlife India Insurance Co. Limited, 1^st Floor, Techniplex Complex, Off  Veer Sawarkar Flyover, Goregaon,  West, Mumbai 400062, Maharashtra.

                                                                          ….Opposite parties.

                   Complaint u/s 12 of the Consumer Protection Act.

Before:        Smt. Neelam Kashyap, President.

                   Ms. Neelam, Member.

                   Sh.  Issam Singh Sagwal, Member.

         

Present:      Sh.Raj Singh Advocate for the complainant.

                   Sh.Arvind Bhardwaj Advocate for the Ops.

ORDER

                   This is a complaint under Section 12 of the Consumer Protection Act, 1986 has been moved by Smt.Babita Rani against PNB Metlife Insurance Co. etc.-Opposite Parties.

2.                It is stated in the complaint that the husband of the complainant namely Labh Singh took insurance policy bearing No.21950672  dated 22.7.2016 commencing from 22.7.2016 onward and the sum assured under the said insurance policy was Rs.14,20,000/-.It is further submitted that husband of the complainant died on 8.10.2016 at house No.108/3, Ward No.2, Gau  Charan Pehowa District Kurukshetra and funeral  ceremony was done on the same day at Pehowa. The complainant is the nominee of her husband in the said insurance policy. After the death of Labh Singh, the complainant being nominee submitted the claim  documents and completed the required formalities but the Ops rejected the claim of the complainant vide letter dated 31.01.2017 mentioning therein that “ We have received medical records which indicates that late Mr.Labh Singh was suffering from seizure, left Parietal Region, Froth from Mouth, Jerky movements, Face deviation and had a history of weakness of right upper limb and lower limb prior to the obtaining of the said insurance policy. However, the said question in the application form dated 19.7.2016 seeking insurance cover under this policy was answered as No by late Mr.Labh Singh. It is submitted that  the life assured Labh Singh was not suffering from any disease prior to obtaining of the insurance policy in question and the letter dated 31.1.2017 is illegal wrong and not sustainable in the eyes of law and denial of claim by the Ops amounts to deficiency in services on the part of the Ops.  Thus, the complainant has filed the present complaint alleging deficiency in services on the part of the Ops and has prayed that the Ops be directed to make the payment of the claim amount alongwith compensation for the mental agony and harassment suffered by him and the litigation expenses.

3.                Upon notice, Ops appeared and filed their written statement disputing the claim of the complainant.  It is submitted that this Commission does not have territorial jurisdiction to decide the present complaint as none of the cause of action arose in the jurisdiction of this Commission. It is stated that admittedly the policy was issued from the branch of the OP at Karnal , therefore, the present complaint should have been filed at Karnal. It is submitted that during  the claim processing, it was revealed that the LA  was suffering from  “SOL” (LEFT PARIETAL REGION)” THAT IS  space occupying lesion. That he was admitted with the complaint of seizure, left parietal region, froth from mouth, jerky movement, face deviation” and underwent Craniotomy prior to the inception of the subject policy. However, the same was not disclosed in the proposal form which amounts to material suppression of the facts.  However, obtaining of the insurance policy  has not been denied by the Ops. Thus, it is submitted that the policy in question has been obtained in breach of basic doctrine of utmost good faith. Hence, the present complaint is liable to be dismissed on this ground alone as the voidance of the policy by the Ops is due to compliance of provisions of Section 45 of the Insurance Act which find force from the various judgments.  Thus, it is submitted that there is no deficiency in services on the part of the Ops and prayed for dismissal of the present complaint.

4.                The complainant in support of her case has filed her affidavit Ex.CW1/A and tendered documents Ex.C-1 to Ex.C-8 and closed her evidence.

5.                On the other hand, Ops in support of their case have filed affidavit Ex.RW1/A and tendered documents Ex.R1 to Ex.R5 and closed their evidence.

6.                We have heard the learned counsel for the parties and gone through the material available on the case file.

7.                The learned counsel for the complainant while reasserting the averments made in the complaint has argued that husband of the complainant namely Labh Singh took insurance policy bearing No.21950672  dated 22.7.2016 commencing from 22.7.2016 onward and the sum assured under the said insurance policy was Rs.14,20,000/-.It is further argued  that husband of the complainant died on 8.10.2016 at house No.108/3, Ward No.2, Gau  Charan Pehowa District Kurukshetra and funeral  ceremony was done on the same day at Pehowa. The complainant is the nominee of her husband  in the said insurance policy. After the death of Labh Singh, the complainant being nominee submitted the claim  documents and completed the required formalities but the Ops rejected the claim of the complainant vide letter dated 31.01.2017 mentioning therein that “ We have received medical records which indicates that late Mr.Labh Singh was suffering from seizure, left Parietal Region, Froth from Mouth, Jerky movements, Face deviation and had a history of weakness of right upper limb and lower limb prior to the obtaining of the said insurance policy. However, the said question in the application form dated 19.7.2016 seeking insurance cover under this policy was answered as “No” by late Mr.Labh Singh. It is submitted that  the life assured Labh Singh was not suffering from any disease prior to obtaining of the insurance policy in question and the letter dated 31.1.2017 is illegal wrong and not sustainable in the eyes of law and denial of claim by the Ops amounts to deficiency in services on the part of the Ops. 

8.                On the other hand, learned counsel for the Ops while reiterating the submissions made in the written statement has argued that that admittedly the policy was issued from the branch of the OP at Karnal , therefore, the present complaint should have been filed at Karnal. It is submitted that during  the claim processing, it was revealed that the LA  was suffering from  “SOL” (LEFT PARIETAL REGION)” THAT IS  space occupying lesion. That he was admitted with the complaint of seizure, left parietal region, froth from mouth, jerky movement, face deviation” and underwent Craniotomy prior to the inception of the subject policy. However, the same was not disclosed in the proposal form which amounts to material suppression of the facts.  However, obtaining of the insurance policy  has not been denied by the Ops. Thus, it is submitted that the policy in question has been obtained in breach of basic doctrine of utmost good faith. Hence, the present complaint is liable to be dismissed on this ground alone as the voidance of the policy by the Ops is due to compliance of provisions of Section 45 of the Insurance Act which find force from the various judgments. Thus, it is argued that there is no deficiency in services on the part of the Ops and prayed for dismissal of the present complaint. Reliance has been placed on the authority Pavanb Sachdeva Vs. Office of Insurance Ombudsman and another  W.P.(C)6304/2019  decided on 27.7.2020 by the Hon’ble Delhi High Court.

9.                In this case obtaining of insurance policy by late Sh.Labh Singh, husband of the complainant is not in dispute.  Ex.C-2 is the premium receipt.  It is also not in dispute that the policy was obtained on 22.7.2016 and death of the deceased life assured took place on 8.10.2016 which is proved from the death certificate Ex.C-5. The complainant lodged the claim with the Ops and the Ops repudiated the claim of the complainant vide repudiation letter Ex.C-1.  The Ops have repudiated the claim of the complainant on the ground that “during  the claim processing, it was revealed that the LA  was suffering from  “SOL” (LEFT PARIETAL REGION)” THAT IS  space occupying lesion. That he was admitted with the complaint of seizure, left parietal region, froth from mouth, jerky movement, face deviation” and underwent Craniotomy prior to the inception of the subject policy. However, the same was not disclosed in the proposal form which amounts to material suppression of the facts”  The Ops have relied upon the investigation report Ex.R-3 relating to one Labh Singh.  In the  said investigation report it is mentioned that “LA took treatment for space occupying lesion (SOL) Surgery in brain on 24.4.2015 from Mayo Hospital Mohali.” In the said discharge summary name of patient is also mentioned as Labh Singh. The complainant took the insurance policy on 22.07.2016 whereas the complainant was admitted in Mayo Health care hospital on 24.4.2015 more than one year prior to inception of the policy and at that time he was found suffering from  “SOL” (LEFT PARIETAL REGION)” THAT IS  space occupying lesion.  This fact was concealed by the life assured at the time of obtaining of the insurance policy. Therefore, the claim of the complainant has been rightly denied by the OP and the present complaint deserves to be dismissed.  The authority  Pavan Sachdeva’s case (Supra) cited on behalf of the OPs is fully applicable to the facts of the present case. Therefore, there is no deficiency in services on the part of the Ops.

10.              For the reasons recorded above, we do not find any merit in the present complaint, therefore, same is hereby dismissed without any relief to the complainant. Certified copy of this order be supplied to the parties concerned as per rules and the file be consigned to the record room after due compliance.

 

Announced in the open Commission.

Dated: 18.02.2022.                                                                 President.

 

                                      Member                 Member.