Punjab

Sangrur

CC/354/2019

Manju Singh - Complainant(s)

Versus

Punjab National Bank - Opp.Party(s)

Sh.G.S.Shergill

22 Nov 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR .

                                                                         Complaint No. 354

  Instituted on:   18.07.2019

                                                                         Decided on:     22.11.2024

 

1. Manju Singh wife of Late Sh. Charanjit Singh;

2.Yashmeeta daughter of Late Sh. Charanjit Singh;

3.Mehul Singh Rana son of Late Sh. Cahranjit Singh;

4.Gurmanpreet Singh minor son of Late Sh. Charanjit Singh, minor under the guardianship of his mother Manju Singh;

5.Dhanraji wife of Sh. Jagroop Singh, all residents of H.No.424, Bombay Street, Sunami Gate, Sangrur.

                                                         …. Complainants 

                                                 Versus

1.             Punjab National Bank, Branch office: BGIMT Branch, Sangrur through its Branch Manager. (Bhai Gurdas College Sangrur).

2.             PNB Met Life Insurance Company Limited, 1^st Floor, Techniplex-1, Techniplex Complex, Off Veer Savarkar Flyover, Goregaon (West), Mumbai-400062 through its Managing Director.

                                                        ..Opposite parties.

For the complainant    :       Shri Hardeep Singh, Adv.

For OP No.1              :       Exparte.

For OP No.2              :       Shri Sanjeev Goyal, Adv.

 

Quorum                                           

Jot Naranjan Singh Gill                   :President

Sarita Garg                                                :Member

Kanwaljeet Singh                                      :Member

ORDER

JOT NARANJAN SINGH GILL, PRESIDENT.

 

1.             The complainants have filed this complaint against the OPs on the ground that in the month of November, 2016, the husband of complainant number 1, father of complainants number 2 to 4 and son of complainant number 5 obtained the house loan from OP number 1 vide loan account number 487800NC00000903. Further case of the complainants is that at the time of granting the loan, the officials of OP number 1 allured the husband of complainant number 1 for the life insurance policy from OP Number 2 to secure the loan and accordingly policy number 00000653 was obtained from OP number 2 through OP number 1 by paying the premium amount of Rs.59805/- alongwith tax of 7800/- and the policy was issued for the period from 11.11.2016 to 11.11.2026. It is further averred that before issuing the policy, the husband of complainant number 1 was thoroughly medically checked up by the panelled doctors of OPs. It is further averred that as per the policy, in case of death of the insured, the entire loan amount was to be adjusted from the insurance amount and remaining amount was to be released to the legal heirs of the deceased/insured but no terms and conditions of the policy were supplied to the husband of the complainant number 1 by the opposite parties. 

2.             Further case of the complainant is that on 14.01.2019 Charanjit Singh felt some severe pain in his chest and was immediately taken to PGI Chandigarh for treatment where he died on 15.01.2019 due to refractory cardiogenic shock.   Thereafter the complainants approached the OPs and requested them to release the claim amount and also to adjust the loan amount from the insurance amount and to issue NOC. Though the complainants submitted all the required documents to the OPs, but the claim amount was not paid rather OP number 2 repudiated the claim vide letter dated 30.05.2019 on false grounds.  Further case of complainants is that after the death of Charanjit Singh, OPs deducted the loan instalment from the account of complainant number 1, which is illegal and without any basis. Thus,  alleging deficiency in service on the part of the OPs, the complainants have prayed that the Ops be directed to release the sum assured i.e. Rs.18,70,000/- after adjusting the balance loan amount alongwith interest and other benefits from the date of death of Charanjit Singh and further claimed compensation of Rs.50,000/- on account of mental tension, agony, pain  and further an amount of Rs.11,000/- was claimed as litigation expenses.

3.             Record shows that OP number 1 did not appear despite service, as such OP number 1 was proceeded against exparte.

4.             In reply filed by OP number 2,  preliminary objections are taken up on the grounds that the complaint is not maintainable, that this Forum/Commission has no pecuniary jurisdiction to try and decide the present complaint as the relief claimed by the complainants is more than Rs.20 Lacs, that the information provided by the life insured in the proposal form was established to be incorrect as per the medical documents procured during investigation, as such the claim has rightly been repudiated. Further it is stated that during investigation, it was found that the deceased life assured was suffering from Diabetes Mellitus type-2 since 7 years much prior to policy issuance and was under regular treatment. However, the relevant question in the application form dated 11.11.2016 seeking insurance cover under this policy was answered in ‘NO’ by the DLA. That the complainant has concealed and suppressed material and relevant facts. That complicated questions of law and facts are involved in the present case, which requires voluminous evidence i.e. examination and cross examination of witness which is not possible in the summary proceedings of Consumer Protection Act, that the complainants have unnecessarily dragged the OP into uncalled litigation under the garb of Consumer Protection Act.  On merits, it is denied that officials of the OP number 1 allured the husband of the complainant to purchase the policy rather he at its own in order to cover the home loan risk, opted for Met Loan and Life Suraksha level cover option and submitted proposal form number 673134281 dated 11.11.2016 and the policy in question was issued. As per the terms and conditions of the policy, in case of unfortunate death the sum assured was payable as per the terms and conditions of the policy. It has been denied that husband of the complainant was medically examined by the doctors of the OP at the time of issuance of the policy in question. It has been denied that on 14.01.2019 Charanjit Singh (DLA) felt severe pain in his chest and was taken to PGI Chandigarh. It is further denied that DLA died due to refractory cardiogenic shock. Since the life assured died within three years from the date of proposing the policy, the OP appointed Probe-India, an investigation agency to investigate the genuineness of the claim of complainants.  During investigation, investigator came to know that the DLA expired on 15.01.2019 at PGI Chandigarh. Before taking the PGI he was firstly taken to Patiala Heart Institute Patiala where he was diagnosed with DM-2 (7 years) HTN/CAD/Severe LVT/EF-31%/Deranged/RFT/B/L PNEUMONITES and then referred to PGI Chandigarh for further management. On 15.01.2019 he died at PGI Chandigarh.  As such, the claim of the complainants has rightly been repudiated by the OPs vide letter dated 30.05.2019 as per terms and conditions of the policy.  Lastly the OPs have prayed that the complaint be dismissed with costs.

5.             The learned counsel for the complainants has produced Ex.C-1 to Ex.C-6 copies of documents and affidavit and closed evidence. On the other hand, the learned counsel for OP number 2 has produced Ex.OP2/1 to Ex.OP2/2 copies of documents and affidavit and closed evidence.

6.             We have gone through the pleadings put in by the parties along with their supporting documents with their valuable assistance. 

7.             The learned counsel for the complainants has contended vehemently that the deceased i.e. Shri Charanjit Singh, husband of complainant number 1 was insured with OP number 2  to secure the loan and accordingly policy number 00000653 was obtained from OP number 2 through OP number 1 by paying the requisite premium amount of Rs.59805/- which was valid for the period from 11.11.2016 to 11.11.2026, a copy of which on record is Ex.C-2 (Met Loan and Life Suraksha-Certificate of Insurance) wherein in the column of Loan Account Number Home Loan-487800NC0000903 is mentioned. Ex.C-3 is the copy of repudiation issued by OP number 2.  It is further contended that before issuing the policy, the husband of complainant number 1 was thoroughly medically checked up by the panelled doctors of OPs. It is further contended by the learned counsel that as per the policy, in case of death of the insured, the entire loan amount was to be adjusted from the insurance amount and remaining amount was to be released to the legal heirs of the deceased/insured but no terms and conditions of the policy were supplied to the complainant.  Further the learned counsel for the complainant has contended that during the subsistence of the insurance policy, on 14.01.2019 Shri Charanjit Singh felt some severe pain in his chest and was immediately taken to PGI Chandigarh for treatment where he died on 15.01.2019 due to refractory cardiogenic shock.   Thereafter the complainants approached OPs and requested them to release the claim amount and also to adjust the loan amount from the insurance amount and to issue NOC. Though the complainants submitted all the required documents to the OPs, but the claim amount was not paid rather OP number 2 repudiated the claim of complainants vide letter dated 30.05.2019 on false grounds of pre-existing disease of DM-2.  Further the learned counsel for the complainants has contended that after the death of Shri Charanjit Singh, OPs deducted the loan instalment from the account of complainant number 1, which is illegal and without any basis.  Thus,  the complainants have prayed for acceptance of the complaint.

8.             On the other hand, the learned counsel for the OPs has contended vehemently that the information provided by the life insured in the proposal form was established to be incorrect as per the medical documents procured during investigation, as such the claim has rightly been repudiated. Further it is stated that during investigation, it was found that the deceased life assured was suffering from Diabetes Mellitus type-2 since 7 years much prior to policy issuance and was under regular treatment. However, the relevant question in the application form dated 11.11.2016 seeking insurance cover under this policy was answered in ‘NO’ by the DLA. It is further contended that the the life assured had concealed and suppressed material and relevant facts at the time of obtaining the policy and complicated questions of law and facts are involved in the present case, which requires voluminous evidence i.e. examination and cross examination of witness which is not possible in the summary proceedings of Consumer Protection Act, that the complainants have unnecessarily dragged the OPs into uncalled litigation under the garb of Consumer Protection Act.  Further purchase of the policy in question by the life assured is admitted. Further it is contended that as per the terms and conditions of the policy, in case of unfortunate death the sum assured was payable as per the terms and conditions of the policy. It has been denied that husband of the complainant was medically examined by the doctors of the OPs at the time of issuance of the policy in question. It has been denied that on 14.01.2019 Charanjit Singh (DLA) felt severe pain in his chest and was taken to PGI Chandigarh. It is further denied that DLA died due to refractory cardiogenic shock. Since the life assured died within three years from the date of proposing the policy, the OP appointed Probe-India, an investigation agency to investigate the genuineness of the claim of complainants.  During investigation, investigator came to know that the DLA expired on 15.01.2019 at PGI Chandigarh. Before taking the PGI he was firstly taken to Patiala Heart Institute Patiala where he was diagnosed with DM-2 (7 years) HTN/CAD/Severe LVT/EF-31%/Deranged/RFT/B/L PNEUMONITES and then referred to PGI Chandigarh for further management. On 15.01.2019 he died at PGI Chandigarh.  As such, the claim of the complainants has rightly been repudiated by the OPs vide letter dated 30.05.2019.  Lastly the OPs have prayed that the complaint be dismissed.

9.             After perusal of the complaint, reply thereto, documents produced on record and after hearing the arguments of the learned counsel for the parties, we find that the complaint of the complainant is fully maintainable as the complainant has claimed the insured amount of Rs.18,70,000/- alongwith interest and further claimed compensation of Rs.50000/- and litigation expenses to the tune of Rs.11,000/-, if we total the amount, then it is less than Rs.20.00 Lacs. As such, the complaint of the complainant is fully maintainable as this Commission has the pecuniary jurisdiction to hear and decide the present complaint.

10.            Further  the OP number 2 has repudiated the claim of the complainant vide letter Ex.C-3 on the ground that intentional non disclosure of material facts, as highlighted in the letter Ex.C-3 i.e. Charanjit Singh was suffering from Diabetes Mellitus Type 2 prior to policy issuance and fraud committed to deceive the company after misleading it to issue to the policy.  It is worth mentioning here that the OP number 2 has not produced iota of evidence that Shri Charanjit Singh was suffering from the above said disease i.e. Diabetes Mellitus Type 2 for the last seven years as mentioned in the written reply of the complaint. Further copy of  report of Probe-India, an investigation agency to investigate the genuineness of the claim of complainants has not been produced on record, more so when the OP number 2 has taken the plea that during investigation, investigator came to know that the DLA expired on 15.01.2019 at PGI Chandigarh and before taking the PGI he was firstly taken to Patiala Heart Institute Patiala where he was diagnosed with DM-2 (7 years) HTN/CAD/Severe LVT/EF-31%/Deranged/RFT/B/L PNEUMONITES and then referred to PGI Chandigarh for further management. There is no explanation from the side of OP number 2 that why the investigation report of Probe India has not been produced on record. Moreover, the medical certificate of Cause of Death issued by the PGI Chandigarh Ex.C-5 shows that the cause of death was Refractory Cardiogenic shock and not due to Diabetes Mellitus Type 2. Moreover, diabetes is a life style disease.

11.            Further to support the contention, the learned counsel for the complainant has relied upon the judgment in RP No.4461 of 2012 in case titled Neelam Chopra versus Life Insurance Corporation of India and others,  decided on 8.10.2018 (NC), wherein it has been held that the insurance claim cannot be denied on the ground of these life style diseases that are so common. The Hon’ble National Commission in Life Insurance Corporation of India vs. Sunita and others 2020(3) CPR 301 (NC), the death of the life assured was due to cardiac arrest and the deceased-assured was suffering from diabetes mellitus and chronic liver diseases, when he was brought to hospital. It was held by the Hon’ble National Commission that cause of death of the life assured was nowhere connected to his pre-existing disease.  Further the Hon’ble Punjab State Commission in Life Insurance Corporation of India versus Smt. Kulwant Kumari, First Appeal No.1337 of 2005, decided on 09.11.2005 found that the repudiation of claim on the ground that accused was suffering from diabetes at the time of policy is not justified. There is no nexus of concealed disease (diabetes) and cause of death (heart failure). Repudiation of claim rightly set aside by District Forum. Award of full claim with 8% interest and cost of Rs.5000/- upheld. As such, we find that the OPs have wrongly and illegally repudiated the rightful claim of the complainant.

12.            In view of our above discussion, we find it to be a clear cut case of deficiency in service on the part of the OP number 2 and accordingly, we direct OP number 2 to pay to OP number 1 the sum assured amount i.e. Rs.18,70,000/- for the adjustment of the remaining balance loan amount. We further direct OP number 1 that after the adjustment of the loan amount if any amount is remained left then the same shall be distributed among/between the complainants in equal share and if any of the complainant is minor then the amount shall be kept in the shape of FDR in any nationalized bank till he/she attains the age of majority. We further direct OP number 2 to pay to the complainant an amount of Rs.10,000/- as compensation for mental tension, agony and harassment and further an amount of Rs.10,000/- as litigation expenses.  This order be complied with by the opposite party number 2 within 60 days from the date of receipt of certified copy of this order.

13.            The complaint could not be decided within the statutory time period due to heavy pendency of cases.

14.            Copy of this order be supplied to the parties free of cost. File be consigned to the records.

       

                        Pronounced.

 

                November 22, 2024.