Haryana

Karnal

CC/664/2019

Bimla - Complainant(s)

Versus

Reliance Life Insurance Corporation Limited - Opp.Party(s)

Ashok KUmar Bhatia

25 Nov 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 664 of 2019

                                                        Date of instt.26.09.2019

                                                        Date of Decision:25.11.2022

 

Bimla wife of late Shri Naresh, aged 41 years, resident of village Nara, Tehsil Madlauda, District Panipat. Mobile no.8053604468,

 

                                               …….Complainant.

                                              Versus

 

1.     Reliance Life Insurance Corporation Ltd. SCO 15, Shri Ganpati Ji Market, near Sabzi Mandi, Dayal Singh Colony, Karnal through its Branch Manager/authorized person.

2.     Reliance Life Insurance, registered office H-Block, 1^st floor, Dheeru Bhai Ambani Knowledge City, Navi Mumbai, Maharashtra, Corporate office: 9^th floor/10 floor, Building no.2, R-Tech Park, Nirlon Compound, next to Hub Mall, Behind 1^st flex building, Goregaon (East) Mumbai.

3.     Rajesh son of Shri Inder, resident of village Nara, Tehsil Madlauda, District Panipat.

                                                                      …..Opposite Parties.

 

Complaint under Section 12 of the Consumer Protection Act, 1986 as amended under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary……Member

          

 Argued by: Shri Ashok Kumar, counsel for the complainant.

                    Shri Ashok Vohra, counsel for the OPs no.1 and 2.

                    Shri Naveen Khetarpal, counsel for the OP no.3.

 

                    (Jaswant Singh President)

ORDER:   

                

                The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 as after amendment under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that husband of complainant namely Naresh (since deceased) had purchased a Life Insurance Policy bearing no.92605476 on 23.07.2015 sum assured of Rs.7,86,495/- from the OPs. The premium of policy is payable yearly installments of Rs.49,486/-. Husband of complainant had paid the installment of premium of policy regularly to the OPs. Complainant is the nominee in the said policy. Unfortunately, husband of complainant died on 28.06.2017 due to heart attack and complainant tried her best to get her husband proper treatment. Complainant being nominee, approached the OPs, for the life claim amount of her deceased husband and completed all the formalities.  Thereafter, complainant visited the office of OPs so many times and requested to OPs to settle the claim but OPs did not pay any heed to the request of complainant and lastly refused to pay the same without assigning any reason. In this way there was deficiency in service on the part of the OPs. Hence this complaint.

2.             On notice, OPs no.1 and 2 appeared and filed its written version raising preliminary objections with regard to maintainability: jurisdiction and concealment of true and material facts. On merits, it is pleaded that OP received a duly filled online application from under the subject policy to be issued in the name of Mr. Naresh Kumar. Company received the first premium deposit of Rs.49,486/- and duly signed customer declaration form  (CDF) in the name of DLA for policy named Reliance Fixed Savings Plan. Believing the disclosures made in the proposal form to be true, correct and complete in all aspects, OP had issued the policy bearing no.52300207, issuance date 23.07.2015, mode of payment yearly, policy term 20 years, paying premium term 10 years, premium amount 49,486/-, sum assured 7,86,495/- and contract status deceased. OP had sent the policy document to the complainant. It is further pleaded that company received a death claim from dated 17.10.2017, wherein name of claimant was Mrs. Bimla Naresh Kumar, informing that the DLA died on 28.06.2017. It is further pleaded that on receipt of death claim, OPs conducted an enquiry and was found that the prior to application of said policy life assured had taken treatment in OPD on 17.06.2014, where he was diagnosed for CVA & Ie Hemiparesis. Doctor also advises to take surgeon opinion, and also refer to Dr. Khonakar for physician opinion. This OPD card belongs to PHC, the investigator got he stamped by birth-death register and concerned PHC doctor. The medical detail not disclosed to the company at proposal stage (proposal signing date-21.07.2015). Life assured was paralyzed about three years prior to his death and it is also confirmed by the Sarpanch in his written statement. The company has procured copy of OPD card dated 17.06.2014 i.e. prior to policy issuance wherein it has been clearly mentioned that life assured was suffering from CVA and paralysis. It is further pleaded that after concluding the investigation where certain discrepancies as described above were observed and evidence were collected, the company repudiated the claim, vide its letter dated 01.03.2018 which was duly communicated to the complainant. It is further pleaded that at the time of purchasing the policy and filling up proposal form the company had specifically asked the life assured under question 31 and 33 wherein he had answered as “No”, the said questions read as under:-

Question 31:     Are you currently taking any medication or drugs, other than minor conditions (e.g. cold and flu), either prescribed or not prescribed by a doctor, or have you suffered from any illness, disorder, disability or injury during the past 5 years which has required and form of medical or specialized examination (including chest x-rays, gynecological investigation, pap smear or blood tests), consultation, hospitalization or surgery?

Answer: No.

Question 33:     Do you suffer from any medical ailments e.g. diabetes, high blood pressure, cancer, respiratory disease (including asthma), kidney or liver disease, stroke, any blood disorder, Heart problems, Hepatitis or Tuberculosis, Psychiatric Disorder, Depression, HIV, AIDS, or a related infection?

Answer: No.

Had the said questions been correctly answered by life assured then policy would have been issued to him. OP believing the answers and questionnaire to be correctly filled in good faith issued the policy to the life assured, and the life assured despite knowing about his medical conditions and treatment being taken intentionally chose not to disclose the same in the proposal form and fraudulently purchase the said policy. There is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             OP no.3 appeared and filed its separate written version raising preliminary objections with regard to maintainability and concealment of true and material facts. On merits, it is pleaded that OP no.3 is the agent of OPs no.1 and 2 and no relief has been sought for the OP no.3. There is no deficiency in service on the part of the OP no.3. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

4.             Parties then led their respective evidence.

5.             Learned counsel for the complainant has tendered into evidence her affidavit Ex.CW1/A, copy of policy schedule Ex.C1, copy of premium deposit receipt Ex.C2, copy of premium cancelation receipt against lapsed policy Ex.C3, copy of claim form-A Ex.C4 to Ex.C6, copy of claim form-B, medical attendant certificate by the last treating doctor Ex.C7, copy of form-C-certificate of identity Ex.C8, copy of Pay out form for death Ex.C9, copy of death certificate Ex.C10, copy of Bank authorization form Ex.C11, copy of key feature document Ex.C12, copy of Aadhar card of deceased Ex.C13, copy of legal notice dated 21.08.2019 Ex.C14 and closed the evidence on 15.03.2022 by suffering separate statement.

6.             On the other hand, learned counsel for the OPs no.1 and 2 has tendered into evidence affidavit of Nikunj Chikani, Manager Ex.OP1/A, affidavit of Pardeep Malhotra, proprietor of A-One Investigation Services Ex.OP2/A, copy of premium receipt Ex.O1, copy of proposal form Ex.O2, copy of application for fixed saving plan Ex.O3, copy of PAN card Ex.O4, copy of repudiation letter Ex.O5, copy of final investigation report Ex.O6, copy of observation of the claimant Ex.O7, copy of outpatient health card Ex.O8 and closed the evidence on 09.09.2022 by suffering separate statement.

7.             Learned counsel for the OP no.3 has tendered into evidence affidavit of Rajesh Ex.RW1/A and closed the evidence on 09.09.2022 by suffering separate statement.

8.             We have heard the learned counsel for the parties and perused the case file carefully and have also gone through the evidence led by the parties.

9.             Learned counsel for complainant, while reiterating the contents mentioned in the complaint, has vehemently argued that the husband of complainant (since deceased) insured his life from the OPs. The sum assured was Rs.7,86,495/-. On 28.06.2017 husband of complainant expired due to heart attack. After the death of her husband, complainant being nominee approached the OPs and requested to settle the death claim but OPs did not settle the claim and refused to pay the policy amount, vide letter dated 01.03.2018 on the false and frivolous ground and lastly prayed for allowing the complaint.

10.           Per contra, learned counsel for the OPs no.1 and 2, while reiterating the contents of written version, has vehemently argued that husband of complainant expired 28.06.2017. Prior to his death, life assured had taken treatment in OPD on 17.06.2014, where he was diagnosed for CVA & Ie Hemiparesis. Doctor also advises to take surgeon opinion, and also refer to Dr. Khonakar for physician opinion. The life assured has not disclosed the medical detail to the company at the time of filling of the proposal form. Life assured was paralyzed about three years prior to his death and it is also confirmed by the Sarpanch in his statement. The company has procured copy of OPD card dated 17.06.2014 i.e. prior to policy issuance wherein it has been clearly mentioned that life assured was suffering from CVA and paralysis. He further argued that during investigation certain discrepancies were observed and evidence were collected, the company has rightly repudiated the claim, vide its letter dated 01.03.2018 and lastly prayed for dismissal of the complaint.

11.           We have duly considered the rival contentions of the parties.

12.           Admittedly, the life assured was insured with the OPs for the sum assured of Rs.7,86,495/- and the policy in question was issued on 23.07.2015. It is also admitted that complainant is the nominee of the deceased life assured. The claim of the complainant has been repudiated by the OPs, vide repudiation letter Ex.O5 dated 01.03.2018 on the ground of concealment of material facts with regard to pre-existing disease at the time of filling the proposal form as life assured Naresh Kumar was diagnosed with CVA lift Hemiparesis on June 17, 2014 which is prior to the inception of this policy.

13.           The onus to prove that the life assured was having pre-existing disease prior to commencement of the policy lies upon the OPs. OPs have duly proved its version by leading evidence. It is evident from out patient health care card Ex.O8 dated 17.06.2014 the life assured was diagnosed with CVA lift Hemiparesis. OPs have also placed on record final investigation report Ex.O6 and Ex.O7 dated 09.01.2018 wherein it is specifically mentioned that life assured was suffering from CVA and paralysis for the last three years prior to his death. To rebut the evidence produced by the OPs, complainant has failed to produce any cogent and convincing evidence. Thus, it is proved on record that deceased life assured was having pre-existing disease and has concealed the true and material facts regarding his health at the time of obtaining the insurance policy. In this regard, we are fortified with the observations of Hon’ble Supreme Court in case titled as Branch Manager, Bajaj Allianz Life Insurance Company Ltd. and others Vs. Dalbir Kaur in civil appeal no.3397 of 2020 decided on 09.10.2020 wherein Hon’ble Supreme Court held that a policy of insurance is governed by the principles of utmost good faith. The suppression of material facts by the insured/policyholder entitles the OP to repudiate the policy under section 45 of the Insurance Act. The said authority is fully applicable to the facts of the present case.

14.           It is settled principle of insurance law that contract of insurance is a contract uberrima fides and utmost faith must be observed by the contracting parties. Every material fact must be disclosed, otherwise there is good ground for rescission of contract. If, there are misstatements or suppression of material facts, the policy can be called into question. In this regard reference may be made to the judgment of the Hon’ble Supreme Court in case titled Satwant Kaur Sandhu Versus New India Assurance Co. IV( 2009) CPJ 8 (SC) and judgment of Hon’ble National Commission in case Life Insurance Corporation of India and another Versus Bimla Devi Revision Petition no.3806 of 2009 decided on 12.8.2015 and Sunita Rani Versus PNB Metlife India Insurance Company Limited in appeal no.1252/2015 dcided on 21.04.2017.

15.           In the present case deceased life assured has concealed the true and material facts regarding his health at the time of commencement of the policy in question. Hence, we are of the considered view that OPs have rightly repudiated the claim of the complainant. Thus, we found no deficiency in service on the part of the OPs, while repudiating the claim of the complainant.

16.           Thus, present complaint is devoid of any merits and same deserves to be dismissed and the same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Dated:25.11.2022

                                                                       

                                                                  President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal.

 

 

(Vineet Kaushik)        (Dr. Rekha Chaudhary)

                    Member                         Member