Haryana

Charkhi Dadri

CC/19/2021

Naresh Kumar - Complainant(s)

Versus

Sale Representative ,PNB Metlife Inida Insurance Company Ltd - Opp.Party(s)

Jitender Yadav

09 Oct 2024

ORDER

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL

COMMISSION, CHARKHI DADRI.     

 

                                                           Complaint No.         19 of 2021.                                                                                      Date of Institution:  01.02.2021

                                                           Date of order:                  09.10.2024         

 

Naresh Kumar son of Indraj Singh, resident of village and post office Misri, Tehsil & District Charkhi Dadri.

..Complainant.

                                                VERSUS

1. Sale Representative, PNB Metlife India Insurance Company Ltd, C/o Punjab National Bank, Loharu Road, Near Bus Stand, Charkhi Dadri, Tehsil & District Charkhi Dadri..
2. PNB Metlife Insurance Company Ltd. through its MD/CEO, Regd and Corporate office 1^st Floor, Techniplex-1, Techniplex Complex, Off Veer Sarvarkar Flyover, Goregaon (West), Mumbai-400062.
3. Punjab National Bank through its Chief Manager, Branch Office Nr. Bus Stand, Loharu Road, Charkhi Dadri

                                                                                         ..Opposite parties.

                   COMPLAINT UNDER THE CONSUMER         PROTECTION ACT,

Before: -   Hon’ble Sh. Manjit Singh Naryal, President

                Hon’ble Sh. Dharam Pal Rauhilla, Member.

 

Argued by: Sh. Jitender Yadav,Adv. for complainant.

                   Sh. Rajender Verma, Adv. for OP no. 2.

                   Sh. K.S. Chhikara, Adv. for OP no.3.

                    OP no.1 exparte vide order dt.09.03.2021

 

O R D E R

                    Brief facts of this case are that Sh. Indraj Singh (since deceased), father of complainant, had purchased a life insurance policy No.21743049 on 29.12.2015 for a sum assured Rs.4,20,000/-.  It was averred that father of complainant died on 03.05.2018, after that, complainant lodged a claim with OPs, being nominee, but claim was not passed by OPs. So, complainant made requests as well as visited the office of OPs many times but of no avail despite issuance of a legal notice dated 15.06.2019. Complainant has averred that due to non-release of the claim, the complainant had suffered monetary loss as well as mental and physical harassment. Hence, the present complaint has been preferred seeking directions against the OPs to pay the amount of death claim amounting to Rs. 4,20,000/- alongwith interest to the complainant, further to pay Rs.50,000/- on account of mental and physical harassment and a sum of Rs.11,000/- towards litigation expenses.

2.                    Notice was sent to the opposite party no.1 through registered post, but when none has appeared on behalf of the opposite party no.1, the opposite party  no.1 was proceeded against ex-parte vide order dated 09.03.2021.

3.                Upon notice, OP no.2 appeared and filed written statement submitting therein that  repudiation letter dated 26.09.2018 has been rightly issued to the complainant and same has been carried out in the light of the investigation report supported with the documentary proof of the diseases which the Deceased Life Assured (DLA) was suffering  from prior  to purchase of the policy. It is further submitted that mere making of payment of premium under the policy does not legalize the contract which otherwise is based upon misrepresentation of facts. In the end, prayer for dismissal of complaint with costs was made.

4                 Upon notice, OP no.3 appeared and filed written statement submitting therein that complainant got insurance policy from OP no.2 at his own free will and choice for his requirements and for that OP no.3 has no relation.   Hence, the complaint of the complainant is liable to be dismissed with costs.                 

5.                     To prove its complaint, the complainant has tendered in evidence affidavit of complainant as Exhibit CW1/A and documents Ex. C-1 to Ex.C-10 and closed the evidence vide order dt. 06.09.2021

6.                     On the other hand, the counsel for the OP no.2 has filed affidavit Ex.RW2/A and tendered documents Ex.R1 to Ex.R7 and closed the evidence vide order dt. 30.05.2022. The counsel for the OP no.3 has filed affidavit Ex.RW-1/A and documents Ex.RW-2/B to Ex.RW-2/C and closed the evidence vide order dt.30.05.2022. OP no.2 has also filed written arguments.

7.                We have heard the arguments advanced by learned counsel for both the parties and gone through the entire material available on record thoroughly and carefully and also perused the entire records including the citations produced by both sides

Advocate for the complainant has submitted following decisions:

Civil Writ Petition No. 11522 of 2023, decided on 16.10.2023, titled as Star Health and Allied Insurance Co. Ltd. Vs. Anant Ram and Anr (Punjab and Haryana Court at Chandigarh).

Complaint no. 05 of 2011, decided on 14.03.2019, titled as  Virpal Nagar Vs. HDFC Standard Life Insurance Co. Ltd.

First appeal No.195 of 2010, decided on 15.11.2017, titled as Oriental Insurance Company Ltd. Vs. Romesh Suri and anr. (Delhi State Consumer Disputes Redressal Commission, Delhi) Order dated 03.10.2006, passed by Hon’ble National Consumer Disputes Redressal Commission, New Delhi in revision petitionNo. 1696 of 2005 ( Praven Damani Vs. Oriental Insurance Co. Ltd.)

Learned counsel for the OP no.2 has cited the following citations in support of his contentions, wherein the judgments were given against the complainants on the ground that the complainant had concealed the pre-existing disease and the repudiation of claim was justified as per terms and conditions of the insurance policy:-

1. Branch Manager, LIC of India Vs. Jyoti Sudhir, R.P. No.1134/2016 decided on 20.10.2016 by NCDRC.
2. Satwant Kaur Sandhu Vs. New India Insurance Co., (2009) 8SCC 316
3. Reliance Life Insurance Co. Ltd. & Anr. Vs. Rekhaben Nareshbhai Rathod,II (2019)CPJ 53 SC in civil appeal No.4261 of 2019 judgment pronounced by Hon’ble Supreme Court.
4. Order dated 15.04.2019 passed in  Civil Appeal No. 3944 of 2019 by the Hon’ble Supreme Court  in LIC of India Vs. Manish Gupta.
5. Order dated 09.10.2020 passed in  Civil Appeal No. 3397 of 2020 by the Hon’ble Supreme Court  in Branch Manage, Bajaj Allianz Life Insurance Co. Ltd Vs. Dalbir Kaur.
6. Senior Manager, LIC of India Vs. Rajesh Kumar, R.P. No.650 of 2020 decided on 15.10.2020 by NCDRC.

 

We are having in our mind the principles stated in the above said decisions for disposal of this case.

8.           At the outset, the insurance policy taken from OP no.2 for basic sum assured to the extent of Rs.4.20,000/- vide Ex R-3, is not in dispute. Death of the insured during the period of the insurance policy has also not been disputed. The complainant herein is nominee of the insured is also admitted. The payment of premium on due date by and on behalf of insured is also not in dispute. Date of commencement of policy is 02.12.2015 and its date of completion of the policy is 02.12.2045 and such fact also not disputed by the OP no.1&2. The main opposition of the OP no. 2 is that at the time of filing the proposal form, the insured did not provide information qua disease before commencement of the policy period.
9.           Admittedly the OP no.1&2 has rejected that the claim of the complainant sating that the deceased life assured i.e. father of the complainant had suppressed the material facts regarding his health condition at the time of submitting the proposal form and signing it. Consequently as per prevailing practices of the insurance company, the insurance company made the investigation about the genuineness of the said policy.
10.           OP no.1&2 contended that in the investigation it was revealed that the deceased Indraj Singh was suffering from asthma & hypertension for the last 2-3 years for which he was taking medicines and treatment from ECHS Polyclinic, Bhiwani. But polyclinic did not share any documents related to life assured. In the month of February 2018, the life assured health got worse and he was admitted at Ravindra Hospital & Heart Centre, Hisar on 05.02.2018. after treatment the life assured discharged from the hospital. In the month of  May 2018, again the life assured got worse and he was again hospitalized in Ravindra Hospital & Heart Centre, Hisar on 03.05.2018 with complaints of breathlessness  and there the life assured was diagnosed with COPD, HTN etc. but the life assured could not survive and died on the same day. So prior to issuance of policy of deceased life assured, he was suffering  from Asthma & Hypertension but he has suppressed his previous illness while procuring  the policy and therefore OP no.1&2 has legally repudiated the claim as per policy conditions.
11.           So like this OP no.1&2 main contention is that while procuring policy DLA has suppressed his previous illness and his health conditions and so there is no any illegality in rejecting the claim of the complainant and there is no any deficiency of service on the part of insurance company.
12.           Perusal of document  stated supra makes it clear that the DLA had not disclosed his previous illness i.e., heart disease, asthma and also treatment taken for the same before availing/procuring the policy from OPs specifically by answering concerned questions about the same by answering as 'NO' in the proposal form submitted for procuring the policy. Certificate issued by Village Sarpanch  certified that deceased Indraj Singh was suffering from Asthma  since 2014, Naresh Kumar son of deceased Indraj Singh made a statement  that his father suffering from 2-3 years ago from asthma , but he has suppressed all these facts.. Admittedly complainant has not adduced any contrary evidence to show that DLA was not at all suffering from any disease and he was not at all admitted to any hospital as contended by OPs and further the complainant has not at all challenged the documents submitted by OPs stating that same are not genuine and they are fabricated documents.
13.           So in view of the admitted facts and documentary evidence produced by OP no.1&2 we are of the considered opinion that the principles stated in the decisions relied on by Advocate for complainant cannot made applicable in this case and said decisions will not help the complainant in any manner.
14.           Moreover, the Hon’ble Apex Court in a case reported in (2019) 6 SC 175 (Reliance Life Insurance Company Ltd., V/s. Rekhaben Nareshbai Rathod), held as under:

   “A. Insurance – Repudiation/Rescission of Insurance Policy – Repudiation by insurer of the claim under a policy of life insurance, within a period of two years from the commencement of the insurance cover, on the ground of non-disclosure a material fact, as in the present case for suppressing/not disclosing a preexisting life insurance – Legality of – “Material fact” – What is – Doctrine of uberrima fidei i.e. that there must be complete good faith on the part of the insured – Applicability of – Held, the expression “Material” in the context of an insurance policy can be defined as any contingency or event that may have an impact upon the risk appetite or willingness of the insurer to provide insurance cover.

 - In the present case, the insurer had sought information with respect to previous insurance policies obtained by the assured but the same was not disclosed by the insured – on 22.09.2009, the appellant issued a policy of life insurance based on the disclosures contained in the proposal form and the insured died on 08.02.2010 – The appellant repudiated the respondent’s claim on 30.08.2011 on the ground of non-disclosure of the earlier cover for life insurance held by the insured – Held, the duty of full disclosure required that no information of substance or of interest to the insurer be omitted or concealed and whether or not the insurer would have issued a life insurance cover despite the earlier cover of insurance was a decision which was required to be taken by the insurer after duly considering all relevant facts and circumstances – Thus, the failure of the insured to disclose the policy of insurance obtained earlier in the proposal form entitled the insurer to repudiate the claim under the policy - Insurance Regulatory and Development Authority (Protection of Policyholders Interests) Regulations, 2002 – Regns. 2 (d), 4(3) and 4(4) – Consumer Protection – Services – Insurance – Insurance Act, 1938 – S.45 – Words and Phrases – “Material fact”

XXXXXXXXXX

 B. Insurance – Contract of Insurance/Insurance Policy/Cover Note – Proposal filed by agent and signed insurer - Bindingness of, on insured – Inaccurate/untrue statements in such proposal – Effect of - A person who affixes his signature to a proposal which contains a statement which is not true, cannot ordinarily escape from the consequence arising there form by pleading that he chose to sign the proposal containing such statement without either reading or understanding it – In filling up the proposal form, the agent normally ceases to act as agent of the insurer but becomes the agent of the insured and no agent can be assumed to have authority from the insurer to write the answers in the proposal form – In the present case, the contention that signatures of the assured on the form were taken without explaining the details, rejected – Contract and Specific Relief – Formation Defects – Void and Voidable Contracts – Formation Defects Rendering Contracts Voidable – Misrepresentation and Non-disclosure – Doctrines and Maxims – Nudum Pactum/Nudum Pactum Ex Quo Non Oritur Actio. ”

15.               It is worthwhile to note here that the issue involved in the case stated supra was whether the insurer can repudiate the claim arising under a policy of life insurance, within two years, Under Section 45 of the Insurance Act, 1938 when the insured has suppressed / not disclosed a pre-existing life insurance cover in its proposal form ?. Hon'ble Supreme Court answering the said question in the affirmative and allowing the appeal held that the repudiation of the claim on 30.8.2011 was on the ground that there was a non-disclosure of material fact on the part of insured in not disclosing that he held a prior insurance cover. The insurer stated that if this was to be disclosed in the proposal form, it would have called for and evaluated financial income documents together with the terms for the acceptance of the cover.

16.               Further, approving the decision reported in AIR 1971 Bom 304 stated that Section 45 of the Insurance Act, 1938 is divided into two parts. Under the first part, if the insurer calls in question the policy within a period of two years from the date on which it was effected, then the insurer company has only to show that a statement made in the proposal for insurance, or in any report of a medical officer, or referee, or friend of the insured, or in any other document, leading to the issue of the policy was inaccurate or false. Even an incorrect statement which may not be a material fact and suppression of fact which may not be on a material point, would be enough for the insurer company to avoid the contract of policy under this part.

17.              Therefore, looking to the principles stated in the decision rendered by the Hon'ble Apex Court stated supra and also looking to the admitted facts and documentary evidence on record, we are of the considered view that the complainant has failed to prove that there is deficiency of service on the part of OPs as OPs have not committed any error in repudiating the claim of the complainant and it is in accordance with the law laid down by the Hon'ble Apex Court. Resultantly, in view of the abovesaid discussions and for the foregoing reasons, the complainant’s complaint has to be dismissed with no order as to costs. The copies of this order be supplied to the parties free of cost. File be consigned to the record room, after due compliance