Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. : 178
Instituted on : 18.03.2020
Decided on : 13.12.2022
- Harshil minor Son and Nominee of Sh. Deepak(Assured)through his appointee Sh. Jaswant Singh S/o Sh. Hari Chand aged-67 yrs, R/o 1597, Sector-1, Rohtak.
- Jaswant Singh aged-67 yrs. S/o Sh. Hari Chand, R/o 1597, Sector-1, Rohtak.
………..Complainants.
Vs.
SBI Life Insurance its Regional Manager, SBI Life Insurance Company Ltd., 1st Floor, Plot No. 144, Industrial Area, Phase-2, Chandigarh-160002
….….Opposite party.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
DR.VIJENDER SINGH, MEMBER.
Present: Sh. Parveen Phougat, Advocate for the complainants.
Sh. Gulshan Chawla, Advocate for opposite party.
ORDER
SH.NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case, as per the complainants are that Sh. Deepak S/o Sh. Jaswant Singh during his life time purchased a policy from opposite party on dated 05.12.2017 which was commenced from 08.12.2017 bearing product name as Smart Scholar, Child Plan option policy no. 5179384702(wrongly mentioned as the same is 51793384702 as per Ex.C2) dated 08.12.2017. Sh. Deepak named the complainant no. 1 as his nominee and as the Nominee being minor, complainant No. 2 was named as “appointee”. Sh. Deepak Paid the premium regularly during his life time. After more than one year of commencement of policy Sh. Deepak(assured) expired on dated 26.12.2018. It is further submitted that complainant No. 2 being appointee of minor nominee applied for claim with the opposite party and submitted all the documents but was surprised to receive the repudiation letter on the ground that Sh. Deepak(Life assured) suppressed the material fact as he was suffering from chronic disease and Renal Disease and was taking treatment for the same prior to the date of commencement of policy i.e. 08.12.2017 and has returned the premium paid for policy. The act of opposite parties is illegal and amounts to deficiency in service. Hence this complaint and it is prayed that opposite parties may kindly be directed to pay Rs.5,52,000/- plus interest @ 18% P.A., also to pay Rs.1,00,000/- for harassment and to Rs.11,000/- as litigation charges as explained in relief clause.
2. After registration of complaint, notice was issued to the opposite party. Opposite party in its reply has submitted that the deceased life assured, Mr. Deepak was the holder of the policy bearing No. 51793384702 for a sum assured of Rs.5,52,000/- policy term of 22 years and premium paying term of 8 years and date of commencement of the policy as 08.12.2017. Deceased Life assured reported to have died on 26.12.2018. The policy resulted in claim within 1 year 18 days. The opposite party conducted death claim investigation. During the investigation it was revealed that the DLA was suffering from Chronic Kidney Disease and Juvenile Rheumatoid Arthritis(JRA) prior to the date of signing of proposal form. As per the dialysis record book of Mann Multi Speciality Hospital Rohtak, the DLA was on dialysis from 23.08.2018 and he was diagnosed for Chronic Kidney Disease. Further DLA had also taken HBV(Hepatitis B Vaccine) on 10.02.2017,10.03.2017 and 10.04.2017 and Booster on 10.08.2018. It is further submitted that as per the discharge summary of Mann Multi Speciality Hospital, the DLA was hospitalized for a period from 22.08.2018 to 27.02.2018(wrongly mentioned as the date is 23.02.2018 to 27.02.2018 as per Ex.R5) and was diagnosed for “CKD ESRD, RRT started, B/L Grade II Renal Medical Disease Chplelithiasis.... known case of Juvenile Rheumatoid Arthritis, Nephrotic.....”. The policy was issued on 08.12.2017 and the DLA was taking dialysis since February 2018 and diagnosis was chronic kidney disease. It cannot be develop within short period of 3 months. It is clear that the DLA was suffering from kidney disease prior to date of signing the proposal form and has also taken vaccine for HBV in 2017, these vaccines could not be referred to adult who is healthy. Thus it is evident that there is a suppression of material fact and the DLA availed the insurance cover fraudulently. There is a deliberate suppression of material fact with a fraudulent intention to obtain insurance. All the other contents of the complaint were stated to be wrong and denied and prayed for dismissal of complaint with costs.
3. Ld. counsel for the complainants in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C6 and closed his evidence on dated 06.04.2021. Ld. counsel for the opposite party has tendered affidavit Ex.RW1/A and documents Ex. R-1 to Ex. R-6 and closed his evidence on 30.09.2021.
4. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
5. In the present case claim of the complainant has been repudiated by the opposite party vide its letter Ex.C3. The main contention of the opposite party is that the deceased life assured was suffering from chronic disease at the time of inception of the policy and he has not disclosed any fact regarding the disease in his proposal form. It has been further submitted that the policy has been procured fraudulently and he also suppressed the material information from the insurance company. The insurance policy has been issued on the principal of “utmost good faith” . We have minutely perused the documents placed on record by both the parties. The main stress of the insurance company was upon the document Ex.R4. A thorough perusal of document Ex.R4 itself show that this document is a dialysis record of Deepak of Maan Multi Spciality Centre Rohtak. As per respondent/insurance company the deceased was suffering from chronic kidney disease at the time of inception of the policy and he has firstly took treatment from the hospital on dated 10.02.2017 and thereafter he continuously took follow up treatment and also took dialysis from Maan Hospital. But perusal of document Ex.R4 itself shows that the information regarding Plus HBV Vaccination has been mentioned at page no.2 and it has been specifically mentioned that first dose was given on dated 10.02.2017, 2nd on 10.03.2017, 3rd on 10.04.2017 and thereafter booster dose was given on 10.08.2017. It is also observed that the full form of HBV is ‘Hepatitis B Vaccination’ and the same is used for liver disease. Whereas as per record the deceased was suffering from kidney disease in the month of February 2018. This document itself shows that deceased LA took treatment firstly from Maan Hospital on 23.02.2018 and the record itself shows that thereafter he took continuous dialysis from that hospital and ultimately he died on 26.12.2018. In fact Ex.R4 itself establishes that the deceased was not suffering from chronic kidney disease on dated 08.12.2017. Hence there is deficiency in service on the part of opposite party and opposite party is liable to pay the insurance claim under the policy to the L.Rs of deceased. It has been further submitted by the insurance company that they have already paid an amount of Rs.88000/- to the LRs of complainant and a letter Ex.C2 has been sent to Sh. Jaswant Singh in this regard. As such opposite party is liable to pay the remaining claim amount of Rs.464000/-(Rs.552000/- less Rs.88000/-) to the nominee (Harshil).
7. In view of the facts and circumstances of the case, we hereby allow the complaint and direct the opposite party to pay the amount of Rs.464000/-(Rupees four lac sixty four thousand only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e.18.03.2020 till its realization to the nominee(Harshil) i.e. complainant no.1 and also to pay a sum of Rs.5000/-(Rupees five thousand only) as compensation on account of deficiency in service and Rs.5000/-(Rupees ten thousand only) as litigation expenses to the complainant no.2 i.e. Jaswant Singh(appointee). Order shall be complied within one month from the date of decision. However, complainant no.2 i.e. appointee Jaswant Singh is directed to deposit the alleged amount awarded to the complainant no.1 in any nationalized bank in the form of FDR till the date of date of attaining the age of majority and shall be disbursed to the complainant no.1 on attaining his age of majority.
8. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
13.12.2022
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Nagender Singh Kadian, President
………………………………..
Tripti Pannu, Member.
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Vijender Singh, Member.
