Haryana

StateCommission

A/1075/2019

PNB METLIFE INDIA INSURANCE COMPANY - Complainant(s)

Versus

SHAKUNTLA DEVI - Opp.Party(s)

SANJEEV GOYAL

08 Jan 2020

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA, PANCHKULA   

 

                                                 

                                                First Appeal No.1075 of 2019

                                                Date of Institution: 11.12.2019

                                                Date of Decision: 08.01.2020

 

 

PNB Metlife India Insurance Company, 1^st Floor, Techniplex -1, Techniplex Complex, Off Veer Sawarkar Flyover, Goregaon, West Mumbai-400 062 through its Authorized Signatory Mr. Rajeev Sharma son of late Sh. Lekh Ram Sharma, Senior Manager (Legal), available at PNB Met Life Insurance Company Limited, 4^th Floor, Platinum Tower, Sohana Road, Sector 47, Gurugram-122001.

 

…..Appellant-Opposite Party

 

 

VERSUS

 

 

Shakuntla Devi widow of Sh. Rameshwar Dass, resident of Village Kheri Matarwa, Post Office Kaul, District Kaithal (Haryana).

…….Respondent-Complainant

         

 

 

 

 

 

CORAM:    Hon’ble Mr. Justice T.P.S. Mann, President.

                   Shri Ram Singh Chaudhary, Judicial Member.

 

 

 

                                                        

Present:-    Shri Yugansh Siwach, counsel for the appellant.

                  

 

                                                O R D E R

 

 

T.P.S. MANN, J.  

 

          For the reasons stated therein, the misc. application for condonation of delay is allowed and delay in filing of the appeal is condoned.

2.      Opposite party-PNB MetLife India Insurance Company Limited, 1^st Floor, Techniplex -1, Techniplex Complex, Off Veer Sawarkar Flyover, Goregaon, West Mumbai-400 062 through its Authorized Signatory Mr. Rajeev Sharma, Senior Manager (Legal) has filed the instant appeal against the order dated 20.09.2019 passed by learned District Consumer Disputes Redressal Forum, Kaithal whereby complaint preferred by complainant Shakuntla Devi widow of Rameshwar Dass, resident of Village Kheri Matarwa, Post Office Kaul, District Kaithal was allowed and the opposite parties directed to pay an amount of Rs.9,10,000/- as basic sum assured of the deceased namely Rameshwar Dass to the complainant being his nominee within 45 days after receiving the copy of the order failing which the complainant would be entitled to interest @ 9% per annum for the defaulted period.  The opposite parties were further directed to pay Rs.10,000/- as lump sum compensation to the complainant on account of harassment, mental agony and litigation charges. 

2.      According to the complainant, her husband Rameshwar Dass was insured with the opposite parties vide policy No.21959125 dated 24.08.2016 for a sum of Rs.9,10,000/-.  The complainant’s husband died due to heart attack in Gaur Hospital, Kurukshetra.  The complainant lodged the claim with the opposite parties and submitted all the necessary documents.  The opposite parties issued letter dated 05.07.2017 regarding the additional requirement of the policies and demanded the letter of PGI, Rohtak but the same was replied by the complainant that the complainant never got her husband treated from PGI, Rohtak and ever received any letter there from.  The complainant requested the opposite parties several times to pay the claim but the opposite parties did not settle the claim of the complainant.  As it was a case of deficiency in service on the part of the opposite parties, the complainant filed the complaint seeking to the opposite parties to bear the claim on the file of death benefits of the complainant’s husband alongwith interest thereon @ 18% per annum with effect from the date of the complainant’s husband till its payment and also to pay Rs.5,000/- as litigation charges to the complainant.

3.      Upon notice, the opposite parties appeared before the learned District Consumer Forum and filed reply by raising preliminary objections with regard to locus standi; maintainability; and; cause of action.  It was also pleaded that the complainant’s husband had submitted the duly signed proposal form dated 29.07.2016 and offered to pay Rs.11,716/- towards the initial premium against the sum assured of Rs.9,10,000/-.  During investigation and assessment of the claim, it was revealed that the deceased life assured did not provide true and correct information while filling the proposal form with respect to his medical history.  It was revealed that the DLI was suffering from cancer prior to the issuance of the insurance policy and he was under treatment at PGI, Rohtak. The Investigating Department filed an RTI with PGI, Rohtak for obtaining medical documents of the DLI.  In response thereto, RTI, PGI, Rohtak sent a letter addressing Sh. Simru Ram, father of Rameshwar Dass seeking consent for sharing the medical documents of the DLI.  The opposite parties also approached the complainant and asked her to provide the consent within seven days.  However, the complainant neither provided any consent nor responded to the said letters.  The DLI submitted the proposal form on 29.07.2016 and despite a specific question with respect to the medical history of the DLI in the proposal form, replied in negative only with the malafide intention for causing wrongful loss to the opposite parties.  There was no deficiency in service on the part of opposite parties. Accordingly, the opposite parties prayed for dismissal of the complaint.   

4.      The complainant tendered in evidence affidavit (Ex. CW1/A) and documents (Annexures CA to CF). 

5.      On the other hand, the opposite parties tendered into evidence affidavit (Ex.RW1/A) and documents (Annexures R1 to R-4).

6.      After hearing learned counsel for the parties and on going through the record, learned District Forum allowed the complaint and granted relief to the complainant, as mentioned above. 

7.      Learned counsel for the appellant has submitted that the DLI did not provide true and correct information while filling up the proposal form with respect to his medical history.  The DLI was suffering from cancer prior to the issuance of the insurance policy for which he was under treatment at PGI, Rohtak.  The Investigating Department sought to obtain medical documents of the DLI by filing RTI with PGI, Rohtak.  Letter was addressed to Sh. Simru Ram seeking consent for sharing of medical documents of the DLI.  The opposite parties also approached the complainant and asked her to provide the consent within seven days but she neither provided consent nor responded to the aforementioned letters.  As such, the claim of the complainant was repudiated. Hence, the learned District Consumer Forum was not justified in granting relief to the complainant, as mentioned above.

8.      Having heard learned counsel for the appellant and on going through the impugned order, the State Commission finds that the factum of death of Rameshwar Dass, husband of the complainant is not in dispute.  He had died of heart attack on 01.11.2016.  However, the claim was declined by the opposite parties as the deceased had not disclosed the material facts.  He had been suffering from cancer prior to obtaining the insurance policy and taking treatment from PGI, Rohtak.  Though the opposite parties had approached PGI, Rohtak for obtaining information regarding treatment record of the deceased but no such material has been made available.  On the other hand, the opposite parties had placed on the file the proposal form from which it is clear that the deceased had mentioned that he was not suffering from any disease.  The onus to prove that the deceased had obtained policy by suppressing the facts relating to his cancer was on the Insurance Company.  However, no such evidence has been produced by the Insurance Company.  Therefore, it is difficult to hold that the deceased had been taking treatment from PGI, Rohtak for cancer as from which he was suffering.  Therefore, the opposite parties were not justified in repudiating the claim of the complainant, which act of the opposite parties amounted to grave deficiency in service on their part and unfair trade practice. 

9.      In view of the above, no case is made out for any interference in the impugned order passed by the learned District Forum. The appeal is devoid of any merit and accordingly dismissed.

10.    The statutory amount of Rs.25,000/- deposited by the appellant while filing the appeal be disbursed in favour of the complainant against proper receipt and identification in accordance with rules, subject to appeal/revision, if any.     

 

  

Announced 08.01.2020

(Ram Singh Chaudhary) Judicial Member

(T.P.S. Mann) President

U.K