Complainant Smt.Jaswinder Kaur has filed the present complaint against the opposite parties U/S 12 of the Consumer Protection  Act (for short, C.P.Act.) seeking necessary directions to the opposite parties to make payment of Rs.3,50,000/- along with interest @18% w.e.f. the date of death of policy holder i.e. 25.03.2014 alongwith litigation expenses and compensation on account of harassment to the tune of Rs.30,000/-, in the interest of justice.

2.        The case of the complainant in brief is that her husband who died on 25.03.2014 was having a Life Insurance Cover under Policy No. 21032756 of  PNB Met Life Insurance Company Ltd., which was issued on 1.3.2013  assured for a sum of Rs.3,50,000/-. Her husband was paying regular installments. A sum of Rs.62,182.64 already stands deposited by him through installments. She has further pleaded that the policy holder suffered from chest infection and consequently was admitted on 22.3.2014 in the EMC Super Specialty Hospital, Amritsar for the treatment but unfortunately died on 25.3.2014 due to sudden cardiac arrest, in the hospital. As per Life Insurance Policy Cover, the opposite parties were to pay a sum of Rs.3,50,000/- to his wife. She along with all requisite documents deposited the policy cover with the opposite parties and the opposite parties also acknowledged the receipt of all documents alongwith policy cover for making payment of the sum assured under the policy. The opposite parties instead of making payment of the claim amount of Rs.3,50,000/- which was due under the policy w.e.f. the date of death of Sarabjit Singh, later on started putting off the matter on one pretext or the other and the opposite party no.1 issued a letter dated 2.7.2014 stating therein that they have sent/transferred the amount of Rs.62,182.64 through NEFT in her account under reference No.CITIN 14449596987 being the full and final payment of the above mentioned claim.  The opposite parties have illegally retained the claim amount of Rs.3,50,000/- which was due under the abovesaid policy of the deceased and which was to be paid to the claimant being a nominee under the  said life insurance cover. The opposite parties illegally repudiated the claim under abovsaid policy and even did not send the amount of Rs.62,182.64 as per their letter dated 2.7.2014 either in the her account or in the account of deceased Sarabjit Singh from where they used to auto debit the policy premium amount. She repeatedly made representation to the opposite parties for making payment of the claim amount of Rs.3.50 lacs under the policy but the opposite parties failed to pay the same till date. A legal notice dated 23.9.2014 was also given through his counsel to the opposite parties. The opposite parties now illegally and wrongly not making payment of the claim amount to her being nominee, as such, the opposite parties are guilty of deficiency in services. Hence this complaint.

3.     Upon notice, opposite party no.1 appeared and  filed its  written reply through its counsel by taking preliminary objections to the effect that the complaint is false, malicious and has been filed with a  malafide intent;  the complainant has made misconceived and baseless allegations of deficiency of services without any documentary evidence in support of the same; the complaint filed by the complainant does not fall within the definition of a ‘Consumer Dispute’ as enunciated under the Consumer Protection Act, 1986;the deceased, Late Sh.Sarabjit Singh, who was the husband of the complainant , after completely understanding the terms and conditions of the product “Met Smart Platinum” Plan had submitted a duly signed Application Form bearing No.201710407 on 01.03.2013 wherein he was required to pay an annual premium of Rs.35,000/- for a premium paying term of 10 years and for a sum assured of Rs.3,50,000/-. On merits, it was submitted that the opposite party is not entitled to get any sum assured under the policy due to suppression of material facts by the DLI at the time of taking policy.  On 19.5.2014 the opposite party received a Death Claim Intimation from the complainant thereby intimating the opposite party that the Person Insured died on 25.3.2014, which was duly acknowledged by the opposite party vide letter dated 20.05.2013 wherein the complainant was requested to furnish few documents to process the claim. Upon the receipt of the Claim intimation and the ancillary documents, the opposite party as per the procedure and being the early claim, got an investigation conducted by an independent investigative agency, Probe India at New Delhi. It was also submitted that during the course of investigation and assessment of the claim, it was revealed that the DLI was a heart patient and was being treated at Army Hospital and Fortis Hospital, Amritsar for the same. He expired due to the illness at the EMC Hospital, Amritsar on 25.03.2014. The medical records procured from the EMC Hospital, Amritsar showed that the DLI was a known case of Coronary Artery disease (CAD), Dilated Cardiomyopathy (DCMP) for which he had undergone Coronary Artery Byepsss  Graft (CABG), Type 2 Diabetes Mellitus (Type 2 DM) after which, eventually the DLI expired on 25.03.2014. This implies that the DLI was aware about his health condition at the time of filling the Proposal Form however the DLI refrain from divulging the same. Thus, even being aware of the fact that the DLI had such health ailments, the DLI applied for the Policy to take undue advantage of the same and suppressed the said Material medical fact of treatment and thereby misrepresented to the Opposite Party. It was further submitted that the claim of the complainant was repudiated in view of the suppression of material facts. It is submitted that as a contract of insurance is based on utmost good faith, the DLI was obliged to give full and correct information on all matters which would influence the judgment of a prudent Insurer in determining whether they would accept the risk or not, and if they would, at what rate of premium and subject to what condition.   It was next submitted that Heart Diseases & Diabetes cannot be considered a normal disease and the DLI was suffering from the same much prior to availing of the said policy. The DLI after understanding the contents of the Proposal Forum was duty bound to answer the questions with regard to his health conditions of which he alone had person knowledge and was aware of. Further the amount of Rs.62,182.64 which was the fund value of the Policy was refunded vide UTR CITINI4449596987through NEFT towards full and final settlement of the policy.  It was further submitted that the opposite party had timely responded to the representations and the legal notice.  Thus there is no deficiency of services on the part of the opposite party in dealing with the said claim and the claim was rightly repudiated by the opposite party on the basis of suppression of material facts by the DLI.  All other contents of the present complaint have been denied by the opposite party in its written reply. Lastly, the complaint has been prayed to be dismissed with costs.

4.      Upon notice, opposite party no.2 appeared and filed its written reply through its counsel by taking preliminary objections to the effect that opposite party no.2 has been wrongly impleaded as party in this complaint. Because OP2 (Punjab National Bank) is a totally separate entity from OP1. OP2 is a banking Company having its Head office in New Delhi. OP1 is a Insurance Company having its Head Office in Bangalore. OP2 has no concern at all with Insurance transaction in question. Rather OP2 is not at all doing any insurance business. OP2 is only doing Banking Business. Moreover OP2 is not having any privity of contract in the transaction in question. The Insurance claim has been rejected by the claims Department of OP1 Insurance Co. So OP2 has no concern with it. The liability, if any, is only of OP1 and oP2 has no liability in it. So this complaint deserves out right dismissal against OP2 on this score alone. On merits, it was admitted that the deceased policy holder was having Saving Bank Account in Punjab National Bank Fatehgarh Churian. All other contents of the present complaint have been denied by the opposite party in its written reply. Lastly, the complaint has been prayed to be dismissed with costs

5.     Complainant tendered into evidence her own affidavit Ex.C1, alongwith other documents Ex.C2 to Ex.C14 and closed the evidence. 

6.       Counsel for the opposite party no.1 tendered into evidence affidavit of Urmila Mekalki, Deputy Manager of opposite party no.1 Ex.OP-1/1, alongwith other documents Ex.OP-1/2 to Ex.OP-1/7 and closed the evidence.

7.     Sh.KaramjitSingh, Mnager PNB Fatehgarh Churin opposite party no.2 tendered into evidence his own affidavit Ex.2/1 and closed the evidence.

8.         We have examined all the documents/evidence produced on record and have also duly considered and perused the arguments duly put forth by the learned counsels for both the sides, while adjudicating the present complaint. We find that the impugned claim has been repudiated (Ex.C3, Ex.OP1/5 & Ex.OP1/6) since the DLA (Deceased Life Assured) had been suffering from various diseases/ailments like CAD (Coronary Artery Disease), HTN (Hypertension), diabetes etc prior to his having purchased the Insurance Policy in question and he had willfully suppressed these pre-ailments in his application Ex.OP1/2 dated 01.03.2013 while applying for the said purchase of the Policy. Further, the Policy-Terms (duly accepted and acknowledged by the DLA and duly governing the settlement of the present claim) do permit and justify the ‘repudiation’ decision of the OP insurers. However, we find here that in the Claim Decision Letter dated 02.07.2014 (Ex.C2, same as Ex.OP1/5) the OP1 (Sr. Manager – Claims) has clearly and categorically advised the complainant as: ‘we are unable to admit liability for the above claim due to non-disclosure of material facts and have treated the said policy as void ab initio’; and further: ‘kindly note that the fund amount of Rs 62,182.64p has been transferred through NEFT to your bank account, under the reference number CITIN14449596987, being the full and final payment of the above mentioned claim. Also, attached is the account statement for your reference’. However, the complainant has alleged having Not Received the said credit of the referenced NEFT as claimed/ stated above and the OP insurers have neither rebutted the same nor have produced any cogent evidence to confirm the said NEFT credit. Since the Policy in question had been treated ‘first’ as void ab initio by the OP insurers there could be no question of its ‘subsequent-repudiation’ and ‘holding’ of the policy funds all the more when its NEFT credit stood duly communicated/ confirmed vides Ex.C2/ Ex.OP5 to the complainant. The above discussed ‘ACT’ also transpires as ‘deficiency in service’ on the part of the OP insurers and thus we hold them guilty of the same under the Act.    

9.       In the light of the all above, we partly accept the present complaint and thus ORDER the OP insurers to pay the NEFT unsent-amount of Rs. 62,182.64p to the complainant with Savings Bank interest with effect from the date of the unsent NEFT besides Rs 2,000/- as cost of litigation; within 30 days of receipt of the copy of these orders, otherwise the entire awarded amount shall attract interest @ 9 % PA form the date of these orders till actually paid.

10.     Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to records.

                                                            (Naveen Puri)

                                                                 President

ANNOUNCED:                                            (Jagdeep Kaur)

August, 19 2015.                                         Member                       

*MK*