Haryana

Karnal

CC/166/2018

Rekha - Complainant(s)

Versus

Star Union Dai-Ichi Life Insurance Company Limited - Opp.Party(s)

Tarun Sharma

20 Feb 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

                                                          Complaint No. 166 of 2018

                                                          Date of instt. 11.07.2018

                                                          Date of Decision 20.02.2019

Rekha wife of late Shri Parveen Malik son of Shri Randhir Singh resident of near Hanuman Mandir, Kutani, Rajkheri, District Panipat-132103.

                                                                        …….Complainant.

                                                  Versus

1. Star Union Dai-Ichi Life Insurance Company Limited through its authorized officer situated at SCO no.388-389, 1^st floor, Mughal Canal, Karnal.

2.  Star Union Dai-Ichi Life Insurance Company Limited through its authorized officer situated at 11^th floor, Vishwaroop I.T. Park, plot no.34, 35 & 38 Sector 30-A of IIP Vashi Navi Mumbai.

                                                                                                                                                                 …..Opposite Parties.

 

           Complaint u/s 12 of the Consumer Protection Act. 

 

Before    Sh. Jaswant Singh……President. 

      Sh.Vineet Kaushik ………..Member

                Dr. Rekha Chaudhary…….Member

 

 Present:  Shri Deepak Tuteja Advocate for complainant.

                   Shri Naveen Sharma Advocate for OPs.

 

                   (Jaswant Singh President)

ORDER:                    

 

                        This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986 on the averments that the husband of complainant namely Parveen Malik had taken a insurance policy naming SUD Life Aayushmaan Non Linked Deferred Participating Plan (UIN-142N050V01), vide policy no.00980625 from OP. The sum assured was Rs.6,20,000/-, commencing from 29.06.2016 as per his policy in case of death, sum assured is (6,20,000x150%) i.e. Rs.9.30,000/- plus other benefits. The husband of complainant paid Rs.23,444/- as premium for the abovesaid policy. The husband of complainant died on 02.09.2016 due to heart attack. The complainant being nominee of her husband lodged the death claim with the OPs and completed all the formalities as required by the OPs. The complainant requested the OPs so many times for her claim amount but OPs did not pay any heed to his request and lastly repudiated the claim of the complainant. Then complainant sent a legal notice to the OPs in this regard but it also did not yield any result. In this way there was deficiency in service on the part of the OPs. Hence complainant filed the present complaint.

2.             Notice of the complaint was given to the OPs, who appeared and filed written version raising preliminary objections with regard to cause of action and concealment of true and material facts. On merits, it is pleaded that Late Parveen Malik (hereinafter referred as Deceased Life Insured/DLI) after completing understanding the terms and conditions of the policy SUD Life Aayushmaan submitted a duly signed proposal form dated 27.06.2016. On the basis of the information provided by the DLI in the proposal form and believing the same to be true and correct, the OP issued the policy bearing no.00980625 with Risk commencement date being 29.6.2016 stipulating annual premium of Rs.23,444/- against the sum assured of Rs.6,20,000/- for the premium paying tenure of 20 years and policy tenure of 20 years. It is further pleaded that as per terms and conditions of the policy DLI was required to provide the details of the other insurance policies obtained by him or applied with other insurance companies simultaneously alongwith the OPs and DLI replied negative in this regard. It is further pleaded that OPs received the Death Claim intimation from the complainant on 10.03.2017 wherein it was mentioned that the DLI had expired on 02.09.2016 due to heart attack. It is further pleaded that the insured died within a short span of 2-3 months from the date of issuance of the policy. During the course of investigation, it was revealed that the DLI had obtained a policy of insurance bearing no.5014456122 from Bharti Axa Life Insurance on 26.02.2016 for a sum cover of Rs.12 lakhs prior to submitting the proposal form with the OP. It is further submitted that the DLI submitted the proposal form with the OPs on 27.06.2016 and despite having a specific question in this regard, the DLI answered in the negative whereas in fact the DLI was having insurance to the tune of Rs.12 lakhs. Thus the DLI suppressed the material facts from the OPs. Hence the OPs repudiated the claim of the complainant, vide letter dated 26.03.2017 on the ground of misrepresentation and suppression and concealment of material facts. Hence 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.             Complainant tendered into evidence her affidavit Ex.CW1/A and documents Ex.C1 to Ex.C10 and closed the evidence on 14.11.2018.

4.             On the other hand, OPs tendered into evidence affidavit of Karun Batta Ex.OP1/A and documents Ex.OP1 to Ex.OP4 and closed the evidence on 28.01.2019.

5.             We have appraised the evidence on record, the material circumstances of the case and the arguments advanced by the learned counsel for the parties.   

6.             The case of the complainant is that husband of the complainant had taken an insurance policy naming SUD Life Aayushmaan Non Linked Deferred Participating Plan (UIN-142N050V01), vide policy no.00980625 from OP. The sum assured was Rs.6,20,000/-, commencing from 29.06.2016 as per his policy in case of Death, sum assured is (6,20,000x150%) i.e. Rs.9.30,000/- plus other benefits and the complainant’s husband paid Rs.23,444/- as premium for abovesaid policy which was accepted by OPs. The husband of the complainant died on 02.09.2016 due to heart attack. The complainant being a nominee lodged death claim with OPs but till today death claim of the complainant has not been paid by OPs nor has any acceptance or denial of the claim been informed to the complainant. The claim of the complainant was repudiated by the OPs on the ground that the insured did not disclose the previously policy. The complainant relied upon the judgments of Hon’ble National Commission in case Aviva Life Insurance Co. Ltd. & Others Versus Rekhaben Ramjibhai Parmer decided on 12.04.2017.

7.             On the other hand, the case of the OPs is that Deceased Life Insured (DLI) after completing understanding the terms and conditions of the product ‘SUD Life Aayushmaan submitted a duly signed proposal form dated 27.06.2016. On the basis of information provided by the DLI in the proposal form and believing the same to be true and correct, the OPs issued the policy in question. The tenure of the policy was 20 years. DLI did not disclose the other insurance policy which was taken by him prior to taking the policy in question. Thus, DLI has violated the terms and conditions of the policy by concealing the previous policy. DLI had obtained a policy of insurance bearing no.5014456122 from Bharti Axa Life Insurance on 26.02.2016 for a sum cover of Rs.12 lakhs i.e. prior to submitting the proposal form with the OPs. So, the claim fo the complainant was rightly repudiated by the OPs.

8.             Admittedly, Deceased Life Insured (DLI) had taken a policy form OPs on 27.06.2016 and DLI paid annual premium of Rs.23,444/- against the sum assured of Rs.6,20,000/-. The premium paying tenure was 20 years and policy tenure was also 20 years. The complainant lodged her claim with the OPs alongwith relevant documents. Claim of the complainant was repudiated by the OPs on the ground that DLI Parveen Malik did not disclose the previous policy of insurance bearing no5014456122 from Bharti Axa Life Insurance on 26.02.2016 for a sum cover of Rs.12 lakhs i.e. prior to submitting the proposal form with the OPs and such DLI was having insurance to the tune of Rs.12 Lakhs. Thus, the DLI misrepresented before the OPs by suppressing the material facts and defrauded the OPs. The claim of the complainant was repudiated on 26.03.2017 on the ground of misrepresentation and suppression and concealment of the material facts.

9.             As per version of the OPs, the DLI Parveen Malik had taken life insurance policy on 26.02.2016 from Bharti Axa Life Insurance for a sum cover of Rs.12 lakhs. But no documents in this regard placed on the file by the OPs. The claim of the complainant cannot be repudiated on the score ground. The case law cited by the complainant is fully applicable to the present case. Thus, we are of the considered view that the acts of the OPS amounts to deficient in service while repudiating the claim of the complainant.

10.            Thus, as a sequel to above discussion, we allow the present complaint and direct the OPs to pay the sum assured to the complainant alongwith interest @ 9% per annum from the date of repudiation of the claim till its realization. We further direct the OP to pay Rs.25,000/-to the complainant for mental agony, harassment and towards litigation expenses. This order shall be complied with within 30 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 20.02.2019

                                                                        President,

                                                           District Consumer Disputes

                                                           Redressal Forum, Karnal.

 

 

                     (Vineet Kaushik)     (Dr. Rekha Chaudhary) 

                        Member                       Member