Haryana

Fatehabad

CC/160/2019

Sushila - Complainant(s)

Versus

Tata AIG Insurance - Opp.Party(s)

Sukhbir Dhaka

15 Nov 2023

ORDER

BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION FATEHABAD.

                                      Sh.Rajbir Singh, President.                                                         Dr.K.S.Nirania and Smt.Harisha Mehta, Members

 

                                                Complaint Case No.: 160 of 2019.

                                             Date of Institution:    11.04.2019

                                                        Date of order:            15.11.2023.      

 

Smt.Sushila wife of Rajpal son of Ram Kumar resident of Dhani Sanchla Tehsil Tohana District Fatehabad.

 

                                                                          ….. Complainant.

                                        

                                                      Versus   

 

 

1.Tata AIA Life Insurance Company Limited, Registered & Corporate Office: 14^th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai-400013 through its Chairman-cum-Managing Director.

 

2.Divisional/Branch Manager, Tata AIA Life Insurance Company Limited, PINo.23-25, 1^st & 2^nd Floor, Near Bharat Gas, Red Square Market, Delhi Road, Hisar-125001.

 

3.Indusind Bank, G.T.Road, Fatehabad through its Branch Manager.

 

 

….Opposite parties.

 

 

Complaint U/s 12 of the Consumer Protection Act, 1986

 

                                                                                

Present:          Sh. Sukhbir Dhaka, Advocate for the complainant.

                  Sh.Yogesh Gupta, Advocate for the opposite parties No.1 & 2.                  Sh.Amit Wadhera, Advocate for opposite party No.3.

 

 

ORDER

SH.RAJBIR SINGH, PRESIDENT

                   Brief facts of the present complaint are that husband of the complainant namely Sh.Raj Pal took an insurance policy No.C258042179, by making insurance premium of Rs.49115/-,  for sum assured of Rs.5,17,000/- from the Ops No.1 & 2 through the Op No.3;  that the life assured died on 10.06.2018 and the complainant lodged the claim with the OPs besides submitting all the requisite documents  to release the claim; that the Ops instead of making the payment of claim wrongly and illegally deposited the amount of Rs.49,115/- in the account of Raj Pal (life assured) after his death with a view to escape from their liability; that the complainant has requested the Ops besides serving of legal notice to release the claimed amount as per policy schedule  but to no effect; that the aforesaid acts of omission and commission on the part of the OPs amount to deficiency in service and unfair trade practice.. 

2.                On notice Ops appeared. Ops No.1 & 2 in  their joint reply have submitted that the present compliant is not maintainable as the policy in question was obtained after concealing the material facts; that it was the solemn duty of the life assured to disclose correct and material facts but he did not do so, therefore, the complainant is not entitled for the benefit arising out of the policy in question; that the replying Ops had issued the policy bearing No.C258042179 on dated 07.02.2018 and parallel had conducted post verification enquiry to ascertain the truthfulness of the disclosure as made by the life assured and found that the life assured was suffering from bad health, therefore, his policy was cancelled vide letter dated 18.07.2018 and the amount of Rs.49,115/- was refunded to him; that thereafter, no claim intimation has been given to the replying Ops and till date no death claim has been submitted by the complainant with the replying Ops. Other contentions have been controverted and in the end, a submission was made for dismissal of the complaint.

3.                Op No.3 in its separate reply has taken preliminary objections such as time barred, jurisdiction and concealment of material facts from this Commission etc. It has been further submitted that the role of replying Op is limited as of a corporate agent/facilitator and the policy in question was issued by Ops No.1 & 2, therefore, the present complaint is liable to be dismissed against the replying Op. Other contentions have been controverted and prayer for dismissal of the complaint has been made.

4.                The complainant has tendered in evidence her affidavit as Annexure CW1/A and documents Annexure C1, Annexure C2 and Ex.C1. On the other hand, the Ops have tendered into evidence affidavit of Sh.Harsimran Singh, Manager (Legal) as Annexure RW1/A and documents Annexure R1 to Annexure R3. Learned counsel for the OP No.3 closed the evidence on 14.08.2020.  

5.                We have heard learned counsel for the parties and with their kind assistance, the material available on the case file, have been perused and examined.

6.                It is not disputed that the husband of the complainant had obtained life insurance policy from Ops No.1 & 2 and regarding this premium amount of Rs.49,115/- was paid on 07.02.2018 (Annexure C1). It is established on the case file that the life assured died on 10.06.2018   (Annexure C2) during the subsistence of the policy which was valid up to 07.02.2039 (Annexure C1).  The fact regarding cancellation of the policy on 18.07.2018 as well as returning of premium amount of Rs.49115/- to the complainant/life assured is also not disputed.

7.                The Ops No.1 & 2 in their written statement have submitted that during investigation/inquiry it was found that the life assured had obtained the policy in question fraudulently by concealing the true health status at the time of filling of proposal form, therefore, the policy was cancelled and the premium amount was returned to the life assured on 18.07.2018. In support of this plea learned counsel for the Ops No.1 & 2 drew the attention of this Commission towards Investigation Report (Annexure R2) wherein it has been mentioned that During discreet checks at Sanchla, Fatehabad it was found that LA Rajpal s/o Ram Kumar has already died. He was suffering from Throat Cancer for last 1-1/2 years. He took treatment from Jaipur, Bikaner and Jindal Hospital villagers also informed that LA underwent operation in hospital in Hisar about 2-3 days before his death. He probably died in hospital or he might have died in the way back to his home. Some villagers also informed that he died at his home.

                   We have checked anganwadi records and anganwadi worker informed verbally that LA died on 11.06.2018.  There is variation of 3 years in age, income and occupation of LA. He was around 33 years of age as per his adhar card details however, he was 36 years of age as per his voter adhar card. Learned counsel for the Ops No.1 & 2 have also drew the attention of this Commission towards Annexure R3 wherein it has been mentioned that in view of significant medical non-disclosure the contract of insurance issued to you vide policy number C258042179 stands cancelled and made null and void since inception with refund of premiums.

8.                            The burden of proof was upon the OPs to prove that the insured was suffering from pre-existing diseases prior to taking the policy, but they have miserably failed to discharge this onus, by not leading any cogent and convincing evidence to prove the pleas mentioned in Investigation Report (Annexure R2). On this point, reliance can be taken from the case law titled as Bajaj Allianz Life Insurance Co. Ltd. & Ors. Vs. Raj Kumar III (2014) CPJ 221 (NC),  wherein it was held by the Hon'ble National Commission that usually, the authorized doctor of the Insurance Company examines the insured to assess the fitness and after complete satisfaction, the policy is issued. Thus, the repudiation of the claim on the ground of pre-existing disease was held to be invalid. After considering all the facts and going through the material available on the case file, we have no hitch to reach at a conclusion that the Ops No.1 & 2 are only trying to back out from the contract and it is a general observation that in a number of cases, the insurance companies are issuing policies basing on the statements made by the proposer in utmost good faith but when it comes to settlement of claims, they start examining the matter under the microscope.  The present case is squarely covered by the case law relied upon by learned counsel for the complainant. Moreover, the premium amount was returned after the death of the life assured on 18.07.2018. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation.  This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.  It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. Hence, the present compliant deserves acceptance against the Ops No.1 & 2/insurance company only. Since the premium amount of Rs.49,115/- has already been refunded, therefore, this amount is being deducted from the total sum assured i.e. Rs.5,17,000/-. (Rs.517000 – Rs.49115= Rs.467885/-)

9.                          Thus, as a sequel to our above discussion, we accept the present complaint and direct the Ops No.1 & 2/insurance company to pay Rs.467885/-  to the complainant alongwith interest @ 6% per annum from the date of filing of present complaint till actual realization. We also direct the Ops No.1 & 2/insurance company to further pay a sum of Rs.11,000/- for mental agony and harassment including litigation expenses to the complainant.  The order be complied within a period of 45 days from today.  The complaint against Op No.3 stands dismissed.

10.                        In default of compliance of this order, proceedings against respondents shall be initiated under Section 72 of Consumer Protection Act, 2019 as non-compliance of court order shall be punishable with imprisonment for a term which shall not be less than one month, but which may extend to three years, or with fine, which shall not be less than twenty five thousand rupees, but which may extend to one lakh rupees, or with both. A copy of this order be sent to the parties free of cost. This order be also uploaded forthwith on website of this Commission, as per rules, for perusal of parties herein. File be consigned to the record room after due compliance.     

Announced in open Commission.                                                            Dated: 15.11.2023

 

                                                                                                        

          (K.S.Nirania)                       (Harisha Mehta)                (Rajbir Singh)                              Member                               Member                                           President