View 32914 Cases Against Life Insurance
View 32914 Cases Against Life Insurance
Mitanjali Sahu filed a consumer case on 30 May 2018 against The Branch Manager Claim Section HDFC Standard Life Insurance Co.Ltd. in the Jajapur Consumer Court. The case no is CC/37/2017 and the judgment uploaded on 30 May 2018.
IN THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, JAJPUR.
Present: 1.Shri Jiban ballav Das , President
2.Sri Pitabas Mohanty, Member,
3.Miss Smita Ray, Lady Member.
Dated the 30th day of May,2018.
C.C.Case No.37 of 2017
Mitanjali Sahu , W/O Late Pradeep ku.Sahu
Vill. Phajalpur , P.O/P.S. Korei
Dist.- Jajpur . …… ……....Complainant . .
(Versus)
1.The Branch Manager claim section H.D.F.C Standard Life Insurance Co.Ltd,
At/P.O.Jajpur Road , Dt.Jajpur
2.The Branch Manager, Standard Life Insurance Co.Ltd, Corporate Registered Office
Lodha Excelus,13 th floor,A poilo Mills Compound, N.M Joshi Marg,
Mahalaxmi ,Mumbai .
……………..Opp.Parties.
For the Complainant: Sri Umakanta Sahoo , Sammy Sahoo, Advocates ,
For the Opp.Parties : No.1 and 2 Sri B.K.Tripathy, S.Chakraborty,J.P.Mondal,, Advocates.
Date of order: 30 .05.2018.
SHRI JIBAN BALLAV DAS , PRESIDENT .
Deficiency in Insurance service is the grievance of the complaint.
The fact relevant as per complaint petition shortly are that the petitioner husband has opened a Insurance Policy bearing No. CPO00044 under the O.P namely HDFC Life Group Protect a sum assured value of Rs. one lakh towards death benefit which has been commenced of membership on 29.07.15 and terminal date is 28.7.18 . That while the policy was in force the policy holder namely Pradeep ku Sahoo died on 08.12.15 leaving his wife who is also nominee of the said policy .
That after death of policy holder the wife being the nominee of policy placed her claim in time with all required documents which was accepted by the O.P and finally the O.P in order to avoid liability issued a letter dt. 04.4.16 repudiating the claim stating that the life assured was suffering from chronic kidney disease, chronic liver disease with typell, diabetics mellifes much prior to getting policy which was not disclosed in the application form and declined in the application .
It is stated that the Insurance policy was opened when the policy holder was in healthy condition and after satisfying the same the policy was accepted and the husband of the complainant has paid premium regularly but in order to avoid the same the O.P declined the claim of the petitioner and finally the O.P as per letter dt. 04.04.16 and dt.30.12.2016 the claim of the petitioner has been denied . The O.Ps neglected to provide assistance as per insurance benefit for which the petitioner suffered mental agony and harassment and sustained damage of 1,30,000/- .Accordingly the petitioner knocked the door of this fora with the prayer to direct the O.Ps to pay Insurance amount of Rs. one lakh , cost Rs. 20,000/- for mental agony and Rs. 10,000/- for harassment totaling Rs 1,30,000/- along with bank interest .
The O.Ps after appearance through their learned advocate filed their written version taking the following stands :-
That the Hon’ble forum has no jurisdiction to entertain , try and adjudicate the claim . The complainant has raised issues , facts as well as law and it necessarily requires deposition of evidence and trials and can be appropriately done only by civil court . Hence the proper forum to agitate the grievance before the Civil Court . Therefore , the complaint is liable to be dismissed on this score alone .
1.That after accepting the above policy proposal the policy paper were dispatched to the customer, wherein terms and conditions of the policy are clearly stated. The mode ,method and frequency of payment of premium were clearly mentioned in the policy documents . In this case policy no. CPO00044 was issued to Mr Pradeep ku Sahoo who is one group term policy on the basis of duly signed form for the purchase of HDFC standard Life Group Credit Protect plan “ having single premium Rs.998/- for sum assured of Rs . one lakh .The commencement of policy was 29.07.15 . The members information Form ,LA has declared that he has read and understood the term and condition of the policy opted by signing the same . On the basis of the members information form and the document submitted by the petitioner, the O.P had accepted the proposal and issued the aforesaid policy. It is stated that the said policy question was done securing the two wheeler loan from HDFC Bank Ltd. It is further stated that in this kind of policy holder filed the Members information form , instead of proposal form . In members information Form, policy holder should answered “ short medical questioner about Health Details of member ,where the LA denied from any medical unfitness which was suppression of material facts .
It is submitted that the allegation made by the complainant is false and fabricated . It is submitted that after receiving the death intimation , the O.Ps received the claim documents from the petitioner and further requested to submit medical records and other relevant documents to proceed the process of claim of the petitioner on behalf of LA. It is stated that after going through all the documents it was observed from the medical report which was done by the petitioner at the time of treatment and suppressed that deceased LA was suffering from Chronic kidney Disease, chronic Liver Disease with Type of 11 , Diabetic mellitus much prior to the policy issuance which was not disclosed in declaration ( mandatory as per law ) at the time of purchase of the policy . In the fact and circumstances of the case , it is respectfully submitted that the Forum would be pleases to dismiss the instant case with exemplary cost .
On the date of hearing we heard the argument from the learned advocate of both the parties . After perusal of the record and documents in details we are inclined to decide the dispute as per our observation given below :-
1It is undisputed fact that the husband of the petitioner is a policy holder of the O.P and during enforcement of policy period the LA was died .
2. It is also undisputed fact that the O.Ps have repudiated the claim of the petitioner on the ground of suppression of material facts ( pre-existing disease and treatment ) . It is also a fact that as per broucher supplied by the O.Ps against the above Insurance policy such disease which are raised by the O.Ps are also cover under the policy . In such situation we are of considered view that the onus having lies with the O.Ps to prove the same by reliable cogent evidence that prior to submission of proposal form the DLA was suffering with pre existing ailment as per observation of appellate forum
2008(3)-CPR-53(Rajsthan) ( Mumini vrs L.I.C of India & Others)
2005(2) CPR-528-Odisha (D.M.L.I.C Vrs. Surendranath Samal )
2005-CTJ-1008-N.C(Surinder Kaurd & Others Vrs L.I.C of India )
AIR-1991-SC-392( LIC of India Vrs. Smt G.M.Chennabasemna )
In the present case the O.Ps have not filed any documentary evidence prior to accepting the proposal form , the O.Ps have examined the health of the petitioner . Accordingly we are inclined to follow the observation of Andhra Pradesh ,State Commission reported in 2014 (4) CLT-115-Hyderabad ( B.M L.I.C & Others Vrs. Pasupulet Bhagya Laxmi & Others) wherein it is held that
“ Insurance claim (life Repudiation on the ground that insured suppressed the material information with regard to health – Held - when the policy was issued by the Insurance company with utmost good faith, the same yardstick has to be applied while settling the claims also - The LIC ought to have made thorough enquiry, investigation or necessary medical health check – ups before issuance of policy irrespective of the amount involved- without doing so, when they have issued the policy, now they cannot turn round and contend that they need not pay any amount as there was suppression of material information with regard to his health - All these discreet enquiries, investigations and health check-ups etc. ought to have been made before issuance of the policy itself - Having issued the policy they cannot repudiate the claim on the ground or the other - The Insurance company failed to establish that the life assured had taken treatment prior to obtaining the policy as stated supra, nor could prove the nexus between the alleged treatment and the cause of death-Appeal dismissed.”
We have been observing that 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”.
In view of the above narrated analysis as well as owing to the above observations of Appellant Forums and in absence of any documentary proof, cogent and valid evidence regarding pre-existing ailment prior to submitting proposal form , it is crystal clear that the O.Ps. have issued the Insurance policy to the insured without medical examination at the time of accepting the proposal form and subsequently have repudiated the Insurance claim of the complainant on the pretext of pre-existing ailment which is only malafide ,arbitrary on the part of the O.Ps. and such plea /stand is not sustainable in the eye of law. Accordingly the interest of justice will be best served in case this dispute will be allowed in favour of the complainant.
Hence this order.
In the net result the dispute is allowed against the O.P. The o.ps are directed to pay the insurance claim of the petitioner Rs .one lakh within one month after receipt of this order ,failing which the ops are liable to pay 9% interest on the above awarded amount from the date of filing of the present dispute till its realization .
This order is pronounced in the open Forum on this the 30th day of May,2018. under my hand and seal of the Forum.
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