Haryana

Karnal

CC/128/2021

Yuvraj - Complainant(s)

Versus

The General Manager, Life Insurance Corporation Of India - Opp.Party(s)

Pardeep Singh

26 May 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                       Complaint No. 128 of 2021

                                                        Date of instt.26.02.2021

                                                        Date of Decision:26.05.2022

 

Yuvraj (minor) son of late Shri Manoj Kumar, resident of VPO Gonder, District Karnal, through her mother Reeta Devi being his natural guardian.

 

                                               …….Complainant.

                                              Versus

 

1.     The General Manager, Life Insurance Corporation of India, Branch office Bay shop 1-2, Sector 12, urban Estate, Karnal.

2.     The Divisional Manager, Life Insurance Corporation of India, Divisional Office P.O. Box no.106, Jeevan Parkash, Model Town, Karnal.

3.     The Zonal Manager, Life Insurance Corporation of India, Jeevan Bharti, Tower-II, 124, Cannaught Circus, P.B. no.630, New Delhi-110001.

                                                                      …..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary……Member

          

 Argued by: Shri S.S. Chauhan, counsel for the complainant.

                    Shri Charanjit Wadhwa, counsel for the OPs.

 

                    (Jaswant Singh President)

ORDER:   

                

                The complainant has filed the present complaint under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that the father of the complainant namely Shri Manoj Kumar (now deceased) during his life time had purchased a Life Insurance Policy bearing no.178173035. The details of policy is as under:-

Policy no.                                          178173035

Date of Commencement                     28.10.2017

Date of Maturity                                 28.10.2041

Plan and Policy Term                          833/24

Maturity Sum Assured                        Rs.2,50,000/-

Total Installment Premium                  Rs.5908/-

Due date of payment of                      28.04.2038

Last premium

Mode of payment of premium              Half Yearly

Nominee                                           Yuvraj (son)

 

During his life time the father of the complainant was depositing all premium installments regularly. The father of complainant was expired on 07.05.2020. After the death of his father, complainant being nominee of the aforesaid policy approached to OP no.1 and requested for disbursement of claim amount in his favour. The official of the OP no.1 had taken signature of mother of the complainant on some printed and blank papers and also received copies of relevant documents of policy as well as identification documents, treatment record, death certificate bank account details etc. and had assured to the complainant that the claim in respect of aforesaid policy would be disbursed in favour of the complainant and amount of claim would be credited in the bank account of guardian/mother of the complainant. After waiting sufficiency, when complainant neither received the claim amount in the bank account nor received any satisfactory response from OP no.1 then complainant again approached to OP no.1 number of times, but OP no.1 has not given any satisfactory response to the complainant and has not disburse the claim amount and started postponing the matter on one pretext or the other. Thereafter, complainant received a letter dated 01.10.2020 sent by OP no.2 through registered post, vide which OP no.2 has repudiated the claim of complainant and also forfeited the premium amount already deposited by father of the complainant during his life time, on the basis of false averments that aforesaid policy has not completed three years from the date of commencement of risk and OP no.2 has also alleged in this letter that deceased life assured was ill prior to insurance and was suffering from Tuberculosis for which he had consulted a medical man and had taken treatment in a hospital and the father of the complainant did not however disclose these facts in his proposal form. It is further averred that at the time of obtaining the policy the agent of the OPs had approached to the father of complainant and insisted him for getting said policy and at that time, father of complainant has not concealed any of fact from his including his treatment etc. and had given each and every answer of his quires in truthful manner. After getting verified all facts the agent of the OPs had told that there is no legal bar in issuance of insurance policy in  favour of father of the complainant and only then father of the complainant had given first premium amount. The agent of the OPS had also stated that the risk of said policy would be started from the first day of commencement of said policy. Thereafter, OP no.2 has sent a letter dated 04.01.2021, in which OP no.2 has mentioned that the decision of committee is final and it will not be possible for any of our offices review the claim in future. Then complainant sent a legal notice dated 15.02.2021 to the OPs but it also did not yield any result. In this way there is deficiency in service on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability; jurisdiction; mis-joinder and non-joinder of necessary parties and concealment of true and material facts. On merits, it is pleaded that the life assured/father of complainant Shri Manoj Kumar had purchased policy no.178173035 with date of commencement of 28.10.2017 for a sum assured of Rs.2,50,000/- under Plan/Term/ Premium paying term 833/24/21 (LIC’s Jeevan Lakhsay Plan) with half yearly premium of Rs.5908/- from Branch Office Karnal and nominated his minor son Shri Yuvraj as nominee and his mother Smt. Reeta Devi was appointed as his appointee. It is further pleaded that the death intimation and other claim forms and necessary papers have been submitted by Smt. Reeta Devi and as per the death certificate submitted by complainant the life assured Manoj Kumar died on 07.05.2020. It is denied that OPs have taken signatures of the mother of complainant on blank papers, rather she had not provided any information/documents regarding treatment taken by DLA and mentioned on form no.3784 (Treating Doctor’s Certificate) “Not gone to any Dr./Hospital”. In column no.5 and 6 form no.3783 she had not provided any information regarding treatment taken by deceased life assured. It is further pleaded that the date of commencement of risk was 28.10.2017 and life assured expired on 07.04.2020, hence the duration of policy was 2 years and 6 months 10 days. Since the aforesaid policy, has not completed three years from the date of commencement of risk i.e. 28.10.2017, which is early to date of death of life assured, the competent authority has examined the claim keeping in view the provision of Section 45 of Insurance Act 1938 and during investigation it was revealed that the deceased life assured was not having good health prior to taking the policy and suffering from Tuberculosis. Life assured did not disclose these facts in his proposal form and gave false answering therein. Hence, the claim of the complainant was repudiated with forfeiture of all the money received. 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.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of Reeta Devi Ex.CW1/A, copy of repudiation letter dated 01.10.2020 Ex.C1, copy of letter dated 04.01.2021 Ex.C2, copy of death certificate Ex.C3, copy of medical report Ex.C4, copy of insurance policy Ex.C5, copy of postal receipts Ex.C6 to Ex.C8, copy of legal notice Ex.C9 and closed the evidence on 11.08.2021 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Puneet Kumar Manager Ex.OP1/A, copy of proposal form Ex.OP1, copy of insurance policy Ex.OP2, copy of Tuberculosis Register Ex.OP3 to Ex.OP5, copy of repudiation letter Ex.OP6, copy of letter dated 04.01.2021 Ex.OP7, copy of letter dated 29.12.2020 Ex.OP8, copy of summary of case in appeal Ex.OP9, copy of form no.3816 Ex.OP10, copy of form no.3784 Ex.OP11 and closed the evidence on 05.04.2022 by suffering separate statement.

6.             We have heard the learned counsel of the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that life assured during his life time had purchased a Life Insurance Policy and deposited all premium installments regularly. The father of complainant was expired on 07.05.2020. After the death of his father, complainant being nominee approached to OP no.1 and requested for disbursement of claim amount in his favour. The official of the OP no.1 had assured to the complainant that the claim in respect of aforesaid policy would be disbursed in favour of the complainant but OPs failed to pay the claim amount and repudiated the claim of complainant on the false and frivolous ground. Hence prayed for allowing the complaint. Learned counsel for the complainant relied upon the judgment of Hon’ble Supreme Court in case titled as D.Srinivas Versus SBI Life Insurance Co. Ltd. and another 2018 (1) Law Herald (SC) 832; Life Insurance Corporation of India Versus Smt. Asha Goel in civil appeal nos.4186-87 of 1988 date of decision 13.12.2000 and The Chairman Life Insurance Versus Smt. Arati Bose in first appeal no.A/718/2016, decided on 31.01.2022 of Hon’ble State commission West Bengal.

8.             Learned counsel for OPs, while reiterating the contents of the written version, has vehemently argued the life assured had purchased policy no.178173035, for a sum assured of Rs.2,50,000/- and nominated the complainant as nominee. On receipt of death intimation, the competent authority has examined the claim and during investigation it was revealed that the deceased life assured was not having good health prior to taking the policy and suffering from Tuberculosis. Life assured did not disclose these facts in his proposal form. He further argued that the commencement of risk was 28.10.2017 and life assured expired on 07.04.2020, hence the duration of policy was 2 years and 6 months 10 days. Since the aforesaid policy, has not completed three years from the date of commencement of risk i.e. 28.10.2017, which is early to date of death of life assured, Thus, the claim of the complainant was rightly repudiated and prayed for dismissal of the complaint. Learned counsel for the OPs relied upon the judgment of Hon’ble Supreme Court in case titled as Bajaj Allianz Insurance Company Ltd. and others Vs. Dalbir Kaur in civil appeal no.3397 of 2020, decided on 09.10.2020 and  Life Insurance Corporation of India Vs. Shahida Khatoon and another 2014(1) CPC.

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, the deceased life assured had obtained life insurance policy from the OPs for  sum assured of Rs.2,50,000/-. The date of commencement was 28.10.2017 and date of maturity was 28.10.2041. Life assured had died on 07.05.2020, during the subsistence of the insurance policy.

11.           The complainant being nominee lodged the claim with the OPs, but the same was repudiated, vide letter Ex.OP6 dated 01.10.2020, on the ground that the deceased life assured has intentionally withheld correct information regarding his health in the proposal form and declaration and did not disclose about the ailments with which he was suffering from Tuberculosis prior to submission of the proposal form and the policy in question has not completed three years  from the date of commencement of risk i.e. 28.10.2017, which are early to date of death of life assured.

12.           The onus to prove its version was relied upon the OPs, but OPs have miserably failed to prove the same by leading any cogent and convincing evidence. The case of the OPs based upon the documents i.e. Tuberculosis Register Ex.OP3 to Ex.OP5. On perusal of the said documents, genuineness of the Tuberculosis Register is doubtful, in the said documents, nowhere has mentioned, the name and place of the hospital and name of doctor who treated/issued the said documents. Only mere entry in the alleged Tuberculosis Register cannot be considered as ground for the confirmation of the T.B. disease. When the said documents remain unproved, then the question of pre existence of disease does not arise at all. 

13.           OPs have also taken a plea that duration of the policy in question was two years six months and fourteen days only, and policy has not completed three years from the date of commencement of risk, which is early to date of death of life assured. In this regard OPs have miserably  failed to prove on record that life assured was suffering from any disease as alleged by the OPs and thus exclusion clause does not applicable.

14.            Further,  Hon’ble Punjab and Haryana High Court in case titled as New India Assurance Company Ltd. Versus Smt. Usha Yadav & others 2008 (3) RCR (Civil) 111, has held as under:-

                It seems that the Insurance Companies are only interested in earning the premiums which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance companies make the effected people to fight for getting their genuine claims. The Insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy.

15.           Keeping in view that the ratio of the law laid down in the aforesaid judgment and the facts and circumstances of the present complaint, we are of the considered view that the insurance company has failed to prove the allegations, on the basis of which they have repudiated the claim of the complainant. Thus, the act of the OPs while repudiating the claim of the complainant amounts to deficiency in service and unfair trade practice, which is otherwise proved genuine one.

16.           The authorities cited by the learned counsel for the complainant are fully applicable to the facts of the present case.

17.           As per insurance policy ExC5/Ex.OP2, the sum assured is Rs.2,50,000/-(Rs.Two lakhs fifty thousand only). Hence, the complainant is entitled for the said amount alongwith interest, compensation for mental harassment and litigation expenses etc.

18.           Thus, as a sequel to abovesaid discussion, we allow the present complaint and direct the OPs to pay Rs.2,50,000/- (Rs. two lakhs fifty thousand only) i.e. 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 OPs to pay Rs.20,000/- to the complainant on account of mental agony and harassment and Rs.11,000/- towards the litigation expenses.  This order shall be complied with within 45 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:26.05.2022.

                                                                       

                                                        President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.

 

 

       

                (Vineet Kaushik)        (Dr. Rekha Chaudhary)      

                      Member                        Member