Order by:
Sh.Amrinder Singh Sidhu, President
1. The complainant has filed the instant complaint under section 35 of the Consumer Protection Act, 2019 on the allegations that on the allurement of the officials of the Opposite Party, Smt.Sarabjeet Kaur mother of the complainant purchased policy bearing No.19596356 starting from 14.09.2017 from the Opposite Party and paid the first installment of Rs.85,000/- for a sum assured of Rs.10 lakhs and the duration of the policy was ten years. Further alleged that on 30.09.2017 said policy holder Sarabjeet Kaur died whereas the father of the complainant is also pre-deceased. Thereafter, the complainant being the nominee filed the claim with the Opposite Party for the claim amount and also completed all the formalities, but the Opposite Party has not made the claim amount, rather refused to admit the rightful claim of the complainant and hence, there is deficiency in service on the part of the Opposite Party. Vide instant complaint, the complainant has sought the following reliefs.
a) The Opposite Party may be directed to pay the sum of Rs.10 lakhs in respect of the policy in question alongwith interest and and also to pay Rs.50,000/- on account of compensation for causing her mental tension and harassment and also to pay Rs.11,000/- as litigation expenses or any other relief to which this District Consumer Commission may deem fit be also granted.
Hence, the Complainant has filed the present complaint for the redressal of her grievances.
2. Opposite Party-Insurance Company appeared through their counsel and contested the complaint by filing the written version taking preliminary objections therein inter alia that the present complaint is not maintainable and is liable to be dismissed as there is no deficiency in service on the part of the Opposite Party. The intricate questions of law and facts are involved in the present complaint which requires voluminous documents and evidence for determination which is not possible in summary procedure under the Act and the appropriate remedy, if any, lies only in the civil Court. The complainant has concealed material facts and documents from this District Consumer Commission and the policy was issued on the basis of proposal dated 14.09.2017 and the same was accepted based on the information provided in the proposal form. It has been alleged by the complainant that on 30.09.2017 the DLA Sarabjeet Kaur died at home due to sudden heart attack. The complainant being the nominee intimated the Opposite Party and applied for death claim on 07.06.2018. As it was an early death claim i.e. the DLA died within 15 days from the date of policy, the Opposite Party hired an investigation agency namely KLCR Investigations Private Limited to know about the past history of DLA and said agency submitted its report on 24.06.2018 from which it came to the notice of the Opposite Party that the DLA was suffering from diabetes from the last 6 years and her left leg was amputated in some hospital in April/May 2017 i.e before the issuance of the policy in question. Since the DLA made a false statement in the enrolment form, whereby she did not disclose the past history of herself. Since the DLA intentionally and wilfully did not disclose in the application about her past history. Had this information been provided to the Opposite Party at the time of applying for the insurance policy, hence, the Opposite Party declined the claim of the complainant. However, the Opposite Party processed an amount of Rs.81,370.24 paisa towards the refund of fund value payable under the above said policy and hence the claim of the complainant was rightly declined. On merits, the Opposite Party took up the same and similar pleas as taken by them in the preliminary objections and it was prayed that the complaint may be dismissed with costs.
3. In order to prove her case, the complainant has tendered into evidence the copies of documents Ex.C1 to Ex.C4, affidavit Ex.C5 and Ex. and closed the evidence on behalf of the complainant.
4. On the other hand, Opposite Party also tendered into evidence the affidavit of Sh.Arpit Higgins Ex.Ops1 alongwith copies of documents Ex.Ops2 to Ex.Ops9 and closed the evidence on behalf of Opposite Party- Insurance Company.
5. We have heard the ld.counsel for the parties and also gone through the documents placed on record.
6. During the course of arguments, ld.counsel for the Complainant as well as ld.counsel for Opposite Party have mainly reiterated the facts as narrated in the complaint as well as in the written statements respectively. We have perused the rival contentions of the parties and also gone through the record on file. The main contention of the complainant is after the death of DLA Sarabjeet Kaur, she lodged the death claim with the Opposite Party, but they refused to admit the rightful claim of the complainant without any reason. On the other hand, ld.counsel for the Opposite Party has repelled the aforesaid contention of the ld.counsel for the complainant on the ground that the policy was issued on the basis of proposal dated 14.09.2017 and the same was accepted based on the information provided in the proposal form. It has been alleged by the complainant that on 30.09.2017 the DLA Sarabjeet Kaur died at home due to sudden heart attack. The complainant being the nominee intimated the Opposite Party and applied for death claim on 07.06.2018. As it was an early death claim i.e. the DLA died within 15 days from the date of policy, the Opposite Party hired an investigation agency namely KLCR Investigations Private Limited to know about the past history of DLA and said agency submitted its report on 24.06.2018 from which it came to the notice of the Opposite Party that the DLA was suffering from diabetes from the last 6 years and her left leg was amputated in some hospital in April/May 2017 i.e before the issuance of the policy in question. Since the DLA made a false statement in the enrolment form, whereby she did not disclose the past history of herself. Since the DLA intentionally and wilfully did not disclose in the application about her past history. Had this information been provided to the Opposite Party at the time of applying for the insurance policy, hence, the Opposite Party declined the claim of the complainant. However, the Opposite Party processed an amount of Rs.81,370.24 paisa towards the refund of fund value payable under the above said policy and hence the claim of the complainant was rightly declined. In this regard, Hon’ble National Consumer Disputes Redressal Commission, New Delhi in Revision Petition No. 434 of 2017 titled as Shriram Life Insruance Company Limnited Vs. K.Viraja decided on 15th January, 2020 has held that the Insurance contracts are governed by the Principle of ‘UBERRIMA FIDE” and the proposer applying for insurance is expected to correctly furnish all the material information regarding his health, family history, personal medical history, income etc. Policyholder failed to disclose his pre-proposal health ailment of hypertension. According, the State Commission Order was set aside and the complaint dismissed. Furthermore, Hon’ble Supreme Court of India in Civil Appeal No.8701 of 1997 decided on 02.11.1999 titled as Ravneet Singh Bagga Vs. M/s.KLM Royal Dutch Airlines has held that a Bonafide decision in good faith and a bona fide dispute is not covered within the term of ‘deficiency in service and only inefficiency, lack of due c are, absence of bona fide, rashness, haste or omission like acts on the part of the agency rendering services under a contract may be held guilty of deficiency in rendering service. Further Section 45 of the Insurance Act permits an insurer to cancel a life insurance policy in case a material concealment is made even if it does not amount to fraud. Moreover, the Opposite Party has already processed an amount of Rs.81,370.24 paisa towards the refund of fund value payable under the above said policy and at this stage, the complainant has no insurable interest with regard to the policy in question.
7. Keeping in view the aforesaid facts and circumstances and replying upon the judgements of Hon’ble Supreme Court of India as well as Hon’ble National Commission, New Delhi (supra), we are of the view that the complainant has failed to prove any deficiency in service on the part of the Opposite Parties.
8. In view of the above discussions, there is no merit in the complaint and the same stands dismissed. Keeping in view the aforesaid facts and circumstances, the parties are left to bear their own costs. Copies of the order be furnished to the parties free of cost. File be consigned to record room after compliance.
9. Reason for delay in deciding the complaint.
This complaint could not be decided within the prescribed period because the State Government has not appointed any of the Whole Time Members in this Commission for about 3 years i.e. w.e.f. 15.09.2018 till 27.08.2021 as well as due to pandemic of COVID-19.
Announced in Open Commission.
