BEFORE THE DISTRICT CONSUMER

DISPUTES REDRESSAL FORUM, DHARWAD.

COMPLAINT NO.245/2016
 

Date: 14^th day of June, 2017

P r e  s e n t:    

                                                 Smt.C.H.SamiunnisaAbrar, B.A., LLB   :  President

Sri.B.S.Keri, B.A., LLB (Spl)                  :   Member

V/s

JUDGEMENT DELIVERED BY

SMT.C.H.SAMIUNNISA ABRAR, PRESIDENT:

The complainant has filed this Complaint against the Opposite Party (herein after referred in short as OP) u/s 12 of Consumer Protection Act, 1986 alleging deficiency in service against OP.

2.      It is submitted that the complainant’s husband by name Arjun Huligeppa Bovi had taken a policy by name MET FAMILY INCOME PROTECT PLKUS LIFE INSURANCE POLICY under policy No.21420614 with the OP’s.  The complainant further submits that the representative of the OP’s company had visited and explained the benefits of the policy and persuaded complainants husband to take up the policy, believing the words of the OP’s representative the complainant’s husband purchased the policy.

3.      Further, the Complainant submits that her husband late shri. Arjun Bovi is an illiterate had studied up-to 4^th standard and was unaware of worldly affairs and was almost illiterate who could not read and write except had learned to sign, as such the complainants husband was not explained all the terms and conditions of the OP’s, nor any question were asked to the deceased.

4.      The complainants submits that her husband after paying the 1^st premium towards the policy, which was duly accepted by the OP’s unfortunately, the husband of complainant Arjun Bovi died of heart attack on 10.02.2015. Complainant met the OP’s officials at Hubballi and requested to give the claim amount under the MET FAMILY INCOME PROTECT PLUS INSURANCE POLICY, the complainant was directed to submit original policy bond, original receipt of the 1st premium and other original documents.  The complainant had submitted the same to the respondent’s branch office at Hubballi.

5.      Further the complainant submits that on September 15, 2015 the complainant received a communication stating that the claim of the complainant was refused on the ground that the husband of the complainant had taken insurance policies with other insurance company prior to taking the policy from the OP’s and the complainant’s husband had not disclosed this fact in the proposal form. The complainant submits that the respondent agent was very well present at the time of taking the policy by the deceased and no such questions or clarification was sought by the respondents.  The deceased husband of complainant was illiterate had never filled up any form but he had only signed in the places shown by the representative of the OP representative. Hence rejection of the claim of the complainant is uncalled for and the OP’s are evading their liability under the policy on flimsy grounds.   Hence the complainant approached this forum and prayed to direct the respondents to pay the claim amount of Rs;9,10,000/- with cost  and interest  to the ends of just.

The predecessor on seat registered the Complaint and notices Ops. The Ops are appeared through counsel and filed their objection to the complaint as under;

Brief facts of the Written Version of OP NO: 1,2,3 & 4

6.      OP had denied all the allegations contained in the complaint, except those, which are specifically admitted hereinafter in this Written Statement or otherwise dealt with, and nothing stated in the complaint should be deemed to be admitted merely because the same is not specifically traversed.

7.      OP’s had referred the Judgment passed by the Hon’ble National Consumer Disputes Redressal Forum in the case of Dinesh Bhai Chandarana&Anr, v Life Insurance Corporation &Anr reported in III (2010) CPJ 358 (NC) wherein it was held that has held that non-disclosure of details of last policy by the deceased is a material fact and hence the Insurer was well within its right to repudiate the claim under the policy. It is submitted that in the present case the OP repudiated the claim of the Complainant for the reason that the DLI had concealed the fact with respect to his previous Insurance Policy. thus, the present Complaint is liable to be dismissed in view of the Law settled by the Hon’ble National Commission.

8.      Further the OP’s have stated that the averments made therein, are vague, baseless and with malafide intention. The complainant has made misconceived and baseless allegations of deficiency of services without any documentary evidence in support of his allegations made in the complaint. It is submitted that at page No.2 of the proposal Form there was a column wherein the DLI was required to provide the details of the previous Insurance Policies of the DLI. However, the DLI stated that there were no previous policies taken by him. That the said policy was issued by the OP relying upon the information provided in the proposal Form, regarding the various aspects including the personal, professional and other details.  Thus the DLI in this case had fully understood the terms and conditions of the policy and further agreed under the Agreement therein that if any untrue statement be contained in the application/Proposal Form, the Policy contract shall be null and void and the money which have paid in respect thereof shall stands forfeited to PNB MetLife. the above mentioned observations it clearly reflects that the deceased had willfully suppressed the material facts as the same was not disclosed by him in the Proposal Form at the time of availing the said Policy, the contract of insurance being of utmost good faith, insured was obliged to give full and correct information on all matters which would influence the Judgment of a prudent insurer in determining whether he will accept the risk, and if he would, at what rate of premium and subject to what conditions.

9.      It is submitted that the insurer, has to rely entirely on the information, which the proposer gives at the time of proposal.  If a material fact is suppressed, the insurer will be misled about the risk covered and hence the same will vitiate the contract.  The insurer will then be well within its right to treat the contract as void as per the terms and conditions of the policy document. Thus, any non-disclosure of material medical facts or misrepresentation in the proposal Forms would render the contract voidable at the option of the Insurer.  Thus, the Opposite Party has rightly repudiated the claim of the Complainant on the ground of suppression of material medical facts by the insured (deceased) at the time of filling up of the Proposal Form, based on which the said policy was issued by the Opposite party to him.  The said fact and grounds for repudiation was duly communicated by the Opposite party to Complainant vide its letter dated 30.06.2015.

10.    It is submitted that the deceased (insured) had previous Insurance Policies with other Companies amounting to a total sum of Rs.17.50 Lakh was a material fact for the OP, for arriving at a decision whether to issue the said policy or not and if yes, at what premium, etc. Thus, the insured by concealing the material facts with respect to the other insurance policies induced the Opposite party to issue the said Policy in his favour and hence, the Opposite Party rightfully repudiated the claim of the complaint.

Further the OP’s have prayed to dismiss the complaint with cost.

11.   In the background of the above said pleadings, the Complainant filed his affidavit and produced following EX C-1 to C-7. The documents produced are:

COMPLAINANT FILED DOCUMENTS AS follows

12.    On the other hand one Shri Raju Sharma Snr.Manager, Legal of PNB MET Life India Insurance Co., filed chief affidavit behalf of all the Ops and all the Xerox copy of the documents filed before the Forum at Annexure OP -1 to Op-4.

Heard argument on both the sides.  Now the points arises for consideration are;

1. Whether the OPs made un fair trade practice and deficiency in service?
2. Whether the complainant is entitle for relief?
3. What order?

Answer to the above points  as under;

1. Point No.1: Affirmative
2. Point No.2: Partly affirmative
3. Point No.3: As per the final order

                     REASONS

13.   Point No.1 &2: Since Point No.1 and 2 interlink and identical  we proceed both the points together for consideration.

14.   The complaints husband had availed a policy by name family income project plus life insurance policies from ops bearing policy number 21420614 through a representative of ops who had visited the insured, and explained the benefit of the policy and complainant’s husband agreed to buy the life insurance.

15.   The spouse of the complainant died on 10/02/2015. The complainant submitted the claim form with op’s, Op had repudiated the claim sating the reason that the insured had suppressed the material fact by not disclosing the previous policies availed by the insured from other insurance companies, in the proposal form.

16.   The op had not denied any averment made in the complaint expect that the deceased have suppressed the material facts that he had obtained life insurance policies from other insurance companies which had not been disclosed in the proposal from, the counsel for the complainant submits that the complainant is an uneducated, he does not know to read or write except he had learned to make his signature.

17.   The counsel for the complainant drawn our attention while arguing the matter that one of the authorized representative of op himself visited to the complainants husband and explained the benefits of policy, on believing the words of the representative of OP’s complainants spouse purchased a policy by paying the yearly premium of Rs.5,319.

18.   Generally the proposal form are filled by agents or representative of insurance company. In this case the deceased insured is an uneducated, there are no records on file to believe the words of submission made by the counsel of the OP, such being the facts the representative would have asked the details of previous policies but it shows that he would have missed out it inadvertently.

19.   We have gone through the documents on record but there is no documents to prove that the representative of op have readout or explained the terms and conditions of policy while taking the signature on the proposal form. Moreover the deceased (insured) was illiterate therefore we are of consideration that the op’s are vicariously liable for act of their representative However as per the records filed by the ops it reveals that complainant’s husband have already purchased other policies also. Hence the claim is settled on a non-stranded basis. Since complainant is entitled for partial relief. Hence we answer point no1 in affirmative. No 2 in partially affirmative.

20. Point No.3:- For the reasons and discussion made above and findings on the above points, we proceed to pass the following

-::Order::-

            1.      The complaint is partly allowed

2.      Ops are directed to settle the claim amount by paying  75% of maturity amount.

3.      Further ops are directed to pay Rs. 1000/-(Rupees One thousand only) towards litigation charges.

4.      Further ops are directed to comply this order within 45 days from the date of this order failing which ops are liable to pay an          interest @ 9% from the date of filing this complaint till realization.

            5.      Send a copy of this Order to both parties free of  

                    cost.