IN THE CONSUMER DISPUTES REDRESSAL FORUM, KOLLAM
Dated this the 21st day of May 2018
Present: - Sri. E.M.Muhammed Ibrahim, B.A, LL.M. President
Sri. M.Praveen Kumar,Bsc, LL.B ,Member
CC.No.36/2018
Rosamma Helen : Complainant
W/o Late George Helen
Eben Ezer, Nethaji Nagar
Asramam P.O, Kollam-691002
[By Adv.K.Gopishkumar]
V/s
The Manager : Opposite party
Branch Office, HDFC Standard Life Insurance Co.
IInd Floor, A.Narayana Shopping Complex
Near Dhanya Theatre, Kadappakkada, Kollam.
ORDER
E.M.MUHAMMED IBRAHIM , President
This is a consumer complaint filed under Sec.12 of the Consumer Protection Act. The averments in the complaint in short are as follows.
The Manager of the HDFC Life Insurance Company approached her husband he was alive and persuaded him to take HDFC Life Insurance Policy by making him to believe that in case death occurred better benefits will be available and one member of the family will get pension under the insurance policy and by believing the words and deeds of the manager her husband on 08.06.15 taken the Policy No.11715334 from the opposite party HDFC Standard Life Insurance Company towards the premium of the above policy her late husband has paid Rs.2,50,000/- as 5 instalments of Rs.50,000/- each while working abroad. However her husband while working abroad become ill and was admitted at Atlas Hospital, Ghoubra on 31.08.14 and due to the gravity of the illness her husband became unconscious. Later he was brought to native
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place at Kollam on 29.12.16 and got admitted at the Benziger Hospital and discharged on 30.12.16. However on 08.01.17 he was again admitted at the same hospital and while under treatment he died on 14.01.14 due to heart attack. After remitting 5 instalments of the insurance policy her husband fell ill uprubtly and therefore he could not continue to remit the policy premium. Her husband returned to Kollam as he was referred to Benziger Hospital and while at the treatment of the said hospital he died. After the death of her husband the complainant on 30.04.17 approached the opposite party seeking to allow death benefit and other claims. But denied the claim by the claim review committee, Mumbai by stating the policy is not having paid up value and hence it has become lapsed. The claim review committee has sent a letter denying the claim benefit. But her husband who was lying in unconscious at Atlas Hospital, Muscat and Benzigar Hospital, Kollam and was under treatment at the ICU of the above hospitals. As per the undertaking of the manager of the opposite party hospital the complainant is entitled to get Rs.7,26,631/- and pension to herself. But the above claim has been illegally denied by the opposite party and their by committed deficiency in service and unfair trade practice. Hence the complaint. Though notice was served the opposite party has neither appeared nor contested the case. Hence the opposite party set exparte.
The complainant filed proof affidavit by re-iterating the averments in the complaint and also got marked Ext.A1 to A6 documents. Heard the complainant’s counsel and peruse the records.
The unchallenged averments in the pleadings and proof affidavit Ext.A1 to A6 documents would establish that there is clear unfair trade practice on the part of the opposite party HDFC Life Insurance Company would indicate that the opposite party manager has made the complainant’s husband to believe that after he joining the policy happen to die he will get heavy death benefit including the premium amount paid, bonus and its interest and one legal heir
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will get pension also by believing the above representation of the manager of the opposite party, the husband of the complainant had joined the policy and paid premium for 5 years @ Rs.50,000/- per annum and he could not continue to pay the premium as he was laid up due to serious illness and admitted at the ICU and while under treatment he died due to heart attack. In the circumstance the opposite party insurance company is bound to comply with the terms and stipulations made to the policy holder while he was alive and now they cannot turn round and say that the policy has lapsed without any paid up value before the death of the policy holder(life assured). The above denial of claim put forward by the wife of the deceased policy holder/life assured is definitely an unfair trade practice. Similarly the denial of claim amount made by the legal heir of the diseased policy holder amounts to deficiency in service on the part of the opposite party. The unchallenged averments in the affidavit coupled with Ext.A1 to A6 documents the complainant’s case stands proved. Therefore we hold that the complainant is entitled to get decree as prayed for.
In the result the complainant stands allowed in the following terms.
The opposite party is directed to pay Rs.7,26,631/- being the death benefits claim due to the legal heir of the policy holder along with interest @ 9% per annum from the date of rejecting the claim from the ie, 30.04.2017 till realization.
The opposite party is further directed to arrange pension as per the terms of the policy to the complainant who is the legal heir of the diseased policy holder Sri.George Helen. The opposite party is also directed to pay compensation to the tune of Rs.50,000/- to the complainant.
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If the opposite party fails to comply with the terms of the above order the complainant is entitled to realize the amount of Rs.7,76,663/- with interest @12% per annum from 30.04.2017 till realization along with costs Rs.5000/- from the opposite party and its assets.
Dictated to the Confidential Assistant Smt.Deepa.S transcribed and typed by her corrected by me and pronounced in the Open Forum on this the 21st day of May 2018.
E.M.Muhammed Ibrahim:Sd/-
M.Praveen Kumar:Sd/-
Forwarded/by Order
Senior superintendent
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INDEX
Witness Examined for the Complainant: Nil
Documents marked for the complainant
Ext.A1 : Claim review committee letter dated 30.04.2017
Ext.A2 : Copy of medical records
Ext.A3 : Copy of death certificate
Ext.A4 : Discharge summary of Benzigar Hospital
Ext.A5 : Copy of Policy details
Ext.A6 : Copy of letter dated 06.09.15
Witnesses examined for the opposite parties: Nil
Documents marked for the opposite parties: Nil
E.M.Muhammed Ibrahim:Sd/-
President
M.Praveen Kumar:Sd/-
Member
Forwarded/by Order
Senior superintendent
