BEFORE THE DIST. CONSUMERS DISPUTES REDRESSAL FORUM; DHARWAD.
DATE: 24th July 2015
PRESENT:
1) Shri B.H.Shreeharsha : President
2) Smt.M.Vijayalaxmi : Member
Complaint No.: 83/2015
Complainant/s:
Rakesh Hanchinal,
Age: 30 years, Occ: Employee, R/o. Plot No.17, Gadag Road, Tyothi Colony, Near Geet Mandir, Hubballi-20
(By Sri.V.G.Bhat, Adv.)
v/s
Respondent/s:
- The Ratnakar Bank Ltd., 1st Lane, Shahpuri Kolhapur, Maharashtra.
(By Sri.S.C.Jainar, Adv.)
- The HDFC Standard Life Insurance Co. Ltd., 13th Floor, Apoll Mills, Compound, N.M.Joshi Marga, Mahalaxmi, Mumbai – 11.
- The Manager, The HDFC Standard Life Insurance Co. Ltd., Vernekar Plaza, 3rd Floor, Deshapande Nagar, Hubballi – 29.
(By Sri.J.M.Patil, Adv.)
O R D E R
By: Shri. B.H.Shreeharsha : President.
1. The complainant has filed this complaint claiming for a direction to the respondents to pay in all Rs.2,35,640/- towards policy amount, mental agony, deficiency in service and cost of the proceedings and to grant such other reliefs.
Brief facts of the case are as under:
2. The case of the complainant is that, the mother of the complainant at the instance of respondent.1 obtained the policy of the respondent.2 through respondent.3 bearing no.16777460 by name HDFC Life Classic Assured Plus for assured sum of Rs.1,25,640/-. At the time of the proposal as well as prior to the proposal the mother of the complainant was hale and healthy and she was not suffering from any diseases. The respondents have issued the policy after ascertaining good health from the complainant’s mother as per Sec.3 of the Insurance Act. Accordingly as per Sec.3 of the Act the complainant’s mother had also revealed in detail with regard to the health condition. The mother of complainant i.e. insured died on 21.09.2014 at home due to heart attack. Subsequently the complainant came to know that his mother had obtained the policy and the complainant being nomtnated as nominee the complainant submits claim to have benefit under the policy on 01.10.2014 to the respondents. Accepting the claim the respondent through letter dtd.23.12.2014 undertakes to settle the claim within 14 days. As such complainant waited all along thinking that the respondents will settle the claim but not settled. Hence, complainant got issued legal notice on 27.01.2015. For the said notice neither replied nor complied. The act of respondents amount to deficiency in service as such the complainant filed the instant complaint praying for the relief as sought.
3. In response to the notice issued from this Forum the respondents appeared and filed the written version in detail.
4. While the respondent.1 admits written version stating that the answering respondent is only the corporate agent to HDFC Standard Life Insurance Co. Ltd. As a corporate agent of respondent.2 answering respondent explained in detail the benefits of the policy then only on the consent of the complainant’s mother only the respondent.2 issued the policy to the complainant’s mother with all details. While at the time of proposal the mother of complainant/insured ought to have give all details with regard to status of health and the facts known to her. The proposer ought to have to give all details regarding prior history with regard to the health. On the investigation by the respondent.2 and 3 it came out, the assured did not disclose previous condition of her health while obtaining the policy as such the respondent.2 and 3 have repudiated the claim. The complaint averments and allegations made against the respondent.1 are all denied. Further the answering respondent contended that when the proposer approached the respondent.1 and shown her intention to obtain the policy during that time the respondent.1 had revealed all the terms and conditions of the policy as such the respondent.1 has not committed any deficiency in service that apart respondent.1 is only a corporate agent no liability be fixed against the answering respondent and prays for dismissal of the complaint.
5. The respondent.2 & 3 also have filed separate written version contending that the complaint as brought is not maintainable, frivolous and prayed to dismissal of the complaint. Further taken contention that the assured at the time of proposal deliberately suppressed the facts and knowing well aware of the status of health intentionally did not revealed the same and obtained the policy in order to reap the fruits of the policy by furnishing false statement and by suppressing the sufferings and illness. Though it is stated in Clause.14 of the policy to furnish the real facts and also the facts all known to the proposer, the proposer intentionally suppressed the known facts and obtained the policy. Even for the questionnaire of the proposal form 30, 31, 32, 42 and 43 the assured answered “NO” instead of narrating the real facts & obtained the policy. Investigated medical records reveals the deceased assured was under medical treatment on 03.03.2014 at NIMHANS hospital Bangalore and the deceased was diagnosed suffering from L2 wedge compression. The death certificate issued by Tatwadarsha hospital Hubli noted cause of death of the life assured is due to motor neuron decease which has got nexus to the previous ailments which facts not been disclosed to the respondent insurance company by the insured while obtaining the policy. The sufferings of ill health by the insured was well known both to the complainant as well as his deceased insured mother. Hence, the respondent contended that on investigation of the death cause only and as the insured by suppressing the facts had obtained the policy the respondent company repudiated the claim on sound reasoning and for the reason for non disclosure of real facts. Hence, the respondents have not committed any deficiency in service as such complainant is not entitled for any relief under the policy nor the relief claimed in the complaint and prays for dismissal of the complaint.
6. On the said pleadings the following points have arisen for consideration:
- Whether complainant has proved that there was deficiency in service on the part of respondents ?
- Whether complainant is entitled to the relief as claimed ?
- To what relief the complainant is entitled ?
Both have filed sworn to evidence affidavit, relied on documents. Heard. Perused the records.
Finding on points is as under.
- Negative
- Negative
- As per order
Reasons
Points 1 and 2
7. On going through the pleadings & evidence coupled with documents of both the parties it is evident that there is no dispute with regard to the fact, that the complainant’s mother insured Smt.Yamunavva H.Hanchinal had obtained the policy from the respondent and the said policy was in force at the time of death of the insured.
8. Now the question to be determined is, whether repudiation of the claim amounts to deficiency in service, if so, for what relief the complainant is entitled.
9. On perusal of the documents relied it is evident that the date of proposal is 28.03.2014. The insured died on 21.09.2014. This being an earlier claim the respondent insurance company investigated with regard to the death of the insured and traced out the document Ex.R3 screening registration slip maintained by NIMHANS, Bangalore. As per the Ex.R3 it is evident that the assured had visited NIMHANS hospital for medical treatment on 03.03.2014. In the column of brief history in Ex.R3 it is noted back injury x dyeors – weakness of right lower limbs x 3 month, spine wedge compression of L2, Advise- refer to neuro surgeon. It is also mentioned in Ex.R3 that the insured was suffering from weakness of left foot from last 3 months. At the column summary and diagnosis at page.8 of Ex.R3 it is mentioned L2 Wedge compression #. In Tatwadarsha hospital case record dt.10.08.2014 in the diagnosis column cardiorespiratory arrest with septicemia. In the death certificate Ex.R4 issued by Tatwadarsha hospital the cause of death is mentioned – A) cardiorespiratory arrest, B) Septicemia with pneumonia, C) Motor neuron disease hypertension immediate cause of death.
10. As discussed supra date of proposal is dtd.28.03.2014 as per Ex.R1. Ex.R3 of NIMHANS hospital case sheet reveals the assured had approached the hospital prior to the proposal i.e. on 03.03.2014 and underwent medical checkup and diagnosed and sufferings were clearly mentioned. Ex.R4 death certificate corroborates the death of the deceased on 21.09.2014 is nexus with the sufferings which the insured was suffering prior to proposal as per Ex.R3.
11. With these background the learned counsel for respondent taken attention of the Forum to the policy schedule Ex.R2 particularly clause.14 incorrect information and non disclosure amounts to violation of terms and conditions and breach of contract as per Sec.45 of Insurance Act and not entitlement for the benefits under the policy. Highlighting these facts with above background the learned counsel for respondent also taken the Forum to the Ex.R1 to the personal details of life to be assured particularly to the column.30, 31, 33 and submits the proposer i.e insured knowingly well aware of the facts at the time of proposal suppressing the ill health answered to the above questionnaire “NO” & further submits in consonance of the proviso 14 of the schedule the suppression of facts amounts to breach of contract in accordance with the Sec.45 of the Insurance Act, 1938 and contended by submitting argument the respondents have justified in repudiating the claim and have not committed deficiency in service. The complainant in support of their contention did not placed any cogent evidence to corroborate the contention of deficiency in service by the respondents. So also the complainant did not adduce any rebuttal evidence to the evidence putforth by the respondent. As such the complainant failed to establish his case of deficiency in service against respondents accordingly complainant is not entitled for any benefits under the policy or reliefs as claimed. On the other hand the respondents have successfully justified in repudiating the claim.
12. In view of the above discussions we have arrived and proceed to held issue.1 and 2 in Negative.
13. Point.3: In view of the finding on points 1 and 2 proceeded to pass the following
Order
The complaint is dismissed. No order as to costs.
(Dictated to steno, transcribed by him and edited by us and pronounced in the open Forum on this day on 24th day of July 2015)
(Smt.M.Vijayalaxmi) (Sri.B.H.Shreeharsha)
Member President
Dist.Consumer Forum Dist.Consumer Forum
MSR
