Chandigarh

DF-II

CC/262/2022

Kritagya Kumra - Complainant(s)

Versus

The Regional Manager, Canara HSBC OBC Life Insurance Co. Ltd. - Opp.Party(s)

Ripu Daman

09 Feb 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II,

U.T. CHANDIGARH

Consumer Complaint  No	:	262 of 2022
Date  of  Institution	:	17.03.2022
Date   of   Decision	:	09.02.2024

 

 

 

 

Kritagya Kumra son of Sh. Munish Kumra, R/O Kothi No 61, Hukam Singh Road, Amritsar - 1, Amritsar (Punjab).

Present Address:-

C/o Sunil Kumar, Kothi No 221 FF, Sector 40 A, Chandigarh, 160036 - UT.

….Complainant

Versus

1]  The Regional Manager, Canara HSBC OBC Life Insurance Co Ltd, SCO no. 3, First Floor, Madhya Marg, above State Bank of India, Sector 26, Chandigarh - 160019. (The Insurance Company).

2]  Chief Director, Canara HSBC Oriental Bank of Commerce Life Insurance Limited, R/o Unit No. 208, 2nd Floor Kanchenjunga building, 18 Barakhamba Road, New Delhi - 110001, India. Phone (The Insurance Company)

3]  Chief Operating Officer, Canara HSBC Oriental Bank of Commerce Life Insurance Company Limited, 4th Floor, SCO - 128, Nagpal Tower - 1, District Shopping Centre, Ranjit Avenue, Amritsar - 143001. (The Insurance Company)

4]  MD, Canara HSBC Oriental Bank of Commerce Life Insurance Company Limited, 4th Floor, SCO - 128, Nagpal Tower - 1, District Shopping Centre, Ranjit Avenue, Amritsar - 143001, through Auth. Signatory (The Insurance Company)

5]  Chief Manager, Canara Bank Nagpal Towers 1, SCO-128, Distt. Gave up a Shopping Centre, Ranjit Avenue Amritsar Punjab, 143001 {Given up vide order dated 04.05.2023}

6]  Chief Manager, Head office, Canara HSBC Oriental Bank of Commerce Life Insurance Limited, R/o Claim Unit, 2nd Floor, Orchid Business Park, Sector - 48, Sohan Road, Gurugram- 122018, Haryana, India.

7]  Chief Manager, HSBC Bank, R S Towers Hall Bazar, Amritsar, Punjab- 143001. (The Bank of Insurance Company) {Given up vide order dated 04.05.2023}

8]  Chief Manager, Oriental Bank of Commerce (Now known as PNB), Queens Road, Civil Lines, Amritsar, Punjab - 143001. (The Bank)

9]  Mr. Ajay Kumar, Insurance Sales Manager, Canara HSBC Oriental Bank of Commerce Life Insurance Limited, 4th Floor, SCO - 128, Nagpal Tower -1, District Shopping Centre, Ranjit Avenue, Amritsar 143001. (The Insurance Company).

10] M/s Canara HSBC Oriental Bank of Commerce Life Insurance Company Limited, 4th Floor, SCO - 128, Nagpal Tower - 1, District Shopping Centre, Ranjit Avenue, Amritsar - 143001, through its MD, Directors & Auth Signatory (The Insurance Company)

….. Opposite Parties

 

BEFORE:  MR.AMRINDER SINGH SIDHU,       PRESIDENT

        MR.B.M.SHARMA                 MEMBER

 

PRESENT:-    Sh.Sunil Mallan, Counsel for the complainant

              Sh.Alankrit Bhardwaj, Counsel for OPs No.1 to 4, 6,9, & 10

              OPs No.5 & 7 given up

             OP NO.8 exparte.

 

             

ORDER BY AMRINDER SINGH SIDHU, M.A (Eng.), LLM, PRESIDENT

         The complainant has filed the present complaint pleading that his mother namely Deepty (since deceased) and other family member were customers of OP Bank (Oriental Bank of Commerce now merged into Punjab National Bank).  It is stated that a team of said bank approached his mother-Deepty, during her life time, to purchase an insurance policy.  Accordingly she purchased a Policy bearing No.0098207812 – Plan Name – Canara HSBC Oriental Bank of Commerce Life Insurance Guaranteed Saving Plan having Policy Term of 15 years with maturity date as 30.9.2034 (Ann.C-1) from the OPs on 30.9.2019 by paying requisite premium thereof and the complainant is the nominee under said policy.  It is stated that the OPs issued the said policy to his mother Deepty only after verifying all her documents such as ID proof, bank details etc. It is submitted that unfortunately Mrs.Deepty, life assured, expired on 30.1.2021 during the policy period and as such, the complainant being nominee under the policy lodged claim with the OPs along with all requisite documents.  However, the OPs vide letter dated 27.3.2021 (Ann.C-3) rejected the claim stating that they are unable to establish the identity of late Mrs.Deepty and that the policy was solicited on fake identity. The complainant agitated the matter with the OPs and also sent legal notice (Ann.C-4) but they did not pay any heed.  Therefore, the present complaint has been filed alleging the said act & conduct of the OPs as well as repudiation of claim as deficiency in service and unfair trade practice, with a prayer to direct the OPs to pay full claim amount with all benefits along with interest as well as to pay compensation and litigation expense.

 

2]       After service of notice, the OPs NO.1 to 4, 6, 9 & 10 have put in appearance and filed their written version while admitting the factual matrix of the case stated that upon receipt of intimation of death of life assured and lodging of claim thereof, the Company investigated/evaluated the claim and noted significant discrepancy in the proposal form and allied documents showing that the life assured tried to misrepresent material information to the complainant. It is stated that the photograph provided at the time of proposal did not match with photograph in Aadhar Card of the life assured and accordingly, in view of the findings viz. Photograph Recognition Report and  Claim Investigation Report, the Company vide  its decision dated 27.3.2021 (Ann.R-4) communicated the ground for declining the claim under the policy. It is pleaded that the life assured misrepresented her identity to the company. It is pleaded that on the basis of findings of investigation, the Company rightfully repudiated the claim of the complainant. Denying all other allegations, lastly it is prayed that the complaint be dismissed with cost.

         The OPs No.5 & 7 were given-up vide order dated 04.05.2023.

         The OP No.8 did not turn up despite service of notice, hence it was proceeded against exparte vide order dated 01.12.2022.

 

3]      Replication has also been filed by the complainant controverting the assertions of the contesting OPs as made in their reply.

 

4]       Parties led evidence in support of their contentions.

 

5]       We have heard the ld.Counsel for the contesting parties and have gone through the documents on record including written submissions.

 

6]       The main question to be decided is whether there is deficiency in service or unfair trade practice on the part of the OPs in repudiating the claim of the complainant on the ground of alleged identity issue of deceased Life Assured - Mrs.Deepty or not ?

 

7]       To find out answer to this issue, it is important to take into consideration the following facts and circumstances of the present complaint:-

         The OPs have rejected the claim under the policy in question on the ground that the photographs of the life assured - Deepty as in the proposal form and Aadhar Card and other documents are not matching, raising suspicion about her identity issue, so the claim is not payable. 

8]       It is observed that the OPs have not disputed that the life assured Deepty was the customer of Oriental Insurance Bank. It is also observed that once the OPs had issued the policy in question to Life Assured Deepty through her bank after verifying all her details/credentials & identifications and received premium through her bank account so now they have no right or reason to raise doubt about her identity. It appears that OPs in order to deny the claim have raised such issue, which is not justified.   Therefore, it is held that the OPs have wrongly & illegally rejected the genuine claim under the policy in question, which amounts to deficiency in service as well as unfair trade practice.  However the OPs in their written version stated that they have refunded the total premium amount paid under the policy in question towards the specified ICICI Bank Account ending with xxxx3444 (Ann.R-3 Pg.52).

9]       It is important to mention here that the consumers rights as enshrined in Section 2 of the Consumer Protection Act 2019, the consumers has right to be informed about the quality, potency, purity, standard and price of the goods, products or services as the case may be so as to protect him from unfair trade practice.

         Definition of ‘unfair trade practice’ as defined under Section 2(47) of the Consumer Protection Act 2019 states as under:

(47) "unfair trade practice" means a trade practice which, for the purpose of promoting the sale, use or supply of any goods or for the provision of any service, adopts any unfair method or unfair or deceptive practice including any of the following practices, namely:—

(i)             making any statement, whether orally or in writing or by visible representation including by means of electronic record, which—

(a) to (c)   xxxxxx

(d)            represents that the goods or services have sponsorship, approval, performance, characteristics, accessories, uses or benefits which such goods or services do not have;

 

10]         In the present case, the OPs have raised suspicion over the identity of the life assured only after lodging of the claim, even after verifying her credentials at the time of issuance of policy and accepting premium. So it is a clear-cut case of unfair trade practice conducted by the OPs to make a wrongful loss to the complainant and wrongful gains to the OPs. Hence, the OPs are liable to pay the claim under the policy along with interest and compensation.

            In similar set of facts the Hon’ble Punjab & Haryana High Court in the case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-

“It seems that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy. The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich”.

11]      It is usual with the insurance company to show all types of green pastures to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation.  This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.  It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. The principle of law settled in the aforesaid judgments is squarely applicable to the facts and circumstances of the present case.

                The Hon'ble Supreme Court of India in Lucknow Development Authority Vs. M.K.Gupta, reported as III (1993) CPJ 7 (SC) observed as under:-

“To begin with the preamble of the Act, which can afford useful assistance to ascertain the legislative intention, it was enacted, 'to provide for the protection of the interest of consumers'. Use of the word 'protection' furnishes key to the minds of makers of the act. Various definitions and provisions which elaborately attempt to achieve this objective have to be construed in this light without departing from the settled view that a preamble cannot control otherwise plain meaning of a provision. In fact the law meets long felt necessity of protecting the common man from such wrongs for which the remedy under ordinary law for various reasons has become illusory. Various legislations and regulations permitting the State to intervene and protect interest of the consumers have become a haven for unscrupulous ones as the enforcement machinery either does not move or it moves ineffectively, inefficiently and for reasons which are not necessary to be stated. The importance of the Act lies in promoting welfare of the society by enabling the consumer to participate directly in the market economy. It attempts to remove the helplessness of a consumer which he faces against powerful business, described as, 'a network of rackets' or a society in which, 'producers have secured power' to 'rob the rest' and the might of public bodies which are degenerating into store house of inaction where papers do not move from one desk to another as a matter of duty and responsibility but for extraneous consideration leaving the common man helpless, bewildered and shocked. The malady is becoming so rampant, widespread and deep that the society instead of bothering, complaining and fighting for it, is accepting it as part of life. The enactment in these unbelievable yet harsh realities appears to be a silver lining, which may in course of time succeed in checking the rot.”

 

12]      As far as the Photograph Recognition Report – Expert Opinion submitted by the OPs as Ann.R-2 is concerned, it shows that the person who prepared & signed it i.e. Ankit Tripathi has not mentioned his qualifications anywhere in the report.  Further the said expert neither appeared to tender his evidence nor submitted his affidavit on oath before this Commission in support of his report and therefore, the complainant cannot be provided chance to cross-examine him. It is a settled law that an expert report is not per se admissible in evidence unless the same is proved in evidence as per the requirement of The Indian Evidence Act, 1872.  Hence this report cannot be considered.

 

13]      Similar is the position with Claim Investigation Report (Ann.R-4) which does not show as to who has prepared it, what qualification he/she is having, neither he/she appeared to depose nor affidavit on oath of said person has been submitted before this Commission.  Therefore, this report Ann.R-4 too cannot be considered.

 

14]      Taking into consideration the above discussion and findings, we are of the opinion that deficiency in service and unfair trade practice on the part of OPs No.1 to 4, 6, 9 & 10 has been proved. Therefore, the present complaint stands partly allowed with directions to the OPs No.1 to 4, 6, 9 & 10 (jointly & severally) as under:-

a)  To pay the balance sum assured amount of Rs.5,35,418/- due under the policy in question (i.e. Rs.7,42,168 minus Rs.2,06,750/- already refunded as two years premiums), to the complainant being nominee of life assured with other benefit attached to it along with interest @9% p.a. from the date of repudiation of claim i.e. 27.3.2021 (Ann.C-3) till its payment to the complainant.

b)  To pay Rs.30,000/- to the complainant as compensation on account of mental agony and physical harassment.

c) To pay Rs.20,000/- as costs of litigation.

         This order be complied with by the OPs No.1 to 4, 6, 9 & 10 jointly & severally, within 90 days from the date of receipt of its certified copy.

15]      The complaint qua other OPs stands dismissed.

16]      The pending application(s) if any, stands disposed of accordingly.

         The Office is directed to send certified copy of this order to the parties, free of cost, as per rules & law under The Consumer Protection Rules & Act accordingly. After compliance file be consigned to record room.     

Announced

09.02.2024                                                           Sd/-

 (AMRINDER SINGH SIDHU)

PRESIDENT

 

Sd/-

(B.M.SHARMA)

MEMBER