State Consumer Disputes Redressal Commission
Gurinder Singh vs Dhfl Pramerica Lic on 20 February, 2018
2nd Additional Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH
First Appeal No. 172 of 2017
Date of Institution : 14.03.2017
Date of Reserve : 24.01.2018
Date of Decision : 20.02.2018
Gurinder Singh son of Heera Singh, resident of House No. 188,
Village Dhunn, Tehsil Patti, District Tarn Taran.
....Appellant/Complainant
Versus
1. DHFL Pramerica Life Insurance Company Limited through
its Authorized Signatory, SCO-128, Nagpal Tower-2, B-Block,
Ranjit Avenue, Amritsar.
2. DHFL Pramerica Life Insurance Company Limited through
its Executive Vice President/Authorized Signatory, Registered
Office, DLF Centre, Sansad Marg, New Delhi - 110001.
3. DHFL Pramerica Life Insurance Company Limited through
its Authorized Signatory, Office at 4th Floor, Building No. 9-B,
Cyber City, DLF City, Phase III, Gurgaon, Haryana 122 002.
....Respondents/Ops
First Appeal against the order dated
7.2.2017 of the District Consumer
Disputes Redressal Forum, Tarn Taran.
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member.
Shri Rajinder Kumar Goyal, Member
Present:-
For the appellant : Sh. Amit Arora, Advocate
For the respondents : Sh. Parmal Singh, Advocate for
Sh. Karan Nehra, Advocate
First Appeal No. 172 of 2017 2
GURCHARAN SINGH SARAN, PRESIDING JUDICIAL MEMBER
ORDER
The appellant/complainant (hereinafter referred as complainant) has filed the present appeal against the order dated 7.2.2017 passed in consumer complaint No.9 dated 1.2.2016 by the District Consumer Disputes Redressal Forum, Tarn Taran (hereinafter referred as the District Forum) vide which the complaint filed by the complainant was dismissed.
2. Complaint was filed by the complainant under Sections 11, 12 & 13 of the Consumer Protection Act, 1986 (in short 'the Act') against the respondents/opposite parties (hereinafter referred as Ops) on the averments that mother of the complainant-Gurinder Singh, namely, Balwinder Kaur had taken a policy of the Ops bearing No. 000269527 with date of commencement 9.10.2013 with an annual premium of Rs. 25,000/- and death benefit minimum sum assured of Rs. 5 Lacs and complainant was appointed as a nominee of the policy. However, Balwinder Kaur (hereinafter referred as DLA) died a natural death on 25.1.2014. Complainant lodged the claim with the Ops and had given the information required with regard to the death of DLA Balwinder Kaur. However, the Ops in an arbitrary manner repudiated the claim vide order dated 29.7.2014 on the basis of incomplete, false and self interpreted medical record and refunded the premium of Rs. 21,573.95p to the complainant. Alleging deficiency in service on the part of Ops, complaint was filed by the complainant seeking First Appeal No. 172 of 2017 3 directions against the Ops to pay sum assured of Rs. 5 Lacs, Rs. 20,000/- on account of compensation and on account of mental and physical harassment and Rs. 10,000/- as litigation expenses.
3. Upon notice, Ops appeared and filed their written reply through their Authorized Signatory taking preliminary objections that the complaint is false, malicious, incorrect and malafide, which is just an abuse of process of law; there is no consumer dispute between the parties as there is no deficiency in services on the part of Ops. Before taking the policy, the DLA had submitted the proposal form and gave declaration on page No. 2 of the proposal form admitting the contents of the proposal form to be correct. Based upon the proposal form, the policy in question was issued in the name of DLA. After receipt of the notice of the claim, as it was early death, during investigation it was revealed that DLA suppressed the material information from the Ops in the proposal form. In fact before getting the policy, she was suffering from malignant ovarian tumour and had taken the treatment from Mahajan Hospital, Amritsar. Therefore, the DLA had violated the principle of uberimma fides by not disclosing the true facts at the time of taking the policy, therefore, the claim was rightly repudiated by the Ops vide their letter dated 29.7.2014. In the complaint filed before Ombudsman, Ombudsman vide its order dated 19.6.2014 had also dismissed the complaint of the complainant; in the case of mis-representation, Ops reserves the right to repudiate the claim in view of the judgment of the Hon'ble Supreme Court in "Satwant Kaur Sandhu v. New India Assurance Company Ltd.", First Appeal No. 172 of 2017 4 (2009) 8 SCC 316 and some other judgments were also referred. On merits, issuance of the policy and the sum insured is a matter of record. After death of the DLA, claim was received but it was rejected in view of the averments made in the preliminary objections. There is no deficiency in services on the part of Ops. Complaint is without merit, it be dismissed.
4. Before the District Forum, the parties were allowed to lead their respective evidence.
5. In support of his allegations, the complainant had tendered into evidence his affidavit Ex. C-1, affidavit of Kuldeep Singh Ex. C-2 and documents Exs. C-3 to C-12. On the other hand, Ops had tendered into evidence affidavit of Yogesh Rohilla Ex. Ops/1 and documents Exs. Ops/2 to 7.
6. After going through the allegations in the complaint, written version filed by the Ops, evidence and documents brought on the record, the learned District Forum vide impugned order dismissed the complaint.
7. Aggrieved with the order passed by the learned District Forum, the appellant/complainant has filed the present appeal.
8. We have heard the learned counsel for the parties and have carefully gone through the record of the case.
9. It has been argued by the counsel for the appellant the investigation report is Ex. Op-5 is their inhouse investigation and no medical record was placed on the record as part of the investigation. No report was proved by summoning any official/representative from the Mahajan Hospital, Amritsar and First Appeal No. 172 of 2017 5 similarly no official from Nijjar Lab & Diagnostic Centre was examined to prove the CT Scan report. Therefore, without any proper evidence on the record, the claim has been wrongly rejected by the Ops. The Ops have placed on the record their proposal form Ex. Op-2 in which there is no reference with regard to an pre-existing disease to the DLA at the time of filling the proposal form on 5.10.2013 and she has further made a declaration that the contents of the proposal form are correct. The counsel for the Ops has placed on the record the investigation report Ex. Ops-4. Alongwith documents from Mahajan Hospital was attached, it is dated 17.6.2013. Number of tests on that day in Mahajan Hospital, report of Navya Diagnostic Centre in which impression is that 'Moderate Exudative Ascites Cystic Mass in right side of pelvis, Ovarian Cystademoma with Mucinousiascitis', Nijjar Lab & Diagnostic Centre report dated 21.9.2012 in which it was mentioned features are suggestive of Malignant Ovarian Tumour, Advised Immunohistochemistry for confirmation and surgery was conducted in the Mahajan Hospital. In our order dated 8.1.2018, a plea was taken by the counsel for the appellant that she was never admitted in Mahajan Hospital, accordingly, complainant was directed to file an affidavit before this Commission that DLA was never admitted in hospital. Affidavit dated 23.1.2018 was filed by complainant Gurinder Singh s/o Heera Singh. In his affidavit, he has not denied that DLA was not admitted with Mahajan Hospital from 17.6.2013 to 21.6.2013 but has simply stated that Ops have failed to examine any doctor from First Appeal No. 172 of 2017 6 the said hospital. The proceedings before the Consumer Fora are summary in nature. Examination of every witness is not required. During the course of arguments, counsel for the appellant/complainant failed to rebut the judgments of the Hon'ble Supreme Court in "Satwant Kaur Sandhu v. New India Assurance Company Ltd.", (2009) 8 SCC 316, "P.C. Chacko and Another v. Chairman, Life Insurance Corporation of India and Others", (2008) 1 SCC 321 and Hon'ble National Commission in "Life Insurance Corporation of India Vs. Smt. Surekha Shankar Jadhav" in R.P. No. 2130 of 2017, decided on 31.7.2012 held that insurance company can repudiate the claim in case of non-disclosure of pre-existing disease or any material information and the same may or may not be the exact cause of death of the deceased life assured.
10. Whereas counsel for the complainant has referred to the judgment 2014(1) CPR 13 "ICICI Lombard General Insurance Co. versus Jasbir Singh" of Hon'ble National Commission. In that case, the insured was medically examined by the Medical Officer of the Insurance Company before issuing the insurance policy. It was only with regard to hyper tension. It was observed that diabetic and hyper tension are a life style disease and accordingly, the claim was allowed. But the counsel for the complainant has not been able to rebut the judgment of "Satwant Kaur Sandhu v. New India Assurance Company Ltd." (supra) and other judgments referred above wherein it has been specifically observed by the Hon'ble Supreme Court that in case of material First Appeal No. 172 of 2017 7 concealment, then Ops reserves the right to repudiate the claim. Certainly, judgment of the Hon'ble Supreme Court will prevail upon the judgments of Hon'ble National Commission. The same plea was taken by the District Forum that serious disease of malignant ovarian tumour has been concealed by the DLA and just after 3 months, she had died, which shows that the DLA was knowing about the dangerous disease to which she was suffering and with malafide intention, this policy was taken after concealing the material facts. Therefore, we are of the opinion that the claim was rightly repudiated by the insurance company. The order passed by the District Forum is justified.
11. Sequel to the above, we do not find any merit in the appeal and the same is dismissed with no order as to costs.
12. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
13. The counsel for the parties/parties are directed to collect free certified copy of the order from the office of the Commission within a period of 15 days from the date of pronouncement.
(GURCHARAN SINGH SARAN) PRESIDING JUDICIAL MEMBER (RAJINDER KUMAR GOYAL) MEMBER February 20, 2018.
as