State Consumer Disputes Redressal Commission
Jit Singh vs Hdfc Standard Lic Ltd. on 21 February, 2019
FIRST ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
Consumer Complaint No.946 of 2017
Date of Institution: 01.11.2017
Order reserved on: 14.02.2019
Date of Decision : 21.02.2019
Jit Singh son of Santokh Singh, aged 61 years, resident of no.338,
Model Town Road, Bharat Nagar, Ludhiana.
.....Complainant
Versus
1. HDFC Standard Life Insurance Company, SCO no.41, 3rd and
4th floor, Pakhowal Road, Feroze Gandhi Marg, Ludhiana-
141002, through its Authorized Signatory.
2. HDFC Standard Life Insurance Company Registered office
Lodha Excelus, 13th floor, Apollo Mills Compound, N.M. Joshi
Marg, Mahalakshmi, Mumbai-400021, through its Authorized
Signatory.
3. HDB Financial Services Ltd., New number 128/4F, Old number
53A, 4th Floor, Greams Road, M.N. Office Complex, Chennai-
600006, through its Authorized Signatory.
.....Opposite Parties
Complaint U/s 17(1)(a) of the Consumer
Protection Act, 1986 (as amended up to
date).
Quorum:-
Shri J. S. Klar, Presiding Judicial Member
Shri Rajinder Kumar Goyal, Member Present:-
For the complainant : Sh. Mukand Gupta, Advocate For opposite party nos.1&2: Sh. Nitin Thatai, Advocate For opposite party no.3 : Sh. Rahul Katoch, Advocate .................................................................................. J. S. KLAR, PRESIDING JUDICIAL MEMBER:-
The complainant has instituted this complaint U/s 17(1)(a) of the Consumer Protection Act 1986 (in short the "Act") against opposite parties (in short the 'OPs'). The round up of factual matrix in this case is that Harjinder Singh since deceased assured Consumer Complaint No.946 of 2017 2 took loan from OP no.3 HDB for running his business and the latter compelled him to insure the loan amount by purchasing life insurance policy from its sister concern HDFC Life Insurance Company. Harjinder Singh since deceased purchased one insurance policy called HDFC Life Group Protected Plus Insurance Plan bearing no.PP000001, UIN No.101N096V01, member no.13631, LAN account no.824645 from OP nos.1 and 2 for the sum insured of Rs.59,55,118/- for the period of five years w.e.f. 31.12.2014 to 30.12.2019 by paying premium of Rs.1,05,198/-. OP nos.1 and 2 had not issued any detailed terms and conditions of the policy to insured Harjinder Singh except the cover note and proceeded to receive premium from the above proposer. Harjinder Singh insured suddenly expired due to cardiac arrest on 23.07.2016 at the age of 52 years. The complainant is the brother of late Harjinder Singh and was his nominee in the life insurance policy as well. The complainant lodged the insurance claim with OP nos.1 and 2 on 03.08.2016 with regard to death claim of his brother and also intimated the insurance company about the death of insured, besides supplying all the required documents, as requisitioned by OP nos.1 and 2. He lodged claim no.PC016085 with them specifically stating that Harjinder Singh insured was not having any medical history and he died due to cardiac arrest all of a sudden. The attending doctor also stated the exact cause of death of insured Harjinder Singh deceased, as a case of cardiac arrest. The OPs have been unnecessarily harassing the complainant. The complainant submitted representations to OP Consumer Complaint No.946 of 2017 3 Insurance Company on 21.02.2017, 25.02.2017 and 08.03.2017 with the request to settle the claim and to pay insured amount to him. OP nos.1 and 2 suddenly issued letter dated 31.03.2017 to him stating that as per report given by investigator, deceased Harjinder Singh insured was suffering from acute pancreatitis and diabetes mellitus prior to issuance of life insurance policy to him. He was suffering from pre- existing diseases and concealed this material fact from the insurance company OP nos.1 and 2. The rejection of claim by OPs is alleged to be manipulated by complainant, as conveyed to him in letter dated 31.03.2017. The complainant is the only brother of deceased Harjinder Singh life assured and his nominee in the policy as well. The investigator wrongly stated that late Harjinder Singh was getting the treatment from CMC and DMC, whereas late Harjinder Singh insured had not received any such treatment from any hospital. The report of investigator is only anecdotal and conjectural in nature. He further averred that late Harjinder Singh also purchased life insurance policy of PNB Met Life, vide no.21186430 for sum insured of Rs.35,00,000/- and wife of Harjinder Singh was nominee therein. The claim was lodged by her with PNB Met Life Insurance Company after death of insured due to his cardiac arrest, which has been paid by the insurance company to the nominee of Harjinder Singh insured to the tune of Rs.35 Lakh and duly stood credited in the account of nominee of Harjinder Singh in the above policy. The complainant has, thus, prayed for below noted directions against OPs:-Consumer Complaint No.946 of 2017 4
(i) OPs be directed to pay the claim amount of Rs.59,55,118/- i.e. sum insured amount to him with interest @12% per annum from the date of death of assured till actual realization.
(ii) to pay compensation of Rs.10 Lakh on account of mental harassment.
(iii) to pay Rs.Two Lakh as litigation expenses.
2. Upon notice, OP nos.1 and 2 filed their joint written reply and contested the complaint of the complainant vehemently. Preliminary objections were raised by them that complaint is not maintainable, as it is based on misleading facts. The complaint is alleged to be without cause of action, being abuse of process of law only by OPs. It is denied that complainant is consumer of answering OPs. The complaint is related to commercial transaction entered into by diseased life assured Harjinder Singh (herein after referred as 'DLA'), who obtained loan of Rs.58,50,000/- in respect of his furniture business carrying out at Ludhiana. He got his life insured from answering OP under master policy bearing no.PP00001, membership no.13631. Since the basic transaction between DLA and OP no.3 bank pertained to financial transaction and policy was taken by DLA just to secure the said loan for commercial purposes, hence he is not consumer. It is further averred that answering OPs received application form dated 31.12.2014 from DLA at the instance of OP no.3 by signing proposal form and declaration and on going through its contents, which were duly explained to him and on the Consumer Complaint No.946 of 2017 5 basis of this information, OP Insurance Company issued members' certificate of insurance bearing no.824645 and member no.13631 to him for initial sum assured of Rs.59,55,118/- towards death in this case. The details provided by DLA, as fielded to him, to short medical questionnaire-health are as under:
1. Have you ever suffered of are Yes No currently suffering from (a) Chest pain or heart attack or any other heart disease (b) cancer, tumor growth or cyst or any kind (c) Stroke, paralysis, epilepsy any psychiartic/ mental disorder, disorder of brain/nervous system or any kind physical disability (d) Asthma, Tubercolosis or lung disorder (e) Disease or disorder of muscles, bones or joint, arthritis or blood disorder (Anemia) or any endocrine disorder (f) Disease of the Kidney, digestive system (stomach, pancreas, gall bladder, intestine) liver, hepatitis B or C or HIV/ AIDS infection (g) diabetes, high blood pressure.Consumer Complaint No.946 of 2017 6
2. During the last 5 years have Yes No you undergone any major √ surgery or been hospitalized for more than one week.
3. Do you take part in any Yes No adventurous sports or hobbies? √ (like paragliding, mountaineering, deep sea diving, motor racing, bungee jumping etc.)
4. Do you smoke more than 10 Yes No cigarettes a day? √
5. Has more than one of your Yes No close relatives died before the √ age of 60 years as a result of heart attack, stroke, cancer, diabetes?)
6. Are you taking any medication Yes No or has a doctor ever attended √ you for any conditions, diseases or impairment not mentioned above (except for cough for cold?) During processing of the death claim of DLA, it was established that he was suffering from Acute Pancreatitis and Diabetes Mellitus much prior to issuance of policy and he took treatment therefor at Consumer Complaint No.946 of 2017 7 Dayanand Medical College and Hospital, Ludhiana, vide C.R.no.109469 in Gastro Department vide Admn No.33505 and he also remained admitted in the above hospital for more than one week from 08.08.2014 to 16.08.2014 and DLA had not disclosed this material fact in his application for insurance. OP nos.1 and 2 further averred that he suppressed the material fact of his pre-existing ailment willingly by suppressing it from OP nos.1 and 2 thereby justifying the repudiation of the insurance claim by them. OP nos.1 and 2 denied any deficiency in service or unfair trade practice on their part. They alleged the complaint to be false and frivolous meriting dismissal on that ground. The case of the complainant was contested even on merits on the above referred grounds by answering OPs. OP nos.1 and 2 justified the repudiation of the contract of insurance on account of conduct of DLA in suppressing the material fact of his pre-existing disease fraudulently and hence prayed for dismissal of the complaint.
3. OP no.3 filed its separate written reply and contested the complaint of the complainant vehemently. Preliminary objections were raised by OP no.3 that complaint is not maintainable against it, as DLA took loan from it only and not the insurance policy. It is denied that complainant is consumer of OP no.3 with regard to insurance policy. No cause of action accrued against OP no.3 for filing of complaint by complainant. There is no privity of contract between complainant and OP no.3 and hence the complaint is not competent against it at all. Any deficiency in service on the part of Consumer Complaint No.946 of 2017 8 OP no.3 was vehemently denied. OP no.3 further averred in written reply on merits that DLA obtained financial assistance from it in the shape of loan for his furniture business. It is denied that OP no.3 compelled DLA to obtain the policy from OP nos.1 and 2, as there was no such condition for sanctioning the loan. OP no.3 controverted the averments of complainant on merits and prayed for dismissal of the complaint.
4. The complainant tendered in evidence his affidavit Ex.C-A with documents Ex.C-1 to Ex.C-14 and closed the evidence. As against it, OP nos.1 and 2 tendered in evidence affidavit of Gaurav Sikka, Deputy Manager (Legal) Ex.OP-A with documents Ex.OP-1 to Ex.OP-7 and closed the evidence. OP no.3 tendered in evidence affidavit of Amit Kumar Legal Officer of it and closed the evidence.
5. We have heard the learned counsel for the parties and have also appraised the evidence on the record. The incontrovertible facts in this case are that DLA, being brother of complainant Jit Singh, took loan from OP no.3 to run his business. He also purchased a life insurance policy from OP nos.1 and 2 being sister concern of OP no.3 at the insistence of OP no.3, the financer. He purchased life insurance policy for insured amount of Rs.59,55,118/- for five year duration period by paying premium of Rs.1,15,116.49. He appointed complainant Jit Sngh his brother as nominee therein. Ex.C-1 is the personal detail of DLA. Ex.C-2 is the copy of death certificate of Harjinder Sigh DLA showing his date of death as Consumer Complaint No.946 of 2017 9 23.07.2016. Ex.C-3 is the copy of group claim form (Non-employer- employee) submitted by complainant for claiming the insurance claim to OP nos.1 and 2 showing the cause of death of DLA as cardiac arrest. Ex.C-4 and C-6 are the copies of letters written by complainant to OP insurance company for payment of insurance claim. Ex.C-5 is the copy of letter by complainant to OP insurance company regarding giving certificate to the effect that DLA was not treated by any doctor for above diseases. Ex.C-7 is copy of repudiation letter to the effect that investigation at the instance of insurer established that life assured Harjinder Singh was suffering from Acute Pancreatitis and Diabetes Mellitus before issuance of policy and he concealed this material fact at the time for applying for policy and hence the claim cannot be allowed by the insurer. Ex.C-8 is the copy of confidential report of DLA on the record to the effect that he was down with illness and remained admitted at CMC and Hospital Ludhiana for treatment of diabetic and kidney problem. He took treatment from CMC & Hospital 5-6 years ago. Discrete inquiry was also conducted regarding the diseases of DLA to the effect that he was suffering from Acute Pancreatitis and Diabetes Mellitus and visited DMC & Hospital Ludhiana for treatment and remained admitted there more than one week before taking the policy. Ex.C-9 is the copy of letter by complainant to OP nos.1 and 2. Ex.C-10 is the copy of legal notice served upon OPs by complainant dated 17.07.2017 alongwith track consignment. Ex.C-11 is the copy of welcome letter issued by OP nos.1 and 2 to DLA. Ex.C-12 is the Consumer Complaint No.946 of 2017 10 copy of claim decision letter written by PNB Metlife to Mrs. Kuldeep Kaur wife of DLA for paying death claim of her husband Harjinder Singh to her. Ex.C-13 and C-14 are the copies of status report of policy no.172037680 of DLA issued by LIC. This is the only evidence of complainant.
6. As against it, OP nos.1 and 2 relied upon authority letter Ex.OP-1 authorising Gaurav Sikka to pursue the complaint. Ex.OP-2 is the copy of HDFC Life group credit project plus insurance plan Members information form dated 31.12.2014 in the name of Harjinder Singh DLA and he filled up the non medical cases form as well by giving the answers to the questionnaire regarding his health status in the negative. Ex.OP-3 is the copy of Member's Certificate of Insurance in the name of Harjinder Singh DLA for the sum insured of Rs.59,55,118/- for the period of five years from 31.12.2014 to 30.12.2019. Ex.OP-4 is the copy of letter regarding free look period option clause. Ex.OP-5 is the copy of confidential report of DLA Harjinder Singh. Ex.OP-6 (colly) is the photostat copy of discharge summary of Harjinder Singh issued by DMC & Hospital Ludhiana. Diagnosis of Harjinder Singh recorded in this discharge summary is Acute Pancreatitis and Diabetes Mellitus and his address is recorded in it as House no.45/8, Model Town Ludhiana Punjab and this address tallies with the address of DLA Harjinder Singh in his death certificate Ex.C-2. On the basis of reliance of OPs on this photostat copy of discharge summary of DMC hospital Ludhiana of Harjinder Singh, the case of OPs, as built up in this case is that life insured Consumer Complaint No.946 of 2017 11 Harjinder Singh concealed the material information regarding his state of health and supplied wrong information deliberately to the insurer leading it to accept proposal form in darkness. Ex.OP-7 is the copy of repudiation letter dated 31.03.2017.
7. The bone of contention between the parties in this case is whether Harjinder Singh DLA was already suffering from Acute Pancreatitis and Diabetes Mellitus and he willfully concealed this fact by suppressing it from OP nos.1 and 2 by supplying the wrong information at the time of taking the policy. The basis of reliance of OPs to repudiate the contract of insurance is the discharge summary record of DMC hospital Ludhiana of Harjinder Singh Ex.OP-6(colly). The counsel for complainant submitted that this record is forged document and hence no reliance can be placed on it by the Insurance Company. On the other hand, the counsel for insurance company argued that DMC and hospital is renowned medical institute at Ludhiana and there is no chance of this record being tampered with by it. To resolve this point of controversy, this Commission appointed Rohit Mittal Advocate as Local Commissioner on 30.11.2018 to examine the medical record of Harjinder Singh in the above hospital and he submitted his detailed report with regard to above record of Harjinder Singh at above hospital. As per his report, he met the concerned officials thereat. DMC & hospital authorities supplied copy of newspaper cutting, whereby public notice was given by above hospital that the record of the patients for the period from 01.01.2009 to 31.12.2009 in medico Consumer Complaint No.946 of 2017 12 legal cases and in other cases, records from 01.01.2011 to 31.12.2011 would be destroyed within a period of seven days, vide Annexure A. He further submitted that the list of patients, whose medical record has been destroyed by DMC & Hospital Ludhiana was supplied to him and the name of Harjinder Singh s/o Santkh Singh bearing CR no.109469 and Admn no.33505 with date of admission as 08.08.2011 is mentioned in it, vide annexure B on the record. He further submitted in his report to this Commission that he was handed over a diagnostic report confirming the aforesaid dates of admission and discharge vide Annexure-C. Annexure A cutting of newspaper has established this fact that above hospital's authorities destroyed the record after specified span after giving public notice to the concerned persons under rules. The list of patients whose record has been destroyed by the above hospital was supplied to Rohit Mittal Advocate (Local Commissioner) and name of Harjinder Singh S/o Santokh Singh has been recorded in it. Annexure C is the diagnostic details supplied to the Local Commissioner by Senior Medical Officer establishing that Harjinder Singh S/o Santokh Singh remained under consultancy of Dr. Sandeep Singh Sidhu from 08.08.2011 to 16.08.2011 thereat. The diagnostic detail is recorded as Acute Pancreatitis. The submission of counsel for complainant is that this document is tampered with, as some portion of it has been blacked out. The Local Commissioner Sh. Rohit Mittal has thrown light on it in his report by stating that the details of ailment regarding the said period between 08.08.2011 to 16.08.2011 were handed Consumer Complaint No.946 of 2017 13 over to him with diagnostic report confirming the date of discharge of the patient. Discharge summary Ex.OP-6 coupled with diagnostic report Annexure C of Harjinder Singh DLA finds support from the report of Local Commissioner. We find that the submission of complainant is that it is a fake medical record is without any substance. How, it could be a fake record when DMC & Hospital Ludhiana supplied the diagnostic details of the patient to Local Commissioner, whose record has been destroyed and Harjinder Singh's name has been mentioned therein. He has been recorded to be a patient of Acute Pancreatitis who remained under the consultation of Dr. S.S. Sidhu for the above referred period in the year 2011 in the above hospital. We dispel the contention of complainant that it is a forged record, which cannot be relied upon in this case, as emphasized by him.
8. The counsel for the complainant referred to law laid down by the Apex Court in "P. Vankat Naidu Vs. Life Insurance Corporation of India and another" 2011(4)CPJ-6, wherein it has been held that insurer did not produce any tangible evidence to prove that deceased withheld information about his hospitalization and treatment and it was for the insurance company to prove the allegations and order of the National Commission was set aside. Similarly, the complainant relied upon the judgment by the National Commission in case "Life Insurance Corporation of India & others Vs. Kunar Devi" IV(2008)CPJ-89(NC) to the effect that no document has been produced in support of allegations for Consumer Complaint No.946 of 2017 14 suppression of disease at the time of revival of the policy. History recorded in hospital's bed ticket, not to be treated as evidence as doctor, recording history, not examined. Suppression of disease not proved- Insurer held liable under policy. The complainant further referred to law laid down by the National Commission in "Sushil Kumar Jain Vs. United India Insurance Co. Limited" I(2012)CPJ- 204(NC) that insured unable to produce any credible evidence including documentary evidence or medical record to show that petitioner had been treated for any pre-existing disease and hence insurer was directed to pay the claim by the National Commission. Similarly, reference was made by complainant to law laid down by the National Commission in "Satinder Singh Vs. National Insurance Co. Limited" I(2011)CPJ-126 (NC). We find that the facts of the case in hand are different and the cited authorities would not be helpful to the complainant in this case. Even Local Commissioner has not found the record of DMC as fake. DMC & Hospital Ludhiana is renowned institute and there is no reason for it to prepare the fake medical record to help a person. Even the investigator, who was deputed to look into the matter by OPs on account of suspicious nature of the case submitted therein that access to the treatment record was not permitted by Dr. S.S. Sidhu, who was bent upon to favour the complainant. Affidavit of complainant Jit Singh and affidavit of Gaurav Sikka Deputy Manager (Legal) of OP Insurance Company have been duly considered by us. The OP submitted that as held by the National Commission in case Consumer Complaint No.946 of 2017 15 titled as "Birla Sun Life Insurance Company Limited Vs. Ronanki Rangarao" 2016(4)CPJ-640 that insured remained under treatment for carcinoma stomach and was operated prior to applying for policy. Fact of pre-existing disease not disclosed at the time of taking of insurance policy. The complainant produced no evidence in support of averments that medical record is fabricated and deceased was hale and hearty at the time of filling of proposal. Except the bald statement of complainant, there is no evidence aliunde on the record that the medical record was fabricated. Consequently, the claim was repudiated by the National Commission in the cited authority. The OPs further referred to laid down by National Commission in "LIC of India & others Vs. Anupama and others" 2012(2)CPJ-672 that medical records of deceased produced from Apollo Hospital indicated his treatment for his pre-existing disease of cirrhosis of liver caused by consumption of alcohol. Authenticity of hospital documents was proved by record keeper of Apollo Hospital before Fora below and insured suppressed the information about pre- existing disease in the proposal form and the National Commission held the repudiation justified. The counsel for OPs further relied upon law laid down in case "Kamoda Devi Vs. Life Insurance Corporation of India and another" 2012(1)CPJ-401 that in the absence of any proof in support of such mere allegations that medical record is forged by complainant, cannot be accepted.
9. In this view of the matter, we find that there is no reason for denying the medical record prepared by renowned medical Consumer Complaint No.946 of 2017 16 institute like DMC and Hospital Ludhiana. Even Sh. Rohit Mittal Advocate Local Commissioner found the record not forged and the record is maintained by the above hospital for a period of three year under Regulation 1.3.1 of Indian Medical Council (Professional Conduct and Ethics) Regulation 2002 and thereafter stands destroyed it. We find no illegality on the part of DMC and Hospital in destruction of record after prescribed period of three years under the above Regulation. Consequently, it cannot be said that the discharge summary record of Harjinder Singh DLA is fabricated one. The contention of complainant is without merit that identity of Harjinder Singh has not been established in this case on the point that above medical record of patient is of some other Harjinder Singh, as the address on Ex.OP-6 the medical record and death certificate Ex.C-2 produced by in his evidence is the same.
10. For the reason recorded above, we find that DLA Harjinder Singh concealed the material fact regarding his ailment at the time of filling up the proposal form, which was duly signed by him in English after reading the contents of the proposal, being literate person. Consequently, he suppressed the material information from insurer by wrongly stating his good state of health willfully. The contract of insurance is based upon principle of uberimma fides and the parties must not conceal any information before entering into contract from the other side. The contract of insurance obtained by DLA Harjinder Singh by means of misrepresentation is vitiated and it is not binding upon OP nos.1 and 2. OP nos.1 and 2 have, thus, Consumer Complaint No.946 of 2017 17 rightly repudiated the claim of complainant on account of suppression of material information knowingly by DLA with regard to his previous ailment in the proposal form, swaying the insurer to enter into contract with him.
11. As a result of our above discussion, we find no merit in the complaint and the same is hereby dismissed.
12. Arguments in this complaint were heard on 14.02.2019 and the order was reserved. The certified copies of the order be communicated to the parties, as per rules.
13. The complaint could not be decided within the statutory period due to heavy pendency of court cases.
(J. S. KLAR) PRESIDING JUDICIAL MEMBER (RAJINDER KUMAR GOYAL) MEMBER February 21, 2019.
(MM)