State Consumer Disputes Redressal Commission
Hdfc Life Insurance Company Ltd. & Anr. vs Jaswinder Kaur on 22 May, 2024
STATE CONSUMER DISPUTES REDRESSAL COMMISSION
PUNJAB, DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
First Appeal No.761 of 2022
Date of Institution : 31.08.2022
Reserved on : 14.05.2024
Date of Decision : 22.05.2024
1. HDFC Life Insurance Co. Limited, SCO 149-151, Ground, First
and Second Floors, Sector 43-B, Chandigarh-160022, through
its Branch Manager.
2. HDFC Life Insurance Co. Limited, 12th Floor, Lodha Excelus,
Apollo Mills Compound, N.M. Joshi Marg, Maha Laxmi,
Mumbai, Maharashtra 400011, through its Branch Manager.
Presently filed through Sh. Arpit Higgins, Senior Manager-
Legal, HDFC Standard Life Insurance Company Limited, SCO
Nos.149 to 151, 1st & 2nd Floor, Sector 43-B, Chandigarh-
160022.
.....Appellants/Opposite Parties
Versus
Jaswinder Kaur wd/o Dharminder Singh, R/o Village Tahra, Post
Office Janwal, Tehsil Pathankot, District Pathankot PIN-145001.
.....Respondent/Complainant
Present:
For the Appellants : Ms. Monika Thatai, Advocate
For Respondent : Sh. Dinesh Mahajan, Advocate
Appeal has been filed under Section 41 of
Consumer Protection Act, 2019 for setting
aside the order dated 12.05.2022 passed
by the District Consumer Disputes
Redressal Commission, Gurdaspur in
C.C. No.157 of 2020.
2
First Appeal No.761 of 2022
AND
2) First Appeal No.784 of 2022
Date of Institution : 12.09.2022
Reserved on : 14.05.2024
Date of Decision : 22.05.2024
Jaswinder Kaur wd/o Dharminder Singh, R/o Village Tahra Post
Office Janwal, Tehsil Pathankot, District Pathankot PIN-145001.
.....Appellant/Complainant
Versus
1. HDFC Life Insurance Co. Limited, SCO 149-151, Ground, First
and Second Floors, Sector 43-B, Chandigarh-160022, through
its Branch Manager.
2. HDFC Life Insurance Co. Limited, 12th Floor, Lodha Excelus,
Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai,
Maharashtra 400011, through its Branch Manager, Mumbai,
Maharashtra.
.....Respondents/Opposite Parties
Appeal has been filed under Section 41 of
Consumer Protection Act, 2019 for grant
of interest, as the same has not been
granted vide order dated 12.05.2022
passed by the District Consumer Disputes
Redressal Commission, Gurdaspur in C.C.
No.157 of 2020.
Quorum:-
Hon'ble Mrs. Justice Daya Chaudhary, President
Ms. Simarjot Kaur, Member
Present:-
For the Appellant : Sh. Dinesh Mahajan, Advocate For the Respondents : Ms. Monika Thatai, Advocate 3 First Appeal No.761 of 2022
1) Whether Reporters of the Newspapers may be allowed to see the Judgment? Yes/No
2) To be referred to the Reporters or not? Yes/No
3) Whether judgment should be reported in the Digest? Yes/No JUSTICE DAYA CHAUDHARY, PRESIDENT:-
By this order of ours, two Appeals i.e. F.A. No.761 of 2022 titled as "HDFC Life Insurance Co. Limited & another Vs. Jaswinder Kaur" and F.A. No.784 of 2022 titled as "Jaswinder Kaur Vs. HDFC Life Insurance Co. Limited & another" shall be disposed off by this common order as both the said Appeals have been filed under Section 41 of the Consumer Protection Act, 2019 (in short the 'Act') against the order dated 12.05.2022 passed by the District Consumer Disputes Redressal Commission, Gurdaspur (in short the 'District Commission') in C.C. No.157 of 2020.
2. The facts are being extracted from F.A. No.761 of 2022 titled as "HDFC Life Insurance Co. Limited & another Vs. Jaswinder Kaur" which has been filed by the Appellants/OPs to challenge the order dated 12.05.2022 whereby the Complaint was partly allowed. F.A. No.784 of 2022 has been filed by the Appellant/Complainant for grant of interest on the awarded amount only as the same has not been granted by the District Commission despite prayer.
3. Briefly, the facts of the case of the Complainant as made out by the Complainant Jaswinder Kaur in the Complaint filed before 4 First Appeal No.761 of 2022 the District Commission are that she is widow of insured Dharminder Singh. Her husband Dharminder Singh had obtained Life Insurance Policy which was issued on 15.02.2017 with the sum assured of Rs.50,00,000/- with certain features. The sum assured was Rs.50,00,000/- which was payable on the death of life assured (policy holder). The Complainant was the nominee in the policy. Further it was mentioned that said Dharminder Singh was medically examined clinically and by conducting some others test by the medical team of the Hospital of the Insurer's choice. The health of the insured was found in order. The policy was accepted on 17.02.2017 by the OP. The medical tests were also conducted of the insured by the designated Medical Practitioner. However, the insured Dharminder Singh had expired on 28.12.2018. The claim was submitted by the nominee of the insured and the investigation was conducted by the OPs to settle the death claim. It was found in the investigation that it was a case of pre-existing disease and the claim was repudiated vide letter dated 14.03.2019. Said claim was not paid to the Complainant being the nominee of the insured. The Complaint was filed for paying the sum assured of Rs.50,00,000/- alongwith interest @9% per annum alongwith other amount towards compensation and litigation.
4. Upon issuing notice in the Complaint to the OPs, they appeared through their Counsel and filed the written reply wherein certain preliminary objections were raised. Further, it was mentioned that there was no cause of action in favour of the Complainant and the Complaint was bad for non-joinder of necessary party. Further it 5 First Appeal No.761 of 2022 was also mentioned that the insured had not disclosed all the material facts at the time of purchase of the policy. It was not a case of any 'deficiency in service' on the part of the OPs as policy was issued only on the basis of information so provided in the Proposal Form. Other averments made in the Complaint were also denied. Finally it was prayed that the Complaint be dismissed with cost.
5. Complainant in support of the averments as made in the Complaint and to prove her version had produced in evidence Ex.CW-1/A as declaration and the copies of documents Ex.C-1 and Ex.C-8.
6. Similarly, OPs in support of their version and the pleadings had produced on record self declaration of Legal Manager Sh. Gurpreet Singh Ex.OP1,2/1 alongwith the copies of documents Ex.OP1,2/2 to Ex.OP1,2/5.
7. By considering the averments made in the Complaint and reply thereto and also the evidence/documents so produced by both the parties and also on hearing the oral arguments raised from both the sides, the Complaint was partly allowed vide order dated 12.05.2022. The relevant portion as mentioned in para No.11 of the order is reproduced as under:-
"11. Finally, in the matter pertaining to the present Complaint and in the light of the all above, we set aside the OP's impugned repudiation of the death-claim being arbitrary (contra to laws of natural justice) and amounting to 'deficiency 6 First Appeal No.761 of 2022 in service'. Thus, we ORDER the OP insurers to pay the impugned 'insurance claim' to the full Sun Insured (S.I.) of Rs.50 Lac pertaining to the related Policy, in question, with full accrued benefits, if any, along with Rs.50,000/- as compensation for the undue harassment inflicted upon the widow Complainant besides Rs.10,000/- as cost of litigation within 45 days of receipt of the copy of these orders, otherwise the entire awarded amount shall attract interest @9% PA from the date of the orders till actually paid."
8. Being aggrieved by the order dated 12.05.2022 passed by the District Commission, the Appellants/OPs Insurance Company has filed the present Appeal No.761 of 2022 for setting aside the impugned order dated 12.05.2022 whereas the Respondent/Complainant has filed First Appeal No.784 of 2022 for grant of interest.
9. There was delay of 53 days in filing of the Appeal No.761 of 2022 filed by the OPs/Insurance Company. M.A. No.1181 of 2022 was filed for condonation of delay which was supported by an affidavit. Said Application was allowed and delay of 53 days in filing the Appeal was condoned vide order dated 05.09.2022. Said MA was disposed off accordingly.
10. There was delay of 59 days in filing of the Appeal No.784 of 2022 filed by the Complainant. M.A. No.1212 of 2022 was filed for condonation of delay which was supported by an affidavit. Said 7 First Appeal No.761 of 2022 Application was allowed and delay of 59 days in filing the Appeal was condoned vide order dated 14.09.2022. Said MA was disposed off accordingly.
11. Ms. Monika Thatai Advocate, learned counsel for the Appellants/Insurance Company has submitted that the District Commission while passing the impugned order had not appreciated the material facts and the circumstances in the right perspective and the order has been passed without any application of mind. Further it has been submitted that the findings have been recorded by the District Commission which are only on the basis of surmises and wrong reasons as certain material facts have not been appreciated. Learned Counsel has further submitted that the District Commission had failed to appreciate and consider the contents of Proposal Form and also the illustration and Addendum Form which was duly understood by the deceased life assured (DLA) in the language known to him and also after understanding all the terms and conditions of the policy, the online Proposal Form was signed by the Complainant. On the basis of information so furnished in the online Application, the Proposal Form was processed by the Appellant Company and thereafter policy was issued. The District Commission had failed to appreciate that in the said Proposal Form, the DLA had made a specific declaration that he had replied all the questions and had also made the statement in respect of the matter so desired. It was also mentioned that the insured had understood and agreed that the replies so given and the statement so made in the Proposal Form 8 First Appeal No.761 of 2022 and the documents submitted for processing of the Application was on the basis of Contract entered into both the parties. Further it has been submitted that it was clear from the declaration that the DLA was well aware about features of the plan including exclusions. It has also been submitted by the learned Counsel for the Appellant that the claim of the insured was got investigated from the Investigator and it was found that the DLA was suffering from Diabetes Mellitus, Chronic Renal Failure and Hypertension even much earlier to the issuance of the policy. Further it has been submitted that the DLA had suppressed certain material facts regarding his previous disease and had obtained the policy by suppressing certain material facts about medical history. In the Proposal Form, the Complainant had responded against the column by concealing certain material facts. All these factors have not been taken into consideration by the District Commission while passing the impugned order. Learned Counsel has relied upon judgments of cases of various courts i.e.
1. Manmohan Nanda Vs. United India Assurance Co. Ltd. &Anr., 2022 (1) CPJ 20 (SC), 2. Life Insurance Corporation of India Vs. Manish Gupta, 2019 (2) RCR (Civil) 906 (SC), 3. Maya Devi Vs. Life Insurance Corpn. of India, 2011 (3) CPJ (NC) 43, 4. Life Insurance Corporation of India Vs. Koshalya Devi, RP No.550 of 2015, decided on 29.11.2019 (NC) in support of her contentions.
12. Mr. Dinesh Mahajan Advocate, learned Counsel for the Respondent/Complainant has opposed the submissions made by the learned Counsel for the Appellants and has also submitted that the 9 First Appeal No.761 of 2022 order passed by the District Commission is based on proper appreciation of facts and evidence and detailed findings have been recorded by considering not only the facts but the evidence so produced by both the parties. However, in spite of specific prayer, no interest has been awarded for which the Respondent/Complainant had to file separate Appeal No.784 of 2022. Learned Counsel has relied upon judgments of cases i.e. 1. Sarbjit Singh Vs. State Bank of India and Anr., RP No.642 of 2017, decided on 04.12.2023 (NC), 2. New India Assurance Co. Ltd. Vs. ArunKrishanPuri, 2009 (3) CPJ 6 (NC),
3. New India Assurance Co. Ltd. Vs. B.Y.Srikanta, 2015 (4) CPJ 380, 4. Reliance Life Insurance Co. Ltd. &Anr. Vs. MarriSujata, 2020 DNJ 5 (NC), 5. Life Insurance Corporation of India Vs. Vidya Devi, 2010 (13) RCR (Civil) 92 in support of his contentions.
13. We have heard the oral arguments raised by learned Counsel for both the parties. We have also carefully perused the order dated 12.05.2022 passed by the District Commission and have gone through the judgments relied upon by learned Counsel for both the parties.
14. Undisputedly, the Complaint was filed by the Complainant before the District Commission which was partly allowed and thereafter both the parties have filed Appeals before this Commission. The Complainant has filed Appeal No.784 of 2022 for grant of interest as the same was not awarded by the District Commission inspite of specific prayer. Similarly the OPs, have challenged the order dated 12.05.2022 passed by the District 10 First Appeal No.761 of 2022 Commission mainly on the ground of pre-existing disease which had stated to be concealed by the DLA at the time of taking the policy.
15. As per the version of the Appellants/Insurance Company that on submission of death claim, the Appellants/Insurance Company got investigated the matter to settle the death claim. As per stand of the Insurance Company, there was existed pre-existing disease and the claim was repudiated on this ground vide letter dated 14.03.2019. Undisputedly, the sum assured was Rs.50,00,000/- in case of death of the life assured during subsistence of the policy. The claim was repudiated on the ground of pre-existing disease. It is not in dispute that the medical tests were conducted of the insured by conducting clinical and other tests by medical wing of the Hospital as per choice of the Insurer/Insurance Company. The following tests were got conducted by the Insurance Company of the insured :-
(i) Biochemistry, (ii) Urine Cotinine, (iii) Fasting Blood Sugar,
(iv) Complete Hemogram, (v) HIV I & II, (vi) HbAIC, (vii) Serum Liquid Profile, (viii) Medical Examination report Except the said tests, 11 tests were also conducted including Midstream Urine Analysis, HsbsAG Australia Antigen Test and Computerized Treadmill Test as is evident from Ex.C-3 and C-4. By considering the result of above said tests, the policy was issued on 17.02.2017. It is also not in dispute that the Insured had expired on 28.12.2018. Nothing has come on record that the death had occurred due to any ailment as it was a case of sudden death. The claim was 11 First Appeal No.761 of 2022 repudiated by the OPs by mentioning that it was a case of pre-
existing ailment and there was concealment on the part of the insured as the insured was stated to be suffering from Diabetes Mellitus, Hypertension and Chronic Liver Disease. The OPs Insurance Company has relied upon the documents issued by the Fortis Hospital. However the policy was issued on 15.02.2017 and the documents of the Fortis Hospital which were produced on record was of the period of August, 2017 i.e. after issuance of the policy. Meaning thereby, there was no ailment suffered by the DLA upto the period of issuance of the policy. Nothing has been mentioned in the arguments as to how medical record of the period subsequent to the issuance of the policy was relevant for repudiating the claim of the Claimant. Moreover, the above mentioned tests were conducted upon the DLA before issuance of the policy and only after conducting the entire body tests as desired by the Insurance Company the Application of the Insured was accepted on 17.02.20217 as is clear from letter of acceptance Ex.C-5. It is pertinent to mention here that the before taking the policy, the medical checkup of the insured was conducted and after his full satisfaction with the result of medical tests of the DLA, the policy was issued. The Hon'ble National Commission in case "Baja Allianz Life Insurace" (Supra) has held that when the insurer is satisfied by the result of medical tests at the time of issuing policy, the claim cannot be rejected later on the ground of non-disclosure.
12First Appeal No.761 of 2022
16. The Appellants had also investigated the matter at their own level and as per their own Investigator's report, it is apparent that Insured was stated to be fully fit and fine and never remained ill at any point of time. He was also never treated anywhere prior to his death. The relevant portion of said report of Investigator is reproduced as under:-
"During our investigation we searched in several hospitals nearby locality and after searching all records hospitals authority confirmed that no such admission available by the name of LA in hospital records."
Even thereafter, the claim was repudiated by the Insurance Company vide letter dated 14.03.2019. As per the version the Insurance Company, the claim was repudiated by the Insurance Company on the ground that the relevant questions regarding health were answered incorrectly. However, the Insurance Company has failed produce on record any document to show that the DLA was suffering from the ailments as alleged by the Insurance Company, as is clear from the above said report of the Investigator. As such the judgments relied upon by the Appellants/ Insurance Company are not applicable to the facts and circumstances of the case.
17. The Hon'ble National Commission in case Sarabjit Singh (Supra) while relying upon the judgment of the Hon'ble Supreme Court of case titled as "Satwant Kaur Sandhu Vs. New India Assurance Company Liited, Civil Appeal No.2776 of 2022, 13 First Appeal No.761 of 2022 decided on 10.07.2009 has held that "The respondents have failed to discharge the burden of proving willful concealment of material information by the DLA at the time of obtaining the policy and have failed to bring on record any evidence of the treating doctor byway of evidence or affidavit." The Hon'ble National Commission had allowed the Revision Petition filed by the Petitioner Sarabjit Singh.
18. The Hon'ble National Commission in case Arun Krishan Puri (Supra) had held that "Insurer is under onus to prove pre- existing disease at the time of taking of policy. Failure on part of Insurer to produce any evidence in support of concealment of pre- existing disease." The Hon'ble National Commission had dismissed the Revision Petition filed by the Insurance Company.
19. In case Marri Sujata (Supra) the Hon'ble National Commission had held that the petitioner had failed to establish that deceased had undergone treatment and it was held that the petitioners were not justified in repudiating the claim.
20. The Hon'ble Supreme Court of India in case "Mahakali Sujatha Vs. The Branch Manager, Future Generali India Life Insurance Company Limited" 2024(2)R.C.R.(Civil) 554 has held that "The cardinal principle of burden of proof in the law of evidence is that "he who asserts must prove", which means that if the respondents herein had asserted that the insured had taken fifteen more policies, then it was incumbent on them to prove this fact by leading necessary evidence. In the present case, no evidence has 14 First Appeal No.761 of 2022 been produced on record by the Appellants Insurance Company alongwith the concerned Doctor's affidavit to prove that before purchase of the policy, the DLA had been taking the treatment of any ailment/problem from any Hospital or Doctor and the DLA had the knowledge that he was suffering from said ailments. However, in absence of any such evidence, the claim was wrongly repudiated by the Insurance Company.
21. The Hon'ble National Commission in case titled as "PNB Metlife Insurance Company Limited Vs. Vinita Devi" 2019(1) C.P.J. 441 (NC) had held that burden to prove that the life assured was suffering from any pre-existing disease lies with the Insurance Company.
In the present case, the Appellants have failed to produce on record any authentic medical documents/treatment record alongwith any affidavit of concerned doctor or hospital to prove that the life assured had suffered such ailment at the time of taking the policy neither before the District Commission nor before this Commission.
22. In view of above detailed discussion and as per ratio of judgments of number of cases as mentioned above, we find no reason to interfere with the order passed by the District Commission and the Appeal No.761 of 2022 filed by the Appellants/OPs/Insurance Company being devoid of any merit is hereby dismissed.
15First Appeal No.761 of 2022
23. The Appellant had deposited an amount of Rs.25,69,328/- at the time of filing of the Appeal with this Commission. Said amount, alongwith interest which has accrued thereon, if any, shall be remitted by the Registry to the District Commission forthwith. The Respondent/Complainant may approach the District Commission for the release of the same and the District Commission may pass an appropriate order in this regard in accordance with law.
24. The Appellant/Complainant has filed First Appeal No.784 of 2022 for grant of interest on the awarded amount as the District Commission had not awarded any interest inspite of prayer.
25. We have gone through the record of the case carefully. The District Commission has held the OPs deficient in service and had set aside the order of repudiation but inspite of said observation, no interest had been awarded to the Complainant. No reasons have been recorded by the District Commission for not granting the interest. In our considered opinion, the Complainant is entitled interest on the awarded amount i.e. Rs.50,00,000/- from the date of repudiation till its actual payment. As such, First Appeal No.784 of 2022 filed by the Appellant/Complainant is allowed and the Respondents/Insurance Company are directed to pay interest @8% per annum on the awarded amount i.e. Rs.50,00,000/- from the date of its repudiation till actual payment. Accordingly, the order dated 12.05.2022 passed by the District Commission is modified to this 16 First Appeal No.761 of 2022 extent only and remaining part of the impugned order dated 12.05.2022 shall remain the same.
The Respondents/Insurance Company are also directed to comply the order within the period of 45 days from the date of receipt of the copy of this order, failing which, the OPs shall be liable to pay interest @18% per annum instead of 8% on the awarded amount from the date of repudiation till its realization.
26. Since the main cases are decided, the pending applications, if any, are also disposed of.
27. The appeals could not be decided within the stipulated period due to heavy pendency of Court cases and due to pandemic of Covid-19.
(JUSTICE DAYA CHAUDHARY) PRESIDENT (SIMARJOT KAUR) MEMBER May 22, 2024 (MM)