The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant against the Opposite Parties (hereinafter to be referred as OPs) with the averments that the husband of the complainant late Shri Ram Rattan was a policy holder of Ops, who had availed the services of the Ops for consideration. Mrs. Babli Vs MAX Life Insurance Company Limited etc.
2. It is further submitted that the authorized corporate agent of the Ops No.2 & 3 visited the house of the complainant and advised to the husband of the complainant to get insured his person and it will be for the interest and benefit of Sh.Ram Rattan. Therefore, husband of complainant Mr.ram Rattan gave consent to authorized corporate agent of the Ops No.2 & 3 i.e. OP No.1 who obtained the signatures of the husband of the complainant on various printed blank papers without making known the contents of the same and thereafter the Ops issued an insurance policy No.135868131 dated 31.3.2017 i.e. Max Life Monthly Income advantage Plan and the yearly premium for the above said policy was Rs.50,948.72p and the term for premium was 12 years and the maturity date of the policy was 31.3.2039. It was also agreed that the maturity benefit to the tune of Rs.6,49,000/- will be paid. It is also submitted that the life assured paid the premium till his death and the policy was issued on 06.04.2017. It is further submitted that when the proposal was accepted by the Ops, it had no right to repudiate the liability under the policy on the ground of non-disclosure of material fact. In fact, the agent of the Ops obtained the signatures of the husband of the complainant on various printed blank papers.
3. It is further submitted that the husband of the complainant died on 10.9.2017 and after death of her husband a death claim was preferred by the complainant to the Ops and all the relevant documents were submitted. However, the Ops repudiated the insurance claim of the complainant on frivolous and self imaginary objections on 25.12.2017. On account of the repudiation of the insurance claim the death benefits could not be released in Mrs. Babli Vs MAX Life Insurance Company Limited etc. favour of the complainant. The complainant has suffered humiliation physical harassment and mental agony on account of the above said Act by the Ops. The repudiation of the insurance claim of the complainant vide letter dated 25.12.2017 is totally illegal, arbitrary, against principles of natural justice and as such the same is liable to be set aside. It is further prayed that the Ops may be directed to release the amount of Rs.6,49,325/- alongwith interest and compensation etc.
4. On receiving notice, the OP No.1 appeared through its counsel and resisted the complaint by filing a written version wherein various preliminary objections with regard to maintainability, false and frivolous, cause of action, concealment of true and correct facts etc. have been raised.
5. In reply on merits, it is submitted that the complainant has no cause of action to file the present complaint against the answering OP as the answering OP is only a facilitator and the insurance claim has to be paid by the insurance company. The dispute regarding the payment of insurance claim is between the complainant and Ops No.2&3 and there is no privity of contract between the complainant and the answering OP. All the allegations levelled against the answering OP has been denied and it is further submitted that there is no deficiency on the part of the OP No.1 in rendering service to the complainant and as such the present complaint against OP No.1 is liable to be dismissed being devoid of any merit.
6. On receiving notice, the OP No.2 & 3 appeared through their counsel and resisted the complaint by filing a written version wherein various Mrs. Babli Vs MAX Life Insurance Company Limited etc. preliminary objections with regard to maintainability, cause of action, concealment of true and correct facts etc. have been raised.
7. In reply on merits, it is submitted that Late Shri Ram Rattan husband of the complainant obtained insurance policy in question. It is further submitted that after receiving the information regarding the death of the life assured the insurance claim was got investigated and medical documents were procured by the Investigator and as per the medical treatment record of the life assured, the life assured was suffering from DM with HCV related cirrhosis with PHTN with ascites, SMV Thrombosis and diabetic neuropathy since August 2015 which is prior to the signing of the proposal form. Therefore, it is evident that the life assured was suffering from pre existing illness which was concealed at the time of proposal. The life assured was diabetic patient and had kidney problem and was taking regular treatment in Malwa Hospital. Therefore, the repudiation of the insurance claim of the complainant by the Ops is perfectly in accordance with the terms and conditions of the insurance policy and the same is sustainable in the eyes of law. It is also submitted that the present complaint is without any merit and as such the same is liable to be dismissed.
8. The complainant tendered in evidence her affidavit Ex.CW1/A along with documents Ex.C-1 to Ex.C-5 and closed her evidence. On the other hand, the learned counsel for the OPs No.2 &3 tendered in evidence affidavit of Aanchal Yadav Manager, Max Life Insurance company ltd. as Ex.RW-1/A along with documents Ex.R-1 to Ex.R-18 and closed the evidence of the OPs No.2 & 3 and counsel for OP No.1 tendered in evidence affidavit of Sh. Amit Bhatia, Br. Mrs. Babli Vs MAX Life Insurance Company Limited etc. Manager, Axis Bank Ltd. Budha Khera Branch District Hisar as Ex.RW-2/A along with documents Ex.RW2/1 and Ex.RW2/2 and closed the evidence of the OP No.1.
9. We have gone through all the documents placed on record carefully and have also heard ld. counsel for both the parties.
10. It is not disputed that the insurance policy in question to late Sh.Ram Rattan husband of the complainant was issued by the Ops No.2 & 3 on 31.3.2017 for insured amount of Rs.6,49,000/- It is also not disputed that the complainant being wife of the life assured was nominated as nominee in the above said insurance policy. It is also not disputed that the life assured died during the validity period of the insurance policy. It is also not in dispute all the amount of premium had already been paid by the life assured to the insurance company till the date of his death. In the present case the insurance claim of the complainant has been repudiated by the insurance company vide letter dated 25.12.2017(Annexure C-4) on the ground that the life assured Sh.Ram Rattan was having a history of diabetes with hepatitis C Virus related cirrhosis with portal hypertension with ascities since 2015 which is prior to the signing of the proposal form. The above said material fact was concealed by the life assured at the time of filing of the proposal form.
11. In view of the letter dated 25.12.2017 the onus was upon the insurance company to prove that the life assured was suffering from the above mentioned disease prior to the filing of the proposal form. In support of the above said Mrs. Babli Vs MAX Life Insurance Company Limited etc. contention, the Ops have relied upon the document Ex.R-15 i.e. Discharge summary. A perusal of Ex.R-15 reveals that one Sh.Ram Rattan age 48 years was admitted in Dayanand Medical College & Hospital Ludhiana on 15.8.2015 and he was discharged on 24.8.2015. In the above said Discharge summary only the name of the patient as Ram Rattan aged 48 years has been mentioned. Father name and address of the patient has no where been mentioned. From the document Ex.R-15 it cannot be concluded that discharge summary Ex.R-15 pertains to the life assured in absence of his complete and proper address. Moreover in the year 2015 the age of the life assured was 53 years (As per the document placed on record he was born in the year 1962) whereas in the discharge summary Ex.R-15 the age of the patient has been shown as 48 years. Therefore, we are of the considered opinion that it cannot be conclusively said that the discharge summary Ex.R-15 pertains to the life assured. No other medical treatment history or any cogent or convincing evidence has been placed on record by the Insurance company to prove that the prior to the filing of the proposal form the life assured Sh.Ram Rattan was suffering from any illness.
12. In view of the aforesaid discussion, we are of the considered opinion that the repudiation of the insurance claim of the complainant in the present case is not sustainable in the eyes of law. Therefore, the repudiation of the insurance claim of the complainant by the insurance company is hereby set aside. The complainant has been able to prove deficiency on the part of the Ops in rendering service to him. The present complaint is accordingly allowed and the Ops are directed for making a payment of Rs.6,49,325/-(Six lakh forty nine thousand three hundred Mrs. Babli Vs MAX Life Insurance Company Limited etc. twenty five only) to the complainant. The OPs are further burdened with compensation/cost of litigation which we quantify at Rs.7000/- payable to the complainant. This order be complied with by the Ops within 45 days from the date of passing of this order. A copy of this order be supplied to both the parties free of costs. File be consigned to record room after due compliance. Announced in open court: Dated:04.09.2019 (Raghbir Singh), President, District Consumer Disputes Redressal Forum,Hisar (Rajni Goyat) Member (Tripti Pannu) Member