Haryana State Consumer Disputes Redressal Commission, Chandigarh
T.P.S. Mann, President and Harnam Singh Thakur, Judicial Member
PNB MetLife India Insurance Co. Ltd.
and Anr. – Appellants
versus
Charanajit Kaur and Anr. – Respondents
First Appeal No.338 of 2020
Decided on 4.8.2021

IMPORTANT POINTS
1. It is the responsibility of the insurance company to ensure due diligence while approving a policy
2. The interval between the start of the insurance period and death cannot be a cause for not providing a claim of a life insurance policy
3. Arguments of suppression of material facts cannot be considered if due diligence wasn’t done at early stage

Headnote:

(A)Consumer Protection Act, 1986 – Sec. 2(1)(g) [Sec. 2(11) of Consumer Protection Act, 2019] - Deficiency in service – Complaint – Nominee of the insured deceased filed complaint in Distt. Commission alleging deficiency in service – Two life insurance policies taken by the deceased – Deceased passed away 13 days after taking the 2nd policy - Opp. Party insurance company denied claim stating suppression of material facts, alleging that deceased had not disclosed pre-existing medical issues –Appellant approached State Commission for dismissal of complaint. (Paras 2, 3, 4 &7)

(B) Consumer Protection Act, 1986 – Section 15 – First Appeal [Consumer Protection Act, 2019 – Section 41] – First Appeal against Distt. Commission order allowing the complaint – Appellant alleged that surveyor found that deceased had pre-existing ailments at the time of taking out 2nd policy – Distt. Forum declined appellant’s request of providing medical records – State Commission held that since the deceased had taken 2nd policy, it was the duty of the appellant to ensure that the medical check-up was up-to-mark at the time of taking this policy – Immaterial whether the deceased died within 13 days and after 3 years of taking the insurance policies – Issues related to obtaining consent for obtaining medical records at this stage cannot be considered as grounds for dismissal.

Held: It is further contended by learned counsel for appellants that DLA died on 15.06.2016 just within 13 days from the commencing the insurance policy bearing No. 21912316 with effect from 02.06.2016. In support of his arguments learned counsel placed reliance upon “Hon’ble National Consumer Disputes Redressal Commission in case of LIC of India & Anr. Vs Balbir Kaur 1 (2009) 212 (NC), Hon’ble State Consumer Disputes Redressal Commission Punjab in Life Insurance Corporation of India Vs Smt. Piari Devi & Others, II (2008) CPJ 156 and by Hon’ble Uttarakhand State Consumer Disputes Redressal Commission in LIC of India Vs Radhika Devi, III (2008) CPJ 226, wherein it has been held that the very fact of early claim is a good corroborative evidence to prove misrepresentation, material non-disclosure or contemplation of death.

At the outset, it is the contention of learned counsel for appellants that DLA was suffering from Liver and Kidney diseases which were not disclosed by him at the time of filling of form. Thus, he has committed breach of trust with appellant-insurance company but this contention is not much convincing because appellant has failed to prove on record that deceased was suffering from Liver and Kidney problems. No doubt he made efforts to collect some information from PGI, Rohtak and other hospitals but unable to do so. Similarly, his application to summon the medical record from PGI, Rohtak and other hospitals was rightly rejected by learned District Commission on the ground that no details of DLA treatment has been mentioned in the said application. Moreso, it is the case of complainant that DLA died of heart attack but appellant failed to corelate the suffering of heart attack by DLA due to Liver and Kidney diseases. Another plank of arguments advanced by appellant is that DLA died within 13 days of taking policy bearing No. 21912316 dated 02.06.2016. However, this argument is also bereft of legal force because DLA had not only taken the above said policy bearing No. 21912316 dated 02.06.2016 but admittedly before that he had taken another insurance policy bearing No. 21124235 dated 22.07.2013 for a sum of Rs. 3 lakhs. Now, when DLA was taking second life insurance policy from the same company and that too for a much higher amount then it was bounden duty of appellant-company to verify his status of health through medical check-up before issuing second policy.

In these circumstances, it is immaterial whether DLA died within 13 days and after 3 years of taking the insurance policies. The authorities (supra) relied on by learned counsel for appellants are not applicable to the facts and circumstances of the case in hand because appellant-insurance company failed to prove that DLA suffering from Liver and Kidney problems before taking the above said policies and he concealed the material fact of his pre-existing disease. It is pertinent to mention that even the investigation report prepared by the investigator of the appellant-insurance company is also not on the record. (Paras 8, 11 & 12)

Result: Appeal dismissed in limine without any order of costs.