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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
C. Viswanath, Presiding Member and Ram Surat Ram Maurya, Member
Master Nikhil Sharma —Complainant
versus
PNB Metlife India Insurance Co. Ltd. and Anr. —Opp. Parties
Consumer Case No.496 of 2014
Decided on 9.2.2022
Counsel for the Parties:
For the Complainant:Mr. Vikas Mishra, Advocate
For the Opp. Party No.1:Mr. D. Varadarajan, Advocate
For the Opp. Party No.2: Mr. Rajat Prakash, Proxy Counsel
IMPORTANT POINT
(1) Suppressions of Material Fact – After two years have elapsed the Insurance Policy cannot be called into question on the ground that the statement made in the proposal form or in any other document leading to the issuance of the Policy was inaccurate or false, unless such a statement led to suppression of material fact.
Headnote:
(A) Consumer Protection Act, 1986 – S.21 [Consumer Protection Act, 2019 – S.58] – Services – Insurance – Life Insurance – Repudiation of the claim – Aggrieved by repudiation of claim by Insurance Company, Complaint has been filed – Whether Complainant has alleged clubbed three claims and filed Complainant – In the instant Complaint, the Complainant has challenged the repudiation letter dated 05.03.2012. It cannot be said that the Complainant had clubbed three claims. It is Opposite Party No.1 which had clubbed all the claims and repudiated the same, vide common letter dated 05.03.2012. The objection taken by Opposite Party No.1 that the Complaint is not maintainable for want of pecuniary jurisdiction is, therefore, rejected. [Para 11].
(B) Consumer Protection Act, 1986 – S.21 [Consumer Protection Act, 2019 – S.58] – Insurance Act, 1938 – S.45 – Services – Insurance – Life Insurance – Repudiation of the claim – is whether Opposite Party No.1/Insurance Company can repudiate the claim “after expiry of more than two years” on the ground of suppression of material fact / Whether repudiation of Claim by Insurance Company is justified – Section 45 stipulates restrictions upon the Insurer calling into question a Life Insurance Policy after expiry of two years from the date on which it was affected. After two years have elapsed the Insurance Policy cannot be called into question on the ground that the statement made in the proposal form or in any other document leading to the issuance of the Policy was inaccurate or false, unless such a statement led to suppression of material fact. Beyond two years, the burden lies on the Insurer to establish the inaccuracy or falsity of a statement on a material matter or the suppression of material facts – In the present case, the repudiation has been made after expiry of more than two years. The onus to prove that the Life Assured had filed wrong ITR was on Opposite Party No.1, which they failed to do. Opposite Party No.1 thus failed to discharge the onus of proof – Therefore, repudiation of Insurance claim by Opposite Party No.1 was not justified. Complaint is allowed and Opposite Party No.1 is directed to make payment of Rs.1.35 crores duly adjusting amounts paid, if any. Opposite Party No.1 shall also pay compensation in the form of 9% interest per annum on this amount to the Complainant from the date of repudiation of claim till the date of payment – Complaint is allowed. [Paras 13, 14].
Result: Complaint allowed.
ORDER
The present Complaint is filed by the Complainant Nikhil Sharma through his father Sh. Ajay Sharma. The Complainant was the nominee in the Insurance Policy taken his deceased grandfather Sh. Gopal Dass. Opposite Party No.1 is Insurance Company. Opposite Party No.2 is a Bank engaged inter alia in providing financial facilities to its Customers.
2. The case of the Complainant is that the representative of Opposite Party No.1 approached and visited the deceased grandfather of the Complainant at the behest of Sh. Jairam and Sh. Pardeep Kr. Shukla, the then Branch Manager and Asst. Manager respectively in Karnataka Bank Ltd., Varanasi, Opposite Party No.2. They assured the credibility of M/s Metlife India Insurance Company Limited, as highly reputed and esteemed Insurance Company in the field of Life Insurance. On their advice, Mr. Gopal Dass took three MetLife Life Insurance Policies on following terms:-
| S. No.
| Policy Particulars of Sh. Gopal Dass (Deceased Father) | Sum Assured | Annual Premium | Tenure | Premium till Death |
| 1. | Met Smart Plus Life Insurance Policy No. 20005412 Date of Commencement: 14.05.2009 | Rs.30,00,000/- (Thirty Lacs) | 2,00,000 | 34 Years | 6 Lacs |
| 2. | Met Smart Plus Life Insurance Policy No. 20175062 Date of Commencement: 19.11.2009 | Rs.70,00,0000/- (Seventy Lacs) | 2,00,000 | 34 Years | 4 Lacs |
| 3. | Met Smart Plus Life Insurance Policy No. 20191448 Date of Commencement: 07.12.2009 Initially policy was Rs.30 Lacs, later on revised to Rs.35 lacs on date 14.04.2010 @ same premium of Rs. One Lac Total | Rs.35,00,000/- (Thirty Five Lacs) | 1,00,000 | 34 years | 2 lacs |
| Rs.1,35,00,000/- (One Crore Thirty Five Lacs) |
|
| 12 Lacs |
Opposite Party No.1 issued the aforesaid Life Insurance Policies only after conducting medical tests. Sh. Nikhil Sharma (Complainant herein), the minor grandson of the deceased was appointed as assignee/appointee/nominee. Sh. Gopal Dass expired on 25.10.2011. On 24.11.2011, the Complainant filed Insurance Claim for all three Policies with Opposite Party No.1 for an amount of Rs.1,35,00,000/- along with relevant documents. Opposite Party No. 1 repudiated the claim against all Policies, vide letter dated 05.03.2012, on the ground that the Life Assured had supressed the material fact relating to his income. However, Opposite Party No.1 paid the following amount to the Complainant: -
| S. No. | Demand Draft Amount, drawn on HDFC Bank Ltd. | For Policy No. | Sum Assured |
| 1. | Rs.4,43,941/- | 20005412 | Rs.30,00,000/- |
| 2. | Rs.54,137/- | 20175062 | Rs.70,00,000/- |
| 3. | Rs.31,140/- | 20191448 | Rs.35,00,000/- |
The Complainant wrote several letters to Opposite Party No. 1 refuting and controverting the Demand Drafts, but Opposite Party No.1 did not reply. The Complainant also wrote letter to Opposite Party No. 2 to resolve the grievance with Opposite Party No.1 as the Policy was purchased through Opposite Party No. 2, but they also remained silent. Opposite Party No.1 did not adduce any evidence to justify the repudiation.
3. Aggrieved by repudiation of the claim, the Complainant approached the Insurance Ombudsman by filing three separate Complaints. The Insurance Ombudsman rejected the Complaints, vide order dated 12.03.2014, on the ground of delay as well as pecuniary jurisdiction as the amount exceeded Rs.20 Lakhs in each Policy. Ombudsman also observed that the Complaints against the agent were not maintainable and the subject matter of forgery of signatures etc. did not fall within their jurisdiction. It was also observed that as the Complainant had also approached other Forum, the Complaint was not maintainable. Alleging deficiency in service and unfair trade practice on the part of the Opposite Parties, the Complainant filed this Complaint with the following prayer:-
“(a) Direct all the Opposite Parties to p
