The complainant along with her husband took a housing loan of Rs.1,18,00,000/- from the respondent PNB Housing Finance Limited. The sanction issued by the lender required the borrower to take an insurance policy and according to the complainant, on the advice of the opposite parties, she and her husband decided to take an insurance policy from the ICICI Lombard General Insurance Co. Ltd. Premium of Rs.4,00,000/- was paid by the husband of the complainant by way of a cheque. It is alleged that no Cover Note of any insurance policy or the policy terms and conditions were sent to him. The husband of the complainant having died on 04.10.2016, a claim under the insurance policy was submitted by the complainant. The claim however, was repudiated vide letter of the insurer dated 27.12.2016. Being aggrieved from the repudiation of the claim, the complainant is before this Commission, seeking payment of Rs.1,20,00,000/- from the opposite parties, along with interest etc.
2. IA/16458/2018 was filed by the opposite parties No. 1
and 2 namely, PNB Housing Finance Limited, seeking deletion of its name on the ground that the matter had been settled between lender and the borrower. Vide order dated 14.9.2018, it was directed that though the name of PNB Housing Finance Limited would not be deleted from the array of parties, the complainant cannot claim any relief against the said opposite party. Thus, the complaint practically continues only against the insurer.
3. The claim was repudiated vide letter dated 27.12.2016, which to the extent it is relevant reads as under:
'Refer the claims documents submitted by you for the above mentioned claim number. On scrutiny of the documents, we regret to inform you that the claim stands rejected for the following reasons as per the policy terms and conditions:
|Sl. No.||Policy condition||Clause (s)|
|1.||Policy certificate Part I of the schedule, benefit table, the policy cover Death||Policy wordings Part II of the schedule, the term ‘Accident’ is defined as 'A sudden, unforeseen and undesirable physical event caused by external, violent an visible means beyond the control of the Insured Person.'|
|Remarks||It is evident from Brought Dead Summary certificate provided by Dr. Ankur Verma, Max Super Speciality Hospital, that Insured had expired due to Severe Chest pain. Further, there is no evidence of accidental injuries involved leading to death of insured. Hence the claim is inadmissible.|
4. The complainant has filed a photocopy of the proposal form stated to have been submitted by her late husband to the insurer. The photocopy of the first page of the proposal form is available on page 75 of the paper book and the serial number of the proposal form given on the said photocopy is 96261. The photocopy of the second page / back of the first page of the proposal form is available on page 72 of the paper book and it can be clearly seen from the said photocopy that the serial number printed on the original document was 90786. The insurer has placed on record the original proposal form submitted by late husband of the complainant. A perusal of the said proposal form would show that the serial number of the proposal form was 90786 which can also be seen on the reverse of the first page / back page of the proposal form. Since the original proposal form is printed on both the sides, and the serial number of the proposal form appears only on its first page, it is evident that the photocopy of the first page of the proposal form filed by the complainant is an interpolated copy and not a true and correct copy. Had the photocopies on page 71 and 72 of the paper book been the true and correct photocopies of the first and second / back of the first page of the proposal form, the serial number would have been shown as 96261 and not as 90786 on the photocopy of the second page / back of the first page of the proposal form. If the photocopies filed by the complainant are compared with the original proposal form filed by the insurer, there can be no doubt that the serial number of the proposal form was 90786 which can also be verified from the photocopy available on page 72 of the paper book. The photocopy of the first page available on page 71 of the paper book thus is an interpolated copy.5. It is settled proposition of law that a person approaching the Court for redressal of his grievance must place all the relevant facts before the Court clearly, candidly and frankly without any reservation even if those facts are against him. If the person approaching the Court tries to mislead the court, the Court has inherent power to proceed further with the examination of the case on merits. The Court / Tribunal certainly has to take into consideration the conduct of the party which invokes its jurisdiction and if it finds that the litigant has tried to mislead or hoodwink, it must necessarily prevent him from abusing its process by refusing to hear him on merits of the case. Such a person, by his very conduct, disentitles himself from getting any relief from the Court even if it is otherwise made out on merits.
6. The next question which arises for consideration is as to why the complainant would file interpolated copies of the proposal form. The answer to this question is a quite simple. As per the original proposal form filed by the insurer, the insured had scored off Part B of the proposal form which he had to sign in case he opted for Group Secure Mind Coverage. The aforesaid Part B has been scored off in the original proposal form but is not shown scored off in the photocopy filed by the complainant on page 71 of the paper book. In fact, Part B of the proposal form had been scored off even in the original proposal form submitted by the complainant vide Form No. 90787, which the insurer has filed in original in order to show that both, the complainant as well as her husband, had scored off Part B of the proposal form and thereby had not opted for Group Secured Mind Cover.
7. The insurer has in this regard, stated in its written version and affidavit by way of evidence that though, late Dinesh Kumar, husband of the complainant wanted coverage under Group Secured Mind, Home Insurance and Group Personal Accident Insurance, he opted not to take Group Secured Mind Coverage when he was informed that he will have to pay a premium of Rs.11,50,128/- and taxes for taking the said coverage on a sum assured of Rs.1.2 crores and thereafter, he proposed coverage under Group Personal Accident and Home Insurance Sections of the policy. The plea taken by the insurer stands substantiated form the original proposal form filed by it as well as from the act of the complainant in filing an interpolated copy of the first page of the proposal form.8. The case of the complainant is that no cover note or terms and conditions of the policy were sent to her husband. A perusal of the insurance policy would show that the policy document bears the name and address of the insured. Therefore, in the normal course of the conduct of its business, the insurer would have sent the policy to the insured. It has been stated in the written version of the insurer that the policy document was sent to the insured on 06.3.2015 through First Flight Courier and was delivered to him on 06.3.2015. The policy document has a lookout period of two weeks within which the insured was at liberty to reject the policy issued to him if its terms and conditions were not acceptable to him and in that case, he was entitled to refund of the premium paid by him. There is no evidence of the husband of the complainant having rejected the policy document within the free lookout period of the policy. He thus, accepted the policy as
sent to him. 9. It would also be pertinent to note that the premium payable for taking an insurance cover under all the three Sections of the insurance policy was much much higher than the premium which late husband of the complainant actually paid to the insurer. This is yet another indicator that he had not opted for Part B of the proposal form which was to be signed by him in case he was to opt for Group Secured Mind section of the policy.10. I therefore, have no hesitation in holding that the deceased husband of the complainant had opted only for Home Insurance Cover and Group personal Accident. He having not opted for Group Secured Mind Cover and he having not died an accidental death, the claim under the policy was not payable. The insurer, therefore, was fully justified in rejecting the claim. The consumer complaint, being devoid of any merit is hereby dismissed.