1. This is a petition filed by one Smti. Minoti Talukdar (hereinafter referred as the petitioner) against the Branch Manager, Reliance Insurance Company Limited, Nagaon Branch and two others (hereinafter referred to as the opposite parties) U/S  12 of the consumer Protection Act, 1986 praying for recovery of money, compensation and other relief.

2. The fact and circumstances for filing of the aforesaid petition as narrated by the petitioner are as follows:-

                     The mother of the complainant, namely, deceased Kanmai Talukdar opened a policy with the opposite party, namely, Reliance Life Insurance on last 24/11/2012 vide application No.-C-66485836 through company’s authorized agent Mr. Haren Chandra Kalita (opposite party No.4) under the plan & scheme of Reliance endowment Plan for Rs.1,00,000.00 and the term and condition of the policy was duly followed and also accepted by the opposite parties/Company without any objection. Further case of the complainant is that after accepting and satisfying the proposal form/ application of the policyholder, namely, deceased Kanmai Talukdar, the opposite parties duly represented by one Anasuya Ghosh, Head Central Operation, also received an amount of premium of Rs.12,000.00 vide receipt No.WC0018162789, dated 24/11/2012 and accordingly, issued a premium deposit receipt to the policyholder. The rider benefit of the aforesaid policy was that on death of the Life assured prior to 29^th November, 2023, Rs.1,00,000.00 plus vested bonus and term benefit will be payable. The complainant stated that she was declared as a nominee of the said policy of her mother under section 39 of the Insurance Act 1936 and after accepting the proposal of the policy and initial premium, the opposite parties/Company issued a policy to the policyholder vide policy No.50538389 with effect on 29/11/2012. It is also stated in the complaint petition that the said policy being an annual policy, the next date for payment of installment amount was fixed on last 29/11/2013 but unfortunately the policyholder Kanmai Talukdar died on last 15/02/2013. The complainant stated that after death of policyholder, she being nominee lodged her claim before the insurance company with all relevant documents for obtaining the benefit of the said policy but the opposite parties/ company without disposing her claim, simply intimated her on last 16/05/2014 that all the claim benefit shall be forfeited with explanation that the age of the life assured was 73 years and the permissible age at the entry of the plan of insurance opted was up to 63 years. The complainant alleged that in the policy, the age of the policyholder - Kanmai Talukdar was specifically written as 64 years and date of birth mentioned was 1^st April, 1948 which was duly acknowledged by Anasuya Ghosh and under such circumstances, the opposite parties illegally hold the age of the policy holder as 73 years and thus, violated the term of the contract between the policyholder and   the insurer company and such act on the part of the opposite parties amount to deficiency in service. The complainant stated that she had made approach many a time for settlement of her claim but the opposite parties paid no heed and did not dispose her claim without any sufficient cause. Hence, this claim petition is before this Commission praying for the relief.

                   The opposite party No.1 to 3 filed their written version denying all the allegation of the petitioner leveled against them. By their written version, the opposite party No.1 to 3 pleaded inter- alia that there is no cause of action for the complainant to file the petition and that the petition is unsustainable in law and liable to be dismissed. The opposite party No.1 to 3 submits that the law of insurance is governed by the legal doctrine “Uberrima Fides” meaning “almost good faith” (literally, “most abundant faith”) which means all the parties to an insurance contract must deal in good faith, making a full declaration of all material facts in the insurance proposal. The opposite party No.1 to 3 submitted that in the instant case there are inherent misrepresentation and suppression of material facts and intentional false statement  was made regarding the age of the life assured in order to get the insurance coverage. The opposite party No.1 to 3 further stated that the age of the policyholder was beyond the insurable age limit and the insurance policy was obtained by fraud and misrepresentation. The opposite party No.1 to 3 also stated that the instant claim is barred by section 45 of the Insurance Act as because during investigation of the claim, it was found that fake document was filed with the insurance proposal regarding the age of the policyholder and her age was found to be beyond permissible age limit and hence, the act of opposite party No. 1 to 3 in repudiation of the claim on the ground of non-disclosure of material fact is squarely within the ambit of section 45 of the Insurance Act as the life assured died within two years from the date of commencement of the policy. They stated that the claim being an early state was investigated by independent investigator, namely, M/S Globel Risk Management where it was found that the policyholder furnished a fake certificate of her age issued by Sarkari Gaonburha and during investigation, the date of birth of the policy holder was verified and admitted by Sarkari Gaonburha to be false and he also admitted that he issued the certificate only as an address proof. The opposite party No.1 to 3 further submitted that Sarkari Gaonburha provided them with the authenticated voter list wherein the age of the policyholder was mentioned as 73 years. Their further version is that even the terms and condition set forth in the policy document under the Heading “Forfeiture in certain events” clearly and specifically prescribed that the policy shall be treated void if there is any inaccurate or false statement made in the policy and the deceased policyholder by signing the policy acknowledged the terms and condition set forth in the policy. The opposite party No.1 to 3 again submitted that the repudiation of the claim in the instant case is as per the terms and condition mentioned in the contract of insurance in view of case laws, namely, (1) Polymate India Private Limited and another –vs- National Insurance  Company Limited and others (AIR 2005 SC 286, (2) Oriental Insurance Company Limited –vs – Samayanallar Primary Agricultural Co-operative Bank (AIR 2000 SC 10) and (3) General Assurance Society Limited –vs- Chand Mall Jain ([1966J3 SCR 500]. The answering opposite party submitted that the claim of the complainant is based on impermissible conjectures, inferences and surmise and the complainant is not entitled to any relief. Under the above circumstances, the opposite party No.1 to 3 pray for dismissal of the complainant petition.

3.         Upon pleading of parties the following points are found for discussion and decision in the case.

1. Whether the opposite party No.1 to 3 illegally denied to extend the benefit to the complainant for the insured policy No.50538389 as nominee for the deceased policy holder Kanmai Talukdar without any justified cause and such act on the part of opposite party No.1 to 3 amounts to deficiency in service?
2. Whether the claimant is entitled to any relief as prayed for?

4.              The complainant filed evidence in affidavit of one witness and also exhibited several documents in support of her claim. The opposite party No.1 to 3 did not cross-examine the P.W. nor adduced any evidence in support of their written version.

5.             Written argument filed by the complainant side and perused the same.

6.                               Decision and reasons theref:-

7.                     For the sake of brevity both the Point (i) & (ii) are taken jointly for discussion and decision:-

                          The claim of the complainant is that her mother deceased Kanmai Talukdar during her life time opened a policy with the opposite parties, namely, Reliance Life Insurance Company Limited and on her death, the complainant being her daughter and nominee filed her claim for insurance benefit of the policy of her mother but the opposite party, namely, Reliance Life Insurance Company Limited, without any justified cause hold that the age of her mother was beyond permissible age at the time of opening the policy and refused to provide her with the insurance benefit. In support of her claim, she as P.W.1 adduced evidence to the effect that her mother namely, deceased Kanmai Talukdar opened a policy with the opposite party on last 24/11/2012 and the term and condition of the policy was duly followed and also accepted by the opposite parties/ Reliance Life Insurance Company Limited without any objection. Further evidence of this P.W. is that after accepting and satisfying the proposal form/ application of the policyholder, namely, deceased Kanmai Talukdar, the opposite parties duly represented by Anasuya Ghosh, Head Central Operation, also received an amount of premium of Rs.12,000.00 vide receipt No.WC0018162789, dated 24/11/2012 and accordingly, issued a premium deposit receipt to the policyholder. P.W.1 again deposed that the rider benefit of the aforesaid policy was that on death of the Life assured prior to 29^th November, 2023, Rs.1,00,000.00 plus vested bonus and term benefit will be payable. Further evidence of this P.W. is that she was declared as a nominee of the said policy of her mother and after accepting the proposal of the policy and initial premium, the opposite parties/ Company issued a policy to the policyholder vide policy No.50538389 with effect on 29/11/2012.  It is also deposed that the said policy being an annual policy, the next date for payment of installment amount was fixed on last 29/11/2013 but unfortunately the policyholder Kanmai Talukdar died on last 15/02/201 and thereafter, the complainant being the nominee lodged her claim before the insurance company with all relevant documents for obtaining the benefit of the said policy but the opposite parties- Reliance Life Insurance Company Limited without disposing her claim, simply intimated her on last 16/05/2014 that all the claim benefit shall  be forfeited with explanation that the age of the life assured was 73 years and the permissible age at the entry of the plan of insurance opted was up to 63 years. P.W.1 deposed that in the policy, the age of policyholder - Kanmai Talukdar was specifically written as 64 years and the date of birth was mentioned as 1^st April, 1948 which was duly acknowledged by Anasuya Ghosh and under such circumstances, the opposite party illegally hold the age of the policyholder as 73 years and thus, violated the term of the contract between the policyholder and   the insurer company and such act on the part of the opposite party- Reliance Life Insurance Company Limited, amounts to deficiency in service.  

             The opposite party No.1 to 3 while filing their written version submitted that the policy was obtained by fraud and at the time of opening the policy, the policy holder submitted fake document regarding her age and at the time of investigation it was found that the age of policy holder was 73 years and hence, the act of opposite party No. 1 to 3 in repudiation of the claim on the ground of non-disclosure of material fact is squarely within the ambit of section 45 of the Insurance Act as the life assured died within two years from the date of commencement of the policy  and such act on their part does not amount to deficiency of service. However, the opposite party No.1 to 3 neither cross-examined the P.W.1 nor adduced any evidence in support of their written version. Hon’ble Apex Court in many judicial pronouncement specifically stated that mere filing of written statement is not sufficient unless supported by evidence.  In the instant case the opposite party No.1 to 3 neither cross-examined the P.W.1 nor adduced any evidence in support of their written version for reasons best known to them. In view of above we are of the opinion that the that the complainant has successfully established that there is a deficiency of service on the part of the opposite party No.1 to 3.

                  In result both the points for discussion and decision are answered in affirmative and goes in favour of the complainant.

                                            O   R  D   E  R

8.                        In view of the above discussion, it is found that the petitioner has succeeded to prove that there was a deficiency of service on the part of opposite party No.1 to 3.

                       Accordingly, the prayer made by the petitioner U/S 12 of the Consumer protection is allowed on contest. Issue direction to the opposite party No.1 to 3 to pay the complainant  the insurance benefit for the Insurance Policy No.50538389 of deceased Kanmai Talukdar as per terms and condition of the policy with interest @ 12 per annum from today till realization. 

                         Inform all the parties concern.

                      Given under the hand and seal of this Commission, we signed and delivered this Judgment on this  20^th Day of April 2021.