DISTRICT CONSUMER DISPUTES REDRESSAL FORUM. BOLANGIR.
………………………
Presents:-
- Sri P.Samantara, President.
- Sri G.K.Rath, Member.
- Smt. S.Rath, Member.
Dated, Bolangir the 31st day of August 2016.
C.C.No.42 of 2015.
Sunadhar Tandi son of Dhananjaya Tandi., Resident of
Village- Bankiamunda Post-Deshanda P.S.Tusura,
Dist- Bolangir.
.. .. .. Complainant.
-Versus-
1.Authorised Signatory,
Reliance Life Insurance Company, Bolangir Branch Office,
At-Ramjeepada, Bolangir town, P.O/P.S./Dist-Bolangir.
2.Reliane Life Insurance Company Ltd. Regd. Office,
H.Block,1st Floor,Dhirubhai Ambani Knowledge Centre,
Navi Mumbai,Maharastra-400710.
3.Reliance Life Insurance Company Ltd. Corporate Office,
Mides Wings,6th Floor,Sahara Plaza, Andheri, Kurla Road,
J.B.Nagar,Andheri (East) Mumbai-69.
4.Sukru Kumbhar son of Purusottam Kumbhar.
At-Bhandarbanji, P.O.-Karamtala, Via-Saintala,
Dist- Bolangir.
.. .. .. Opp.Parties.
Adv. for the complainant- Sri B.C.Pradhan & Associates.
Adv.for the O.Ps 1 to 3 - Sri A.K.Tripathy & Associates.
Adv. for the O.P.No.3 - None.
Date of filing of the case – 25.05.2015.
Date of order - 31.08.2016
JUDGMENT.
Sri P.Samantara, President.
Succinctly put, the life assured named Ashami Tandi has taken a Reliance Endowmet Plan (Regular) from reliance life Insurance commencing on 12th October 2012,the policy No.50453029 the contract span over 12th Oct 2011 and the sum Assured is Rs 1,12,000/- under yearly frequency payment. The complainant stated on the death of the life assured prior to 12th Oct 2022 ,the sum accrues to Rs 1,12,000/- plus vested bonus. The declared nominee under section 39 of the Insurance Act,1938 is Mr.Sunadhar Tandi,in expressed policy.
2. The complainant averred a payment premium of Rs 12,581/- under Endowment plan regular in Term No.10 vide application No.D129075. The application is filed by the nominee, being a competent consumer under C.P.Act.
3. The complainant also made out that the deceased life assured all of a sudden suffered fever, get admitted to C.H.C.Belpada on 04.03.2013 vide admission No.2467 and remained as indoor patient thereafter being with discharged.
4. Further said, the deceased died on 16.03.2013 due to cardiac failure. Lodged the claim for death settlement benefit but on dated 26.10.2013, intimated, the claim has been repudiated on the ground that the life assured grossly understated the age while submitting proposal for life insurance cover even though the permission age at entry for the plan of Insurance was 65 years. Therefore, the contract is void ab-initio and the premium is forfeited.
5. The complainant also added, during submission of proposal the voter ID of the deceased Ashami Tandi was taken into consideration, accordingly policy was issued but the claim was repudiated. Prayed the O.Ps may kindly be directed to make payment of the Endowment sum along with interest, compensation and cost that deems fit and proper. Relied on voter identity card, death certificate, Form-B, medical certificate, Form-A, Initial premium deposit receipt, policy schedule, policy document, Repudiation letter treatment documents in photo copies and affidavit.
6. Pursuant to notice, the O.Ps 1,2 and 3 appeared and made the version, in admission of policy issued in verification of proposal. The life assured is of Rs 1,12,000/- .The relevant term and conditions of the policy has been well explained by the Advisor and contended the column No.32 of the proposal form was ticked negative, which spells that medical ailments such as diabetes, high blood pressure, cancer & respiratory disease etc has not been suffered with but in verification it was found at the time of signing of the proposal form the DLA was suffering from cardiac problem which she suppressed the material fact, which is vital for the contract, thereby as per columbn-16 makes the policy void, claims to all benefits cease and monies paid shall be forfeited.
7. Further contended I submission that basing on the investigation report of the Medical History of the DLA, the repudiation letter was sent as the age difference between the DLA and the Nominee i.e her son is only 11 years, as to the age mentioned in the voter’s Identity card is taken into account. This age difference conveys ,she lied about her age, unbelievable to conceive the nominee at such tendered age so on this ground the policy stands terminated and any claim towards the policy is liable to be forfeited. As lieing and suppress of the fact of being suffering from cardiac problem is intentional breach of utmost good faith & also a dereliction under the ratio decided in various cases of Apex court . Under the aforesaid circumstances, the petition be pleased to reject/dismiss the claim of the complainant in limine.
8. The O.P.4 in answering admitted the policy issuance, sum assured, the nominee and sufferance of cardiac failure but contended that the life assured has taken into consideration on the basis of age mentioned in the Voter Identity card of the deceased Ashami Tandi and the same was accepted and thereby she has not under stated and not misled the insurer to offer life insurance cover because when the proposal forms submitted before the O.Ps 1 to 3, along with first premium, same could have refused to accept the policy at that time stating misleading of facts.
9. Hence prayed that the prayer made in the complaint petition by the complainant, who is the nominee of the deceased policy holder may kindly be allowed.
10. Record has been perused, submissions have been considered.
11. On the outset it is not in dispute that the policy was issued and initial premium has been received under (Regular) Endowment Plan a sum of Rs 12,580/- and the complainant was the nominee so also sufferance of cardiac failure except the acceptance of age in question.
12. The submission of the petitioner is that the age has been accepted by voters Identity card not under any surmise which is public information and widely accepted by the all Insurers and it is confirmed during acceptance of proposal form, the DLA or deceased life Assured was on the date 12.10.2012 age is 49 years but in comparing to the age of nominee, the discrepancy come to surface, but on perusal, no substantive or corroborative document has been filed by the O.P to establish the fact. The technicalities raised only to repudiate the claim in totality. On this context, the clause 6(2) of I.R.D.A. Regulation 2005 spells:
13. Clause 6(2):- “While acting under Regulation 6(1) in forwarding the policy to the insured, the insurer shall inform by the letter forwarding the policy that he has a period of 15 days from the date of receipt of the policy document to review the terms and conditions of the policy and where the insured disagrees to any of those terms or conditions, he has the option to return the policy stating the reasons for his objection, when he shall be entitled to a refund of the premium paid, subject only to a deduction of a proportionate risk premium for the period on cover and the expenses incurred by the insurer on medical examination of the proposer and stamp duty charges”.
14. In the present case in terms of above noted clause discussion, same is not abided with and petitioner is estopped intentionally in countenance of same dispute.
15. We also observe, the advisor is a party in this case. The insurer counsel admitted the age and also opposed the repudiation on ground of suppression of fact in his pleadings. On the matter of point of sale of I.R.D.A. Regulation 3(2)-reads- An insurer or it’s agent or other intermediary shall provide all material information in respect of a proposed cover to the prospect to enable the prospect to decide on the best cover that would be in his or her interest. Again-(3) reads- where the prospect depends upon the advise of the Insurer or his agent or an insurance intermediary, such a person must advise the prospect dispassionately. So in this the advisor advise to obtain the voter identity card to muster the basis of age in obtaining the policy can be treated as irrelevant ,fraudulent and ill will to harness profit. The petitioner is an illiterate lady, which is a trivial in nature and does not evinced any fraudulent intention, we can say provided the advisor has given the right advise that such document (voter I Card) is a unfit one, then she would not subscribe the endowment plan. It is observed contract of Insurance is matter of “Utmost good Faith”, the terms binds both, where as the Insurer in ill-intention to grab the premium devise the ploy in knowing that in future such type insurance claim will be repudiated thereby forfeit the monies collected in premium. Therefore the insurer in fraudulent intention, which is being confirmed, in repudiation of genuine death claim on such technical and flimsy grounds.
16. On the other hand the nominee has not produced any document in support of his age and the comparison is not needed under any regulation or Act then henceforward all nominees will be subject to verification irrespective of age and relation which is completely unwarranted.
17. It is unfortunate, that on one hand the Insurance raises the voice of “Utmost good faith”, but in contrast, the faith will be lost, while not settling the genuine claims for some or other reasons. It is an exploitation of policy holder. The consumers are literally under fear or dilemma that, whether after death, the beneficiaries even certainly get any fruits from the insurer or orphaned policy in force.
18. On the other hand, the petitioner submitted since the date of birth of Ashami Tandi was accepted by the Insurer themselves on 12.10.2012,they had no right to go back and repudiated the claim by taking the plea that wrong date of birth was given the DLA in her proposal form. Our same view is fortified by the observation made in Tej Kaur and another Vs Senior Divisional Manager Life Insurance Corporation of India. 2001(1) CLT 193 and concurrent finding made out in –Balwinder Singh Vs The Life Insurance Corporation of India & Another. Held- Once the Insurance Company accepted the age of the life Assured, they have no right to repudiate the Insurance claim by alleging her age to be different than that- 2010(3)CPR 235. Once accepting premium and having entered into agreement without verifying facts, Insurance company cannot wriggle out of liability- Life Insurance Corporation of India Vs Dali Kanwar Devda- 2012(2)CPR 220.
19. From the reasons stated above, we are of the firm opinion that the deceased life Assured has no intention to defraud rather she has been defraud due to open document, she relied with as to the advise of the advisor in depute to sale the product. So we find no suppression fact has been committed, whereas the claimant is entitled to the assured amount as laid out in the policy. Thus it is ordered.
ORDER.
The O.Ps 1,2 & are directed to pay the petitioner a sum of Rs 1,12,000/- (Rupees One lakh twelve thousand) only along with 6% interest per annum from the date of application in addition of Rs 2,000/- as compensation inclusive cost, within forty days of this order, failing which @ 8% interest per annum will accrue on the entire amount till realization.
ORDER PRONOUNCED IN OPEN FORUM THIS THE 31st DAY OF AUGUST 2016.
(S,Rath) (G.K.Rath) (P.Samantara)
MEMBER MEMBER PRESIDENT.
