Haryana

StateCommission

CC/233/2016

MAMTA RANI - Complainant(s)

Versus

AVIVA LIFE INSURANCE CO. - Opp.Party(s)

S.B.GUPTA

13 Mar 2018

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

Complaint No     :      233 of 2016

Date of Institution:      16.08.2016

Date of Decision :       13.03.2018

 

Mamta Rani wife of late Shri Sanjay Kumar, Resident of Village Bahri, Tehsil Thanesar, District Kurukshetra.

                                      Complainant

Versus

1.      M/s Aviva Life Insurance Company India Limited, Second Floor, Prakashdeep Building, 7 Tolstoy Marg, New Delhi through its Managing Director.

2.      The Branch Manager, M/s Aviva Life Insurance Company India Limited, S.C.O. No.242, Second Floor, Part 1 opposite Mini Secretariat, Sector-12, Karnal-132001.

                                      Opposite Parties

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Mr. Balbir Singh, Judicial Member.

                                                                                                         

Argued by:          Shri Gaurav Singla, Advocate proxy for Shri Sanjay Bharti Gupta, Advocate for Complainant.

                             Shri Tushar Arora, Advocate for Opposite Parties.

 

                                                   O R D E R

 

BALBIR SINGH, JUDICIAL MEMBER

 

        As per version of complainant-Mamta Rani, Opposite Party No.1 – M/s Aviva Life Insurance Company India Limited (for short ‘the Insurance Company’) gave an offer to Shri Sanjay Kumar-husband of the complainant regarding purchase of an insurance policy having total sum assured as Rs.60,00,000/- on payment of Rs.7219/- as premium after every six months. Lateron Sanjay Kumar (hereinafter referred to as the ‘life insured’) was provided life insurance policy bearing No.ALA3106049 mentioning date of commencement as May 18^th, 2012, Sum Assured as Rs.30,00,000/- and date of maturity as May 18^th, 2042. The life insured was required to make payment of premium amount of Rs.7219/- after every six months. The life insured made payment of the premium of the insurance policy regularly from the month of May, 2012 up to the month of May, 2014. Unfortunately, the life insured died on October 11^th, 2014 during the insurance period. After death of her husband, the complainant submitted her insurance claim with needed documents but the same was repudiated by the opposite parties mentioning that the driving licence produced by the life insured as proof for identity and age was a fake document. Information was given in this regard to the complainant on April 25^th, 2016 when she visited the office of the opposite parties. She was told by some officials that repudiation letter was sent on her address on March 23^rd, 2015. It is pleaded that the driving licence of her husband was valid document and she also produced before the opposite parties the copy of Ration card as well as Voter Card as proof of identity and age of her husband. It is pleaded that husband of the complainant was a man having simple habits and she is living these days with her two minor daughters.

2.                The complainant has filed the present complaint under Section 17 of the Consumer Protection Act, 1986 with a prayer to direct the opposite parties to pay an amount of Rs.60,00,000/- with interest at the rate of 24% per annum from October 11^th, 2014 and to pay an amount of Rs.5,00,000/- on account of un-necessary harassment, mental agony and costs of litigation.

3.                The opposite parties in their written version have taken plea that the contract of insurance in between the insured and the opposite parties was void ab initio as material facts were not disclosed and false documents were produced; that the complaint is not maintainable in the present form and that this Commission has no jurisdiction to decide this complaint. It is pleaded that the insurance policy has been obtained on the basis of false and fabricated documents. The life insured produced his driving licence as proof of his identity and age at the time of submitting the proposal form which is a fake document. The life insured was not having any valid and effective driving licence and he had no source of income even to purchase the life insurance policy. In fact, the life insured used to earn his livelihood as a beggar as he was handicapped. He was not capable to do even labour work. No medical test was conducted before providing insurance policy as the life insurance policy was a non-medical policy. The complainant also could not give any proof regarding income of the life insured. Most important and basic principle of insurance is uberrima fides utmost good faith and in the present case the policy holder has suppressed material facts. It is also pleaded that during the process of obtaining an insurance policy, agent of the insurance company acts an agent of the life insured. In case any fraud has been played by the insured and his agent, the insurance company is within its right to repudiate the claim. The terms and conditions have been mentioned in the insurance policy. The insurance claim of the complainant was rightly repudiated vide letter dated January 19^th, 2015. The complainant is not entitled to receive any amount from the opposite parties. It is prayed that the complaint filed by the complainant be dismissed.

4.                The complainant in her evidence has appeared as CW-1 and produced following documents:-

1	Life Insurance Policy of Sanjay Kumar issued by insurance company	Exhibit C-1
2	Policy Account Statement issued by Insurance Company	Exhibit C-2
3	Application written by complainant to the Insurance Company on 16.03.2015	Exhibit C-3
4	Ration Card	Exhibit C-4
5	Elector Photo Identity Card of Sanjay Kumar	Exhibit C-5
6	Elector Photo Identity Card of the complainant	Exhibit C-5/A
7	Death Certificate of Sanjay Kumar	Exhibit C-6
8	Legal notice dated 3.6.2016	Exhibit C-7
9	Postal receipts	Exhibit C-8

 

5.                The opposite parties failed to adduce any evidence despite availing three opportunities.

6.                We have heard learned counsel for the parties and perused the case file.

7.                During the course of arguments, there was no controversy of any type that Sanjay Kumar husband of the complainant during his life time purchased a life insurance policy Exhibit C-1 from the opposite parties mentioning date of date of commencement as May 18^th, 2012, date of maturity as May 18^th, 2042 and sum assured as Rs.30,00,000/-.  As per terms and conditions of the insurance policy, the life insured was required to make payment of an amount of Rs.7003/- after every six months. It is evident from the Policy Account Statement Exhibit C-2 that the life insured made payment of seven installments of premium after every six months regularly. The life insured made payment of total amount of Rs.35,771/- up to May 28^th, 2014. It is evident from Death Certificate Exhibit C-6 that Sanjay Kumar died on October 11^th, 2014.

8.                The insurance claim of the complainant has been repudiated only on the ground that false information was given by the life insured at the time of submitting proposal form as he produced a fake driving licence in his name as proof of his identity. Plea has also been taken by the opposite parties that the life insured also did not give correct information regarding his source of income and he was not eligible for providing insurance policy mentioning total sum assured amount of Rs.30,00,000/- and he used to earn his income by begging. This version of the opposite parties certainly does not appear to be believable. This plea has been taken by the opposite parties so that the opposite parties may be able to repudiate the insurance claim of the complainant. The complainant in her evidence adduced copy of Ration Card Exhibit C-4, Electro Photo Identity Card of Sanjay Kumar Exhibit C-5. In the copy of Ration Card Exhibit C-4 as well as copy of the Elector Photo Identity Card of Sanjay Kumar age of the life insured is mentioned as 32 years. Admittedly, the driving licence was produced by the life insured at the time of submitting the proposal form to prove his identity and source of income etc. The opposite parties have taken plea that the driving licence of the life insured was a forged document but the opposite parties did not adduce any evidence to prove that the driving licence produced by the life insured was a forged and fake document.

9.                Learned counsel for the opposite parties raised arguments that the life insured used to earn income by begging. He was handicapped and as such was not eligible for providing the life insurance policy under this category.  On the other side version of the complainant as per statement recorded in this case and affidavit produced, her husband was a driver and his monthly income was approximately Rs.8,000/- per month. It appears that the opposite parties have no hesitation in leveling allegations and taking false pleas. Plea has been taken that the life insured produced fake and false driving licence but did not adduce any evidence to prove this fact. The opposite parties have taken plea that the life insured was a handicapped and his source of income was begging. The opposite parties could not produce any evidence.

10.              Moreover, we feel when the proposal form was submitted, the insurance company should have got medically examined the life insured. Even without medical examination also, it was not difficult for agent of the insurance company or any official or officer of the insurance company to have knowledge that the life insured was a handicapped and was unable to do physical work. Mere naked eyes are enough to make correct assessment that a particular person standing before is handicapped and unable to work. It is also not specifically mentioned as to whether the life insured was having problem in his legs or arms or in which particular part of his body. Moreover, we feel it was not so much difficult for the life insured to make payment of premium amount of Rs.7003/- after every six months. Although the life insured was a driver but even if it be presumed that he was not holding a valid driving licence, even then he could have earn sufficient income by doing labour work and in this regard his wife who was also young aged at that time could have been helpful by doing labour work or any such type of casual work to meet day to day household expenses. 

11.              As per discussions above in detail, we have no hesitation in holding that the opposite parties have taken false plea that the driving licence produced by the life insured was a fake and false document or that the life insured was a beggar and handicapped. Moreover, for the Insurance Companies it has become a routine matter not to make verification of the documents produced to prove identity, age and income of the life insured when the proposal form is submitted because at that time the Insurance Companies and their agents are found willing and worried only to increase the business of the insurance companies and income from commission of the agents by receiving premium amount. As and when the insurance claim is submitted, the insurance companies start investigation regarding the documents produced by the life insured to prove age, identity as well as income to avoid liability of the Insurance Company to make payment of the insured amount. It does not like a welfare body like Insurance Company to use such type of clever tactics to grab money from the public persons to increase its business.

12.              Resultantly, it is held that the life insured had not given any false information regarding his age, income and identity.  He had sufficient income to make payment of the premium of the insurance policy regularly and he proved this fact by making payment of the premium amount regularly till his death. Resultantly, it is held that on this ground the repudiation of the insurance claim of the complainant by the Insurance Company-opposite parties was not justified.

13.              No other point was raised during the course of arguments.

14.              As per discussions above in detail, we have no hesitation in holding that the complainant is entitled to receive the total insured amount of Rs.30,00,000/- (Rupees Thirty Lacs only) as mentioned in the insurance policy Exhibit C-1 alongwith compensation and costs of litigation.  Resultantly, the complaint filed by the complainant is allowed directing the opposite parties to pay total sum assured as Rs.30,00,000/- to the complainant with interest at the rate of 9% per annum from the date of filing of the complaint till its realisation; to pay an amount of Rs.25,000/- as compensation on account of unnecessary harassment, mental agony and Rs.11,000/- as litigation expenses.

 

 

Announced: 13.03.3018

(Balbir Singh) Judicial Member

(Nawab Singh) President

 

CL