BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FATEHABAD.
Complaint No.:120 of 2018.
Date of Instt.: 23.04.2018.
Date of Decision: 11.01.2019.
Smt. Soma aged 33 years wife of Haw Singh son of Hanuman, resident of village Badopal, Tehsil & District Fatehabad.
…Complainant.
Versus
1. AXIS Bank Limited, G.T. Road, Branch Office, Fatehabad through its Branch Manager.
2. MAX Life Insurance Company Limited, Operation Centre, Claim Unit, Plot No. 90-A, Sector-18, HUDA Gurgaon through its Senior Manager.
…Opposite Parties.
Complaint U/s 12 of the Consumer Protection Act, 1986
Before: Sh.Raghbir Singh, President.
Sh. Jasvinder Singh, Member.
Dr. Rajni Goyat, Member.
Present: Sh.S.C. Jangu, counsel for the complainant.
Sh.Amit Wadhera, counsel for the OP no. 1.
Sh. R.S. Sandhu, counsel for the OP no. 2.
ORDER:
The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant against the Opposite Parties (hereinafter referred as OPs) with the averments that the husband of the complainant namely, Haw Singh, resident of village Badopal, District Fatehabad has raised loan from OP no. 1/bank and while raising the loan his insurance was also issued by OP no. 2 through OP no. 1 for a sum assured of Rs.12,17,000/- and insurance premium amounting to Rs.12,190/- was paid to OP no. 2 by OP no. 1. After making deduction of the said amount from account of the complainant on 6.7.2016 and the complainant was appointed as nominee in the abovesaid insurance policy. Therefore, the life assured Sh. Hawa Singh during his lifetime and after his death the complainant is consumer of the OPs as defined in the Consumer Protection Act, 1986. The abovesaid insurance policy bearing no. 35001204 issued by OP no. 2 was valid from 6.7.2016 to 5.7.2021.
2. It is further submitted that unfortunately Hawa Singh died on 28.5.2017 and intimation regarding his death was given to the OPs and she was assured by the OPs that the sum assured will be disbursed to her very soon. However, only an amount of Rs.10,600/- was received from the OPs vide letter dated 29.12.2017 and OP no. 2 informed that death of Hawa Singh was on account of committing suicide and as such payment as per entitlement has been made as per terms and conditions of the policy.
3. It is further submitted that the letter dated 29.12.2017, wherein it has been mentioned that death of Hawa Singh has been caused on account of committing suicide is totally wrong and without any evidence and as such repudiation of the insurance claim of the complainant on the abovesaid ground is not sustainable in the eyes of law. The abovesaid act on the part of OPs in repudiating the genuine claim of the complainant amounts to deficiency and as such she is entitled to compensation of Rs. 1 lakh on account of mental agony and physical harassment suffered by her. The complainant has further prayed that the OPs may be directed for making a payment of Rs.12,17,000/- as insurance claim to her along-with interest and compensation of Rs. 1 lakh. Hence, the present complaint.
4. On being served, the OP no. 1 appeared through counsel and resisted the complaint by filing written statement wherein various preliminary objections with regard to maintainability, barred by limitation, jurisdiction, cause of action and concealment of true and correct facts etc. have been raised.
5. In reply on merits, it is denied that the complainant is consumer of OP no. 1 qua the insurance policy issued by OP no. 2. It is further submitted that OP no. 1 only had acted as an agent of OP no. 2 and as such the complainant does not fall within the definition of consumer of OP no. 1. All the allegations made by the complainant against OP no. 1 in the present complaint have been denied and it has been further submitted that there is no deficiency of any kind on the part of OP no. 1 in rendering service to the complainant. Therefore, the present complaint against OP no. 1 is without any merits and as such the same is liable to be dismissed.
6. OP no. 2 also resisted the complaint by filing a written statement wherein various preliminary objections with regard to maintainability, cause of action, suppression of true and correct facts etc. have been raised.
7. In reply on merits, it is admitted that the insurance policy in question was issued by OP no. 2 to late Sh. Hawa Singh, husband of the complainant for an amount of Rs.12,17000/-. It is further submitted that at the time of submission and filing of the proposal form the life assured was explained all the terms and conditions of the policy and the policy document was issued to the life assured on 18.7.2016. It is further submitted that after receiving information regarding death of the life assured on 23.8.2017, the case was sent for investigation and after investigation it was found that the life assured had committed suicide after consuming pesticides. It is further submitted that the complainant submitted an affidavit to the OP no. 2 which states that prior to death the life assured consumed pesticides and died due to the same and as such claim of the complainant was repudiated on 15.12.2017 under suicide clause on the basis of affidavit given by the family of life assured. It is further submitted that as per the terms and conditions of the policy the benefit cannot be paid to the life assured if he commits suicide within a period of one year from the date of issuance of the insurance policy. Therefore, since in the present case the life assured had committed suicide within a period of one year from the date of issuance of the policy as such the repudiation of the insurance claim of the complainant by the OP no. 2 is perfectly in accordance with the terms and conditions of the insurance policy. Therefore, there is no deficiency on the part of OP no. 2 in rendering service to the complainant and as such the present complaint is without any merits and liable to be dismissed.
8. The learned counsel for the complainant tendered in evidence affidavit of the complainant as Annexure CW-1 along-with documents as Annexure 1 to Annexure 6. On the other hand, Shri Dhiraj Malik, Legal Manager tendered his affidavit in evidence on behalf of OP no. 2 along-with documents as Annexure R-1 to Annexure R-19 and closed the evidence on behalf of OP no. 2.
9. We have duly considered the arguments advanced by learned counsel for the parties and have also perused the entire material placed on record. It is not disputed that insurance of late Sh. Hawa Singh husband of the complainant was issued by OP no. 2 for a sum assured of Rs.12,17,000/-. It is also not disputed that the abovesaid policy was valid from 6.7.2016 to 5.7.2021. It is also not in dispute that the life assured late Sh. Hawa Singh died on 28.5.2017 i.e. during the subsistence of the abovesaid insurance policy. It is also not in dispute that on the date of death of the life assured the installment of premium had already been paid. It is also not disputed that the complainant was nominated as nominee in the abovesaid policy. The insurance claim of the complainant in the present case has been repudiated by the OP no. 2 on the ground that the life assured had committed suicide within a period of one year from the date of issuance of the policy and as such as per terms and conditions of the policy (Clause 6 Suicide Exclusion), the benefit of insurance cannot be paid to the complainant. In support of its contention that the life assured had committed suicide, the OP no. 2 has relied upon the affidavit submitted by the complainant before OP no. 2 which states that the life assured had consumed pesticide and died on account of consumption of pesticide. We have examined affidavit dated 29.6.2017, (Annexure R-16) submitted by the complainant and in the affidavit the complainant has deposed that her husband namely, Hawa Singh had consumed the pesticide on account of mistake and as such due to the consumption of pesticide her husband died in Dayal Hospital at Agroha. From perusal of the abovesaid affidavit, it cannot be concluded that the life assured had committed suicide. Possibility of intake of pesticide by mistake cannot be ruled out. Merely on the basis of probabilities it cannot be concluded that the life assured had committed suicide. No other cogent, convincing or credible evidence has been produced by the Ops to prove that the life assured had committed suicide. Even the investigation report has not been placed on record nor the investigator who investigated the matter has placed any affidavit on the file.
10. In view of the aforesaid discussion, we are of the considered view that repudiation of the insurance claim of the complainant by the Ops is not justified and the complainant has been able to establish deficiency on the part of Ops in rendering service to her. The present complaint is accordingly allowed. The OP no. 2 is directed for making payment of Rs.12,17,000/- after deducting Rs.10,600/- which has already been credited in the account of Hawa Singh by the OP no. 2, to the complainant. The OP no. 2 is further directed for making a payment of Rs. 10,000/- to the complainant as compensation and litigation charges. This order shall be complied with within a period of 30 days, otherwise the amount shall carry an interest at the rate of 9% per annum for the default period. Copy of this order be supplied to the parties free of costs. File be consigned to record room after due compliance.
Announced in open Forum. Dated:11.01.2019
(Rajni Goyat) (Jasvinder Singh) (Raghbir Singh)
Member Member President,
DCDRF, Fatehabad
