Haryana

Ambala

CC/73/2018

Vidya Devi - Complainant(s)

Versus

Axis Bank Ltd - Opp.Party(s)

Rupinder Singh

14 Mar 2019

ORDER

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA

 

 

                                                                      Complaint case no.        : 73 of 2018

                                                          Date of Institution         : 28.02.2018

                                                          Date of decision    : 14.03.2019

 

 

Vidya Devi wd/o Sh. Gurmukh Singh, aged about 62 years R/o Village Dhurkara Tehsil and District Ambala.

……. Complainant.

 

 

1.  AXIS Bank Ltd, Branch Vill. Dhurkra, Tehsil and District Ambala.

2.  TATA AIG General Insurance Company Ltd, Lotus Towers, 1^st Floor, Community Centre, New  Friends Colony, New Delhi.

3.  TATA AIG General Insurance Company Ltd. A-501, 5^th Floor, Building  No.4, Infinity IT Park, Dindoshi, Malad(E), ,Mumbai-400097

 

  ….…. Opposite Parties.

 

Before:        Ms. Neena Sandhu,  President.

                   Ms. Ruby Sharma, Member,

Sh. Vinod Kumar Sharma, Member.

                  

                            

Present:       Sh. Rajesh Kumar, counsel for complainant.

OP No.1 ex parte v.o.d. 26.04.2018.

Sh. Mohinder Bindal, counsel for OP Nos. 2 & 3.

 

 Order:        Smt, Neena Sandhu, President

Complainant has filed this compliant under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the Opposite Parties(hereinafter referred to as ‘Ops’) praying for issuance of  following directions to them:-

1. To release the death claim of Rs. 5,00,000/- to the complainant as per policy alongwith interest @24% P.A. from the date of death of her husband, till its realization.
2. To pay Rs. 50,000/- as compensation for the mental agony and physical harassment suffered by her alongwith litigation charges. 

 

In nutshell, brief facts of the present complaint are that the deceased husband of the complainant was having saving account with Axis Bank, branch Village Dhurkara, OP No.1. In the month of December 2015 an employee of OP No.1 allured the husband of complainant to get himself insured through accidental insurance policy of OP No.2 as the OP No.1 has an agreement with the TATA AIG General Insurance Co. Ltd. It was told to the complainant that this policy is only for those who are maintaining their saving accounts in the Axis Bank and this policy is for the period of 3 years having death cover of Rs. 5,00,000/-. Yearly premium of Rs. 1,349/- has to be paid for 3 years. As enticed by the employee of OP No.1, the husband of complainant had taken the said policy and submitted all the requisite documents and also deposited an amount Rs. 1,349/- as first premium vide receipt dated 17.12.2015 against policy no.0285032058 and was insured for the period from 22.12.2015 to 21.12.2018. Unfortunately, due to accident, the husband of complainant expired on 15.05.2017 and a DDR bearing no.30 dated 15.05.2017 got registered with the police station Sadar, Ambala City.  After the death of Gurmukh Singh his wife i.e. complainant, who being beneficiary under the said policy lodged the claim and submitted all the requisite documents  with the Ops but the OP No.3 rejected claim of the complainant vide letter dated 22.09.2017 for the reason that as per Adhar card and death certificate, the age of late Sh. Gurmukh Singh was of 78 years  and in  the post mortem report his age has been mentioned as 70 years whereas at the time of taking of the policy, the age of  Late Sh. Gurmukh Singh was above 65 years. In proposal form its date of birth of husband of complainant is mentioned as 01.01.1950. Thus, insurance company was unable to process the claim. The husband of complainant was an illiterate person and at the time of taking the said policy, he submitted all the documents with the insurance company but its official own its own mentioned the date of birth as 01.01.1950,  as there is no such document,  in which the date of birth of husband of complainant has been mentioned as 01.01.1950. The Ops have issued the policy in the name of the husband of complainant after scrutinising all the documents and if there was any discrepancy then they should not have issued the policy. By not paying the claim amount to the complainant, the Ops have committed deficiency in service. Hence, the present complaint.

2.       On notice, OP No.1 failed to appear despite service and was thus proceeded against ex parte. Upon notice, OP Nos. 2 & 3 appeared through counsel and filed written version stating therein that as a matter of fact the claim of the insured Sh.Gurmukh Singh was duly entertained in due course, on being presented by his widow-complainant being nominee and the entire case with all set of papers was gone through by the concerned team of the Ops. During processing, it was observed that in the Adhar card the year of birth of late Sh. Gurmukh Singh has been mentioned as 1939. In the Adhar card and death certificate his age has been mentioned as 78 years and in the post-mortem report his age has been mentioned as 70 years. It is noteworthy that in the proposal form the date of birth of deceased has been mentioned as 01.01.1950, meaning thereby at the time of taking the Accidental Shield policy, the insured was of 65 years of age which clearly shows that late Sh. Gurmukh had taken the policy by misrepresentation of facts and concealing his actual age. The insurance company by not paying the claim amount has not committed any deficiency in service and prayed for dismissal of the complaint against OP No.2 & 3.

3.       To prove her version complainant tendered her affidavit as Annexure CW1/A alongwith documents as AnnexureC-1 and C-6 and closed her evidence. On the other hand, Counsel for OP Nos.2 & 3 tendered affidavits as Annexure R/A alongwith document as Annexure R-1 and closed their evidence.

4.                 We have heard the learned counsel for contesting parties and carefully gone through the case file and the written arguments filed by the learned counsel for complainant.

5.                The controversy involved in the present case is regarding the age of the Deceased Life Assured (hereinafter referred to as DLA). As per the version of the insurance company the DLA had taken insurance policy no. 0285032058 Annexure R-1 by mispresentation/concealing the material facts, he had given wrong information about his age at the time of obtaining the insurance policy by mentioning the date of birth as 1.1.1950. As per the said date of birth the DLA was of 65 years of age at the time of inception of the policy.  However, at the time of processing the claim it was observed that in the Aadhar card of the DLA, so submitted by the complainant for settlement of the claim, the year of birth of DLA has been mentioned as 1939 and his age has been mentioned as 78 years. Even in the death certificate the age of the complainant has been mentioned as 78 years. In the post mortem report, the age of DLA has been mentioned as 70 years. From the said documents it is clear that at the time of taking of the policy, the DLA was of the age more than 65 years, therefore, complainant has not entitled to get any benefit under the Accidental Shield Policy because this policy has to be issued in favour of the person, who was not the age more than 65 years at the time of taking of policy. It may be stated here that the documents regarding proof of age, address and income can easily be obtained at the time of issuance of insurance policy. It is the standard practice of the insurance companies to ask for the proof of age, residence and income, while taking the proposal form for issuance of policy and the insurance company only issue the policy to a person after verifying all the antecedents. It may be stated here that the insurance company instead of believing the information given by the DLA should have issued the insurance policy after verifying all the relevant documents submitted by him. By not doing so the insurance company has committed a mistake and for its mistake it cannot blame somebody else. In the case of Balwan Singh Vs. Reliance Life Ins. decided on 19.03.2018,  Hon’ble State Commission, Haryana has held that if the information given by the insured is believed at the time of receiving premium amount, then version of the claimant should be believed in the same manner at the time of acceptance of the insurance claim also. The insurance company cannot be allowed to take benefit of its own mistake using clever tactics and the technicalities. In the case of Life Insurance Corporation of Vs. Kulwinder Singh decided on 13.08.2012,  Hon’ble State Commission, Punjab has held that it is a settled law that when the factum of age as given in the proposal form is accepted either at the time of issuing the policy, or thereafter during the life time of policy holder, the insurer cannot turn around to repudiate the claim after the death of insured.  

Taking all the facts and circumstances of the case into consideration and the view taken by the superior fora in the cases referred to above, we are of the considered opinion that the insurance company was wrong in repudiating the claim of the complainant. As per DDR Annexure C-4, the DLA died due to accident. From the perusal of the policy schedule Annexure C-1 it is evident that the DLA was fully covered for Rs. 5,00,000/-under Accidental Death Cover. From the said policy, it is revealed that under the heading “beneficiary details” the name of complainant has been mentioned. Since, the DLA had died due to accident therefore the complainant being beneficiary is entitled to get a sum Rs. 5,00,000/- as accidental benefits. The OP Nos. 2 & 3 by not paying the said amount have committed deficiency in service. Therefore, they are liable to pay the claim amount of Rs.5,00,000/- to the complainant along with interest. They are also liable to compensate the complainant for the metal agony and physical harassment cause to her along with litigation expenses. So far as, the deficiency in service on the part of the OP No.1 is concerned. It may be stated here that neither any specific allegation has been levelled against OP No.1 by the complainant nor it has been proved, therefore, the complaint filed against OP No.1 is liable to be dismissed.

In view of the aforesaid discussion, we dismiss the present complaint against OP No.1 and allow the same against OP Nos. 2 & 3. The OP Nos. 2 & 3 are directed in the following manner:-

1. To pay to the complainant Rs. 5,00,000/- (Rupees Five Lacs) along with  interest @ 7% p.a. from the date of repudiation  i.e. 22.09.2017 till its realization.
2. To pay Rs. 10,000/- (Rupees Ten thousand) as compensation. 
3. To pay Rs.5,000/-(Rupees Five thousand) as litigation expenses.

 

The  Op No.2 & 3 are further directed to comply with the aforesaid directions within the period of  30 days  from the date of receipt of the  certified copy of this order, failing which the awarded amount mentioned in column no.(i) & (ii) shall carry interest @ 9% per annum for the period of default. Certified copies of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

Announced on :14.03.2019

 

 

 

          (Vinod Kumar Sharma) (Ruby Sharma)     (NeenaSandhu)

              Member                        Member             President