Present         (1)     Nisha Nath Ojha,   

                              District & Sessions Judge (Retd.)                                                                                         President

                    (2)     Smt. Karishma Mandal,

                              Member

Date of Order : 31.10.2016

                    Nisha Nath Ojha

1. In the instant case the Complainant has sought for following reliefs against the Opposite party:-

1. To direct the opposite parties to pay the insured amount of all three policies of death benefit amounting to Rs. 6,50,000/- ( Rs. Six Lakh Fifty Thousand only ).
2. To direct the opposite parties to pay Rs. 3,00,000/- ( Rs. Three Lakh only ) as compensation.
3. To direct the opposite parties to pay Rs. 30,000/- ( Rs. Thirty Thousand only ) as litigation costs.

2. The facts of this case lies in a narrow compass which is as follows:-

The complainant has asserted that Late Devendra Pandit was holder of three policies being policy no. 0147643216, 0182703081 and 0146694403, the details of which have been mentioned in annexure – 1, 2 and 3 series. The aforesaid policies were issued after all verification and being satisfied by the concerned agent. Unfortunately the aforesaid policy holder Devendra Pandit died on 19.11.2010 due to acute respiratory failure in Sushila Nursing Home Pvt. Ltd. In support of the aforesaid fact, the complainant has annexed a certificate of death of insured Devendra Pandit as annexure – 4 of the complaint petition. Again the death certificates issued by appropriate authority of the state of Bihar have been annexed as annexure – 4 series. It appears that after death of policy holder namely Devendra Pandit his nominee Ramshila Devi has submitted appropriate application for payment of death benefit of aforementioned three policies contained in annexure – 1 series as will appear from annexure – 5.

It has been further asserted that after receipt of aforesaid application contained in annexure – 5, the opposite parties told her to surrender all the three policies in the office and thereafter she surrendered all three documents. The opposite parties assured her that her payment will be done through account payee demand Draft or account payee cheque. Thereafter, as per assurance by opposite parties the complainant had given her account number bearing 5004475741 which belongs to Allahabad Bank. It is unfortunate that after some delay the claim of the complainant has been rejected vide annexure – 6 series on the ground that the original policy holder has understated his age by 18 years by submitting fake documents and as such her claim has been rejected due to misrepresentation of original insurer.

The grievance of the complainant is that the aforesaid fact was not brought in the knowledge of original insurer or the complainant at the time of accepting the insurance proposal or issuing certificate. The complainant has thereafter sent a legal notice to opposite parties as will appear from annexure – 7 series but her case has not been reconsidered.

On behalf of opposite party a written statement has been filed in which it is asserted that the three policies have been obtained by the deceased life assured within a period of seven months and the life assured is alleged to have died on 19.11.2010 due to acute respiratory failure which is within ten months from the date of two policies and within 3 ½ months from the date of third policy. The opposite party in terms of sec 45 of Insurance Act got the detail investigated and found that the original insurer ( now deceased ) had passed 7^th class examination and left his study in his early life. In support of this fact the opposite parties have annexed annexure – A which is the statement of the wife of deceased, Annexure – B is the transfer certificate of Sardar Patel Ucha Vidyalaya, Jarkha as well as the certificate of the head master of the school. The voter list of phulwari vidhansabha has been annexed as annexure – D. On behalf of opposite party several documents such as annexure – F, F/1 and G have been annexed from which it appears that the insurer was brought to hospital after death.

Heard both the parties and perused the entire record in light of respective submissions of learned counsel for the parties.

The fact asserted by the respective parties have been narrated in the foregoing paragraphs, hence it is not proper to repeat the same.

The three insurance policies, the photocopy of which have been annexed by the complainant in annexure – 1 series have been admitted by the opposite party in the counter affidavit. It is also admitted that the life assured died within ten months of first two policies and within 3 ½ from the date of third policy.

It is needless to say that the insurance company is within right to get the matter investigated regarding genuineness of the claim in terms of sec 45 insurance Act.

On behalf of opposite parties it have been asserted that the basis of entering the Date of Birth of the complainant is school certificate. This fact also appears from annexure – 2 and 3 series.

From bare perusal of annexure – 2 and 3 series, it appears that voter card were also made basis of identity proof. The school leaving certificate of the complainant has been annexed as annexure – B by the opposite parties from perusal of which it appears that the complainant took admission in the Sardar Patel Ucha Jarkha ( Patna ) on 02.03.1978 and he left the school on 05.04.1981 but from perusal of annexure – C of written statement it appears that aforesaid school wasestablished in 1984 then it is surprising how the complainant got admission in the school in 1978 while the aforesaid school was not in existence. From annexure – C it is also clear that no student of the name of the complainant was not found in the school. Annexure – C is certificate of the school issued by head master of the school on 15.02.2011.

Apart from it, annexure – D and E annexed by opposite parties with written statement shows the age of the life assured as 49 years and 50 years in 2009 – 10 but from perusal of transfer certificate it appears that the age of the complainant was about 42 years in 2010 hence his age does not tally even approximately with the age mentioned in transfer certificate of Devendra Pandit (annexure – B).

It further transpires from annexure – F series that the complainant was under treatment of Dr. R.J. Pandit who had referred him to PMCH for illness of tuberculosis but this fact has not been mentioned at the time of filling original proposal form by the complainant.

From annexure – A it further transpires that the complainant died on the way to hospital. Annexure – A is the statement of wife of Late Devendra Pandit which is not being challenged by cogent evidence.

On behalf of complainant a reply has been filed and in this reply the fact asserted in the written statement in Para – 8 of the written statement has not been challenged by filing cogent evidence. Even the genuinity of annexures – B, C and F series have not been challenged by the complainant by filing cogent evidence. As there is no cogent evidence to show that the annexure – B, C and F series are not genuine hence we have no option but to accept the statement of the opposite parties that the transfer certificate which was the basis of age at the time of proposing for insurance is forged and fabricated. We are further forced to admit the genuinity of annexure – F series which clearly shows that the insured Late Devendra Pandit was suffering from tuberculosis and this fact has not been disclosed by Devendra Pandit.

It goes without saying that in Para – 5 of reply only the dispute has been raised with regard to statement mentioned in Para – 8 (e) of the written statement which only concern with annexure – A but no documents have been annexed to show that the annexure – A was obtained under coercion.

In view of the fact and circumstances we have no option but to dismiss the case on the ground of forged and fabricated documents furnished by the complainant at the time of taking insurance policy.

We further find that there is suppression of fact on the part of Late Devendra Pandit as will appear from annexure – F series and G.

In view of the aforesaid fact and circumstances we find that there is no deficiency on the part of opposite party. However taking compassionate view of the matter we direct the opposite parties to return only the premium amount deposited with opposite party by Late Devendta Pandit to his wife who is now widow.

This complaint petition stands dismissed with the aforementioned direction but without cost.

                             Member                                                                              President