PER:
Charanjit Singh, President;
1 The present complaint has been received from the District Consumer Disputes Redressal Commission Amritsar by the order of the Hon’ble State Consumer Disputes Redressal Commission Punjab, Chandigarh for its disposal.
2 The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 11 and 12 against the opposite parties on the allegations that the opposite party No. 1 i.e. Bajaj Allianz Life Insurance Company Ltd. is dealing in the life insurance policies and for that process they had spread out number of agents in the field for covering the life risks of common man and the opposite party No. 2 i.e. Branch office situated at Amritsar and working under the guidelines of opposite party No. 1. The company officials and the agent approached the complainant and her husband and gave lucrative offers for having a life insurance policy and they were attracted to the offers made by the opposite parties agents. The husband of the complainant has obtained a life insurance policy from the opposite parties vide police No. 322684114. The said policy was under the plan of ‘I secured’. The Life insurance policy commenced w.e.f. 15.4.2015 and the sum assured was Rs. 9,00,000/- and yearly premium to be paid fixed for 3191/-. The complainant was nominee in the said insurance policy which was taken by his son Talwinder Singh son of Kikar Singh. On 29.5.2015 the son of the complainant died due to heart attack. After the death of son of the complainant on 15.9.2015, the complainant submitted his claim alongwith all the requisite documents with the opposite party and submitted the death claim form. The claim was lodged at the opposite party No. 2 branch of the insurance company at Amritsar. Now vide impugned communication dated 21.12.2015, the death claim of the policy purchased by the son of the complainant was rejected by the opposite party by holding that pre-existing disease/ pathological test hospitalization/ treatment not disclosed by the son of complainant. The perusal of the rejection letter shall clearly reveal that the only ground on the basis of the death claim for the policy has been rejected by the opposite parties is because of the act mentioned above. At the time of filing the information related to the son of complainant, the true and detailed facts inquired by the opposite parties were provided and all the necessary information related to the applicant and his family members were taken by the officials who collected the information and relevant documents, had verified the facts from other sources. Hence, the ground on the basis of which the insurance company has refused to honour the claim submitted by the complainant is absolutely baseless and is clear cut instance of unfair trade practices and deficiency in services. Now, just in order to decline the right of the complainant, the opposite parties have repudiated the claim of the complainant and the complainant had made number of requests regarding re consideration of death claim of his son Talwinder Singh but the opposite parties have done nothing favourable in this respect. The complainant has prayed that the following reliefs may kindly be granted to the complainant against the opposite parties.
(a) Opposite parties No. 1, 2 be directed to pay an amount of Rs. 9,00,000/- to the complainant being the sum assured as per the insurance policy alongwith interest @ 18% per annum as the impugned communication of rejection is bad in the eyes of law, in the interest of justice.
(b) Compensation of Rs. 2,00,000/- on ground of mental pain, agony, inconvenience and harassment suffered by the complainant may be awarded to him against the opposite parties.
(c) Costs of proceedings alongwith sum of Rs. 11,000/- as advocate fee
(d) Interest @ 18% be awarded on amounts above mentioned.
3 After formal admission of the complaint, notice was issued to Opposite Parties and opposite parties appeared through counsel and filed written version and contested the complaint by interalia pleadings that the deceased deliberately and intentionally concealed the material facts relating to his health and gave wrong and false answers, information, statements and declaration knowing well that those were false and incorrect. The deceased maliciously and fraudulently did not disclose the true and correct facts which were known to him at the time of filling up and signing the proposal form with an intent to induce the opposite parties to accept risk on his life. The various medical reports, investigations and hospital records revealed that Liver function during 28th March, 2015 indicating adverse levels of B Bilirubin, Serum glutamic Oxalaccetic transminase, Serum glutamic pyruvic transmiine, S.Alk Phosphataseas and adverse levels of Blood investigations reports i.e. Serum Amylase and lipase, were pre-proposal. This fact was suppressed in the proposal form dated 15th April 2015 resulting in to fraud (active concealment of a fact by the insured having knowledge or belief of the fact). The deceased however, suppressed the material facts regarding his ill health which were known to him prior to signing the proposal form, just to induce the answering opposite parties to issue the insurance policy. Had she disclosed true and correct facts regarding his existing health conditions which were known to him prior to submission of the proposal form, the risk of his life would not have been accepted by the answering opposite party and the insurance policy would not have been issued to him. Thus, the death claim has legally and rightly been repudiated for non disclosure of material facts. The complainant has not approached this commission with clean hands as the complainant also did not disclose the true facts regarding the health of the deceased life assured even while submitting the death claim and deliberately gave wrong and false information just to deprive illegal pecuniary benefits under the membership. As the opposite parties have acted strictly in accordance with the terms and conditions of the master policy as well as certificate of insurance. There is no deficiency in service on the part of the answering opposite parties as defined under section 2(1)(g) of the Consumer Protection Act, 1986 and the claim has been repudiated on legal and valid grounds. Since, the deceased deliberately and fraudulently suppressed the material facts regarding his health thus, the contract of insurance is void ab initio strictly in accordance with the declaration made by the deceased in the proposal form. The contract of insurance is a contract of utmost Good Faith technically known as ‘UBERRIMA FIDES’ According to this doctrine the proposer who is one of the party of the contract is presumed to have means of knowledge, which are not accessible to the opposite party, who is the other party to the contract. Therefore, the proposer (life assured) is bound to disclose everything affecting the judgment of the insurer, no matter howsoever unimportant it may seem to him (proposer). In all the contracts of life insurance, the proposer is bound to make full disclosure of all the material fats and not merely those, which he thinks material. Misrepresentation, non disclosure or fraud in any document leading to acceptance of the risk automatically discharges the insurance company from all liabilities under the contract. As the deceased gave wrong and false information, statements and declaration at the time of filling up the Proposal form, the claim has rightly been repudiated as per law and terms and conditions of the insurance contracts. The deceased got himself insured by way of fraud and the consent of the opposite parties was obtained by way of misrepresentation and suppression of material facts by the deceased, hence, the contract of insurance is nullity ab initio. The insurance policy was maliciously obtained by way of fraud and mis-representation and the consent of the insurance company was not free as defined in Section 14 of Indian Contract Act. The deceased member reportedly expired on 24.1.2015 i.e. within one month of acceptance of risk giving rise to every early death claims which itself is a strong ground to raise reasonable doubt over the correctness of the material representations made in the proposal form. The present complaint has been filed by the complainant only to injure the goodwill and reputation of the opposite party. The complainant has no locus standi or cause of action to file the present complaint against the answering opposite party. The contract of insurance does not provide for the payment of interest on the money due under the insurance policy, There is no usage, whereby the insurer becomes liable to pay interest on the policy claim particularly when the claim is repudiated for suppression of material facts by deceased life assured. The issues involved in the complaint are complex in nature and needs full scale trial enabling all the parties to examine number of witnesses, thus, the instant complaint cannot be adjudicated in summary trial before this commission. The policy was offered and accepted by the opposite party after the complainant had understood salient features of the policies and benefits covered therein as per its terms and conditions and the opposite parties have denied the other contents of the complaint and prayed for dismissal of the same.
4 To prove his case, the complainant has placed on record affidavit of complainant Ex. C-1 alongwith documents i.e. copy of Adhar Card of complainant Ex. C-2, Copy of repudiation letter dated 21.12.2015 Ex. C-3, Copy of death certificate of Talwinder Singh Ex. C-4, Copy of the voter card of Talwinder Singh Ex. C-5. On the other hands, Ld. counsel for the opposite parties has tendered in evidence affidavit of Sh. Sandeep Gupta Manager Ex. OP1, 2/1 alongwith documents Ex. OPs. 1, 2/2 to Ex. OP1, 2/18, investigation report Ex. OPs 1, 2/19, copy of register of ashes issued by Gurudwara Sri Bauli sahib, Goindwal Sahib (Tarn Taran) Ex. OP1,2/20, Copy of email Ex. OP1, 2/21 and closed the evidence.
5 We have heard the Ld. counsel for the parties and have gone through the record on the file.
6 In the present case, there is dispute regarding the insurance policy, the case of the complainant is that the son of the complainant namely Talwinder Singh died on 26.5.2015 and he got insurance policy from the opposite party which was commenced on 15.4.2015 and the complainant is entitled to the death claim of his son. The complainant has also placed on record death certificate Ex. C-4 which shows the date of death of Talwinder singh as 29.5.2015 But on the other hands, the case of the opposite party is that the Talwinder Singh died prior to purchasing the policy and to support their version, the opposite party has appointed one investigator who in his investigation report in Para No. 11 has specifically mentioned that ……………..LA was married but his wife is not residing with her in laws. Father is nominee whereas as per legal/ social obligation wife/ son/ daughter must be nominee. It was also revealed perhaps she did not aware about the insurance because the policies were purchased after the death of LA. The investigator has also giving finding in conclusive remarks that …Policy purchased after the death of L.A. DC is pending for cancellation. In support of their version, the opposite parties have also placed on record one another document Ex. OP1,2/20 which is certificate of ashes issued by Gurudwara Bauli Sahib, Goindwal Sahib (Tarn Taran in which there is entry of name of Talwinder Singh son of Kikkar Singh resident of village Sudan, P.S. Makhu District Ferozepur has been written at serial No. 2185 and date of death of Talwinder Singh is mentioned as 30.3.2015.
7 As such there is dispute regarding the death of Talwinder Singh, according to complainant, Talwinder Singh died after purchasing the policy i.e. on 29.5.2015 but according to opposite parties, Talwinder Singh died prior to the purchasing the policy i.e. on 30.3.2015. As such, to ascertain this fact whether Talwinder Singh died on 29.5.2015 or on 30.3.2015 a detail evidence, cross examination is required and intricate questions of law and facts are involved in the present case. As such , this District Commission cannot exercise its jurisdiction to decide the intricate questions of law and facts in a summary manner. Reliance in this regard is placed upon Oriental Insurance Company Ltd. Vs. Munimahesh Patel 2006(IV) CPJ page 1, wherein the Hon'ble Supreme Court has held that :-
“Proceedings before the commission are essentially summary in nature and adjudication of issues which involve disputed factual questions should not be adjudicated. It is to be noted that commission accepted that insured was not a teacher. Complainant raised dispute about genuineness of the documents (i.e. proposal forms) produced by the appellant.”
Their lordships have further held that :-
“The nature of the proceedings before the commission as noted above, are essentially in summary nature. The factual position was required to be established by documents. Commission was required to examine whether in view of the disputed facts it would exercise the jurisdiction. The State Commission was right in its view that the complex factual position requires that the matter should be examined by an appropriate court of Law and not by the Commission.”
The nature of the dispute, in the present complaint, is squarely covered by the law laid down by their lordships of the Hon'ble Supreme Court in the judgment supra. A similar view has been taken by the Hon'ble National Consumer Disputes Redressal Commission in 1(2004) CPJ page 101 wherein it has been held by the Hon'ble National Commission in a revision petition titled as R.D. Papers Ltd. Vs. New India Assurance Co. Ltd. & Ors. in para No.7 of the judgment which reads as under:-
“After going through the complaint and the written version, it appears to us that the complaint raises complicated questions of facts which cannot be decided by us in our summary jurisdiction. It may be though the amount in this case is in few lacs and when we are receiving complaints involving crores of rupees, but then enormous evidence would be required in the present case especially in respect of allegation of forgery made by the complainant and denied by the Insurance Company.”
8 In view of above discussion, the instant complaint is relegated to the Civil Court for deciding the matter in accordance with law. All the applications pending if any in this case are disposed off. Copy of order be supplied by the District Consumer Disputes Redressal Commission, Amritsar as per rules. File be sent back to the District Consumer Disputes Redressal Commission, Amritsar.
Announced in Open Commission
24.11.2022
