Charanjit Singh, President
1 The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 35 against the opposite parties on the allegations that the husband of the complainant namely Kedeep Singh son of Jeet Singh, resident of Phase-II, Fatiabad Road, Goindwal Sahib, Tarn Taran had got his life insured from opposite party by purchasing a life insurance policy and also paid premium amounting to Rs. 19,480.97 per Semi-annual for the same and opposite parties had issued an insurance policy No. 501-8130806 and date of commencement of policy was 10 November 2018, the deceased insured Kedeep Singh had named the complainant i.e. his wife in his life insurance policy as nominee, hence the complainant become the consumer of the opposite parties. Insurance taken policy with guaranteed sum assured of Rs. 12,00,000/-. During the continuation of the life insurance company the insured meet his unfortunate and untimely death on 26.1.2019. The death was timely intimated to the opposite parties and its concerned officials and death claim was made with the opposite parties by the complainant. Information regarding the death of the insured was given to the opposite parties through its representatives, who visited the house of the complainant. The complainant presented all the necessary documents as required by the opposite parties representatives. The representatives who visited the house of complainant took all the documents such original policy documents, documents pertaining the policy claim, death proof, medical bills etc. with an assurance that the claim will be settled at the earliest and the documents will be returned. The complainant is rustic person and is not aware of the technicalities of insurances and is neither well educated nor well conversant with the English language, the officials of the insurance company used to take all the documents, letter received from the complainant on the pretext that they are helping the complainant and soon her claim will be settled, thus believing upon the assurance of the officials of the insurance company, the complainant very innocently handed over all the documents received or asked by the officials of the insurance company. Till date, the complainant has requested the officials of the opposite parties and pleaded with folded hands many a times to kindly settled the claim made on the death of her husband but all in vain and till date neither the claim is settled nor any explanation is given to the complainant by the opposite parties regarding the delay on the same, the complainant is made to wait for no reason and her repeated request were ignored causing mental trauma, mental harassment to her. The complainant through her counsel Advocate Priya Chopra also sent legal notice to the opposite parties through registered post on 25.2.2021 but till date neither any reply has been received from opposite parties nor the claim made was settled. Now the complainant was forced to file the present complaint. The opposite party sent investigator and while investigating the claim, officials representing themselves to be investigator of the company of the opposite party came to the complainant and demanded a huge amount for passing the claim of the complainant since the complainant did not oblige the investigator, so the claim is not settled till date. The complainant has prayed the following relieves.
- Directing the opposite parties to decide the claim and to release the sum assured i.e. amount of Rs. 12,00,000/- as sum assured which the complainant is entitled as per policy due to the unfortunate death of her husband Kedeep Singh (insured) during the continuation of policy alongwith interest to the tune of 18% per annum till full and final realisation and Rs. 1,00,000/- as compensation for mental torture and agony and Rs. 15,000/- as litigation expenses and from the date of lodging of the complaint.
Alongwith the complaint, the complainant has placed on record documents i.e. Policy document i.e. welcome letter, policy schedule, (Policy detail, plan detail, premium detail, nominee detail) policy preamble, first premium receipt nomination schedule Ex. C-1, C-2, copy of death certificate Ex. C-3, Copy of legal notice as well as postal receipt Ex. C-4, C-5, C-6, Aadhaar card of complainant of deceased, Pan Card of complainant and Pan cared of deceased are Ex. C-7 to C-10, affidavit of Rachna Rani Ex. C-11.
2 Notice of this complaint was sent to the opposite party and opposite party appeared through counsel and filed written version by interalia pleadings that the complaint filed by the complainant is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead this commission. The commission has suppressed material facts from this commission. Policy under question i.e. policy bearing Number 5018130806 is an outcome of a fraud which has been played on the opposite party company. It is submitted that the present policy was outcome of a fraud as the identity of the Life Assured is disputed and the mere existence of the assurance can also not be ascertained. Even the alleged death of the Life assured is a conspiracy in order to cheat the company. The investigation which was necessitated because of various frauds being committed on the insurance companies and examined the matter in detail and possessed evidences which establish that the proposal form and other documents purportedly bearing the signatures of the life insured were fraudulently submitted at the proposal stage. There is dispute with respect to the identity of the assured and his mere existence. The death certificate submitted at the claims stage has also been cancelled by the authority. It has been found that it is a case of impersonation or a very calculated conspiracy. The opposite party company was misled to issue the aforesaid policy on the life of the alleged Mr. Kedeep Singh. Furthermore, the policy was acquired through forged documents and by a well planned criminal conspiracy involving various including the present complainant and as such the present complaint is not maintainable before this commission. This commission has no jurisdiction to entertain the present complaint. In the instant case the proposal form and other documents purportedly bearing signature of the life to be insured were fraudulently submitted at the proposal stage and the existence and death of the Life assured could not be established. In the present case there are serious issues of impersonation, forgery, fabrication, cheating and misdeeds. Such serious allegations require a proper trial by a civil/ criminal court and evidence has to be taken which is not possible in a summary trial. The matter in question involves complicated questions of facts and law as well as voluminous evidence, which can only be dealt with by a civil Court. Furthermore, the opposite party company is contemplating criminal proceedings against the applicant and other persons for committing fraud and forgery. The malafide intentions of the complainant and the fraudsters is clear from the fact no medical documents have been submitted by the complainant till date. The idea of the fraudsters to directly file this present complaint was to avoid any thorough investigation in the matter, whenever any claim is submitted a thorough investigation has to be done regarding the same, the identity of the claimant has to be verified, the genuineness of the claim has to be verified, the status of the policy has to be checked and if it is in accordance with the policy terms and conditions then only the claim can be processed. The complainant has with malafide and dishonest intention has twisted and distorted the same to suit her own convenience and to mislead this commission as such, the present complaint is not maintainable before this commission. The present case is a perfect example of a very well- planned Organized Fraud against the opposite party Company and the entire insurance industry. Insurance fraud is one of the most serious problems threatening viability of insurance companies Insurance frauds are driving up the overall costs of insurers and premiums for policyholders. It encompasses a wide range of illicit practices and illegal acts. The organized insurance fraud can be categorized into-
(a) Internal Fraud: Internal frauds are those perpetrated against a company or its policyholders by agents, managers, executives, or other employees.
(b) External Fraud: External frauds are directed against the company by individual or entities as diverse as medical providers, policy holders, beneficiaries, vendors and career criminals
The Respondent would like to bring to the attention of the court that the present case is a classic case of an external fraud on the company on the basis of the location. That the Company has received various claims from location Ferozepur and Tarn Taran and neighboring areas, wherein:
a) The LA mysteriously dies within 6 months from the issuance of the policy.
b) It is noticed that the Claimants do not provide any medical certificate from treating doctor or a medico legal cause of death.
c) The identities of the assured are disputed. The mere existence of the assureds are also disputed
d) Even the dead bodies get cremated in the absence of any doctor certifying the death or even when no post mortem is done to ascertain the cause of death.
e) Adhaar card, Income Tax Returns and Bank accounts and other documents are created before issuing of the policy:
In the present case too, the claim was received from and the above mentioned nexus is clearly and blatantly evident. The company got investigation done and they revealed the following facts
1 The proposal form and other documents purportedly bearing signatures of the Life to be insured were fraudulently submitted at the proposal stage.
2 The Death Certificate Submitted at the claims stage has been proposed to be cancelled.
3 Municipal Councilor Ram Lal gave a statement that he was mislead to issue the document for issuance of death certificate. He has also recommended cancellation of the Death Certificate as no person by the name of Kedeep had ever died or existed in Village Goindwal.
4 The Multipurpose Health worker of ESI Dispensary Goindwal Sahib also gave a statement and Certified that Kuldeep Singh S/o Jeet SinghR/o Phase 2, Fatehabad Road Shri Goidwal Sahib Tarn Taran does not exist in the village. There is no record/entry registered in the name of Kedeep Singh declaring him dead.
5 The Angarwari Worker Mandeep Kaur Kang also certified that Kuldeep Singh S/o Jeet SinghR/o Phase 2, Fatehabad Road Shri Goidwal Sahib Tarn Taran was not a resident of the village and there is no entry of his death in the survey record register.
6 Investigation revealed Nexus Involvement and one Balhar Singh is involved in the case who is running a chain of frauds in the area.
7 This is suspected to be fake case of death and impersonation. No Record was found in the Cremation Ground. Nor any record was found in the register of the Local Gurudawara as confirmed by Gurudwara In-Charge Mr. Satnam Singh.
8 The Local People did not know the life assured Neighbors denied the existence of any such person Various local people such as Mr. Mohit, Mr. Sukhpal Singh, Mr Mohan Singh and Mr. Rajendra Singh who have been residents of the area for 10-20 years confirmed that there is no Kedeep Singh or Rachna Rani the complainant.
9 No medical documents were provided to prove that the LA died of Heart Attack.
10 Various other discrepancies were found.
All the above points clearly speak of the ill-intent and motive behind taking the insurance policy. The complaint is devoid of any material particulars, and has been filed merely to harass and gain undue advantage and unjustified monies from the opposite party, and hence the application deserves to be dismissed in limine. It is submitted that the application has been filed with ulterior motive and malafide intention, to cause harassment and prejudice to the opposite party, which is a company of long standing and high repute, and to extract money from it without just cause or valid reason. The opposite party Company has been induced to issue the policy vide a very well planned conspiracy. The subject matter for the above policy itself is proved to be initiated by fraudulent act and therefore, the said policy is declared void by the opposite party Company, and consequently, no benefit or amount under the said policy becomes payable, as the applicant is guilty of suggesto vari supresso falsi. This commission has no jurisdiction to entertain the present application. The applicant has failed to demonstrate any deficiency in service on the part of the opposite party. In the present case, the opposite party has strictly acted as per the terms and conditions of the policy contract. The terms of the policy are in the nature of a contract and their interpretation has to be made in accordance with the strict construction of the contract. The opposite party has denied the other contents of the complaint and prayed for dismissal of the same. Alongwith the written version, the opposite parties have placed on record affidavit of Sandeep Kumar alongwith docuemnts Ex. OPO1/1 to Ex. OP1/11.
3 We have heard the Ld. counsel for the complainant and opposite party and have carefully gone through the record placed on the file.
4 In the present case, according to complainant, Kedeep Singh has availed insurance from the opposite party and Kedeep Singh has since died and after his death, the complainant is entitled to his insurance claim. But on the other hands, according to opposite parties Policy bearing number 501- 8130806 is an outcome of a fraud which has been played on opposite party Company. The identity of the Life Assured is disputed and the mere existence of the Assured can also not be ascertained. Even the alleged date of death of the Life assured is disputed. The investigation which was necessitated because of various frauds being committed on the insurance companies and examined the matter in detail and possessed evidences which establish that there is dispute with respect to the identity of the assured and his mere existence. The opposite party was misled to issue the aforesaid policy on the life of the alleged Mr. Kedeep Singh. Furthermore, the policy was acquired through forged documents and by a well planned criminal conspiracy involving various individuals including the present applicant. This commission has no jurisdiction to entertain the present complaint. Moreover, the opposite party has appointed the investigator and the revealed the following facts
1 The proposal form and other documents purportedly bearing signatures of the Life to be insured were fraudulently submitted at the proposal stage.
2 The Death Certificate Submitted at the claims stage has been proposed to be cancelled.
3 Municipal Councilor Ram Lal gave a statement that he was mislead to issue the document for issuance of death certificate. He has also recommended cancellation of the Death Certificate as no person by the name of Kedeep had ever died or existed in Village Goindwal.
4 The Multipurpose Health worker of ESI Dispensary Goindwal Sahib also gave a statement and Certified that Kuldeep Singh S/o Jeet SinghR/o Phase 2, Fatehabad Road Shri Goidwal Sahib Tarn Taran does not exist in the village. There is no record/entry registered in the name of Kedeep Singh declaring him dead.
5 The Angarwari Worker Mandeep Kaur Kang also certified that Kuldeep Singh S/o Jeet SinghR/o Phase 2, Fatehabad Road Shri Goidwal Sahib Tarn Taran was not a resident of the village and there is no entry of his death in the survey record register.
6 Investigation revealed Nexus Involvement and one Balhar Singh is involved in the case who is running a chain of frauds in the area.
7 This is suspected to be fake case of death and impersonation. No Record was found in the Cremation Ground. Nor any record was found in the register of the Local Gurudawara as confirmed by Gurudwara In-Charge Mr. Satnam Singh.
8 The Local People did not know the life assured Neighbors denied the existence of any such person Various local people such as Mr. Mohit, Mr. Sukhpal Singh, Mr Mohan Singh and Mr. Rajendra Singh who have been residents of the area for 10-20 years confirmed that there is no Kedeep Singh or Rachna Rani the complainant.
9 No medical documents were provided to prove that the LA died of Heart Attack.
10 Various other discrepancies were found.
The opposite party has placed on record report of investigator Ex. OPs 1/11. In the report of investigator he gave overall remarks and concluded that during Investigation Investigator found that this a case is Negative. Investigator visit LA's address but address not Confirmed because no one is living on this address, Investigator met with Neighbours and local people and they give verbal statement which are mentioned in the report. Investigator found that Mr. Balkhar Singh is involved in this case who run the chain of fraud in this area. After that our executive visited to LA's house location and found that local Nexus involved in this case who run a chain of fraud. So we are sending this case to Sarpanch of this location and verified the information because previous case of Mr. Prem Singh, Kuldeep Singh and Balwinder Singh look out by her. Investigator also visited to Branch o PNB and met with Branch manager Mr. Harvendra Singh (7527001763), he told that this account opened by his Employee Mr. Mohit (PNB Met Life) and only one transaction done by this account till now, and this policy was login from Mukhtsar District where DC was issued. and when he opened this account, phone number-9592908790 number was mentioned and this number is wrong and Mr. Harvendra Singh also told that he already lodged a complaint on the name of Mr. Mohit dated 04/10/2018 for forgery. After that Investigator visited to Gurudwara and according to Sikh customs after the funeral of the person's dead body, his ashes are taken to the Gurudwara and after that, the death of that date is mentioned in the record and which is sent to the Municipal Commission and becomes a DC. So, when investigator visited there and met with Gurudwara in-charge Mr. Satnaam Singh (9878513313), He provided death register in that Mr. Kedeep Singh name was not mention and he also confirmed that No one in the name of Kedeep Singh died there. After that investigator called on to provide nominee number and one person picked the call and he asked to come to Firozpur District and meet there so Investigator visited there and that person provide all KYC of LA and Nominee. This person was belonging to nexus. He also given observation that we also checked in the Bank that this account only open for forgery because when they opened this account and in 2 days, they login the policy and in this account, LA was unmarried and within 2 days when they login this policy, they mention status married in policy details how that possible within 2 days marital status has been changed. LA was mentioned Agriculture occupation in Bank account and income below 60 K PA and according to nominee statement LA income was 2-2.5 LAC PA and in the policy, proposal form LA mentioned Dairy farm occupation and income mentioned 3 Lac Pa, all details are mismatched. Request the company to take a call based on the available report. As such, according to opposite party fraud has been committed in the present case upon the opposite party. But on other hands, according to complainant, his case is genuine. Now in the present case, during post investigation, the identity of insured is not established. Now the point involved in the present case, as to whether, Kedeep Singh life assured has validly taken the insurance policy or not ? Whether, Kedeep Singh was residing on the given addresses or not ? Whether, the complainant alongwith others has made fraud with the insurance company or not ? detailed 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.”
5 In view of above discussion, the instant complaint is relegated to the Civil Court for deciding the matter in accordance with law. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Commission and due to COVID-19. Copies of the order be furnished to the parties as per rules. File is ordered to be consigned to the record room.
Announced in Open Commission.
07.03.2024
