Punjab

Moga

CC/17/68

Jarnail Singh - Complainant(s)

Versus

Bharti Axa Life Insurance Co. Ltd. - Opp.Party(s)

Sh. Sukhbeer Singh

29 Jan 2018

ORDER

THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA

 

                                                                             C.C. No.68 of 2017

                                                                             Instituted on 12.07.2017

                                                                             Decided on 29.01.2018

Jarnail Singh aged about 62 years son of Kartar Singh, resident of village and Post Office Chak Kannian Kalan, District Moga (since deceased), through legal representatives:-

(i)      Kailash Kaur (daughter)

(ii)     Jagjit Singh

(iii)    Mukhtiar Singh both sons of Jarnail Singh aged about 62 years son of Kartar Singh, resident of village and post office Chak Kannian Kalan, District Moga.

....... Complainants

                                                Versus

1)      Bharti Axa Life Insurance Company Limited, Khasra 1518, 1^st Floor, opposite Santa Singh Market, Moga, through its Branch Manager.

 

2)      Bharti Axa Life Insurance Company Limited, Sector 34, Chandigarh, through its Branch Manager/Senior Branch Manager.

 

3)      Bharti Axa Life Insurance Company Limited, Grievance Redressal Cell, 8^th Floor, Times Square Building, Near Sai Service, Western Express Highway Andheri (East) Mumbai 400069, through its Chief Manager/Authorized Signatory.

 

4)      Bharti Axa Life Insurance Company Limited, Registered office: Unit 601 & 602, 6^th Floor, Raheja Titanium, off Westerm Express Highway, Goregoan (E) Mumbai, through its Manager/Chief Manager.

....... Opposite parties

 

Complaint U/s 12 of the Consumer Protection Act, 1986

 

 

Quorum     Smt. Vinod Bala, Presiding Member

                   Smt. Bhupinder Kaur, Member

 

Present        Sh. Sukhbeer Singh Ghai, Advocate Cl. for complainant.

                   Sh. Gurmeet Singh Dhaliwal, Advocate Cl. for opposite parties.

 

ORDER:

 

(Per Vinod Bala, Presiding Member)

1.                Complainant has filed the instant complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as the "Act") against Bharti Axa Life Insurance Company Limited, Khasra 1518, 1^st Floor, opposite Santa Singh Market, Moga, through its Branch Manager and others (hereinafter referred to as the opposite parties) directing them to pay Rs.5,37,706/- alongwith interest @ 18% per annum to complainant. Further they may be directed to pay Rs.50,000/- as compensation for mental harassment and Rs.11,000/- as litigation expenses to the complainant or any other relief to which the complainants are found entitled may also be granted to the complainants.

2.                Brief facts of the case are that the wife of the complainant namely Ram Kaur wife of Jarnail Singh resident of village Chak Kannian Kalan, District Moga got a Life Insurance Policy under Endowment Plan bearing no.501-2373139 for a terms of 5 years for a sum assured of Rs.5,37,706/- from opposite party no.1 and the opposite parties issued the policy bond on dated 31.08.2014 which is already submitted to the opposite parties by the complainant for death claim. The premium under the said policy was Rs.99,999/- annually and wife of the complainant paid the first premium of Rs.99,999/- on 31.08.2014. The complainant was nominee in the said policy being husband of the policy holder. The wife of the complainant i.e. policy holder died on 3.12.2014 due to Heart Attack and thereafter the complainant fulfilled all the requirements which are necessary for death claim and submitted the documents i.e. Policy bond, death claim form, medical report to opposite party no.1. The complainant received a letter dated 30.06.2016 issued by the opposite parties and was surprised to receive the said letter whereby the opposite parties stated that “The Policy holder had already expired prior to signing the Proposal for Insurance without Prejudice to what is stated above, the company is hereby rejecting the claim under the said policy since this contract entered for Insurance itself is void ab initia. However, neither policy holder nor the complainant had committed any kind of fraud with the opposite parties. The policy holder i.e. wife of the complainant expired (sudden death) after purchasing the Insurance Policy due to heart attack. Many a times, the complainant approached to the branch Manager of opposite party no.1 and requested to pay the death claim amount, on which they asked for written request and the same was given by the complainant and they assured that he will receive the death claim amount very shortly, but even passing of two years, a single penny has not been released to the complainant. Thereafter, the complainant sent a legal notice dated 8.12.2016 to opposite parties on 13.12.2016. However the opposite parties gave a vague reply to the said notice. Thereafter the opposite parties got conducted an investigation/enquiry through Additional Director General Police, Intelligence Punjab SAS Nagar which was marked to Senior Superintendent of Police Moga and the SSP Moga further marked the said enquiry to SP Investigation Moga who after conducting investigation submitted the report to SSP Moga vide letter no.81-M-R-SP(I) dated 2.3.2017 and further the SSP, Moga vide letter no.862-S dated 13.03.2017 submitted the report to Additional Director General Police, Intelligence Punjab SAS Nagar. In the thorough investigation, it is found that the wife of the complainant namely Ram Kaur (Policy Holder) has since expired on 3.12.2014. Thereafter the complainant approached the opposite parties and requested them to make the whole payment of Death Claim alongwith interest to the complainant and also submitted the aforesaid reports to the opposite parties, but the opposite parties refused to pay the death claim, hence the necessity has arisen to file the present complaint. Due to the aforesaid act and conduct of the opposite parties, the complainant has suffered a huge financial loss, mental pain, agony and was being physically and mentally harassed at the hands of opposite parties. Hence this complaint.

3.                Upon notice, opposite parties appeared through counsel and filed written reply taking certain preliminary objections 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 the Forum. In fact, the complainant has suppressed material facts from this Forum; that the policy under question i.e. policy bearing no.501-2373139 is an outcome of a fraud which has been played on the opposite party company. It is submitted that complainant sent a Claim statement dated 27.05.2016 intimating the opposite party company that the LA Mrs. Ram Kaur died on 3.12.2014 (3 Month and 4 days since policy issue date) and requested the company to process the claim under the policy. But the opposite party company examined the matter in detail and possessed indisputable evidences which establish that Mrs. Ram Kaur has already expired prior to signing the proposal for insurance and that the opposite party company was mislead to issue the aforesaid policy on the life of Mrs. Ram Kaur through forged documents and by a well planned criminal conspiracy involving various individuals including the present complainant; that the complainant has tried to challenge the veracity of the decision of the opposite party company to repudiate the claim. The opposite party company has repudiated the claim under the said policy by a speaking order, which lists out the specific reasons for the decision. By no stretch of imagination the said decision can be brought under the umbrella of ‘Deficiency in Services”. The complainant should approach the Civil Court in order to challenge the veracity of the decision of the opposite party company to repudiate the claim; that furthermore this Forum has no jurisdiction to entertain the present complaint. In the present case there are serious issues of Forgery, Fabrication, Criminal Conspiracy, Cheating, Mis-selling 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. It is clear from the facts of the case that the matter in question involves complicated questions of facts and law as well as voluminous evidence, which can be dealt with by a civil court; that the instant case there has been a deliberate attempt to defraud the opposite party company of a huge sum for which the opposite party company is contemplating to launch appropriate criminal proceedings against the complainant and other involved in the fraud in order to wrongfully obtain the subject policy from the opposite party company. The entertaining of said case would be against the principles of natural justice and this would not be in the interest of consumers of services of a life insurance company; that the complaint has been filed with ulterior motive and malafide intention, to cause harassment and prejudice to the answering opposite parties. That 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 complainant is guilty of suggesto vari supresso falsi; that this Forum has no jurisdiction to entertain the present complaint. In the present case, the opposite parties have strictly acted as per the terms and conditions of the policy contract. That 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 Forum cannot pass any order in contravention to the terms and conditions of the policy contract; that the complainant has not acted in good faith with respect to subject of this complaint and has approached the Forum with unclean hands. Additionally, the complainant is merely nominee under the subject policy and not the actual beneficiary of the policy proceeds. However, it is a settled principled of law that only a beneficiary falls under the definition of “Consumer” within the confines of the Consumer Protection Act, 1986. As per the investigation, it came to notice that it was planned work executed by the complainant who is also the proposer under the policy, Advisor/Agent and other individuals. The contract of insurance is based on the Doctrine of Uberrimae Fide and even if any due diligence is done by the insurance company, it does not change the basic element of an insurance contract. It has been also found that the incorrect income details of the Deceased were mentioned in the proposal form which clearly proves that there is a clear attempt to defraud the opposite party company; that the complainant has sought a relief from this Forum which he is not entitled to get under the terms and conditions of the subjected life insurance policy; that there is no deficiency in service rendered by answering opposite parties in the present case and the answering opposite parties are not a necessary or a proper party to the present dispute, accordingly present complaint ought to be dismissed against the answering opposite parties. The complaint being frivolous and vexatious is liable to be dismissed under section 26 of Consumer Protection Act.

                   In parawise reply, all other allegations made in the complaint have been denied and a prayer for dismissal of the complaint with costs has been made.

4.                In order to prove the case, counsel for complainant tendered in evidence duly sworn affidavit of Sh. Mukhtiar Singh s/o Jarnail Singh as Ex.C-1 and copies of documents Ex.C-2 to Ex.C-24 and closed the evidence.

5.                On the other hand, opposite parties tendered in evidence affidavit of Sh.Sachin Kalra, Vice President Legal Ex.OPs-1 and copies of documents Ex.OPs-2 to Ex.OPs-6 and closed the evidence.

6.                We have heard ld. counsel for the parties and have very carefully gone through record placed on file.

7.                Ld. counsel for complainant argued that the wife of the complainant namely Ram Kaur got a Life Insurance Policy under Endowment Plan for a terms of 5 years for a sum assured of Rs.5,37,706/- from opposite parties and the opposite parties issued the policy bond on dated 31.08.2014. The premium under the said policy was Rs.99,999/- annually. The wife of the complainant duly paid the first premium. The complainant was the nominee in the said policy being husband of the policy holder. The life assured died on 3.12.2014 due to Heart Attack. After the death of life assured, the complainant Jarnail Singh lodged the claim with opposite parties for the release of sum assured, after complying with the procedure laid down by the opposite party company. However opposite parties rejected the claim of the complainant, which was intimated to complainant vide letter dated 30.06.2016 on the ground that the Policy holder had already expired prior to signing the Proposal for Insurance. The policy holder i.e. wife of the complainant expired (sudden death) after purchasing the Insurance Policy due to heart attack. Many a times, the complainant approached to opposite parties and requested for the death claim amount, but to no effect. The complainant also sent a legal notice dated 8.12.2016 to opposite parties. However the opposite parties gave a vague reply to the said notice. Thereafter the opposite parties got conducted an investigation/enquiry through Additional Director General Police, Intelligence Punjab SAS Nagar and in the thorough investigation, it is found that the wife of the complainant namely Ram Kaur (Policy Holder) has since expired on 3.12.2014. The opposite parties illegally rejected the genuine claim of the complainant on flimsy grounds.

8.                On the other hand, ld counsel for opposite parties argued that Smt. Ram Kaur had died  before the issue of insurance policy in dispute and as such, on concluded contract took place interse Ram Kuar and Insurance Company. The opposite party company examined the matter in detail and possessed indisputable evidences which establish that Mrs. Ram Kaur has already expired prior to signing the proposal for insurance and that the opposite parties were mislead to issue the aforesaid policy through forged documents. As a matter of fact the complainant got the formalities regarding the filling of the proposal form completed by impersonation. Since, it was the case of fraud and misrepresentation, therefore no concluded contract of the insurance was executed interse insured and the insurer. As such, the opposite party was justified in declining the claim of the complainant. Learned counsel for opposite parties has further contended that this Forum has got no jurisdiction to entertain the complaint, as the complaint contains intricate and vexed questions of law and facts and the proceeding of the Forum being summary in nature, the instant complaint is liable to be dismissed on this score alone. It is therefore contended that the complaint is liable to be dismissed and the same may be dismissed with cost.

9.                There is no denying the fact that Smt. Ram Kaur got herself insured with opposite parties vide policy no.501-2373139 on 31.08.14 for an amount of Rs.5,37,706/-. It is also admitted that the life insured paid the first premium of the insurance policy. It is proved on record that life assured Smt. Ram Kaur died on 03.12.2014, copy of the death certificate Ex.C-3 is on record. The contention that Smt.Ram Kaur died before the issue of insurance policy is not proved on record, because the death certificate contains the date of death to be 03.12.2014. The intimation regarding the death of Ram Kaur was duly given to the authorities concerned. Even the investigation conducted by the investigator of the opposite parties has failed to bring any contrary evidence on record that Smt.Ram Kaur had died prior to 03.12.2014. Rather the evidence collected by the investigator shows that Smt.Ram Kaur died on 03.12.2014 on account of heart attack. Furthermore from the investigation got conducted by opposite parties through Additional Director General Police, Intelligence Punjab SAS Nagar which was marked to Senior Superintendent of Police Moga and the SSP Moga further marked the said enquiry to SP Investigation Moga and  who after conducting investigation submitted the report to SSP Moga vide letter no.81-M-R-SP(I) dated 2.3.2017 and further the SSP, Moga vide letter no.862-S dated 13.03.2017 submitted the report to Additional Director General Police, Intelligence Punjab SAS Nagar it is clear that the wife of the complainant namely Ram Kaur (Policy Holder) expired on 3.12.2014, copies of which are Ex.C-12 and Ex-C-13 on record. In such a situation, the plea of fraud and misrepresentation coined by the opposite parties appears to be concocted one and it has no legal semblance. It is usual on the part of the insurance companies to decline the claim on false and flimsy grounds. But at the time of getting the insurance premium, they show all sorts of green pastures to the clients. Reliance in this regard can be had on National Insurance Company Limited, Gurgaon versus Ravi Dutt Sharma & another, Civil Writ Petition no.9716 of 2011- (2011(3) RCR (Civil) page 631 decided by Hon'ble Punjab & Haryana High Court, wherein, it has been observed as under:-

"Insurance Companies, in my view, are not acting fairly in all such matters after charging huge premium. Intention is always to repudiate the claim on one ground or the other. The conditions of the Insurance agreements are so minutely printed that person gets hardly any time to go through such conditions to make it legally binding in any appropriate manner."

 

                   From the aforesaid discussion, it is transpires that the opposite parties has not acted fairly in declining the rightful claim of the complainant. The claim of the complainant has been thrown out without assigning any legal or reasonable cause. The opposite parties are deficient in service. The contention that this Forum has no jurisdiction to entertain the instant complaint is also not tenable, because merely mentioning that some fraud or misrepresentation has taken place at the time of entering the agreement of insurance will not oust the jurisdiction of District Forum, particularly when, there is no evidence to support such an allegation. Even otherwise also District Forum has sufficient powers to entertain and look into the plea of fraud and misrepresentation on the basis of pleadings as well as evidence on record. Since there is nothing on record to substantiate the allegations of fraud and misrepresentation on the part of the insured, the plea raised by the opposite parties falls to the ground. As such, we hold that the complainant is entitled to get the assured amount under the insurance policy being her nominee.

10.              Consequently, the instant complaint succeeds. As during the pendency of the complaint, complainant Jarnail Singh died, so the opposite parties are directed to release the amount of Rs.5,37,706/- on the basis of the policy no.501-2373139 in favour of legal heirs of the complainant Jarnail Singh in equal share, , within 30 days of passing of this order. Opposite parties are further directed to pay Rs.5000/-(Five thousand only) on account of damages, mental and physical harassment to the legal heirs of the complainant. The complaint stands allowed accordingly. If the compliance of the order is not made within stipulated period, legal heirs of complainant Jarnail singh shall also be entitled to interest @ 6% per annum on the awarded amount from the date of pronouncement of the order till realisation. Copies of the order be sent to the parties free of cost immediately and thereafter the file be consigned to the record room.

Announced in Open Forum.

Dated: 29.01.2018.

 

                                       (Bhupinder Kaur)                             (Vinod Bala)

                                          Member                                 Presiding Member