Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. : 33
Instituted on : 24.01.2018
Decided on : 05.07.2022
- Bale Ram s/o Sh. Lakhi Ram aged-57 years.
- Smt. Parkashi Devi w/o Bale Ram aged-51 years
Both rs/o H.No. 366/2, Ward No. 21, Basant Vihar Colony, Ladhot Road, Rohtak, Distt. Rohtak.
......................Complainant.
Vs.
- Bharti AXA Life Insurance Co. Ltd.,
Through its Managing Director, Regd. & Head Office, Unit 601 & 602, 6th Floor, Raheja Titanium, off Western Express Highway, Goregoan(E) Mumbai-400063(Maharashtra).
Service may please be affected through its office situated at Distt. Rohtak(by respondent No. 2.)
- Branch Office of Bharti AXA Life Insurance Co. Ltd Rohtak Branch. Through its Branch Manager, 105/30, above Jockey Showroom, D-Park, Opp. Hotel Tandoori Nights, Main Delhi Road, Rohtak. Distt. Rohtak.
- Sh. Mukesh Kumar, Advisor(Advisor Code:163947) to the Bharti AXA Life Insurance Co. Ltd. Rohtak Branch. Through its Branch Manager,105/30,above Jockey Showroom, D-Park, Opp. Hotel Tandoori Nights, Main Delhi Road, Rohtak. Distt. Rohtak.
(Service to respondent/OP No. 3, is to be effected through respondent No.2.)
...........…….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
DR. SHYAM LAL, MEMBER
Present: Sh.R.S.Rajain, Advocate for the complainant.
Sh. Rajesh Sharma, Advocate for opposite party No. 1 and 2.
OP No.3 already exparte.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the present complaint, as per the complainant are that the late son of complainant namely Sh. Shiv Kumar s/o Sh. Bale Ram had got his life insured with opposite parties for a sum of Rs.6,58,482/- vide policy no. 501-3474068 dt. 14.08.2015, having policy term for 20 years with semi annual premium payment mode. The complainant has also been nominated in the said policy. Though initially Smt. Monika w/o Shiv Kumar since deceased (Life insured) was shown as nominee, however she got replaced being nominee in the policy by the life insured himself during his life time. It is further submitted by the complainant that before taking the policy, the son of the complainant was medically examined by the experienced doctors from the Insurance Co. who had given clearance certificate of fitness accordingly. It is further submitted that the life assured died on 23.01.2017 in the ordinary course of nature at his residence. Thereafter complainant applied for death claim of his son being nominee and submitted all the relevant documents to the opposite party no. 2 but instead of settling the insurance claim of the complainant, they have repudiated the genuine claim wrongly and illegally vide their letter dated 30.09.2017 alleging that “The company has been misled into issuing the policy by non disclosure of material facts in the proposal for insurance” qua applications submitted to the other insurance companies. The act of opposite parties is illegal and amounts to deficiency in service. Hence, this complaint and it is prayed that opposite parties may kindly be directed to pay the amount of insurance(Life Assured) of the policy i.e. Rs.6,58,482/- alongwith interest @18% P.A. from the date of death till realization to the complainant and also to pay compensation for causing mental agony, harassment and financial loss to the complainant as well as to pay litigation expenses to the complainant as explained in relief clause.
2. After registration of complaint, notices were issued to the opposite parties. Opposite parties no.1 & 2 in their reply has submitted that the opposite parties no. 1 & 2 believing the information given by the Life Assured in the proposal form to be true and correct in all aspects, and as per the underwriting norms of the company, issued life insurance policy to the life assured. It is further submitted that the complainant lodged death claim intimation with the opposite parties, stating that the life assured had passed away on 23.01.2017 which is less than 16 months from the date of commencement of the said policy. That careful evaluation of the records obtained during investigation conclusively established that the Life Assured had not disclosed about obtaining other life insurance policies from other insurance companies at the time of availing the policies involved in the present dispute. As per death claim investigation it was revealed that the life assured had substantial life insurance cover with the other insurance companies i.e. Birla Sun life Insurance Company, Bajaj Allianz Life Insurance Company and Reliance Life Insurance and the same was not disclosed at the application stage prior to issuance of the present policy. During investigation it also came to the knowledge of the company that the life assured was suffering from Cancer since the year 2015 and was taking treatment from Army Hospital, Delhi. . Had the company known that the life assured had not disclosed the correct details in the proposal form, then the company would have declined the proposal upfront. In view of the concealment of facts by the complainant, the company vide its letter dated 30.09.2017 had repudiated the said claim, which is legal, valid and justified and in accordance with the policy terms and conditions. All the other contents of the complaint were stated to be wrong and denied and opposite party no. 1 and 2 prayed for dismissal of complaint with costs. However, notice sent to opposite party no. 3 received back with the report of refusal and as such opposite party no. 3 was proceeded against exparte vide order dated 07.03.2018 of this Commission.
3. Ld. counsel for complainant in his evidence has tendered affidavits Ex.CW-1/A and Ex. CW-1/B, documents Ex.C-1 to Ex.C-8 and closed his evidence on dated 05.07.2018. At the time of arguments, ld. Counsel for the complainant has also tendered documents Annexure JN-A and JN-B. Ld. Counsel for opposite party no.1 & 2 has tendered affidavit Ex.OP1/A, document Ex.OP1/1 to Ex. OP1/7 and closed his evidence on dated 14.11.2018.
4. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
5. In the present case, the claim of the complainant was repudiated by the insurance company on the ground that other life insurance policies have not been disclosed by the life assured at the time of obtaining the present insurance policy before the officials of answering opposite party. The respondent has placed on record proposal form of the life assured Ex.OP1/1. This document is a computer generated document and is not been signed by the life assured at any time. Moreover one another document is also filed with this document as “Customer declaration form” Ex.OP1/2. Through this document it has been submitted by the insurance company that the proposal form was submitted online and the information has been provided by the life assured himself but the perusal of the document itself shows that signatures of the proposer have not been mentioned on this document. So it cannot be believed that information mentioned in the online proposal form were signed by the life assured himself. The other ground taken by the opposite party is that complainant had taken treatment of the disease of cancer from Army Hospital but no such document has been placed on record by the opposite party to prove that the complaint was taking cancer treatment from Army hospital. Hence the repudiation of claim is on false grounds and the opposite party is liable to pay the insurance claim to the complainant.
6. It is also on record that initially this complaint has been filed by “Bale Ram(father of deceased Shiv Kumar) w/o Sh. Lakhi Ram on dated 24.01.2018. Thereafter an amended title has been filed by the complainant on dated 14.11.2018 and the complainant no.1 is the father of deceased Shiv Kumar and another complainant is Smt. Parkhi Devi i.e. mother of deceased Shiv Kumar. Perusal of the complaint, affidavit and other relevant documents placed on record by the complainant shows that Smt. Monika is the legal wedded wife of deceased Shiv Kumar. As per pleadings made by the complainant, a mutual consent divorce has been effected between Shiv Kumar and Monika in the year 2016 in local Panchayat. So she is not entitled for any claim. It has been further pleaded that Shiv Kumar during his life time deleted the name of Monika as nominee from the policies and regarding this effect information has been given to the respondent no.3. But no such document has been placed on record by the complainant that Smt. Monika was deleted from the array of nominee from the insurance policy. Moreover no such judgment has been placed on record by the complainant regarding the divorce of Shiv Kumar and Smt. Monika. At the time of arguments, only two documents ‘Annexure JN-A and Annexure JN-B’ have been placed on record by the complainant but these are merely photocopies and are not legal documents and hence cannot be considered as an authentic documents of divorce. Hence Smt. Monika being the legal wedded wife of Shiv Kumar is also entitled for the insurance claim.
7. In view of the facts and circumstances of the case we hereby allow the complaint and direct the opposite party to pay the insurance claim of Rs.658482/-(Rupees six lac fifty eight thousand four hundred and eighty two only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 24.01.2018 till its realization and shall also pay a sum of Rs.5000/-(Rupees five thousand only) as compensation on account of deficiency in service and Rs.5000/-(Rupees five thousand only) as litigation expenses to the L.R.s of deceased i.e. 34% of the alleged awarded amount shall be disbursed to Sh.Bale Ram father of deceased Shiv Kumar, 33% to the Smt. Parkashi Devi mother of deceased and remaining 33% to Smt. Monika wife of deceased Shiv Kumar. Order shall be complied within one month from the date of decision.
8. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
05.07.2022
........................................................
Nagender Singh Kadian, President
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Tripti Pannu, Member.
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Shyam Lal, Member
