BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMRITSAR.
Consumer Complaint No. 667 of 2015
Date of Institution: 17.11.2015
Date of Decision: 29.06.2016
Jasbir Kaur aged 38 years wife of Late Jaimal Singh Resident of House No. 302, Village Bachiwind ,Tehsil Ajnala District Amritsar
Complainant
Versus
- Birla Sun Life Insurance Company Limited, Registered Office, One Indiabulls Centre, Tower I, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai – 400013 through its Authorized Signatory/Manager/Principal Officer
- Birla Sun Life Insurance Company Limited, Branch Office, SCO 35, Ranjit Avenue, District Shopping Centre, Ist Floor, Circular Road, Amritsar through its Branch Head/Manager/Principal Officer
Opposite Parties
Complaint under section 11, 12 & 13 of the Consumer Protection Act, 1986 as amended upto date.
Present: For the Complainant: Sh.Amit Monga, Advocate
For Opposite Parties No.1 and 2: Sh.Pardeep Arora, Advocate.
Coram
Sh.S.S.Panesar, President
Ms.Kulwant Kaur Bajwa, Member
Mr.Anoop Sharma, Member
Order dictated by:
Sh.S.S. Panesar, President.
1. Sh.Jasbir Kaur has brought the instant complaint under section 11, 12 & 13 of the Consumer Protection Act, 1986 on the allegations that she is the permanent resident of house No. 302, Village Bachiwind ,Tehsil Ajnala District Amritsar. Opposite parties are dealing in Life Insurance policy and for this purpose they had spread out number of agents in the field for covering the life risks of common man. Complainant and her family members agreed to insure the life of her husband namely Jaimal Singh s/o Santa Singh through the opposite parties vide presence policy which is “BSLI WEALTH SECURE PLAN’ vide policy number 006549628. The policy was issued on the basis of application dated 10.7.2014 and policy issued on 24.7.2014. The date of maturity of the policy was fixed for 24.1.2019 (5 years) and the basic annual premium to be paid was Rs. 30,000/-. The installments were fixed semi annual and due to be paid after six months i.e. on or before January and then in July of every year and the installment premium was fixed Rs. 15000/- for 6 months and the sum assured was Rs. 13,50,000/- towards death benefits . Policy was issued in favour of Jaimal Singh , whose date of birth being 10.9.1973 and the complainant was appointed as nominee of Jaimal Singh. As such complainant is competent to file the present complaint . Copy of the policy is attached. The last installment of the policy was given at the time of issuing the policy i.e. Rs. 15000/- was paid on 10.7.2014. Copy of the receipt is attached. Before issuing the policy to the deceased Jaimal Singh, Dr. S.P.S. Randhawa of Randhawa Hospital, Amritsar conducted the complete medical examination of the deceased and submitted the report to opposite parties. After examining the report, opposite parties issued the policy to the deceased. After wards, unluckily Jaimal Singh died due to sudden heart attack on 1.8.2014 at village Bachiwind, Tehsil Ajnala, District Amritsar. Copy of the death certificate is attached. Statement of doctor confirming death is also attached. The complainant had given the required information on 29.1.2015 to opposite party No.2 regarding death of the applicant Jaimal Singh for death claim under policy No. 006549628 . All the requisite details in original i.e. death certificate, forms and information were submitted to the officials of opposite party No.2. Copy of the acknowledgement dated 29.1.2015 submitted to opposite party No.2 is attached. The officials kept mum for several months since the death of applicant Jaimal Singh and again the complainant requested the opposite party vide letter dated 11.8.2015 to settle the claim. Thereafter just in order to save their skin, opposite parties declined the genuine claim of the complainant vide letter dated 24.9.2015, copy whereof is attached. The true facts are that at the time of submitting the death claim of the deceased, complainant submitted original death certificate and receipt of Gurudwara Baoli Sahib, Sri Goindwal Sahib confirming the death of deceased to opposite parties. It clearly reflects that deceased died on 1.8.2014 and Baj Singh brother of deceased performed the last rites vide receipt No. 187 dated 5.8.2014. Complainant has sought the following reliefs vide instant complaint:-
a) Opposite parties be directed to release the sum assured of Rs. 13,50,000/- alongwith interest @ 18% p.a.
b) Compensation of Rs. 2,00,000/- alongwith Rs. 11000/- be also awarded to the complainant.
Hence, this complaint.
2. Upon notice , opposite parties appeared and contested the complaint by filing joint written statement taking certain preliminary objections therein inter alia that complaint filed by the complainant is not maintainable and is liable to be dismissed as complainant has attempted to misguide and mislead the Forum. Infact the complainant has suppressed the material facts from this Forum and as such the complaint is liable to be dismissed ; that policy in question is an outcome of a fraud which has been played on the opposite party. It is submitted that the complainant sent a claim statement dated 22.1.2015 intimating the opposite party that LA Mr.Jaimal Singh died on 1.8.2014 i.e. 8 days since policy issue date and requested the opposite parties to process the claim under the policy. But the opposite parties examined the matter in detail and possessed indisputable evidence which established that Mr.Jaimal Singh has already expired prior to signing the proposal for insurance and opposite party was misled to issue the aforesaid policy on the life of Jaimal Singh through forged documents and by a well planned criminal conspiracy involving various individuals including the present complainant and as such the present complaint is not maintainable before this Forum ; that the complainant has tried to challenge the veracity of the decision of the opposite parties to repudiate the claim. Opposite parties have 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 service. The complainant should have approached the civil courts in order to challenge the veracity of the decision of the opposite parties to repudiate the claim; that this Forum has no jurisdiction to entertain the present complaint. That in the present case there are serious issues of forgery, fabrication, criminal conspiracy, cheating, misspelling 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 only be dealth with by a civil court ; that complaint is devoid of any material particulars and has been filed merely to harass and gain undue advantage and unjustified monies from the opposite parties. It is submitted that the complaint has been filed with ulterior motive and malafide intention to cause harassment and prejudice to the answering opposite parties which is a company of long standing and high repute and to extract money from it without just cause or valid reason. It is pertinent to state that the opposite party 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 and consequently, no benefit or amount under the said policy becomes payable as the complainant is guilty of suggest vari supresso falsi ; that this Forum has no jurisdiction to entertain the present complaint. The complainant has failed to demonstrate any deficiency in service on the part of replying opposite party. Deficiency is defined under section 2(g) of the Consumer Protection Act which means any fault,imperfection, shortcoming or inadequacy in the quality, nature and manner of performance, which is required to be maintained in pursuance of a contract. In the present case, the opposite party has strictly acted as per the terms and conditions of the policy contract and has no deficiency in service can be attributed to the opposite parties ; that the complainant has not acted in good faith with respect to subject of this complaint and has approached this Forum with unclean hands, whereas it is a settled legal preposition that “one who seeks equity must come with clean hands’. Additionally, the complainant is merely the nominee under the subject policy and not the actual beneficiary of the policy proceeds. However, it is a settled principle of law that only a beneficiary falls under the definition of “consumer” within the confines of the Consumer Protection Act, 1986 ;that as per the investigation , opposite parties came to know that it was planned work executed by LA’s wife, doctors and Advisor Akshay Singh. It is pertinent to note that insurance is a contract of utmost good faith and that 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. In parawise reply, facts narrated in the complaint have been specifically denied and a prayer for dismissal of the complaint with cost was made.
3. In her bid to prove the case, Sh.Amit Monga,Adv.counsel for the complainant tendered affidavit of complainant Ex.C-1, copy of policy information Ex.C-2, copy of premium receipt Ex.C-3, copy of death certificate of Jaimal Singh Ex.C-4, copy of declaration and authorization Ex.C-5, copy of letter dated 24.9.2015 Ex.C-6, copy of letter dated 11.8.2015 Ex.C-7, copy of doctor certificate dated 3.8.2014 Ex.C-8 and closed the evidence on behalf of the complainant.
4. To rebut the aforesaid evidence Sh. Pardeep Arora,Adv.counsel for the opposite parties tendered affidavit of Ms.Kshama Priyadarshini,Senior Chief Manager Ex.OP1/A, copy of proposal form Ex.OP1, copy of claim letter Ex.OP2, copy of investigation report Ex.OP3, affidavit of Sh. Dilpreet Singh Ex.OP4 and closed the evidence on behalf of opposite parties.
5. We have heard the ld.counsel for the parties and have carefully gone through the record on the file.
6. From the appreciation of the facts and circumstances of the case, it becomes evident that life assured Jaimal Singh has obtained Life Insurance Policy , copy whereof is Ex.C-2 which was valid from 24.7.2014 to 24.1.2019 on the payment of the premium to the tune of Rs. 30000/-. Jaimal Singh life assured died on 1.8.2014, copy of the death certificate accounts for Ex.C-4. However, opposite party declined the insurance claim regarding life assured Jaimal Singh now deceased on the ground that life assured has died on 14.6.2014 i.e. prior to the issuance of the insurance policy in dispute. It is further contended that the insurance policy was void abinitio and was absolutely not enforceable in the eye of law. But in order to prove that Jaimal Singh died on 14.6.2014, opposite party has placed reliance upon the report of the surveyor/investigator, which is Ex.OP3 on record. But, however, from the perusal of the report of the investigator, there is absolutely no ground to reach the conclusion that the life assured actually died on 14.6.2014 and not on 1.8.2014. The most important evidence upon which the investigator has allegedly relied upon is the record of Baoli Sahib Gurudwara, Sri Goindwal Sahib regarding the immersion of ashes of Jaimal Singh by his brother. But, however, no such record saw the light of the day in the Forum for reaching the conclusion that the date given by the complainant regarding death of Jaimal Singh was wrong. Even otherwise also, report of the surveyor is not sacrosanct nor it was the final word on the matter. Reliance in this regard can be placed upon in New India Assurance Co.Ltd. Vs. Pradeep Kumar IV(2009) CPJ 46 (SC), wherein it has been held that Surveyor’s report is not last and final word. It is not that sacrosanct that it cannot be departed from, it is not conclusive. The approved surveyor’s report may be basis or foundation for settlement of a claim by the insurer in respect of the loss suffered by the insured but surely such report is neither binding upon the insurer nor insured.
7. Simply saying that some fraud , manipulation etc. has been pressed into service for getting the claim, cannot be a ground to dislodge the genuine claim of the complainant. Over-whelming evidence adduced by the complainant in support of her claim has gone unrebutted on record. Not even an iota of doubt arises that the death of Jaimal Singh has not taken place on 1.8.2014. Moreover, before getting the Insurance policy in dispute issued in favour of Jaimal Singh , now deceased, he was medically examined on 10.7.2014. Had Jaimal Singh actually died on 14.6.2014, there was no occasion for his medical examination to be conducted on 10.7.2014. Opposite party cannot be allowed to blow hot and cold in same breath.
8. The opposite parties have erred in repudiating the genuine claim of the complainant. It is usual with the insurance companies to show green pastures to the persons to allure them to purchase the policies & when it comes to payment of claim, they invent flimsy excuses to deny the claim. Reliance in this regard can be placed upon Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) of the Hon’ble Apex Court, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation. This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible. It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. On this point, Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 has held to the following effect:-
“It seams that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.
The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.
9. From the aforesaid discussion, it transpires that the complainant has been able to prove her case through cogent evidence. No fraud or manipulation is proved to have been indulged by the complainant regarding date of death of life assured Jaimal Singh. Consequently, the claim of the complainant succeeds and opposite parties are directed to pay insurance claim to the tune of Rs.13,50,000/- in favour of the complainant alongwith interest @ 9% p.a. from the date of filing of the claim until full and final recovery. Cost of litigation is assessed at Rs. 2000/-. Compliance of this order be made within 30 days of the receipt of copy of the order . Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum. Copies of the orders be furnished to the parties free of costs. File is ordered to be consigned to the record room.
Announced in Open Forum
Dated : 29.6.2016
