DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ROOM NO.  208 2^ND FLOOR, DISTRICT ADMINISTRATIVE COMPLEX, TARN TARAN (PUNJAB)

                              Complaint No.2/2017

                              Date of Institution: 17.1.2017.

                              Date of Order: 18.05.2017.

Davinder Singh (now deceased) through L.Rs.

1. Smt.Manjinder Kaur, wife

2. Gursahib Singh (minor son) through his mother, Smt.Manjinder Kaur, both residents of village Jhamke, Tehsil and District Tarn Taran.

……Complainants.

                                               Versus.

1. Birla Sun Life Insurance Co. Ltd. one India Bulls Centre Tower, 1, 15^th and 16^th Floor, Jupiter Mill, Compound, 841, Senapati Bapat Marg, Elphinestone Road, Mumbai.

2. Birla Sun Life Insurance Co. Ltd. Branch Tarn Taran, through its Branch Manager. 

      …….. Opposite parties.

       Complaint under Section 12 of the Consumer Protection Act, 1986.

Present: For the complainant(s):       Sh. M.P. Arora , Advocate.

    For the opposite parties:     Sh. Rajbir Singh, Advocate.

Quorum: Sh. Naveen Puri, President, Sh. Jatinder Singh Pannu, Member & Smt.

      Jaswinder Kaur, Member. 

ORDERS:

Naveen Puri, President;

           The present resolve has been in compliance to the Remand Orders dated 27.12.2016 of the honorable Pb. State Consumer Commission, Chandigarh (PSCDRC); in F A No 624 of 2016 setting aside the orders dated 19.07.2016 of this Forum in CC # 17/2016. Incidentally, the said Forum orders (of 19.07.2016) have been in compliance to the orders dated 18.01.2016 of the State Commission (PSCDRC) in FA No 1116 of 2012 setting aside the Forum’s orders of 06.06.2012 in CC No 8 of 22.02.2012. Further, for the sake of better interpretation-fidelity, the instant judicial resolve need be better perused in the light of the above referred ‘four’ orders.           

2.        The governing facts of the dispute manifesting into the present complaint that somewhat in brief are as hereunder:   

“Smt. Darshan Kaur DLI (Deceased Life Insured) during her lifetime (on 09.08.2011) had purchased the insurance policy # 005035539 with some of its pertinent features as:             i) SI (Sum Insured): Rs 4.55 Lac payable at the death of the policy holder;

ii) Nominee: Davinder Singh, the Nominee Son and also the complainant, who somehow demised during the complaint proceedings and thus has been currently represented by his legal heirs i.e., his widow and minor son;

iii) The insured Darshan Kaur (at the time of purchase of the policy, in question) did not have a standard proof of age and thus her Election Card Ex.C3 exhibiting her (the then) current age as 68 years was accepted by the insurers (may be) in its endeavor to sell policy;         

iv) The issuance of Policy in question was preceded by successful conduct of the medical examination of the insured by the insurer’s designated Medical Practitioner and somehow he had neither disapproved nor disagreed with her (insured under medical examination) declared age (68 years) vis-à-vis her apparent/ presently contested age (80 years) etc;

v) Somehow, Darshan Kaur insured had suddenly expired on 29.08.2011 i.e., just 20 days of the date of policy (09.08.2011) and thus being an instance of quick mortality, the insurers got conducted an investigation in order to settle the related death-claim;

vi) The investigation revealed that there existed two nos of other non-standard proofs of the DLI (Deceased life Insured) Darshan Kaur’s age: a) Ration Card as per which the DLI was 75 years old at the time of purchase of policy and b) Voter’s List assessing the DLI’s age as 80 years at that material point of time of purchase of policy;

vii) The insurers had finally repudiated the related death-claim Ex.C5 & Ex.C6 of 11.10.2011 and 23.12.2011, respectively; on the grounds of breach of Buyer’s agreement through the DLI’s wrong-declaration pertaining to her age, at the time of purchase of the policy;  

viii) Aggrieved at above claim-repudiation, Davinder Singh complainant filed CC # 08/2012, with this Forum who vide its orders of 06.06.2012 had relegated the matter to Civil Court on account of its ‘limitations’ for of the statutory prescribed ‘summary-procedure’;

ix) However, complainant Davinder Singh preferred the First Appeal # 1116/2012 with Punjab State Consumer Disputes Redressal Commission, Chandigarh (against the Forum’s orders of 06.06.2012) who vide its orders dated 18.01.2016 allowed the instant appeal setting aside the Forum’s impugned orders and remanding the complaint back to the Forum for disposal on merits in accordance with law;

x) The remanded complaint was registered vide CC # 17 of 2016 with the Forum and who (in compliance to the orders (18.01.2016) of honorable State Commission) did adjudicate the dispute vide its orders dated 19.07.2016 dismissing the complaint on the grounds of ‘commercial purpose’ in premium investment since the related policy fell under the ULIP (unit linked insurance policy) category;

xi) Again, the complainant feeling aggrieved at the Forum’s above orders filed the First Appeal # 624/2016 with the honorable Punjab State Consumer Commission who vide its orders dated 27.12.2016 held that the complainant has been the ‘consumer’ of the opposite party insurers since the policy in question duly covered the life of the insured in spite of its being unit linked insurance (market-investment) policy & finally remanded the complaint back to the forum for the requisite statutory resolve on merits;

xii) And, the remanded complaint has thus prompted with fresh registration no 02 of 2017 ready for subjection to the instant statutory resolve; 

3.        We have thoroughly examined the available documents/ evidence on the records so as to statutorily interpret the meaning and purpose of each document and also the scope of adverse inference on account of some documents ignored to be produced by the contesting litigants against the back-drop of the arguments as put forth by the learned counsels for their respective litigants. We find that the present dispute has arisen on account of the impugned ‘repudiation’ of the insurance death-claim pertaining to the Policy in question (by the opposite party insurers, hereinafter for short ‘the OP’) as filed by the present complainant pertaining to the ‘death-claim’ of her late (demised) mother Darshan Kaur, the DLA (deceased life assured). The complainant has also since demised and is presently represented by his legal heirs i.e., widow and minor son;

4.        We observe that the one and the only prime reason for the repudiation of the impugned 'death claim' in question has been the intentional non-disclosure/ concealment (by the DLA) of her actual age and annual income at the time of the purchase of the policy vide her ‘personal-proposal/ signed-application’ dated 03.08.2011 in the related ‘proposal for assurance’ duly accepted by the OP and the policy issued on 09.08.2011. Further, the OP vide its written reply and its supporting affidavit Ex.OP1 have alleged that the insured had filed her Election-Card in proof of her age of 67/68 years whereas her Ration Card and Voter’s List assessed her age at 75 and 80 years respectively and the same amounted to intentional non-disclosure/ suppression of factual and material information justifying the impugned repudiation.     

5.       Somehow, we have been inclined to examine the validity & legality of the impugned repudiation (of the related insurance death-claim) in the back-drop of the preceding and also the succeeding acts & events in the light of the facts on records and current law on insurance vis-à-vis consumer subject matter, in issue. We find that the related insurance policy was admittedly issued on the strength of the DLA filed Election Card that has never been a standard proof of age and presently the OP are estopped from repudiating the death-claim on the strength of Ration Card and Voter’s List which again are admittedly not the standard proofs of age and the Election Card has been suo-moto acceptable to them in spite of its not being a standard proof of age and an additional premium @ 2/1000 (on this very count) was levied and collected from the DLA while accepting the policy-proposal and issuing the policy. Again, it has never been the case of the OP that the filed proof of age has been a false, fake and/ or a doctored document. Moreover, it has been placed on records that the DLA underwent medical examinations etc before issuance of the LIP in question. And, the OP’s own designated Medical Practitioner had not observed any such vast difference of 12/13 years in the documented age and the otherwise apparent age of the DLA who has, on records, filed the same Election Card as ID proof during her medical examination. Moreover, section 45(3) of the Insurance Act, 1938 (as amended up to date) bars repudiation of Policy on account of mis-statement(s) and/or suppression of fact(s) that are within the knowledge of the insurers.  

6.       Thus, the OP have failed to produce some cogent evidence, to support its prime allegation of intentional non-disclosure/ suppression of correct ‘age’ by filing Election Card that did not exhibit her correct age and has also produced no evidence to support its allegation of ‘incorrect’ declared income. We find that the OP insurers here have arbitrarily repudiated the present claim merely on the ‘presumption’ that the DLA had knowledge of her correct age @ 80 years or so at the time of purchase of ‘insurance’ since she had demised shortly thereafter and she intentionally concealed the material information that was material to disclose. To remove all ambiguity, it may be clarified here that an ‘insurance claim’ and for that matter any ‘issue’ can be neither legally ‘favored’ nor legally ‘ousted’ on the basis of mere ‘presumption’ how strong it might appear to be. We further find that the present policy in question was purchased through the services of insures representative(s)/ agent(s) carrying their name(s)/ nos/ signature(s) on the policy and the proposal/ report(s) etc; hence it is understood that all the DLA’s information in totality was fully available in the hands of the OP insurers’ Representative(s)/Agent(s) and thus the OP are estopped from taking the plea of non-disclosure etc. The OP insurers must realize that their administrative decisions in settling insurance claims are open to judicial review and thus need be taken with due application of mind and not arbitrarily and these should also be speaking in nature duly explaining the reason and logic of the decision as to how the same has been reached. The facts in issue need be appreciated while awarding sanctity to the current applicable law.   

7.       In the matter pertaining to the present complaint and in the light of the all above, we set aside the OP’s impugned repudiation of the death claim being arbitrary (contra to laws of natural justice) and amounting to ‘deficiency in service’. Thus, we ORDER the OP insurers to pay the impugned ‘insurance claim’ in full pertaining to the related Policy in question with full accrued benefits etc if any, along with Rs.50,000/- as compensation for the undue harassment inflicted besides Rs.10,000/- as cost of litigation; within 30 days of receipt of the copy of these orders, otherwise the entire awarded amount shall attract interest @ 9 % PA from the date of  filing of the complaint till actually paid.

8.       Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.