Sh.Amrinder Singh Sidhu, President
1. This complaint has been received by this District Consumer Commission, Moga on 03.04.2018 by remand from Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh vide its order dated 13.02.2018 with the directions that the District Forum (Now District Consumer Commission) has the jurisdiction to entertain the complaint and on the basis of evidence led by the parties, it should be decided on merits including opportunity to the parties to lead additional evidence, if so required.
2. Brief facts of the case are that the complainant has filed the instant complaint under section 12 of the Consumer Protection Act, 1986 (as amended upto date) on the allegations that the father of the complainant i.e. Inder Singh (here-in-after referred to as ‘Life Assured’) had applied for life insurance on 21.03.2012 with the Opposite Parties-Birla Sun Life while opting BSLI Vision Plan policy and accordingly the Life Assured got insured vide policy no.005468334 for a sum of Rs.9,81,500/- for a pay term of 19 years. The premium was fixed at basic premium @ Rs. 68,014/- and policy premium of Rs.34,007/- to be paid half yearly in a period of 19 years. The Life Assured had appointed his daughter (complainant) as his nominee. The life assured duly paid his 1st premium. Unfortunately, Life Assured died due to Heart Failure on 04.07.2012. The Complainant alleges that the Life Assured was leading perfectly healthy and normal life prior to his death. The factum of the said death was duly registered with the Registrar Births & Death, Punjab. After the death of life assured, the complainant lodged the claim with opposite parties through its Moga Branch office for the release of sum assured and also complied with the procedure as required by the Opposite Parties and also completed all the formalities while supplying the entire documents to the Opposite Parties. Thereafter, the Complainant made so many visits to the office of the Opposite Parties for the payment of insurance claim of her father, but initially, the officials lingered on the matter on one pretext or the other, but on last, they refused to admit the rightful claim of the Complainant. It is pertinent to mention here that complainant earlier filed an application before Permanent Lok Adalat at Moga for the redressal of her grievances, but the said application has been dismissed in default due to non appearance of the complainant and the matter was not decided by Permanent Lok Adalat on merits and hence, this Hon’ble District Consumer Commission has jurisdiction to entertain and decide the present complaint as there is deficiency in service on the part of the Opposite Parties. Vide instant complaint, the complainant has sought the following relief.
a) The Opposite Parties may be directed to release the insured amount of the Life Assured alongwith interest @ 18% per annum from the date of death of Life Assured.
b) The amount of Rs.50,000/- may also be awarded to the Complainant on account of compensation due to mental tension and harassment.
c) And any other relief to which this Hon’ble Consumer Commission, Moga may deem fit be granted in the interest of justice and equity.
Hence, this complaint.
3. Upon notice, opposite parties appeared through counsel and contested the complaint by filing written reply taking certain preliminary objections therein inter alia that the complaint is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead this District Consumer Commission; that the present complaint is false, frivolous and vexatious and is gross misuse of process of law; that the complainant has not approached this District Consumer Commission with clean hands; that this District Consumer Commission has no jurisdiction to entertain the present complaint; that the present complaint is barred by limitation because the life assured i.e. Inder Singh died on 4.7.2012, the cause of action, if any arose to the complainant to file the present complaint on the death of the life assured and the same continued for 2 years from the date of death of the life assured, whereas, the present complaint has been filed in July/August 2016. So much so that death claim was lodged to the opposite parties after 3 years from the date of death; that the complainant has created a false story in her complaint to mislead this District Consumer Commission by concocting and distorting the facts and circumstances of the present case. Further alleges that in fact, Inder Singh, Life Assured had submitted a proposal/application dated 21.03.2012 to the Opposite Parties for the purchase of BSLI Vision Plan and said proposal was accepted on the standard rates based on the information provided by the Life Assured and consequently a policy in question was issued on 31.03.2012 and the same commenced on even date. The policy term was 49 years, pay term was 19 years, basic premium was Rs.33,999/- (under semi-annual mode of premium payment) with policy premium as Rs.68,014/- (annually). The complainant i.e. Paramjit Kaur was appointed as a nominee in the policy and total sum assured was Rs.7,70,000/-. After understanding all the terms and conditions of the policy, the proposal form was signed by the DLA to that effect. On the basis of the information furnished in the application/proposal form, the proposal was processed by the opposite parties and thereafter the said policy was issued to the DLA. The policy bond was sent on 18.04.2012 via Blue Dart at the registered address of the policyholder on 23.04.2012. The applicant had also signed a Benefit illustration after fully understanding the terms and conditions of the policy. The opposite parties after receipt of duly filled proposal form alongwith other requisite documents and the amount of first semi-annual premium deposit had issued the subject policy. A copy of the proposal form was sent to policy holder alongwith the policy document. The claim under the policy is an outcome of a fraud which has been played upon the Opposite Parties. Thereafter, the Opposite Parties received death claim intimation dated 12.07.2013 stating that the Life Assured, Inder Singh has expired on 04.07.2012. It is to be noted that the Life Assured Inder Singh has expired within 3 months & 3 days from the issuance of the policy. After receiving the death claim of the DLA and being an early claim, the claim was investigated and it was revealed that the Deceased life assured was an illiterate person and his age was about 73 years at the time of signing of proposal form. At the time of issuance of the policy, the Life Assured had submitted ration card in which his date of birth was mentioned as 01.11.1960 making him to be of 52 years of age at the proposal stage. However, at the time of investigation voter list was procured wherein the age of the Life Assured was stated to be 73 years of age as on 2012 i.e. making the DLA beyond the insurable age at the proposal stage. The actual facts regarding the age of the DLA was re-verified by the opposite parties by visiting the house of the life assured. The Investigator Manager got the copy of the application form submitted by the deceased life assured to get the Ration Card and the said application form was thumb marked. Further in the voter list of year 2012, the age of the deceased life assured was mentioned as 73 years at the time of applying for the said policy i.e. in the year 2012. It is pertinent to note herein that said policy plan is given to a person with a maximum age of 65 years only. Hence, the opposite parties were satisfied to the effect that the disclosed age of the deceased life assured in the proposal form was false. There was a breach of one of the basic principles of life insurance contract which is 'utmost good faith'. Hence, there was no alternative for the opposite parties except to repudiate the claim of the complainant. Moreover, during the investigation, it was revealed that the life assured was an illiterate person. In the proposal form the life assured has affixed his signatures, but in application of issuance of the Ration card, it bears the thumb impression of the life assured. The said facts questionable that a person who put thumb impression in the form for ration card can sign a proposal form for the issuance of the policy. It has further come to light that in the Medical Attendant Certificate submitted by the complainant with the answering opposite parties for processing the death claim, only name of the Doctor has been mentioned as Surinder Singh, B.M.P. and despite the fact that there is column of address, contact number, Mobile Number, e-mail address and signature also, but all the said fields have deliberately been left blank. From all this, it can be well transpired that there has been a conspiracy which has been hatched by the deceased life assured initially. It is worthwhile to mention that the LA has signed a declaration wherein, he declared that:-
“I (we) understand and agree that completion of this application and addendum, if any, in no way implies that a policy for insurance on the life to be insured will be issued by BSLI.
I(we) hereby declare that the contents of this application and addendum, if any, for insurance have been fully explained to me and I have fully understood the significance of the proposed contract of insurance.".
The aforesaid facts clearly reveals that the policy in question was not only obtained by filing fake and fraudulent document, but was an intention attempt to defraud the Opposite Parties. It is further alleged that it is quite evident that the life assured was fully aware of the facts that he is making a false statement in the proposal form while mentioning his date of birth as 01.11.1960 when in fact he was far older than the date of birth mentioned by him in the proposal form. Since disputed questions of facts are involved in the present complaint which can only be decided by the Civil Court after leading cogent evidence, therefore, the present complaint is not maintainable and this Forum does not have the jurisdiction to try and decide the present complaint; that the present complainant has not disclosed true and correct facts and the complainant is guilty of suppressing material particulars which should have been disclosed for just and proper decision of the case; that the complaint filed by the complainant is not maintainable as it is not filed within the statutory period of two years as provided in Section 24A of the Consumer Protection Act, 1986. On merits, all other allegations made in the complaint have been denied and a prayer for dismissal of the complaint with heavy costs has been made.
4. In order to prove her case, complainant tendered in evidence her duly sworn affidavit Ex. C-1 alongwith copies of documents Ex.C-2 to Ex.C-5 and closed her evidence.
5. On the other hand, opposite parties tendered into evidence affidavit of Ms. Kshama Priyadarshini, Chief Manager- Legal Ex.OP-1, 2/1 and witness Sh. Simranjeet Singh, Clerk, Tehsil Office Bhulath, District Kapurthala as Ex.RW-1 and copies of documents Ex.OP-1, 2/2 to Ex.OP-1, 2/8 and Ex.RW1/A and B and closed the evidence.
6. Further, as per the directions of Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh vide its order dated 13.02.2018, numerous opportunities were granted to both the parties to lead their respective additional evidence, if any. But both the parties did not tender any more evidence and rather made their statements before this District Consumer Commission that their previous evidence may be read as evidence and accordingly, closed their respective evidence.
7. We have heard ld. counsel for the parties and have very carefully gone through record placed on file.
8. During the course of arguments, Ld.counsel for the complainant has mainly reiterated the facts as narrated in the complaint and contended that the father of the Complainant namely Inder Singh purchased a life insurance policy from opposite parties and paid requisite premium for it. In that insurance policy, the complainant was appointed as nominee. Unfortunately, the father of the Complainant died during the policy period and after the death of her father, she lodged the claim with opposite parties alongwith death claim of her father, but the opposite parties did not pay the insurance amount to her.
9. On the other hand, Ld.counsel for opposite parties has repelled he aforesaid contention of the ld.counsel for the Complainant and contended that admittedly the father of the complainant had purchased an insurance policy from the Opposite Parties, but at the time of purchase of policy, he suppressed and concealed the material facts regarding his age and given wrong information in the proposal form. So, after lodging of claim, the opposite parties appointed investigator to investigate the claim of complainant and after thorough investigation, it has come into the notice of opposite parties that at the time of insurance, insured concealed true facts from opposite parties and stated his wrong age in the proposal form. Moreover, the Complainant has lodged the claim after the period of limitation and since disputed questions of facts are involved in the present complaint which can only be decided by the Civil Court after leading cogent evidence, therefore, the present complaint is not maintainable before this District Consumer Commission and this District Consumer Commission has no jurisdiction to try and decide the present complaint. As such, the claim of the complainant was repudiated as per terms and conditions of the policy.
10. There are three points on which the Opposite Parties have repudiated the claim of the Complainant.
a) This District Consumer Commission has got no jurisdiction to entertain and decide the present complaint since disputed questions of facts are involved in the present complaint which can only be decided by the Civil Court after leading cogent evidence
b) The Life Assured/ Inder Singh has concealed his date of birth and wrongly mentioned his date of birth and there is different in his date of birth in ‘ration card’ and ‘voter list’ and wrongly mentioned less age while purchasing the policy in question and hence, there is breach of terms of the policy.
c) The Complainant has filed the instant complaint beyond the period of limitation.
11. It is not disputed that the Life Assured-Inder Singh had purchased the policy bearing No. 005468334 vide application No. A46269899 with commence date 31.03.2012 having policy plan: BSLI Vision Plan-GSB Pay-19 and the Complainant-Paramjit Kaur is his nominee and it is also not disputed that the gross annual premium was Rs.68,104/- with total sum assured Rs.7,70,000/- and the Opposite Parties received Rs.32,551.16 paisa, which is duly mentioned by the Opposite Parties itself in its reply as well as in the sworn affidavit of Ms.Kshama Priyadarshini Chief Manager-Legal Ex.Ops1 &2/1.
12. First of all, the Consumer Fora/ Commission has fullest jurisdiction to settle the disputes relating to complicated questions of facts, as per law laid down in case Bharat Sanchar Nigam Limited (BSNL) and another vs. M.D. Imtiyaz-IV (2014) CPJ- 25 (Meghalaya State Consumer Disputes Redressal Commission). So, certainly this District Consumer Commission has jurisdiction to decide the matter in question.
13. The second plea of the Opposite Parties is that that Complainant has lodged the claim with them after the period of limitation, but as per our opinion, there is no ground to decline the genuine claim of the claimant on this sole ground. Reliance in this connection can be had on National Insurance Company Limited versus Kamal Singhal IV (2010) CPJ297 (NC) wherein the Hon'ble National Consumer Disputes Redressal Commission, New Delhi relying upon various decisions in the matter of (1) National Insurance Company Ltd. v. J. P. Leasing & Finance Pvt. Ltd. (RP No. 643/2005), (2) Punjab Chemical Agency v. National Insurance Company Ltd. (RP No. 2097/2009), (3) New India Assurance Co. Ltd. v. Bahrati Rajiv Bankar, (RP) No. 3294/2009) and (4) National Insurance Company Ltd. v. Jeetmal, (RP No.3366/2009) and also judgment of the Hon'ble Apex Court in the matter of Insurance Company Versus Nitin Khandewal IV (2008) CPJ 1(SC..
14. Third plea raised by the Opposite Parties while repudiating the claim of the Complainant is that there is breach of terms of conditions as the Life Assured has concealed his age at the time of purchasing the policy. It is not disputed that Life Assured was an illiterate person and he thumb marked the documents at the time of filling the proposal form with the Opposite Parties and he may have mentioned the wrong date of birth. The contention of the ld.counsel for the Opposite Parties is that there is difference of date of birth of Life Assured in Ration Card as well as Voter Card. In this regard, ld.counsel for the Opposite Parties has relied upon the judgement in similar matter titled as DLF Premerica Life Insurance Vs. Buharh Singh, in First Appeal No. 695 of 2015 decided on 27.01.2017, in which Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh has held that the voter list is not a conclusive proof of the date of birth and this point is not res integra. In this regard, Hon’ble National Commission has held in Life Insurance Corporation of India and another versus Gopal Singh, reported in 2011(2) CPJ (NC) 7 that in the matter of suppression of material facts regarding date of birth, the assured while filing the proposal form gave his date of birth incorrectly on the basis of voter list, as contended by the insured. The contention is not acceptable. The relevant para of the judgement is reproduced as under:-
8. Now, we are confronted with this point, as to whether the voter list is conclusive proof of the date of birth or not. The point is not res integra. The National Commission has held in Life Insurance Corporation of India and another versus Gopal Singh, reported in 2011(2) CPJ (NC) 7 that in the matter of suppression of material facts regarding date of birth, the assured while filing the proposal form gave his date of birth incorrectly on the basis of voter list, as contended by the insured. The contention is not acceptable to us. Age given in voter list can not be taken as sure test to determine exact age of a person. It is common knowledge that frequently small mistakes with regard to residence, age, parentage, do occur while preparing voter list. There is no conclusive evidence on the record to reveal that assured had mentioned his age incorrectly with malafide intention with any ulterior motive. In the absence of any conclusive evidence on the record, it would be assumed that assured had correctly mentioned his age in proposal form. In view of this observation recorded by National Commission, we are bound to hold that voter list is not sure test to determine the exact age of a person. No birth certificate, passport or educational testimonial of insured has been produced on the record by OP to prove this fact that he intentionally gave the wrong date of birth in the proposal form to take the benefit of the insurance policy. The mistake in preparing voter list can occur at various stages at the time of collecting information and transmitting the same to the printing press or in the printing press itself. This is not conclusive to hold that assured mentioned his date in the proposal form wrongly. Reliance of appellant on law laid down by Hon'ble Supreme Court in case titled as Satwant Kaur Sandhu versus New India Assurance Company in Civil Appeal no. 2776 of 2002 decided on 10.07.2009 would not be applicable in this case, in view of our finding as recorded at above because no material facts affecting the validity of the policy has been concealed by the assured.
9. As a result of our above discussion and on the basis of law laid down by National Commission in above authority, we find no illegality or material infirmity in the order of the District Forum and same is affirmed in this appeal and appeal of the appellant is hereby dismissed.”
15. Furthermore, no insurance company can deny the claim of the life assured in toto after issuance of insurance policy, on account of breach of terms and conditions, if any. It does not matter if the insured (who is an illiterate person) hide any material information or committed fraud regarding his age at the time of filling the proposal. The insurance company must pay. They have no recourse. The onus is on the insurance company find out any irregularity in the information shared by the life assured. In this regard, for arguments sake it is admitted that the Life Assured has concealed the factum regarding his age, even then the Insurance Company ought to have settled the claim of the complainant on “non standard basis” even if some of the conditions of the insurance policy are not adhered by the insured. In this regard, we rely upon the case titled National Insurance Company Limited versus Kamal Singhal IV (2010)CPJ297 (NC) wherein the Hon'ble National Consumer Disputes Redressal Commission, New Delhi relying upon various decisions of the National Consumer Disputes Redressal Commission in the matter of (1) National Insurance Company Ltd. v. J. P. Leasing & Finance Pvt. Ltd. (RP No. 643/2005), (2) Punjab Chemical Agency v. National Insurance Company Ltd. (RP No. 2097/2009), (3) New India Assurance Co. Ltd. v. Bahrati Rajiv Bankar, (RP) No. 3294/2009) and (4) National Insurance Company Ltd. v. Jeetmal, (RP No.3366/2009) and also judgment of the Hon'ble Apex Court in the matter of Insurance Company Versus Nitin Khandewal IV (2008) CPJ 1(SC), wherein Hon'ble Apex Court held in the matter of deciding the claim, breach of condition of the policy was not germane and also held further that : “ the appellant Insurance Company is liable to indemnify the owner of the vehicle when the insurer has obtained comprehensive policy to the loss caused to the insurer”. The Hon'ble Supreme Court has further held that; “even assuming that there was a breach of policy, the appellant Insurance Company ought to have settled the claim on “non-standard basis.” Hon'ble Apex Court in back drop of these features, in these cases, allowed 70% of the claim of the claimant on the “non-standard basis”. This view was again reiterated by the Hon'ble Apex Court in the matter of Amalendu Sahoo versus Oriental Insurance Company Limited. II(2010) CPJ 9(SC)=II (2010)SLT 672. Hon'ble National Commission in the case National Insurance Company Limited versus Kamal Singhal referred to above relying upon the law laid down by the Hon'ble Supreme Court has held that;
“there being a long line of decisions on this score, we have no option but to uphold the finding of Fora below with modification that the claim be settled on 'non-standard' basis”, in terms of the guidelines issued by the Insurance Company. In case petitioner company fails to carry out the direction contained therein, the amount payable on 'non-standard' basis, shall carry interest @ 6% p.a from the date of expiry of six weeks till the date of actual payment”.
16. In such a situation, the repudiation made by Opposite Party regarding genuine claim of the complainant appears to have been made without application of mind. It is usual with the insurance company to show all types of green pesters to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, 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. In similar set of facts the 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 went on to hold as under:-
“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.
17. Having regard to the position of the law, as has been laid down by the Hon'ble Apex Court in the various decisions referred to here-in-above and also the view expressed by the Hon'ble National Commission, we are of the considered view that in the present case the complainant, if not entitled for the entire insured amount, the Insurance Company definitely ought to have settled the complainant's claim on 'non-standard basis”, which in the facts and circumstances taking the assistance of the view expressed by the Hon'ble Apex Court and also by the Hon'ble National Commission, we allow 70% of the claim of the complainant on 'non-standard' basis”.
18. Admittedly, the total sum assured under the policy in question was Rs.7,70,000/- and hence 70% of the claimed amount comes to Rs.5,39,000/- and hence, in view of the aforesaid facts and circumstances, the Opposite Parties are directed to make the payment of Rs.5,39,000/- (Rupees five lakh thirty nine thousands only) i.e. 70% of the sum assured of Rs.7,70,000/- to the Complainant, within 45 days from the date of receipt of copy of this order, failing which the awarded amount shall carry interest @ 8% per annum from the date of filing the complaint till its actual realization. Opposite Parties are also directed to pay the lump sum compensation to the complainant to the tune of Rs.5,,000/- (five thousands only) on account of harassment, mental tension and litigation expenses. Copies of the order be furnished to the parties free of cost. File be consigned to record room after compliance.
19. Reason for delay in deciding the complaint.
This complaint could not be decided within the prescribed period because the government has not appointed any of the two Whole Time Members in this Commission since 15.09.2018. Moreover, the President of this Commission is doing additional duties at District Consumer Commission, Bathinda as well as Faridkot. There is only one working day in a week when the quorum of this Commission remains complete.
Announced in Open Commission.
