Haryana

StateCommission

A/1356/2017

KUSUM DEVI - Complainant(s)

Versus

BIRLA SUN LIFE INSURANCE CO. - Opp.Party(s)

PARDEEP SOLATH

29 Apr 2019

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA,PANCHKULA

 

First Appeal No.1251 of 2017

Date of Institution: 18.10.2017

                                                          Date of Decision: 29.04.2019

 

1.      Birla Sun Life Insurance Company Ltd., GT Road, Panipat through Ms. Aakriti Manocha, Manager-Legal.

2.      Manager Director/Asstt. Manager (claims) Birla Sun Life Insurance Company Ltd. 1, India Bulls Centre, Tower-1, 16^th Floor, Jupitor Mills compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai-400013 through Ms. Aakriti Manocha, Manager-Legal.

…..Appellants

Versus

Kusum Devi w/o Sh. Late Sh.Suraj Bhan R/o Village Behrampur Mandir Wali Gali, Tehsil Bapoli, Distt. Panipat (Haryana).

…..Respondent

First Appeal No.1356 of 2017

Date of institution:- 10.11.2017

Date of Decision:- 29.04.2019

 

Kusum Devi w/o Sh. Late Sh.Suraj Bhan R/o Village Behrampur Mandir Wali Gali, Tehsil Bapoli, Distt. Panipat (Haryana).

…..Appellant

Versus

1.      Birla Sun Life Insurance Company Ltd.,  through its Branch Manager, GT road, Panipat.

2.      Manager Director/Asstt. Manager (claims) Birla Sun Life Insurance Company Ltd. 1, India Bulls Centre, Tower-1, 16^th Floor, Jupitor Mills compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai-400013.

…..Respondents

CORAM:    Mr.Ram Singh Chaudhary, Presiding Judicial  Member

                             

Present:-    Mr.S.C.Thathai, Advocate counsel for appellant in appeal No.1251 of 2017 and respondent Nos.1 and 2 in appeal No.1356 of 2017.

          Mr.Pardeep Solath, Advocate counsel for respondent in appeal No.1251 of 2017 and appellant in appeal No.1356 of 2017.

 

                                                 ORDER

RAM SINGH CHAUDHARY, JUDICIAL MEMBER:

         Delay in filing the appeal bearing No.1356 of 2017 is condoned for the reasons stated in the application filed for condonation of delay.

2.      Vide this common order above mentioned two appeals bearing No.1251 of 2017 and 1356 of 2017 will be disposed of as both have been preferred against the order dated 31.08.2017 passed by the District Consumer Disputes Redressal Forum, Panipat (in short ‘District Forum’).

3.      The brief facts of the case are that the husband of the complainant namely Shri Suraj Bhan since deceased had got himself insured with the  opposite party No.2 under BSLI Vision Life Income plan.  The wife of the life insured was appointed as nominee.  On 26.09.2014, the policy under BSLI Vision Plan was purchased for Rs.10,00,000/-. The relevant documents submitted with branch office of the company i.e. O.P.No.1.  The policy was issued in favour of deceased life insured after receiving the half yearly premium of Rs.19,008.98 paise.  Unfortunately, he expired on 10.10.2014.  Intimation regarding death of the insured was sent to opposite party No.1.   Being a nominee, she requested the O.Ps. to pay insured amount, but, O.Ps. did not make payment of the sum assured and other benefits.  She served legal notice dated 28.09.2015 upon the O.Ps., but, they failed to make the payment of the above said policy.  Thus there was deficiency in service on behalf of the O.Ps.

4.      O.Ps. on being served with the notice of the consumer complaint filed written statements, wherein  O.P.Nos.1 and 2, it was pleaded that  DLA Sh.Suraj Bhan obtained an insurance policy from the Delhi office of the O.Ps.  They also admitted premium amount as well as insured amount of Rs.10/- lacs. The policy was issued from Head Office of the OP’s at Mumbai.  On 22.12.2015, the claim was repudiated by O.Ps. The DLA hs grossly mis-stated his income and occupation in the proposal form, whereas DLA was a labourer and his annual income was only Rs.30,000/-.    The filing of death claim in Panipat branch of the OPs does not confer any jurisdiction on the District Forum, Panipat to try and decide the present complaint. Thus there was no deficiency in service on the part of the O.Ps.  Preliminary objections about the maintainability of the complaint, jurisdiction, false and frivolous complaint etc. were also raised and requested to dismiss the complaint.

5.      After hearing both the parties the learned District forum allowed the complaint and ordered as under:-

“We accept the present complaint with the directions to the Ops to pay the sum assured to the complainant as per insurance policy No.006594896 (Ex.C-9).  The complainant shall also be entitled for a sum of Rs.3300/- for the mental harassment caused to him and the litigation expenses.”

6.      Feeling aggrieved therefrom opposite parties  have preferred  the appeal.  The complainant has also preferred the appeal for enhancement for compensation.

7.      This argument have been advanced by Mr.S.C.Thathai, Advocate counsel for appellant in appeal No.1251 of 2017 and respondent Nos.1 and 2 in appeal No.1356 of 2017 as well as Mr.Pardeep Solath, Advocate counsel for respondent in appeal No.1251 of 2017 and appellant in appeal No.1356 of 2017.  With their kind assistance the entire records as well as the original record of the District Forum including whatever the evidence has been led on behalf of  both the parties had also been properly perused and examined.

8.      Learned counsel for the appellant in appeal No.1251 of 2017  and respondent Nos.1 and 2 in appeal No.1356 of 2017 vehemently argued that  due to some alternations, over-writings and cuttings in the proposal form by the deceased life insured, is not entitled for the insured amount. A reliance has been placed upon the celebrated authorities of Hon’ble National Commission in  LIC vs Maya Devi 2016 (2) CPJ 396, Lakbhir Kaur & Ors. Vs. LIC of India and Ors. 2015(1) CPJ 259, LIC of India and Ors. Vs. Shamim  2009 (4) CPJ 217, LIC vs Yogendra Prasad Singh 2009 (3) CPJ 38, OIC vs Munimahesh Patel 2007(1) CPR 93,  District Transport Officer Vs. Amita Goyal 2015(4) CLT 349 OBC Vs.Shankar Chawal Udyog 2014(2) CPR 740, O.Ranjini Vs.Syndicate Bank  2013(2) CPJ 654, United India Insurance co. Ltd. Vs.Dwarika Dhees Industries 2008 (3) CLT 481 and Vishamber Sunderdas Badlani and Anr. Vs. Indian Bank and 3 Ors. 2008 (1) CPR 76.

9.      Learned counsel for the respondent in appeal No.1251 of 2017 and appellant in appeal No.1356 of 2017 vehemently argued that during the subsistence of the Insurance Policy, the life insured was expired. This being so, the Insurance Company is liable to pay the insured amount of Rs.10,00,000/- and other benefits. A reliance has been placed upon the celebrated authorities of Hon’ble National Commission in  Birla Sun Life Insurance Co. Ltd. Vs.Charakapur China Rao 1 (2012) CPJ 557 (NC), Bajaj Allianz Life Insurance Company Ltd. Vs. Virender Singh II (2015) CPJ 701 (NC),  LIC Vs. Chanagoni Upendra & Ors. 1 (2012) CPJ 409 (NC) and similar opinion in Punjab State Commission in Ramesh Kumar Vs. Punjab and Sind Bank & Anr. II (2017) CPJ 178 (Punj.), similar opinion  in Uttar Pradesh State Commission in  Vijay Narain Rai (deceased) Vs. LIC of India 1 (2017) CPJ 166 (UP), opinion expressed in Murala Subba Lakshmi Vs. LIC of India III (2010) CPJ 1 of Andhra Pradesh State Commission and opinion expressed by Orissa State Commission, Cuttack in Life Insurance Corporation of India Vs. Sudhashana Ranee Bhola II (2007) CPJ 294.

10.     The basic dispute involved for adjudication by this Commission is about making some alternations, over-writings and cuttings in the proposal form regarding the income of the deceased life insured?

11.      There are allegations as well as counter allegations that some alternations, over-writings and cuttings in the proposal form have been moved at the level of the office of the insurance company.  Contrary to it, it has been alleged that since a wrong information was given by the insured at the time of submitting the proposal form, lateron, it was realized that the information furnished to the insurance company by the insured are incorrect. 

12.    To rule out this possibility of making some alternations, over-writings and cuttings in the proposal form by the insured, the writing was executed at the level of the Gram Panchayat.  The most unfortunate part is that the Sarpanch of the village could not be examined before the learned District Forum as he had expired before instituting the complaint before the learned District Forum.  To substantiate this averment, affidavit has also been placed on the record, vide which, it is crystal clear that death of the Sarpanch had taken place before instituting the complaint.  In order to achieve the targets given by the insurance company to its workers, agents, the branch manager, in a haste manner, generally the signatures on blank papers are being obtained including the proposal form lateron, wrong information are found to be incorrect, in that eventuality,  the alternations, over-writings and cuttings in the proposal form are being carried out and this is a particular case and in a similar manner all these alternations, over-writings and cuttings in the proposal form have been made at the level of officials of the insurance company. The alternations, over-writings and cuttings in the proposal form or whatever it is not possible to be done at the level of the insured and in all probabilities have been committed at the level of the insurer only.  The technicalities cannot be allowed to stand on the way of natural justice. The laws cited by the counsel for the appellant in appeal No.1356 of 2017 are in similar nature. However, the case laws cited by the counsel for the appellant in appeal No.1251 of 2017 are not relevant because the circumstances of the cases are different from the present case.

13.    Resultantly, with the above observation and discussion this Commission has come to the conclusion learned District Forum has rightly compensated the complainant.  Hence, both the appeal bearing No.1251 of 2017  and appeal bearing No.1356 of 2017 are dismissed.

14.    The statutory amount of Rs.25,000/- deposited at the time of filing of the present appeal  bearing No.1251 of 2016 be refunded to the appellants against proper receipt and due verification.

15.    The original judgement be attached with appeal No.1251 of 2017 and certified copy be placed on the record of appeal No.1356 of 2017.

 

April    29th, 2019                                          Ram Singh Chaudhary                                                                                                        Judicial Member                                                                                                                   Addl.Bench               

S.K.