Punjab

Moga

CC/15/33

Lakhwinder Singh alias Lakhbir Singh - Complainant(s)

Versus

Birla Sun Life Insurance Co.Ltd. - Opp.Party(s)

Sh.Armandeep Singh

07 Sep 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA.

 

                                     Complaint No. 33 of 2015

                                                                Instituted On: 26.05.2015

                                                  Decided On: 07.09.2015

 

Lakhwinder Singh @ Lakhbir Singh, s/o Fauja Singh, R/o Village Mand Tihara, Tehsil Jagraon District, Ludhiana.

Complainant 

Versus

 

Birla Sun Life Insurance Co. Ltd., Fortune Chambers, 3^rd Floor, Opposite Stock Exchange, SCO- 16-17, Feroze Gandhi Market, Ludhiana, through its Manager

         

Opposite Party

 

 

Complaint under section 12 of the

Consumer Protection Act, 1986.

 

 

 

Coram:      Sh.S.S.Panesar, President

                    Smt Vinod Bala, Member

Present:      Sh.Armaan Deep Singh, Advocate Cl. for complainant.

                   Sh.Vishal Jain, Advocate Cl. for opposite party.

 

ORDER

(S.S.Panesar, President)

                  Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘Act’) against Birla Sun Life Insurance Co. Ltd., Fortune Chambers, 3^rd Floor, Opposite Stock Exchange, SCO- 16-17, Feroze Gandhi Market, Ludhiana, through its Manager (herein-after referred to as opposite party)- directing them to release the insured amount of Rs.11,98,430/- of the deceased/life insured alongwith interest @ 12.5% p.a. from the date of death of life assured and to pay Rs.50,000/- as award exemplary costs and damages on account of mental and physical harassment to the complainant alongwith any other relief, which this Forum may deem fit.

2.                Briefly stated, the facts of the case are that wife of the complainant i.e. Nihal Kaur applied for life insurance on 31.01.2012, through the agent of opposite party. Wife of the complainant (hereinafter referred to as "life assured') opted for BSLI Vision Plan Policy. In pursuance of her application for life insurance, the life assured got insured vide policy no.005360418 for a sum of Rs.11,98,430/- for a term of 64 years. Furthermore, the premium for the said policy was fixed at basic premium @ Rs.19,996/- and policy premium of Rs.40,000/- to be paid in semi annual mode period of 30 years. The life assured had appointed her husband/complainant as nominee. The life assured had duly paid her 1^st premium. The life assured died on 15.02.12 due to heart attack at her home. The factum of the death was duly registered with the Registrar Births & Death, Punjab. After the death of the life assured, the complainant lodged the claim with the opposite party for the release of Sum assured duly complying with the procedure as laid down by the OP company. The complainant kept contacting the office of the opposite party to know about the status of the claim on account of death of his wife, but the complainant has been given nothing except false assurances that his case was under process and he shall have the insurance amount released soon. The opposite party has been delaying the claim of the complainant on one pretext or the other. Moreover, the claim was lodged in the month of February 2013 with the opposite party and the opposite party was supposed to decide the claim within 180 days therefrom, but the opposite party did not decide the matter of the complainant within time frame. This fact clearly shows the maladife intention of the opposite party. Thereafter, opposite party repudiated the claim of the complainant vide letter dated 31^st March 2014, on flimsy and illegal grounds. Hence this complaint.

3.                On notice of the complaint, opposite party appeared through their counsel Sh.Vishal Jain, Advocate and filed written reply contesting the same. They took up certain legal objections therein interalia that the complainant has no cause of action and locus standi to file the present case against the opposite party; the complainant has not come before this Forum with clean hands and has suppressed the material facts; complainant has created a false story in this complaint to mislead this Forum. It is further submitted that the policy in dispute was not purchased by Nihal Kaur assured rather a fraudulent group which included the Deceased Life Assured, her family members, nominee, who played a very vital role in the conspiracy to misuse the public exchequer by befooling a reputed public institute. These persons played a pre planned fraud with the company just to get undue advantage from it. Under this policy the husband of the deceased Life Assured was shown as nominee namely Mr.Lakhwinder Singh as well claimant under the policy and he applied for the claim of the deceased Life Assured. The deceased life assured opted the BSLI Vision Plan, Policy Term 64 years, Pay Term 30 years, Basic Premium Rs.19,996/- against total sum assured amount of Rs.11,98,430/- and policy no.005360418 was issued against such application form on 03.02.12 from the Moga branch of Birla Sun Life Insurance Company Limited, who sent the policy bonds alongwith its entire terms and conditions of the policy. The deceased Life Assured expired on 15.02.12 and the complainant being the nominee under the said policy lodged claim with the answering opposite party on 11.02.13. Further mentioned that (a)    As per section 2(1)(d) of the Insurance Regulatory and Development Authority (Protection of policy Holder's interest Regulations, 2002) Proposal Form means a form to be filled in by the proposer for insurance, for furnishing all material information required by the insurer in respect of a risk, in order to enable the insurer to decide whether to accept or decline, to undertake the risk and in the event of acceptance of the risk to determine the rates, terms and conditions of a cover to be granted.    (b)   As per section 11 of the Insurance Act 1938, the policy holder shall furnish all information that is sought from him by the insurer and also any other information which the insurer considers as having a bearing on the risk to enable the latter to assess properly the risk sought to be covered by a policy. Thus, it is evident that the Act and the regulations framed thereunder also imposes a duty upon the policy holder/proposer/complainant to disclose all the material facts to the insurer to enable them to assess the risk to be undertaken. The insurance is done on the basis of doctrine Uberrima Fides and there was no reason for opposite party to verify the correctness of the facts stated in the said application and revival application, more so since the Deceased Life Assured had signed specific declarations to that effect. To this extent it can be said that material facts were not disclosed by the Life Assured and therefore BSLI is entitled to declare the policy as null and void and repudiate the claim. The intricate questions of law and facts are involved in this case. The parties have to lead their evidence by examining the witnesses and the said witnesses are to be cross examined by the other party. The procedure under the Act is summary in nature and applicant, if so advised, may file civil suit seeking the alleged relief; there is no deficiency in service on the part of the opposite party; the complainant is estopped from filing the present complaint by his own acts, conduct, omissions and acquiescence; the deceased life assured herself committed breach of the pious relationship between the insured and insurer and as such, the present complaint is liable to be dismissed; the complaint is false, frivolous and vexatious in nature and has been filed in order to cause harassment to the opposite party; the alleged claim of the complainant does not fall within the scope of insurance granted by the opposite party, since insured herself committed breach of the terms and conditions of the policy duly supplied, disclosed and in possession of the complainant, as such the complaint is liable to be dismissed summarily.

4.                In order to prove his case, the complainant tendered in evidence his affidavit Ex.C-1 and copies of documents Ex.C-2 to Ex.C-9 and closed his evidence.

5.                To rebut the evidence of the complainant, the opposite party nos.1 & 2 tendered affidavit of Smt.Aakriti Manocha, Authorized Signatory, Birla Sun Life Insurance Company Limited Ex.O.P.10 and copies of documents Ex.O.P.1 to Ex. O.P.9 and closed the evidence on behalf of opposite party.

6.                 We have heard the learned counsel for the parties and have also carefully gone through the record.

7.                On the basis of evidence on record, learned counsel for complainant has vehemently contended that it is not disputed that wife of the complainant namely Smt.Nihal Kaur applied for BSLI Vision Plan Policy on 31.01.12, through agent of opposite party, copy of the insurance policy accounts for Ex.OP1/9. Life assured got insurance policy for a sum of Rs.11,98,430/- for the term of 64 years on payment of premium @ Rs.19,996/- and policy premium of Rs.40,000/- was to be paid in semi-annual mode period of 30 years. The life assured had duly paid first premium. The life assured died on 15.02.12 on account of heart attack, copy of the death certificate Ex.C2 is on record. After the death of the life assured, the complainant Lakhwinder Singh @ Lakhbir Singh lodged the claim with opposite party for release of the sum assured, after complying with the procedure as laid down by the company. Although, the claim was lodged in the month of February, 2013 with the opposite party and the opposite party was supposed to decide the claim within 180 days, but however, the opposite party did not decide the matter within time. Lateron, the opposite party repudiated the claim of the complainant, which was intimated to the complainant, vide letter dated 31^st March, 2014, copy whereof accounts for Ex.C3. The claim has been declined on flimsy grounds that the claimant had already died long before issue of the insurance policy in dispute. Since the company was misled to issue the policy, therefore, they were thereby repudiating their liability under the policy. However, the evidence on record has negatived the plea of the opposite party and there was absolutely no ground to decline the rightful claim of the complainant. It is therefore, requested that the instant complaint may be allowed and opposite party may be directed to pay the insured amount alongwith damages to be assessed by this Forum.

8.                On the other hand, learned counsel for opposite party has vehemently contended that Smt. Nihal Kaur had died long before the issue of the insurance policy in dispute and as such, no concluded contract took place interse Nihal Kaur and Insurance Company. The investigation report Ex.OP1/6 on record also proves that the death certificate produced on record by the complainant is false and fabricated document. As a matter of fact the complainant got the formalities regarding the filling of the proposal form completed by impersonation. Since, it was the case of fraud and misrepresentation, therefore no concluded contract of the insurance was executed interse insured and the insurer. As such, the opposite party was justified in declining the claim of the complainant. Learned counsel for opposite party has further contended that this Forum has got no jurisdiction to entertain the complaint, as the complaint contains intricate and vexed questions of law and facts and the proceeding of the Forum being summary in nature, the instant complaint is liable to be dismissed on this score alone. It is therefore contended that the complaint is liable to be dismissed and the same may be dismissed with cost.

9.                We have given thoughtful consideration to rival contentions.

10.              There is no denying the fact that Smt.Nihal Kaur got herself insured with opposite party vide policy no. 005360418 on 31.01.12 for an amount of Rs.11,98,430/-. It is also admitted that the insured paid the first premium of the insurance policy. It is proved on record that Smt.Nihal Kaur died on 15.02.12, copy of the death certificate Ex.C3 is on record. The contention that Smt.Nihal Kaur died long before issue of insurance policy is not proved on record, because the death certificate contains the date of death to be 15.02.12. The intimation regarding the death of Nihal Kaur was given to the authorities concerned on 17.02.12. Even the investigation conducted by the investigator of the opposite party has failed to bring any contrary evidence on record that Smt.Nihal Kaur had died prior to 15.02.12. Rather the evidence collected by the investigator on spot visit shows that Smt.Nihal Kaur died on 15.02.12 on account of heart attack at her house. In such a situation, the plea of fraud and misrepresentation coined by the opposite party appears to be concocted one and it has no legal semblance. It is usual on the part of the insurance companies to decline the claim on false and flimsy grounds. But at the time of getting the insurance premium, they show all sorts of green pastures to the clients. Reliance in this regard can be had on New India Assurance Company Limited versus Smt.Usha Yadav & others- 2008(3) RCR (Civil) Page 111 decided by Hon'ble Punjab & Haryana High Court, wherein, it has been observed as under:-

"It seems 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."

 

                   Further reliance can be had on National Insurance Company Limited, Gurgaon versus Ravi Dutt Sharma & another, Civil Writ Petition no.9716 of 2011- (2011(3) RCR (Civil) page 631 decided by Hon'ble Punjab & Haryana High Court, wherein, it has been observed as under:-

"Insurance Companies, in my view, are not acting fairly in all such matters after charging huge premium. Intention is always to repudiate the claim on one ground or the other. The conditions of the Insurance agreements are so minutely printed that person gets hardly any time to go through such conditions to make it legally binding in any appropriate manner."

 

                   From the aforesaid discussion, it is transpires that the opposite party has not acted fairly in declining the rightful claim of the complainant. The claim of the complainant has been thrown out without assigning any legal or reasonable cause. The opposite party is deficient in service. The contention that this Forum has no jurisdiction to entertain the instant complaint is also not tenable, because merely mentioning that some fraud or misrepresentation has taken place at the time of entering the agreement of insurance will not oust the jurisdiction of District Forum, particularly when, there is no evidence to support such an allegation. Even otherwise also District Forum has sufficient powers to entertain and look into the plea of fraud and misrepresentation on the basis of pleadings as well as evidence on record. Since there is nothing on record to substantiate the allegations of fraud and misrepresentation on the part of the insured, the plea raised by the opposite party falls to the ground. As such, we hold that the complainant is entitled to get the assured amount under the insurance policy being her nominee.

11.              Consequently, the instant complaint succeeds and opposite party is directed to pay a sum of Rs.11,98,430/- on the basis of the policy no.005360418 in favour of the complainant within 30 days of passing of this order, in his capacity as nominee of the life assured Nihal Kaur (now deceased). Opposite party is also directed to pay Rs.5000/-(Five thousand only) on account of damages, mental and physical harassment to the complainant. The complaint stands allowed accordingly. If the compliance of the order is not made within stipulated period, the complainant shall also be entitled to interest @ 6% per annum on the awarded amount from the date of pronouncement of the order till realisation. Copies of the order be sent to the parties free of cost immediately and thereafter the file be consigned to the record room.

 

                                       (Vindo Bala)                   (S.S. Panesar)

                                        Member                         President

 

Announced in Open Forum.

Dated:07.09.2015.