Punjab

Moga

CC/16/110

Jangir Singh - Complainant(s)

Versus

Birla Sun Life Insurance - Opp.Party(s)

Sh Rakesh Kumar

21 Sep 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA.

 

                                                                                      CC No. 110 of 2016

                                                                                      Instituted on: 13.06.2016

                                                                                      Decided on: 21.09.2016

 

Jangir Singh S/o Saian Singh R/o Village Bulla Rai Uttar Block Guru Har Sahai, Tehsil Jalalabad District Ferozepur.

                                                                          ……… Complainant

Versus

1.       Birla Sun Life Insurance Company Ltd. Gandhi Road, Opp. Union Bank of India, Majestic Palace Wali Gali, Moga, through its Branch Manager.

 

2.       Birla Sun Life Insurance Company Ltd. its Branch Manager having its office at S.C.O. No.16-17, 3^rd Floor, Fortune Chamber, Feroze Gandhi Market, Exchange Stock, Ludhiana- 141001.

                                                                           ……….. Opposite Parties

 

 

Complaint U/s 12 of the Consumer Protection Act, 1986.

 

 

Quorum:    Sh. Ajit Aggarwal,  President,

                   Smt. Bhupinder Kaur, Member.

 

Present:       Sh. Rakesh Kumar, Advocate, Cl. for complainant.

                   Sh. Gurmeet Singh Dhaliwal, Advocate, Cl. for opposite parties.

 

 

ORDER :

(Per Ajit Aggarwal,  President)

1.                Complainant has filed the instant complaint under Section 12 of the Consumer Protection Act, 1986 ( hereinafter referred to as the "Act") against Birla Sun Life Insurance Company Ltd. Gandhi Road, Opp. Union Bank of India, Majestic Palace Wali Gali, Moga, through its Branch Manager and others (hereinafter referred to as the opposite parties) directing them to release the insured amount of the deceased life assured alongwith interest @ 18% p.a. from the date of death of life assured. Further opposite parties may be directed to pay exemplary costs and damages to the tune of Rs.50,000/- on account of mental and physical harassment to the complainant and to grant any other relief as this Forum may deem fit in the facts and circumstances of the present case.

2.                Briefly stated the facts of the case are that the son of the complainant i.e. Kulwinder Singh applied for Life Insurance on 07.11.2012 through the opposite parties. The son of the complainant (hereinafter referred to as 'life assured') opted for BSLI Vision Plan Policy. In pursuance to his application for life insurance, the life assured got insured vide policy no.005829387 for a sum of Rs.8,66,500/- for a term of 74 years. The premium for the said policy was fixed at basic premium @ Rs.13,925/- and policy premium of Rs.28,280/- to be paid for a period of 30 years. The life assured had appointed his father as nominee. The life assured had duly paid his 1^st premium. Unfortunately, life assured died in a road accident on 25.11.2012. The factum of the said death was duly registered with the Registrar Birth & Death, Punjab. After the death of the life assured, the complainant lodged the claim with opposite parties for the release of sum assured, after duly complying with the procedure as laid down by the company. The complainant kept contacting the office of the opposite parties to know the status of the claim on account of death of his son, but the complainant has been given nothing besides false assurances that his case is under process and he shall have the insurance amount released soon. The claim was lodged in the month of May, 2013 with the opposite parties, but till date the opposite parties have not decided the matter of the complainant. Despite the lapse of much time, the complainant has not heard anything from the opposite parties. It is further submitted that the complainant earlier field an application before the Permanent Lok Adalat at Moga and same has been dismissed as default due to non appearance of the applicant as well as the counsel for the applicant and counsel for the complainant never conveyed this fact to him till date and moreover the proceedings before the Permanent Lok Adalat are pre litigation conciliation and settlement and no matter was ever decided by any court on merits till date. Due to the above said act of the opposite parties, the complainant has to suffer mental and physical harassment. Hence this complaint.

3.                Upon notice, opposite parties appeared through their counsel and filed written reply taking certain preliminary objections that the instant complaint is barred by the period of limitation as enshrined under Act; that the complaint filed by the complainant is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead the Forum and has suppressed material facts from this Forum; that since the information provided by the Life Assured in the proposal form was established to be incorrect by the opposite party company, hence the opposite party company was well within its right to repudiate the said claim of the complainant. As such, no case of deficiency in services can be said to have arisen; that the complainant has tried to challenge the veracity of the decision of the opposite party company to repudiate the claim. The opposite party company has 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 Services'. The complainant should approach the Civil Forums in order to challenge the veracity of the decision of the opposite party company to repudiate the claim; that the Insurance contracts are contracts based on 'Utmost Good Faith'. As per the contract, the insurer is bound to honour the claim under the policy had disclosed all relevant information with regard to his income and occupation. Which are the basis on which the insurer decides to cover the said life and at what rates. Since the Life Assured did not perform his duty to disclose all material information, the contract of insurance between the opposite party company and the Life Assured is a void contact. Life insurance claim payouts are made from the pool of funds of many consumers of the services of an insurance company. Hence to honour an illegitimate claim, would mean doing injustice to other genuine policy holders. Hence, even entertaining the said case would be against the principles of natural justice and this would not be in the interest of consumers of services of a life insurance company. Further submitted that the life assured had not disclosed his correct information at the time of availing the policy, it is the duty of the Proposer/Life Assured, at the time of availing the policy, to disclose the material information, which is essential for the purpose of underwriting, during issuance of an insurance policy. Therefore, the present claim is devoid of substance and deserves dismissal; that this Forum has no jurisdiction to entertain the present complaint. In the present case from the face of it there are serious issues of Fabrication, Criminal Conspiracy, cheating, misspelling and misdeeds. Such serious issues required a proper trial by a civil/criminal court and evidence has to be taken which is not possible in a summary trial; that the complaint is devoid of any material particulars and has been filed merely to harass and gain undue advantage and unjustified monies from the answering opposite parties and hence the complaint deserves to be dismissed in limine. The complaint has been filed with ulterior motive and malafide intention, to cause harassment and prejudice to the answering opposite parties. Further submitted that the proposal form is not merely a document to be signed and submitted for formality. It is the basis for the contract of insurance. It is the mode of providing information to the insurer so as to enable them to exercise a lawful right to evaluate the life before providing its services by covering the life. Further submitted that the complainant has not acted in good faith with respect to subject of this complaint and has approached the Forum with unclean hands; that 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.

                   Further in the facts of the case, it is submitted that the opposite party received proposal/application form bearing no.A-47093096 duly filled and signed by the Life Assured seeking insurance on her life under the "BSLI Vision Plan- GSB pay 30". On the basis of information and declaration provided in the said Application Form, the company issued the policies bearing no.005829387. The opposite parties, after receipt of duly filled proposal form alongwith the other requisite documents and the amount of first yearly premium deposit had issued the subject policy. That the applicant had himself opted for semi-annual yearly premium which clearly indicated in the proposal form. The applicant had also signed a Benefit illustration after fully understanding the terms and conditions of the policy. It is stated that the opposite parties company received duly filled and signed application form, wherein the complainant was required to pay a yearly premium of Rs.20,718/- for a premium payment term of 16 years. The policy in question i.e. 005829387 is an outcome of a fraud which has been played on the opposite party company. It is submitted that the complainant sent a claim statement dated 10.05.2013 intimating the opposite party company that the LA, Mr. Kulwinder Singh died on 25.11.2012 (13 days since policy issue date) and requested the company to process the claim under the policy. But the opposite party company examined the matter in detail and possessed indisputable evidences which establishs that Mr. Kulwinder singh has already expired prior to signing the proposal for insurance and that the opposite party company was mislead to issue the aforesaid policy on the life of Mr. Kulwinder Singh through forged documents and by a well planned criminal conspiracy involving various individuals including the present complainant. It has been further submitted that the Life Assured had answered the relevant questions in the proposal form as follows:-

Life to be Insured	Kulwinder Singh
Designation	Owner
Occupation	Agriculturist
Name of Employer/Business	Agriculturist
Annual Income	2.80 lac
Years with Employer	5 Years

 

          Further it is clearly stated in proposal form, that in the event a reply to a question in the proposal form turns out to be false or mis-leading, the contract of insurance is liable to be declared null and void and also that a claim under the policy is liable to be repudiated in such event. It is pertinent to note that the Life Assured, despite being specifically asked about the material information had not disclosed her date of birth and occupation conditions in the proposal form, as is evident above. The opposite party company believing the information given by the Life Assured in the proposal form to be true and correct in all aspects and as per the underwriting norms of the company, issued life insurance policies to the Life Assured. The opposite party company had sent the policy documents to the communication address mentioned in the proposal form of the life assured and had informed the life assured about his right to a Free Look Cancellation of the policy, as per which the Life Assured could prefer a request for free look cancellation of the policy within 15 days from the date of receipt of the policy document, in case of any disagreement with the policy documents. The Life assured did not approach the opposite parties during this period with any request for correction in the proposal form with respect to her age and occupation. Thereafter, the complainant lodged death claim with the opposite party company on 15^th July 2013, stating the life assured had passed away on 25.11.2013 i.e. within 13 days of issuance of the policies. That the opposite party company states that careful evaluation of the records obtained by the opposite party company, during the claim investigation stage in accordance with Regulation 8 (3) of the IRDA (Protection of Policyholders' Interests) Regulations, 2002, it is established that the life assured at the time of filling up the proposal form did not disclose the correct information about his and his family's income. In the proposal for insurance, life assured had mentioned the annual income as 2.80 lac and has mentioned that he is an Agriculturist and his designation is Owner. However, the investigation establishes that the family of the life assured comes under below poverty line and is taking benefits under "Atta Dal Scheme" from the Punjab Government. As per the policy and the proposal form, the life assured was under to pay Rs.14140/- and that for twice a year. A family who is taking benefits from the Punjab Government, stating as below poverty line, how can he pay annual premium of Rs.28280/- for 30 years. If the true and correct facts pertaining to life assureds' income and occupation had been disclosed at the proposal stage, life assured would not have been eligible for insurance policy in the first place. From the stated circumstances, it is evident that the life assured had given wrong information and suppressed material facts from the opposite parties in order to wrongfully obtain the subject policy from the opposite parties. The Life assured in the proposal form has specifically given wrong answers to all the relevant questions. A mere perusal of the proposal form clearly suggests the malafide act on the part of the life assured. The opposite parties relied and believed that the information given by the life assured in the proposal from was true and correct in all aspects. Had the opposite parties known that the life assured has not disclosed his correct income and occupation details in the proposal form then the opposite parties would have declined the proposal upfront. Insurance is a contract of utmost good faith and from the documents on record it is clearly evident that there has been a clear breach of this by the life assured. Further, while forwarding the policy document to the policy holder, the opposite party company had also sent a copy of proposal form, so that the life assured/proposer can verify the replies given in the signed proposal form in response to the questions asked therein and revert to the opposite party company where any such reply has been answered wrong or wrongly recorded. The opposite party company has been induced and misled by the Life Assured to issue the policy by suppressing material facts. In view of the above, the company vide letter dated 28^th March 2014 repudiated the said claim. It is the primary duty of the assured to disclose all the facts truly and correctly in the proposal form. The answering opposite parties was led to issue the policy by suppression of material facts. It is submitted that by concealing material facts in the proposal, the company was denied of the opportunity to assess the risk under the proposal. In an insurance contract, the principle of good faith has to be adhered to. The opposite party company submits that claim has been rightly rejected purely on the basis of documentary evidence of suppression of material facts by the life assured in the proposal of insurance. It is clearly mentioned on the first page of proposal form that insurance is the contract of utmost good faith requiring the proposer and the life assured not only to disclose all the material facts, but also not to suppress any material facts in response to the questions in the proposal form. The Life assured has also put her signature on the Declaration and Authorization that she has understood the nature of questions and importance of disclosing all material information. Inspite of this the complainant suppressed material fact which is nothing, but a fraud in order to gain unlawfully. That the present complaint is an abuse of the process of law and is liable to be dismissed in accordance to Section 26 of the Consumer Protection Act, 1986.

                   In parawise reply, all other allegations made in the complaint have been denied and a prayer for dismissal of the complaint with exemplary costs has been made.

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

5.                In rebuttal, the opposite parties tendered in their evidence duly sworn affidavit of Sh. Kshama Priyadarshini, Senior Chief Manager Legal, Ex.OPs-1 and copies of documents Ex.OPs-2 to Ex.OPs-5 and closed the evidence.

6.                We have heard the learned counsel for the parties and have very carefully gone through record placed on file.

7.                Learned counsel for complainant argued that on 07.11.2012 the son of the complainant namely Kulwinder Singh applied for purchase of life insurance policy to opposite parties and on his application opposite parties issued life insurance policy to him for a sum of Rs.8,66,500/-. For which he has to pay premium to the tune of Rs.13,925/- half yearly premium for 30 years. The complainant was appointed as nominee in that insurance policy. First premium of the said policy was duly paid. Unfortunately son of the complainant namely Kulwinder Singh died in a road accident on 25.11.2012. His death was duly registered with Registrar Births and Death, copy of death certificate is Ex.C4. In the month of May, 2013 the complainant lodged the claim with opposite parties for the release of sum assured on account of death of his son. He submitted all the required documents with opposite parties, but they did not pay the insurance claim to him besides giving false assurances. The complainant gets contacting the office of opposite parties to know the status of his claim, but till date the opposite parties have not decided the matter of the complainant. These act of the opposite parties amounts to deficiency in service and trade mal practice on their part. The complainant is entitled to get the insurance claim of his son. The complainant prayed for the acceptance of the present complaint alongwith interest compensation and litigation expenses.

8.                To controvert the arguments of complainant, learned counsel for opposite parties argued that the present complaint is not maintainable and is liable to be dismissed. The complainant has tried to misguide and mislead this Forum. He suppressed the material fact from this Forum. The present complaint is barred by the period of limitation, as the claim of the complainant was repudiated by the opposite parties in the month of March, 2014 and the letter regarding the same was sent to complainant on 28.03.2014, copy of the same is Ex.OPs-5. The complainant has filed the complaint before this Forum in the month of June, 2016 i.e. out of the period of limitation. The opposite parties have repudiated the claim of the complainant by speaking order after giving specific reason and there is no deficiency in service on their part. It is admitted that vide proposal form dated 07.11.2012 the said Kulwinder Singh applied for the purchase of insurance policy with them and on his application the opposite parties issued insurance policy dated 12.11.2012 securing the life of Kulwinder Singh and under the said policy he had to pay premium half yearly for a period of 30 days, but the said policy is out come of fraud played by complainant with opposite parties. The complainant sent a claim submission dated 10.05.2012 vide which he intimated opposite parties that the Life Assured Kulwinder Singh wad died on 25.11.2012 i.e. within 13 days from the date of issuance of policy. On it, the opposite parties examined the matter in detail and possessed indisputable evidences which establishes that said Kulwinder Singh already expired prior to signing the proposal of insurance and opposite parties were misled to issue the aforesaid policy, through forged documents and by a well planned criminal conspiracy involving various individuals including the present complainant. In the proposal form the complainant submitted false information and did not disclose correct information with regard to his income and occupation. In the proposal for insurance life assured had mentioned the annual income as 2.80 lac and mentioned that he is an Agriculturist and his designation is Owner of Agriculture Land. But during the investigation, it is found that the family of the life assured comes under below poverty line and is taking benefits under "Atta Dal Scheme" from the Punjab Government. As per the policy and the proposal form, the life assured was under to pay Rs.28,280/- as premium of the policy every year for 30 years. A family who is taking benefits of 'Atta Dal Scheme'  under Below Poverty Line how it can be presumed that he can pay this much huge amount as insurance premium. The Atta Dal Scheme is given to the families whom annual income is below Rs.60,000/-, copy of the Ration card of complainant and his deceased son is Ex.OPs-4. All these acts show the malafide intention of the complainant. During investigation conducted by the opposite parties, it transpired that the deceased Kulwinder Singh had already been died prior to signing the proposal form and prior to issuance of the insurance policy. The complainant and his son suppressed the material facts from the opposite parties in order to obtain the wrongful claim amount from them, the investigation report is Ex.OPs-3. The complainant alleged that his son died in a road accident on 25.11.2012, but they did not submit any FIR, Post-Mortem Report or any statement of last attending doctor to prove the fact that life assured died in a road accident. This fact made the claim of the complainant highly doubtful. So, the opposite parties rightly repudiated the claim of the complainant. The complainant has filed the present complaint only to defraud the opposite parties and to get undue monetary benefits from them. The present complaint may be dismissed with costs.

9.                We have thoroughly gone the file, evidence and arguments led by learned counsel for both the parties. The case of the complainant is that son of the complainant namely Kulwinder Singh purchased a Life insurance policy from opposite parties to secure his life and premium of the policy was to be paid for half yearly for 30 years. The said Kulwinder Singh had paid first instalment of the premium. On 25.11.2012, he was died in a road accident. Thereafter, the complainant lodged the claim with opposite parties on account of death of his son in the month of May, 2013, but the opposite parties did not pay his genuine claim till date. In reply, the opposite parties submitted that the son of the complainant applied for purchase of insurance policy vide proposal form dated 07.11.2012 and on his application insurance policy was issued in his favour on 12.11.2012. The complainant lodged the claim on account of death of his son in May, 2013 stating that his son died in a road accident on 25.11.2012 i.e. within 13 days from the issuance of the policy, which is highly doubtful and the opposite parties conducted investigation and inquiry in this regard. During inquiry, it come into knowledge that the life assured suppressed the true and material facts and did not disclose the true information regarding his and his family income in the proposal form. He submitted that his annual income is about 2.80 lac and occupation is Agriculturist and owner. Whereas, during investigation it transpired that life assured and his family are taking the benefits under Atta Dal Scheme from Punjab Government under Below Poverty Line category, whereas according to the policy in question he had to pay annual premium of Rs.28,280/- for 30 years and the person belonging to Below Poverty Line cannot be supposed to pay this much huge amount as insurance premium. Moreover, the claim regarding the death of life assured was lodged in the month of May, 2013 stating that he died on 25.11.2012 in a road accident within 13 days from the issuance of the insurance policy. The complainant failed to furnish any FIR, Post Mortem Report regarding the death of life assured. It is stated that as per law any death except natural death the matter is to be reported to police and post-mortem is to be conducted. Moreover, in case of road accident it is the duty of the police to lodge FIR and to investigate the matter and also to get post-mortem from Civil Hospital on the body of deceased to ascertain the cause of death, but in the present case no FIR or post-mortem report is produced, even no declaration from the last attending doctor is adduced. Further no FIR/DDR etc is found recorded in the nearby police station regarding the alleged accident and death of life assured, which raise highly doubt regarding the alleged death of life assured. During investigation, it comes to the knowledge that the alleged life assured had already died prior to signing of proposal form and issuance of policy. So, the opposite parties insurance company rightly repudiate the claim of the complainant in March, 2014 and this fact is duly informed to complainant vide letter dated 28.10.2014, copy of the same is Ex.OPs-5. Moreover, the present complaint is barred by limitation, the life assured Kulwinder Singh died on 25.11.2012 and the claim was lodged with opposite parties in May, 2013 and insurance company repudiate the claim in March, 2014 vide letter dated 28.03.14. The complainant filed the present complaint in June 2016, as per the Consumer Protection Act the limitation for filing any complaint is two years from the date of cause of action first arose and in the present case the date of cause of action arose on 28.03.2014 when opposite parties repudiate the claim. So, the complainant has to file the present complaint within two years from 28.03.2014, but he filed the present complaint beyond the period of limitation and as such the same is not maintainable. The complainant himself admitted that prior to filing of present complaint, he filed the complaint before the Parmanent Lok Adalat on same cause of action against opposite parties, which was dismissed in default. It is settled law that where two remedies are available for the person for the Redressal for his grievances and if he choose the first one then he cannot be re-agitate the same matter before the second Forum after availing the opportunity before first Forum and if he gets adverse order from that Forum. So, this complaint is not maintainable on this score also.

10.              From the above discussion, we find no merit in the present complaint. Hence the present complaint in hand is hereby dismissed. Parties are left to bear their own costs. Copy of the order be sent to the parties free of costs. File be consigned to record room.  File be consigned to record room.

Announced in Open Forum.

Dated: 21.09.2016.

 

                                                 (Bhupinder Kaur)                    (Ajit Aggarwal)

                                                       Member                                           President