Haryana

StateCommission

CC/111/2014

Kalawati - Complainant(s)

Versus

Birla Sunlife Insurence - Opp.Party(s)

30 Jan 2017

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

                                                Complaint No.111 of 2014

Date of the Institution: 29.10.2014

Date of Decision:31.01.2017

 

Kalawati W/o Late Sh.Dungarmal, R/o VPO Kohli Tehsil Adampur District Hissar Haryana.

…..Complainant

Versus

1.      Birla Sun Life Insurance Company Limited, Branch office SCO No.149-150, Near Minrwa Hotel, Red Square Market, Hisar through its Branch Manager.

2.      Managing Director/authorized signatory, Birla Sun Life Insurance Company Limited, registered office Tower-1, 16^th Floor, Jupiter Mill compound, 841 Senapati Bapat Elphinstone Road, Mumbai-400013.

…..Opposite parties

CORAM:    Mr.R.K.Bishnoi, Judicial Member

                    Mrs.Urvashi Agnihotri, Member

 

Present:-    Mr. Narender Kaajla, Advocate for the complainant.

                   Mr. S.C.Thatai, Advocate for the opposite parties.

O R D E R

R.K.Bishnoi, JUDICIAL MEMBER:

It is alleged by complainant that her son Raj Kumar (since deceased) purchased insurance policy from opposite parties (O.Ps. commencing from 22.11.2012 for Rs.21,00,000/-.  He died natural death on 09.08.2012.  Initially she was her nominee, but, before his death he nominated Saharskiran as his nominee. He cannot supersede legal heir.  Saharskiran submitted claim after his death, but, was repudiated on the following grounds:-

“1.     That the deceased Life Assured had taken insurance policy from some other insurance company, wherein the death certificate submitted was different than the one submitted to us.

2.      The date of death in both the death certificate was different.

3.      It has also been noted that the change of nominee request under the aforesaid policy has been received post the death of the Life Assured.”           

Thereafter she submitted claim after obtaining no objection from Saharskiran, but, the same was repudiated without any reasonable ground.  The O.ps. be directed to pay Rs.21,00,000/- alongwith interest @ 18% per annum from the date of claim besides compensation to the tune of Rs.Five lacs for mental harassment etc. and Rs.55,000/- as legal expenses.

2.      O.P.Nos.1 and 2 filed joint reply controverting her averments whereas O.P.No.3-Saharskiran filed reply admitting her claim.

3.      It is alleged by O.P.Nos.1 and 2 that complainant has concealed true facts from this Commission. She is playing fraud which could be investigated by the civil court.  As per section 45 of the Insurance Act 2015 (In short “Insurance Act”) insurance policy can be called in question on the ground of concealment of material facts within three years from the date of commencement of the policy.  It is specifically mentioned therein that any act committed by insured or by his agent with intent to deceive insurer to issue life insurance policy can be checked. In the present case Raj Kumar, deceased life assured (DLA) submitted proposal form/application for purchase of BSLI Protector Plan which was accepted and policy No.53383366 dated 25.01.2012 was issued commencing from that date.  All the terms and conditions were explained to DLA which was signed by him.  On the basis of information provided by him, the proposal was accepted. DLA obtained this policy alongwith O.P.No.3 (his friend) and Gulab Singh (his brother) with active connivance of agent.  DLA was chronic alcoholic and chain smoker. His both lungs were damaged and he received treatment from Maharaja Agarsen College & Hospital  in the name and address of some other person.  Complainant has not brought on record an other policy No.005426068 dated 22.03.2012 obtained by DLA because claim under that  policy was already repudiated. He obtained two policies within the durations of two-three months.  He was purchased one policy from M/s Aviva Life Insurance Company Limited, in which the proposal date was 12.08.2012 and policy issued date was 24.08.2012, whereas according to death certificate submitted by complainant, DLA died on 09.08.2012. It clearly shows that DLA was playing fraud, as mentioned above.  As per complainant DLA died on 09.08.2012 whereas it is alleged that on that very date he executed change of nominee form.  As per this form he deputed Saharskiran as his nominee in place of his mother Kalawati. Whereas in other policy he changed  the nominee from his mother(complainant) to his brother, namely, Gulab.  She was not entitled for compensation as  DLA changed nominee on his alleged date of death.  Objections about maintainability of complaint, accruing cause of action etc. were also raised and requested to dismiss the complaint.

4.      Both the parties have led evidence. Arguments heard. File perused.

5.      Learned counsel for complainant vehemently argued that nominee cannot supersede legal heir.  Present complainant is mother of deceased and is very much entitled to receive the insured amount.  Saharskiran has also admitted her claim in the reply.  In the present case DLA was resident of village Kohli  Tehsil Adampur, Distt. Hisar, whereas Ex.R-4, issued by Aviva, is pertaining to one Raj Kumar resident of VPO Malapur, Tehsil Adampur, Distt. Hisar.  He is different person and any fact disclosed in the claim submitted with that company cannot be presumed as pertaining to present DLA. On the basis of that information claim submitted by Saharskiran was repudiated on 19.08.2013 as mentioned in Ex.R-9 and C-2. Investigation EX.R-11 is pertaining to Raj Kumar wherein date of death is mentioned as 09.08.2012. There is no evidence on the file showing that DLA ever received treatment at Agroha Medical College and hospital. So complaint be allowed and she may be granted relief as prayed for.  He placed reliance upon the opinion of Hon’ble National Commission expressed in LIC of India Vs. Renuka Devi @ Ramku Devi 2016(2) CPR 317.

6.      This argument is devoid of any force. If we scan evidence available on the file it will be clear that complainant is trying one way or the other to get compensation.  Initially claim of Saharskiran was rejected, on the grounds mentioned above.  If he was nominee and was entitled for compensation then why he did not file any complaint. It appears that to avoid any action against him mother of deceased  was forwarded. Act and conduct of complainant and Saharskiran creates doubt in this case.  If Saharskiran was entitled for compensation then whey he filed reply admitting her claim. He could have alleged that compensation be granted to him as being nominee because his claim was already repudiated.

7.      More-over as per death certificate Ex.C-1 Raj Kumar died on 09.08.2012, whereas proposal form Ex.R-8, bearing signatures of Raj Kumar is dated 14.08.2012. Vide this form he appointed Saharskiran as his nominee. When he had already died on 09.08.2012 then how this document was executed.  His brother Gulab Singh is shown as a witness in this document.  It may be mentioned that as per Ex.R-10 Gulab Singh was appointed as nominee which is dated 09.08.2012, the date on which he had died.  Proposal Form Ex.R-8 is not having any date.  In the absence of any date it cannot be seen that on which date it was executed.  In that form it was no-where alleged that he was suffering from any ailment. This fact clearly shows that there is hanky panky and important facts were concealed from the commission.  However it cannot be presumed that Ex.R-4 is pertaining to some other person. As per this document
Raj Kumar was DLA.  If his address is shown as of Village Malapur it does not mean that he is some other person. It appears that real address is concealed just  for getting money.  In that case also Gulab Singh is nominee.  It is no where alleged that Gulab Singh, mentioned in  Ex.R-4 and Ex.R-10, are different persons.  This appears to be a well-nit scandal to play fraud with company.  Parentage mentioned in this policy and death certificate produced before Aviva is same i.e. Raj Kumar s/o Dungermal.  In that case date of death is shown as 09.08.2012.  When O.Ps. specifically raised plea about this fact complainant should have rebutted the same. When complainant entered the witness box, it was stated by her that she could not tell whether DLA appointed O.P.No.3 as nominee before his death or not. When a party has played fraud it is not entitled for any compensation as opined by Hon’ble National Commission in Life Insurance Corporation of India & Anr.  Vs. Mandava Geetha 2012 (3) C.P.C. 509 (case law cited by O.ps. counsel).

8.      Be that as it may, present complaint is also time barred. As per complainant Raj Kumar died on 09.08.2012. As per this plea, cause of action accrued to her on that very date.  It is no-where alleged that she ever submitted claim with the O.Ps. and they repudiated the same.  Repudiation letter is not produced by the complainant. In this way she was supposed to file complaint within two years from the date of death i.e. 09.08.2012 as provided under section 24 A of Act whereas the present complaint has been filed on 29.10.2014 i.e. beyond two years.  Limitation will not start from the date when opposite party repudiates claim.            Admittedly, present complaint was filed by complainant after a gap of more than 20 days beyond two years from accruing cause of action, which on the face of it time barred.  Opinion of Hon’ble Supreme Court expressed in V.N.Shrikhande (Dr.) Versus Anita Sena fernandes 2011 CTJ 1 (supreme court) CP)  about limitation is as under:-

“Section 24A (1) contains a negative legislative mandate against admission of a complaint which has been filed after 2 years from the date of accrual of cause of action.  In other words, the consumer forums to not have the jurisdiction to entertain a complaint if the same is not filed within 2 years from the date on which the cause of action has arisen.    This power is required to be exercised after giving opportunity of hearing to the complainant, who can seek condonation of delay under section 24A (2) by showing that there was sufficient cause for not filing the complaint within the period prescribed under section 24 a (1).  If the complaint is per se barred by time and the complainant does not seek condonation of delay under Section 24a(2), the consumer Forums will have no option but to dismiss the same.”

          The present complaint is fully covered by V.N.Shrikhande’s case  (Supra).

          Complainant has not filed any application to condone delay before this Commission. 

9.      Looking from any angle, it is clear that request of the complainant cannot be accepted. Resultantly complaint fails and the same is hereby dismissed.

 

January 31st, 2017     Urvashi Agnihotri                   R.K.Bishnoi,                                                        Member                        Judicial Member                                                Addl. Bench                  Addl.Bench                 

S.K.