Haryana

Ambala

CC/405/2016

Anita - Complainant(s)

Versus

Claims Review Committee - Opp.Party(s)

H.S. Mann

15 Mar 2018

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AMBALA

 

                                                          Complaint case no.        : 405 of 2016.

                                                          Date of Institution         : 02.11.2016.

                                                          Date of decision   : 15.03.2018.

 

Anita wife of late Sh.Ravi Kumar son of Sh.Satpal @ Aala aged about 26 years resident of VPO Khabra Kalan District Fatehabad.

 

……. Complainant.

                                      Versus

 

1.Claims Review Committee Bajaj Alliance Life Insurance Company Limited through its authorized signatory, GE Plaza 5^th Floor, B-Wing, Airport Road, Yerawada, Pune (Maharashtra).

2.Bajaj Alliance life Insurance Company Limited through its Authorized signatory, 127, OPP GPO, Staff Road, Ambala Cantt.

                                                                             ….…. Opposite parties.

 

BEFORE:   SH. D.N. ARORA, PRESIDENT

                   SH. PUSHPENDER KUMAR, MEMBER         

                   MS. ANAMIKA GUPTA, MEMBER                 

 

Present:       Sh.Harinder Singh Maan, counsel for complainant.

                   Sh.Varun Chawla, counsel for OPs.

 

ORDER

                   The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 with the averments that husband of the complainant namely Ravi Kumar had obtained a policy No.0322723928 for a sum of Rs.15 lac from OPs on 28.04.2015 and its date of maturity was 27.04.2035.  He had paid the premium to the tune of Rs.2802/- and appointed the complainant as his nominee. At the time of obtaining the policy, husband of the complainant was examined medically and the policy was issued after completing the formalities.  On 25.05.2015 the deceased life insured had died due to severe heart attack and after his death the complainant had submitted claim with the OPs and also submitted requisite documents with it which assured that the claim would be settled soon. Thereafter, the complainant visited the OPs many a times but it lingered on the matter on one pretext or the other. On 30.04.2016 she had received a letter from OPs wherein they have repudiated the claim on the ground that the various investigations done/revealed certain facts, which were known to the deceased life assured and were not disclosed to us. Hence, the death claim under above mentioned policy has been declined for the following reasons, ‘Pre-Proposal, death, fake, death certificate submitted, policy obtained on a pre-deceased life in a fraudulent act fitted to deceive”. At the time of obtaining the policy her husband was hale and hearty and was not suffering from any disease and the death certificate submitted by the complainant is quite genuine document registered at No.115 of 06.06.2015 before Register Birth and Death, CHC, Bhattu Kalan District Fatehabad. The act and conduct of the OPs clearly amounts to deficiency in service on their part. In evidence, the complainant has tendered affidavit annexure CW1/A and documents Annexure C1 to Annexure C12.

2.                          On notice Ops appeared and filed their joint reply wherein it has been submitted that OPs had received a proposal alongwith document proposing a policy in the name of Ravi Kumar vide proposal dated 15.04.2015 concealing the fact that he had already expired on 23.05.2015.  Thereafter, policy was issued with date of commencement as 28.04.2015 without having knowledge of the prior death on the person on whose file a proposal was submitted.  Since it was an early claim, therefore, a bare investigation was conducted and it was revealed that LA had already expired on 25.03.2015 and the authority issuing the Death Certificate had certified that the Death certificate had been got prepared on wrong information and there is difference in date of death and the actual date of death is 25.03.2015.  The death of the life insured was also confirmed by the Asha-Anganwari Worker that the actual date of death was 25.03.2015 and the cause of death was heart attack. The complainant had played fraud with the OPs, therefore, the claim has rightly been repudiated vide letter dated 30.04.2016 and the intimation has already been given to the complainant. It has been further submitted that the policy in question was maliciously obtained by way of fraud & mis-representation, therefore, the contract of insurance is as such null and void as per provisions of Section 17 & 18 of the Act. The contract of insurance under the policy is nullity ab-intio. Preliminary objections such as cause of action, maintainability, locus standi and suppression of material facts from the OPs have also been taken. Other contentions have been controverted and prayer for dismissal of the complaint has been made. In evidence, the OPs have tendered affidavit Annexure RX and documents Annexure R1 to Annexure R8.

3.                We have heard learned counsel for the parties and gone through the case file very carefully.

4.                Undisputedly, the husband of the complainant had obtained an insurance policy from the Ops. The grouse of the complainant is that her husband died on 25.05.2015 (Annexure C5 death certificate) due to severe heart attack during the period of insurance policy (Annexure C2 & Annexure C4) but the OPs have repudiated the claim (Annexure C6) despite the fact that it was the duty of the insurance company to indemnify the same as at the time of obtaining the policy he was hale and hearty and was not suffering from any disease.  Learned counsel for the complainant at the time of arguments drew the attention of this Forum towards the certificate issued by Sarpanch of Gram Panchyat Khabra Kalan wherein it has been mentioned that Ravi Kumar had expired on 25.05.2015 due to heart attack and his cremation was done on the same date. Register maintained by the Chowkidar of the village duly certified by Registrar Death and Birth has also been placed on the file wherein name of Ravi Kumar has been mentioned in the column of dead person.

5.                On the other hand learned counsel for the OPs argued that the policy in question has been obtained by way of playing fraud upon the insurance company as the person on whose name the policy had issued on 28.04.2015 had already expired on 25.03.2015. After receiving the claim form a bare investigation (Annexure R2) was conducted being an early claim and it revealed that LA had already expired on 25.03.2015 and the authority issuing the Death Certificate had certified that the Death certificate had been got prepared on wrong information and there is difference in date of death and the actual date of death is 25.03.2015.  The complainant had played fraud with the OPs, therefore, the claim has rightly been repudiated vide letter dated 30.04.2016 and the Registrar of Death and Birth Annexure R4 on the death certificate made an endorsement on dated 31.03.2016 that the said certificate has been issued wrongly and further cancelled the same because Ravi Kumar had died on 25.03.2015. Learned counsel for the Ops has further drew the attention of this Forum towards the report Annexure R5 made by Asha/ Anganwari Worker wherein it has been mentioned that Ravi Kumar had died on 25.03.2015 and his cremation was also done at the cremation ground of the village. He further drew the attention of certificate dated 30.03.2016 issued by villagers of Khabra Kalan wherein it has been mentioned that Ravi Kumar had expired on 25.03.2015 due to heart attack and they had attended the cremation of Ravi Kumar.

6.                After hearing learned counsels for the parties and going through the material placed on case file we are of the considered opinion that this complaint cannot be decided in a summarily manner because it involves complicated and complex questions of facts and law which require elaborating evidence because the complainant has claimed that Ravi Kumar had expired on 25.05.2015 whereas the Ops have claimed that Ravi Kumar had expired on 25.03.2015. Another strange factor which this Forum has noticed that the Sarpanch of the concerned village in his certificate has clarified that Ravi Kumar had died on 25.05.2015 whereas the Asha/Anganwari worker and other villagers in their certificates have mentioned that Ravi Kumar had expired on 25.03.2015 and even they had attended his cremation also.  Since there is no sufficient evidence is available on the case file to reach at any conclusion as there are two different dates of death of Ravi Kumar available on the case file, therefore, keeping in view the above mentioned fact and circumstances this Forum is of the view that the present complaint before this Forum is not maintainable and the matter in question cannot be adjudicated in summary jurisdiction and it requires elaborating and voluminous evidence.  On this point reliance can be taken from case law titled as Uco Bank vs. Sh.S.D.Wadhwa, 2013 (4) CLT (NC).

7.                Hence, in view of above discussed factual as-well-as legal position, we are of the considered view that the present complaint is hereby dismissed as both the parties have failed to lead sufficient evidence to reach any conclusion. Moreover, in order to resolve the controversy alleged in the pleadings elaborating evidence and enquiry is required. However, the complainant is at liberty to approach at appropriate Court/forum if he so advised and in that eventuality, the period of litigation before this Forum shall not be counted towards the period of limitation for approaching appropriate court/forum.  Exemption of time spent before this Forum is granted  in terms of the  judgment of the Hon’ble Supreme Court of India in the case titled “ Laxmi Engineering Works versus PSG Industrial Institute  (1995) 3 SCC page 583. A copy of this order be supplied to both the parties free of cost.  File be consigned after due compliance.

ANNOUNCED ON: 15.03.2018

                                               

(PUSHPENDER KUMAR)     (ANAMIKA GUPTA)      (D.N.ARORA)                      MEMBER                  MEMBER               PRESIDENT