Haryana

Karnal

304/2013

Ramesh Kumar S/o Nanda Ram - Complainant(s)

Versus

DLF Pramerica Life Insurance Company Limited - Opp.Party(s)

R.K. Sharma

19 Apr 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

                                                              Complaint No.304 of 2013

                                                             Date of instt. 04.07.2013

                                                               Date of decision:19.04.2017

 

Ramesh Kumar son of Shri Nanda Ram resident of village Bhambhar Hedi Tehsil Assandh District Karnal.

 

                                                                             ……..Complainant.

                                      Vs.

1.DLF Pramerica Insurance Company Ltd. SCO 226, Ground Floor Sector-12, Karnal, through its Branch Manager.

2. DLF Pramerica Insurance Company Ltd. 4^th floor Building no.9 Tower-B, Cyber City, DLF City Phase-III, Gurgaon, through its MD.

3. Mr. Harpal Singh on of Shri Balbir resident of village Gudha tehsil Ghraunda District Karnal. (Agent of DLF Pramerica Insurance Company Ltd.)

 

                                                                             ………… Opposite Parties.

 

                     Complaint u/s 12  of the Consumer Protection Act.

 

Before                   Sh.K.C.Sharma……….President.

                    Sh.Anil Sharma…….Member.

                   Ms. Veena Rani…..Member

 

Present:-      Shri Jaswant Singh Advocate for complainant.

                    Shri Naveen Sharma Advocate for opposite parties no.1 and 2.

                    Shri Surender Punia Advocate for opposite party no.3

                            

 ORDER:

 

                   This complaint has been filed by the complainant u/s 12 of the Consumer protection Act 1986, on the averments that on the motivation of opposite party no.3, he got insured his mother Smt. Sona Devi (since deceased and herein after to be referred as deceased life assured) with opposite parties no.1 and 2. The opposite parties issued policy no.000043038 dated 23.11.2010 and annual premium was Rs.24798/-. He was assured that in case of death of the insured the opposite parties would pay the amount of Rs.3,50,000/- approximately i.e. Rs.1,40,000/- as sum assured + Rs.1,89,000/- as guaranteed benefits. His mother expired on 16.4.2011, leaving behind him as legal heir and nominee. He submitted the required documents in the office of opposite parties no.1 and 2 through opposite party no.3 for payment of death claim of his mother, but the opposite parties postponed the matter on one pretext or the other. Ultimately, he got served a legal notice upon the opposite parties, but the same also did not yield any result. There was deficiency in service on the part of the opposite parties, which caused him mental agony and physical harassment apart from financial loss.

2.                Notice of the complaint was given to the opposite parties. The opposite parties no.1 and 2 filed joint written statement controverting the claim of the complainant. Objections have been raised that the complainant has no cause of action to file the complaint; that the complainant has not approached this forum with clean hands and that the complaint is an abuse of process of law.

                   On merits, it has been submitted that the deceased life assured after completely understanding terms and conditions of the insurance product “DPLI Assure Money Plus Plan” had voluntarily applied for an insurance policy, vide proposal form bearing no.AF000229179 dated 27.10.2010, wherein the complainant was proposed as nominee. Relevant details and information were given in the proposal form, for an assured sum of Rs.1,40,000/- for which an annual premium amounting to Rs.25,053/- was proposed and the  policy term was 10 years. In the proposal form, the deceased life assured disclosed her age as 57 years at the time of filing the proposal form. On the basis of the information and declaration contained in the application/proposal form and believing the same to be true, policy bearing no.000043038 commencing from 23.11.2010 was issued. On receipt of the death claim, the opposite parties got conducted investigation as per terms and conditions of the policy contract. During investigation, the opposite parties came to know that the deceased life assured was far older than the age declared in the said application for insurance. She had grossly understated her age and induced the opposite parties to issue the policy on the basis of false and incorrect information. It was found that at the time of issuance of the policy contract the deceased life assured gave the Voter Card as age proof, wherein the age was mentioned as around 57 years. Policy contract was issued on the principle of good faith. However, during investigation, it was found that as per Electoral list 2004 her age was 60 years as on 2004 i.e.66 years at proposal stage, that as per Electoral List 2011 her age was 71 years and that as per letter from Tehsildar records her age was 48 years in the year 1994 i.e.69 years on the proposal stage. The maximum entry age for Assure Money Plus Plan is 60 years. Therefore, as per terms and conditions of the policy contract, non-disclosure made the contract Void Ab inito, as she was beyond the eligible age for the said policy. The other allegations made in the complaint have not been admitted.

3.                Opposite party no.3 filed separate written statement. Objections have been raised that the complainant is not legally maintainable in the present forum; that the complainant has no locus standi and cause of action to file the complaint; that the complainant has not approached this forum with clean hands; that the complainant is estopped from filing the complaint by his own acts and conduct and that the complaint is bad for mis-joinder or non-joiner of necessary parties.

                   On merits, it has been averred that the opposite party no.3 was working with opposite parties no.1 and 2 as Sales Manager and the complainant had asked him about the scheme of insurance policy. He made the complainant aware about the policy and after being satisfied, the complainant got insured the life of his mother Smt. Sona Devi. The opposite party no.3 deposited only the proposal form of the mother of the complainant with the Operation Department of the company, because that was his only duty. After 3.12.2010, he had no concern with the insurance company. There was no deficiency in service on the part of the opposite party no.3.The matter was between the complainant and opposite parties no.1 and 2.

4.                In evidence of the complainant, his affidavit Ex. C1 and documents Ex.C2 to C7 have been tendered.

5.                On the other hand, in evidence of the opposite parties, affidavit of Sujata Bhaduri Ex.OP1/A, affidavit of Harpal Singh Ex.OP3/1 and documents Ex.OP1 to Ex.OP5 have been tendered.

6.                We have appraised the evidence on record, the material circumstances of the case and the arguments advanced by the learned counsel for the parties.

7.                Admittedly, the complainant got insured his mother with opposite parties no.1 and 2 and policy no.000043038 dated 23.11.2010 was issued by opposite parties no.1 and 2. The mother of the complainant expired on 16.4.2011. Complainant claiming himself to be legal heir and nominee lodged claim with the opposite parties no.1 and 2. The claim of the complainant was repudiated by opposite parties no.1 and 2 on the ground that the deceased life assured in the proposal form disclosed her age as 57 years, whereas while conducting enquiry in the death claim, it was found that she was more than 64 years of age at the time of submitting proposal form and thus she mis-represented the opposite parties no.1 and 2 regarding her age, for obtaining policy.

8.                Learned counsel for the complainant contended that the voter card of deceased life assured was produced in support of her age mentioned in the proposal form and the same was got verified by opposite parties before issuance of the policy. Thus, the deceased life assured neither concealed any material fact nor mis-represented the opposite parties regarding her age at the time of submitting proposal form. It has further been argued that in the Electoral Lists for the year 2004, 2011 and 1994 the age of the deceased life assured might have been mentioned on the basis of approximation and that cannot be considered as proof regarding her age. It has lastly been argued that repudiation of the claim of the complainant without any cogent evidence regarding age of deceased life assured at the time of obtaining the policy, amounted to deficiency in service on the part of the opposite parties no.1 and 2.

9.                To wriggle out the aforesaid contentions learned counsel for the opposite parties vehemently argued that the deceased life assured in the proposal form stated her date of birth 6.8.1953, according to which her age was 57 years at the time of submitting the proposal form for the policy, but in the voter list of 2004 her age was mentioned as 60 years, in the voter list for the year 2011, her age was mentioned as 71 years and in the voter list for the year 1994 her age was mentioned as 48 years. Thus, as per the record, her age was more than 64 years at the time of submitting the proposal form, but she mis-represented her age as 57 years, for obtaining the policy. Contract of policy is  based upon the principle of “uberrimae fides” i.e. utmost good faith. As the deceased life assured did not disclose her correct age in the proposal form and mis-represented the opposite parties, the contract of insurance became void, therefore, the opposite parties are not liable to pay the claim to the complainant and this claim was rightly repudiated.

10.                Life Insurance Corporation of India and another Versus Bimla  Devi revision petition no.3806 of 2009 decided by Hon’ble National Commission on 12.8.2015, the judgments of Hon’ble Supreme Court in P.C. Chacko and Another Vs. Chairman, Life Insurance Corporation of India and Ors (2008) 1 Supreme Court Cases 321, Satwant Kaur Sandhu Versus New India Assurance company IV (2009) CPJ 8 (S.C.), LIC of India Vs. Asha Goel, Ratan Lal and Anor. Vs.Metropolitan Insurance Co. Ltd., United India Insurance Co.Ltd. Vs. M.K.J.Corporation 1996 (6) SCC 428 and Carter Vs.Boehm (V) 1966   RR 1965 were considered and it was held that upshot of the entire discussion is that in a Contract of Insurance, any fact which would influence the mind of a prudent insurer in deciding whether to accept or not to accept the risk, is a material fact. If, the proposer has knowledge of such fact, he is obliged to disclose it, particularly, while answering questions in the proposal form. Needless to emphasise that any inaccurate answer will entitle the insurer to repudiate its liability, because there is clear presumption that any information sought for in the proposal form is material fact for the purpose of entering into a Contract of Insurance. In Santwant Kaur Sandhu case’s (supra) also it was held that contract of insurance is uberrimae fides, meaning a contract of utmost good faith on the part of the assured. Thus, it needs little emphasis that when an information on a specific aspect is asked for in the proposal forum, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject, which is within his knowledge. It is not for the proposer to determine whether the information sought for is material for the purpose of the policy or not. Of course, obligation to disclose extends only to facts, which are known to the applicant and not to what he ought to have known.

11.              The facts of the present case are to be analyzed keeping in view aforesaid proposition of law. A perusal of the copy of the proposal form Ex.OP1 shows that the deceased life assured got mentioned her date of birth in the proposal form as 6.8.1953. Proposal form was submitted on 27.10.2010. The copy of the voter list for the year 2004 Ex.OP3 shows that the name of the deceased life assured figured at serial no.60 and her age in the year 2004 was mentioned as 60 years. The said voter list was finalized on 23.2.2004. In the voter list for the year 2011 which was issued on 7.9.2011 her name figured at serial no.82 and her age was mentioned as 71 years. Kamlesh A.W.W. made entry in the death register attested by Meena Kumari Sarpanch of the village. In the said register, the date of death of the deceased life assured was mentioned as 16.4.2011 and her age as 65 years. Tehsildar also submitted report, according to which in the voter list for the year 1994, which was finalized on 12.3.1994, the age f the deceased life assured was mentioned as 48 years. Thus, from the said record, it is emphatically clear that the deceased life assured was not less than 64 years of age at the time of submission of the proposal form on 23.10.2010. The opposite parties have submitted that the maximum entry for “DPLI Assure Money Plus Plan” was 60 years. Thus, the deceased life assured was not eligible to get the said insurance plan in the year 2010, as her age exceeded 60 years. The complainant could not produce any documentary evidence worth the name on record, which may indicate that the deceased life assured was 57 years of age at the time of obtaining the policy. Under such facts and circumstances, we have no hesitation in concluding that the deceased life assured had mis-represented the opposite parties by mentioning her age in the proposal form as 57 years whereas she was not less than 64 years at that time.  Consequently, the contract of insurance was void and as such the complainant is not entitled to get the claim regarding death of the deceased life assured and opposite parties rightly repudiated his claim.

12.              As a sequel to the foregoing reasons, we do not find any merit in the present complaint. Therefore, the same is hereby dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 19.4.2017

                                                                                      (K.C.Sharma)

                                                                                         President,

                                                                             District Consumer Disputes

                                                                             Redressal Forum, Karnal.

 

                             (Anil Sharma)        (Veena Rani)

                               Member                 Member