BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMRITSAR.

Consumer Complaint No. 414 of 2017

Date of Institution: 22.6.2017

Date of Decision: 27.2.2019

Bikramjeet Singh son of late S. Gurnam Singh, S/o S. Mahinder Singh resident of House No. 105, Ward No.2, Ajnala District Amritsar

Complainant

Versus

1. Exide Life Insurance Company Limited , Registered office, 3^rd Floor, J.P.Techno Park No. 3/1, Millers Road, Bangaluru 560001 (Karnataka) through its Authorized Signatory/Manager/Principal Officer
2. Exide Life Insurance Company Limited , Branch Office, SCO 44, 2^nd Floor Nagpal Towers, Circular Road, Ranjit Avenue, Amritsar through its Branch Head/Manager/Principal Officer

Opposite Party

Complaint under section 11, 12 and 13 of the Consumer Protection Act, as amended upto date.

Present: For the  Complainant:  Sh.Amit Monga, Advocate,     

              For the Opposite Party: Sh.Amit Bhatia, Advocate.                   

Coram

Sh.Charanjit Singh, President

Sh.Anoop Sharma,  Member

Ms.Rachna Arora, Member.

Order dictated by:

Sh.Charanjit Singh, President

1.       Bikramjeet Singh, complainant  has brought the instant complaint under section 11, 12  and 13 of the Consumer Protection Act, 1986 on the allegations that father of the complainant had obtained a life insurance policy from the opposite parties vide Policy No. 03003840 under the name of “Exide Life Guaranteed Income Insurance Plan” commencing from 5.11.2014  and the sum assured was Rs. 4,62,240/- + Rider Benefit amount Rs. 4,00,000/- total comes to Rs. 8,61,240/-. The half years premium was fixed for Rs. 26,016.04. The complainant was nominee in the said Insurance policy which was taken by his father S. Gurnam Singh s/o S. Mahinder Singh. On 15.11.2014 the father of the complainant died due to sudden heart attack at home. The death certificate issued by the Chief Registrar, Births and Deaths, Punjab is Annexure C-2. After the death of the father of the complainant on 15.11.2014 the complainant submitted his claim alongwith all the requisite documents  and death claim form. The claim was lodged at the branch office of the Insurance company at Amritsar.  Opposite party vide letter dated 22.10.2015 rejected the death claim for the policy purchased by the father of the complainant holding that the life assured died before proposal. The copy of rejection letter is Annexure C-4 .  In this regard complainant made number of requests regarding reconsideration of death claim of his father, but the opposite parties have done nothing favourable in this respect. The act of the opposite parties in repudiating the genuine claim of the complainant amounts to deficiency in service, unfair trade practice . Vide instant complaint, complainant has sought for the following reliefs:-

(a)     Opposite parties be directed to pay an amount of Rs. 8,61,240/- to the complainant being the sum assured  as per the Insurance policy alongwith interest @ 18% p.a. ;

(b)     Compensation to the tune of Rs. 1,00,000/- alongwith litigation expenses may also be awarded to the complainant .

Hence, this complaint.

2.       Upon notice, opposite parties appeared and filed written version in which it was submitted that a policy of Life Insurance is a contract of utmost good faith wherein life assured is under legal obligation to disclose all the facts and information pertaining to his/her age, income, habit and previous illness details in proposal form for accepting the life risk coverage for Life Insurance company especially when it is non medical policy. Father of the complainant namely Gurnam Singh had submitted a  proposal for life insurance with the opposite party on 5.11.2014 for “Exide Life Guaranteed Income Insurance Plan”, which is approved by the Insurance Regulatory Development Authority of India . The features of the abovementioned plan were explained in detail to the Life assured  and only after understanding the same , the life assured had voluntarily opted for the said plan. The premium opted by the Life assured was Rs. 25,093/- to be paid half yearly for 15 years and the policy term is 30 years for a sum assured of Rs. 4,61,240/-. Nomine under the said policy is the complainant. The life assured had confirmed that his health was sound on the date of proposal form and these facts were acknowledged with declarations made in the proposal form dated 5.11.2014. On believing the proposal form, the opposite party had issued the Life Insurance Policy bearing No. 03003840 to Life Assured and same was accepted by the Life assured, the details of which are given below:-

Within a very short time, the opposite parties, on 27.4.2015 received the death claim  intimation for the policy No. 03003840 alongwith the death certificate issued thereby  intimating company that life assured demised on 15.11.2014. Being early claim the opposite parties had referred the case for investigation and during investigation it was revealed that Life assured had died on 5.11.2014 in the morning and subsequently on the same day the proposal form of the Insurance policy was submitted by furnishing incorrect details with fake documents at the time of obtaining insurance policy and played fraud against the opposite parties. Accordingly, the claim stands repudiated  on the ground of death of life assured prior to the proposal . While submitting that the life assured had obtained the Life Insurance policy by playing fraud with the opposite parties , as such no liability can be fastened upon the opposite parties and while denying and controverting other allegations, dismissal of complaint was prayed.

3.       In his bid to prove the case Sh.Amit Monga,Adv.counsel for the complainant tendered into evidence affidavit of the complainant Ex.CW1/A, copy of policy Ex.C-1, copy of Premium receipt dated 5.11.2014 Ex.C-2, copy of death certificate of Gurnam Singh Ex.C-3, copy of repudiation letter dated 22.10.2015 Ex.C-4, copy of certificate dated 15.11.2014 issued by Shiv Puri Sudhar Committee, Ajnala Ex.C-5, copy of affidavit of Arun Kanta /o Kuldip Kumar Ex.C-6, affidavit of  Mrs. Arun Kanta Ex.C-7, copy of survey register Ex.C-8, copy of I card duly issued by the department of CDPO Ex.C-9 and closed the evidence on behalf of the complainant.

4.       To rebut the aforesaid evidence Sh.Amit Bhatia,Adv.counsel for the opposite party tendered into evidence affidavit of Sh. Bhardwaj, Legal Manager Ex.OP1, copy of proposal form Ex.OP2, copy of policy terms and conditions Ex.OP3, copy of letter dated 22.10.2015 Ex.OP4, copy of letter dated 13.11.2014 Ex.OP5 and closed the evidence on behalf of the opposite party.

5.       We have heard the Ld.counsel for the parties and have carefully gone through the record on the file.

6.       Ld.counsel for the complainant has vehemently contended that father of the complainant had obtained a life insurance policy from the opposite parties vide Policy No. 03003840 under the name of “Exide Life Guaranteed Income Insurance Plan” commencing from 5.11.2014  and the sum assured was Rs. 4,62,240/- + Rider Benefit amount Rs. 4,00,000/- total comes to Rs. 8,61,240/-, copy of policy is Ex.C-1 on record. It has further been contended that on 15.11.2014 the father of the complainant i.e. Life assured died due to sudden heart attack at home. The death certificate issued by the Chief Registrar, Births and Deaths, Punjab is Ex.C3 on record. After the death of his father on  15.11.2014 the complainant submitted his claim alongwith all the requisite documents  and death claim form. Opposite party vide letter dated 22.10.2015 rejected the death claim for the policy purchased by the father of the complainant holding that the life assured died before proposal. Ld. Counsel for the complainant contended that the act of the opposite parties in repudiating the genuine claim of the complainant amounts to deficiency in service as well as  unfair trade practice on the part of the opposite party.

7.       On the other hand Ld.counsel for the opposite parties has repelled the aforesaid contention of the Ld.counsel for the complainant on the ground that   the opposite parties received the death claim  intimation for the policy No. 03003840 alongwith the death certificate issued thereby  intimating company that life assured demised on 15.11.2014 and being early claim the opposite parties had referred the case for investigation and during investigation it was revealed that Life assured had died on 5.11.2014 in the morning and subsequently on the same day the proposal form of the Insurance policy was submitted by furnishing incorrect details with fake documents at the time of obtaining insurance policy and played fraud against the opposite parties. Accordingly, the claim stands repudiated  on the ground of death of life assured prior to the proposal. But we are not agreed with this plea of the opposite parties as to prove the death of life assured Gurnam Singh, complainant has submitted death certificate issued by Local Registrar, Birth & Death, Ajnala Ex.C-3 which fully proves the date of death of life assured as 15.11.2014 and not before the proposal i.e. 5.11.2014. Not only this the complainant has also placed on record copy of certificate  issued by Shiv Puri Sudhar Committee Ajnala, copy of which is Ex.C-5  which also fully proves the date of death of Life assured Gurnam Singh as 15.11.2014. The complainant also produced on record affidavit of Arun Kanta, who was working as Angarwari Worker , who also affirmed  the date of death of life assured on 15.11.2014 and also placed on record copy of  survey register  to affirm the date of death of life assured on 15.11.2014. As such the plea taken by the opposite party that the life assured died before the date of  proposal  is not sustainable. On the other hand, the documents produced by the opposite parties can not be given any weightage.    

8.       In such a situation, the repudiation made by Opposite Party regarding genuine claim of the complainant appears to have been made without application of mind. It is usual with the insurance company to show all types of green pastures  to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation.  This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.  It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-

“It seams 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.

9.       However, at the time of arguments Ld.counsel for the opposite party submitted that no doubt complainant is the nominee of the policy issued by the opposite party to the deceased life assured Gurnam Singh, but to obtain the benefit of the policy, the complainant has to produce the succession certificate from the competent court. But we are not agreed with the same as section 39 – Nomination by policyholder of the terms and conditions of the policy itself speaks that “The policyholder of a life insurance on his own life may nominate a person or persons to whom money secured by the policy shall be paid in the event of his death. As such the opposite party cannot deny the insured amount to the complainant being nominee.

10. Resultantly, we allow the complaint with costs and the Opposite Party is  directed to pay sum assured Rs. 4,61,240/- + rider benefit amount of Rs. 4,00,000/- to the complainant, within one month from the date of receipt of copy of this order, failing which the Opposite Party  shall be liable to pay interest @ 6% per annum on the awarded amount, from the date of filing the complaint till the payment is made to the complainant. Opposite Party  is also directed to pay the litigation expenses to the complainant to the tune of Rs.5,000/-.  Copies of the order be furnished to the parties free of cost. File is ordered to be consigned to the record room. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum.

Announced in open Forum

27.2.2019

(Charanjit Singh)

                             President    

                   (Anoop Sharma)                      (Rachna Arora)

                             Member                          Member