1.                     The brief history of the case of the complainant is that his father late Gobinda Khora during his life time had obtained FG Family Secure insurance Policy bearing No.01055214 with Customer ID No.22692840 from the OP through its Agent vide ID No.80042182 and the said policy was initiated from the native place of the complainant at Laxmipur.  It is submitted that the policy commenced w.e.f. 24.12.2012 with annual premium of Rs.8661/- for a sum assured of Rs.43, 904/- under which the complainant was the nominee.  It is further submitted that the LA died on 16.5.2014 and on submission of claim application, the OP verified the documents and referred the matter to Insurance Ombudsman at Bhubaneswar who passed award ordering the complaint being devoid of merit is dismissed.  The complainant submits that he filed petition before the authorities to review the decision but in vain.  Thus alleging deficiency in service on the part of the OP, he filed this case praying the Forum to direct the OP to pay the claim amount of Rs.1, 26,015/- with assured bonus and interest @ 22% p.a. from 16.5.2014 and to pay Rs.10, 000/- towards compensation and costs to the complainant.

2.                     The OP filed counter denying the allegations of the complainant with certain preliminary objections but admitted about the alleged policy issued in favour of the LA vide Policy No.01055214 dt.24.12.2012 for a sum assured of Rs.43, 904/-.  The OP contended that they received claim intimation on 25.6.14 from the complainant intimating that the LA had passed away on 16.5.14 and due to early claim; the OP investigated the matter through an independent agency.  It is contended that the said agency submitted its report stating that the LA in the proposal form stated his date of birth as 01.01.1962 and had submitted copy of his voter ID card as age proof, as per which, the LA was 32 years of age as on 01.01.1994 and hence at the time of proposal the age of the LA was 52 years but the concerned investigating agency obtained a cancelled voter ID card submitted as age proof by the LA at the time of proposal, from the Sarapanch of Kuttinga village and Sarapanch certified that the LA was approximately 68 years of age as on the date of death.  The OP also further contended that the online Voter ID Card of the LA was also procured by the said investigating agency as per which the approximate age of the LA was 68 years.  Considering the said issues and the declarations made by the LA during proposal, they have repudiated the claim and decided to refund the premium amount of Rs.16, 738/- to the complainant.  Thus denying any fault on their part, the OP prayed to dismiss the case of the complainant.

3.                     Both the parties have filed certain documents in support of their cases.  The OP only filed affidavit.  Heard from the complainant through his A/R and perused the materials available on record.

4.                     In this case, FG Family Secure insurance plan vide No.01055214 obtained by the father of the complainant during his life time from the OP with annual premium of Rs.8661/- commencing w.e.f. 24.12.12 for a sum assured of Rs.43, 904/- and the nomination of the complainant under the policy are all admitted facts.  It is also an admitted fact that the LA had deposited 2 instalments and thereafter died of heart attack on 16.5.14 which is within the risk period.  The case of the complainant is that he being the nominee lodged a death claim before the OP and the OP repudiated the claim on the ground of misrepresentation of age.  However, the date of repudiation or any correspondence thereto has been filed by none of the parties and hence the fact of repudiation remains ambiguous.

5.                     The OP through its counter challenged the territorial jurisdiction of this Forum stating that the OP has no branch office in Koraput district and the policy was initiated at Rayagada through agent.  In this context, it is seen that the LA is an illiterate and impressed his thumb on the proposal form.  He is also a labour class man.  We do not believe to the contention of the OP that the LA had gone to Rayagada to propose for the policy.  Rather the clever agent of OP had visited the native of the LA to sell the policy of the OP as disclosed by the complainant and by any means has succeeded to get the proposal.  Hence the agent has initiated the proposal at Laxmipur and as such this Forum has got territorial jurisdiction to entertain this case.  Further all correspondences by the OP have been made to the Laxmipur address of the LA.

6.                     It is seen that on receipt of claim intimation the OP repudiated the same and agreed to pay Rs.16, 738/- which is the premium amount deposited by the LA.  The OP has also engaged an agency to investigate into the death claim preferred by the complainant.  The said agency revealed to the OP that the LA was not approximately 50 years of age but was approximately 66 years as on the date of proposal.  The OP stated that the Voter ID furnished by the LA during proposal was a created one and the local Sarapanch after cancelling the said Voters ID card has certified that the age of the LA was approximately 68 years as on the date of his death.

7.                     Perused the copy of Voters ID card of the LA which appears to be genuine on the face of it.  The age as on 01.01.1994 as per ID card was 32 years.  The Voters ID card of the complainant is a Government document provided for identity and to know the approximate age of a person.  The age as provided in the Voters ID card is being used for all purposes.  Hence it cannot be challenged by the agency or by a Sarapanch.  Further the complainant is totally illiterate person and he cannot show his exact age before any Government officials visited for the purpose of collection of report for preparing Voters ID card.  Rather the LA has prudently shown his Voters ID card at the time of proposal with no other ulterior motive.

8.                     Further the OP stated that the Sarapanch has cancelled the Voters ID card of the LA and stated that the approximate age of the LA was 68 years at the time of death.  A Sarapanch has no authority to cancel a Voters ID card issued by the State Election Officer/District Election Officer but in this case as the LA is dead, the Sarapanch might have cancelled the Voters ID card as a precautionary measure for any misuse of the Voters ID card of the LA.  In the above circumstances, it can be safely concluded that the Voters ID card of the LA was genuine.  The OP further stated that they have procured online voter ID card of the LA through investigating agency and as per said information, the approximate age of the LA was 68 years as on the date of death.  We do not lay any emphasis on that record as because the said information might have been changed later on during any correction program of Voters ID card but the said information has not been communicated to the LA by issuing fresh ID card.  Hence the LA was not at fault by stating his age as found in his Voters ID card.

9.                     It is further seen that the OP is grumbling about Sec.4 “STATEMENT OF AGE” under the policy which stipulates that “if the correct age of the life assured is such as would have made the life assured uninsurable under the plan of insurance specified in the policy document, the plan of insurance shall stand altered to such plan of insurance as is generally granted by the Company for the correct age of the life assured, which will be subject to the terms and conditions as are applicable to that plan of insurance.  If it is not possible to grant any other plan of insurance, the Policy shall stand cancelled from the date of issue of the Policy and the premium paid shall be refunded subject to the deduction of the expenses incurred by the Company on the Policy”.  This being the rule, we do not understand as to when and how the OP would find out the age discrepancy and effect necessary correction to the policy.  It can be possible at the initial stage only but not at the time of maturity.  Further the OP has nowhere stated that at this stage of so called age as they found, it was not possible on their part to grant any other plan and they are bound to cancel the policy in question.

10.                   Further the OP stated that the rules and regulations were read over and made the LA understand at the time of proposal by an independent person as the complainant was illiterate.  Practically this type of procedure is not being adopted by the agents during proposal.  The OP has not mention the name and qualification of the person who was entrusted with that job on their behalf and how much fees have they paid to that person.  However, this contention of the OP is an afterthought and entire doubt goes to the agent who had succeeded to obtain the proposal from the LA but after death of the LA, the OP is playing hide and seek game with the nominee under the policy.

11.                   It is a settled principle of law that the insurance claim must be honestly settled without any delay.  Insurance Company being in a dominant position often act in an unreasonable manner and after accepting the proposal they disown their liability on one pretext or the other when they called upon to pay compensation.  This “take it and leave it” attitude is clearly unwarranted not only is being bad in law but ethically unacceptable.

12.                   In the above facts and circumstances, the OP by repudiating the death claim of the complainant had committed deficiency in service.  As such the OP is liable to settle the death claim in favour of the nominee-complainant.  It is seen that the Sum Assured under the Policy is Rs.43, 904/- and the policy is also attached with other facilities on maturity.  As the LA is dead the policy got matured.  Further due to non settlement of legitimate claim, the complainant must have suffered some mental agony for which he is also entitled for some compensation and costs of this litigation.  Considering the sufferings of the complainant, we feel a sum of Rs.10, 000/- towards compensation and costs in favor of the complainant will meet the ends of justice.

13.                   Hence ordered that the complaint petition is allowed in part and the OP is directed to pay the sum assured of Rs.43, 904/- and other benefits attached to the policy with interest @ 12% p.a. from the date of decision of the Claims Review Committee i.e. 27.11.2014 and to pay Rs.10, 000/- towards compensation and costs to the complainant within 30 days from the date of communication of this order.

(to dict.)