Haryana

StateCommission

A/649/2017

EXIDE LIFE INSURANCE CO.LTD. - Complainant(s)

Versus

GOMTI - Opp.Party(s)

INDERJIT SINGH

01 Dec 2017

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No  :      649 of 2017

Date of Institution:      29.05.2017

Date of Decision :      01.12.2017

1.     Exide Life Insurance Company Limited (formally ING Vysya Life Insurance Company Limited) Commercial Urban Estate-II, Near Jindal Chowk, Hisar.

2.     Exide Life Insurance Company Limited (formally ING Vysya Life Insurance Company Limited) “ING Vysya House” 5^th Floor, No.22, MG Road, Bangalore-560001 both through their authorised signatory available at Corporate Office, ‘ING Vysa House, 5^th Floor No.22, M.G. Road, Bangalore-560001.

                                      Appellants-Opposite Parties

Versus

 

Mrs. Gomti wife of late Shri Jai Singh, aged 42 years, VPO Malapur, near Ramdev Mandir, Tehsil Adampur, District Hisar, Haryana.

 

                                      Respondent-Complainant

 

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri Balbir Singh, Judicial Member.

                             Shri Diwan Singh Chauhan, Member.            

 

Argued by:          Shri Inderjeet Singh, Advocate for appellants.

                             Shri J.S. Thind, Advocate for respondent.

 

                                                   O R D E R

 

BALBIR SINGH, JUDICIAL MEMBER

 

        This appeal has been preferred against the order dated October 03^rd, 2016 passed by District Consumer Disputes Redressal Forum, Hisar (for short ‘the District Forum’).

2.                Jai Singh (since deceased)-husband of Mrs. Gomti-complainant (respondent herein) was provided Life Insurance policy bearing No.02594973 by ING Life Insurance Company Limited – Opposite Party No.1 (appellant No.1 herein and referred to as the ‘LIC’) for a period of ten years mentioning date of commencement as January 07^th, 2013, date of maturity as January 07^th, 2023 and total sum assured as Rs.10,00,000/-. Jai Singh (hereinafter referred to as the ‘Life Assured’) was required to pay premium amount of Rs.5,995.53 to be paid semi-annually. Unfortunately, the life assured died on January 19^th, 2013. The complainant being nominee of the life assured submitted her insurance claim with the opposite party along with needed documents. Ultimately, the insurance claim of the complainant was repudiated by the LIC vide letter dated 28^th August, 2013 (Exhibit R-7) mentioning that the life assured had misrepresented the LIC regarding his financial status at proposal stage. The complainant has taken plea that her deceased husband (life assured) did not misrepresent the LIC or the agent of the LIC regarding his financial status. Moreover, it was the duty of the LIC to confirm regarding financial status of the life assured before issuance of the insurance policy and receiving premium amount. The repudiation of the insurance claim by the LIC is wrong and illegal. The complainant is entitled to receive total sum assured along with interest and cost of litigation.

3.                The complainant filed the present complaint under Section 12 of the Consumer Protection Act, 1986 with a prayer to direct the LIC to pay an amount of Rs.10.00 lacs being the sum assured with interest at the rate of 18% per annum; to pay an amount of Rs.1.00 lac on account un-necessary harassment, mental agony and an amount of Rs.11,000/- as litigation expenses.

4.                The Opposite Parties - Exide Life Insurance Company Limited in their written version have taken plea that the complaint is not maintainable in the present form and that it is not a case of deficiency in service. It is pleaded that the features of the “ING Term Life Plan” a life insurance produce were explained in detail to the life assured and only after understanding the same in its entirety, the life assured had voluntarily opted for the said plan.  The premium amount to be paid by the life assured was Rs.6,000/- semi-annually for a period of ten years for the sum assured as Rs.10,00,000/-. The complainant was mentioned as nominee in the proposal form. The life assured along with his proposal form dated January 07^th, 2013 also submitted Form-J and other documents in support of his age and income. The life assured had given information regarding his pre-existing health condition, age and income in the proposal form. As per Clause-13 of the policy terms and conditions, if any such information is suppressed by the life assured which is vital for issuance of this policy in time after the proposal date, the LIC has right to forfeit the premium amount and to discharge itself from any such liability by considering the policy of life insurance as null and void.

5.                The life assured died on January 19^th, 2013 due to heart attack as per information received within 12 days from the date of issuance of the insurance policy. During internal investigation, it was found that the life assured had submitted a fake and fraud income proof at the time of obtaining the life insurance policy.  On verification Pan Card which was provided in the Form-J was also found invalid. During external investigation it also revealed that the life assured was suffering from small intestine problem and had taken treatment for such illness before availing the life insurance policy. The opposite parties could not get any information in this regard because one Anil Kumar Ex-employee of the opposite parties is currently working as investigator and he had threatened the investigator of the LIC-Opposite parties and hospital authorities not to share any details. In this regard, a complaint was also filed by the opposite parties before the Inspector General of Police, Hisar. Anil Kumar and his associates had sourced policies approximately amounting to Rs.60 to 70 lacs sum assured from December 2012 to January 2013 for opposite parties fraudulently by fabricating documents. The insurance policies were provided to those poor and sick persons who were likely to die during next 2-3 months. All it was done by Anil Kumar to earn income by fraud and cheating. The complainant is not entitled to receive any amount as claimed in the complaint. The opposite parties prayed that the complaint be dismissed with cost.

6.                Parties adduced evidence in support of their respective claims before the District Forum.

7.                After hearing arguments, vide impugned order dated October 03^rd, 2016 passed by the learned District Forum, the complaint filed by the complainant was allowed directing the opposite parties to pay the sum assured Rs.10.00 lacs to the complainant with interest at the rate of 9% per annum from the date of filing of the complaint.

8.                Aggrieved with the impugned order dated October 03^rd, 2016, the opposite parties-appellants have filed the present appeal bearing No.649 of 2017 with a prayer to set aside the impugned order and to dismiss the complaint filed by the complainant.

9.                We have heard learned counsel for the parties and perused the case file.

10.              During the course of arguments, it was common case of both the parties that during his life time Jai Singh and husband of complainant Smt. Gomti was provided life insurance policy (Exhibit R-2) by the opposite party No.1 mentioning the total sum assured as Rs.10.00 lacs and date of commencement of the insurance policy as January 07^th, 2013 and date of maturity as January 07^th, 2023. In the insurance policy, the premium amount to be paid semi-annual is mentioned as Rs.6,000/-. It is also admitted fact that the life assured died within 12 days from the date of commencement of the insurance policy due to heart attack. First premium amount was paid vide receipt dated January 07^th, 2013. Admittedly, the complainant – Smt. Gomti was mentioned as nominee of her husband-life assured. The insurance claim of the complainant which was submitted well within time, was repudiated vide letter dated 28^th August, 2013 (Exhibit R-7). The insurance claim was repudiated on the ground that the life assured had misrepresented the LIC regarding his financial status.

11.              In their written version, the opposite parties have also taken plea that during external investigation it was revealed that the life assured was suffering from small intestine problem and he had taken treatment for such illness before availing the life insurance police. The record regarding ill health of the life assured could not be obtained due to problems created by Anil Kumar who was earlier employee of the opposite parties. Anil Kumar was successful in managing insurance policies for few poor and sick persons who were likely to die during next 2-3 months, to grab money.  In the investigation report Exhibit R-5 submitted by the investigator Jitender Khurana, it is mentioned that the life assured got treatment from a hospital at Delhi and Rohtak but he could not collect information regarding any such hospitals where the life assured got treatment. In our view, on the basis of a complaint Exhibit R-6 filed in the office of Inspector General of Police and the investigation report Exhibit R-5, certainly findings cannot be given that the complainant was having any pre-existing disease prior to issuance of the insurance policy. For want of any convincing evidence in this regard, the insurance claim of the complainant cannot be repudiated on this ground.

12.              Version of the opposite parties is that the life assured misrepresented the LIC-opposite parties regarding his financial status. It is true that in his proposal form Exhibit R-1, the life assured mentioned that he is an agriculturist and his annual income is Rs.3.00 lacs. As per version of the opposite parties, the complainant could not produce any document to prove that the life assured was owner of agricultural land at the time of issuance of the insurance policy and as such the life assured had given wrong information that he is an agriculturist and his annual income is Rs.3.00 lacs. The complainant has placed on the file copies of Form-J, Annexure A-6 to Annexure A-8 issued by a Commission Agent, Grain Market, Adampur. In Form ‘J’ dated April 04^th, 2011, Annexure A-6, the sale price of Guar crop is mentioned Rs.80,333.50; in Form ‘J’ dated May 27^th, 2011 Annexure A-7, total sale price of Guar crop sold by Jai Singh is shown as Rs.1,42,560/- and in Form ‘J’ dated November 28^th, 2012 Annexure A-8, total sale price of (cotton) Narma crop is mentioned as Rs.1,75,992.50.  In our view, even if Jai Singh during his life time was not owner of agricultural land, still he was in a capacity to earn income from agricultural profession. A person can earn agricultural income by working as a lease holder or tenant also.  

13.              Moreover, we feel, the income of the deceased (life assured) from agricultural land is not so much material for the decision of this complaint. The date of birth and health of the life assured may be an important factor at the time of issuance of insurance policies but the source of income of the life assured cannot be considered as an important factor.  The information is received regarding financial status of the life assured so that the LIC-opposite parties may not feel any problem regarding payment of the premium amount. In our view, the premium amount of Rs.6,000/- which is to be paid semi-annual, is not such a big amount which may be difficult to be paid even by a person doing labour work also. Moreover, the first premium amount was paid in time and after twelve days, unfortunately the life assured died on account of heart attack. The LIC-opposite parties could not prove that there was any pre-existing disease in the body of the life assured before issuance of the insurance policy.

14.              Moreover, we fail to understand why the LIC-Opposite Parties did not prefer to ask the life assured to produce documentary proof that he was owner of agricultural land when the Proposal Form Exhibit R-1 was submitted by the life assured. It is strange that the LIC did not think it proper to make inquiry regarding agricultural land, source of income and annual income of the life assured when he was provided insurance policy because at that time the LIC was in haste to receive the premium amount. The LIC should not have believed the oral version of the life assured regarding his annual income and that he is an agriculturist. The LIC preferred to make verification regarding annual income and regarding ownership of the agricultural land owned by the life assured Jai Singh when the LIC was required to pay the sum assured to the complainant, being nominee and wife of the life assured. It appears to be unfair on the part of the LIC. The information which the LIC was in a position to obtain at the time of issuance of the insurance policy, the LIC should not have waited for seeking any such information till the death of the life assured and till the date of submitting the insurance claim. If the LIC believed the oral version of the life assured regarding his income at the time of receiving premium, the LIC should have believed the version of the life assured and the complainant at the time of settlement of the insurance claim also.  We feel such type of clever tactics used by the LIC to repudiate the genuine insurance claim of the claimants cannot be allowed to be used.

15.              As per discussions above, we feel the life assured had not violated any terms and conditions of the insurance policy. The impugned order dated October 03^rd, 2016 passed by the learned District Forum does not suffer from any material illegality and invalidity. Accordingly, findings of the learned District Forum stand affirmed and the appeal stands dismissed.

16.              The statutory amount of Rs.25.000/- deposited at the time of filing the appeal be refunded to the complainant against proper receipt and identification in accordance with rules, after expiry of period of appeal/revision, if any.

 

Announced 01.12.2017

Diwan Singh Chauhan Member

Balbir Singh Judicial Member

Nawab Singh President

CL