PER:
Charanjit Singh, President
1 The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 12 against the opposite parties on the allegations that Gurjant Singh son of complainant was insured with the opposite parties vide policy No. 18662400-HDFC SL ProGrowth Plus dated 8.9.2016 for a sum of Rs. 9,60,000/- and he paid premium of Rs. 48,000/- and opposite parties having office at HDFC Ltd. at Makhu handed over policy alongwith first premium receipt dated 7.9.2016 issued by the opposite parties. Unfortunately, Gurjant Singh son of the complainant has died on 8.11.2016 leaving behind complainant his mother as his legal heir. In the last week of November, 2016, the complainant visited H.D.F.C. Bank ltd. Makhu District Ferozepur for the payment of insurance amount but the opposite party No. 3 postponed the matter on one pretext or the other. In the month of November, 2017, the complainant received a letter from the opposite parties regarding the discontinuance of policy on the ground that death certificate is forged one which is absolutely false and baseless. Son of the complainant had never concealed any fact from the opposite parties. After verifying the proposal form, the opposite parties issued the policy to son of complainant. The opposite parties have withheld the above mentioned entire amount knowingly, willfully and intentionally which amounts to deficiency of services. The complainant has requested the opposite parties many a times to pay the insured amount alongwith interest and incentives etc. to her but of no avail. The complainant has prayed that the opposite parties may kindly be directed to pay Rs. 9.60.000/- alongwith interest up to date and incentives etc. and the complainant has also prayed Rs. 2,00,000/- as compensation and damages. Alongwith the complaint, the complainant has placed on record affidavit of complainant Ex. CW/A, Policy of HDFC Ex. C-1, Schedule of Benefits Ex. C-2, Nomination Schedule Ex. C-3, Death certificate of Gurjant Singh Ex. C-4, Death Claim reconsideration Request Ex. C-5.
2 Notice of this complaint was sent to the opposite parties and opposite party No. 1 appeared through counsel and filed written version by taking the preliminary objections that the complainant has willfully and fraudulently concealed the material facts regarding the death of the insured in order to get wrongful claim from the opposite party. As per the statement of death claim dated 12.9.2017 submitted by the complainant, it has been confirmed that the death of the Life assured occurred on 8th November 2016. As per record of opposite party, on the basis of application dated 1.9.2016 submitted by the insured at the time of obtaining insurance the said application was accepted on the basis of information provided in the application form and policy was issued on 7th September, 2016. On receipt of the death claim, the insurance company got the matter investigated and it was revealed that in fact the date of death of the life assured was prior to the application/ policy issuance and not on 8th November, 2016 as conveyed in the death information letter and the investigations further established that the death certificate submitted at the time of claim intimation was not genuine. As per the investigations, it was confirmed beyond doubt that the date of death of the insured was 7.8.2016 i.e. prior to issuance of the insurance policy and the policy was fraudulently obtained subsequent to death by submitting in-genuine and forged documents to establish the wrong date of the death to get the wrongful claim. Therefore, based upon the investigations conducted by the opposite party, the claim was rightly rejected and already conveyed to the complainant vide letter dated 20.11.2017, therefore, the complainant is not entitled to the claim amount as alleged. Even otherwise, in view of the facts stated above, since the claim submitted by the complainant is based on fraud and submission of forged and in genuine documents, therefore, the present complaint cannot proceed before this Commission and is liable to be rejected with directions to the complainant to raise the grievances before competent Court of law where both the parties would get ample opportunity to produce their evidence and get the orders on merits. The claimant has submitted a wrong claim by concealing the actual facts from the opposite party knowing well that those were incorrect. The claim of the complainant was rightly rejected by the opposite party on account of misrepresentation and concealment of facts. Therefore, it is evident that the claim was prejudicial to the contents of ‘Uberrima Fides’ which is the basis of all insurance contracts. The fact of in-genuine claim submitted by the claimant was well within the knowledge of the claimant and she has tried to get wrongful claim by submitting forged and fabricated documents by concealing true facts. Therefore, on the strength of above factors, the competent authority of opposite party repudiated the liability under the said policy. The complainant is debarred to file the instant complaint due to her own act and conduct. The complainant tried to defraud the opposite party and knowingly concealed the actual date of death of the insured at the time of submission of the claim which clearly reveals that malafide intention of the complainant to grab the public money. Hence the complaint is liable to be dismissed. The complainant is estopped to file the present complaint as there is no deficiency in service on the part of the opposite party as defined in Section 2(I)(g) of the Consumer Protection Act, 1986 under the heading of deficiency. The complaint against the opposite parties does not lie before this commission under the Consumer Protection Act 1986 with regard to the rejected claim. The matter is also to be decided by a civil court at full scale trial requiring the complete pleadings and evidence according to law the summary trial under the Consumer Protection Act, 1986 is not the proper remedy for the complainant. The opposite party had rightly refused the death claim of the Life Insurance Policy of the deceased. On Merits, it was pleaded that the documents were rightly demanded to establish the contention regarding the genuineness of the claim and before considering the claim, the opposite party got the matter investigated from which it was clearly established that the claim was entirely wrongful and fraudulent as detailed above and the complainant was trying to get wrongful claim by submitting forged and fabricated documents to the insurance company. The letter rejecting the claim was rightly issued by the opposite party in view of findings of the company based upon investigations. The complainant is not entitled to get any claim amount. The opposite party No.1 has denied the other contents of the complaint and prayed for dismissal of the same. Alongwith the written version, the opposite party No.1 has placed on record affidavit of Gurpreet Singh Deputy Manager Legal Ex. OP1/1 alongwith documents Ex. OP1/2 to Ex. OP1/14.
3 Notice of this complaint was issued to the opposite party Nos. 2, 3 but none has appeared on behalf of opposite party Nos. 2, 3, therefore, opposite party Nos. 2, 3 were proceeded against ex-parte vide order dated 28.2.2019 of this commission.
4 We have heard the Ld. counsel for the complainant and opposite party No. 1 and have carefully gone through the record placed on the file.
5 In the present case, the opposite party has repudiated the claim of the complainant vide letter dated 20.11.2017 Ex. OP-4 which is reproduced as follows:-
“We had received a duly signed ‘Statement of Death Claim’ dated September 12, 2017 confirming the death of the Life Assured on November 8, 2016 wherein you have declared that the statements made in the said form are true in each and every respect.
The policy was issued on the basis of application dated September 01, 2016 to HDFC Standard Life Insurance Company Limited (herein after referred as ‘the company’) for purchase of HDFC Life ProGrowth Plus, for a sum assured of INR 960000.
The application was accepted based on the information provided in the application form and the policy was issued on September 07, 2016.
However, we hold indisputable proof to show that the death of the Life Assured was prior to the application / policy issuance and not on November 08, 2016 as conveyed in your death intimation letter.
However, our investigations have established that the death certificate submitted at time of claim intimation was not genuine.
It is obvious from what is stated above that you have produced forged documents and used false statements with a view to defraud the Company of the policy monies. Hence, we regret our inability to accept your death claim under this policy.
It may be noted that the rejection of your claim is without prejudice to the company’s rights to take appropriate criminal proceedings against you.
In case you wish to re-present your claim to company, you can do so within 30 days of receipt of this letter at any HDFC Life branch (In case of any quarries regarding he refund, please fee free to contact us”
6 In the present case the opposite party has denied the claim on the ground that the death of the Life Assured was prior to the application/ Policy issuance and not on November 8th, 2016 as conveyed in death intimation letter and their investigations have established that the death certificate submitted at time of claim intimation was not genuine. To established their case, the opposite parties have appointed investigator i.e. J.K enterprises. Alongwith the investigation report, the investigator has placed on record register of Asthian (ashes) Gurudwara Sri Bauli Sahib Gonidwal, District Tarn Taran on which there is entry at serial No. 7634 dated 10.8.2016. The name of mother of life assured is mentioned at Ex. OP/7, Ex. OP/8, Ex. OP/9 as ‘Simarjit Kaur’. Infact the name of the mother of the life assured is Paramjit Kaur who is complainant and surveyor in its report at page No. 2 of Ex. OP/6 himself written the name of mother of life assured as ‘Paramjit Kaur’. The name of village of life assured is village ‘Sabhra’ whereas the name of village of life assured is mentioned at Ex. OP/7, Ex. OP/8, Ex. OP/9 as ‘Blair’. The village Sabhra is different and village Blair is different village. The age of the life assured on the Ex. OP/7 and Ex. OP/8 is mentioned as 35 years in the year 2016, whereas from the policy document Ex. OP/2, report of surveyor Ex. OP/6 the date of birth is mentioned as 1.1.1997 (20 years as per UID). As such, all the above said facts prove that Gurjant Singh life assured is different person from the person regarding which the surveyor has made the investigation. The opposite party and its surveyor have also miserably failed to connect the document Ex. OP/7, Ex. OP/8 and Ex. OP/9 with the life assured. The opposite party has brought on record, the document of one person namely Gurjant Singh aged about 35 years who was resident of village Blair and whose mother’s name was Simarjit Kaur. Infact, Gurjant Singh was aged about 20 years and was resident of village Sabhra and mother’s name of Gurjant Singh was Paramjit Kaur who is complainant in the present case. As such, the opposite party and its surveyor have failed to establish on record that the life assured died prior to taking the policy i.e. on 7.8.2016. The opposite party has also placed on record statement of Shingara Singh son of Ram Singh resident of village Sabhra Tehsil Patti who stated that Gurjant Singh son of Sukhwant Singh was resident of village Sabhra and he died on 8.11.2016 due to heart attack and he was not having any disease prior to his death. As such, the date of death as alleged by the opposite party 7.8.2016 is not established. On the other hands, the complainant has placed on record death certificate of life assured Ex. C-4 in which date of death has been shown as 8.11.2016 and the death certificate Ex. C-4 is issued by Local Registrar Birth and Death and same has been issued by the official of the Punjab Government and death of life assured has been recorded as on 8.11.2016 and this document is admissible under Indian Evidence Act. The opposite party has alleged in the repudiation letter that forged document has been produced and used false statements with a view to defraud the company. But the opposite party has not taken any action against the opposite party in this regard against the complainant and or any other person, reason best known to them. The opposite party has rejected the claim of the complainant on the report of the surveyor but the opposite party has not placed on record affidavit of surveyor. In the absence of which no evidentiary value can be made on the report submitted by the surveyor. Reliance in this connection has been placed upon Manikant Vs. New India Assurance Co.Ltd. 1(2012) CPJ 88 (NC) of the Hon’ble National Commission wherein it has been held that the surveyor did not appear in court and subject himself to cross examination nor was any affidavit filed by him to prove his report . Producing a document in court does not by itself constitute proving the document. It has to be backed by credible evidence. In the instant case, no evidence was led to prove the surveyor’s report in the absence of which the surveyor’s report has little evidentiary value. Moreover, 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.5,000/- for luxury litigation, being rich.
The proposal form has been duly accepted by the opposite party and issued the said policy. Now they cannot take the plea that proposer was died before the inception of policy. The opposite parties are duty bound to check the credentials of the policy holder at the time of issuance of policy. The proposal form was duly signed by the deceased before the competent authority of the insurance policy. The opposite party has not placed on record even a single document which is going to establish that the death certificate is not genuine. The document placed on record by the complainant proves that the deceased was alive at the time of date of inception of the insurance policy, whereas opposite party could not prove that at the time of issuance of policy the deceased was not alive. Hence, by rejecting the genuine claim of the complainant, the opposite parties have committed deficiency in service and unfair trade practice on their part.
7 In light of the above discussion, the complaint succeeds and the same is hereby allowed with costs in favour of the complainant. The opposite parties are directed to pay the insurance claim to the complainant. The complainant has been harassed by the opposite parties unnecessarily for a long time. The complainant is also entitled to Rs. 20,000/-( Rs. Twenty Thousand only) as compensation on account of harassment and mental agony and Rs 10,000/- ( Rs. Ten Thousand only) as litigation expenses. Opposite Parties are directed to comply with the order within one month from the date of receipt of copy of the order, failing which the complainant is entitled to interest @ 9% per annum, on the awarded amount, from the date of complaint till its realisation. Copy of order be supplied to the parties free of costs as per rules. File be consigned to record room. This complaint could not be decided within prescribed period due to heavy pendency of cases in this commission and COVID-19.
Announced in Open Commission
29.3.2022
