Orissa

Ganjam

CC/72/2009

Purusottam Pedalu - Complainant(s)

Versus

HDFC Standard Life Insurance Company Ltd - Opp.Party(s)

Sri Aditya Kumar Panigrahy, Advocate

24 Sep 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, GANJAM,
BERHAMPUR
 
Complaint Case No. CC/72/2009
 
1. Purusottam Pedalu
S/o. Late Pedalu Raghunath, Resident of Vill.Rangunipalli, Po. Badakhandi, Via. Kanchuru, Pin - 7611011
...........Complainant(s)
Versus
1. HDFC Standard Life Insurance Company Ltd
having its Regd office at ramon house, H.T. parekh marg. 169, Backbay Reclamation, Curch gate, mumbai - 400020
2. HDFC Standard Life Insurance Company Ltd
5th Floor, Eureka Towers, Mind space complex, link road, malad, mumbai - 400064
3. HDFC Standard Life Insurance Company Ltd
Bhubaneswar branch, 98, kharavela nagar, keshari complex, unit - III, bhubaneswar - 751000
4. HDFC Standard Life Insurance Company Ltd
Spectrum centre, 2nd floor, old bus stand, brahmapur - 760001
5. Nidan Diagnostics & Research Centre
In front of D.I.G officek, Brahmapur - 760010
Ganjam
Odisha
............Opp.Party(s)
 
BEFORE: 
 HON'BLE MS. Soubhagyalaxmi Pattnaik PRESIDENT
 HON'BLE MR. N. Tuna Sahu MEMBER
 
For the Complainant:Sri Aditya Kumar Panigrahy, Advocate, Advocate
For the Opp. Party: Mr. Mahesh Kumar Jena & Mr. Manoj Kumar Patra, Advocates, Advocate
 Mr. Mahesh Kumar Jena & Mr. Manoj Kumar Patra, Advocates, Advocate
 Mr. Mahesh Kumar Jena & Mr. Manoj Kumar Patra, Advocates, Advocate
 Mr. Mahesh Kumar Jena & Mr. Manoj Kumar Patra, Advocates, Advocate
 Mr. Surendra Panda, Advocate, Advocate
Dated : 24 Sep 2016
Final Order / Judgement

DATE OF FILING: 15.7.2009.

     DATE OF DISPOSAL: 24.09.2016.

Dr. N.Tuna Sahu, Member.

 

            The complainant has filed this consumer complaint under Section 12 of Consumer Protection Act, 1986 alleging deficiency in insurance service against the Opposite Parties (for short, O.Ps) and redressal of his grievance before this Forum.

 

            2. Briefly stated the case of the complainant is that the O.P. No.1 is the registered office, O.P.No.2 is the policy issuing office, O.P.No.3 & 4 are the Branch office at Bhubaneswar and Berhampur respectively and collectively they carry on business in “Life insurance coverage of individuals”.  The said Opposite Party No.1 to 4 are hereinafter referred to as the “Insurers” and O.P. No. 5 is their authorized diagnostic centre at Berhampur conducting routine medical examinations of prospective applicants for life insurance coverage as are referred to it by the said insurers.  One Pedalu Raghunath hereinafter called the “deceased” an upcoming middle aged self employed businessman with an idea to gradually build up his personal savings over a period of 20 years and at the same time availing insurance coverage to safeguard and protect his family members against any unexpected contingency that might fall upon him, opted a plan floated by the insurers commonly known to the general public as “HDFC Term Assurance”. Since it was made known to the deceased by the insurers in the proposal form that suppression of material facts and giving inaccurate or false information would result in repudiation and or cancellation of the policy, the deceased  not wanting to lose his hard earned money and to safeguard his interest while supplying  “material information” more particularly with regard to his “age” , supported the same by relying upon  entries of the school  register in form of his transfer certificate, driving license and incorporated the said material facts in the proposal form and also indicated therein that the complainant i.e. his son would be the nominee. Upon receipt of proposal form from the deceased, since the amount of coverage opted for by the deceased was for Rs.10,00,000/- the insurers by their letter dated 30.1.2007 directed the deceased to subject himself for further requirements  of medical tests which is to be done at O.P.No.5  the designated diagnostic centre of the insurers at Berhampur. Since the deceased was eager to avail the insurance coverage, on 4.2.2007 he presented himself before the O.P.No.5 for subjecting himself to various pathological tests and the O.P.No.5 satisfying itself about identify of the deceased conducted the pathological test. While the matter stood thus, unfortunately the deceased was attacked with cerebral malaria and on 26.10.2007 while he was being shifted to Visakhapatnam for better medical treatment died at Konisi Hatta within the jurisdiction of this Forum. On 4.3.2008 the complainant appraised the fact of death of his father to the insurers for settling the claim, yet the insurers instead of settling the claim intimated and indicated that the liability is repudiated since there had been a suppression of the actual date of birth and further indicated therein that the assured was born on 7.3.1938 as is revealed from their investigation. The unilateral reasoning as adopted by the insurers in repudiating the policy is a deliberate attempt to disallow and/or is to negate  a genuine death claim and is a calculated move not to settle the claim and the insurers having resorted to such flimsy and illogical pleas are only to put the claimant to wrongful loss. The insurers are jointly and severally liable to pay the insured amount along with interest as is provided for under regulation 8(5) of the I.R.D.A. (Projection of Policy holders’ interest) Regulation, 2002.  The date of birth i.e. 7.3.1938 as mentioned in Annexure 5 belongs and relates to one Raghunath G.Pedalu, S/O Late Ghanasyam Pedalu. The date of birth of the deceased policy holder Raghunath Pedalu, S/O late Gangalu Pedalu is 15.12.1961 and the insurers taking advantage of almost identically similar named persons residing in the same village have sought to negate the claim which amounts to deficiency in service.  Alleging deficiency in service on the part of the O.Ps the complainant prayed to direct the O.Ps to pay the basic sum assured amount of Rs.10,00,000/- with interest, compensation of Rs.1,00,000/- for causing unnecessary harassment and mental torture in the best interest of justice.

 

            3. Upon notice the O.P. No. 1 to 4 filed written statement through his Advocates.  It is stated the complainant has no right to file this instant petition before the Consumer Forum against this O.P. as the complainant is not a consumer of this O.P. and therefore question of deficiency of service does not arise. The complainant’s father Pedallu Raghunath, who shall be mentioned in herein as Deceased Life Assured (DLA) has availed one policy having No. 10876306 as per the HDFC TERM ASSURANCE plan for insuring his life with the Opposite Parties and the policy that was issued to the DLA also called policy Holder (PH) envisages the contract of life insurance executed between the DLA or deceased life assured (who is the father of the complainant) and the answering Opposite Party vide the policy bond with certain terms and conditions. The above referred policy is issued to the deceased life assured (DLA) by the Opposite Party after making due consideration and acceptance Urber Rimae Fidei of the proposal for procuring the aforesaid life insurance policy plan which was duly received from the DLA. The complainant had intimated vide a letter dated 29.2.2008 about the expiry of the DLA on 26th October 2007. Thereafter the complainant filed a Claim Form dated 4.3.2008 received on 13.3.2008 towards obtaining the Death Claim in respect of the aforesaid policy. The O.P. carried out certain enquiries and has come to know that the date of birth mentioned in the Proposal Form is incorrect and DLA had made deliberate and intentional suppression and non-disclosure and incorrect representation and false statement of the date of birth in the aforesaid proposal form. The aforesaid proposal Form the DLA had deliberately and intentionally suppressed the facts that his date of birth is 7.3.1938 instead of mentioned 15.12.1961 in the proposal form. The complainant did not provide any proof in support of the fact that the date of birth of DLA is 15.12.1961 as mentioned in the aforementioned proposal form. The DLA had also provided a few documents like Driving License, Transfer Certificate from School attached to the proposal form in support of the fact that his date of birth is 15.12.1961 as mentioned in the aforesaid proposal form. However these documents upon enquiry by the Answering Opposite Party are found to be fake and forged. This act of deliberate suppression of the fact is true and actual date of birth of the DLA being 7.3.1938 amounts to commission of fraud and deception which the DLA had committed with the ulterior motive to obtain the aforementioned life insurance policies by deceiving the answering Opposite Party which the DLA would not have procured if the fact that the DLA’s date of birth is 7.3.1938 was known to the O.P. who would have rejected the aforesaid proposals. In other words because of the reason that by the commission of fraud on the part of DLA his proposal got accepted by the Opposite Parties hence the aforementioned policy become void ab-initio and liable to be repudiated/avoided by the Opposite party. Moreover the DLA had also made an declaration cum undertaking on page 11 of the proposal form that the life insurance policy shall be repudiated and no benefits be available in case the contents of the proposal form is found to be incorrect and defective because of suppression of facts, misrepresentation etc. The deceased life assured had also undertaken and provided a declaration and warranty in the proposal form on page No.11 to make correct statement of fact without making any suppression, false and incorrect representation, concealment, fraud, deception and to truly disclose all the facts which had been asked to disclose falling to which the aforementioned policy shall be cancelled/avoided/ repudiated/ terminated/ rescinded without providing any benefit of the aforementioned life insurance policies and without making any refund of premium in accordance to the provision of the law of the land in vogue. Hence the answering Opposite Party had declined the payment of the Death claim and had duly served a letter dated 30.9.2008 stating very clearly the reason for the repudiation of the claim as well the life insurance policies. The O.Ps has rightfully response to the claim made by the complainant by sending the letter of repudiation dated 30.9.2008 intimating the complainant about its decision to decline the claim, which cannot be treated as deficiency in service rather it is prove the deficiency. The dispute or claim is a matter of contract and can only be decided before proper Civil Court but not before this Hon’ble Forum. The contractual obligation can only be enforced or questioned under contract Act read with specific Relief Act.  Since the claim has come within a period of seven months, from the date of commencement of the policy section 45 of the Insurance Act, barred to question any policy after two years only. So by virtue of the provisions laid down in the Act it is crystal clear about the maintainable of the dispute before this Hon’ble Forum. The Consumer Protection Act is only for protection of consumer, if his right is violated or any deficiency of service arrows. Therefore on this instance case the complainant never objected for deficiency of service but challenges terms and conditions of the contract which can only be adjudicated under contract act in Civil Court. The complainant had filed complain before the Hon’ble Ombudsman at Bhubaneswar but preferred to withdraw the case after hearing that had taken place on 15.5.2009.  The deceased died on 26.10.2007 due to Cerebral Malaria was not true and correct. The real fact is that the deceased P. Raghunath died on 5.4.2007 due to old age and the complainant made an application to the health worker Rangunipalli area Badakhandi Sub-center of PHC, Belagam not to register the death of the deceased in their Death Register. It is pertinent to mention that according to the proposal Form the deceased declared that he was a graduate but submitted a T.C. of class-III in support of his age instead of H.S.C. Board Certificate. After repudiation of the policy dated 30.9.2008 the complainant and his deceased father is ceased to be a consumer of the company. After repudiation of claim and policy on 30.9.2008, the present case has been filed, which is not maintainable in the eye of law. So the question of deficiency in service does not arise and the case is liable for dismiss having no merits. It is pertinent to mention that Raghunath G.Pedalu and Raghunath Pedalu is the same and one person whose date of birth is 7.3.1938 and raised in the same village now deceased which proved from the documents supplied by the Godfrey Phillips India ltd. Mumbai and date of death is 5.4.2007 which proved from the Death Register maintained by the PHC Belagam, Dist: Ganjam. It is submitted that after repudiation of policy and claim the complainant and the deceased are no more a consumer of the company and as such the forum has no jurisdiction to try the complaint petition. After repudiation of the policy, the Insurance Ombudsman is the appropriate authority to entertain the complaint petition but not the consumer Forum.  Hence, prayed to dismiss the petition in the ends of justice.

 

            4. Upon notice the O.P.No.5 filed version through his Advocate. It is stated that all the allegations made in the complaint petition are not true and complainant is put to strict proof such of the allegations which are not expressly admitted herein. This O.P. is a diagnostic centre where fleet of doctor engaged in diagnosing events. This O.P. is a designated diagnostic centre of the insurers at Berhampur. As per letter dated 30.1.2007 of the insurers one Peddalu Raghunath has been directed by the HDFC standard life Insurance Co. ltd. to contact this O.P. for require diagnostics.  One person called Pedalu Raghunath of Rangunipalli approached this O.P. for conducting various pathologic tests of the persons who came with letter of insurance company dated 30.1.2007 but he had not produced any valid identification documents to this O.P.  But as desired by the Insurance Company this O.P. has after due examination on 4.2.2007 of Pedalu Raghunath he has sent the reports to the insurance company through him. The other allegations made in the complaint petition this O.P. has no knowledge about the same the complainant is put to strict proof the same. There is no cause of action against this O.P. to file this case against him. Only for the purpose to harass him the complainant files this case. Hence this O.P. prayed to dismiss the complaint petition with cost in the interest of justice.

            5. On the date of disposal of the consumer dispute the complainant as well as the O.Ps are absent on repeated calls. In fact, both parties were absent from 18.11.2015 to 18.5.2016. However, to meet the ends of justice, this Forum once again issued notice to O.Ps vide this office letter No.343 (2) dated 25.5.2016 and to the complainant vide letter No.455 dated 22.6.2016 respectively. Despite notices served to the parties, they were not preferred to proceed with the case. Even despite several opportunities given to the complainant, he did not prefer to file the written argument. This is a year old consumer dispute and due to non-cooperation of both parties, this case is pending in this Forum without disposal.  It is duty of both parties to proceed with their case and it is also duty of this Forum to dispose of the matter on merits if parties failed to proceed with the case. Accordingly, on the date of disposal, we have gone through the materials on the case record and decided to dispose of the consumer dispute on merits as per Section 13(2)(c ) of the Consumer Protection Act, 1986.

 

            6. On perusal of the case record on merits, it reveals that it is not in dispute or doubt that the deceased policy holder P. Raghunath procured a policy bearing No. 10876306 from the O.Ps No.1 to 4 on payment of annual premium of Rs.7620/- for an assured sum of Rs.10,00,000/- with death benefit. The term of the policy was for 20 years and the policy was commenced with effect from 12.2.2007.  The present complainant Purusottam Pedalu, son of the deceased policy holder was nominated as nominee of the said policy. As per the complaint, while the policy is in force, the deceased policy holder unfortunately died on 26.10.2007 at Kanisi Hatta, Berhampur due to Cerebral Malaria while he was being shifted to Vishakhapatnam for better treatment. After the sad demise of the deceased policy holder, the nominee i.e. the present complainant intimated the matter to the O.Ps on 4.3.2008 with a request to settle the death claim of the complainant. However, the O.Ps repudiated the insurance claim of the nominee complainant on the ground of suppression of actual date of birth of the deceased policy holder. As contended by the complainant in his complaint, the date of birth of his father as recorded in the alleged policy is 15.12.1961 but the O.Ps repudiated the claim of the complainant contending that the actual date of birth of the deceased policy holder was on 07.03.1938. It is also contended by the complainant that as per the letter dated 30.1.2007 the deceased policy holder had undergone medical test before O.P.No.5 on 4.2.2007 and submitted the medical test reports to the O.P.No.1 to 4. It is also contended in the complaint that insurers being satisfied and assured of themselves as to the genuineness and correctness of the material facts regarding age, identity and health condition had issued the insurance policy. The O.Ps have categorically admitted to have taken into consideration the applicable medical evidence while issuing the policy of insurance and that admittance is not retractable to suit the fancy of the insurers. It is further stated in the complaint that according to the guidelines provided under Regulation 6(i) (h) of the I.R.D.A. (Protection of Policy holder’s Interests) Regulation 2002 has specifically indicated in the insurance policy to have admitted the age of the assured by the O.Ps. The O.Ps have adopted deliberate attempt to disallow a genuine death claim having resorted to flimsy and illegal pleas to put the claimant wrongful loss. The insurers are jointly and severally liable to pay the insured along with interest as provided under Regulations 8 (5) of the I.R.D.A. (Protection of Policy holder’s interests) Regulations, 2002. It is not fair to repudiate the claim of the complainant by the O.Ps on the ground of suppression of actual date of birth of the deceased policy holder. Hence the complainant has prayed before this Forum to direct the insurers to pay the basic sum assured under the aforesaid policy i.e. Rs.10,00,000/- along with interest as entitled and Rs.1,00,000/- towards compensation for causing harassment and mental torture and cost of litigation in the interest of justice.  The complainant has filed documents along with the complaint which has been placed on the case record as Annexure 1 to 6.  On the contrary, as per the written statement, the O.P.No.1 to 4 contended that deceased life assured, complainant’s father Pedallu Raghunath availed one policy bearing No.10876306 with effect from 12.2.2007 on payment of yearly premium of Rs.7620/-for a term of 20 years for assured death benefit of Rs.10,00,000/-. During the subsistence of the aforesaid policy, the complainant intimated to the O.Ps vide a letter dated 29.2.2008 about the expiry of the deceased policy holder on 26.10.2007 and filed a claim form on 4.3.2008 which was received by the O.Ps on 13.3.2008 to settle the death claim of his father.  It is also stated that during taking of the said policy, the deceased life assured deliberately and intentionally suppressed the facts that his actual date of birth is 7.3.1938 and instead mentioned 15.12.1961 as his date of birth on page-5 of the proposal form. The Deceased Life Assured (DLA) also provided a few documents like driving license, transfer certificate from school in support of his date of birth as 15.12.1961 but the documents on enquiry found to be fake and forged. The life insurance policy is a matter of Uber Rimae Fidei i.e. based on utmost good faith. However, during taking of the policy the DLA in the proposal form which is part of agreement, had committed fraud by causing deliberate suppression and concealment of material facts about his date of birth. So, after enquiry, the O.Ps No. 1 to 4 on 30.9.2008 repudiated the claim since the claim was come within a period of seven months from the date of commencement of the policy according to Section 45 of the Insurance Act, 1938. It is also informed that the complainant had filed a complaint before the Hon’ble Insurance Ombudsman at Bhubaneswar but preferred to withdraw after hearing on 15.5.2009. It is also contended in the written statement that it is pertinent to mention the facts that the deceased died on 26.10.2007 due to cerebral malaria was not correct. The real fact is that the deceased life assured died on 5.4.2007 due to old age and the complaint made an application to the health worker Rangunipolli area Badakhandi Sub Centre, Balagam not to register the death of the deceased in their Death Register. The complainant created forged documents showing the date of his father is on 26.10.2007 to get insurance benefits. It is further contended that due to suppression of date of birth by the deceased policy holder the O.Ps also rejected the prayer letter dated 17.10.2008 of complainant to revoke the letter of repudiation. It is, therefore, the O.P. insurers repudiated the insurance claim of the complainant on 30.9.2008 and the O.Ps insurance Company not liable to pay anything and the complainant is also not entitled to get any relief under Regulation 8 (5) of IRDA (Protection of Policy holder’s  interests) Regulation, 2002. From investigation it is also found that the deceased policy holder was a retired employee of Godfrey Phillips India Ltd, Mumbai and he took retirement in the year 1996 and his date of birth is 07.03.1938 and his date of death is 05.04.2007 which proved from the Death Register maintained by PHC, Balagam, Ganjam. The O.P.No.1 to 4 have also submitted some documents as evidence in support of their contentions which has been numbered as Annexure A to H that includes intimation letter of complainant, medical treatment details,  repudiation letter dated 30.9.2008, letter of personal hearing of complaint by Ombudsman on 15.5.2009, reply of O.Ps No.1 to 4 to Ombudsman under redressal of Public Grievances Rules, 1998, proof of withdrawal of complaint from Ombudsman office by complainant’s letter dated 27.05.2009, letter of complainant to health worker on 20.4.2007 not to register death of his father, copy of death register etc and prayed before this Forum to dismiss the complaint of complainant in the interest of justice.

 

            7.  The O.P. No.5 stated in his written version that the O.P.No.5 is a designated diagnostic centre of the insurers at Berhampur.  As per the letter dated 30.01.2007 of the insurers one Peddalau Raghunath was directed by the HDFC Standard Life Insurance Co. Ltd to contact this O.P. for required diagnosis. Accordingly, one person called Pedalu Raghunath of Rangunipalli approached this O.P. No.5 for conducting various pathological tests of the person who came with the letter dated 30.01.2007 but he did not produce any valid identification documents to this O.P but as desired by the insurers the O.P. after due examination on 4.2.2007 of Pedalu Raghunath sent the report to the insurance company through him. All other allegations are not within the knowledge of this O.P. and denied so the Forum may be please to dismiss the complaint with cost.

 

            8.  We have carefully gone through the complaint of the complainant and its Annexures marked as 1 to 6 placed on the case record. We have also carefully perused the written statement and documents of O.P.No.1 to 4 placed on the case record as Annexure A to H. We have also duly considered the complaint of the complainant and written submissions of O.P.No.1 to 5 filed on behalf of all parties to this dispute.

 

            9. On careful perusal and matriculation verification of the documents, it appears that the deceased policy holder obtained a policy bearing No.10876306 from the O.P.No.1 to 4 as discussed above which was commenced with effect from 12.02.2007 for a term of 20 years on payment of Rs.7,620/- towards yearly policy premium. It is also a fact not in dispute that the O.P.No.5 being the authorized diagnostic centre checked the health conditions of the deceased policy holder and after receipt of the test reports from the O.P. No.5 the O.P. Insurers issued the insurance policy in dispute to the deceased policy holder on 12.2.2007. It is also a fact not in dispute that the policy was issued in favour of the deceased policy holder by the O.P.No.1 to 4 as per the information supplied by the deceased insured through the proposal form of the O.P.No.1 to 4. As per the policy, the O.P.No.1 to 4 issued a  20 years term policy to the deceased policy holder for an assured sum of Rs.10,00,000/- with death benefit and the present complainant was nominated as the nominee of the said policy on payment of Rs.7,620/- towards yearly premium which is beyond doubt or dispute. As per the contention of complainant that the date of birth of the deceased policy holder as mentioned in the proposal form of the O.Ps is 15.12.1961. But the O.Ps after death of the deceased policy holder repudiated the death claim of the nominee complainant on the ground of suppression of material fact relating to the date of birth of the deceased policy holder.  As per the written statement of the O.Ps No.1 to 4 the actual date of birth of the deceased policy holder is 07.03.1938 which was revealed after investigation of the death claim of the nominee complainant. It is also a fact that the complainant as well as the O.P No. 1 to 4 admitted that the policy was issued to the deceased policy holder as per the transfer certificate and driving license of the complainant as mentioned in the proposal form where it was recorded the date of birth of the deceased policy holder was 15.12.1961.  However, now the O.P. No. 1 to 4 contending that the actual date of birth of the deceased policy holder is 07.03.1938 since it was found from the documents supplied by the Godfrey Phillips India Ltd. Hence, if we consider the factual aspect of this dispute with regard to the actual date of birth of the deceased policy holder, we cannot arrive at a particular conclusion since the claim of the complainant as well as the O.P.No.1 to 4 do not have any corroborated documentary evidence on record. On careful perusal of case record, we do not find a single document with regard to the date of birth of the deceased policy holder neither as per the claim of the nominee complainant nor by the O.P.No.1 to 4. Even neither the school transfer certificate nor the driving license of the deceased policy holder is available in the case record for our perusal. So, it is difficult for us to hold which one is actual date of birth of the deceased policy holder. In the present facts and circumstance of case, we are of the considered opinion that this Forum cannot adjudicate this point of dispute relating to date of birth of the deceased policy holder since no concrete, credible convincing and cogent documentary evidence placed on the case record to decide the dispute by this Forum.  Besides, the O.Ps No.1 to 4 have also raised disputes regarding the date of death of the deceased policy holder in their written contention and have also produced some documentary evidence in support of their contentions placed in the case record as Annexure F, G  and H. On perusal of the aforesaid Annexures submitted by the O.Ps No. 1 to 4 it reveals that the present complainant had requested the local health worker of Rangunipalli area under Badakhandi sub centre which was forwarded to Medical Officer, In-charge PHC Ballagaon regarding the request for non-registration of death of the father of the complainant on 21.4.2007 where it was also mentioned the date of death of father of the complainant as 5.4.2007. We have also perused the copy of death register where under Sl. No. 168 it is mentioned that Pedalu Raghunath, aged 75, male of Rangunipalli died on 5.4.2007 due to old age. From above discussion, it is clear that the date of death of the deceased policy holder is also in dispute since the complainant in his complaint mentioned that the policy holder died on 26.10.2007 due to cerebral malaria whereas the O.P Insurance Company contends that the policy holder P. Raghunath was died on 5.4.2007 due to old age as discussed above from this discussion.  It is amply clear that the date of death of deceased is also in controversy due to the rival contention of complainant as well as the O.P.No.1 to 4. Under the present fact and circumstances, it is also not possible on part of this Forum to adjudicate this point of dispute regarding date of death and birth of the deceased policy holder. 

 

            10. Further, while perusing the case record, we have also come across a petition filed by the learned counsel for the complainant on 5.5.2010 under Section 13(4) (ii) of the Consumer Protection Act, 1986 read with Section 51 of Insurance Act, 1938 and with regulation 4(2) of the I.R.D.A. (Protection of Policy holder’s interest) Regulation 2002 where it was prayed before the Forum to direct the O.P.No.1 to 4 to produce the medical report prepared by the O.P.No.5 and other policy papers which are essential material documents for adjudicating the matter while perusal and appreciation of the rival contentions between the parties to this dispute. However, the said petition dated 5.5.2010 of the learned counsel for the complainant was dismissed on 10.12.2012 and no direction was issued by this Forum to produce the medical report of the deceased policy holder for the proper adjudication of this consumer dispute. In the light of the above discussion, we find that a lot of factual complexity involved in this case which are extremely complicated and controverted and complex. Of course, the Hon’ble Supreme Court has ruled in J.J. Merchant Vs. Srinath Chaturvedi reported in (2002) CTJ 757, where it was held that the District Forum do not lack the competency or where withal to dispose of even complicated  questions of law and fact, but that is a general rule. However, it is well known that to every rule there are exceptions and the present case is one of these exceptions. Besides, the allegations of fraud have also been made by the O.P No.1 to 4 against the deceased policy holder and prima facie we find that the possibility of fraud cannot be ignored in view of the disputed date of birth and date of death as discussed earlier. As interalia ruled by the Hon’ble National Commission in Reliance builders Vs. Maria Noronha (1986-2000) Consumer 6820 NS, the Consumer Fora should not entertain complaints which contain allegations of fraud and forgery and should leave the parties to go to Civil Court where they can lead elaborate evidence in support of their pleas.  We also place reliance on the authority of Hon’ble Supreme Court in the case of Oriental Insurance Company Ltd. Vs. Munimahesh Patel decided vide Civil Appeal No.4091 of 2006, where it was held by the Apex Court that proceeding before the Commission or Forum are essentially summary in nature and adjudication of issues which involves disputed factual questions should not be adjudicated. The factual position was required to be established by documents which requires examination and cross examinations of facts by an appropriate Court of Law and not by consumer Commission or Fora.

 

            11. For the reasons stated above, complainant is advised to approach the appropriate Court and the complainant may file a civil suit for seeking suitable remedy against the O.Ps in accordance with law. Regarding the computation of period of limitation for the civil suit, the time spent by the complainant in the District Forum shall be exempted under Section 14 of the Limitation Act and our finding is also supported by the authority of Hon’ble Supreme Court in the case of Laxmi Engineering Works versus P.S.G. Industrial Institute reported in (1995) CPJ (SC).

            12.  In a sequel to the above discussion and decision of law, the case of the complainant is dismissed and directed to redress his grievance before appropriate court of law. The case of the complainant is disposed of accordingly however; there is no order as to cost.

 

12. The order is pronounced on this 24th day of September 2016 under the signature and seal of this Forum. The office is directed to supply copies of this order to the parties free of cost.

 
 
[HON'BLE MS. Soubhagyalaxmi Pattnaik]
PRESIDENT
 
[HON'BLE MR. N. Tuna Sahu]
MEMBER

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