BEFORE THE DISTT. CONSUMER DISPUTES REDRESSAL FORUM; FATEHABAD.
Complaint case No.157 of 2015.
Date of Instt.: 11.08.2015.
Date of Decision: 09.02.2017.
Smt.Kalawati widow of Manohar Lal resident ofHouse No.108, village Bhuthan Kalan Tehsil & District Fatehabad.
..Complainant.
Versus
1. ING Life Insurance Registered Office ‘ING Vyasa House” 5th Floor No.22 MG Road, Bangalore-560001 through its Chairman-cum-Managing Director/Managing Director.
2.Smt.Alka Rani c/o Parveen Kumar resident of four Marla Colony, Fatehabad Tehsil & District Fatehabad.
..Opposite Parties.
Complaint U/S 12 of the CP Act,1986
Before: Sh.Raghbir Singh, President.
Smt. Ansuya Bishnoi, Member.
Present: Sh.Jitender Thakker, Advocate for complainant. Sh.Hanumant Singh Raghav and Sh.Vishnu Delu, Advocate for opposite party No.1. Sh.V.K.Mehta, Advocate for opposite party No.2.
ORDER
The complainant has filed the present complaint against the Ops with the averments that husband of the complainant namely Manohar Lal was insured with the OP No.1 obtained through OP No.2 vide policy No.02313740 for a sum assured of Rs.3,14,830/- and the complainant has been appointed as nominee in the said policy. Life assured Manohar Lal, husband of the complainant died on 20.12.2011 and after his death the complainant informed the OPs about the death of her husband besides submitting all the requisite documents but despite that the opposite party No.1 illegally, arbitrarily and against facts has repudiated the claim of the complainant vide letter dated 28.08.2013 on false and flimsy grounds of mis-representing his age by submitting forged Driving License for obtaining the policy in question. The complainant requested many times to the opposite parties to make the payment alongwith interest @ 12 % per annum but to no effect. The complainant has suffered mental agony and harassment at the hands of opposite parties and he is also entitled for compensation. Hence, this complaint. In evidence, the complainant has tendered her affidavit Annexure C3 besides documents Annexure C1 and Annexure C2.
3. On notice, the opposite parties appeared and resisted the claim of the complainant. OP No.1 in its reply has submitted that the insurance policy is a contract of utmost good faith; therefore, it was obligatory on the part of the proposer/life assured to disclose all the material fact pertaining to his/her age, occupation, previous illness, habits and income details in proposal form. It has been further submitted that in the present case the life assured had disclosed his age 48 years (date of birth as 06.10.1963) as shown in his self-attested driving licence but when the death claim was submitted by the complainant then during investigation it came to notice of the OP No.1 that at the time of availing the life insurance policy the life assured had suppressed his actual age as in the voter ID No.HR/10/78/0204560 the age of the deceased life assured had been shown as 58 years in the year 2011 but he has obtained the policy in question by tendering forged/tampered driving licence with the Op No.1.This information was very vital for the OP No.1 qua accepting the risk. Clause No.7 of the terms and conditions of the policy on admission of age is reproduced as under:
“The age of the life assured has been admitted on the basis of the declaration made by the life assured/policy holder in the proposal and/or in any statement based on which this policy has been issued. If the age of the life assured is found to be different from that declared, the company may, adjust the premium and /or benefits under this policy and/or recover the applicable balance amounts, if any, as it deems fit. This policy shall however become void from commencement, if the age of the life assured at the policy commencement date is found to be higher than the maximum or lower than the minimum entry age that was permissible under the plan of this policy at the time of issue and the amounts received under the policy shall be liable to be forfeited, at the option of the company”
The ground for repudiation of the claim has been communicated to the complainant vide letter dated 28.08.2013. Objections about maintainability, locus standi, jurisdiction and cause of action etc.have also been taken. Lastly, prayer for dismissal of the complaint has been made. Learned counsel for the Op No.2 did not file separate reply to the complaint and adopted the reply filed by the Op No.1 by making separate statement on 18.04.2016. In evidence, the Ops have tendered affidavit Ex.RW1 and documents Annexure OP1 to Annexure OP9.
4. Heard. The counsel for the complainant reiterated the averments made in the complaint and prayed for its acceptance whereas the counsel for opposite parties reiterated the averments made in the reply and prayed for dismissal of the complaint.
5. After hearing learned counsels for the parties and going through the material placed on case file we are of the considered opinion that this complaint cannot be decided in a summarily manner because it involves complicated and complex questions of facts and law which require elaborating evidence. The complainant has come with the plea that the deceased life assured had died during the subsistence of the policy but the OP No.1 instead of settling the genuine claim has repudiated the same wrongly and illegally because the deceased life assured had never withheld any information qua his age. On the other hand the OPs have come with the plea that the deceased life assured had obtained the policy in question by playing fraud upon the insurance company as he had submitted forged driving licence as a proof of his age for getting him insured. Undisputedly, the insurance company had issued the policy in question to the deceased life assured but when the complainant had submitted claim on account of the death of deceased life assured then the insurance company had got conducted an enquiry through Unimax Surveillance & HR Manage Private Limited which investigated the matter and submitted its report (Annexure OP8) with the insurance company and in final observation it has been held that After all these investigations, we found that Manohar Lal was died due to heart attack as he was suffering with Asthama for long time. He used to have hukka continuously and his age was 64-65 years at time of death. When we observe documents which were attached with proposal form, we found that licence of Manohar Lal was forged which was attached as proof of age. When we observe the format of DL of Manohar Lal and Banwari Lal, we found that format of DL was same and agent was Alka. In both DLs, issuing authority and city was not mentioned and was forged. As per DL of Manohar Lal, his age was 50 years but when we investigated, we found that his actual age at time of death was about 64-65 years. The policy was taken by Manohar Lal’s family in influence of Satpal (agent of Alka in village) to get policy benefits. The conspiracy has been done by Alka, Satpal and Balraj (Manohar Lal’s son), Dr.S.K.Rai. It has also been brought to the notice of this Forum that a complaint dated 31.05.2013 before Inspector General of Police, Hisar has been filed by the Insurance Company for initiating criminal proceedings against the officials of the company for issuing insurance policies on the basis of forged documents or other illegal ways. Issuance of the policy to Manohar Lal/DLA in the present case is also the subject matter of that complaint.
7. Since the OPs have specifically taken the plea of fraud played upon it by the deceased life assured at the time of getting the insurance policy in question and for obtaining the policy the complainant has submitted forged driving licence as proof of his age, therefore, keeping in view the above mentioned fact and circumstances this Forum is of the view that the present complaint before this Forum is not maintainable and the matter in question cannot be adjudicated in summary jurisdiction and it requires elaborating and voluminous evidence. On this point reliance can be taken from case law titled as Uco Bank vs. Sh.S.D.Wadhwa, 2013 (4) CLT (NC).
8. Hence, in view of above discussed factual as-well-as legal position, we are of the considered view that the present complaint is hereby disposed of as both the parties have failed to lead sufficient evidence to reach any conclusion. Moreover, in order to resolve the controversy alleged in the pleadings elaborating evidence and enquiry is required. However, the complainant is at liberty to approach at appropriate Court/forum if he so advised and in that eventuality, the period of litigation before this Forum shall not be counted towards the period of limitation for approaching appropriate court/forum. Exemption of time spent before this Forum is granted in terms of the judgment of the Hon’ble Supreme Court of India in the case titled “ Laxmi Engineering Works versus PSG Industrial Institute (1995) 3 SCC page 583. A copy of this order be supplied to both the parties free of cost. File be consigned after due compliance.
ANNOUNCED IN OPEN FORUM Dt.09.02.2017
(Raghbir Singh)
President District Consumer
Disputes Redressal Forum, Fatehabad.
(Ansuya Bishnoi)
Member
