STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA
Date of Institution: 14.09.2017
Date of final hearing: 01.05.2023
Date of pronouncement: 29.05.2023
First Appeal No.1114 of 2017
In the matter of :-
1. Branch Manager, LIC of India, Branch Office Bahadurgarh Jhajjar.
2. Senior Divisional Manager, LIC of India, Division Office, Rohtak.
Both through authorized signatory, Divisional Office, LIC Building, Sector 17B, Chandigarh. .…..Appellants
Versus
- Laxmi Devi Wd/o Krishan Kumar, resident of Village & Post Office Dujana, Tehsil Beri, Distt. Jhajjar.
- Shri Krishan Kumar, Agent LIC of India, Code 10457-176, Branch Office Bahadurgarh (Jhajjar). ....Respondents
CORAM: Naresh Katyal, Judicial Member
Argued by:- Sh.S.S. Sidhu, Advocate for the appellant.
Respondent No.1 proceeded exparte.
Service of respondent No.2 dispensed with.
ORDER
NARESH KATYAL, JUDICIAL MEMBER:-
Delay of 98 days in filing of this appeal stand condoned for the reasons mentioned in the application for condonation of delay.
2. Order dated 05.06.2017 passed by District Consumer Disputes Redressal Forum, Jhajjar(In short “District Commission”) in complaint case No. 268 of 2016 has been assailed in this appeal by Opposite parties (OPs No. 1&2)i.e.Life Insurance Corporation of India.
3. Krishan Kumar-husband of complainant Laxmi Deviobtained life insurance policy bearing No. 179102956 from appellants (OPs No. 1 & 2) which commenced from 06.03.2012. Sum assured was Rs.5.00 lacs and payment of premium was on quarterly basis. At the time of inception of policy; Krishan Kumar was 44 years of age.His date of birth was 10.05.1968. He unfortunately expired on 11/12.11.2013. His wife Laxmi Devi, being nominee filed claim which was repudiated by OP No. 2 vide letter dated 31.12.2014 allegedly on false grounds. Hence, by asserting cause of action, and deficiency in service of OPs; she filed complaint before District Commission.
4. OPs No. 1& 2 raised contest. In joint defence,in preliminary objections thereof, it is pleaded that complainant has no locus standi and cause of action. Compliant is not maintainable. She has suppressed true material facts and forum has no jurisdiction. There is no deficiency in service of OPs. It is admitted that OPs issued policy in the name of Krishan Kumar S/o Shanti Swaroop and his wife was nominee. It is pleaded that policy was in question was not in force at the time death of life assured and nothing is payable as per terms and conditions of policy. Claim has been repudiated on genuine ground. It is pleaded that life assured died on 11/12.11.2013 (as per death register which is overwritten) and also as per claimant’s statement he was suffering from fever for last two days. The last two quarterly premiums (due on 06.2013 and 09.2013) were deposited on 11.11.2013, just to defraud the insurer and to extract money. There are major contradictions between the record of Asha Worker and Anganwari worker; on the basis of which death certificates are issued because in both these records; name and date of death of deceased are different as Krishan son of Munna Ram and Krishan son of Shanti Swaroop, date of death is 11.11.2013 & 12.11.2013 respectively. It is pleaded that complainant is clever and cunning lady and in view of above facts and circumstances; she has not only cheated the OPs to extract money but also misguided the forum. It is pleaded that death of life assured was on 11.11.2013 as per death register which is overwritten. These facts were brought to the knowledge of Permanent Lok Adalat, Jhajjar and complaint was disposed of vide order dated 28.06.2016. Inter-alia on these pleas dismissal of compliant has been prayed.
5. OP No. 3 in his separate defence has admitted that complainant’s genuine insurance death claim of her husband has been repudiated. She is entitled to Rs.5,00,000/-plus bonus as death claim of her deceased husband.
6. Parties led evidence(oral as well as documentary). On subjectively analyzing the same; learned District Commission, Jhajjar vide order dated 05.06.2017 has allowed the complaint and directed OPsNo. 1 & 2 to make payment of Rs.5,00,000/-as sum insured under policy in question along with any other benefits, if any (as per policy Ex. C-2) along with interest @ 9% p.a. from date of death of life assured i.e. 12.11.2013, till realization of final payment to the complainant along with Rs.5500/- as litigation expenses.
7. Feeling aggrieved, OPs No. 1 & 2 have preferred this appeal.
8. Learned counsel for appellants/OPs No. 1& 2 has been heard at length and with his assistance; record too has been perused. It is urged on behalf of appellants that impugned order dated 05.06.2017 is grossly illegal, in as much as, facts and evidence have not been appreciated in proper legal perspective. Krishan Kumar had died on 11.11.2013. It is urged that as per register of death Annexure A-6; his father’s name of deceased has been mentioned as Munna Ram and date of death has been mentioned as 11.11.2013 and deceased died because of illness. As per document Annexure A-7; deceased Krishan’s father name has been mentioned as Shanti Swaroop and date of death has been shown as 12.11.2013(there is overwriting of digit 2 over digit 1 regarding date of death) and it is also mentioned therein that deceased was an old man. It is urged that if deceased Krishan Kumar had already died on 11.11.2013, then how come premium of last two quarters (June, 2013 & September, 2013) was deposited on 11.11.2013 at 12:39 pm as per receipt Annexure A-9. Since policy was not valid and already stood lapsed in July-2013 therefore, deposit of premium on 11.11.2013 will not revive the policy. It is urged that information given by PGIMS-Rohtak Annexure A-10 and death certificate issued by Municipal Corporation, Rohtak reflect that Krishan Kumar had died on 11.11.2013 at Medical College, Rohtak. On these submissions, it is urged that impugned order dated 05.06.2017 is legally unsustainable and deserves to be set aside by accepting this appeal.
9. Respondent No.1-Laxmi Devi (nominee of deceased life assured Krishan Kumar) did not appear during proceedings of this appeal and was proceeded against ex-parte vide this Commission’s order dated 12.02.2020.
10. Complainant informed appellants through her communication Annexure A-3 at its Branch office at Bahadurgarh that her husband Krishan Kumar had died on 12.11.2013 due to illness in Village Dujana, District Jhajjar. This communication was received by appellants on 30.01.2014. Insurer/appellant through its letter dated 28.02.2014 Annexure A-4 apprised complainant that form No. 3784 is to be filled by treating doctor regarding ailment, which deceased was last suffering. In response to this communication; complainant apprised OPs that her husband came after depositing premium of policy on 11.11.2013; he complained of mild headache in evening at home; he was suffering from mild fever. She brought Paracetamol tablet from medical store and gave him.After feeling relief, her husband properly took meal of dinner and went asleep at 10:00 pm. On 12.11.2013 in the morning at 06:00 am he was made to wake up for tea then it was noticed that he had died. Her husband had not obtained any medical treatment before his death.
11. In separate written statement furnished to appellants by complainant she has mentioned the date of death of her husband as 12.11.2013 at 06:00 am and also mentioned that immediate cause of his death is fever of preceding three days. Mahender Singh S/o Surat Singh Verma has given his certificate to the effect that cremation of deceased Krishan Kumar was performed on 12.11.2013 at 02:00 pm in cremation ground of Village Dujana. He has also mentioned that he knew Krishan Kumar since last 35 years who died on 12.11.2013 at 06:00 am due to fever and tenure of fever was three days before death. He also mentioned that deceased was 45 years old. There is death certificate (Ex.C-6) of Krishan Kumar S/o Shanti Swaroop issued by Registrar Birth and Death PHC, Dujana, District Jhajjar. As per this certificate; deceased had died on 12.11.2013. Ex.C-7 is the declaration in lieu of medical attendant certificate on Form No. 3784. This declaration Ex.C-7 has been given by Tilak Raj S/o Leela Ram who has stated in his affidavit that deceased Krishan Kumar died at home on 12.11.2013 due to fever and no medical attendant could be available during his last illness as he died at home. Tilak Raj (declarant) has been duly identified by Sarpanch Gram Panchayat Dujana in document Ex.C-7.
12. Above facts demonstrate that requisite formalities in lieu of death claim have been duly complied with by complainant. Ex.C-8/Ex.R-2 is the registered letter dated 31.12.2014 of appellants vide which complainant has been apprised that death claim has been repudiated. Following is the text of this communication:-
“With reference to your claim under the above policy on the life of your husband we have to inform you that above said policy was not inforce at the time of death i.e. 11/11/2013 as per anganwari register. Premium due June 2013 & Sep 2013 were deposited on 11/11/2013 i.e. after death of L.A. As the policy was not inforce at the time of death. Nothing is payable as per policy conditions.”
13. Ex.C-9 is another document of appellants. This piece of evidence recites that: life assured suffered from fever from last two days from death. He was taken to local RMP doctor at village. No record was maintained by doctor. Life assured died from fever. Claim seems genuine. Reliance placed by appellants in present appeal is on document Annexure A-10 which pertains to Krishan S/o Munna Ram. As per this record, patient landed in PGIMS on 10.11.2013 and expired during treatment on 11.11.2013 at 12:40 am.Meaning thereby, this record shows that deceased Krishan S/o Munna Ram had died in intervening night of 10/11.11.2013 at 12:40 am. Based on this record learned counsel for appellants has urged that it was not possible for deceased life assured to deposit two premiums concerning to his policy on 11.11.2013 at 12:39 pm, as he was no more in world by that time. This contention has no force. Reason is obvious. If insurer’s document Ex.C-9 recites that deceased was taken to village RMP doctor and said doctor did not maintain any record, then on what basis insurer/appellants came to know that deceased Krishan had landed himself in PGIMS-Rohtak on 10.11.2013. This mystery was required to be unveiled and unfolded by insurer only by leading explicit evidence, because insurer had taken a specific plea of ‘fraud’ by complainant in its written version. Legal Position in this regard is no more res-Integra.
14. It is by far well settled that plea of ‘fraud’, like any other charge whether made in any civil or criminal proceedings must be established beyond reasonable doubt. Howsoever suspicious may be the circumstances; however strange the co-incidence and however grave the doubts may be; suspicion alone can never take the place of proof. Reliance in this regard can be placed on ratio of law laid down by Hon’ble Apex Court in case titled as “Union of India versus M/s Chaturbhai M. Patel and Company” 1976 current Law Journal, 166. A person who pleads ‘fraud’ must prove it by cogent evidence. ‘Fraud’ should be of egregious nature as to vitiate the entire underlying transaction. Finding of ‘fraud’ cannot be left to the vagaries of preponderance of probability and conjectures. Degree of proof to prove ‘fraud’ has to be of highest level. In present appeal in hand; no circumstance, worth credible, even remotely, are apparent which could establish plea of ‘fraud’. There is no semblance of any so-called ‘fraud’. Since, policy in question entail financial implications for insurer therefore, insurer was required to prove its plea of ‘fraud’ beyond doubt. In the light of above discussion; insurer having miserably failed to lead any evidence as to how and from what source it came to know that life assured had been hospitalized in PGIMS Rohtak and expired there; it cannot garner any advantage from record of PGIMS Rohtak Annexure A-10. Even if, as per claimant’s case; deceased had been suffering from fever for three days, prior to his death, yet it will not ipso-facto lead the appellants to presume that deceased had landed in PGIMS Rohtak on 10.11.2013 and expired there on following night.
15. May be, premium of two quarters i.e. June, 2013 & September, 2013 was paid on 11.11.2013 at 12:39 am, yet appellants hadadmittedly accepted the premium amount of Rs.15,391/-. This premium receipt Annexure A-9 recites above fact. By realizing that policy of life assured has lapsed and still by accepting the premium amount of Rs.15,391/- appellants have ratified the flow of policyby their own act and conduct. Else, appellants should not have accepted the premium amount, belatedly. It was just a coincidence that life assured had expired on the intervening night of 11/12.11.2013 after depositing premium amount. There is absolutely no reason to doubt the authenticity of certificate Ex.C-4 regarding cremation of deceased which took place at 12.11.2013 at 02:00 pm in cremation ground village Dujana. Also, there is no reason to doubt and discard the credibility of death certificate Ex.C-6 issued by the competent authority stationed at PHC, Dujana, District Jhajjar (village of life assured) which recites the death date of life assured as 12.11.2013 in village Dujana. It relates to Krishan Kumar S/o Shanti Swaroop. This certificate (Ex.C-6) prevails over certificate Annexure A-8 issued by Municipal Corporation-Rohtak which relates to Krishan S/o Munna Ram. In view of ambiguity in two death certificates (Annexure A-8 and Ex.C-6) concerning father’s name of deceased; the one which is beneficial to the cause of complainant should be believed. Also there is no doubt to disbelieve the declaration Ex.C-7 given by Tilak Raj duly verified by Sarpanch of Village Dujana regarding death of life assured as 12.11.2013. This Commission is not oblivious of the fact that Sarpanch of village holds a responsible position in village and by sitting on seat of Sarpanch, he always remain aware of happenings in village. In this view of matter; the contention of learned counsel for appellants that there is an overwriting on digit 1 to make it digit 2 in the date, as visible from document Annexure A-7 regarding death of deceased Krishan Kumar pale into insignificance.
16. Moreso, another document Ex.R-3 produced by appellants before District Commission also supports the cause of claimant. It also recites that claim seems to be genuine;no medical aid was availed by deceased life assured; date of death of life assured is 12.11.2013 after correction on previous date 11.11.2013. Once this was the exact factual position available before appellants, then mere reliance on medical record of PGIMS Rohtak pertaining to Krishan S/o Munna Ram of village Dujana will not sub-serve any cause of appellant because as per proved stance of claimant deceased never landed in PGIMS Rohtak. Instead he died in his village Dujana.Repudiation by appellants of death insurance claim was legally not permissible.
17. Learned Counsel for the appellant has relied upon judgment of Hon’ble Apex Court in case titled as “Life Insurance Corporation of India and another versus Sunita” 2022 (1) Apex Court judgments (SC) 293. In view of nature of facts of present case, reliance placed by learned counsel for appellants on cited judgment is unfounded. There is no error in appreciation of evidence by learned District Commission while non-suiting the appellants through impugned order dated 05.06.2017.
18. Consequently, this appeal carries no substance and merit. Being devoid of merits, it is accordingly dismissed. Impugned order dated 05.06.2017 is affirmed and maintained.
19. Statutory amount of Rs.25,000/- deposited by the appellantsat the time of filing of appeal, be refunded to appellantsagainst proper receipt and identification in accordance with rules, after the expiry of period of further appeal/revision, if any.
20. Applications pending, if any stand disposed of in terms of the aforesaid judgment.
21. A copy of this judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986/2019. The judgment be uploaded forthwith on the website of the Commission for the perusal of the parties.
22. File be consigned to record room.
Date of pronouncement: 29th May, 2023
Naresh Katyal
Judicial Member
Addl. Bench-II
