BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KAITHAL.
Complaint No.235/2017.
Date of instt.:01.09.2017.
Date of Decision:21.01.2019.
Balbir Singh son of Bhagwan Dass, near Jai Bharat School Pai District Kaithal.
……….Complainant.
Versus
- Branch Manager, L.I.C. Near Geeta Bhawan Kaithal, District Kaithal.
- Senior Divisional Manager, Life Insurance Corporation of India, Kunjpura Road, Karnal.
- Ashok Kumar Agent, s/o Dharmpal r/o VPO Songal Distt. Kaithal.
- Virender Kumar, s/o Shri Chand r/o Harijan Basti Village Pai District Kaithal now posted at LIC Office, Sector 2, Panchkula Bay No.71-72 Panchkula, Pin 134115 (Haryana).
..……..Opposite Parties.
COMPLAINT UNDER SEC. 12 OF CONSUMER PROTECTION ACT, 1986.
Before: Shri Rajbir Singh, Presiding Member.
Smt. Suman Rana, Member.
Present: Shri Ajay Sharma, Adv. for the complainant.
Shri Manoj Ichhpilani, Adv. for Op Nos.1 & 2.
OP No.3 exparte.
Sh.Mukesh Bansal, Adv. for Op No.4.
ORDER
(RAJBIR SINGH, PRESIDING MEMBER).
The complainant has filed the present complaint under Section 12 of Consumer Protection Act, 1986 against the OPs with the averments that Mamta Devi d/o complainant had purchased insurance policy No.479275064 dt.05.05.2016 (single premium policy) “Jiwan Shikhar” from Op No.1 through Op Nos.3 & 4 and made premium to the tune of Rs.41,280/- for maturity/assured amount of Rs.4,18,200. The complainant has been appointed as nominee in the said policy. On 11.10.2016, Mamta Devi died due to heart attack and the complainant being nominee submitted death claim with the Ops after completing all the necessary formalities but the Ops repudiated the claim vide letter dt.05.5.2017 on false and flimsy grounds. The complainant got served legal notice upon the OPs but to no avail. The act and conduct of the Ops clearly amounts to deficiency in service. In evidence, the complainant has tendered affidavit Ex.CW1/A and documents Ex.C1 to Ex.C8.
2. Upon notice, Op Nos. 1 & 2 filed their joint reply wherein preliminary objections such as maintainability, locus-standi and cause of action have been taken. It is submitted that Mamta d/o complainant had submitted a proposal form dated 29.04.20-16 for taking a policy under table 837-15 (Jeewan Shikar Plan) for sum of Rs.1,00,000/- & death sum assured of Rs.418200/- with single mode of premium of Rs.41280/-. The life assured in column No.11 had given wrong statement regarding her health despite the fact that she was handicapped and was getting disability pension from Social Welfare Office, Karnal since November, 2010. In the present case, policy No.479275064 was taken on 05.05.2016 by deceased life assured on the basis of false information given in proposal form. After receiving the claim forms qua death claim, matter was enquired as per Section 45 of Insurance Act and during the investigation it was found that she was unable to stand on her own legs and she was drawing disability pension from Social Welfare Department, Kaithal under ID No.1814-3027466. The deceased life assured had studied upto 7th class whereas she had mentioned her educational qualification as 12th in proposal form. The deceased life assured was guilty of suppressing of material facts, therefore, the claim was rightly repudiated vide letter dated 05.05.2017 as per clause 2 of Part D. Other contentions have been controverted and prayer for dismissal of the claim has been made.
OP No.3 did not appear before this Forum and was proceeded against exparte vide order dated 09.01.2018.
OP No.4 has tendered his separate reply wherein several preliminary objections such as cause of action, maintainability, estoppal, locus standi, suppression of material facts from this Forum and non joinder of necessary parties have been taken. It is further submitted that after issuance of policy in the name of life assured the matter remains between OP No.1 and complainant. Other contentions have been controverted and prayer for dismissal of the complaint has been made.
In evidence, the Op No.1 & 2 have tendered affidavit Ex.RW1/A and documents Ex.R1 to Ex.R11 and Mark RA. No evidence on behalf of Op No.4 has been led and the same was closed by the order of the Forum.
3. We have heard ld. counsel for both the parties and perused the case file carefully and minutely and have also gone through the evidence led by the parties.
4. Purchasing of policy No.479275064 dt.05.05.2016 (single premium policy) from Op No.1 of Single Premium to the tune of Rs.41,280/- for maturity/assured amount of Rs.4,18,200 in case of death wherein the complainant has been appointed as nominee in the said policy is not disputed. Life assured Mamta Devi had expired on 11.10.2016 as is evident through Ex.C8. It is also established on the case file that said Mamta Devi had also purchased another policy No.178260331 commencing from 19.03.2013 with date of maturity 19.03.2023. It is also established on the case file that after the death of Mamta Devi the OP No.1 had honoured the death claim by paying an amount of Rs.333180/- (sum assured) in the account of the complainant, being nominee, through NEFT as is evident through Ex.C7.
5. Undoubtedly, the deceased life assured had two different insurance policies in her name and out of two, one claim qua death of life assured Mamta Devi has been honoured qua policy No.178260331 and the insurance company-OP No.1 instead of making the payment of another policy No.479275064 dt.05.05.2016 (single premium policy) has avoided the death claim on the ground of suppression of material facts such as the permanent disability and educational status in the proposal form Ex.R1. Perusal of this very document reveals that all the columns have been filled in English and the deceased life assured had only signed in Hindi which shows that the agent/official of the Op No.1 had filled in the proposal form and OP No.3 had put his signature on the column of witness. The OP No.1 after taking the facts mentioned in the proposal form issued the policy in question, therefore, it cannot be said that there was any suppression/concealment of material facts. When the Op No.1 had already received the premium for another policy and also honoured the death claim in that policy, therefore, in the present complaint it cannot take the ground of suppression of material facts. Moreover, in the present case had the agent carried out his instructions properly then no complications could have taken place and therefore, the principal i.e. insurance company is bound by his acts. If the agent’s acts are within the scope of his authority, the principal is bound by those acts irrespective of the agent’s mistake and the prejudice caused to him by the acts. Since the Op No.1 had accepted the premium for the said policy which shows that agent had acted on its behalf, therefore, it cannot be escaped from making the death claim for which it had received premium. On this point reliance can be taken from case law titled as Rigid Global (India) vs. Iffco Tokio General Insurance Co.Limited & Ors. II (2008) CPJ 365 wherein it has been held by Rajasthan State Consumer Disputes Redressal Commission, Jaipur that Agent-Misrepresentation/ fraud-Principal liable for agent’s fraud/ misrepresentation, acting within the scope of his authority. The conduct of OP No.1 shows its sweet will whether to accept the claim of any person or not. The OPs only want to make the profit and not to compensate the insured. In this era, when there is a competition among the Insurance Companies for developing their business, unhealthy practices are developing to get maximum benefits and profits. It has become a common experience of the Insurance Policies to repudiate genuine claims of the insured on one pretext or other. A common man is not supposed to know all the niceties and technicalities of law. The insured puts his hard earned money in taking Insurance with a hope and aspiration that in case of any mishap, he or his family shall get some immediate financial assistance, but in most of cases, claims are rejected with a stroke of pen on the ground that he/she did not abide the terms & conditions of the Insurance Policy. The ground of concealment of material facts by the deceased life assured is not sustainable because the Op No.1 had already paid the death claim of deceased life assured in another policy in the bank account of nominee through NEFT as shown in Ex.C7. So, the Ops have wrongly repudiated the death claim of complainant. Hence, the Ops are deficient in providing services to the complainant.
6. Thus, in view of above discussion, we allow the complaint and quashed the repudiation letter dated 05.05.2017 with a direction to Ops to pay Rs.4,18,200/- (being sum insured in case of death vide policy No.479275064 dt.05.05.2016) to the complainant. The Ops are also burdened with costs of Rs.5500/- as compensation for harassment, mental agony and costs of litigation charges to the complainant. Let the order be complied with jointly and severally within a period of 30 days failing the amount would carry interest @ 9 % per annum from the date of order till its realization. A copy of this order be sent to the parties free of costs. File be consigned to the record room after due compliance.
Announced.
Dt.21.01.2019.
(Suman Rana) (Rajbir Singh),
Member. Presiding Member.
Present: Shri Ajay Sharma, Adv. for the complainant.
Shri Manoj Ichhpilani, Adv. for Op Nos.1 & 2.
OP No.3 exparte.
Sh.Mukesh Bansal, Adv. for Op No.4.
Remaining arguments heard. Order pronounced, vide our separate order in detail of even dated, the present complaint is allowed. File be consigned to record-room after due compliance.
Dated:21.1.2019. Member Presiding Member
