Subhash Chander (since deceased), husband of the complainant had taken life insurance policy No.178510534 dated 28.7.2009(Ex.R-12), from Life Insurance Corporation of India i.e. from the opposite parties, for sum insured of Rs.five lacs, with quarterly premium of Rs.5031/-. His wife complainant Parvati, was his nominee. This complaint has been filed on 2.7.2013, with the averments that insured Subhash Chander her husband had died on 9.8.2009 due to sudden heart attack. She then lodged her insurance claim with the opposite parties, but it was repudiated, vide impugned repudiation letter dated 28.3.2013(Ex.C-3 or Ex.R-1); on the ground that there was manipulation in his date of death from 2.8.2009 to 9.8.2009. It is pleaded in this complaint that repudiation of her claim is illegal and invalid. In fact, her husband insured Subhash Chander had all of a sudden died on 9.8.2009 due to heart attack, which is also clear by his death certificate (Ex.C-2 or Ex.R-8), issued by Registrar Births & Death, Haryana. That allegations of manipulation in the date of death, are totally false and baseless, so repudiation of her claim, is not only deficiency of service but is also unfair trade practice on the part of the opposite parties. She has prayed for a direction to the opposite parties for payment of the insured amount of Rs.five lacs, to her with upto date interest, besides compensation for her harassment, mental agony etc. and litigation expenses.
2. Simple case of the opposite parties, in their joint reply is that claim of the complainant has been validly repudiated on genuine ground. That as per their investigations conducted by Branch Officer, there are manipulations in the date of death of Subhash Chander. He had attended his duties only up to 2.8.2009. It is as per Anganwari worker and Kabrel dispensary record. He was a part time sweeper in the dispensary.
3. That Subhash Chander had died on 2.8.2013 but the insurance policy in question for him was procured by submitting proposal form dated 5.8.2013 i.e. after his death. It was with intention to grab money from the insurance company.
4. In order to make out her case, the complainant has placed on record Ex.C-1 copy of insurance policy in question showing her as the nominee of the insured; ExC-2 copy of death certificate of Subhash Chander issued by Registrar Birth & Death, showing date of his death as 9.8.2009 registered on 24.8.2009; Ex.C-3 copy of impugned repudiation letter; Ex.C-4 copy of confidential claim enquiry report of Senior Manager of the opposite parties dated 24.3.2011. It was obtained by the complainant by way of RTA. In Q.No. 11, thereof it is specifically mentioned that during investigation it was found that on 9.8.2009, DLA was at his residence, when while doing household jobs, he felt chest pain and collapsed. He was taken to the hospital where he was declared brought dead. That he had died due to sudden heart attack. Beside it, the complainant has also placed on record Ex.CW1/A her own supporting affidavit.
5. In reply thereto, opposite parties have placed on record Ex.R1 copy of impugned repudiation letter; Ex.R-2 copy of letter of Divisional Manager written to the Secretary, Ministry of Health. Govt. of Haryana, Chandigarh dated 12.11.2012, requesting for an enquiry for actual date of death of the insured; Ex.R-3 to Ex.R-5 again copies of letters of Divisional Manager, written to the Deputy Commissioner, Hisar dated 3.11.2012, 5.10.2012 and 21.9.2012 respectively requesting for said enquiry, Ex.R-6 copy of another confidential claim enquiry report dated 14.3.2000 of the bank suspecting the date of death of Subhash Chander as 2.8.2009; Ex.R-7 copy of employer’s certificate, inter-alia mentioning that 2.8.2009 was the last date of attendance of Subhash Chander; Ex.R-8 and R-9 copies of his death certificates after mentioning date of his death as 9.8.2009, but registration dates in Ex.R-8 is 24.8.2009 and in Ex.R-9 9.8.2009; Ex.R-10 copy of status report of the insurance policy; Ex.R-11 copy of proposal form filed by Subhash Chander dated 5.8.2009 for obtaining insurance policy in question w.e.f. 28.7.2009; and Ex.R-12 original insurance policy.
6. We have gone through the record of the case carefully and have heard learned counsel for the parties. We are of the considered opinion that repudiation of the claim of the complainant is not legal or valid. It is certainly deficiency of service on the part of the opposite parties. In this regard, it is note worthy that very case of the opposite parties in this regard is only regarding their suspicious, that date of death of Subhash Chander is 2.8.2009. But there is absolutely no evidence nor any reliable material to prove or to presume date of death as 2.8.2009. It is settled proposition of law that howsoever strong suspicion may be, but it cannot take the place of proof. There is also presumption of correctness, attached with the certificate issued by Registrar Births & Deaths. It carries presumption of correctness unless and until rebutted. But here in the case in hand, there is absolutely nothing reliable or trustworthy to rebut the presumption. Even as per the copies of death certificates Ex. R-8 and Ex.R-9, placed on record by the opposite parties, date of death of Subhash Chander is 9.8.2009. Further as per departmental confidential claim report, Ex.C-4 dated 24.3.2011 date of death of Subhash Chander is 9.8.2009. However earlier report Ex.R-6 dated 24.3.2000 mentioning date of death as 2.8.2009 is not reliable. At the most, it was the opinion of said Enquiry Officer. Relevant material on the basis of which, date of death as 2.8.2009 could have been inferred, is not placed on record nor it is even so mentioned in this report Ex. R-6. Opinion not based upon any reliable material, is no opinion in the eyes of law. This Enquiry officer who had given said report Ex.R-6 even did not bother to record statement of any co-villager or to visit the hospital where allegedly insured was declared “brought dead”. Moreover, this Enquiry report dated 24.3.2011 which was earlier in time has been superceded by subsequent departmental enquiry report. Ex.C-4 dated 14.3.2011 conducted by Branch Manager. In this regard it is also noteworthy that for the reason best known to the opposite parties, they had withheld this valuable material. It was later on procured by the complainant in right to information act and then placed it on record as Ex.C4. Here subsequent Investigating Officer, of the opposite parties, gave his clear cut finding that on 9.8.2009, insured was at his residence and was doing household jobs; that while he was carrying buffalos to the water, he felt chest pain and came back to the house where he collapsed; that the doctor was called and then he was taken to the hospital where he was declared brought dead. The opposite parties cannot come out from this subsequent enquiry report on their own, amply proving that Subhash Chander had died on 9.8.2009 because of sudden heart attack and not on any earlier date.
7. Learned counsel for the opposite parties has also contended that deceased was a part time sweeper and died only on 4th day of obtaining the insurance policy and that he had obtained this insurance policy of Rs.5,00,000 (five lakhs) with quarterly premium of Rs.5031/- which are strong suspicious circumstances against the insured. We have considered the contention, but find that this contention as of no material avail to the opposite parties. Deceased might be part time Sweeper but there is no evidence to prove his finical back ground or capacity to pay. Moreover, he had taken life insurance policy only of Rs.five lacs, which cannot be said as unproportionate to his earning. Since he had died because of sudden heart attack, so also cannot be said that he was anticipating any such like sudden death.
8. There is also absolutely nothing on record to prove or to presume the allegations of manipulation in date of death as 2.8.2009 instead of 9.8.2009. These are simple allegations without any basis to support. In this regard, it is also note worthy that ever Senior Divisional Manager of the bank wrote so many letters to the higher authorities requesting for making enquiry but higher authorities ever did not find any substance even to initiate any inquiry.
9. It is also note worthy that death of insured is 9.8.2009. But insurance claim of the complainant duly lodged was repudiated, belatedly on 28.3.2013 i.e. after about 3 and ½ year of the death. This act, on the part of the opposite parties itself, is gross deficiency of service and speaks in volume against the opposite parties.
10. It is also a matter of common knowledge that at the time of settlement of even genuine claims, insurance companies do raise flimsy and unsubstantiated grounds to deny the due. This practice, on the part of insurance companies has already been condemned by Hon’ble Apex Court.
11. Resultantly, this complaint is hereby allowed, with a direction to the opposite parties, to pay insured amount of Rs.five lacs to the complainant with interest @ 9% per annum from the date of death i.e. 9.8.2009, till payment. Complainant is also hereby awarded compensation of Rs.10,000/- for her harassment, mental tension etc. and litigation expenses of Rs.1100/- against the opposite parties.
Announced in open court:
Dated:07.05.2015
