BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, FATEHABAD.
Complaint no. 419/2018. Date of instt. 28.11.2018. Date of Decision: 25.02.2020
Inder Singh son of Adda Ram resident of village & Post Office Dhano Thi Chhoti Tehsil Rajgarh District Churu(Rajasthan)
..Complainant.
Versus
- Life Insurance Corporation of India, Divisional Office, Rohtak-124001 through its Divisional Manager.
- Branch Manager, Life Insurance Corporation of India, Branch Office, Near Auto Market, RATIA District Fatehabad.
..Respondent/OP.
Complaint under Section 12 of Consumer Protection Act, 1986.
Before: Sh. Raghbir Singh, President. Sh. Jasvinder Singh, Member.
Argued by: Sh. Jitender Thakkar, Advocate for complainant. Sh. S.K.Dharnia, Advocate for OPs.
ORDER:-
The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant against the Opposite Parties (hereinafter to be referred as OPs) with the averments that son of complainant namely Mahender Singh got himself insured with the Ops vide insurance policy number 504607342 for a sum assured of Rs.15,00,000/-. The insurance policy was valid from 04.02.2016 to February 2036 and an amount of Rs.3465/- was paid by Mahender Singh as insurance premium on 03.02.2016. The complainant was nominated as nominee in the above said policy. Therefore, Late Sh. Mahender Singh during his lifetime and after his death the complainant is consumer of the Ops as defined in the Consumer Protection Act 1986.
2. It is further submitted that unfortunately Sh. Mahender Singh life assured expired on 23.02.2016. Information regarding death of life assured was given to the Ops by the complainant and all the requisite formalities were completed for settlement of the insurance claim. It was assured by the Ops that the insurance claim will be released to the complainant very soon.
3. It is further submitted that instead of making payment of the claim the insurance claim of the complainant was repudiated by the Ops on 13.02.2017 on false and flimsy ground to the effect that the answers to the questions were not given correctly by the life assured and whereas all the replies given by the complainant to the questions were correct. It is further submitted that the repudiation of the insurance claim by the Ops vide letter dated 13.02.2017 is null and void and as such the same is liable to be set aside. The repudiation of the genuine insurance claim of the complainant by the Ops amounts to deficiency on the part of Ops in rendering service to the complainant. The complainant has further prayed that the Ops may be directed for making payment of Rs.15,00,000/- as insurance claim alongwith interest and compensation. Hence, the present complaint.
4. Upon notice, the Ops appeared through their counsel and resisted the complaint by filing a written version wherein various preliminary objections with regard to cause of action, locus standi, maintainability and concealment to true and correct facts have been raised.
5. In reply, on merits it is submitted that the insurance policy in the name of Mahender Singh for an amount of Rs.15,00,000/- was issued by the OPs and the date of commencement of policy was 04.02.2016. It is denied that Mahender Singh son of the complainant had got himself insured with the Ops because the proposer of the insurance policy had already died prior to the date of proposal as the proposal forum was submitted on 03.02.2016 and the death of the life assured had already taken place on 27.12.2015. It has been further denied that Mahender Singh unfortunately died on 23.02.2016 whereas death of life assured Mahender Singh had taken place on 27.12.2015 i.e. prior to the filing of the proposal form. It has been further submitted that insurance policy was obtained with malafide intention to defraud the corporation and to fetch the false compensation.
6. It is further submitted that after receiving the application for settlement of claim, the Ops appointed Mr. N.S.Raghava, Chief Manager as an investigation officer and after investigation it was found that the proposer of the insurance policy had already died prior to the date of proposal. It is further submitted that in view of the above said submissions the repudiation of the insurance claim of the complainant by the Ops is perfectly in accordance with the terms and conditions of the insurance policy and the same is sustainable in the eyes of law. The present compliant is without any merits and as such the same is liable to the dismissed.
7. The learned counsel for the complainant tendered in evidence affidavit of the complainant as Annexure C-1 alongwith the documents as Annexure C-2 to C-4 and closed the evidence of the complainant. On the other hand the learned counsel for the Ops tendered in evidence affidavit of Rajender Singh Manager as Annexure R-1 alongwith the documents as Annexure R-2 to Annexure R-8 and closed the evidence of Ops.
8. We have duly heard the arguments advanced by learned counsel for the parties and have also perused the documents placed on record.
9. It is the case of the complainant that his son Late Sh. Mahender Singh had obtained an insurance policy from the Ops for an amount of Rs.15,00,000/- and the same was valid from 04.02.2016 to February 2036. It is further the case of the complainant that on 23.02.2016 i.e. during the subsistence of insurance policy, the life assured Mahender Singh unfortunately died. It is further the case of the complainant that intimation regarding death of life assured was given to the Ops timely and all the requisite documents were also furnished by the complainant to the Ops for settlement of the claim. However the genuine insurance claim of the complainant have been declined by the Ops on a false ground that at the time of filing of proposal, material information was not disclosed. It is further the case of the complainant that nothing was concealed by the life assured at the time of obtaining the insurance policy and as such the ground taken by the Ops for repudiation of his insurance claim is null and void and the complainant is entitled for receiving the insurance claim alongwith interest and compensation.
10. On the other hand, it is the case of the Ops that the life assured Late Sh. Mahender Singh had died on 17.12.2015 whereas the insurance policy in the present case was issued on 03.02.2016. Meaning thereby the life assured had already died prior to the issuance of the insurance policy and as such the insurance policy was obtained fraudulently to fetch the insurance claim from the Ops.
11. In view of the aforesaid discussion, the insurance claim of the complainant has been repudiated by the Ops only on the ground that the life assured Sh. Mahender Singh was not alive on the date of commencement of the insurance policy i.e. 03.02.2016 and he had already died on 27.12.2015. In view of the above the onus was upon the Ops to prove that the life assured had died prior to 03.02.2016 i.e. the date of filing of proposal form. However the Ops have not placed on record any convincing, authenticate or credible evidence to prove that the life assured Mahender Singh had died prior to 03.02.2016. No death certificate or any other documentary evidence has been produced by the Ops in this regard. On the other hand, the complainant has placed on record death certificate (Annexure R-5) of life assured Mahender Singh s/o Inder Singh. A perusal of Annexure R-5 issued by the Government of Rajasthan, it is revealed that Sh. Mahender Singh son of Inder Singh life assured had died on 23.02.2016. Moreover, Smt. Rajwanti Aanganwari Worker of the concerned village was examined by the Ops regarding the date of death of the Mahender Singh. In her evidence, Smt. Rajwanti deposed that she has brought the original copy of survey register for the period from 2005-2018 and Annexure R-8 is photocopy of the same. As per Annexure R-8 Mahender Singh had died on 23.02.2016.
12. In view of the above, the Ops have failed to prove that the life assured Sh. Mahender Singh had died prior to 03.02.2016 i.e. date of filing of the proposal form and on the other hand the complainant has been able to prove that the life assured had died on 23.02.2016. Therefore, the repudiation of the insurance claim of the complainant in the present case is not sustainable in the eyes of law.
13. In view of the above, we are of the considered opinion that the complainant has been able to prove deficiency on the part of Ops in rendering service to him. The present complaint is accordingly allowed and the Ops are directed for making a payment of Rs.15,00,000/- to the complainant as insurance claim on account of insurance policy issued by the Ops in the present case. The Ops are further directed for making a payment of Rs.5,000/- as compensation and litigation charges to the complainant. The Ops are further directed for making compliance of present order within a period of 2 months from the date of receiving the copy of the present order, otherwise the amount shall carry an interest at the rate of 8% during the default period. A copy of this order be furnished to both the parties free of cost as provided in the rules. File be consigned to record room after due compliance.
ANNOUNCED IN OPEN FORUM Dt. 25.02.2020
(Jaswinder Singh) (Raghbir Singh) Member President, District Consumer Disputes Redressal Forum, Fatehabad
