Before the District Consumer Disputes Redressal Commission, Rohtak.

                                                          Complaint No. : 667

                                                          Instituted on     : 11.11.2021

                                                          Decided on       : 21.08.2024.

Bittu age about 24 years, son of Dharam Kumar and late Smt. Sheela, resident of village Medina, Pana Korsan, Tehsil Meham, District Rohtak.

                                                                             ………..Complainant.

                                      Vs.

1. Life Insurance Corporation of India, through its Senior Divisional Manager, Office at SCO-3-4-5, Sector 1, Rohtak.
2. Life Insurance Corporation of India through its Branch Manager, office at 1^st Floor, Richi Rich Plaza, opposite D-Park, Bohtak-124001.

                                                          ……….Respondents/Opposite parties.

          COMPLAINT U/S 35 OF CONSUMER PROTECTION ACT

BEFORE:  SH.NAGENDER SINGH KADIAN, PRESIDENT.

                   DR. TRIPTI PANNU, MEMBER.

                   DR.VIJENDER SINGH, MEMBER.

Present:       Sh.J.S.Hooda, Advocate for the complainant. 

                   Sh.Krishan Lal Advocate for opposite party No.1 & 2.

                                                ORDER

NAGENDER SINGH KADIAN PRESIDENT:

1.                Brief facts of the case, as per the complainant are that  the mother of complainant namely Smt. Sheela had obtained four LIC policy bearing no.144097102 sum assured Rs.5,00,000/-, T-T 914-15, 144097193, 144097194 and 144097195 sum assured therein Rs.1,00,000/- each T-T 944-16, 944-17 and 944-18 respectively from the opposite parties at Rohtak. Date of commencement of the said policy is 14.09.2020. Mother of complainant paid the required premium of said policies on 13.09.2020. Before availing the aforesaid LIC policy, the mother of complainant had disclosed all the required facts regarding her health and after fully satisfying with the same, the respondents had issued the aforesaid policy and complainant was nominated as nominee for the said policies. Unfortunately the mother of complainant had died in the intervening night of 15/16.09.2020. The complainant being nominee for the said policies has submitted his claim for said policy to get the assured amount and all other accrued benefits under the aforesaid policies.  He also submitted the original policies and other required documents as required by respondents. The complainant visited to the office of the respondents many a times to get the genuine claim amount but the respondents have illegally& arbitrarily declined the claim of the complainant on flimsy grounds on 01.09.2021.Opposite parties have wrongly shown the time of death of Smt. Sheela on 15.09.2020 at 9.30 AM. The mother of complainant had already taken one Life assured policy from Bajaj Allianz Life Insurance on 26.08.2020 and its benefit hasbeen extended in favour of complainant being nominee after the death of her mother. The act and conduct of respondents not to pay the genuine claim to the complainant is highly illegal & against the principle of natural justice and also amounts to deficiency in service. Hence this complaint and it is prayed that opposite parties may kindly be directed to pay the claim amount of alleged policies amounting Rs.8,00,000/- alongwith all other accrued benefits therein alongwith interest @ 18%p.a.. Opposite parties be further directed to pay Rs.1,00,000/- as compensation on account of mental agony &harassment alongwith Rs.22,000/- as counsel fee to the complainant.

2.                 After registration of complaint, notices were issued to the opposite parties. Opposite parties in their reply has submitted that the respondents have issued following policies in the name of Sheela Devi:-

In all these policies the nominee is Bitoo. Above policy was completed on the basis of questions answered in the proposal form by life assured and medical report. The claim in respect of the aforementioned policies is an early death claim and the respondent corporation examined the claim in view of provisions of section 45 of the Insurance Act 1938 and the claim of the complainant was repudiated. In the proposal form the income of the deceased life assured has been shown as Rs.5 lacs yearly, but in the statement of the complainant at the time of investigation by the Corporation shown the income of deceased life assured as Rs.20000/- per month. As per claimant own written statement while investigation, life assured died at 9.30 A.M. on 15.9.2020 whereas the first premium receipt were issued after the time of death on 15.9.2020 at 15.39, 15.40, 15.42 and 15.43 pm. This suppression of material facts, which have had a bearing on the granting of risk, was clearly done with intent to mislead the respondent corporation, hence it has been decided to repudiate all the liabilities. According to the terms and conditions of the policy, the premium must be paid during the life of the assured. But in the present case, the receipts were issued after the death of the life assured and the true facts have been concealed while obtaining the aforementioned policies. It is further contended that life assured was suffering from Cancer for few months before taking insurance. As per claimant's statement, the deceased life assured was not having her own income. The proposal No.3643, 3646, 3648 and 3649 were completed on 15.9.2020 at 15.30, 15.40, 15.42 and 15.43 p.m while the life assured died on 15.9.2020 at 9.30 a.m. as per claimant's statement. It is clearly evident that the deceased life assured was not having good health on date of taking policy under aforementioned proposal forms. The illness history and annual income of life assured which was material to the risk was not disclosed by the deceased life assured in the proposal forms dated 13.9.2020. By suppression of material facts, which have had a bearing on the granting of risk was clearly done with fraudulent intention to deceive the respondent corporation. Hence it has been rightly decided by the respondent corporation to repudiate all the liabilities under the above mentioned policies. The respondent corporation acted in accordance with law.  There is no deficiency in service on the part of opposite parties and dismissal of complaint has been sought.

3.                Ld. Counsel for the complainant in his evidence has tendered affidavit Ex.PW1/A, documents Ex.P1 to Ex.P13 and closed his evidence on 05.12.2022. Ld. Counsel for the opposite parties has tendered affidavit Ex.RW1/A, documents Ex.RW1 to Ex.RW6 and closed his evidence on 09.02.2023.

4.                We have heard learned counsel for the parties and have gone through the written arguments on behalf of respondents as well as material aspects of the case very carefully.

5.                In this case respondent has submitted that the life assured died on 9.30AM on 15.09.2020 whereas the first premium receipts were issued after the death of life assured i.e. 15.09.2020 at 3.39, 3.40, 3.42 and 3.43 pm. So the risk starts from 15.09.2020 after the clearance of cheque. Hence they have no liability as per the terms and conditions of the policy. We have perused the documents placed on record by both the parties.The perusal of documents shows that the agent of the respondents issued the receipt Ex.P4, Ex.P5, Ex.P6 & Ex.P7 on dated 15.09.2020. As per our opinion the policy number is mentioned in the receipt, it is not simply the proposal but these are the receipts of amount received by the respondent officials on dated 14.09.2020. This amount has been fed in the system of the respondent and the system generated the policy numbers i.e. 144097193, policy no.144097194, 144097192 and 144097195. Without receiving the amount policy number cannot be generated. Here if the cheque would have been bounced then there was strength in the version of respondents but the amount has been received on 15.09.2020 at 3.40 P.M.  In fact the amount hadalready been received by the respondent officials and all the particulars like age, name, policy period and other formalities like premium amount had been fedin the system of respondents on 14.09.2020. Proposal form was filled on 13.09.2020, amount received by the respondents on 14.09.2020 and it was in process on 14.09.2020. Meaning thereby all the formalities have been completed on 14.09.2020 and thereafter the amount was received in the bank on 15.09.2020 i.e. on the date of death of life assured.  The respondents have wrongly mentioned the date of commencement of risk as 15.09.2020 in the written statement as well as in the affidavit whereas as per Ex.P4 to Ex.P11, the date of commencement is mentioned as 14.09.2020. It is also observed that as per the respondents, the life assured died on 15.09.2020 at 9.30 AM. To prove the same respondents have placed on record a photocopy of statement of complainant Ex.RW1. But this statement is merely a photocopy and is not supported with the affidavit of complainant and cannot be believed. No other document has been placed on record by the respondents to prove the fact that life assured had died on 15.09.2020 at 9.30A.M.  On the other hand, as per the complaint and affidavit filed by the complainant, the mother of the complainant had died in the intervening night of 15/16.09.2020 whereas wrong and false facts about the time of death of life assured has been mentioned by the respondents only to decline the genuine claim of the complainant.  We have also perused the law cited by ld. Counsel for the respondents in Civil Appeal No.35 of 2024 of Hon’ble Supreme Court of India in case titled as Reliance life  Insurance Company Ltd. &Anr. Vs. Jaya Wadhwani, whereby Hon’ble Supreme Court has held that: “The date of issuance of policy would be the relevant date for all the purposes and not the date of proposal or the date of issuance of the receipt”.  In the case cited above, the proposal form was submitted on 14.07.2012 with respect to the cheque dated 13.07.2012 wherein also it was mentioned that the receipt is issued subject to the clearance of the cheque and further the insurance protection shall only be provided effective from the date of acceptance of the risk, which happened on 16.07.2012, when the policy was issued and the date of commencement was notified to be the same date.  But in the present case the date of issuance of policy is 15.09.2020 and the date of death of life assured is 15.09.2020 in the intervening night of 15-16.09.2022 i.e. after the date of issuance of policy. Hence this judgment has no adverse effect on this case. The life assured was fully covered under the policies on the date of death.  As such complainant is fully entitled for the insurance claim under the policies. We have also perused the policy Ex.RW2, as per which there are 3 children of deceased Sheela and his husband is also alive.  As such the claim will be payable to all the L.Rs of deceased.

6.                In view of the facts and circumstances of the case, we hereby allow the complaint and direct the opposite parties to pay the claim amount under the policies no.144097193, policy no.144097194, 144097192 and 144097195 respectively, other benefits under the policies, if any, alongwith interest @ 9% p.a. from  the date of filing the present complaint i.e.11.11.2021  to till its realisation and also to pay a sum of Rs.5000/-(Rupees five thousand only) as compensation on account of deficiency in service aswell as Rs.5000/-(Rupees five thousand only) as litigation expenses to all the legal heirs of the deceased. However, complainant is directed to submit the detail of legal heirs to the department within 15 days from the date of decision and thereafter the opposite parties shall pay the awarded amount to the legal heirs of deceased in equal share within one month.

7.                Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.

Announced in open court:

21.08.2024.

                                                          ........................................................

                                                          Nagender Singh Kadian, President

                                                          ..........................................

                                                          TriptiPannu, Member.

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                                                          Vijender Singh, Member.