BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL COMMISSION, JALANDHAR.

 Complaint No.476 of 2017

      Date of Instt. 13.12.2017

      Date of Decision:18.04.2022

Lovepreet Singh Aged about 22 years S/O Amarjeet Singh, S/O Dilip Singh, Village and Post Office Talvandi Choudhrian, Tehsil Sultanpur Lodhi, District Kapurthala.

..........Complainant

Versus

1.       Life Insurance Corporation of India, Divisional Office, “Jeevan         Parkash” Model Town Road, Jalandhar-144001, through its          Senior Divisional Manager.

2.       Life Insurance Corporation of India, Branch Office, “Jeevan Jyoti      Building”, Model Town, near Water Pump, Kapurthala, through      its Branch Manager.

3.       Manager (Claims), Life Insurance Corporation of India, Divisional Office, “Jeevan Parkash” Model Town Road,   Jalandhar-144001.

4.       Manager (NB/Actl) Life Insurance Corporation of India,          Divisional Office, “Jeevan Parkash” Model Town Road,   Jalandhar.

5.       Manager (CRM)/Central Public Information Officer, Jalandhar          Division, Life Insurance Corporation of India, Divisional Office,          “Jeevan Parkash” Model Town Road,           Jalandhar-144001.

6.       Harjinder Kaur Wife of Manjeet Singh Agent/Agency code      no.10297152 village Bhuee, Post Office Shekhupur, District          Kapurthala.

….….. Opposite Parties

Complaint Under the Consumer Protection Act.

Before:        Dr. Harveen Bhardwaj             (President)

                   Sh. Jaswant Singh Dhillon       (Member)

Present:       Sh. Aman Puri, Adv. Counsel for the Complainant.

                   Sh. M. S. Sachdev, Adv. Counsel for OPs No.1 to 5.

                   None for OP No.6.

Order

Dr. Harveen Bhardwaj (President)

1.                The instant complaint has been filed by the complainant, wherein he has alleged that this complaint is in respect of Life Insurance Policy NO.133413341 for Rs.5,00,000/- Sum Assured on the life of Amarjeet Singh deceased life assured (herein after referred to as DLA) fully described in the tabular in Sr. No.2 against composite Letter Ref. Claims/Repdt. No.152/61/62/63 dated 28.02.2017 while policy number 133413170 and 133413355 at serial No.1 and 3. That the complainant law abiding citizen is unfortunate son of Amarjit Singh DLA who whilst alive was having life insurance policy/s on his life as under:-

                   Obtained through authorized agent OP No.6 whose agency attached under Sh. Mukesh Anand Development Officer Code No.2337013 Working in Branch Office of OP No.2 under the administrative and supervisory control of OP No.1. These policies were under LIC’s New Bima Gold Plan Table No.179 for term 16 years. The risk under each of the policy alongwith respective Proposal number, mode of premium installment has been mentioned in tabular succinctly. The half yearly installment of premiums were paid regularly without any default on due date/s. The signature of DLA on blank printed prescribed Proposal Form No.300 was taken on a single proposal form, but OP No.6 with connivance of her development officer Sh. Mukesh Anand manipulated and maneuvered made bifurcation in multiple policies and diverted Rs.50,00,000/- invested and paid by DLA for one singly policy only for larger amount of Rs.50,00,000/- only canvassed proposed and allured tempted sweet words of OP No.6 as described in tabular above mentioned without information knowledge and consent of DLA. That the OP No.6 attached to Sh. Mukesh Anand, Development Officer working in OP No.2, Branch Office submitted two proposal each for Rs.25,00,000/- sum assured in clandestine, surreptious and fraudulent manner prejudicial and detrimental to the interests of DLA for wrongful gain with evil and nefareious design for the reasons best known to OPs. The OP No.2 forwarded Proposal Form of Policy No.133413355 at serial No.3 of tabular to OP No.1 for processing, underwriting and acceptance of the policy because sum assured of Rs.25,00,000/- proposed was beyond the competence power and authority vested in OP No.2. OP No.1 accepted the proposal vide its hand written decision dated 01.12.2011 on Prescribed Proposal Review Slip for Rs.20,00,000/- reduced Sum Assured instead of originally sum proposed Rs.25,00,000/- in proposal form. The decision as recorded on Proposal Review Slip reads “Accepted Plan 179-16 for SA Rs.20,00,000/- with Class-I extra + AB-ST and consent for extra premium sd/-G. S. Parmar Sr. Div. Mgr/01.12.11”. The proposal was under written by NB Department of OP No.4 who had made notings in his own hand and recommended for acceptance of proposal for reduced sum assured of Rs.20,00,000/- with stipulation ante. That the OP No.2 and OP No.6 alongwith Development Officer Sh. Mukesh Anand were hands and gloves and as per decision of OP No.2 issued policy for reduced sum assured of Rs.20,00,000/-. Interestingly on the other hand, these OPs manipulated proposal of Policy No.133413341 for Rs.5,00,000/- sum assured fully described in serial no.2 of the tabular mentioned above. Amazingly, the date of proposal was 16.11.2011 at Serial No.2 and 3 were the same whereas date of proposal in serial No.1 was different from other respective proposals forms. It is a mystery and myth in respect of the dates of proposal and manner sum proposed in proposal form were divided in different amount of sum assured of Rs.50,00,000/- proposed for single life insurance policy by DLA. That the OP No.2 was fully conscious that OP No.2 was not vested with power authority and competence to accept the proposal for sum assured of Rs.25,00,000/- sum assured but had a power authority and competence upto limit of Rs.15,00,000/- at that point of time because OP No.2 itself had referred proposal  of policy mentioned at Serial No.1 to OP No.1 as narrated elaborately ante. It is necessary and relevant to apprise factual aspects and to through light of mischief manipulation made by OPs detrimental to the interests of innocent rustic lay man DLA unaware of technicalities of life insurance. DLA was victim of OPs. That DLA had perfect and good health profile and insurability with no trace of physical impairment and disease or sickness at the time of proposing for life insurance. The proposal for life insurance policy was under medical scheme. DLA underwent through, complete, comprehensive and careful medical checkup by panel doctor (Medical Examiner) of choice of OP No.2 at the time of submission of proposal for own life insurance and additional special medical test reports relating to health profile were also obtained, DLA good and perfect health, age insurability as Standard Life with no trace of any physical impairment and disease/illness after clinical and physical check up and special test reports was duly certified by the panel doctor in prescribed medical examination in Form No.300 in answer to the specific query/question. The panel medical examiner further categorically certified that the panel medical examiner did not notice/observe any adverse feature of past history and habit or existence of any other complaint/complication and that the panel doctor had examined DLA personally in private and recorded true findings in his own hand on the eve of proposing for life insurance. That the OPs No.1 & 2 after scrutiny and verifying particulars of respective proposal form, medical examination and special additional medical reports on requisite prescribed forms also obtained Agent’s Confidential Report/Moral Hazard Report from securing agent and Development Officer and after fully satisfying as to health and habits, physical condition and insurability and age of the DLA evaluated and underwritten proposal with Proposal Review Prescribed from for acceptance of risk of policy at Serial No.3 for reduced of sum assured of Rs.20,00,000/- fully described in foregoing paras of the complaint. On other hands, two policies at Serial No.1 and 2 were accepted by OP No.2 though of Policy No.133413170 for Rs.25,00,000/- Sum Assured in Sr.1 processed and accepted was beyond the authority and power, competence, and jurisdiction of OP No.2 explained elaborately in foregoing para of the complaint. It is significant and important to mention here that consent for reduced sum assured and imposition of extra premium was not over taken from DLA. That DLA had healthy existence and normal health profile, led simple active healthy life by participating in day to day activities in tedious hard work of farming of land as agriculturist by occupation throughout his span of life, DLA was not harboring and laboring under any disease or sickness when DLA opted for life insurance single policy of his life DLA was insurance minded fully conscious to the needs for life insurance risk and saving. That to misfortune and ill luck of the complainant, DLA expired on 26.08.2014 premature. The cause of death was sudden heart attack. DLA had no prior medical treatment at any time before submitting the proposal form for life insurance. The death was natural. It was GOD’s Will. That subsequent to death of DLA, the complainant lodged claim by death for paying claim amount of Sum Assured with Bonus accrued thereon and other benefits flowing from the policy with OP No.2 Policy Serving Branch. That claim by death so preferred has been repudiated by composite letter vide letter Ref. Claims/Repd.No.152/61/61/63 dated 28.02.2017 conveyed by registered post by OP No.1 could not legally repudiated by single letter though each policy was separate and independent individual contract of life insurance between DLA and OPs. The repudiation of liability is not legally sustainable on this score alone. The claim had been repudiated after expiry of statutory period of two years from the date life insurance policy was “effected”. The repudiation of liability of policy subject matter of complaint is vitiated and void and not binding on the complainant in any manner. On this ground alone repudiation of claim of Life Insurance Policy is not sustainable. The complainant made application under 6(1) of RTI Act, 2005 to OP No.5, but discloseable information and particularly office note and recommendation of CRM Standing Committee was declined. The complainant also preferred and appeal to First Appellate Authority under Section 19(1) of RTI Act, 2005 and the same was rejected. Now the complainant is intending to file Second Appeal to Central Information Commission Apex body under RTI Act, 2005. That OP No.5 has not adhered to the provisions of RTI ACT, 2005 and the precedent of law settled therein and refused access to discloseable information and documents and consciously gave incomplete, misleading information rather dozed the complainant in order to cover up lapse and laxity, inaction of other OPs to suppress truth under mat. It was obligatory and mandatory on OP No.2 to lodge FIR with Policy Authorities and supply code of FIR in respect of alleged untraced or missing original basic records and also failed provide complete and truthful information as to the efforts made to trace out the missing record of policies, besides basis to repudiate policies purely on guess and fiction. The repudiation of liability of Death Claim was not germane to the facts prior to the date of proposal form. The averments mentioned in letter of repudiation are founded on baseless presumption and conjectures rather than facts. The OPs is guilty of deficiency in rendering service, negligent and resorting to unfair trade practice as envisaged under the provisions of the Act and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to pay death claim of the policy No.133413341 subject matter of complaint for Rs.5,00,000/- total sum assured with vested Bonus as per terms and conditions of the policy with interest @ 12% per annum on claim amount from the date of death upto the date of actual payment to the complainant. Further OPs be directed to pay Rs.2,00,000/- as compensation for causing mental tension, pain, agony and  harassment to the complainant and Rs.10,000/- as litigation expenses.

2.                Notice of the complaint was given to the OPs and accordingly, OPs No.1 to 5 filed joint written reply and contested the complaint by taking preliminary objections that no ground is made out for allowing this complaint, so on this score alone, this complaint is liable to be dismissed with costs. That no cause of action has accrued to the complainant to file the present complaint and as such, the same is liable to be dismissed with special and compensatory costs. That the complainant has got no locus-standi to file the present complaint and the same is liable to be dismissed with special and compensatory costs. That the present complaint is liable to be dismissed with special and compensatory costs as the same is false, frivolous and vexatious to the knowledge of the complainant and she has suppressed the material facts from this Commission while filing the present complaint, so on this score also, this complaint is liable to be dismissed with special and compensatory costs. It is further averred that the present complaint is barred by limitation, so on this score also, the same is liable to be dismissed with costs. That the brief facts of the case, which would facilitate this Commission to dismiss the present complaint are that the Policy bearing No.133413341 was taken in the name of Amarjit Singh for a sum assured of Rs.5,00,000/- and the same was commenced on 28.10.2011 with the Table Term 179-16 and the mode of payment of premium was half yearly and the duration of the policy was 2 years 8 months and 26 days, the FUP was 10/2014. The installment premium of the policy was Rs.14,599/- and the age at the entry, of the life assured was 38 years. As per the facts which have been mentioned, are that Amarjit Singh, Life Assured has died on 26.08.2014. After due enquiry, the death claim of in respect of the Life Assured has been repudiated by the competent authority on 28.02.2017 on the grounds that the life assured Amarjit Singh obtained the above three policies by not disclosing the simultaneous or previous proposals, the proponement submitted a letter dated 30.11.2011 stating that his Sum Assured be reduced from Rs.25,00,000/- to Rs.20,00,000/- for Proposal under policy No.133413355. But he simultaneously obtained another policy no.133413341 which was completed on 30.11.2011 for 5 lacs through a separate proposal without disclosing the previous insurance. It is further submitted that the order was duly communicated to the complainant Lovepreet Singh with an opportunity to him to file representation in case, he is not satisfied within 3 months for review of the said claim alongwith all supporting documents to the Zonal Office. This claim was repudiated by Sr. Divisional Manager. Thereafter, the complainant Lovepreet Singh had filed an appeal against the said repudiation before the ZODRC and the said appeal was also disposed off by the committee constituted of a retired judge of Hon’ble High Court on 16.09.2017 whereby the repudiation of the claim was upheld and this fact was duly informed to the complainant and even after the decision of the said appeal, this false complaint has been filed which is liable to be dismissed. So, as per the detailed facts given herein above, the present complaint is liable to be dismissed with special and compensatory costs. It is further averred that there is no deficiency in service nor there is any ground for allowing this complaint, hence on this score also, this complaint is liable to be dismissed. On merits, the factum with regard to taking policy in the name of Amarjit Singh for a sum assured of Rs.5,00,000/- is admitted, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.

3.                OP No.6 filed its separate written reply and contested the complaint by stating that the complaint filed by the complainant is not maintainable. That the OP No.6 is an agent of OP No.2. That the OP No.6 is not defaulter in this case. That all the required formalities were completed while making the insurance of deceased complainant Amarjeet Singh S/o Dalip Singh. That the OPs No.1 and 2 are liable to give the claim and responsible to give claim. That the OP No.6 works under the development officer Mukesh Anand/OP No.2. That the name of the OP No.6 has been involved in this case without any reason and cause and lastly submitted that the name of OP No.6 may kindly be deleted/withdrawn from this case.

4.                In order to prove his case, the complainant himself tendered into evidence his duly sworn affidavit Ex.CA alongwith some documents Ex.C-1 to Ex.C-6 and closed his evidence.

5.                In order to rebut the evidence of the complainant, the counsel for the OPs No.1 to 5 tendered into evidence affidavit Ex.OPA alongwith some documents Ex.OP-1 to Ex.OP-12 and closed the evidence.

6.                No affidavit as well as evidence has been tendered by the OP No.6.

7.                We have heard the learned counsel for the respective parties and have also gone through the case file as well as written arguments submitted by counsel for the complainant, very minutely.

8.                It is proved on the record that the father of the complainant was having three life insurance policies issued by LIC’s New Bima Gold Plan, Table No.179 for term 16 years and the detail of the policies is as under:-                

                   The allegations of the complainant are that these policies were obtained through OP No.6 and the signatures of DLA were obtained on blank printed prescribed proposal form No.300 on a single proposal form, but OP No.6 in connivance with her development officer bifurcated the policy in multiple policies and diverted the amount of Rs.50,00,000/- in three policies. The present complaint has been filed by the complainant regarding the policy bearing No.133413341 for Rs.5,00,000/-. The three policies have been proved on record as Ex.OP1, Ex.OP2 and Ex.OP3. It has been proved that the DLA expired on 26.08.2014 due to sudden heart attack. The complainant lodged the claim with the OPs. The complainant has proved on record the intimation to the OPs regarding the death of DLA Ex.C-1, Statement of Claimant Ex.C-2, Certificate of Identity and Burial or Cremation Ex.C-3 and the repudiation of the claim has been proved as Ex.C-6. The claim of the claimant has been repudiated on the ground that he has suppressed the material facts of the previous proposals and policies for total sum of Rs.50,00,000/-. He had moved an application to obtain information under RTI Act, which has been proved as Ex.C-4. The Senior Divisional Manager, vide Ex.C-5 gave the time to the complainant to move application or representation for review of their claim alongwith supporting documents to Zonal Manager within three months. The Zonal Manager also disposed of the appeal filed by the complainant and upheld the repudiation of the claim.

9.                The contention of the OPs is that the complaint is not maintainable being barred by limitation. It has further been argued by the Learned Counsel for the OPs that the complainant has not disclosed about the previous policies, therefore the claim was rightly repudiated. It has further been submitted by him that the present complaint cannot be proceeded with as the matter is pending before the Hon’ble Supreme Court.

10.              So far as the contention of the OPs regarding the complaint being barred by limitation is concerned, the same is not tenable. As per the record, the complainant filed claim before the OPs after the death of the DLA. The claim was repudiated by the Senior Manager on 28.02.2017 as per Ex.C-6. The appeal of the complainant was also declined by the Zonal Manager and the Committee on 16.09.2017 as per Ex.OP-10 and the intimation was sent to the complainant regarding the repudiation of the claim, vide letter Ex.OP-11 on 28.09.2017 and thereafter, the complainant filed the present complaint on 13.12.2017 before the Commission. It is proved that the claim of the complainant was rejected on 28.09.2017 and the complainant filed the present complaint on 13.12.2017, which is well within the limitation.

11.              The next contention of the OPs is that the complainant has not disclosed about his previous policies, therefore, his claim has rightly been rejected, but this contention is not tenable. As per the policies filed on record by the OPs, the complainant obtained three policies bearing No.133413341 i.e. the present policy and the other two policies under the Nos.133413355 and 133413170. Perusal of Ex.OP-1 to Ex.OP-3 shows that the present policy no.133413341 is of Rs.5,00,000/-, which is Ex.OP-1 and the policy no.133413355 is of Rs.20,00,000/- as per Ex.OP-2 and the third policy no.133413170 is of Rs.25,00,000/- as per Ex.OP-3. As per Ex.OP-1 to Ex.OP-3, the date of commencement of the policy was 28.10.2011, date of commencement of risk 30.11.2011 and date of proposal was 16.11.2011 and in the second policy Ex.OP-2 the date of commencement of the policy was 28.10.2011, date of commencement of risk 30.11.2011 and date of proposal was 16.11.2011. Similarly, in the third policy Ex.OP-3 the date of commencement of the policy was 28.11.2011, date of commencement of risk 29.11.2011 and date of proposal was 29.11.2011. The number of the agency code mentioned on all the three policies is 152 which shows that the policies were issued by the same agent and the agent was of LIC New Bima Gold as per Ex.OP-1 to Ex.OP-3 and the date of proposal on Ex.OP-1 and Ex.OP-2 is the same and date of commencement of policy and commencement of risk on both these policies is also same, whereas the third policy regarding number 133413170 was issued later on. It cannot be presumed that an agent who has been authorized by the DLA to invest Rs.50,00,000/- in the LIC policy and the authorized person, who is investing the money of DLA by bifurcating the same in three policies would not be knowing about the previous policies. In the present days of digital system everything can be found in the computer by mentioning the name of the insured. It was the duty of the agent to inform and to bring this fact to the notice of the OPs regarding the policies issued by him in favour of the DLA as he was the agent of all the three policies. But the OPs have wrongly repudiated the claim on the ground of non-disclosure of previous proposals. As per Ex.OP-10, it has been mentioned that the claim was rejected only on the ground of non-disclosure of the previous policy, but it has also been admitted by the Zonal Manager that the agent and Divisional Officer are the same, but it has been alleged that the two policies were completed at branch level due to non-disclosure of previous simultaneous proposal, but this observation of the Zonal Manager is wrong as they cannot take the ground that there was non-disclosure on the part of the complainant as the Divisional Officer and agent are of their company and the proposals were completed in the office of LIC may it be at branch level or the divisional level. The entire data was with them. The agent could have refused at the time of issuing the policies that three policies cannot be issued simultaneously. Therefore, the contention of the Ld. Counsel for the OPs is not tenable.

12.              The next contention of the Ld. Counsel for the OPs is that the complaint cannot be proceeded with as the matter is pending before the Hon’ble Supreme Court. This contention is also not tenable as the complainant has filed complaint regarding two claims i.e. Policy No.133413355 and 133413170 before the Hon’ble State Consumer Disputes Redressal Commission, which was allowed by the Hon’ble Commission, vide Order dated 27.05.2021. The present complaint has been filed regarding the policy 133413341, which is the third policy of Rs.5,00,000/- and is different policy. No claim has been filed by the complainant before the Hon’ble State Commission regarding this policy number. There is no stay order of the Hon’ble Supreme Court, not to proceed with the claim of third policy no.133413341, which is not subject matter of the matter pending before the Hon’ble Supreme Court. Therefore this contention is not tenable.

13.              So, from all the above observations, we come to conclusion that the complainant is entitled for the relief as claimed and the complaint of the complainant is partly allowed and OPs are directed to pay Rs.5,00,000/- as sum assured amount of Policy No.133413341, with the benefits, as per policy terms and conditions alongwith 7% interest from the date of filing of the complaint i.e. 13.12.2017 till realization. Further, OPs are directed to pay Rs.10,000/- as compensation on account of mental agony and harassment and Rs.5000/- as litigation expenses. The entire compliance be made within 45 days from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.

14.               Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

Dated                             Jaswant Singh Dhillon                    Dr. Harveen Bhardwaj     

18.04.2022                     Member                                 President