The complainant Smt. Sushma Devi has filed this complaint petition against the Managing, Director, Sri Ram Life Insurance Company Ltd. Hyderabad and two others (o.ps) for realization of Rs. 8,42,000/- as sum assured, Rs. 1 lacs/- for physical and mental harassment and Rs. 31,000/- for litigation cost. along with 18 % p.a. interest on the total sought amount since the date of death of life assured person till the date of final payment/ realization.
The brief, facts of the case is that the complainant is wife and nominee of L.A. Subodh Kr. The further case is that L.A. Subodh Kr purchased a policy bearing no-NP14130082241 from Sri Ram Insurance Company (o.p) on 18-10-2013 for sum assured amount Rs. 3,44,000/-, by paying 1st installment of policy of Rs. 20033/-, Which was valid since 23-10-2013 to 23-10-33. He also purchased another policy bearing No. NN141400009967 from above o.p on 31-01-2014 for sum assured Rs. 5,00,000/- which was valid from 11-02-2014 to 11-02-34. The further case is that on 08-09-2014 L.A. Subodh Kumar died suddenly due to burst of appendix. The further case is that after death of L.A. the complainant filed death claim before o.p company with all relevant documents regarding death of Subodh Kumar. The further case is that the o.p company repudiated the claim of the complainant on the ground that D.L.A died prior to issuance of policy.
The complainant has filed the following documents with the complaint petition- Photocopy of First Premium Receipt of policy Nos. NN141400009967 & NP141300082241–annexure-1 & 2, photocopy of death certificate of Subodh Kumar-annexure-3, photocopy of death certificate of Subodh Kumar issued by Sarpanch annexure-4., photocopy of death certificate of Subodh Kumar issued by Mukhiya, Gram Panchayat Raj Jalalpur Gangati annexure-5, photocopy of death certificate of Subodh Kumar issued by Member Panchayat Samiti Gram Panchayat Raj Jalalpur Gangati annexure-6, and photocopy of repudiation letter annexure-7.
On issuance of notices, o.p. nos. 1 & 2 appeared and filed their w.s. on 29-02-2019 with prayer to dismiss the complaint with cost. It has been further mentioned in the w.s. that the Life assured (hereinafter referred as L.A.) during his life time had applied for the Insurance policy by submitted duly signed and filled in proposal form. Issuance of aforesaid policies without medical test is an admitted fact.
Intimation regarding the death of L.A. to the o.p company is also an admitted fact. In para-4 of the w.s., It has been mentioned that in view of the early death claim within 1 year from the date of issuance of the policy, the respondents conducted an investigation to know the veracity of the claim. After investigation, the investigator submitted his report to the respondents. On perusing the report, it was found that LA Subodh Kumar died before applying for policies i.e., on 18-10-2013 and 31-01-2014 and the polices were obtained on a dead person. It has been further mentioned in the w.s. that in the birth certificate of the deceased LA’s son, which was registered on 06-10-2013, the father (deceased LA) is shown as Late Subodh Kumar. Therefore, it manifest that the policy was taken on a dead person. The death certificate of L.A submitted is manipulated, forged and fabricated document. It has been further mentioned that considering the fact that the policy was taken in the name of deceased LA through forged and fabricated means, the respondents demanded LA’s son’s date of birth certificate from the nominee but they couldn’t give the same even after giving several opportunities to the nominee to produce the necessary document. Hence, respondent/company repudiated the claim on 30-06-2015, which is based on sound principle law. It has been further mentioned in the w.s. that L.A. disclosed/furnished false information in subsequent policy No.-NN141400009967 in respect of his occupation income. It has been further mentioned that there is no deficiency on the part of o.ps.
The complainant has Smt. Susma devi has examination her self on affidavit as AW-1. She has annexed the annexures already annexed with the complaint petition. She has also annexed the true Xerox copy of correct Birth certificate in the name of son of L.A as annexure-8.
On behalf of o.ps o.p w-1 E. Shridhar has been examined who has mentioned the annexures- ‘A to E’ in his affidavit which is as follows-
- Photocopy of proposal form as annexure/Exhibit- annexure-A.
- Photocopy of policy documents which includes first premium receipt policy Schedule & terms and Conditions annexure-B
- Photocopy of Death Intimation is annexure-C
- Photocopy of Investigation Report is annexure-D
- Photocopy of Repudiation letter dt. 30-06-2015 is annexure-E.
On behalf of o.ps, o.p, w-2 Deepak Kr. Pandey ( investigator) has also been examined who has stated in his examination -in –chief that he investigated in the death claim filed in the name of Subodh Kr. and submitted his report on 25-03-2015.
The o.ps company has repudiated the claim of the complainant on the ground that after verifying after death certificate, it came to the notice to the investigator that Subodh Kr. died before applying the policies i.e 18-10-2013 and 31-01-2014. The complainant has annexed the repudiation letter as annexure-7. whereas the same document has been annexed on behalf of o.ps as annexure-E.
The o.ps have mentioned in first line of preliminary objection and reply to the complaint which is as follows- “That the diseased Life Assured (hereinafter referred as L.A) during his life time had applied for the insurance policy by submitting duly signed and filled in proposal form.”
As per above mentioned fact it appears that the L.A was alive at the time of filing of proposal form. The o.ps have raised the fact in their w.s. that the birth certificate of diseased L.A’s son which was registered on 06-10-2013, father, the deceased L.A. is shown as late subodh Kr. The above document has not been produced on behalf of o.ps. The o.ps have examined o.p.w-2 (Investigator) on the above point who investigated the matter/the death claim and submitted his report to the o.p company. He has supported his investigation report but he has not stated that Subodh Kr. had died before filing of proposal form. He has mentioned in his report as follows- “The date of death suggested by the villager’s was tentatively in the last of July or first week of August 2013. If we believe the neighbours, the L.A. died prior to the policy and documentary evidence, is L.A’s son’s birth certificate [D.O.B., 06-10-2013]. At that time of birth L.A. was no more and his name was written as late Subodh Ram Mukhiya, Aganbari and D.C. issuing Authority all have been Managed by master mind as the case belongs to identified racket area.” The investigator has mentioned about neighbours visits in his report in support of his contention, but enquiries have not been filed on behalf of o.ps. The o.ps have not examined Mukhiya, Aganbari and D.C. who are competent authority to issue the death certificate. On the other hand, the complainant has filed death certificate of L.A. granted by competent authority on proper form as annexure-3. He has also filed the certificate granted by Sarpanch, Mukhiya and Member of Panchayat Samiti of Gram Panchyat Raj Jalalpur Gagati who have stated that Late Subodh Kr died on 08-09-2014. The above certificates have been annexed on behalf of complainant as annexure-4 to 6. Above certificate also supports the date of death as mentioned in annexure-3. The complainant AW-1 Smt. Susma Devi has also supported the above facts. The o.ps have not produced any document to show that the certificate issued by competent authority annexure-3 was cancelled by proper authority. The learned Lawyer for the complainant relied on the decision of N.C.D.R.C New Delhi observed in the case of Aegon Religare Life Insurance Company Ltd. V/s Rajendra Rai, first appeal no.-1696/2016 decided on 31-05-2018. In the above order Hon’ble National Commission has observed as follows-
“The Panchayat Secretary is the competent authority to issued death certificate in proper Performa under Panchayat Raj Act. The o.p has not produced any other death certificate in proper proforma of the L.A Randhir Kr and his elder brother Sudhir Kr. Hence the allegation of o.ps that the Insurance Policy was obtained of dead person Sri Randhir is not proved. It becomes baseless allegation.”
The o.ps have not produced any death certificate issued by proper authority to show that the D.L.A had died before issuance of policies. O.p w-1 E.Sridhar, examined on behalf of o.ps, is only formal witness. So, we find that o.ps have not able to prove their allegation and as such the ground of repudiation become baseless.
The o.ps have also mentioned in the w.s. that the L.A disclosed /furnished false information in subsequent policy No.- NN141400009967 in respect of his occupation. In the w.s, o.ps have stated that in the policy no.NP14130000082241, the occupation was mentioned as contractor/business whereas in the other policy bearing No. NN141400009967 the occupation has been mentioned as self employed/ business. So, in both proposal of policies business was common occupation. The complainant has mentioned in his complaint petition that the complainant has no understanding of English and the agent of o.ps company had filled the proposal form. The complainant has also supported the above facts in his examination-in-chief.
In the business the income may vary from time to time, so it may not be ground for repudiation.
On the basis of above discussions, we are of the considered opinion that there is deficiency on the part of the o.ps and they are liable to pay compensation.
In the circumstances the complaint petition is allowed with direction to o.ps to pay Rs. 8,42,000/- as sum assured on death with 8 % interest p.a from the date of filing of complaint petition that is on 3-04-2018, Rs. 20,000/- as physical and mental harassment and Rs. 10,000/- as litigation cost within two months from the date of order, /, on failure they shall be responsible to pay the above amount with 9 % p.a. interest till realization. Let a copy of this order be furnished to both the parties as per rule.
