JUSTICE V.K. JAIN, PRESIDING MEMBER (ORAL)

          Late Sh. Sanjay Kumar, husband of the complainant obtained an insurance policy from the appellant, the sum assured on his life being Rs.30 lacs.  A half yearly premium of Rs.7,219/- was payable on the said policy.  Thus, the monthly outgo towards the premium came to Rs.1,200/- per month.  The deceased paid insurance premiums for the period from May 2012 to May 2014.  Before the next premium was to fall due, he died on 11.10.2014.  A claim for payment in terms of the insurance policy was submitted by the complainant with the appellant.  The claim was repudiated vide letter dated 19.01.2015 which, to the extent it is relevant, reads as under:

          “As per the information procured by us during the course of claim evaluation, it has been established that the Driving License submitted by the deceased life assured as identity and age proof towards proposal of insurance dated 10 May 2012 was a fake document. 

As per Article 13 of the standard terms and conditions:

13) If you or anyone acting on your behalf or at your direction or with your knowledge makes or advances any claims under this policy knowing it to be dishonest, misleading, false, or fraudulent in any respect then this policy shall be void and any amount actually paid or potentially payable shall be forfeited. 

The submission of a fabricated document amounts to serious fraud, which is a violation of the terms and conditions of the insurance policy.  Insurance being a contract of ‘uberrimae fidae’(utmost good faith), the Policy Holder is duly bound to reveal all relevant facts to the insurer in order for the insurer to determine the Policy Holder’s eligibility for availing the insurance.”

          It would thus be seen that the claim was repudiated solely on the ground that the driving license submitted by the deceased as proof of his age and identity was a fake document and therefore, the insurer was entitled to deny the claim under Article 13 of the standard terms and conditions of the policy. 

2.      Article 13 of the standard terms and conditions, as reproduced in the repudiation letter, refer to any claim knowing the same to be dishonest, misleading, false or fraudulent.  The driving license was submitted by the deceased husband of the complainant whereas the claim was lodged by the complainant, after the death of her husband.  Since no forged document is even alleged to have been submitted by the complainant, reliance upon Article 13 of the standard terms and conditions, as reproduced in the repudiation letter dated 19.01.2015 was wholly misplaced. 

3.      The next question which arises for consideration is as to whether the appellant was entitled to repudiate the claim on the ground that the driving license submitted by the deceased insured while taking the insurance policy, was a forged document.  A perusal of the proposal form would show that the driving license was submitted as a proof of the age and identity of the proposer.  This is not the case of the appellant that the age of the insured was materially different from the age shown in the alleged fake driving license submitted by him.  This is also not the case of the insurer that the insured had submitted his driving license of some other person.  This is also not the case of the insurer that the correct name and the identity of the deceased was different from the name and identity disclosed in the proposal form.  Therefore, it cannot be said that the insured had made a false representation or concealed a material fact at the time the insurance policy was sought by him. 

4.      Though in the written version, the appellant has alleged that the insured did not have the resources to purchase the policy and was earning his livelihood as a beggar, no such ground is taken while repudiating the claim.  As held by the Hon’ble Supreme Court in ‘Galada Power and Telecommunication Limited Vs. United India Insurance Company Limited & Anr.’ (2016) 14 SCC 161, the insurer cannot be allowed to travel beyond the ground on which the claim is repudiated.  Since the claim was not repudiated on the ground that the insured did not have resources to purchase the policy and was a beggar, the said plea, when taken in the written version, cannot be considered. 

5.      The appellant has today filed an application for permission to file additional documents alongwith the affidavit of one Raju Kumar who as employed with Sharp Eagle Investigation Pvt. Ltd., to whom the claim was referred by the appellant for investigation.  The said documents were not filed before the State Commission and therefore, cannot be taken into consideration unless the application for additional affidavit is allowed.  However, for the purpose of satisfying myself, I have considered the additional documents sought to be filed by the appellants.  As per the statements purported to be recorded by the investigator, wife of the complainant told him that her husband was earning Rs.300-400/- per day, his annual income being about Rs.50,000/-.  She also stated that she was also working as a labourer.  Therefore, the combined annual income of the complainant and her husband cannot be less than Rs.1 lac per year.  As noted earlier, the monthly premium payable in respect of the policy taken by the husband of the complainant was only about Rs.1,200/-.  It is not at all difficult for a family having annual income of Rs.1 lac to pay a monthly premium of Rs.1,200/- which comes to about Rs.14,400/- per year, the said amount being less than 15% of the annual income.  Moreover, admittedly, the deceased had paid the premium regularly till the time he died.  This is also a corroborative circumstance to prove that he did have the means to pay the requisite premium. 

6.      The investigator also recorded the statement of one Gangaram who inter-alia stated that deceased Sanjay Kumar was a labourer.  Even as a labourer, he was earning about Rs.300-400/- per day as was stated by his wife to the surveyor.  Though another witness Maamchandra allegedly told the investigator that the deceased did not have any source of income, he did not say that even in May 2012 when the insurance policy was taken, the deceased was not working at all.  The statement of Sarpanch of Gram Panchayat would show that he had become handicapped about 2-3 years before his death.  This does not rule out the possibility that he may have become handicapped after taking the insurance policy in May 2012.  From a combined reading of the aforesaid statement recorded by the investigator, it cannot be said that the deceased was not in a position to pay the requisite premium in respect of the insurance policy taken by him. 

7.      For the reasons stated hereinabove, I find no ground to interfere with the order passed by the State Commission.  The appeal being devoid of any merits, is hereby dismissed.