Punjab

Moga

CC/17/45

Prem Singh - Complainant(s)

Versus

Managing Director of Exide Life Ins. Co. Ltd - Opp.Party(s)

Sh. Vishal Jain

11 Oct 2017

ORDER

THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA.

 

 

                                                                                      CC No. 45 of 2017

                                                                                      Instituted on: 08.05.2017

                                                                                      Decided on: 11.10.2017

 

Prem Singh s/o Uttam Singh, aged 37 years r/o village Attu Wala Uttar, Tehsil Guruharsahai, District Ferozepur.

                                                                                ……… Complainant

 

Versus

1.       Managing Director of Exide Life Insurance Company Limited (Formerly known as ING Vyasa Life Insurance Company Limited), Building no.1267-68 & 69, Akalsar Road Chownk, Above OBC Bank, G.T. Road, Near Petrol Pump, Moga.

 

2.       Exide Life Insurance Company Limited through its Managing Director having registered office at 3^rd Floor, J.P. Techno Park no.3/1, Millers Road, Banglore-560001.

 

                                                                           ……….. Opposite Parties

 

 

Complaint U/s 12 of the Consumer Protection Act, 1986.

 

 

Quorum:    Sh. Ajit Aggarwal,  President

                   Smt. Bhupinder Kaur, Member

 

Present:       Sh. Vishal Jain, Advocate Cl. for complainant.

                   Sh. Lovelesh Gupta, Advocate Cl. for opposite parties.

 

 

ORDER :

(Per Ajit Aggarwal,  President)

 

1.                Complainant has filed the instant complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as the "Act") against Managing Director of Exide Life Insurance Company Limited (Formerly known as ING Vyasa Life Insurance Company Limited), Building no.1267-68 & 69, Akalsar Road Chownk, Above OBC Bank, G.T. Road, Near Petrol Pump, Moga and others (hereinafter referred to as the opposite parties) directing them to release the insured amount of the deceased/life assured with interest @ 18% p.a. from the date of death of life assured. Further they may be directed to pay Rs.25,000/- as award exemplary costs and damages on account of mental and physical harassment and to grant any other relief which this Forum may deem and fit in the facts and circumstances of the present case to complainant.

2.                Briefly stated the facts of the case are that in the year, 2014, the agent of opposite party approached mother of the complainant and allured her to purchase their insurance policy and being allured by agent of the opposite parties, mother of the complainant namely Hukma Bai purchased life insurance policy from opposite parties and deposited requisite premium being first insurance premium for a sum assured of Rs.2,10,379/- for the aforesaid life insurance policy and accordingly the opposite parties issued only receipt on proposal no.02946188 and the premium was payable annually, but no terms and conditions ever issued to the complainant or his mother. In the said insurance policy the complainant was appointed as nominee by her mother. Unfortunately, the mother of the complainant died a natural death on 07.01.2015 and thereafter, intimation regarding the death of the Life Assured was given to opposite parties and thereafter the complainant being nominee in the said insurance policy lodged an insurance claim of Rs.2,10,379/- and submitted all the original documents required by the opposite party for settlement of aforesaid lawful claim of the complainant and officials of the opposite parties assured the complainant that his claim shall be settled at the earliest. The factum of the said death was duly registered with the Registrar Births & Death, Punjab. The opposite parties also appointed investigator regarding the aforesaid insurance claim of the complainant and investigator of the opposite parties approached the complainant and took photocopies of some documents and also got signatures of the complainant on some blank papers and some blank printed forms and conveyed the complainant that his claim shall be paid shortly, but opposite parties failed to make any payment of claim to complainant. The complainant kept contacting the office of the opposite parties to know the status of the claim on account of death of his mother, but the complainant has been given nothing besides false assurances that his case is under process and he shall have the insurance amount released soon. After that besides to pay the genuine claim of the complainant under the policy, the opposite parties sent a rejection letter dated 04.04.2016 submitting that the life assured misrepresented about her age at the time of purchasing the policy. Complainant alleged that the life assured was not well educated lady, so entire proposal filled by the agent of opposite parties by its own handwriting. Complainant alleged that opposite parties only sent repudiation letter, but not sent the investigator's report. Due to repudiation of lawful claim and due to non providing of investigation report, the opposite parties has played hide and seek method. After receipt of aforesaid repudiation letter, the complainant approached many a time with the request to withdraw repudiation letter and to make the payment of the insurance claim of the complainant, but to no effect, rather they flatly refused to do the same. Due to the aforesaid act of the opposite parties, the complainant has suffered mental tension, agony and harassment. Hence this complainant.

3.                Upon notice, opposite parties appeared through counsel and filed written reply taking certain preliminary objections that the present complaint is not maintainable either on legal grounds or on factual basis. The complainant is guilty of suppressing material and pertinent facts relevant for the adjudication of the present complaint apart from filing a vexatious and frivolous complaint; that the present complaint is false, malicious and incorrect and is filed with mala-fide intention. It is nothing but the abuse of the process of law and it is an attempt to waste the precious time of this Forum, as the same has been filed by the complainant just to avail undue advantage. The complaint thus liable to be dismissed under section 26 of The Consumer Protection Act. Further submitted that Smt. Hukma Bai (in short 'Life Assured' LA), mother of the complainant submitted a proposal form dated 5.7.2014 with opposite party company opting for life insurance product named Exide Life Nirmal Jeevan Insurance Plan. The premium opted by the life assured was Rs.12,526/- to be paid annually for a premium paying term of 15 years for a sum assured of Rs.2,10,379/- with maturity date being 05.07.2029. Based on the information and declarations provided by the life assured in the proposal form opposite parties in good faith and with utmost trust issued insurance policy no.02973623 in the name of life assured with details i) date of policy commencement 5.7.2014, date of risk commencement-5.7.2014, date of policy maturity-5.7.2029 alongwith covering letter dated 14.07.2014. As per regulation 6(2) of (Protection of Policyholder's Interest) Regulation 2002 issued by the IRDAI, the policyholder/proposer is at liberty to review the terms and conditions of the policy and has the option to cancel the policy by stating the reason for his/her objection within 15 days of receipt of policy bond(free look period) and these facts were clearly intimated in the welcome letters, which were issued to complainant alongwith the policy schedule and terms and conditions. However life assured had never sought for cancellation of both policies within free look period. Hence, it is presumed that life assured is duly satisfied with the policies terms and conditions which were issued to him and the contract is concluded. Further life assured in the proposal form has declared that her date of birth as 01.01.1962. Life assured produced Ration card as documentary evidence to substantiate her declaration on DOB, opposite parties trusting that the details furnished by the life assured in the proposal form would be true and correct issued in good faith the concerned insurance policy. In this regard, it is pertinent to note that as per terms of the policy "the age of the LA has been admitted on the basis of the declaration made by the LA in the Proposal Form and/or in any statement based on which this policy has been issued". The opposite parties received the death claim intimation from the complainant informing that the life assured has died on 07.01.2015. As death of the life assured has taken place within a period of 6 months from the date of policy, internal investigation was conducted as per the routine business practice of the opposite parties. During the investigation it was revealed that the life assured has suppressed her actual age in the proposal form and produced false and fake Ration Card to prove her age. During investigation, it was revealed that the Voter list 2016 life assured is 70 years old at the time of proposal, her husband is 88 years old and her son is 55 years old. From the PAN card produced by the complainant as an alternative proof for the age of life assured reveals that the date of PAN card is 22.01.2015. Thus, it is clearly evident that the PAN card was made by the nominee/claimant after the date (7.1.2015) of death of life assured just to misguide the opposite parties with malafide and fraudulent intention of getting the death benefit under the policy. It is submitted that Ration card produced by the life assured is not genuine document and the life assured has produced forged/fabricated fraudulent Ration card to prove her age intentionally to get the death benefit (sum assured) of the policy to the nominee her son (complainant herein). The very fact of early death of life assured within 6 months of the policy corroborated the same and life assured was aware that she may not live long and as such to get the insurance policy in her name has resorted to creation of fraudulent and fabricated Ration Card. The very fact of death of life assured has taken place within 6 months from the date of the policy also raises suspicion on the claim. It is submitted that section 45 of the Insurance Act, 1938 stated that "No policy of life insurance shall, after the expiry of three years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the Proposal for insurance or in any report of medical office, or referee, or friend of the insured, or in any document leading to the issue of the policy, was inaccurate or false". Also further clause 5.4 of the policy term states that " the age of the LA has been admitted on the basis of the declaration made by the LA in the Proposal Form and/or in any statement based on which this policy has been issued". This, it is evident from the above that opposite parties is legally entitled to repudiate the death claim under the policy on the grounds of suppression of information of Age as the Policy due to suppression of information on real age would become void from the date of commencement itself. Opposite parties rightly as per terms and conditions of the policy repudiated the claim of the complainant vide letter dated 4.4.2016. The complainant in spite of receiving the repudiation letter from the opposite parties, which is based on sound principles of law and contract, with regard to above death claim, has filed the case before this Forum on frivolous and baseless grounds which cannot be tenable in the eyes of law. The complainant thus wants to wriggle out of the terms and conditions of a concluded contract has intentionally twisted the fact to the core and is trying to misrepresent before the Forum by alleging deficiency of service and unfair trade practices. The opposite parties have either never committed any deficiency of service nor adopted any unfair trade practice while dealing with the complainant.

                   In Parawise Reply all other allegations made in the complaint have been denied and a prayer for dismissal of the complaint with cost has been made.

4.                In order to prove the case, complainant tendered in evidence his duly sworn affidavit as Ex. C-1 and copies of documents Ex.C-2 and Ex.C-5 and closed the evidence. 

5.                On the other hand, opposite party tendered in evidence copies of documents Ex.OPs-1 to Ex.OPs-17 and duly sworn affidavit of Sh.Bharadwaj, Assistant Manager, Exide Life Insurance Company Limited as Ex.OPs-18 and closed the evidence.

6.                We have heard ld. counsel for the parties and have very carefully gone through record placed on file.

7.                The case of the complainant is that in the year, 2014 agent of opposite parties approached to the mother of the complainant and allured her for the purchase of insurance policy. On the allurement of agent of opposite parties mother of the complainant namely Hukma Devi purchased the life insurance policy from the opposite parties and deposited requisite premium for a sum assured of Rs.2,10,379/-. The opposite parties duly issued receipt regarding the payment of premium. The premium was payable annually. However no term and condition was ever issued to the complainant or his mother. In the said insurance policy the complainant was appointed as nominee. Unfortunately, the mother of the complainant died a natural death on 07.01.2015 and the complainant duly intimated the opposite parties regarding the death of the Life Assured and lodged the claim with opposite parties being nominee in the said insurance policy and submitted all the documents required by opposite parties for settlement of the claim. On submission of claim opposite parties appointed investigator regarding the insurance claim of the complainant. The said investigator approached to complainant and took photocopies of some documents and also got signatures of the complainant on some blank papers and forms and conveyed to complainant that his claim shall be paid shortly, but opposite parties failed to make any payment of claim to complainant. The complainant kept contacting the office of the opposite parties to know the status of the claim, but the complainant has been given false assurances that the claim is under process and will be released shortly. Rather to pay the claim of the complainant the opposite parties sent a rejections letter dated 04.04.2016 submitting that the life assured misrepresented about her age at the time of purchasing of policy. The complainant submitted that he or his mother never misrepresented regarding the age of life insured, rather they declared all the real facts and further more the proposal form was filled by the agent of opposite parties in his handwriting. The complainant requested to opposite parties to admit his genuine claim, but he failed to do so, which amounts to deficiency in service and trade mal practice on the part of opposite parties.

8.                On the other hand, ld. counsel for opposite parties argued that the complainant has filed the present complaint on false and frivolous grounds. The complainant is guilty of suppressing material facts and true facts from this Forum. He filed the present complaint only to get undue advantages. He argued that Smt. Hukma Devi mother of the complainant submitted a proposal form dated 5.7.2014 with opposite party for the purchase of life insurance policy and opted for the premium Rs.12,526/- to be paid annually for a premium paying term of 15 years for a sum assured of Rs.2,10,379/- with policy commencing date 05.07.2014 and date of maturity 05.07.2029. The opposite parties issued the policy in question in good faith and with utmost trust and based on information and declaration provided by the life insured in the proposal form declared that her date of birth as 01.01.1962 and produced Ration card as documentary evidence regarding her date of birth. The opposite parties trusting the details furnished by the life assured in the proposal issued the policy in question. As per terms of the policy age of the life assured is admitted on the basis of the declaration made by the life assured in the Proposal Form and/or in any statement based on which policy has been issued. The opposite parties received the death claim intimation from the complainant informing that the life assured has died on 07.01.2015. As death of the life assured has taken place within a period of 6 months from the date of policy, internal investigation was conducted as per the routine business practice of the opposite parties. During the investigation it was revealed that the life assured has suppressed her actual age in the proposal form and produced false and fake Ration Card to prove her age. During investigation, it was revealed that as per the Voter list 2016 life assured was 70 years old at the time of proposal and her husband was 88 years old. So, it is clear that ration card produced by the complainant is not a genuine document and she had produced forged, fabricated ration card to prove her age intentionally to get the death benefits under the policy. As per terms and conditions of the policy, the opposite parties are legally entitled to repudiate the death claim under the policy on the grounds of suppression of information regarding age as the policy due to suppression of information on real age would become void from the date of commencement itself. As such, opposite parties have rightly repudiated the claim of the complainant vide their letter dated 04.04.2016 based on the sound principles of law and contract. There is no deficiency in service and trade mal practice on the part of opposite parties. The complainant has filed this false, frivolous and baseless complaint against opposite parties, which deserves dismissal.

9.                We have thoroughly gone through the file, evidence and arguments lead by both the parties. Ld. counsel for the complainant submitted that the complainant or his mother never suppressed or concealed any fact regarding the age of the life assured at the time of purchase of policy and they stated all the facts at the time of purchase of policy. As there is no standard birth certificate issued by Death and Birth Department or educational certificate to prove the date of birth of deceased Hukma Devi, so in support of the age proof they produced ration card as non standard proof of date of birth, which was duly issued by the Government Authorities. The mother of the complainant was not well educated lady and the entire proposal form was filled by the agent of the opposite parties itself and verified all the documents personally. Moreover, as per Advisor's Confidential Report, agent of the opposite parties under the heading General Health details as observed/informed/enquired by you under query Does the LA look older than the age stated and/or obese by visible means? The advisor mark the box 'NO'. This report is duly verified by Sales Manager and Customer Service Executive of the opposite parties, copy of the Advisor's Confidential Report is Ex.OPs-3 produced by the opposite parties themselves. Meaning thereby that the officials of the opposite parties themselves physically verified the age of life assured. Further as the life assured has no standard age proof and documents and she submitted non standard age proof/document. The opposite parties charged extra age premium from the life assured for issuance of policy in question, they got the consent for age extra premium from life assured and charged extra premium at the rate of Rs.2.50 per thousand sum assured, copy of the said document is Ex.OPs-5 produced by the opposite parties themselves. The ration card and voter list is not a standard proof of age and these documents are prepared only for the convenience to get ration under PDS and to cast voter in elections. Moreover the opposite parties relied upon the voter list for the year 2016 for rejection of the claim of the complainant, whereas life assured Hukma Devi died on 07.01.2015 i.e. very much prior to the prepration of voter list for the year 2016, then how can it be presumed that the age of the life assured is correctly mentioned in that voter list when legally her name cannot be enrolled in the voter list of 2016 as she already died in January, 2015. How the opposite parties can rely upon this voters list. Ld. counsel for the complainant put reliance on the citation II (2014) CPJ 20A (CN) titled as Reliance Insurance Vs. B. Kotiratnam, where Hon'ble Andra Pardesh State Commission after relying upon the judgement titled as Life Insurance Corporation of India Vs Smt. Asha Devi 1996 (2) CPR 103, opined that the age mentioned in the ration card or hospital bed ticket could not be taken as admissions of insured with regard to his/her age. There could not have been any basis for the enumerators to note the age as mentioned in the voter's identity card. Sometimes inmates or villagers may give age without knowing the exact age so the age mentioned in the voter's identity card cannot be decisive. It is only a tentative age in order to show that she had attained the age in order to exercise her franchise. However, it could not be as record showing her age. There is no law that voter identity card is final or authenticated. Therefore, the age mentioned in the voter card was not final.

10.              He further put reliance on the judgement passed by our Hon'ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh in first appear no.729 of 2016 titled as Mrs. Manju Sharma Vs SBI Life Insurance Company Ltd. decided on 19.05.2017, where our Hon'ble State Commission held that whereas the opposite parties have relied upon the voter list, which is not an authenticated piece of evidence to prove the age of the person. No other document has been placed on record that on the date of getting the policy, the DLA was more than 65 years of age and was incompetent to get the policy.

11.               After going through the above discussion and case law produced by the complainant, we are of the opinion that opposite parties wrongly and illegally repudiated the claim of the complainant on false grounds of misrepresentation of the age, which amounts to deficiency in service and trade mal practice on the part of opposite parties. Hence the present complaint stands allowed and opposite parties are directed to pay the insurance claim regarding the death of Smt. Hukma Devi mother of the complainant to the tune of Rs.2,10,379/- i.e. sum assured with interest @ 9% per annum from 04.04.2016, when they repudiated the claim of the complainant till realization. Further opposite parties are directed to pay Rs.5000/-(Five thousand only) as compensation on account of mental tension, agony and harassment suffered by the complainant and to pay Rs.3000/-(Three thousand only) as litigation expenses to the complainant. Compliance of the order be made within 30 days of the receipt of the copy of this order, failing which, the complainant shall be entitled to initiate proceedings under section 25 & 27 of the Consumer Protection Act. Copy of the order be supplied to the parties, free of costs. File be consigned to record room.

Announced in Open Forum

Dated: 11.10.2017

                                                (Bhupinder Kaur)                    (Ajit Aggarwal)

                                                      Member                                 President