Haryana

Kaithal

62/21

Krishna Etc - Complainant(s)

Versus

Max Life Insurance Co. - Opp.Party(s)

Sh.Anurag Gupta

19 Feb 2024

ORDER

                  

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KAITHAL

 

                                                               Complaint Case No. 62 of 2021.

                                                               Date of institution:   10.03.2021.

                                                               Date of decision:      19.02.2024.

 

1. Krishna wd/o Ghanshyam,
2. Sona w/o Shri Ravi Dutt,
3. Ritu d/o Ghansham,
4. Ankit s/o Shri Ghansham,
5. Amit (minor) s/o Shri Ghansham, through his mother Krishna being his next friend, all residents of village Pilni, Tehsil Pundri, District Kaithal.

 

                                                                                      …Complainants.

                                                   Versus

 

Max Life Insurance, Branch Office Co. Ltd., through its Branch Manager, SCO 7 & 8, Sector-17, Kurukshetra.

...Opposite Party

 

          Complaint under Section 35 of the Consumer Protection Act

 

 

CORAM:   SMT. NEELAM KASHYAP, PRESIDENT.

                   SMT. SUMAN RANA, MEMBER.

                   SHRI SUNIL MOHAN TRIKHA, MEMBER.

                  

Present:       Shri J.B. Sharma, Advocate for the complainant.   

                   Shri Rajesh Kaushik, Advocate for the Opposite Party.

                  

ORDER  -  NEELAM KASHYAP, PRESIDENT:

        Complainant has filed this complaint under Section 35 of Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’), against the OPs.

2.                In the complaint, complainant alleged that Ghansham s/o Shri Ravi Dutt had purchased a life insurance policy under plan known as Max Life Future Genius Education Plan-104N094V02 dated 10.10.2018 vide policy No.520981747 from OP. That term of said policy was 15 years with maturity amount of Rs.3,79,651/-. That said Ghanshyam had suddenly died due to heart failure on 11.05.2019 at village Pilni and after his death, complainant No.1 being wife of deceased visited office of OP and requested to pay the sum insured of Rs.3,79,651/-, but they instead of paying the same, repudiated the claim vide letter dated 31.08.2019 under false ground that Ghanshyam had died due to suicide on 11.05.2019 i.e. within twelve months from the date of insurance policy. The above act of OP of illegal repudiation of their claim, amounts to gross deficiency in service, on its part, due to which, they suffered huge physical harassment, mental agony as well as financial loss, constraining them, to file the present complaint, against the OP, before this Commission.

3.             Upon notice of complaint, OP appeared before this Commission and filed written statement stating therein that Shri Ghanshyam had died on 11.05.2019 and thereafter, the complainants lodged the death claim with OP and during the process of evaluation of the claim, OP came to know that said Ghanshyam died due to suicide on 11.05.2019, which is within one year from the policy issue date. There is a basic condition in the insurance policy:

“5”    Suicide Exclusion

5.1     Notwithstanding anything stated herein, if the Life Insured dies due to suicide, whether sane or insane, within 12 (twelve) months from the date of commencement of Risk or from the date of revival of this policy, then this policy will terminate and we shall only pay the following to the claimants:-

5.1.1  Higher of the Surrender Value or total premium received by us, if the policy was acquired a Surrender value; or

5.1.2  Total premium received by us, if the policy has not acquired a Surrender Value”.

                   Rukka regarding consuming poisonous substance was sent by the doctors concerned to the policy on the basis of which GD Request No.11 was registered in the Police Station Pundri on 11.05.2019. Due to the suicide exclusion, the death claim lodged by complainant, which was repudiated vide letter dated 31.08.2019 and premium of Rs.30,000/- was refunded into the bank account No.3285000107102838 against said policy on 21.08.2019. So, there is no deficiency in service, on the part of OP and prayed for dismissal the present complaint.

4.                To prove the case, complainant tendered into evidence affidavit Ex.CW1/A alongwith documents Annexure-C1 to Annexure-C3.

5.                On the other hand, OP in its evidence tendered affidavit Ex.RW1/A and documents Annexure R-1 to Annexure R-10.

6.                We have heard the learned counsel for the parties and perused the record carefully.

7.                Learned counsel for the complainant has argued that Ghanshyam s/o Shri Ravi Dutt had purchased a life insurance policy from OP with maturity amount of Rs.3,79,651/-. He further argued that said Ghanshyam had suddenly died, due to heart failure on 11.05.2019 at village Pilni and after his death, complainant No.1 being wife of deceased visited office of OP and requested to pay the sum insured of Rs.3,79,651/-, but they instead of paying the same, wrongly and illegally repudiated the claim vide letter dated 31.08.2019 under false ground that said Ghanshyam has committed suicide by consuming poison. He further argued that there is no postmortem report in this regard on the case vide which it can be gathered that said Ghanshyam had consumed poison or not. He further argued that there is no inquest report or visra report on the case file. He further argued that the OP has wrongly and illegally repudiated claim of complainants, which amounts to gross deficiency in service, on its part. In order to support his contentions, he placed reliance upon case laws titled Joshinder Yadav Versus State of Bihar, Criminal Appeal No.259 of 2009, Date of Decision 20.01.2014 (SC) and Radha Mohan Singh @ Lal Saheb & Others Versus State of U.P., Criminal Appeal No.1183-1185 of 2004, Date of Decision 20.01.2006 (SC).

8.                On the other hand, learned counsel for the OP has admitted about issuance the policy in question. He argued that Shri Ghanshyam had died on 11.05.2019 and thereafter, the complainants lodged the death claim with OP and during the process of evaluation of the claim, OP came to know that said Ghanshyam died due to suicide on 11.05.2019, which is within one year from the policy issue date. He further argued that Rukka regarding consuming poisonous substance was sent by the doctors concerned to the policy on the basis of which GD Request No.11 was registered in the Police Station Pundri on 11.05.2019. He further argued that due to the suicide exclusion, the death claim lodged by complainant, which was repudiated vide letter dated 31.08.2019 and premium of Rs.30,000/- was refunded into the bank account No.3285000107102838 against said policy on 21.08.2019, so, there is no deficiency in service, on the part of OP and prayed for dismissal the present complaint. In order to support his contentions, he placed reliance upon case law titled The Chairman & Managing Director, City Union Bank Ltd & another Vs. R. Chandermohan, Civil Appeal No.7289 of 2009, DOD 27.03.2023.

9.                Admittedly, Shri Ghanshyam (since deceased) purchased a life insurance policy under plan Max Life Future Genius Education Plan-104N094V02 dated 10.10.2018 from OP with 15 years term, having Minimum Guaranteed Death Benefit of Rs.3,79,651/- as is evident from Premium Paid Certificate Annexure C-1. The policy in question has been commenced from 10.10.2018 and said Ghanshyam was died on 11.05.2019, as is clear from Death Certificate Annexure C-2 i.e. within one year of commencement of the policy in question. After his death, complainants lodged the claim with the OPs, demanding the maturity amount of Rs.3,79,651/-, who repudiated the same, vide letter dated 31.08.2019 Annexure C-3.

10.              Learned counsel for the complainants has firstly alleged that said Ghanshyam died due to heart failure, as such, the OP wrongly and illegally repudiated the claim on false grounds. Contrary to it, learned counsel for OP has contended that Ghanshyam committed suicide, by consuming poison, which is within one year from the policy issue date, hence, the OP rightly repudiated the claim of complainants as per Suicide Exclusion 5.1.

11.              After hearing learned counsel for the parties, the first moot question, before this Commission, which requires to be answered, by this Commission, is whether said Ghanshyam died due to heart failure or he committed suicide, by consuming poison.

12.              To support his above contentions, learned counsel for OP has drawn attention of this Commission towards document Annexure R-5, which is Add General Diary Details, recorded on 11.05.2019 in Police Station Pundri by ASI Suresh Kumar to the effect that a Rukka has been received in the police station through one Vinod Kumar s/o Ranjeet Singh, working as Security Guard in Guru Nanak Hospital, Pundri to the effect that one Ghanshyam s/o Ravidutt, r/o Pilni admitted in Guru Nanak Hospital, Pundri due to consuming poison, upon which, ASI Suresh Kumar 9 and EHC Ram Mehar Singh 966 went to Guru Nanak Hospital, Pundri. However, it is pertinent to mention here that neither the OP nor the complainants have produced any further record, on the case file, to show that what action has been taken, by the police of PS Pundri, on the said Rukka, for example, whether the police got conducted postmortem of said Ghanshyam or whether the police had prepared any Inquest Report under Section 174 of the Cr.PC and until the answers to these questions are not found, this Commission cannot reach to any conclusion.

13.              So, in this way, considering the totality of the allegations and material, brought on the record, by both the parties, it is crystal clear that there are intricate questions of law and facts involved that whether Ghanshyam died due to heart failure or he committed suicide, by consuming the poison, and both the parties have failed to place documentary evidence, on the file, to prove their respective version, in this regard and without which, it is not possible for this Commission to come to any conclusion. Thus, before proceeding ahead, we would like to mention that there are the intricate questions of law and facts, which require elaborate evidence, and the same is not possible in the summary proceedings, before this Commission, and Civil Court is the best platform for deciding the same. In this regard, we can rely on the case law titled “The Chairman & Managing Director, City Union Bank Ltd & another Vs. R. Chandermohan, Civil Appeal No.7289 of 2009, DOD 27.03.2023”, decided by Double Bench of Hon’ble Supreme Court of India, wherein, it is held in Para No.12 that “The proceedings before the Commission being summary in nature, the complaints involving highly disputed questions of facts or the cases involving tortious acts or criminality like fraud or cheating, could not be decided by the Commission/Commission under the said act. The deficiency in services as well settled, has to be distinguished from the criminal acts or tortious acts. There could not be any presumption with regard to the willful fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance in service, as contemplated in Section 2(1) (g) of the Act. The burden of proving the deficiency in service would always be upon the person alleging it”.

14.                          So, keeping in view the ratio of the case law, laid down by the superior Fora, referred to above as well as facts and circumstances of the present case and without commenting on the merits of the case, we dispose of the present complaint, with liberty to the complainants, to file afresh complaint, in any appropriate Court of law, as per provisions of law, and in that eventuality, complainant will be entitled to the benefit of Section 69 of Limitation under the Consumer Protection Act, 2019, and the time taken during the pendency of this complaint shall be exempted. Certified copy of this order be supplied to the complainant free of cost, as permissible under Rules. File be consigned to the records, after due compliance.

Announced in open Commission:

Dt.:19.02.2024.

                                                                                      (Neelam Kashyap)

                                                                                      President.

 

(Sunil Mohan Trikha).             (Suman Rana).              

Member.                                  Member.

 

 

 

 

 

 

Typed by: Sham Kalra, Stenographer.