BEFORE THE  DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, FATEHABAD.

Complaint no.79/2017.

Date of instt.27.03.2017. 

                                                          Date of Decision: 29.09.2017.

Hari Singh S/o Partap S/o Manphool R/o village Roopuna Ganja, Tehsil Sirsa, District Sirsa.

                                                                             ..Complainant.

                             Versus

1.Max Life Insurance Company through Axis Bank Ltd., Kumharia Servicing Branch, Ground floor, VPO Kumharia Tehsil and District Fatehabad through its Manager.

2. Max Life Insurance Company Ltd. Operation Centre, 90-A, Udhog Vihar, office at 90A, Sector -18, Gurgaon-122015 through its Manager.

..Opposite parties.

      Complaint under Section 12 of Consumer Protection Act, 1986.    

Before             Sh.Raghbir Singh, President.

                        Sh.R.S.Panghal, Member.

     Smt.Ansuya Bishnoi, Member.

Present :         Sh.Dayanand Siwach, Advocate for complainant.

                       Sh.Dinesh Gera, Advocate for OP No.1.

Sh.Vinod Godara, Advocate for OP No.2.

 ORDER

                   The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant with the averments that father of the complainant Late Sh.Partap s/o Manphool got his life insured with the OPs  insurance company vide policy No.273271577 for a sum of Rs.8,74,086/- through Axis Bank Ltd., Branch Kumharia, Distt. Fatehabad. The policy was issued on 27.11.2015 and the premium was paid by his father. It is further submitted that correct information regarding his age was given by his father in the proposal form. Therefore Late Sh.Partap Singh was the consumer of the OPs as defined in Consumer Protection Act, 1986. The complainant was the nominee of Partap Singh in the policy. However unluckily Sh.Partap Singh died on 24.08.2016 due to heart attack. The complainant gave intimation to OP No.1 regarding death of Partap Singh and completed all the formalities as per instructions of the OPs for settlement of the claim. Thereafter the complainant requested the OPs to make payment of sum assured to the complainant under said policy. It is further submitted that the claim of the complainant was repudiated by the OPs vide order dated 28.02.2017 on the ground that the deceased life assured withheld the correct information regarding his age in the proposal form filed by him for taking the insurance policy. It is further submitted that the claim of the complainant has been wrongly and illegally repudiated by the OPs as the DLA was 47 years old at the time of issuance of the policy and the same is evident from Aadhar Card and PAN-card of deceased life assured (here-in-after referred as DLA). Repudiation of the genuine claim of the complainant by the OPs amounts to deficiency in service on the part of OPs and on account of the same the complainant has suffered huge loss, mental agony and physical harassment. Hence, this complaint.

2.                On notice the OP No.1 appeared and resisted the complaint by filing a written statement. It is admitted in the written statement that OP No.1 is having business tie up with OP No.2. However the remaining, contents of the complaint have been denied for want of knowledge. It is further asserted that there is no deficiency on the part of OP No.1 in rendering service to the complainant and a prayer for dismissal of the complaint against OP No.1 has been made.

3.                The Max Life Insurance Company Ltd. i.e. OP No.2 in its written statement has asserted that the present complaint is devoid of merits, is tainted with malafides and has been filed with motive to harass the OP No.2 herein and to extort benefits and as such the same is liable to be dismissed. It is further submitted that the life assured after due deliberation and pondering over the policy submitted his duly signed proposal form to the Op No.2 and the terms and conditions of the policy were duly communicated to the DLA.

4.                It is further submitted that it is a settled proposition of law that a contract of insurance is  based on principle of utmost good faith on the part of life assured. The life assured is thus under the solemn obligation to make full disclosure of the material facts which may be relevant to insurer to take into account while deciding whether the proposal should be accepted or not. In the present case the life assured had obtained the contract of insurance by suppressing the material information regarding his age and it was a willful concealment of vital information at the proposal stage by the DLA. The DLA at the time of proposal has fraudulently concealed his correct age and misrepresented his age as 46 years in order to avail the Level Term Policy where the maximum age for entry is 55 years of age. However on investigation of the death claim by the OP No.2 herein, it was revealed that the DLA as per voter list was 55 years old as on 01.01.2011. Therefore at the time of filing of proposal form in the year 2015 the DLA was 60 years of age. Hence it is clear that the insured being aware of his correct age prior to signing and submitting proposal form and to get the policy with the malafide intention chose not to disclose the same to the OPs. It is further submitted that had the information regarding his age by DLA was given correctly in proposal form, the said policy would not have been issued by the OP No.1. Therefore the claim of the complainant has been repudiated by the OP No.2 vide order dated 28.02.2017. The order  dated 28.02.2017 is perfectly in accordance with the terms and conditions of insurance policy and sustainable in the eyes of law. There is no deficiency on the part of OP No.2 in dealing with claim of the complainant. The OP No.2 in support of its case has put reliance on the decisions rendered by Hon’ble Apex Court in Mithoolal Nayak Vs. L.I.C. of India, AIR 1962, SC, 814, P.C. Chacko Vs. Chairman L.I.C.(2008)I SCC 321, Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd.(2009)8 SCC 316, L.I.C. of India Vs. Smt. Asha Gogal (2001)2 SCC 160 and prayed for dismissal of the complaint.

5.                In evidence the complainant tendered his affidavit as PW1/A to testify the averments made in the complaint. The complainant also tendered in evidence the affidavit of Vinod Kumar Lamberdar and Randhir Singh, Member, Panchayat of village Roopun Ganja Distt. Sirsa Ex.PW2/A and PW3/A respectively wherein both deponents have stated that Sh.Partap Singh had died on account of heart attack and at that time he was 47-78 years old. The complainant also tendered documents Ex.P1 and Annexure C1 to C5 in support of his case and closed the evidence. Whereas the OP No.2 tendered the affidavit of Dhiraj Malik, Deputy Manager, Legal  as Annexure R-1 and documents Annexure R-2 to R-7 in evidence and closed the evidence.

6.                The learned counsel for the complainant in his arguments reiterated the averments incorporated in the complaint and further contended that the genuine claim of the complainant has been repudiated by the OP No.2 illegally and without any justified ground. The learned counsel further contended that the DLA in the proposal Forum has mentioned his date of birth as 10.08.1969. Date of birth as mentioned in proposal Forum is supported by PAN-Card and Aadhar Card issued by Income Tax Deptt. and Government of India respectively. Copies of the above said documents are on the file as Annexure C-4 and Annexure C-5. Annexure C-4 i.e. copy of PAN Card was handed over to the OP No.2 as age proof of DLA with the proposal forum. Therefore no material fact has been concealed by the DLA regarding his age while obtaining the insurance policy. Therefore repudiation of the claim of complainant on the ground that DLA had suppressed his correct age while obtaining the insurance policy is illegal and it amounts to deficiency on the part of OPs in rendering service to the complainant. In support of his contentions the learned counsel has relied upon the decision of Hon’ble National Commission in case titled as Life Insurance Company Vs. Gopal Singh and reported as II(2011)CPJ 7 wherein the Hon’ble National Commission held that age given in voters list cannot be taken as a sure test for determination of exact age of a person. The learned counsel also put reliance on the decision of Punjab State Commission Chandigarh in case titled as Life Insurance Company Vs. Balbir Sinhg reported as IV(2008) CPJ 326.

 7.               On the other hand the learned counsel for OP No.2 has rebutted the contentions advanced by counsel for complainant and reiterated the averments made in the written statement filed by OP No.2 and relied upon the decisions of Hon’ble Supreme Court as incorporated in the written statement of OP No.2. It is further contended that for obtaining the policy in question the maximum age limit is 55 years. Therefore the DLA who infect was 60 years old at the time of filing proposal form and to avail the above-said policy the DLA procured the PAN Card and Aadhar Card with date of birth as 10.08.1069. In fact the DLA was 60 years old on the date of filing the proposal form.  The same is evident from the voter list (enclosed with investigation report) wherein the age of DLA has been shown as 55 years as on 01.01.2011. Therefore the repudiation of the claim of the complainant by OP No.2 is perfectly in accordance with the settled proposition of law and the instant complaint is liable to be dismissed. In support of his contention the learned counsel put reliance on the case law titled as P.C.Chacko Vs. Chairman L.I.C. and reported as 2008 AIR(SC) 424, Satwant Kaur Sandhu Vs. New India Assurance Company; 2009(4) CPJ Page 8 and L.I.C. Vs. Asha Goyal, 2012(3) CPJ Page 5(SC).

8.                We have heard the rival contentions of the counsel for the parties and have perused all the documents placed on the record of the case file. It is not disputed that the OPs issued insurance policy to  DLA Partap Singh on 02.02.2016 with effective date of coverage from 27.11.2015 against guaranteed maturity sum assured of Rs.5,27,203/- and minimum amount payable on the death of life insured is also Rs.5,27,203/-. It is also evident from record that OPs charged an amount of Rs.50,002/- from DLA as premium including extra premium amount for additional benefits and service tax etc. and it is also not disputed that the DLA died during the subsistence of the policy. The OPs have repudiated the claim of the complainant on the ground that DLA suppressed his age for availing the insurance policy. The DLA was 61 years old on the date of filing of the proposal form whereas in the proposal form he filed his age as 46 years and relied upon the PAN card as proof of his age wherein his date of birth has been mentioned as 10.08.1969. It is the case of the OPs that as per voter list the DLA was 61 years old and the date of birth mentioned in the PAN Card and Aadhar Card is incorrect and PAN Card and Aadhar Card are not proper document, for ascertaining the age of a person. However, we are of the opinion that in case PAN card was not a proper document for correct age proof the OPs were at liberty to seek additional or other proper document for age proof of DLA. Moreover the voter list is not a conclusive proof of age and it cannot be preferred over Aadhar Card and PAN Card. It is also pertinent to note that the difference of age of DLA in voter list and Aadhar card is about 14-15 years. The proposal form must have been filed or submitted by the DLA before the agent or official of the OPs. If the age difference of about 15 years was falsely made by the DLA it is obvious that the proposal form has been accepted by the OPs with closed eyes or the agent or official of OP No.2 were in collusion with the DLA. An approximate age of an individual can be judged by a man of ordinary prudence. There can be error of 3-4 years but in the instant case there is difference of about 14-15 years and the same cannot be missed. It is a matter of common knowledge that in a majority of policies being issued by the Insurance Companies the same are routed through their agents. The agents in their anxiety to get their commission and the insurance companies in order to do more and more business see that the policies are issued the moment they receive the premium amount. Even the insurance companies are not aware of his status or health conditions. Here the intention is very clear that first they induce the people to purchase policies and later they start litigation. The decision rendered by the Hon’ble National Commission in case titled as Asstt. Director Vs. Basta Ram and reported as (2017)II CPJ 520(NC) is relied upon.

9.                The burden to prove that the DLA had concealed his real age is on the OPs. However, the OPs have failed to prove it by leading any cogent and convincing evidence. The only evidence produced by the OPs is voter list vide which the age of the DLA on the date of filing of proposal is 61 years. The age given in voters list cannot be taken as a sure set to determine the exact date of a person. It is a common knowledge that frequently mistakes occurs while preparing the voters list. In this regard we are also fortified with the observations of Hon’ble National Commission in case titled as LIC Vs. Gopal Singh. Reliance can also be placed on the observations of Hon’ble Punjab State Commission, Chandigarh in case titled as L.I.C. Vs. Balbir Singh & Others. Apart from the voters list the OPs has not produced any evidence to prove that the DLA has given his age in correctly. On the other hand the complainant has relied upon the PAN card and Aadhar card and member Panchayat and Lamberdar of the village have also tendered affidavits that the DLA was about 46-47 years old at the time of his death. The decision of UPSCDRC in case titled as Vijay Narain Vs. L.I.C. cited as 1(2017) CPJ 166(UP) is relied upon.

10.              In view of the aforesaid discussion we are of the opinion that the deficiency on the part of OP No.2 in rendering service to the complainant is proved and the present complaint is accordingly allowed and OP no.2 is directed to make  payment of guaranteed death benefit of sum assured of Rs.5,27,203/-  to the complainant along-with  additional sum assured purchased with bonus declared; if any and other benefits as per policy and proposal form within a period of one month, failing which he complainant will be entitled to initiate legal proceedings under Section 25/27 of the Act against the OP No.2. A copy of this order be supplied to the parties free of cost. File be consigned to the record room after due compliance.

Announced in open Forum.

Dated: 29.09.2017.

(Raghbir Singh)

     President

             (Ansuya Bishnoi)  (R.S.Panghal)    District Consumer Disputes                       

     Member                 Member            Redressal Forum,Fatehabad