BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM; FATEHABAD.
Complaint Case No. 298 of 2016.
Date of Instt.:25.11.2016.
Date of Decision: 10. 11.2017.
Satpal son of Roop Singh, resident of village Khabra Kalan, Tehsil and District Fatehabad.
..Complainant
Versus
1.Max Life Insurance Company Limited, Head Office 11th and 12th floor, DLF Square, Jacaranda Marg, DLF City, Phase II, Gurgaon-122002 (Haryana) through its Chairman-cum-Managing Director / Authorized Person.
2.Max Life Insurance Company Limited, through its Corporate Agent Axis Bank Fatehabad Branch, G.T.Road Fatehabad through its Branch Manager.
..Respondents/OPs
Before: Sh.Raghbir Singh, President.
Mrs.Ansuya Bishnoi, Member.
Sh.R.S.Panghal, Member.
Present: Sh.P.S.Sokhal, Adv.for the complainant.
Sh.Vinod Godara, Adv. for the OPs.
The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant against the OPs with the averments that his son namely Ravi Kumar got his life insured with the OP No.1 by purchasing a policy bearing No.271762106 dated 24.05.2015 for coverage amount of Rs.14,83,235/- for a period of twenty years. The above said policy was issued by the OP No.1 by taking premium from the life assured through cheque and proposal form dated 11.05.2015 was submitted by him to the OP No.1 through its agent Axis Bank, Fatehabad. It is further submitted that as per the terms and conditions of the policy the life assured was entitled for the benefits of the policy during his life time and after the death of the life assured the nominee is entitled for the benefits of the policy. It is further submitted that unfortunately the life assured Ravi Kumar died on 25.05.2015 during the subsistence of the policy and the complainant being nominee of life assured informed the OPs about the death of Ravi Kumar life assured and also requested for death claim benefits of the policy issued by the OPs. All the requisite documents as desired by the OPs were furnished to OPs for settlement of the claim. After receiving the requisite documents the OPs assured the complainant that the disbursement of death claim will be released to him at the earliest. However vide letter dated 31.03.2016 OP No.1 declined the death claim of the complainant on the ground that life assured is alive and the death claim has been sought by the complainant on the basis of forged death certificate. It is further submitted by the complainant that the repudiation of the claim of the complainant vide letter dated 31.03.2016 is false and concocted and the same is not sustainable in the eyes of law. In fact the life assured had died on 25.05.2015 and the same is evident from the death certificate issued by the competent authority. The above said act of OPs amounts to deficiency and unfair trade practice on their part in rendering service to the complainant. It is further submitted that the complainant is entitled to death claim of Rs.14,83,235/- along-with compensation on account of mental agony and physical harassment suffered by him. Hence, this present complaint.
2. On receiving notice, the OPs appeared and resisted the complaint by filing written statement wherein various preliminary objections have been raised i.e. that the instant complaint is completely devoid of merits and is tainted with malafides and the same has been filed with the motive to extort money from the OPs; that no cause of action has arisen in favour of the complainant to file the present complaint; that the present complaint is not maintainable in the present form etc..
3. In reply on merits, it is admitted by the OPs that a proposal form dated 11.05.2015 was submitted by the DLA Ravi Kumar and a policy was issued to the complainant by the OPs on 24.05.2015. It is further submitted that the claim of the complainant was declined by the OPs on account on non-disclosure of material medical facts and on the basis of impersonation done by the brother of the DLA Hanuman Singh who represented himself to be Ravi Kumar before the investigation agency, at the time of verification conducted by the insurance company on 31.05.2015. It has been further submitted that from the investigation got conducted by the insurance company it was further revealed that the deceased life assured was suffering from cancer prior to signing to the proposal form and he was treated at SMS Hospital, Jaipur, PBM Hospital, Bikaner and Civil Hospital, Hisar. However no such information was disclosed in the proposal form submitted by the deceased life assured. The following question was submitted to the DLA in the proposal form:
Clause E (3): Have You Ever Been Investigated, Treated or Diagnosed for:
Viii) Cancer, Tumor or growth (Malignant or benign)
The above said question was answered as ‘No’ by the Deceased Life Assured.
4. The above said act of the deceased life assured amounts to non disclosure of material fact, of which if the OPs were aware then the policy would not have been issued to the DLA. It is further submitted by the OPs that the repudiation of the claim of the complainant by the OPs is perfectly in accordance with the terms and conditions of the insurance policy and sustainable in the eyes of law. In support of the above contention the OPs have relied upon the judgment rendered by Hon’ble Apex Court in case titled as P.C.Chacko Vs. Chariman, LIC & Ors (2008) 1 SCC 321 and case titled as Satwant Kaur Sadhu Vs. New India Assurance Company Ltd., SC 2776 of (2002). The OPs have further prayed for dismissal for the complaint being devoid of any merit.
5. In evidence the complainant tendered his affidavit as Annexure C-1 and documents Annexure C-2 and Annexure C-3 and closed the evidence. However no evidence was produced by the OPs.
6. The learned counsel for the complainant in his arguments contended that as per written statement filed by the OPs the claim of the complainant has been repudiated on account of non disclosure of material fact by the DLA regarding his state of health. In support of the above contention the OPs in the written statement have averred that the DLA was suffering from cancer before the filing of the proposal form and he was treated at S.M.S. Hospital, Jaipur, P.B.M. Hospital at Bikaner and Civil Hospital, Hisar, but the said material fact was not disclosed by the DLA in the declaration made by him in the Proposal Form. However the OPs have miserably failed to produce any evidence before this Forum to prove that the DLA was suffering from cancer or any other illness before filing of the proposal form. Neither any document has been produced by the OPs to prove the above said contentions nor any affidavit of the investigator has been tendered in evidence in this regard. It is further contended by the learned counsel that since the life assured had died during the subsistence of the insurance and due premium had been received by the OPs as such a genuine claim of the complainant has been declined by the OPs on a false and baseless ground. It is also contended by learned counsel that no impersonation was done by brother of DLA before the investigation agency during verification on 31.05.2015. The said allegation of the part of OPs is baseless and is not supported by any evidence or affidavit of the investigator before whom the impersonation was made. Therefore the repudiation of genuine claim of the complainant by the OPs amounts to deficiency and unfair trade practice on their part in rendering service to the complainant and the complainant is entitled for payment of insurance claim along-with compensation
7. On the other hand the learned counsel for the OPs rebutted the arguments of learned counsel for the complainant and reiterated the submissions made in the written statement filed by the OPs. The counsel also contended that since the DLA had fraudulently concealed the material fact regarding his state of health in the declaration made by him in the proposal form as such the repudiation of the claim of complainant by the OPs is perfectly in accordance with the terms and conditions of the insurance policy and sustainable in the eyes of law. The learned counsel in support of his contention has relied upon the law laid down by the Hon’ble Apex Court in case titled as P.C.Chacko Vs. Chairman L.I.C. 2008(1)SCC 321 and case tiled as Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. SC 2776 of 2002.
8. We have heard the arguments advanced by the learned counsel for both the parties and have also examined the entire material placed on the record of the case. It is not disputed that in the present case the policy was issued to the life assured by the OPs on 24.05.2015 and the life assured died on the very next day i.e. on 25.05.2015. This fact coupled with the fact that a policy of huge amount of Rs.14,83,235/- was purchased by the life assured creates strong doubt regarding the genuineness /bonafide of the purchase of insurance policy and possibility of malafide of fraud on the part of life assured in collusion with the officials or agent of the insurance company cannot be ruled out.
9. On the other hand it is the case of OPs that the claim of the complainant has been declined on the basis of impersonation done by the brother of DLA at the time of verification conducted by the OPs on 31.05.2015 and also on account of non disclosure of material fact by the DLA regarding his state of health in the proposal form filed by him for obtaining the policy. It is also the case of the OPs that the DLA was suffering from cancer prior to the signing proposal form and he had taken treatment for the same form S.M.S. Hospital, Jaipur, BPM Hospital, Bikaner and Civil Hospital, Hisar.
10. It is also pertinent to mention here that eleven opportunities were given by this Forum to the OPs for submitting their evidence. However no evidence was produced by the OPs in support of their case. Neither the investigation reports have been filed nor affidavits of the persons who conducted the investigation in the matter has been filed. The possibility of collusion of some of the officials of the OPs cannot be ruled out. In the present case huge amount of Rs.14,83,235/- which is a public money, is involved and the same cannot be allowed to be released without ascertaining the genuineness of the claim..
11. As discussed above since there is not sufficient evidence to reach any conclusion and there are allegations of impersonation and fraud levelled by the OPs against the DLA and complainant and adjudication of same requires elaborate evidence as such the same cannot be decided in summary proceedings. On the point reliance can be taken from case law titled as UCO Bank Vs. S.D.Wadhwa 2013(4) CLT (NC). Therefore the present complaint is dismissed with the liberty to the complainant to approach the appropriate court. In case the complainant approaches the appropriate Court/Forum in that eventuality, the period of litigation before this Forum shall not be counted towards the period of limitation for approaching appropriate court/forum. Exemption of time spent before this Forum is granted in terms of the judgment of the Hon’ble Supreme Court of India in the case titled “ Laxmi Engineering Works versus PSG Industrial Institute (1995) 3 SCC page 583. No order as to costs. A copy of this order be supplied to the parties free of costs. File be consigned to the record room after due compliance.
ANNOUNCED IN OPEN FORUM. Dt.10.11.2017
(Ansuya Bishnoi) (R.S.Panghal) (Raghbir Singh)
Member Member President
