Manipur

StateCommission

A/11/2023

Reliance Nippon Life Insurance Company Limited - Complainant(s)

Versus

MD FIROZ KHAND - Opp.Party(s)

Miss L.Brizet

25 Oct 2024

ORDER

1. Shri Th. Saimon Singh, President (Acting):-       Having involved common points of facts and law in these 2 (two) appeals, we are going to dispose of both the appeals by this common Judgment and order.
2. These appeals are filed by the Manager, Reliance Life Insurance Company Limited, MG Avenue, Opposite UBI Bank, Thangal Bazar, Imphal West, Manipur, challenging the common Judgment and Order dated 21.06.2023 passed by the District Consumer Disputes Redressal Commission Imphal, Manipur in Complaint Case No. 20 of 2016 and Complaint Case No. 21 of 2016,  wherein Ld. District Commission inter alia directed the Appellant to pay  a sum of Rs. 23,70,000/- to the complainant within 30 days from the date of order i.e. 21.06.2023, failing which there shall be interest @ 9% p.a. from the date of expiry of the period of depositing the amount mentioned above.

1. It is the case of the Complainant/respondent before the District Commission Imphal, that One Md. Ibungo (now deceased) a resident of Khellakhong Heibong Makhong Mayai Leikai, Imphal West, Manipur, (hereinafter referred to as the deceased life assured) bought the Reliance Endowment Plan (Regular) which is an Insurance Policy from the Reliance Life Insurance Company and accordingly he paid a sum of Rs. 15,061.44/- to the Insurance company on 08.08.2013. And after completing all the necessary formalities and proper verification of all the documents furnished, the company issued policy no. 51138178 and client ID No. 86532301 to Md. Ibungo (now deceased). The appellant accepted the complainant/ respondent as nominee of the policy holder and accepted and acknowledged the payment of the premium without any protest and issued the certificate of insurance to the policy holder and indicted the based assured amount as Rs. 6,00,000/- (Rupees Six Lakhs) only.
2. The said Md. Ibungo (now deceased) bought another insurance policy namely Reliance Special Term Plan (Regular) which is also an insurance policy, from the present appellant for a sum of Rs. 15,563.45/- on 29.11.2013 and after completing all the necessary formalities and proper verification of all the documents furnished, the company issued policy No. 51326607 and Client No ID No. 86532301. The appellant accepted the complainant/ respondent as nominee of the policy holder and accepted and acknowledged the payment of the premium without any protest and issued the certificate of insurance to the policy holder and indicted the based assured amount as Rs. 17,00,000/- (Rupees Seventeen lakhs) only.
3. Unfortunately the policy holder namely Md. Ibungo expired on 04.01.2014 at about 7.30 am due to Cardio Vascular Failure (heart Attack) at his residence. The respondent/complainant being the nominee informed the appellant about the demise of the policy holder (Md. Ibungo) along with necessary documents including the original policy documents with reference to policy no. 51138178 and policy No. 51326607, enclosing attested photo copies of the death certificate issued by the Municipal Authorities, Doctor’s certificate, claim form issued by the Reliance Life Insurance Company Ltd., affidavit and cancelled Cheque A/c No. 30467693647 on 10.02.2014.
4. The appellant without giving any opportunity of being heard to the complainant/ respondent (nominee of  late Md. Ibungo)  repudiated the claim of the complainant /respondent vide letter dated 26^th May 2014 which is reproduced as under:

“We have received all the documents submitted by you and findings from the investigation are:-

-Age proof submitted at the proposal stave is illegitimate.

-Bank Statement provided at proposal stage is also fake.

-As per the discreet checks conducted with LA residence locality we found that no such person living or died on the said date in the locality.

-The submitted death certificate was found to be fake document.

In the light of the above facts and irrefutable evidence we hold that we were provided with false and inaccurate answers, hence the contract is void ab initio. According to our policy conditions, all claim benefit shall cease.”

5. Thereafter, the complainant /respondent filed representation dated 04.09.2014 requesting the appellant not to cease the death claim benefit without proper investigation but with no effect. Hence, the complainant/respondent filed complaint cases being i.) Complaint Case No. 20 of 2016 and ii.) Complaint Case No. 21 of 2016 before the Hon’ble Consumer Disputes Redressal Commission Imphal, at Sangaiprou, Manipur.
6. The appellant filed written statements in response to complaint case no. 20 of 2016 and complaint case no. 21 of 2016.
7. It was case of the opposite party /appellant that the law of insurance is governed by the legal doctrine “Uberrima fide’ meaning “utmost good faith” (literally, “most abundant faith”) which means that all partiers to an insurance contract must deal in good faith, making a full declaration of all material facts in the insurance proposal. However, there are inherent misrepresentation and suppression of material facts, the life assured did not exist and the complainant has forged documents to procure the instant policy in the name of imaginary dead brother. Hence, the policy was void ab initio.
8. It is alleged that the complainant/respondent manufactured documents in order to procure the policy illegally to enrich himself. And repudiation of the claim is justified under section 45 of the Insurance Act, 1938.
9. It is alleged that on investigation the death certificate and the driving license submitted turned out to be fake and manufactured documents and the deceased LA is a non- existent person.
10. Upon pleadings of the parties the District Commission framed 7 (seven) issues in both the complaints on 06/06/2017  and they are as follows:

1. Whether the Complainant is a Consumer being the nominee of the deceased /policy holder under the relevant provision of the Act or not?
2. Whether the deceased in other words policy holder Md. Ibungo insured the policy by submitting requisite documents to the satisfaction of the Opposite party, the Reliance Life Insurance Company Ltd. or not?
3. The Policy Sum assured in question for a sum of Rs. 6,00,000/- was actually happened and accepted on the approach of the deceased person with the requirements of a necessary premium amounting to Rs. 15,061.44 /- being paid to the opposite party Insurance Company or not?
4. Whether the Insurance policy in question had been made after observing due process of rules as laid down in the life insurance Policy or not?
5. Whether the life Insurance Policy in question was a fake misrepresented by the deceased policy Holder by producing fake documents so that he can claim the compensation after the alleged death of the Policy Holder or not?
6. Whether the alleged Death Certificate which had been produced to claim the compensation for the death against the alleged Policy was a forged document or not?
7. Whether the claim made by the nominee of the deceased Policy Holder is justified to the reliefs claim in the present case?

 

11. 4 (four) witnesses on behalf of the complainant /respondent and 5 (five) witnesses for the appellant company were examined in the aforesaid 2 (two) complaints.

The Complainant had produced and marked 13 Documents. The Appellant had produced and exhibited 10 (ten) documents.

 

12.  Since similar facts are involved in the above stated complainant cases the District Commission, Imphal after hearing the parties decided all the 7 (seven) issues in favour of the complainant and passed the common impugned order dated 21.6.2023, wherein the District Commission inter alia directed the opposite party/appellant to pay a sum of Rs. 23,70,000/- to the complainant within 30 days from the date of order, failing which the opposite party/appellant shall be liable to pay interest @ 9% per annum from the date of the order.

Being aggrieved by the aforesaid impugned order dated 21.06.2023 the appellant has filed the present appeals.

13. We have heard Miss Lairenjam Brizet Devi, learned counsel for the Appellant and Mr. Viscount Ahongsangbam, learned counsel for the respondent. Also perused and examined the records of the Complaint cases, Memo of Appeals and written arguments of both sides.

 

14. Ld. Counsel for the appellant has strongly contended that the deceased policy holder late Md. Ibungo is a non- existent person. It is further contended that the (i) driving license (mark X/13), (ii) Bank account of the deceased (Exhibit  Ext-DW-1/F ) submitted at the time of joining the above stated insurance policies are all forged and fabricated documents as reflected in the repudiation letter dated 26/05/2014 (marked X/2). It is also contended that the Death certificate (DW-1E) in respect of late Md. Ibungo submitted by the complainant is also false and fabricated, as per the investigation carried out by the appellant after receipt of the death claim on behalf of the deceased policy holder under the provisions of section 45 of the Insurance Act, 1938. The Ld. Counsel for the appellant has drawn our attention to the findings/conclusion of the investigation  Ext DW-1/A which are reproduced as under:-

“CONCLUSION

(based on details of investigation furnished below)

“After all round investigation, we found that the said policy is completely manipulated,. There was no person at Paobitek, P.O. P.S Wangoi, Imphal West, Imphal, Manipur -795001 by the name Md. Ibungo. Some agents and sales managers of Reliance iefe Insurance have willingly opened this policy for the claim amount. They have managed the claimant and prepared some fraud documents in the name of Md. Ibungo and opened this policy. The claimant had no relation with LA. We found during investigation that the actual name of claimant is Md. Ibrahim.”:

DETAILS OF FIELD /RE-INVESTIGATION

We have verified the Driving License of the LA from DTO, Bishnupur but did not found any records against the said DL. We have also found that LA’s name does not existed in the voter list.” With these submissions the Ld. Counsel for the appellant has contented that the impugned order is liable to be set aside.

17. On the other hand the Ld. Counsel, Mr. Viscount for the complainant/respondent argued that the complainant /respondent submitted death claim application dated 10/02/2014 (marked X/3) enclosing the documents such as i.) Original Policy Documents marked X/12 ii). Attested copy Death Certificate (marked X/1) iii.) Doctor’s certificate (marked X/5) iv.) Claim form issued by Reliance Life Insurance v.) Attested copy of the Bank passbook (SBI account No. 304676936). vi.) Affidavit (mark-X/4) etc. As death claim could not be processed without Original policy Document and Original Death Certificate the said documents were asked to be submitted at the office of the  appellant and as such the same were submitted/ retained in Original by the Appellants.  

The PAN Card (mark DW/B) and  Driving License No. 128745/BPR (Ext. X/13) submitted by the deceased LA at the time of joining the insurance Policy were  not enquired into during investigation by the Insurance Company and Global Risk Management instead they made enquiry over License No. 21035/UKL which was issued by Ukhrul, DTO and found to be in the name of one Laishram Manichand Singh which has nothing to do with the deceased LA. Moreover, the appellant made enquiry over the Bank account bearing no. 3066358185 of Central Bank of India in the name of one Priyanka Devi which is quite irrelevant as the same was never submitted by the deceased LA nor by the respondent/complainant.

18. Further the endorsement(mark Z to mark Z1) appearing at the left side note of the Photostat copy of the Death Certificate (Ext. DW-1E) filed by the opposite party/appellant during the proceedings of the complaint cases which reads as “Mohamad Ibungo, S/o (L) Ibotombi and also mother name Mrs. Anou. He is not exist at the area of Heibong Makhong and its surrounding area. The man is not included in the voter list. And no such name in area in my knowledge as per record. So kindly cancel the death certificate.” was obtained by the Global Risk Management and the appellant after submission of the death claim along with Original Policy Document and Original Death Certificate by the claimant/complainant/respondent during investigation.

 

19. The endorsement on the photo copy of Death Certificate Mark X/1 issued by the Sub- Registrar, Birth and Death Thoubal C.D. block, bears a remark appearing at the side which says “I have found in voter list Sl. No. 152, 36/9 Wabagai A/c. This certificate is true”.

 

DW No. 4, S. Biramangol Singh who made the endorsement at Ext. DW-1E, deposed that he knows the signature appearing on the death certificate. He put his signature in the endorsement Z to Z1 without knowing the contents. He further deposed that the death certificate DW-1E was rejected without any investigation but later on the office came to know that late Md. Ibungo, was in the electoral roll of 36 Wabagai AC in the serial No.152.In the death certificate marked X/1 the Sub- Registrar, Birth and Death, Thoubal C D Block recorded that he found the deceased LA in the voter list of 36/9 Wabagai AC in the serial No.152.

Md. Jamaluddin, Ward Member, Maibam Uchiwa Ward No. 7/5 who issued the certificate Mark DW/C stating that the deceased LA is not included in the latest (2014) voter list of his area was not examined as a witness. And his non examination as witness would be fatal in the case of the OP/appellant. With the above contentions the Ld. Counsel prays for dismissal of the appeals.

21.  The arguments advanced by the parties would show that the appellants issued the insurance policy documents to the deceased LA in reference to the proposal forms accompanied with the documents submitted by the policy holder. The main contention of the appellant is that the deceased LA was non- existent and imaginary person at the time of joining the insurance policies. From the records it is apparent that the appellants did not make proper investigation under section 45 of the Insurance Act, 1938 in regard to the documents submitted by the deceased LA during his lifetime and the complainant/respondent at the time of making the death claim benefit by the respondent as a nominee. The documents are i.) Death Certificate of the deceased LA (mark X/1) ii.). Driving License No. 128745/BPR) issued by DTO Bishnupur (marked X/13) iii.) PAN card bearing No. ADVDI 9255R (marked DW/B) of the deceased LA iv.) Voter List/ Electoral Roll in reference to SL. No. 152, 36 /9 Wabagai A/C in which the deceased LA is recorded as a voter as endorsed by the Sub Registrar Birth and Death Thoubal C.D Block (Marked X/1).

22.     First of all we are going to examine the Photostat copies of the death certificate of the deceased LA being exhibit X/1 and DW-1E respectively with endorsements made thereon. The endorsement at Ext DW-1/E would show that the deceased LA is a non -existent person. But as per deposition the official witness namely Mr. S. Biramangol Singh (DW No. 4), he put his signature at the foot of the endorsement (mark Z to Z1) without knowing the contents thereof and later on he came to know that the deceased LA was one of the voters of 36/9 Wabagai Assembly Constituency. In exhibit X/1 which is photocopy of the death certificate there is an endorsement that, “I have found in voter list Sl. No. 152, 36/9 Wabagai A/C the certificate is true.” The Evidence given by DW No. 4 stands corroborated by the endorsement in exhibit X/1. Again the above stated endorsements in the death certificate do not render the death certificate as “cancelled” in view of the provisions of section 15 of the Registration of Births and Deaths Act, 1969, which is reproduced below:-

“15. Correction or cancellation of entry in the register of births and deaths- if it is proved to the satisfaction of the Registrar that any entry of a birth or death in any register kept by him under this Act is erroneous in form or substance or has been fraudulently or improperly made, he may, subject to such rules as may be made by the State government with respect to the conditions on which and the circumstances in which such entries may be corrected or cancelled, correct the error or cancel the entry by suitable entry  in the margin, without any alteration of the original entry, and shall sign the marginal entry and add thereof the date of correction or cancellation.”   

In view of the discussion above we are of the considered view that the death certificate has not yet been cancelled and is still valid.

23.     The Driving License DL No. 21035/UKL marked –DW/A) issued by the DTO UKL which is alleged to be fake by the DTO Office Ukhrul is irrelevant in as much as the same  cannot determine whether the deceased LA is existent or non -existent one. At the same time the Driving License being DL No. 128745/BPR issued by the DTO Bishnupur which has been verified to be genuine by the DTO Bishnupur vide letter dated 19/09/2016, which was submitted by the deceased LA to the appellant at the time of joining the insurance policies was not investigated and taken into consideration during investigation. It is found that the appellant could not disprove that the Driving License being DL No. 128745/BPR issued by the DTO Bishnupur is not a genuine one. Similarly the PAN card bearing No. ADVDI9255R (marked DW/B) of the deceased LA and the Sl. No. 152 of the electoral Roll of 36/9 Wabagai A/C were not investigated and was not at all taken into consideration in arriving the conclusion that the deceased was a non-existent and a imaginary person. In the situation we are of the view that the District Commission, Imphal, rightly held that the opposite Party did not produce sufficient evidence to substantiate the fact that late Md. Ibungo, the deceased LA is a non- existent person.

Since, the Branch Manager of the Appellant stated that Md. Ibungo was a policy holder and obtained 2 (two) insurance policies from the Appellant, the burden of proof as to the non existence of deceased LA would lie on the appellant which the appellant could not discharge during evidence before the District Commission, Imphal. Furthermore, R.K Bikram Singh, DW No. 2 who was appointed as an investigator by the Appellant did not properly investigate about the genuineness of the claim arising on the death of Md. Ibungo by examining the requisite documents such as Death Certificate, Driving License issued by DTO Bishnupur, Pan Card, Electoral Roll of 36/9 Wabagai A/C.

 It is an admitted fact that the respondent is the nominee of the policy holder Md. Ibungo who obtained two policies during his lifetime and all the premium was paid without any dues. Therefore, this Commission is of the considered view that it shall not be proper and legal for appellant to withhold the payment of the insured amount.

24.     In the case of Life Insurance of Insurance Corporation of India –Vs- Renu Devi reported in (2017) 171 AIC 687 the Hon’ble Patna High Court (Division Bench) by it judgment held as follows :-

35.From the aforesaid discussion, it becomes clear that the opportunity to provide hearing before making any decision was considered to be a basic requirement in the court proceeding, later on, this principle was applied to other quasi- judicial authorities and other tribunals and ultimately it is now clearly laid down that even in the administrative actions, where the decision of the authority may result in civil consequences, hearing before taking a decision is necessary.

         36.     In view of the aforesaid judgments, we have no hesitation to reject the contention of the appellants that the        Insurance Company is not bound to provide opportunity of hearing to the insured or to the legal heir before repudiating the  claim on the policy of Insurance granted by the appellant. An opportunity of hearing communicating the reasons as to why the claim cannot be accepted, should be communicated to the insured or to the legal heirs to provide fairness and transparency in the decision making process

 

Further, the Hon’ble National Consumer Disputes Redressal Commission, had held in the Judgment dated 17^th January, 2018 passed in United India Insurance Co. Ltd. Vs. JhunJhunwala Vanaspati Ltd.(First Appeal No. 273 of 2009) at para no. 19 as follows:-

“19. It is trite law that unless a statutory provision, either specifically or by necessary implication, excludes the application of principles of natural justice, the requirement of giving reasonable opportunity to the affected party to meet the case against him, before an order or direction is made, particularly when the same has adverse civil consequences, is necessary. Obviously, rejection of even a part of the claim made under an insurance policy, entails adverse civil consequences and hence, principles of natural justice demand that any report by the Surveyor, having material bearing on the consideration of the claim, is required to be supplied to the Insured/claimant, to enable him to put forth his stand thereon, before the same is relied upon against him. Evidently, this exercise was not undertaken in the instant case, and therefore, the decision taken by Insurance Company to repudiate the claim, also stood vitiated, being violative of the principle of Natural Justice”.

In the result, this Commission finds no sufficient grounds for interfering with the impugned Judgment and Order. Hence, the Appeal is hereby dismissed with the direction to the Appellant to pay a sum of Rs.23,70,000/- (Rupees Twenty Three Lakhs and Seventy Thousand) Only to the Respondent within 30 (thirty) days from the date of this order, failing which there shall be interest @ 9% p.a. from the date of expiry of the period for payment of the amount.

The Impugned common Order dated 21.06.2023 passed in C.C case No. 20 of 2016 and C.C case No. 21 of 2016 stands modified to the extent indicated above.  

25.     The Appellant deposited Rs.25,000/- (Rupees Twenty five thousand) only with this Commission at the time of filing of the Appeal. This amount of Rs.25,000/- (Rupees Twenty five thousand) only be remitted by the Registry to the Respondent by way of a cross cheque/demand draft within 30 (thirty) days from the date of this order. Remaining amount shall also be paid by the Appellant to the Respondent within 30 (thirty) days from the date of this order.

26.     The argument in this case was heard on 21.08.2024 and the orders were reserved. Now the order be communicated to the parties free of costs. And let this order be uploaded on the website of the Commission for perusal of the parties.

27.     Interim order and pending application if any stands cancelled.

28      Announced in the Open Court.

29.     Registry is directed to send back the records of Consumer Complaint Case No. 21 of 2016 and Complaint Case No. 21 of 2016  to the Ld. District Commission, Imphal along with a copy of this order each for information and doing the needful.

30.     File be consigned in the record room along with a copy of this order.