OFFICE OF THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KAMRUP,GUWAHATI
C.C.20/2013
Present:-
1) Md.Sahadat Hussain, A.J.S. - President
2) Smti Archana Deka Lahkar - Member
Mr.Pankaj Baishya, - Complainant
S/O Late Dambaru Baishya.
Village,Sualkuchi, Hospital Road ,
District:-Kamrup,Assam
Pin-781103
-vs-
1) Met Life India Insurance Company Ltd. - Opp.parties
Head Office at Brigade Seshamahal-5
Vani Velas Road, Banglore-560004.
2) K.R.Anil Kumar,
The Chairman, Claims Committee
Met Life India Insurance Company Ltd.
Brigade Seshamahal-5
Vani Velas Road, Basavanagudi,
Banglore-560004.
3) Branch Manager, Guwahati Branch
Met Life India Insurance Company Ltd.
Above Vishal Mega Mart,5th Floor
A.T.Road,Opposite Pan Bazar over Bridge,
Guwahati-781001.
Appearance-
Learned advocates for the complainant- Mr.Nirmal Kalita
Learned advocates for the opp.party- Ms.Mala Mahanta
Date of argument- 20.6.17
Date of judgment- 5.7.17
JUDGMENT
This is a complaint u/s 12 of the Consumer Protection Act, 1986.
1) The case was admitted on 1.3.2013 and notices was served on all three opp.parties and they also filed their written statement jointly on 6.11.2013. The complainant filed his evidence on 22.4.2015 and he was also cross-examined by the opp.party sides’ counsel on 9.10.15. The complainant also filed evidence of one Smti Anita Baishya and Sri Prasanta Talukdar on affidavit. Thereafter, opp.party sides’ took several adjournments for adducing their evidence, but failed to file their evidence; and accordingly this forum, vide order dtd. 3.11.16, rejected petition of the opp.party (petition No. 1239/16) through which they sought further time to file evidence and closed the stage of hearing of evidence of the opp.party. Thereafter , the complainant side counsel Mr.Kalita filed written argument on 3.2.2017 and Ld.advocate Mr.Samrat Sah Roy filed the written argument on behalf of the opp.parties on 12.4.2017. On 20.6.17, we have heard oral argument of Ld.advocate Mr.Nirmal Kalita for the complainant and of Ld advocate Ms.Mala Mahanta for the opp.parties, and today, we deliver the judgment, which is as below-
2) The gist of the complaint is that father of the complainant, Dambaru Baishya (since deceased) , S/o-Late Raghu Ram Baishya, had insured his life by opening one Life Insurance Policy with the Metlife India Insurance Co.Ltd. on 29.3.2011 by filing his application form under Met Suvidha Plan. The applicant had submitted his school certificate as age proof with the Application Form alongwith some other documents. On 6.4.2011 the Met Life India Insurance Co.Ltd. issued one welcome letter to the policy holder accepting his application and issued the insurance policy being policy No. 20550194. The duration of coverage of the said 1st policy is from 30.3.2011 to 30.3.2031 and Face amount of coverage is Rs.3,65,000/- Mode of payment of this first policy was quarterly basis and premium amount was Rs.5,031/- per quarter. Accordingly , the life insured person Mr.Dambaru BAishya had deposited his first premium of Rs.5083/- with requisite taxes as initial deposit which the opp.parties had acknowledged by issuing a Receipt dated 6.4.11. Again on 18.7.11, 21.10.11, 28.1.12 next three premiums were paid by the life insured person by csh in the office of Opp.Party No.3 which were acknowledged by the opp.parties by issuing money receipt bearing No. c-5239738, c-5268257, and c-5302866 respectively. Again on 6.7.11 Dambaru Baishya applied for Insurance of his life under Met Suraksha Plan and that application was accepted and by issuing another insurance policy on 20.7.2011, Met life India insurance Co.Ltd. had insured the life of Dambaru Baishya under the Met Suraksha Plan also, and issued another Insurance policy being policy No.20610601. The duration of coverage of the said 2nd policy is from 7.7.2011 to 7.7.2021 and face amount of coverage is Rs.700,000/- only. Mode of payment for this 2nd policy was half yearly basis and premium amount was Rs.4580/-only per half year. The insured person Late Dambaru Baishya had deposited his first premium of Rs.5,161/-only including all requisite taxes as initial deposit of the 2nd policy, receipt of which the opp.parties had acknowledged by issuing one premium receipt dated 20.7.11. Thereafter, on 21.3.12 the second premium of the 2nd policy amounting Rs.5,165/- was paid by Late Dambaru Baishya which has been acknowledged by the opp.parties by issuing money receipt bearing receipt No. –c-5321127 dtd.21.3.12. Both the Insurance policies under different policy plans , the owner of the policies Late Dambaru Baishya appointed his son Mr.Pankaj Baishya, the petitioner of this petition as Beneficiaries/Nominee allowing 100 percent shares in his favour. In due time the opp.parties gave policy documents and photo copies of the Application Form of both the policies to the owner of the policies which the applicant received in time. In both the policies the insured person was given his I.D.Number as client ID: 51095792. On 28.3.12 at about 12-45 p.m. Dambaru Baishya suddenly fell ill and was finding difficulty in breathing at his own residence in Sualkuchi. Immediately and was finding difficulty in breathing at his own residence in Sualkuchi. Immediately it was informed to the Doctors of M.G.30 Beded Rural Hospital (PHC),Sualkuchi. After examination doctor declare Dambaru Baishya as dead at about 1 P.M.. The reason for the sudden death of Dambaru Baishya is explained by the doctor as “LV.F”.Thus, the Life Insured person by the aforesaid two policies succumbed his death on 28.3.12 at 1P.M. due to LVF. Thereafter , the village headman came to the residence of the deceased and followed the formalities necessary to do from his corner. Then on the same day in presence of relatives and village men body of the deceased were cremated at Sualkuchi according to the Hindu ritual. On 17.4.12 the Govt.village Head man of the village issued a certificate to substantiate the death of Dambaru Baishya and to substantiate his date of birth as 31.12.1957. On 18.4.12 Department of Health Service under Govt.of Assam issued Death Certificate for the death of late Dambaru Baishya being certificate No. -0672818. After obtaining the death certificate, the petitioner of this petition Sri Pankaj Baishya informed the opp.parties through this agent Sri Prasant Talukdar and the agent supplied the petitioner with the Death/ Disability/ Critical illness Claim intimation Form issued by the opp.parties . Thereafter, the petitioner has submitted the duly filled up claim intimation Form in the Office of the Opp.Party No.3 and was waiting for the further proceeding. On 13.6.12, the opp.pparty sent one condolence letter to the petitioner acknowledging the receipt of claim intimation under policy No. 20550194 and 20610601 of the life of Late Dambaru Baishya. It is worth to mention here that in the said condolence letter, the opp.party admits that the two policies in disputes had been active on the date of death of the Life Insured person. It is also asked to submit- (1) Original policy Bonds (2) Claimant’s Statements (in the prescribed format) (3) Last Attending Physician’s Statements (4)Family Doctors Certificate (5) Copy of the photo identity proof and address proof of the nominee (6) Attested copy of care papers like Medical records, Admission note, Treatment Records, and Discharge/Death summary. After receiving the said condolence letter dtd. 13.6.12 the petitioner of this petition collected the Claimant Application for Death claim-Form-A from the office of the Opp.Party No.3 and collected all necessary documents asked by the opposite party to submit before them . On 30.6.12 the Family Doctor issued one certificate stating the cause, time and place of death of Late Dambaru Baishya. On the same day last Attending Physician, the Sr.Medical and Health Officer,M.G.-30 Beded Rural Hospital (PHD) ,Sualkuchi issued his statement in the prescribed Form Attending Physician Statement –Form-B as required by the opposite parties. Also the petitioner of this petition as claimant /Nominee submitted his HSLC Exam admit card as photo identity along with the Original Policy Records in the office of Opposite Party No-3 after following all formalities and was waiting for the response from the opposite parties. Since all the Original policy papers are in the custody of the Opposite parties those may be called for by the Hon’ble Court whenever necessary . On 9/7/2012 the opposite party issued one Acknowledgement Letter where in it is acknowledge that the opposite party had received all the necessary documents and got assurance for getting settlement of the claim in due process at an early date. On 25/10/2012 the opposite party sent one Claim Decision Letter to the petitioner and surprisingly in the said claim Decision Letter it has been alleged that as per the voter ID the age of the Life Insured person –Late Dambaru Baishya is 74 years and it was under stated as 55 years in his application forms dated 9/7/2011 and 29/3/2011. Based on the said allegation the opposite party refused to honour the claim made by this complainant. That in reply to the Claim Decision Letter dated 25/10/2012, the complainant send one pleader notice to the Opposite Party No-2 through his advocate Sri Nirmal Kalita on 23/11/2012 denying all the allegations made by the opposite party regarding the age of Late Dambaru Baishya and send photo copies of the documents Like Death certificate issued by Govt. o9f Assam, School certificate of Late Dambaru Baishya issued by Sualkuchi Bayan Silpinaish Vidyalay (High School), certificate issued by Village Headman of Madhya Aleka Gaon Burah, Sualkuchi , Family Doctors certificate ,Last attending physicians statements and School certificate of Smti Anita Pathak the wife of Late Dambaru Baishya to establish that the Date of birth of Late Dambaru Baishya is 31/12/1957 and the age stated in voter ID are false, baseless, erroneous and misleading. The age of Smti Anita Baishya, the wife Lt. Dambaru Baishya is 48 years 1month on her last birthday before the death of her husband being her date of birth 1.12.63, which is absolutely correct and stated in her school certificate . But the age of Smti Anita Baishya is shown as 51 years in the same voter ID; where the age of Lt. Dambaru Baishya is 74 years. The substantiate that the age shown in the voter I.D. are not correct. Again if for the sake of argument it is considered (but not admitted) that the age of Lt.Dambaru Baishya is 74 years, than difference of age between Dambaru Baishya and his wife Smti Anita Baishya will be 26 years which is very much absurd, impractical and not true. Hence the age of Lt.Dambaru Baishya stated in the voter I.D.is denied by the complainant. As the A/D of the said pleader notice dtd. 23.11.12 has not been received , the advocate Sri Nirmal Kalita lodged a complaint before the O.C., customer care centre G.P.O. Guwahati on 27.12.12 and on 28.12.12 the complain was settled with the information that –“Basavangudi H.O.Reported the Registered Letter Delivered to the Addressee on 29.11.12. In reply of the said pleader notice dtd.23.11.12, one M.S.Urmila Makalki, Advocate from Bangalore, on behalf of the opp.party sent one reply notice on 11.1.13 where in some base allegations and grounds for repudiating the claims for the said two police are shown. The complainant begs to state that the grounds for non-payment of claims against the alleged two policies are totally unfounded and base less and the purported report the opp.party is relying upon are also vague and biased and everything was done behind the back of the complainant and without knowledge. That act of the opp.parties is an act of deficiency of service towards him and that act also put him in mental agony and therefore, they are liable to pay the complainant the insured amounts of both policies, Rs.3,65,000/- of policy No.20550194 and Rs.7,00,000/- of policy No. 20610601 with interest at the rate of 18% per annum from the date of submission of the claim and also to pay him Rs.50,000/- as compensation for deficiency of service , Rs.50,000/- for causing mental agony as well as Rs.10,000/- for cost of the proceeding.
3) The gist of the pleading of the Opp.Party No.1, 2 & 3 is that Opp.Party No.1-PNB MetLife India Insurance Co.Ltd. is a company and Opp.Party No.2 is the chairman of the said company and Opp.Party No.3 is the branch manager of the company’s, Guwahati branch. Father of the complainant Lt. Dambaru Baishya, did a life insurance policy with them on 29.3.2011 after completely understanding the terms and conditions of their product “Met Suvidha Participating” voluntarily filling up proposal form bearing No. 166704929 for twenty years of which sum assured is Rs.3,65,000/- and quarterly premium is Rs.5,083/- and accordingly they issued policy No. 20550194 on 31.3.2011, and he also did an another policy on 6.7.2011 after understanding the terms and conditions of their product “ Met Suraksha” had voluntarily filling up the proposal form bearing No. 16670000 of which periods is ten years and assured sum is Rs.7,00000/- and premium is half yearly @ 5161/- and they also issued policy No. 20610601 to him accordingly. After few months of assurance of the said policies, they received death claim intimation with death certificate of the said insured whereby they were informed that the insured died on 28.3.12 and they get the matter investigated and after investigation it revealed to them that the insured had misrepresented his age as 55 years in both the application forms dtd. 9.7.11 and 29.3.11 on the basis of which the policy were issued whereas the voter ID of him reveals that his actual age is 74 years and such misrepresentation vitiated the contract between them and him and the age found during investigation was age beyond coverable under the said policy and therefore, there is no legal concluded contract between them and him and the said contract is void- ab-initio. If they had been aware of that fraud practice , they would have issued the policies to the said insured and thus, they rightly repudiated the claim of the complainant which done on the ground of suppression of material fact as to the age of the insured. The mater of repudiation of the claim was communicated to the complainant and he was inform that Rs.3.04 and Rs.2.99 only were credited to the insured’s account under the said policy. Hon’ble Supreme Court of India in the case of Satwant Kaur Sandhu-vs-New India Assurance Co.Ltd. observes that proposal form is to be filled up for the proposer for insurance for furnishing of material information required by the insurer to decide whether to accept or decline, to undertake the risk, and in the event of acceptance of the risk to determine the rates terms and condition of cover to be granted and in the contract of insurance , if any fact which was influence the mind of a prudent insurer in deciding whether to accept or not the risk is a material fact and if the proposer has knowledge of such fact he has oblige to disclose it particularly while answering question of the proposal form and the claimant has no locus standi to claim any assured sum under the policy which was obtained by him by representation an order to defraud the company and in such situation the contract of insurance is void and not enable in the eyes of law as it is entered by insured to defraud the company and in this circumstances the complaint is liable to be dismissed in limine.It is a fundamental principle of insurance law with utmost faith must be observed by the contract of parties and good faith forbids either party from non-disclosure of facts which the party privately knows to draw and the other into a bargain. From him ignorance of that fact and his believing to the contrary. Non-disclosure of material facts by the insured is a sufficient ground for repudiation of the said policies. The insured was suffering from Cerebo Vascular Accident prior to the issuance to the policy and that is the sufficient reason to repudiate the claim under the policy and in such situation, repudiation of the claim does not amount to deficiency of service or negligence on their parts. Therefore, the complainant has no cause of action for filing the instant complaint and is also not entitled to any amount under the said policies nor the compensation as claimed and the complaint is liable to be dismissed.
4) We have perused the pleading of the parties as well as their evidence. It appears to us that both sides’ admit that the father of the complainant, namely Dambaru Baishya had opened one Life Insurance Policy with Met Life Insurance Company Ltd. on 29.3.2011 by filing his application form under Met Suvidha Plan with coverage from 30.3.11 to 30.3.2031 with coverage of Rs.3,65,000/-, of which Rs.5,031/- is to be paid as quarterly premium and his father got the policy bearing No. 20550194 paying premium of Rs.5,083/- on 6.4.2011 and he also paid three more premiums on 18.7.11, 21.10.11, 28.1.12; and he also opened another Life Insurance Policy under the Met Suraksha Plan on 6.7.2011 which was effective on 7.7.2011 to 7.7.2021 with Face value of Rs.7,00,000/- of which payment was ½ yearly premium @ Rs.4,680/- and policy No. is 20610601 and the opp.party also issued a welcome letter to him and thereafter on 21.3.12 he paid next premium which was accepted vide receipt No. 5321127 dtd.21.3.2012, but on 28.3.12, he suddenly fell ill in his residence at Sualkuchi and about that matter Doctor of M.G.30 Beded Rural Hospital, Sualkuchi was informed and the doctor examined him and found him dead at 1 p.m. and he was cremated as per Hindu rite. Both side’s also admit that the present complainant informed the opp.parties about the death of his father ( the original insured) (Dambaru Baishya), though the agent of the opp.party and opp.party also sent condolence letter to him acknowledging the receipt of claim intimation under policy No.2055094 and 20610610 and the opp.party asked him to submit the originals of the policies, Claimant’s Statement,Last Attending Physician’s Statements, Family Doctors Certificate, Photo identity proof, address proof of nominee, copy of care papers like medical records, Admission note, Treatment Records and Discharge certificate, and accordingly he deposited some of said documents to the opp.parties; and the opp.party also, on 9.7.2012, acknowledged the receipt of the documents and assured settlement of the claim in due process, but the opp.party repudiated the claim alleging that as per voter ID, the age of the insured is 74 years but he had stated in the application forms dated. 29.3.2011 and 9.7.2011 his age as 55 years .
5) From the pleading of the parties, it is found that the father of the complainant, namely Lt.Dambaru Baishya had made policy No. 20550194 on 6.4.2011 with the opp.parties by filing application on 29.3.11 of which maturity value is Rs.3,65,000/- and premium was Rs.5,031/- quarterly and he paid the premiums again on 18.7.11, 21.10.11 and 28.1.12; and he also made another insurance policy which policy No. 20610610 on 27.7.11 by filing application on 6.7.2011, of which the premium was Rs.4,680/- per half year, and the maturity value was Rs.7,00,000/- and he also paid next half yearly premium on 21.3.2012; and during effectiveness of both the insurance policies, he died on 28.3.2017; and after his death the present complainant filed claim before the opp.parties , but the opp.party repudiated the claims on the ground that in the voter identity card of the insured his age was 74 years and it was under stated as 55 years in the application form dtd,. 9.7.2011 and 29.3.2011. Now, question is that , whether the insured gave wrong information about his age in the application form of both the policies. The complainant side admits that the insured at the time of filing applications for both the policies quoted his date of birth as 31.12.1957, which means that at the time of filing application for the policies , he was a man of 53 & ½ years . In this case, the wife of the insured namely, Anita Baishya gave evidence and stated that her age on the day of filing affidavit (22.4.2015) is 51 years. As per proposal forms the age of the insured was 53 ½ years, on 6th July,2011, and therefore, had he been alive his age on 22nd April,2015 would have been 57 years 3 months 21 days and that shows that the age difference between the insured and his wife is approximately 6 years 3 months, which quite logical as in this region of our country the range of difference of age between husband and wife is 0 years to 10 years. If we believe that on the date of filling of application forms of insurance policies, the age of the insured was 74 years, but not 53 & ½ years , then difference of age between him and his wife would be 28 years, which cannot be a reasonable difference of age between him and his wife at the time of marriage. So, in such situation, the assertion of opp.parties that at the time of filing application for the policies, the insured was 74 lacks support from the calculation of difference of age between him and his wife. Secondly, if we see the age of complainant , C.W.1 Sri Pankaj Baishya, it is already found that on the date of filing evidence he is a man of 31 years only. So, if we see his age on the day of filing of application of policies i.e.year of 2011 his age would be round about 26 years, meaning thereby on that day the age difference between him and the insured is 48 years . While he is the eldest issue of the insured, that difference of age cannot be an acceptable difference. So, in such situation,the plea of the opp.parties that the age of insured on the day of filling of the applications for the policies as 74 years cannot be said to have sufficient support. In this case the C.W.1 files a certificate from the village headman, which is Ex.23, which shows that the insured had been born on 31.12.57. We have also perused Ex.24, which is a certificate issued by Head master of Sualkuchi Bayan Silpinaish Bidyalaya (High School) and found that the headmaster of that school certifies that the insured left the school in the year 1972 and that his date of birth was 31.12.1957. We have found that Ex.23 and 24 are certificates issued by two government agencies, and the genuineness of these two documents is not questioned by the opp.parties. Therefore, we hold that these two documents are genuine documents and contents thereon are genuine contents. So, these two document can be relied on and we found that these two documents prove that the date of birth of the insured is 31.12.1957. The opp.party side adduces no evidence in this case, but they say that in the voter I card of the insured , it is mentioned that the insured age is 74 years at the time of filing of the applications of the policy, but they fails to produce that voter I.card. We have perused a voter I card of the complainant and found that in the bottom of the voter I card, it is written that voter I card cannot be used as a certificate of age of the holder. Therefore, we cannot hold that the voter I card of the insured is a age certificate. It is known to all that voter I cards were issued only 3/4 years back and I cards bear so many wrongs in the names and age of the holders, and there is scope of correctness of the wrongs in the voter I cards. So, we hold that mistakenly the age of the insured of the voter I might have been printed as 74, while his age would have been printed for 54 years and like that. The insured died on 28.3.12. Therefore, we presume that had he been alive ,he would have applied for rectification of wrong as to his age in the voter I card. So, in such premises, we cannot hold that the voter I card of the insured is a certificate of his age and all the concerned authorities are bound to act upon with voter card as to his age. Closing our discussion as above on the point of age of the insured on the dates of filing the application and instant policies, we, on the basis of analysis given above, hold that on the dates of filling applications of insurance policies , the insured was not a man of 74 years , but a man of 53½ years and he has rightly described his date of birth as 31.12.1957 and that statement as to his age cannot be said to be a mis-representation about his age. So, we parallelly hold that there is also no any mis-representation about anything of him in the said application form. Therefore, we hold that the ground of repudiation of the claim filed by the complainant, which is the complainant mis-represented his age as a man of 53½ years old in application form of the policies, while his actual age was 74 years at that time stands not substantiated.
6) In this case the opp.parties take another plea that before issuance of policies, the insured was suffering from cerebro-vascular accident and that is also a reason sufficient to repudiate the claim. But opp.party adduces no evidence to prove that plea. On the other hand, all three witnesses of the complainant unequivocally state that on 28.3.12 at 12-45 P.M. the insured suddenly suffered from breathing difficulty in his residence in Sualkuchi and the doctor of 30 Beded Rural Hospital, Sualkuchi examined him but the insured died at 1.00 P.M. on that day and the doctor explained the cause of death as L.V.F. Thus, it is clearly established that on 28.3.2012 the insured suddenly felt breathing problem and died on the same day for such problem ,but he was not suffering from cerebro-vascular accident prior to issue of the policies. Therefore, we hold that the 2nd ground of repudiation of the claim i.e. the insured was suffering from Cerebro-vascular accident prior to issuance of policies stands not proved . So, if the claim was repudiated on that ground, then it is a blatant act of illegality. Therefore, we hold that the ground of repudiation of the claim filed is illegal and the complainant being nominee of the both policies are entitled to insured value of both the policies with interest @ 8% per annum from the date of repudiation of the claim alongwith compensation of Rs.10,000/- for causing harassment to him and putting him in mental agony as well as Rs.10,000/- as cost of the proceeding.
7) Because of what has been discussed as above, the complaint against the opp.parties is allowed on contest and they are directed to pay the insured values of the insurance policies i.e.Rs.3,65,000/- against policy No.20550194 and Rs.7,00,000/- against policy No.21610601 with interest @ 8% from the date of repudiation of the claim (25.10.2012) and to pay Rs.10,000/- as compensation for putting complainant in mental agony and causing harassment to him and also Rs.10,000/- as cost of the proceeding, to which, they are jointly and severally liable . They are asked to pay the awarded amount within 45 days, in default, other two amounts shall also carry interest in the same rate.
Given under our hands and seals in this day of the 5th July, 2017.
Free copies of judgment be delivered to the parties.
(Smti A. D. Lahkar) (Md.S.Hussain)
Member President
