DATE OF FILING: 03.11.2015.
DATE OF DISPOSAL: 19.05.2017.
Dr. Alaka Mishra, Member (W):
The complainant has filed this consumer dispute under Section 12 of the Consumer Protection Act, 1986, alleging deficiency in insurance eservice against the Opposite Parties ( in short the O.Ps) and for redressal of her grievance before this Forum.
2. Briefly stated the case of the complainant is that the complainant is the wife of late Krushna Pradhan who made a policy with the O.Ps vide policy number 0138018552 being commenced with effect from 28.10.2009 and date of commencement of the risk from 31.10.2009 with regular premium of Rs.20,000/- for a term of 10 years and sum assured of Rs.2,00,000/- along with minimum death benefit of Rs.2,00,000/-. The husband of the complainant submitted the proposal form wherein the complainant was kept as the nominee. The husband of the complainant at the time of submitting the proposal form has furnished all the required documents for insurance of life and risk to the satisfaction of the O.Ps. The husband of the complainant deposited the premium amount of Rs.20,000/- only and due date of premium was 28th October of every year. Being satisfied with the proposal form and documents furnish by the husband of the complainant, the O.P.No.2 issued the policy bearing number 0138018552 along with the policy bond. While the matter stood thus, the policy holder late Krushna Pradhan husband of the complainant died at village Ektall, District of Nayagarh. The complainant after obtaining the death certificate submitted the claim application to the O.Ps for payment of minimum death benefit of Rs.2,00,000/- as per the terms of contract of the policy bond. On receipt of the said claim forms, the O.P. No.1 instead of payment of the minimum death benefit of Rs.2,00,000/- refunded Rs.25,545/- only towards the account value and credited in the saving account of the complainant. The O.P.No.1 issued its letter of rejection on 1.4.2012 stating that the claim has been repudiated due to misrepresentation of the material facts. The complainant being a widow and at the age of 54 years is suffering from harassments and causing mental agony due to deficiency of services on the part of the O.Ps for non-settlement of the death benefit under the aforesaid policy. Alleging deficiency in service on the part of the O.Ps, the complainant has filed this consumer dispute with the prayer to direct the O.Ps to pay the balance of Rs.1,74,455/- only towards the death benefit, Rs.30,000/- towards compensation for harassment and mental agony, Rs.5000/- towards the cost of the litigation in the best interest of justice.
3. Upon notice, the O.P.No.3 appeared and filed version through his advocate. It is stated the allegations and traversed in various paragraphs of the petition are all not true and correct and are hereby denied. The complainant is put to strict proof all such allegations which are not specifically admitted herein. The averments based on false and fabricated grounds, meant for the purpose of the case. It is stated that one Krushna Pradhan, At/Po: Durdura, via: Mahipur, Dist: Nayagarh, insured himself vide police No.0138018552 and he is not protected by the limitation protected by the law under Section 45 of the Insurance Act and the Insurance Company under Section 45 of the said Act has a right to repudiate the claim if the policy holder is found to have suppressed the material facts. After death of insured, his successor the present complainant filed a claim petition before the concerned authority of Bajaj Allianz Life Insurance Company Ltd. to get the benefit under the scheme reflecting in her claim petition that her husband expired on 08.12.2010 at their residence. As per the company provisions after receipt of the claim petition the O.P. made an investigation through one Sri Siba Sankar Panda, in House Investigator, Odisha and said investigator after investigation submitted report before the concerned authority of the insurance company for necessary action. It is submitted that in the proposal Form the life assured mentioned he was aged about 52 years. But at the time of death his age was 64 years as in the voter list and BPL record. The O.P. rightly repudiated claim of the complainant as the complainant submitted false information to grab the policy claim. There is no cause of action to file the case and the cause of action shown is a creative one for the purpose of this case. The complainant is also liable for criminal proceedings for filing false affidavits and providing false information. The petition is liable to be dismissed as the same has no merit and legal strength.
4. On the date of hearing we heard argument from both sides at length. We perused the complaint petition, written version, written arguments and documents available on the case record. It is an admitted fact that deceased policy holder purchased a policy bearing No.0138018552, the date of commencement of policy is 28.10.2009 and risk of commencement is covered from 31.10.2009 on payment of regular premium of Rs.20,000/- per annum for a policy term of 10 years and sum assured of Rs.2,00,000/- under the said policy. The policy holder died on 8.12.2010. The policy was in force till 28.10.2010 and grace period of one month allowed up to 28.11.2010 to deposit the premiums but death of policy holder was on 8.12.2010 i.e. beyond the policy period coverage. The complainant submitted death certificate to the O.P.No.1 on 2.1.2012 after elapse of one year one month. Thereafter, the O.P.No.1 appointed an investigation namely Sri Sibasankar Panda who submitted his report to the O.P.No.1 on 29.2.2012. The complainant has submitted that the date of death of deceased policy holder is on 8.12.2010 but she intimated to the O.Ps regarding the death of the insured on 02.01.2012. It is also contended by the O.Ps that the deceased life assured (DLA) was willfully suppressed his age as per office records received by the company such as voter list, BPL card and his son and daughter-in-law’s SLC. It was found that the age of DLA is 64 years at the time of his death but as per proposal Form he had mentioned the age as 52 years. So the repudiation of the claim is genuine on the ground of suppression of material fact relating to his age. On careful verification of the report of surveyor, it is found that the surveyor has reported in his conclusive remarks that “as per village neighbors, life assured is dead due to higher age and for that investigation was carried out to find out the actual age of life assured at the time of taking this insurance policy and it was ensured from the office of Sub Collector, Nayagarh and office record for the same justified the actual age of life assured is 64 years which was manipulated at the time of taking the insurance policy to avail the benefit from the product he has taken”. The O.P. 3 submitted proof of age with supporting documents of voter list of 2009 Odisha 121- Dasapalla, Bidhanasabha Mandali , Anurag-1, village: Ektal, Block: Nuagaon, Dist: Nayagarh. Similarly, voter List of 2009 also supported the same facts. On the basis of survey report, the O.P. has rightly rejected the claim and returned the premium amount of Rs.25,545/- (premium Rs.20,000/- + Rs.5,545/- towards interest) vide his letter dated 1.4.2012 towards the account value and credited in the savings bank account of the complainant. It is also a fact that the complainant has not filed any cogent evidence and convincing documentary proof regarding the age of the complainant to counter the findings of the surveyor. With regard to return of balance amount of Rs.1,74,455/- as contended by the complainant towards the death benefit, we are of the view that when the amount of premium has been returned by the O.Ps due to suppression fact by the complainant and when the policy is also in lapsed condition, the payment of rest amount of Rs.1,74,455/- does not arise since the policy is not valid. Moreover, the complainant filed this complaint on 3.11.2015 after elapse of 2 years 8 months which itself is barred by limitation and on that count also this complainant carries no merit.
5. In this case, we have observed that the complainant’s claim appears to be exaggerated and unjust enrichment in a lapsed policy. We failed to find any contemporaneous documents on record with regard to death benefit and we are not convinced to accept the claim of the complainant. In our view, the award of consumer Forum is not a jackpot or a lottery. The contention of the complainant is quite surprising and not tenable under law. We are, therefore, unable to accept the claim of the complainant and reject the same considering the facts and circumstance of the case. In a sequel to the aforesaid discussion and taking into account to the facts and circumstances of the case, we dismiss the case of the complainant against all O.Ps due to devoid of any merit.
6. Resultantly, we find no merit in the complaint filed by the complainant and dismissed the same against all O.Ps leaving the parties to bear their own costs. The case of the complainant is disposed of accordingly.
7. The order is pronounced on this day of 19th May 2017 under the signature and seal of this Forum. The office is directed to supply copy of order to the parties free of cost and a copy of same be sent to the server of
