Shri B. Mukhopadhyay, President.   

This is an application u/s.12 of the C.P. Act, 1986.

            Complainant by filing this complaint has submitted that her husband Dinesh Agarwal since deceased purchased one Janata Personal Accident Insurance Policy during his life time from the OP1 through OP2 having policy No.100300/47/01/ 9600022/02/96/30271 covering the period from 15-11-2002 to 14-11-2012 for sum assured Rs.4 Lakhs in which the nominee’s name was noted the present complainant’s name as wife and present complainant is the wife of deceased Dinesh Agarwal i.e. Smt. Suchitra Awarwal.

            It is specifically alleged that her husband Dinesh Agarwal due to road traffic accidental died 10-01-2009 leaving behind three minor children, and widow the present complainant and regarding said accidental death Baguihati P.S. Case U/D Case being No.4/09 dated 11-01-2009 was started and P.M. Examination was held being P.M.R. No.20 dated 11-01-2009 and final report U.D. Case No.4/09 dated 11-01-2009 was submitted.

            On his death practically complainant’s family suffered financial loss and also suffered mental pain and agony so complainant filed claim form duly filled in along with necessary papers to the OP1 but as because the complainant is illiterate lady and as housewife has no legal knowledge about the business and system of the corporate system so he failed to take any step and owing to illiteracy, economic hardship Insurance Company harassed her on several ways and thereafter released a sum of Rs.2,50,000/- instead of giving her the full benefit of the insured and deprived her from getting balance amount of Rs.1,50,000/- and so, complainant through his lawyer sent a notice to the Insurance Company for the balance payment of Rs.1,50,000/- but they did not pay any heed and also they did not settle the said claim finally and for harassing the complainant in such a way and not for releasing the balance Rs.50,000/- the complainant is filed this case.

            On the other hand, OP Insurance Company by filing written version submitted that admittedly OP1 issued one insurance policy i.e. Janata Personal Accidental Insurance Policy as per declaration of the insured having his monthly income of Rs.9,000/- and Insurance contract was based on principle of Uberimma fides i.e. utmost good faith and on the basis of such declaration of the complainant’s husband the policy was issued and sum insured was Rs.4 lakhs.  But the said policy was a special type of policy and the terms and condition of the said policy had been framed by the IRDA and in such a policy maximum sum insured can be provided to insured or his legal representative is up to 60 times of monthly income of such proposal however in the instant case the wife of deceased submitted claim but complainant was asked to produce the document of his monthly income to the extent of Rs.9,000/- but complainant failed to produce the same.  So, considering the guideline framed by the Hon’ble Apex Court maximum notional income was assessed Rs.4,000/- per month.  Thereafter, it is multiplied by 60 times along with   Rs.10,000/- and Rs.2,50,000/- was released as final settlement of the claim and that the complainant signed in the issued voucher and received the same.  Thereafter, on receipt of the same she signed claim discharge form but subsequently after lapse of 6 months she sent letter for further claim but it is not tenable in eye of law in view of the settled principle of law and also for not filing certificate or document of any employer or any ways that he used to earn Rs.9,000/- prior to his death.  So, the present complaint should be dismissed.

Decision with Reasons

In the present complaint after hearing of the Ld. Advocates of both the parties also considering the terms and condition of the policies it is clear that on the death of insured in such a case 60 times of monthly income of the respective insured shall be multiplied with the income of the insured prior to his death and it is also proved that practically it is a Janata Personal Accidental Insurance Policy which was issued in the name of Golden Trust Financial Services covering the risk of the member of Golden Trust Financial Services but in this case OP2 Golden Trust has failed to produce any paper to show that Dinesh Agarwal was their member of the Golden Trust Financial Services by any means.  Another factor is that at the time of filing the application form for covering the risk of several persons by OP2, OP2 noted the income of this particular fellow Dinesh Agarwal to the extent of Rs.9,000/- per month without any document but it is the settled law that if any person declares any statement falsely for that reason even after issuance of the policy by the Insurance Company the insured shall have to suffer if it would be found that his declaration is false and without any basis.

            Fact remains that present complainant received the cheque of Rs.2,50,000/- on 12-06-2010 submitting an affidavit and in the affidavit she has disclosed that she failed to produce any paper regarding his husband’s income to the extent of Rs.9,000/- and further OP2 GTFS also failed to show that Dinesh Agarwal was the member of their Company and his income was Rs.9,000/- per month.  So, considering that fact it is clear that OP2 or the complainant have failed to prove that Dinesh Agarwal had his income to the extent of Rs.9,000/- till his death.  At the same time OP2 who actually purchased this said Janata Personal Accidental Insurance Policy for the member of that company failed to produce any such document that he was the member of that company and his income was Rs.9,000/- so it is clear that false statement was given by the GTFS and Dinesh Agarwal at the time of opening this insurance policy and it is proved that Dinesh Agarwal was not the member of GTFS but GTFS by adopting this unfair means purchased the same covering the risk the life of present Dinesh Agarwal and no doubt Dinesh Agarwal died to road accident and that is the undisputed fact that he died on 10-01-2009 and fact remains the present complainant is the wife of Dinesh Agarwal and her name is noted in the policy as nominee and admitted position is that Dinesh Agarwal died leaving behind his three minor sons and wife, present complainant as widow.

            Now, the question is whether the complainant can get balance amount of Rs.1,50,000/- legally, in this regard we have heard the Ld. Lawyers of both the parties and after considering the decision of the Hon’ble Apex Court reported in AIR 2010 SC 1704 and also the present fact and circumstances, it is found that it is fundamental principle of insurance law i.e. utmost good faith must be observed by contracting parties without concealing (non-disclosure) what he privately knows to draw and it is the duty of the insured to disclose everything instantly and also the duty of the insurer and their agent to disclose all the facts out of their knowledge obligation of good faith place to them equally with the assured and the duty of the good faith is of continue nature and after completion of the contract no material alteration can be made in its term except by mutual consent materiality of the fact is judged by the circumstances existing at the time when the contract was executed and applying this authority in that present case it is found that the OP GTFS and insured Dinesh Agarwal gave their declaration that income of Dinesh Agarwal was Rs.9,000/- but on his death when the claim was submitted the complainant failed to produce any paper to show that at any point of time prior to his death his monthly income was Rs.9,000/- and further complainant by filing affidavit also admitted that no document was available to show that her husband income was extent of Rs.9,000/-.  Then it is clear that false declaration in respect of the income of Dinesh Agarwal was given by Dinesh Agarwal and GTFS, OP2 at the time of purchasing of this policy for which it could not be filed by the OP2 also who submitted proposal form that Dinesh Agarwal was the member of the GTFS and his income was Rs.9,000/- and OP2 appeared in this case filed a written statement but did not admit that Dinesh Agarwal was the member of his Company and he also did not produce any paper that Dinesh Agarwal had income of Rs.9,000/- per month at the time of opening the policy so considering the above fact it is found Dinesh Agarwal and OP2 gone a false declaration about the income of Dinesh Agarwal and it was the fault of the OP2 and the complainant’s husband who failed to produce such income certificate.  Then invariably the OP1 the Insurance Company took a moral view and relied upon the Supreme Court’s Observation in respect of notional income of the OP to the extent of Rs.4,000/- per month and released Rs.2,50,000/- and informed the complainant.  Thereafter, complainant invariably talked with other family members and submitted affidavit and received the cheque and encashed it and issued discharged voucher and at that time no complaint was filed to the insurance company OP1 about their conduct and after releasing the amount they waited and thereafter she began to roam and, thereafter, with hired opinion he filed this complaint making allegation against the insurance company about practicing fraud and undue pressure of the management to collect signature in the affidavit but we have minutely considered the material of the complaint and also the conduct of the complainant and her entire act wherefrom we have gathered that all allegations are false because at the time of purchasing this policy by Dinesh Agarwal through OP2 they also gave false declaration about his income and that  was not denied even after death by the OP2.

            Not only the allegation are only false against the OP but it has become a practice of the insured and sometime the insured’s relative not to give proper documents not to give proper details at the time of settlement of the claim and thereafter they receive the insured amount from LIC what is issued as final settlement amount and on receipt of that all cause of action is arisen to the consumer and such sort of complaints are being filed.

            Particularly in this case we have gathered no fraud has been practiced by the OP1 but fraud has been practiced by OP2 and complainant’s husband at the time of purchasing insurance policy what we have gathered that insurance company in this particular case no doubt showed their moral values for which complainant got Rs.2,50,000/- and that is not at all very small amount and moreover considering the judgment passed in AIR 2010 SC 1704 and EV (2011) CPJ 2052 NC we are confirmed that the spirit of that judgment are applicable in the present case what we have relied upo and applied in this case and we are convinced to hold that the entire claim is baseless and allegation of the complainant is concocted and no doubt a cock and bull story but final truth is that OP2 and Dinesh Agarwal gave false statement regarding the income of Dinesh Agarwal at the time of purchasing the said policy and no doubt Dinesh Agarwal had no income to the extent of Rs.9,000/- per month till his death and for which complainant also failed to produce such document but OP2 may file the same but failed to produce that means Dinesh Agarwal was not member of GTFS and he was third party and GTFS by manipulation purchased the said policy but even then OP Insurance by passing such technicalities of the said policy released Rs.2,50,000/- out of sum assured Rs.4 lakhs and the present case practically bears no merit in the eye of law in the result complaint fails.

Hence,

Ordered

That the complaint be and the same is dismissed on contest against the OPs but without cost.