Order dictated by:

Sh.Anoop Sharma,Presiding Member

1.       Nirmal  Singh has brought the instant complaint under section 12 & 13 of the Consumer Protection Act, 1986 on the allegations that   Sh.Bakshish Singh (now deceased) father of the complainant was insured with the opposite parties and the complainant being class I legal heir has filed the present complaint. Sh. Bakshish Singh, father of the complainant had obtained one Life Insurance Policy bearing No. 21849227 dated 17.3.2016  with the sum assured Rs. 5,00,000/- by paying premium of Rs. 50000/- with premium paying term of 10 years. The complainant was appointed as nominee in the aforesaid policy. The father of the complainant S. Bakshish Singh died on 25.3.2016 due to sudden cardiac attack and he died at the spot. The father of the complainant was not suffering from any heart disease before his death. Intimation to this effect was sent to the opposite party and all the requirements as called for by the Insurance company were provided. All the original papers and original policy bond were also handed over to the opposite party No.1 . After the death of S. Bakshish Singh, complainant being nominee applied for claim under the said policy, but the opposite parties started putting off the matter on one pretext or the other and ultimately flatly refused to make the payment of the claim and repudiated the claim of the complainant vide letter dated 4.6.2016 stating therein “That during the course of verifying the claim we have found that Late Bakshish Singh had already died prior to the solicitation of the Insurance policy  and the policy was fraudulently and maliciously caused to be issued by unknown fraudsters with the aid of Mr. Sunny Kumar Arora  to make unlawful personal gain”. The said act of the opposite parties in repudiating the genuine claim of the complainant amounts to deficiency in service. Vide instant complaint, complainant has sought for the following reliefs:-

(a)     Opposite parties be directed to pay a sum of Rs. 5,00,000/- alongwith interest @ 12% p.a. ;

(b)     Compensation to the tune of Rs. 2,00,000/- alongwith adequate litigation expenses were also demanded.

Hence, this complaint.

2.       Upon  notice, opposite parties No.1 & 2 appeared and filed written version taking certain preliminary objections therein inter alia that there has been no legally valid contract of Insurance between the opposite party and the Deceased Life Assured. It was submitted that the policy was issued on 17.3.2016 and the deceased life assured (hereinafter to be called DLA) expired on 15.3.2016 i.e. prior to the issuance of the policy ; that the opposite party was in receipt of a duly filled and signed proposal form dated 1.3.2016 from one Bakhsish Singh for obtaining a policy of Life Insurance  “Met Smart Platinum”  and offered to pay Rs. 50000/-  towards the initial premium against the sum assured of Rs. 5,00,000/-. Upon receipt of the duly filled up proposal form alongwith the initial premium, the opposite party processed the proposal form on the basis of information furnished by DLA and issued policy bearing No. 21849227 with risk commencement date 17.3.2016. The complainant was made nominee under the said policy. It was submitted that the opposite party received the death claim intimation from the complainant dated 11.4.2016  thereby intimating that the insured person died on 25.3.2016. That the claim being an early claim, as the person insured died  within a short span of 8 days, from the date of issuance of the policy, the opposite party as per the procedure, carried out an investigation to settle the claim of the complainant. During the course of investigation and assessment of the claim, it was revealed that the death certificate submitted by the complainant was a forged death certificate. The DLA expired on 15.3.2016 and that the policy was issued on 17.3.2016 i.e. the  DLA expired prior to the issuance of the policy. However, the complainant submitted a death certificate wherein it has been mentioned that the DLA expired on 25.3.2016. As such the opposite party has rightly repudiated the claim of the complainant on the ground that there was no valid policy of insurance at the time of death of the DLA.  The fund value amounting to Rs. 47,423.66 with unclaimed amount of Rs. 242.25 was transferred to the complainant. On merits facts narrated in the complaint have specifically been denied and a prayer for dismissal of complaint was made.

3.       In his bid to prove the case complainant tendered into evidence his duly sworn affidavit Ex.CW1/A alongwith documents Ex.C-1 to Ex.C-7, duly sworn affidavit of Sh.Rachhpal Singh Ex.CW2/A, copy of Aadhar card Ex.CW2/1, duly sworn affidavit of Sh.Mahan Singh Lambardar Ex.CW3/A, copy of Aadhar card Ex.CW3/1, affidavit of Sh. Sharanjit Singh Panch Ex.CW4/A, copy of Aadhar card Ex.CW4/1, duly sworn affidavit of Sh.Harvinder Singh Ex.CW5/A, copy of Aadhar card Ex.CW5/1, copy of the entry of the death of Bakhshish Singh Ex.CW6/1, attested copy of BLO card Ex.CW6/2, affidavit of Sh.Gurpreet Singh Ex.CW7/1, copy of bill dated 26.3.2016 ExCW7/2, copy of Aadhar card of Gurpreet Singh Ex.CW7/3, affidavit of Gurpreet Singh Ex.CW8/1, copy of bill dated 26.3.2016 Ex.CW8/2, copy of Aadhar card of Gurpreet Singh Ex.CW8/3 and closed the evidence on behalf of the complainant.

4.       To rebut the aforesaid evidence Sh.Ajay Shanker,Adv.counsel for opposite parties No.1 & 2 tendered into evidence affidavit of Sh.Monty John, General Manager Ex.OP1,2/1A, copy of application form alongwith policy documents Ex.OP1,2/1, copy of death claim intimation and other documents Ex.OP1,2/2, copy of other documents Ex.OP1,2/3, copy of repudiation letter Ex.OP1,2/4 and closed the evidence on behalf of opposite parties No.1 & 2.

5.       We have heard the ld.counsel for the parties and have carefully gone through the record on the file.

6.       From the record i.e. pleadings and evidence produced on record by both the parties, it is clear that father of the complainant Sh.Bakshish Singh obtained Life Insurance policy bearing No. 21849227 dated 17.3.2016 by paying premium of Rs. 50000/-  with premium paying term of 10 years with sum assured Rs. 5,00,000/-. Father of the complainant S. Bakshish Singh unfortunately died on 25.3.2016 due to sudden cardiac attack and died at the spot. Intimation to this effect was sent to the opposite party alongwith all the requisite documents as required by the opposite party. The complainant being nominee lodged claim with the opposite party No.1 with the request to pay the genuine claim of the complainant, but the opposite parties put off the matter on one pretext or the other  vide letter dated 4.6.2016 on the ground that Bakshish Singh,DLA had already died prior to the solicitation of the Insurance policy and the policy was fraudulently and maliciously caused to be issued by unknown fraudsters with the aid of Mr. Sunny Kumar Arora”. The act of the opposite party in repudiating the genuine claim amounts to deficiency in service.

7.       Whereas the case of the opposite party is that the policy was issued on 17.3.2016 and the DLA expired on 15.3.2016 i.e. prior to the issuance of the policy. It was submitted that upon receipt of the duly filled up proposal form on the basis of the information furnished by the DLA issued the policy bearing No. 21849227 with risk commencement date 17.3.2016. The complainant was made under the said policy. It was further submitted that the opposite party received the death claim intimation from the complainant dated 11.4.2016 intimating that the insured died on 25.3.2016. It was further submitted that  the claim being an early claim as the person insured died within a short span of only 8 days, from the date of issuance of the policy, opposite party  carried out an investigation to settle the claim of the complainant. During the course of investigation and assessment of the claim, it was revealed  that the death certificate submitted by the complainant was forged death certificate. The DLA expired on 15.3.2016 and the policy was issued on 17.3.2016 i.e. DLA expired prior to the issuance of the policy.  However, the complainant had submitted a death certificate wherein it has been mentioned that the  DLA expired on 25.3.2016. As the complainant in order to make wrongful gain submitted a forged death certificate. As such the opposite party rightly repudiated the claim of the complainant.

8.       But, however, from the appreciation of the facts and circumstances of the case, it becomes evident that the complainant has obtained Insurance policy bearing No. 21849227 with commencement date 17.3.2016.  The father of the complainant Bakshish  Singh unfortunately died on 25.3.2016 and in this regard complainant has filed death certificate C-1. After the death of Bakshish Singh, complainant being nominee, lodged claim with the opposite party, but the opposite party repudiated the claim of the complainant on the ground that deceased life assured has died on 15.3.2016 i.e. prior to the issuance of the insurance policy in dispute. But in order to prove that Bakshish Singh died on 25.3.2016, complainant has placed on record death certificate Ex.C-1 on record. The complainant has also placed on record  original certificate issued by Local Registrar Birth and Death Ex.C-2, copy of Panchayatnama Ex.C-3, original certificate issued by Punjab National Bank Ex.C-5, affidavit of Mr. Rachhpal Singh Ex.CW2/A, affidavit of Mahan Singh, Namberdar Ex.CW3/A, affidavit of Sh. Sharanjit Singh, Member Panchayat (Panch), affidavit of Sh. Harwinder Singh Ex.CW5/A which fully prove that Bakshish Singh died on 25.3.2016. However, the opposite party could not produce any piece of evidence to rebut the cogent and convincing evidence/affidavits produced by the complainant to prove the factum of date of death of insured Bakshish  Singh

9.       Simply saying that some fraud , manipulation etc. has been pressed into service for getting the claim, cannot be a ground to dislodge the genuine claim of the complainant. Over-whelming evidence  adduced by the complainant in support of his claim has gone unrebutted on record. Not even an iota of doubt arises that the death of Bakshish Singh has not taken place on 25.3.2016.

10.     The opposite parties have erred in repudiating the  genuine claim of the complainant. It is usual with the insurance companies to show green pastures to the persons to allure them to purchase the policies & when it comes to payment of claim, they invent flimsy excuses to deny the claim. Reliance in this regard can be placed upon Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) of the Hon’ble Apex Court, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation.  This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible. It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. On this point, Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 has held to the following effect:-

“It seams that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.       

The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.

11.     From the aforesaid discussion, it transpires that the complainant has been able to prove his case through cogent evidence. No fraud or manipulation is proved to have been indulged by the complainant regarding date of death of life assured Bakshish Singh. Consequently, the claim of the complainant succeeds and opposite parties  are directed to pay insurance claim to the tune of Rs.5,00,000/- in favour of the complainant alongwith interest @ 9% p.a. from the date of filing of the claim until full and final recovery. Cost of litigation is assessed at Rs. 2000/-.  Compliance of this order be made within 30 days of the receipt of copy of the order . Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum. Copies of the orders be furnished to the parties free of costs. File is ordered to be consigned to the record room.

Announced in Open Forum

Dated : 25.4.2017