Order dictated by:

Sh.Anoop Sharma, Presiding Member

1.       Sandeep Singh, complainant has brought the instant complaint under section 12  & 13 of the Consumer Protection Act, 1986 on the allegations that  complainant being son and nominee of deceased Sulakhan Singh has filed the present complaint. Sh. Sulakhan Singh son of Sh. Dalip Singh R/o V. Badowal Kalan, Tehsil Dera Baba Nanak, Gurdaspur obtained an Insurance policy bearing No. 21528028 for Rs. 2,50,000/- from opposite party No.1 . The term of the policy was 10 years and mode of payment of premium was half yearly. The complainant paid half yearly premium of Rs. 12,607/- on 20.3.2015 and policy was issued in favour of Sulakhan Singh, deceased. Due to ill luck, Sulakhan Singh died on 14.6.2015 due to heart attack. The complainant being nominee of deceased Sulakhan Singh submitted claim, but the opposite party repudiated the claim of the complainant on false and frivolous ground. The opposite party alleged that the ID proof i.e. driving license No. 747 dated 12.8.2010 submitted by the insured was not genuine document. The ID proof submitted by the insured at the time of insurance policy is genuine and verification report issued by the Licensing Authority (Motor), Dera Baba Nanak dated 28.3.2016 in respect of driving license No. 747 dated 12.8.2010 valid upto 11.8.2015 is attached. The refusal on the part of the opposite parties is illegal , null and void and the complainant is entitled to the insurance amount covered under the abovesaid Insurance policy. The complainant many times approached the opposite party and made verbal requests, sent e-mails and wrote letter dated 23.5.2016 submitting the verification report of the driving license stating that the ID proof of the insured is a genuine document . But again vide letter dated 17.10.2016 opposite party has refused to make payment of the claim to the complainant. Vide instant complaint, complainant has sought for the following reliefs:-

(a)     Opposite parties be directed to pay the sum assured Rs. 2,50,000/- alongwith other benefits to the complainant ;

(b)     Compensation to the tune of Rs. 50000/- alongwith litigation expenses Rs. 10000/- may also be awarded to the complainant.

Hence, this complaint.

2.       Upon notice, opposite parties No.1 to 3 appeared and filed a joint written version taking certain preliminary objections therein inter alia that complainant had submitted duly signed proposal form after fully understanding and deliberating upon the terms and conditions of the policy concerned. The terms and conditions of the policy are in strict adherence to norms set by IRDA and were duly communicated to the complainant ; that the opposite party has acted strictly on the basis of the terms and conditions contained in the policy. The present case is premature as the complainant had not submitted the required documents for the purpose of the claim despite repeated requests  by the answering opposite parties ; that complainant does not fall under the definition of consumer as per Consumer Protection Act and thus the Consumer Forum has no jurisdiction to try and decide the present complaint. On merits, it was submitted that the policy holder himself approached the opposite parties to purchase the policy as per his own requirements. Different insurance plans, terms and conditions and benefits were explained to the policy holder  and after going through the same, the policy holder opted for the Met Life Money Back Plan/policy. The DLA after being fully satisfied with the terms and conditions of the policy submitted the proposal form. The proposal form was submitted by the DLA which was duly signed and filled. The policy was issued only on the basis of the proposal form and the information which was supplied by the DLA. The claim of the complainant was rightly repudiated  by the answering opposite parties after thorough  investigation conducted by the authorized investigator namely Sanjay Kumar Sharma son of Janak Deo Sharma, who had disclosed that the DLA was of 62 years old at the time of inception of the policy but as per the proposal form the DLA was of 49 years only. The DLA had knowingly and intentionally disclosed his wrong age in the proposal form with the malafide intention just to commit fraud upon the opposite parties. As such the claim of the complainant was rightly repudiated . The alleged ID proof and the verification report is a forged document  or the same was obtained by illegal means. While denying and controverting other allegations, dismissal of complaint was prayed.

3.       In his bid to prove the case  complainant tendered into evidence his duly sworn affidavit Ex.CW1/A, copy of claim decision letter dated 12.10.2015 Ex.C-1, copy of application for license of No Objection Certificate Ex.C-2, copy of death certificate of Sulakhan Singh  Ex.C-3, copy of welcome letter Ex.C-4, copy of Aadhar card Ex.C-5, copy of driving license Ex.C-6, copy of Aadhar card Ex.C-7, copy of claim intimation form Ex.C-8, copy of letter dated 23.5.2016 Ex.C-9, copy of e-mail Ex.C-10 and Ex.C-11, copy of claim review decision letter dated 17.10.2016 Ex.C-12, copy of voter card of  Sulakhan Singh Ex.C-13 and closed his evidence.

4.       To rebut the aforesaid evidence Sh.Ankur Sanon,Branch Service Manager of  the opposite parties tendered into evidence his duly sworn affidavit Ex.OP1, copy of application form Ex.OP2 and closed the evidence on behalf of the opposite party. In additional evidence Sh.Davinder Gujral,Adv.counsel for the opposite party tendered into evidence copy of Metlife Money Bank Plan Ex.OP3, copy of PNB Metlife Investigation report Ex.OP4, copy of voter list Ex.OP5, copy of voter card of Sandeep Singh Ex.OP6. copy of voter card of Manjit Kaur Ex.OP7, copy of affidavit of Investigator Sanjay Kumar Sharma Ex.OP8 and closed the additional evidence on behalf of the opposite party.

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

6.       Ld.counsel for the complainant has reiterated the facts as narrated in the complaint and has vehemently contended that father of the complainant namely deceased Sulakhan Singh son of Sh. Dalip Singh R/o V. Badowal Kalan, Tehsil Dera Baba Nanak, Gurdaspur obtained an Insurance policy bearing No. 21528028 for Rs. 2,50,000/- from opposite party No.1 . As per the policy the term of the policy was 10 years  and mode of payment of premium was half yearly. The insured paid half yearly premium of Rs. 12,607/- on 20.3.2015 and policy was issued in favour of Sulakhan Singh, deceased. It has vehemently been contended that due to ill luck, Sulakhan Singh died on 14.6.2015 due to heart attack. The complainant being nominee of deceased Sulakhan Singh submitted claim, but the opposite party repudiated the claim of the complainant on false and frivolous ground that the ID proof i.e. driving license No. 747 dated 12.8.2010 submitted by the insured was not genuine document. It was the case of the complainant that the ID proof submitted by the insured at the time of insurance policy is genuine and verification report issued by the Licensing Authority (Motor), Dera Baba Nanak dated 28.3.2016 in respect of driving license No. 747 dated 12.8.2010 valid upto 11.8.2015 is attached. Ld. Counsel for the complainant submitted that the opposite party has illegally repudiated the genuine claim of the complainant and all this amounts to deficiency in service.

7.       On the other hand ld.counsel for the opposite party has repelled the aforesaid contentions  of the ld.counsel for the complainant on the ground that the policy holder himself approached the opposite parties to purchase the policy as per his own requirements.  It was submitted that different insurance plans, terms and conditions and benefits were explained to the policy holder  ,who after going through the same, opted for the Met Life Money Back Plan/policy. It was further submitted that the proposal form was submitted by the DLA which was duly signed and filled. On the basis of the proposal form, policy was issued to the policy holder. The claim of the complainant was rightly repudiated  by the answering opposite parties after thorough  investigation conducted by the authorized investigator namely Sanjay Kumar Sharma son of Janak Deo Sharma, who had disclosed that the DLA was of 62 years old at the time of inception of the policy but as per the proposal form the DLA was of 49 years only. The DLA had knowingly and intentionally disclosed his wrong age in the proposal form with the malafide intention just to commit fraud upon the opposite parties. . Ld.counsel for the opposite parties submitted that the claim of the complainant has rightly been repudiated and there is no deficiency in service on the part of the opposite parties.

8.       From the entire above discussion, it stands proved on record that Sh.Sulakhan Singh, father of the complainant obtained insurance policy exbt.C-4 from the opposite parties with commencement date 20.3.2015 and date of maturity 20.3.2025 on payment of Rs.12229/- as premium with a sum assured of Rs.2,50,000/-. Sh.Sulakhan Singh expired on 14.6.2015  due to heart attack.                                                                                                                                                                                                                                                                                    Complainant being nominee of life assured filed death claim with the opposite parties, but the opposite parties repudiated the claim of the complainant vide letter exbt.C-1 on the ground that life assured had mentioned his age while obtaining policy in question as 48 years. It is pertinent to mention here that in the policy Ex.C-4 issued to DLA Sulakhan Singh the date of birth of the insured was mentioned as 28.3.1966 and while obtaining the policy the deceased life assured Sulakhan Singh had submitted his ID proof i.e. driving license  which was issued on 12.8.2010 in which the date of birth of deceased Sulakhan Singh was shown as 28.3.1966 , as such the age of deceased life assured at the time of obtaining the driving license was 44 years and the present policy was issued in the year 2015, as such at the time of getting the policy by the deceased life assured  Sulakhan Singh was 49 years . The complainant himself got verified this fact regarding genuineness of the driving license issued to DLA  Sulakhan Singh from Licensing Authority (Motors) Dera Baba Nanak copy of certificate in this regard is Ex.C-2 on record. In the Aadhar card Ex.C-5 also the year of birth of Sulakhan Singh was shown as 1966. But when the complainant lodged the claim, the opposite parties have repudiated the same on the ground that driving license which was submitted by DLA Sulakhan Singh as standard age proof was found to be not genuine   .  However, opposite parties got the matter investigated from Sanjay Kumar Sharma, who submitted his report exbt.OP4 in which investigator has reported that he inquired about the age of life assured, Sh.Sulakhan Singh from his neighbourers  as well as friends’/relatives and have come to conclusion that age of life assured was 62 years approximately . But the opposite parties have not produced any affidavit of any neighbours to prove that life assured was not 49 years but 62 years as alleged by the opposite party at the time of taking the policy.  The Investigator further submitted that   the DLA was of 62 years old at the time of inception of the policy but as per the proposal form the DLA was of 49 years only. To prove the aforesaid assertion, opposite parties have placed on record copy  of voter card of Sandeep Singh son of Sulakhan Singh showing the age as 28 years  as well as affidavit of Manjit Kaur  being spouse of deceased Sulakhan Singh showing the age as 60 years as well as copy of voter list Ex.OP5 in which age of deceased Sulkahan  Singh was described as 62 years. However, it is strange enough that in the death certificate of deceased Sulakhan  Singh Ex.C-3 the name of wife of deceased Sulakhan Singh was mentioned as Rajwinder Kaur but in the voter card the name of wife of deceased Sulakhan Singh was shown as Manjit Kaur. So it seems that the opposite party has procured the documents in haste only to show the age which was written on this document as 60 years but could not verify all the facts . The plea of the opposite parties with respect to non disclosing his age in the proposal form is also without any force. Voter card as well as Ration card are not conclusive proof of age of any person. Reliance in this regard has been placed upon Life Insurance Corporation of India & Ors Vs. Krishna 1(2010) CPJ 214 wherein it has been held that ration card not a conclusive proof of age of any person    . However, the opposite parties have repudiated the claim  on the ground that driving license which was submitted by DLA Sulakhan Singh as standard age proof was found to be not genuine   . However, complainant has proved the driving license by submitting copy of certificate Ex.C-2 which was issued from the Licensing Authority(Motors) Dera Baba Nanak. But, however, opposite parties have not produced any evidence to rebut the evidence produced by the complainant that the DLA got issued the driving license illegally. Had the age of life assured was 62 years at the time when he applied for the policy, why the opposite party did not check and collect the evidence to prove the age of life assured and why they issued the policy without satisfying themselves about the age of the life assured. Now when the life assured had expired and claim became due, opposite party is blowing hot and cold in the same breath. All this amounts to unfair trade practice on the part of the opposite party. It is seen that insurance companies show green pastures to the insured persons at the time of selling  the insurance policy and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, 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. In similar set of facts the 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 went on to hold as under:-

“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.

9.         From the above discussion. We come to the conclusion that opposite parties have wrongly repudiated the death claim of DLA Sulakhan Singh. Resultantly, we allow the complaint with costs and the opposite parties are directed to pay the insured amount of Rs.2,50,000 (Rupees Two Lakh fifty thousand only ) as death claim of DLA Sulakhan Singh, to the complainant alongwith interest at the rate of 9% p.a.from the date of filing of complaint till payment is made to the complainant. Opposite parties is also directed to pay Rs.2000/- as litigation expenses. Compliance of the orders be made within a period of one month from the date of receipt of copy of orders. 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 : 16.8.2017