PER:

Charanjit Singh, President

1        The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 12 against the opposite parties on the allegations that the late husband of the complainant namely Kedeep Singh had its saving account with Punjab National Bank at the above mentioned address of opposite party No.1. The saving account number was 1932000100181916.  Under the allurement and asking of the officials of the opposite parties, the deceased husband of the complainant agreed to buy life insurance policy from opposite parties. On payment of premium for life insurance policy the opposite parties issued a Policy No.22708904 under "PNB Metlife endowment Savings Plan Plus". The sum assured under the policy was Rs.16,58,405/-. The date of inception of policy was 18.12.2018 and date of commencement of Risk was 31.10.2018. The late husband of the complainant had named the complainant i.e. his wife as nominee of the insurance policy. Thus the complainant became consumer of the opposite parties. Unfortunately the insured husband of the complainant met his untimely and unfortunate death on 26.01.2019 due to sudden heart attack, which was so severe that it took the life of insured. The death of the insured was timely intimated to the concerned officials of the opposite parties and claim was lodged seeking death benefits by the nominee/complainant. The information was given to the opposite parties through their representatives. The complainant on demand presented all the necessary documents to substantiate the death of Insured. The representative who visited the house of the complainant took all the documents such as original policy documents, documents pertaining to policy claim, death proof etc. with an assurance that the claim will be settled at the earliest and the documents will be returned. In the beginning the officials of the opposite parties delayed the claim for one reason or another. Then the complainant to her utter surprise received a letter dated 10.4.2019 stating that death claim of the life insurance of insured Kedeep Singh is repudiated. The reasons mentioned while repudiating the insurance claim are illegal, flimsy, unsustainable, imaginary, false and frivolous to the wildest imaginations of prudent person. The factum of death and reasons which caused the death of the insured was very much in knowledge of the officials concerned of the opposite parties but due to malafide motives of the opposite parties the claim made has been wrongly repudiated to deprive the complainant from her lawful claim. The opposite parties also appointed Investigator as per procedure and while investigating the claim, officials representing themselves to be investigators of the opposite parties, came to the complainant and demanded a huge amount for passing the claim of the complainant. But the complainant showed her inability to pay any amount to the investigator and investigators threatened the complainant that she will not get any claim without their report and thus true to their threats the insurance claim was rejected on flimsy and frivolous grounds. After receiving the repudiation letter the complainant had requested the officials of the opposite parties to re-consider the claim but to no effect and rather the officials of opposite parties No.1 had insulted the window wife of the insured in public view. The complainant with folded hands has on multiple occasions asked for the reason for not allowing her legal claim but no answer has either been communicated or mentioned to the complainant. The complainant is simple rustic villager and is neither well educated nor well conversant with the English Language, the officials of the opposite parties use to take all the documents, letters received from the complainant on the pretext that they are helping the complainant and soon her claim will be settled. Thus believing upon the assurance of the Officials of the insurance company the complainant very innocently handed over all the documents received or asked by the officials of the insurance company.  The complainant prayed that the opposite parties be directed to settle the claim of insurance and to pay Rs. 16,48,405/- alongwith interest from the date of lodging the claim and also prayed Rs. 1,00,000/- as compensation and Rs. 25,000/- as litigation expenses. Alongwith the complaint, the complainant has placed on record affidavit of complainant Ex. C-1, alongwith documents i.e. Adhar Card of complainant as well as her husband Ex. C-2, C-3, Copy of policy document i.e. welcome letter and policy preamble Ex. C-4, C-5, copy of death certificate and claimant statement of death and repudiation letter Ex. C-6, C-7, C-8.

2        Notice of this complaint was sent to the opposite parties and opposite parties appeared through counsel and filed written version by interalia pleadings that the complaint filed by the complainant is not maintainable and is liable to be dismissed. The complainant has suppressed material facts from this commission.  The policy bearing No. 22708904 dated 18.12.2018 was issued by the opposite parties on the basis of the information provided by the DLA in the proposal form dated 29.10.2018. As per the investigation carried out by the opposite party, the policy in question was taken in a very pre planned manner in order to play fraud with opposite parties as the following modus-operandi was used for taking the policy. The series of events showing the modus- operandi is reproduced as under:-

(i)      Firstly the aadhar card of Kedeep Singh and complainant Rachna Rani was prepared at the address of Phase-2, Fatiabad Road, Goindwal Sahib, Tarn Taran. The date of birth of Kedeep Singh and Rachna Rani is the same as 01.01.1996.

(ii)     On the basis of Aadhar Card, PAN Card No. KRMPS9387D and DTMPR321N were prepared on 21.09.2018 in the name of Kedeep Singh and Rachna Rani.

(iii)    On the basis of Aadhar Card and PAN Cards, bank account was opened on 12.10.2018 with Punjab National Bank, Branch Goindwal Sahib, Taran Taran. The mobile number was given as 95929-08790.

(iv)    The policy was proposed on 29.10.2018 from the Mukatsar Branch of Punjab National Bank. The mobile number was given as 81948-57729. Sri Mukatsar Sahib is 145 Km Away from Tara Taran

(v)     Complainant got opened his New Bank Account with Oriental Bank of Commerce, branch Tarn Taran on 23.01.2019. The mobile No. was given as 88724-50413.

(vi)    On 06.03.2019 the opposite party received the Intimation regarding the death of Kedeep Singh alleged death on 26.01.2019 at 06-00 PM, place of death shown as at Relative. Alongwith the claim form, bank account of DLA, complainant herself, death certificate, aadhar card, PAN Card, Policy document (2 pages) were submitted.

(vii)   Since deceased died just within one month & 8 days from the date of issuance of policy. The company immediately appointed Prefecture, an investigator to Investigate the genuineness of the claim.

(viii)  Investigator visited the address of complainant, but address was not found. The investigator met number of persons of the village as well as to the Sarpanch and to verify about Kedeep Singh. But the persons of the locality stated that no Kedeep Singh was lived here. Even one of the person stated that no such address is exists. Nobody in the locality could actually recognize the father name of deceased. The investigator showed Picture of deceased Kedeep Singh to the neighbors but all of them denied knowing/acknowledging person in that picture. They were adamant that no such person exists as per entire neighborhood feedback.

(ix)    The investigator then met Anganwari worker Mandeep Kaur Kang and she got recorded her statement to the investigator that Kedeep Singh S/o Jeet Singh was not resident of Goindwal Sahib and she never seen the said person. The death is not registered in her record. She has no knowledge about his death.

(x)     The investigator met multipurpose health worker who also verified their record and stated that there is no death record of Kedeep Singh S/o Sh. Jeet Singh in their register.

(xi)    The investigator got procured the application form for issuance of death certificate from the office of Registrar & Birth, wherein M.C. Ram Lal of Tarn Taran signed on the information form of death. Interestingly the death of deceased was shown at Muradpur, Tarn Taran and occupation shown as labour work. The investigator then approached in M.C. Ram Lal, who given the statement to the investigator that one lady namely "Babi" of her ward came with him and Informed me that kedeep died at Muradpur Byepass and on verification, he came to know that "Babi"has given wrong information about the death of Kedeep Singh. He never seen the dead body of Kedeep Singh and the death information form was wrongly signed & stamp from him.

(xii)   The death certificate got prepared in a pre- planned manner from M.C. Tarn Taran, which is 25 Km. away from village Goindwal. The death was very cleverly shown at Muradpur in order to easily get the death certificate on the basis of declaration of M.C. of area.

( xiii) The investigator also visited the cremation ground, where the record of all the dead persons were maintained, but the name of deceased was not found in the record of cremation ground.

(xiv)  The investigator also visited at Gurudwara Shri Baoli Sahib, Goindwal Sahib (Tarn Taran), where the ashes are taken. Investigator met Gurudwara Incharge S. Satnam Singh, he provided the death register and no name of the Kedeep was found mentioned in the register.

(xv)   The investigator visited Punjab National Bank, branch Goindwal Sahib (Tarn Taran) and met Branch Manager Harwinder Singh and he told that his employee Mohit opened the bank account and till date only one transaction was done in the account. The mobile number 95929-08790 mentioned in the bank account was found wrong. In the account opening form, deceased disclosed himself as unmarried and income was disclosed as Rs 60,000/- per annum from agriculture.

(xvi)  Then the Investigator called on provided number, where some other person pick the call and asked the investigator to wait, where the person provided complete set of documents to investigate and did not allow to interrogate the complainant. However the person allowed the investigator to record her statement as under:-

"I Rachna Rani W/O Kedeep Singh resident at Phase 2 Fatehahbad Road Goindwal sahib Tarn Taran, Punjab. My husband was a farmer and his annual income was 2-2.5 LAC P.A. He was fit and healthy person. We went to meet our relative where my husband health get worse and he died there. He died on 26.1.2019 due to sudden heart attack and we did his cremation at Goindwal cremation ground".

(xviii)          The Investigator asked the complainant to provide Education proof, Ration Card, Voter Card and other bank account of DLA but the complainant flatly refused to provide the same. (Except the Aadhar Card, Pan Card and Bank account as stated above, which ware prepare), there is no proof that deceased and complainant were residing at the given address and the deceased died at Tarn Taran on 26.01.2019. The investigator also asked to provide the detail of the relatives, where the deceased was allegedly died as mentioned in the claim form but no detail was provided.

(xix)  The investigator also wrote letter dated 02.04.2019 to Executive Officer, Municipal Corporation Tarn Taran for cancellation of death certificate on the basis of the statement given by Anganwari worker and ANM of village Goindwal and further the statement of M.C. Ram Lal.

(xx)   The deceased died at the young age of 22 years within a short period of 39 days only and as such the possibility cannot be ruled out that the deceased was suffering from the dreaded disease. Since the deceased & complainant was not found to be resident of the address mentioned in the proposal form and no person from the locality knows about the deceased and complainant, the deceased was not taken to any doctor, therefore no medical record of the deceased was found.

Thereafter the investigator submitted his report with opposite party and after getting the report from investigator, the claim of the complainant was repudiated vide letter 10.04.2019. Hence the opposite parties was well within its right to repudiate the claim of the complainant. Since the opposite parties has acted within the four corners of the statutory provisions. Therefore the present complaint is liable to be dismissed. The complainant has not impleaded parents of the deceased namely Jeet Singh and Amar Kaur as party to the present complaint, who are the necessary party being the legal heir of deceased Kedeep Singh. Moreover the identity of the complainant is also highly doubtful from the facts and circumstances of the complaint. Therefore the present complaint is liable to be dismissed.  The policies in question was issued on 18.12.2018 (date of commencement is 31.10.2018 and the DLA was died on 26.1.2019 just within 39 days from the date of issuance of policy. The early death of the life assured and taking of high sum assured policy, clearly proves that the policy in question has been taken by the DLA only to play fraud with the opposite parties. The insurance contracts are contracts based on Utmost Good Faith and that the Life Assured/ Proposer being a party to the contract is bound to disclose all material facts known to him at the time of proposal. The proposer/ Life Assured under a legal and solemnly obligation to disclose all material facts correctly, honestly and truthfully to the insurance company at the time of obtaining the policy, failing which the contract is rendered void. The contract of insurance is based on the Doctrine of Uberrimae Fide and even if any due diligence is done by the insurance company, it does not change the basic element of an insurance contract. The opposite parties had sought answers to specific health related questions with respect to DLA during the proposal stage as mentioned above. Despites specific questions being asked in the proposal form, the DLA deliberately and fraudulently concealed the prior medical ailments and replied all answers in negative for questions relating to his past medical history. In view of above information, the repudiation of claim was validly made, after deliberating on the terms and conditions of the said policy.  There is no proof that deceased died due to heart attack on 26.1.2019. The complainant failed to place on record any document regarding the death of DLA. The death certificate produced by the complainant is also procured and has been prepared inconnivance with the officials. There is no evidence where the deceased was lastly taken for treatment where the deceased was cremated and where the ashes were immersed.  There is no evidence regarding the last rites performed at any place.  The opposite parties have denied the other contents of the complaint and prayed for dismissal of the same. Alongwith the complaint, the opposite parties have placed on record affidavit of Ankur Sanon authorized signatory Ex. OP1/A, Copy of policy document Ex. OP1, investigation report Ex. OP2,  affidavit  of Kedeep Singh Ex. OP3, Copy of claim form Ex. OP-4

3        We have heard the Ld. counsel for the complainant and opposite parties and have carefully gone through the record placed on the file.

4        In the present case, according to complainant, Kedeep has availed insurance from the opposite party and Kedeep Singh has since died and after his death, the complainant is entitled to his insurance claim. But on the other hands, according to opposite parties Policy in question is an outcome of a fraud which has been played on opposite party Company.  As per the investigation carried out by the opposite party, the policy in question was taken in a very pre planned manner in order to play fraud with opposite parties as the following modus-operandi was used for taking the policy.  The investigator in his report Ex. OP/2 held that while doing the vicinity check, we have met many people around L.A’s residence (Address as per policy) & we were informed by all the neighbors that nobody with the name Kedeep Singh s/o Jeet Singh stayed in the said area. One of the person also highlighted the fact that no such address exists (Address as mentioned on PF). Nobody in the vicinity could actually recognize L.A’s father name. We also showed picture of LA to the neighbors but all of them denied knowing/ acknowledging person in that Picture. Later, we had also conducted enquiries by showing the picture of LA event and people confirmed the same fact and nobody recognized LA by his picture also. They were adamant that no such person exists as per entire neighborhold feedback, LA. (Kedeep Singh s/o Jet Singh). It is also in the report of surveyor that Sarpanch, ANM and Anganwadi had also highlighted that no such person matching details of LA is staying or existed in village Goinidwal, Punjab.  The opposite party has placed on record report Ex. OPs/2 of investigator is supported with affidavit Ex. OP/3.   As such, according to opposite party fraud has been committed in the present case upon the opposite party. But on other hands, according to complainant, his case is genuine. Now in the present case, during post investigation, the identity of insured is not established. Now the point involved in the present case, as to whether, Kedeep Singh life assured has validly taken the insurance policy or not ? Whether,  Kedeep Singh was residing on the given addresses or not ? Whether, the complainant alongwith others has made fraud with the insurance company or not ?  detailed evidence, cross examination is required and intricate questions of law and facts are involved in the present case. As such , this District Commission  cannot exercise its jurisdiction to decide the intricate questions of law and facts  in a summary manner. Reliance in this regard is placed upon Oriental Insurance Company Ltd. Vs. Munimahesh Patel 2006(IV) CPJ page 1, wherein the Hon'ble Supreme Court has held that :-

“Proceedings before the commission are essentially summary in nature and adjudication of issues which involve disputed factual questions should not be adjudicated. It is to be noted that commission accepted that insured was not a teacher. Complainant raised dispute about genuineness of the documents (i.e. proposal forms) produced by the appellant.”

Their lordships have further held that :-

“The nature of the proceedings before the commission as noted above, are essentially in summary nature. The factual position was required to be established by documents. Commission was required to examine whether in view of the disputed facts it would exercise the jurisdiction. The State Commission was right in its view that the complex factual position requires that the matter should be examined by an appropriate court of Law and not by the Commission.”

The nature of the dispute, in the present complaint, is squarely covered by the law laid down by their lordships of the Hon'ble Supreme Court in the judgment supra. A similar view has been taken by the Hon'ble National Consumer Disputes Redressal Commission in 1(2004) CPJ page 101 wherein it has been held by the Hon'ble National Commission in a revision petition titled as R.D. Papers Ltd. Vs. New India Assurance Co. Ltd. & Ors. in para No.7 of the judgment  which reads as under:-

“After going through the complaint and the written version, it appears to us that the complaint raises complicated questions of facts which cannot be decided by us in our summary jurisdiction. It may be though the amount in this case is in few lacs and when we are receiving complaints involving crores of rupees, but then enormous evidence would be required in the present case especially in respect of allegation of forgery made by the complainant and denied by the Insurance Company.”

5        In view of above discussion, the instant complaint is relegated to the Civil Court for deciding the matter in accordance with law.  The main complaint has been disposed of, therefore, all the applications pending in this complaint stands dismissed. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Commission and due to COVID-19. Copies of the order be furnished to the parties as per rules. File is ordered to be consigned to the record room.

Announced in Open Commission.

18.04. 2023