BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 353 of 2017
Date of Institution : 21.12.2017
Date of Decision : 27.9.2018.
Lilu Ram son of Mool Chand, resident of Dhani Sanchla, Tehsil Tohana, District Fatehabad.
……Complainant.
Versus.
1. Reliance Life Insurance Company Limited, Regd. No.121, Registered Office: H-Block, Dhirubhai Ambani Knowledge City, Navi Mumbai- Maharashtra- 400710 through its Chairman-cum- Managing Director.
2. Corporate Office: 9th Floor/ 10th Floor, Building No.2, R- Tech Park, Nirlon Compound, Next to Hub Mall, Behind Ist Flex Building, Goregaon (East), Mumbai- 400063 through its Chairman-cum- Managing Director.
3. Reliance Life Insurance Company Limited, Branch Office, Near Petrol Pump, Sangwan Chowk, Dabwali Road, Sirsa through its Branch Manager.
..…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. R.L.AHUJA…………………………PRESIDENT
SH. ISSAM SINGH SAGWAL …… MEMBER.
Present: Sh. Sukhbir Dhaka, Advocate for complainant.
Sh. S.S. Mandia, Advocate for opposite parties.
ORDER
The case of the complainant in brief is that Rajender Kumar son of Mool Chand, resident of Dhani Sanchla, Tehsil Tohana District Fatehabad had got himself insured with the opposite parties at Sirsa vide insurance policy No.51938259 dated 5.12.2014 valid from 5.12.2014 to 5.12.2034 for sum assured of Rs.4,80,983/- and he made the payment of the insurance premium amounting to Rs.28,349/- and the complainant is the nominee in respect of the said insurance policy. That Rajender Kumar died on 12.6.2017 at Dhani Sanchla and the information regarding his death was given to the ops and the complainant completed all the requisite formalities of the ops and submitted all the documents to the ops. The complainant was assured by the ops to release the benefits of insurance under the said policy very soon and the complainant regularly visited the ops time and again in this regard but the ops always avoided the matter on pretext or the other and did not release the benefits of the insurance policy to the complainant. It is further averred that the ops instead of settling the claim of complainant and releasing the benefits of the sum assured to the complainant have wrongly and illegally repudiated the claim of complainant vide letter dated 24.11.2017 on false and flimsy grounds that life assured was having another insurance policy and the repudiation of the claim of complainant by the ops is with a view to escape its liability of indemnifying the complainant and to cause wrongful gain to them and wrongful loss to the complainant. It is further averred that repudiation letter dated 24.11.2017 issued by the ops is wrong, against law and facts and as such same is liable to be set aside. There is deficiency in service on the part of the ops and thus the complainant is also entitled to compensation of Rs.10,000/- from the ops on account of mental agony, harassment and humiliation undergone by the complainant. Hence, this complaint.
2. On notice, opposite parties appeared and filed written statement taking certain preliminary objections. It is submitted that opposite parties issued the policy on the basis of the information filled in the proposal form. The life insurance contracts are contracts of ‘uberrmae fides’ where observance of utmost good faith is enjoined on the parties to the contract, i.e. they must disclose all material facts in respect of the risk to be covered by the insurance. The insured is obliged to give full and correct information on all matters which would influence the judgment of a prudent insurer in determining whether he will accept the risk, and if he would, at what rate of premium and subject to what conditions. The material fact as having a bearing on the risk in life insurance contracts viz., the state of health or illness (present & past), occupation and habits, particulars of previous insurance etc. are only within the knowledge of the proposer. The insurer, therefore, has to rely entirely on the information, which the proposer gives at the time of proposal. If a material fact is suppressed, the insurer will be misled about the risk covered and hence the same will vitiate the contract. The insurer will then be well within its right to treat the contract as void as per the terms and conditions of the policy document. It is further submitted that proposal form was received in the office of answering ops, wherein proposer proposed for Reliance Fixed Savings Plan. That believing the information as regard profession/ business, income, state of health and other information given in the proposal form to be correct, answering ops issued the policy no.51938259 on 5.12.2014 for the policy term 20 years and policy premium term of 20 years and paying terms of 10 years, for the basic sum assured of Rs.4,80,983.25 for which DLA was to make the yearly installment of Rs.28,349.75. The contents regarding complainant having been appointed as a nominee being the brother is correct as per the contents of the proposal form. It is further submitted that contract of insurance is based on principle of utmost good faith and the company relies upon the information by the assured. That it was the deceased life assured who approached answering ops and opted for the policy after going through the terms and conditions of the policy. It is further submitted that contents regarding death of deceased life assured on 12.6.2017 is correct as per the intimation provided by the complainant. That on getting the claim intimation regarding the death of the life assured, matter was investigated and it came to the picture that the deceased life assured purchased policy worth Rs.30,20,867/- from other insurance companies excluding policy from answering ops for the sum assured of Rs.4,80,983.25. That all the policies have been purchased by deceased life assured from all insurance companies starting from 27.5.2014 till 5.12.2014 i.e. within shortest span of 7 months. That in the proposal form submitted by the deceased life assured he has stated his annual income to be Rs.3,00,000/- per annum and was to make installment premium of Rs.28,350/-. It is hard to believe that a person having income of Rs.3,00,000/- per annum will be in position to pay the premium for the sum assured of Rs.35,01850/-. It is further submitted that it will be pertinent to mention here that in the proposal form submitted by the life assured, he has disclosed no policy from any other insurance company, but in fact he had already applied with other life insurance companies. Had life assured disclosed the same in the proposal form, answering ops would have called for financial income documents alongwith the terms and acceptance of the cover. That the claim of the complainant has been repudiated on the basis of the documents and after due application of mind. The life assured at the time of getting the policies, intentionally gave the false information as regard to the other insurance policies being not opted by him. That non disclosure of life assured having applied from other insurance companies was material for issuance of the policy and ought to have been disclosed in proposal form, but not doing so, the proponent has misled answering ops. Remaining contents of the complaint have also been denied and prayer for dismissal of complaint has been prayed for.
3. The parties then led their respective evidence. Ld. counsel for complainant has tendered affidavit of Lilu Ram complainant as Ex.CW1/A and documents Ex.C1 to Ex.C4. On the other hand, learned counsel for ops has tendered affidavit of Sh. Pankaj Chawla, CCE as Ex.RW1/A and documents Ex.R1 to Ex.R10.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. Learned counsel for complainant has contended that it is proved fact on record that brother of complainant namely Rajender Kumar son of Mool Chand had got himself insured with the opposite parties vide policy No.51938259 for the period 5.12.2014 to 5.12.2034 for sum assured of Rs.4,80,983.25 and paid Rs.28,349/- as premium of the policy. It is also proved fact that during subsistence of the policy, said Rajender Kumar died on 12.6.2017 at Dhani Sanchla, Tehsil Tohana, District Fatehabad. The claim was lodged by present complainant being nominee of deceased Rajender Kumar, but however, the same was repudiated vide letter dated 24.11.2017 on the ground that life assured was having another insurance policy and this fact has been materially suppressed by deceased while filing the proposal form. Learned counsel for complainant has further contended that there is no bar for a person to take number of policies and it is not obligation of the insured to disclose the particulars of all the policies purchased by him prior to the policy purchased by him. Ld. counsel for complainant has also contended that opposite parties have illegally and arbitrarily repudiated the claim of complainant. He has relied upon judgment of the Hon’ble High Court of Punjab and Haryana in case titled as Bajaj Allianz Life Insurance Company Ltd. Vs. Santosh and another CWP No.24862 of 2017 decided on 2.11.2017 and also judgments of the Hon’ble National Commission in cases titled as Aviva Life Insurance Co. Ltd. & ors. vs. Rekhaben Ramjibhai Parmar, RP No.4204 of 2011 decided on 12.4.2017, IDBI Federal Life Insurance Co. Ltd. & anr. Vs. Rameshwar Prasad Jain, RP No.139 of 2016 decided on 4.11.2016 and Baleshwar Singh vs. Life Insurance Co. & Ors. RP No.1053 of 2008 decided on 16.3.2017.
6. On the other hand, learned counsel for opposite parties has contended that deceased Rajender Kumar had obtained the policy in question by playing fraud and suppressing the material facts while filing the proposal form. He did not disclose about other policies which were purchased by him prior to purchase of this policy. He has further contended that as per record, deceased was having the policies of sum assured of more than Rs.35,00,000/- whereas in the proposal form he has only mentioned his annual income of Rs.3,00,000/- and it was not possible for him to pay premium of all these policies. The opposite parties have rightly repudiated the claim of complainant. Ld. counsel for ops has relied upon judgments of the Hon’ble Supreme Court of India in cases titled as P.C. Chacko and another Vs. Chairman, Life Insurance Corporation of India and others, 2008 (1) RCR (Civil) 127 and Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. CA No.2776 of 2002 decided on 10.7.2009.
7. We have considered the rival contentions of the parties and have gone through the case file as well as law cited by learned counsel for the parties.
8. The perusal of the record reveals that it is undisputed fact between the parties that deceased Rajender Kumar had purchased a policy bearing No.51938259 on 5.12.2014 for sum assured of Rs.4,80,983.25. It is further undisputed fact between the parties that during subsistence of the policy, said Rajender Kumar died on 12.6.2017. The death and cause of death of deceased Rajender Kumar has not been disputed by the opposite parties. The claim was duly lodged by the complainant alleging himself to be nominee of the deceased and same was repudiated vide repudiation letter dated 24.11.2017 on the ground that life assured was having other insurance policies. The perusal of the evidence of the complainant reveals that complainant has furnished his affidavit Ex.CW1/A in which he has reiterated all the averments made in the complaint. He has also placed on record repudiation letter dated 24.11.2017 Ex.C1, copy of policy document Ex.C2, copy of claim form Ex.C3 and copy of death certificate of Rajender Kumar Ex.C4.
9. On the other hand, opposite parties in order to prove their defence plea have furnished affidavit of Mr. Pankaj Chawla, CCE as Ex.RW1/A in which he has reiterated all the averments made in the written statement and they have also furnished copy of proposal form Ex.R1, copy of policy document Ex.R2, copy of letter dated 7.5.2018 of ICIC Prudential Life Insurance Ex.R3, copy of letter dated 5.5.2018 of Bajaj Allianz Ex.R4, copy of another policy document Ex.R5, copy of proposal form Ex.R6, copy of mail Ex.R7, copy of payment confirmation certificate of HDFC Bank Ex.R8 and copy of cheque of Rs.82,501.20 Ex.R9 and copy of repudiation letter dated 24.11.2017 Ex.R10.
10. During the course of arguments, though learned counsel for opposite parties has strongly contended that deceased Rajender Kumar had purchased the policy by suppressing the material facts from the opposite parties regarding purchase of previous insurance policies from the different companies, but however, the opposite parties have not placed on record any affidavit of the concerned insurance companies by whom the alleged insurance policies were issued in the name of deceased Rajender Kumar and further the ops have not led any other cogent and convincing evidence in order to prove the fact that deceased Rajender Kumar was holding some other insurance policies except the fact that ops have placed on record certain photostat copies of the insurance policies.
11. The allegation of the opposite parties is only that deceased did not disclose about other insurance policies purchased by him which amounts to suppression of material facts. Learned counsel for ops though has relied upon judgments referred to above but the perusal of the judgments reveal that the facts of the said judgments are different from the facts of the present case as in those judgments deceased had concealed the fact qua their pre-existing diseases which definitely will affect the rights of the insurance companies and that definitely will amount to suppression of material facts but in the present case the allegation is qua the purchase of other insurance policies and to our mind it does not amount to suppression of material facts as we find force from the judgment of the Hon’ble High Court of Punjab and Haryana in case titled as Bajaj Allianz Life Insurance Company Ltd. vs. Santosh and another (supra) wherein it has been held that “As a matter of fact, this Court has already relied upon the decision of this Court rendered in Narender Kaur Batra’s case (supra) in the case of Aviva Life Insurance Co. India Limited Vs. Permanent Lok Adalat and another, CWP No.24733 of 2017, decided on 01.11.2017, upholding the order of the Permanent Lok Adalat on the ground that non-disclosure of the policy obtained by the insured from other insurance companies is not suppression of material fact because there is no bar in obtaining/purchasing various insurance policies.” The judgments of Hon’ble National Commission in cases titled as Aviva Life Insurance Co. Ltd. & ors. vs. Rekhaben Ramjibhai Parmar, RP No.4204 of 2011 decided on 12.4.2017, IDBI Federal Life Insurance Co. Ltd. & anr. Vs. Rameshwar Prasad Jain, RP No.139 of 2016 decided on 4.11.2016 and Baleshwar Singh vs. Life Insurance Co. & Ors. RP No.1053 of 2008 decided on 16.3.2017 relied upon by learned counsel for complainant are also applicable to the facts and circumstances of the present case.
12. In view of our above discussion, we are of the opinion that opposite parties have wrongly repudiated the claim of the complainant. So, we allow the present complaint and direct the opposite parties to pay claim amount of Rs.4,80,983.25 to the complainant alongwith interest @7% per annum from the date of filing of present complaint till actual realization. We also direct the opposite parties to further pay a sum of Rs.10,000/- as composite compensation and litigation expenses to the complainant. The opposite parties are directed to comply with this order within a period of two months from the date of receipt of copy of this order, failing which the complainant will be entitled to initiate proceedings under Sections 25/27 of the Act against the ops. A copy of this order be supplied to the parties free of costs. File be consigned to the record room.
Announced in open Forum. President,
Dated:27.09.2018. Member District Consumer Disputes
Redressal Forum, Sirsa.
