BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 164 of 2017
Date of Institution : 14.7.2017
Date of Decision : 28.2.2018.
Parveen Kumar S/o Sh. Azad Singh, R/o VPO Jhandwala Bagar, Distt. Fatehabad.
……Complainant.
Versus.
- Reliance Life Insurance Company, Ltd. (Regd No.121) 9th Floor, R-Tech Park, Nirlon compound, Near HUB Mall, Goregaon (East) Mumbai- 400063 and Regd. Office H Block, 1st Floor, Dhirubhai Ambani Knowledge City, Navi Mumbai, Maharastra- 400710.
- Reliance Life Insurance Company, Ltd., 1st Floor, Verma Building, Dabrali Road, Sirsa, Opp. RDS High School, Sirsa.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. R.L.AHUJA…………………………PRESIDENT
SH. MOHINDER PAUL RATHEE …… MEMBER.
Present: Sh. B.S. Gill, Advocate for the complainant.
Sh. S.S. Mandia, Advocate for opposite parties.
ORDER
The case of the complainant in brief is that Ravinder Kumar son of Sh. Azad Singh during his lifetime obtained life insurance policy no.52594651 dated 28.3.2016 from opposite party no.2 at Sirsa named Reliance Classic Plan with the condition that in case of death of policy holder, his nominee will receive a sum of Rs.3,50,000/-. The complainant being his real brother was the nominee/ legal heir of the deceased Ravinder. That Ravinder during his life time paid the annual premium of Rs.15,000/- under Client ID No.95473030 and receipt No.G1451887 dated 28.3.2016 at the time of getting the insurance policy and similarly also obtained life insurance policy no.52594556 dated 28.3.2016 from op no.2 at Sirsa named as Reliance Classic Plan-II and in case of death of policy holder his nominee will receive a sum of Rs.3,50,000/-. The complainant being his real brother was the nominee/ legal heir of the deceased Ravinder and said Ravinder paid the annual premium of Rs.15,000/- under client ID No.95473030 and receipt No.G1451861 dated 28.3.2016 at the time of getting the insurance policy. That before granting the policy, the panel doctor on the panel of op company checked the health condition of Ravinder and after satisfying from the same, the op company issued the above said insurance policy. It is further averred that the official of the op company has suo moto filled in the proposal form without disclosing the fact and detail in the proposal form. That unfortunately on 15.8.2016, Sh. Ravinder died at his home due to heart failure. However, before his death he was very fit and was not suffering from any kind of illness or disorder and he was about 19 years of age. That after the death of Ravinder, complainant informed the ops no.1 and 2 regarding death of his brother and requested for the clearance of death claim in his favour but the ops demanded certain documents to issue the death claim. It is further averred that on this complainant supplied all documents relating to death of his father (it should be brother) within the stipulated period but the op prolonged the matter on one pretext or the other and ultimately the ops issued a letter on 31.3.2017 and declined the death claim under aforesaid policy with the reason “Non disclosure of previous insurance application and mismatch the profile detail.” That the aforesaid reason for declining death claim by the ops no.1 and 2 is totally wrong and illegal and amounts to deficiency in service on the part of ops because the ops never disclosed the facts before the deceased which are mentioned in the proposal form nor the agent of the company has taken any signature in the proposal form. That after his death, the complainant being nominee requested the release of insured amount of Rs.7,00,000/- alongwith interest in his favour and completed all the required formalities as per the directions of ops but the ops have denied the genuine request of the complainant. That the ops are under legal obligation to release the insured sum of Rs.7,00,000/- alongwith interest @18% per annum and other benefits under the policy from date of death of Ravinder. It is further averred that despite repeated requests, the ops did not release the insured sum in favour of complainant till date and have caused unnecessary harassment and mental as well as physical agony to the complainant. Hence, this complaint.
2. On notice, opposite parties appeared and filed written statement taking certain preliminary objections regarding maintainability, cause of action and jurisdiction and that voluminous evidence is required to decide the case on merits and that the factual position as alleged by the complainant is in dispute and thus requires the evidence and thus answering ops request the Forum to relegate the matter to the Civil Court so that case can be decided on merits, after adducing the evidence. It is also submitted that contract of insurance being of utmost good faith and in as much as there has been non-disclosure of material facts in obtaining the said policy it is vitiated and they are unable to process the complainant’s request for the payment of the claim amount as the said policy was void ab-initio. 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 and past), occupation and habits, particulars of previous insurance etc. are only within the knowledge of the proposer. The insurer, therefore, has to reply entire on the information, which the propose 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 policy document. It is further submitted that the complainant has no locus standi to claim any alleged sum assured, as the insurance policy was obtained by the DLI by misrepresenting the material facts in order to defraud the opposite parties and as such the contract of insurance is void. On merits, it is submitted that the proposal form was received in office of answering opos, wherein proposer proposed for Reliance Classic Plan II. That another proposal form was received in the office of answering ops, wherein proposer proposed for Reliance Classic Plan II. That believing the information as regard profession/ business, income, state of health and other information given in the proposal forms to be correct, answering ops issued the policy no.52594556 and 52594651 on 28.3.2016 for the policies terms 15 years and policies premium term of 15 years for the basic sum assured of Rs.3,50,000/- each for which LA was to make the yearly installment of Rs.15,000/- each. It is further submitted that answering ops in accordance with Clause 6(2) of the Insurance Regulatory and Development Authority (Protection of Policy holders’ interest) Regulations 2002 every policy documents sent by the company to the policy holder is accompanied by a forwarding letter which clearly mentions that in case policy holder is not satisfied with the terms and conditions of the policy, he/she can withdraw/ return the policy within 15 days i.e. under the “Freelook period”. Further as per clause 4(1), copy of proposal form duly signed by the policy holder was also sent alongwith the policy document to the policy holder. In the present case, the replying ops sent the policy and policy document alongwith the copy of the form to the life assured which were duly received by him. The life assured never approached the replying ops for any discrepancy made in the form or for any grievance relating to the policy or its terms and conditions during free look period, implying that the life assured had agreed to the contents in the proposal form, policy and their terms and conditions were in order. It is further submitted that claim intimation was received in office of answering ops on 20.2.2017, as regard to the death of life assured occurred on 15.8.2016 i.e. after a span of six months. On getting the early death claim intimation, answering ops got investigated the case and it came to knowledge that life assured Ravinder kumar had submitted the proposal form with other insurance company, prior to the present proposal for insurance amounting of Rs.26,81,048/- and this material act has been concealed by life assured from answering ops. In the proposal form, Ravinder Kumar disclosed his income as Rs.1,80,000/- and has got the insurance from answering ops for the sum assured of Rs.3,50,000/- each totaling Rs.7,00,000/- by making the annual premium of Rs.30,000/- per annum. Apart from the present policies, life assured had also opted for other insurance policies from other insurance companies for sum assured of Rs.26,81,048/- prior to policies in question and all the policies have been purchased within shortest possible period prior to his death, which shows malafide intention on the part of life assured and intentionally there has been delay of six months in intimating insurance company. It is further submitted that life assured in the proposal form disclosed that no policy from any other insurance company has been obtained but in fact had already applied with other life insurance companies. Had the life assured disclosed the same in the proposal form, answering ops would have called for financial income documents alongwith terms and of acceptance of the cover. So the claim of complainant has been rightly repudiated vide letter dated 31.3.2017. Remaining contents of complaint are also denied.
3. The complainant produced his affidavit Ex.C1 and copies of documents Ex.C2 to Ex.C18. On the other hand, ops produced affidavit of Sh. Pankaj Chawla, presently working as CCE Ex.R1 and copies of documents Ex.R2 to Ex.R11.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. Learned counsel for complainant has contended that complainant has proved on record that brother of complainant namely Ravinder kumar had purchased two life insurance policies from opposite party no.2 on 28.3.2016. The policies were issued after medical examination of the deceased life assured by panel doctor. Unfortunately on 15.8.2016, Ravinder Kumar life assured died at his house due to heart failure. Claim was lodged by complainant with the ops but however, same was repudiated vide letter dated 31.3.2017 on the ground of “Non disclosure of previous insurance application and mismatch the profile detail”. The order of repudiation of claims is illegal and arbitrary. The ops were under legal obligation to settle and pay claim of complainant qua death of his brother Ravinder Kumar.
6. On the other hand, learned counsel for ops has strongly contended that present complaint is not maintainable at all. The complainant has tried to misguide and misled the Forum and no cause of action has accrued to the complainant and this Forum has got no jurisdiction to entertain and adjudicate the present complaint. The contract of insurance being of utmost good faith and in as much as there has been non-disclosure of material facts in obtaining the said policy it is vitiated and they are unable to process the complainant’s request for the payment of the claim amount as the said policy was void ab-initio. The life assured has not given the true particulars while getting the insurance policies rather same was obtained by misrepresenting material facts in order to defraud the opposite parties. Learned counsel for ops has relied upon judgments of the Hon’ble National Commission in case titled as M/s. ICIC Prudential Life Insurance Co. Ltd. vs. Lalita Jain, FA No.246 of 2010 decided on 10.2.2015 and LIC Vs. Smt. Asha Goel & anr. (2001) ACJ 806. He has also relied upon judgments of the Hon’ble Supreme Court of India in cases titled as P.C. Chako and another vs. Chairman, LIC and others, AIR 2008 SC 424 and Satwant kaur Sandhu vs. New India Assurance Company Ltd., SC 2776 of (2006).
7. We have considered the rival contentions of the parties and have gone through the record as well as judgments relied upon by learned counsel for opposite parties.
8. The perusal of the record reveals that complainant in order to prove his case has furnished his affidavit Ex.C1 in which he has reiterated all the averments made in the complaint and tendered copies of documents ERx.C2 to Ex.C18. On the other hand, ops in order to rebut the claim of complainant has furnished affidavit of Sh. Pankaj Chawala, presently working as CCE as Ex.R1 in which he has reiterated all the averments made in the written statement and also tendered copies of documents Ex.R2 to Ex.R11.
9. The perusal of the complaint of the complainant reveals that complainant has filed this complaint alongwith an application under Section 12 (c) of the Consumer Protection Act, 1986. It is averred in the application that Ravinder Kumar son of Sh. Azad Singh was life insurance policy holder issued by the ops and after death of Ravinder Kumar, all his legal heirs are entitled for the benefits of the insured sum and as such there are number of consumers of ops but the present complaint is being filed by the present complainant for and on behalf of other legal heirs of the deceased Ravinder Kumar. The perusal of complaint reveals that the complainant has not mentioned the names of any of the LRs of deceased Ravinder Kumar nor he has uttered even a single word in his affidavit Ex.C1. So, it cannot be presumed that only the complainant is entitled and competent to file present complaint.
10. Secondly, the complainant has alleged in the complaint that deceased life assured Ravinder Kumar had obtained two policies on 28.3.2016 for sum assured of Rs.3,50,00/- each and unfortunately Ravinder Kumar died on 15.8.2016 at his house due to heart failure. The perusal of the affidavit of complainant Ex.C1 reveals that he has reiterated the same para no.3 of the complaint in his affidavit qua death of deceased Ravinder Kumar. The complainant has placed on record death certificate Ex.C17 which was allegedly issued by Sub Registrar Birth and Death PHC Manawala, District Amritsar (Punjab). As per this certificate, Ravinder Kumar son of Azad Singh, male died on 15.8.2016 and date of registration is mentioned as 16.8.2016 and place of death is mentioned as PHC Manawala and this certificate was allegedly issued on 23.9.2016. From this certificate, it appears that one person namely Ravinder Kumar son of Azad Singh whose permanent address is mentioned as VPO Jandwala Bagar, District Fatehabad (Haryana) died at PHC Manawala, District Amritsar (Punjab) whereas as per averments of the complainant and deposition of the complainant, the deceased LA Ravinder Kumar died at his home on 15.8.2016. This death certificate Ex.C17 does not relate to the death of deceased LA and complainant has not placed on record any other death certificate of the deceased LA Ravinder Kumar from which it could be presumed that deceased LA who had obtained policies from the ops had died at his house in village Jandwala Bagar, District Fatehabad (Haryana). So, complainant has failed to prove even the death of deceased LA by leading cogent and convincing evidence.
11. Further, as per contention of learned counsel for ops, the deceased LA had furnished wrong information in his proposal form qua his income as Rs.1,80,000/-, whereas he had agreed to pay premium of Rs.30,000/- per annum which was not possible to pay the same by him. Learned counsel for ops has further contended that deceased LA had misrepresented the facts qua his occupation and income and details of other insurance policies of other companies which were material for issuance of the policies and ought to have been disclosed in proposal form, but by not doing so, they have misled the answering ops. The perusal of the record further reveals that deceased LA had made a declaration that he was not having any other policy from another insurance company, but however, the ops have placed on record the record of policies in the name of the deceased LA Ravinder Kumar which are Ex.R4 to Ex.R6.
12. It is settled principle of law that once it is proved on record that policy holder has made false declaration while submitting his proposal form to the insurance company, the company can proceed under Section 45 of the Insurance Act to revoke the insurance contract and make refund of the premium amount. As in the present case false declaration was given by the deceased LA qua his occupation, income and policies purchased by him prior to the policies in question, as a result of which the ops have revoked both the policies and made refund of Rs.15,000/- each vide cheques copies of which are Ex.R10 and Ex.R11 on file. Further, we find force from the judgments relied upon by learned counsel for ops.
13. In view of the above, it appears that complaint of the complainant is not maintainable and is devoid of any merit and same is hereby dismissed but with no order as to costs. 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:28.2.2018. Member District Consumer Disputes
Redressal Forum, Sirsa.
