Haryana

StateCommission

A/730/2017

VIJAY SINGH - Complainant(s)

Versus

SBI LIFE INSURANCE CO. - Opp.Party(s)

NARENDER KAAJLA

02 Jul 2018

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No  :      730 of 2017

Date of Institution:      15.06.2017

Date of Decision :      02.07.2018

 

Vijay Kumar s/o Sh. Banwari Lal, Resident of Village Banawali, Tehsil and District Fatehabad.

                                      Appellant-Complainant

Versus

1.      Branch Sales Manager, SBI Life Insurance Company Limited, First Floor Malhotra Bhawan, Hisar Road, Fatehabad, Tehsil and District Fatehabad, Mobile No.70824-00270.

2.      SBI Life Insurance Company Limited, Registered & Corporate Office Natraj, MV Road and Western Express Highway Junction, Andheri (East), Mumbai-400069 through its Director Authorised Signatory.

                                      Respondents-Opposite Parties

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Mr. Balbir Singh, Judicial Member.

                                                                                                         

Present:               Shri Narender Kaajla, Advocate for appellant.

                             Shri Rajneesh Malhotra, Advocate for respondents.

 

                                                   O R D E R

 

BALBIR SINGH, JUDICIAL MEMBER

 

        This complainant’s appeal is directed against the order dated April 11^th, 2017 passed by District Consumer Disputes Redressal Forum, Fatehabad (for short ‘the District Forum’) whereby the complaint was dismissed.

2.                Smt. Kasturi Devi-since deceased (hereinafter referred to as ‘the Life Assured’) – mother of complainant-Vijay Kumar, during her life time was provided SBI Life – Flexi Smart Insurance Policy bearing No. 56034660603 (Annexure-B) by SBI Life Insurance Company Limited-Opposite Parties (appellants herein) mentioning the total sum assured as Rs.3,00,000/- with effect from February 12^th, 2013. Unfortunately, the life assured died on February 05^th, 2015 due to heart attack during the insurance period. After death of the life assured, the complainant being nominee and legal heir of the life assured Kasturi Devi submitted insurance claim with the opposite parties along with documents needed for this purpose. Despite time and again oral as well as written requests by the complainant, the opposite parties did not accept the insurance claim submitted by the complainant. The insurance claim was wrongly and illegally repudiated vide letter dated October 10^th, 2015 (Annexure-G) mentioning that the deceased life assured had not given correct information regarding her age at the time of providing the insurance policy. The insurance claim was repudiated without any authenticated view and document. 

3.                The complainant filed complaint under Section 12 of the Consumer Protection Act, 1986 (for short ‘the Act, 1986’) before the District Forum with a prayer to direct the opposite parties to pay an amount of Rs.3,00,000/- being the sum assured with interest at the rate of 18% per annum; to pay an amount of Rs.50,000/- to the complainant on account of un-necessary harassment, mental agony and an amount of Rs.11,000/- as litigation expenses.

4.                The opposite parties have taken plea in their written version that the agreement in between the complainant and the opposite parties is void ab initio as the life assured had given wrong information regarding her age at the time of obtaining the insurance policy and committed fraud with the opposite parties. The life assured gave wrong information regarding her age with malafide intention and terms and conditions of the insurance policy are not binding upon the opposite parties. It is pleaded that finding regarding fraudulent acts should be given by the Civil Court. It is also pleaded that the District Forum has no jurisdiction to decide this complaint as the office of the opposite party No.2 exists at Mumbai. It is admitted fact that the life assured died on February 05^th, 2015 due to heart attack after a period of approximately two years. The opposite parties have taken plea that the life assured had mentioned her date of birth as June 20^th, 1958 in her Proposal Form (Annexure-A) whereas she was 55 years old at the time of submitting the proposal form. In the Voter List (Annexure-E) prepared in the year 2014, the life assured has been shown as 72 years old. In the death report (Annexure E/1) also the age of the life assured Kasturi Devi is mentioned as 68 years.

5.                The opposite parties have taken plea that the maximum age entry level is 60 years. If the life assured would have disclosed her correct age, certainly the opposite parties were not likely to provide the insurance policy in the name of the life assured. As the life assured had given wrong information regarding her age, the agreement between the life assured and the opposite parties became illegal and void as the life assured was not eligible for providing the insurance policy. After termination of the insurance policy, an amount of Rs.60,000/- was transferred in the account of the nominee of the life assured on September 15^th, 2015 towards refund of the premium. It is not a case of deficiency in service and the complainant is not entitled to receive any amount as claimed in the complaint.  It is prayed that the complaint filed by the complainant be dismissed.

6.                Parties led evidence in support of their respective claims before the District Forum.

7.                After hearing arguments, vide impugned order dated April 11^th, 2017 passed by the learned District Forum, the complaint filed by the complainant was dismissed mentioning that repudiation of the insurance claim of the complainant is justified.

8.                Aggrieved with the impugned order dated April 11^th, 2017, the complainant has filed the present First Appeal No.730 of 2017 with a prayer to set aside the impugned order and to grant relief to the complainant as prayed in the complaint.

9.                We have heard learned counsel for the parties and perused the case file.

10.              During the course of arguments, there was no controversy of any type that Smt. Kasturi Devi-mother of the complainant during her life time was provided a life insurance policy No. 56034660603 (Annexure-B) by the opposite parties mentioning the date of commencement as February 12^th, 2013 and the total sum assured as Rs.3,00,000/-. It is admitted fact and is evident from the Death Certificate Annexure C-11 that the life assured died on February 05^th, 2015. Admittedly, the life assured died due to heart attack all of a sudden during the insurance period. She died after a period of more than two years from the date of commencement of the Insurance Policy. It is evident from the proposal form Annexure-A that the life assured got mentioned her date of birth as June 20^th, 1958 in the proposal form. It is also admitted fact that at the time of providing insurance policy on account of proof of age, Kasturi Devi produced Voter Identity Card issued by the Election Commission of India (Annexure C-12) wherein it is mentioned that Kasturi Devi was 43 years old on the date of issuance of the Voter Identity Card on October 28^th, 1994. It means when the proposal form was submitted on January 27^th, 2013 her age was 61 years and 3 months. The agent as well as the officers of the Insurance Company accepted the version of the life assured and provided her insurance policy despite this fact that age of the life assured was more than 61 years as per entry in the Voter Identity Card and the life assured had mentioned her date of birth in the proposal form as June 20^th,1958. It means, at the time of submitting the proposal form, her age was approximately 55 years.

11.              The opposite parties repudiated the insurance claim of the complainant on the basis of age of Kasturi Devi mentioned in the Voter List Annexure-E prepared in the year 2014. In the photo state copy of the voter list Annexure-E, age of Kasturi Devi in the year 2014 is mentioned as 72 years. In this way, it is clear that age mentioned in the Voter Identity Card issued in the year 1994, as well in the Voter List Annexure-E, prepared in the year 2014 is different from the age of the life assured mentioned in the proposal form. The opposite parties have taken plea that it is result of fraudulent acts on the part of the life assured and the insurance agreement in between the life assured and the opposite parties has become void keeping in mind the terms and conditions mentioned in the insurance policy.  The opposite parties have taken plea that all it happened due to fraudulent acts on the part of the life assured but the opposite parties could not produce any convincing evidence. Wrong entries in the Voter List, Voter Identity Card may be due to fault of the life assured or due to fault of the officials involved in preparation of Voter Identity Card and Voter List etc. The opposite parties did not prefer to file a criminal complaint with the allegations of fraud etc. against anybody. Version of the opposite parties is that if the Insurance Company would have got information that the age of the life assured was more than 60 years, the insurance company was in a position to decline prayer of the life assured to provide her life insurance policy.

12.              During the course of arguments, learned counsel for the opposite parties argued that Kasturi Devi was successful in obtaining the insurance policy by giving wrong information to the Insurance Company. We are not much impressed with this contention of the learned counsel for the opposite parties. We feel when the proposal form was submitted and the life assured got mentioned her date of birth as June 20^th, 1958, the agent as well as the officers of the Insurance Company should not have believed the version of the life assured as she had produced Voter Identity Card also as proof of her age. Learned counsel for the complainant argued that in fact the date of birth in the proposal form was written by the agent of the Insurance Company himself and agent and officers of the Insurance Company themselves were interested to provide insurance policy to the life assured knowing fully well that her age was mentioned as 43 years in the Voter Identity Card which was issued in the year 1994. In this way, we can give findings safely that it was in the knowledge of the agent as well as officers of the Insurance Company at the time of providing insurance policy that age of the life assured was mentioned as 43 years in the Voter Identity Card issued in the year 1994 (Annexure C-2). The Insurance Company cannot be allowed to take benefit of its own intentional or unintentional mistakes. We also feel that the mistake was not unintentional.

13.              It is generally found that in most of the cases at the time of providing insurance policy, the agents and officers of the Insurance Companies in fact are not found so much willing to get knowledge regarding correct age and income of the proposer/life assured. In fact, at the time of providing insurance policy, the agents as well as officers of the Insurance Company are found so much interested and in haste to provide insurance policy so that they may be able to increase their income in the shape of commission as well as business of the Insurance Company. It is generally found that as and when the insurance claim is submitted, officers of the Insurance Company as well as surveyors appointed by the Insurance Company are found to be so much active and interested to procure more and more documents so that the insurance company may be able to repudiate the insurance claim mentioning that wrong information was given at the time of providing insurance policy regarding age and income etc. In our view, if the agent as well as officers of the Insurance Company were satisfied that the life assured had provided correct information regarding her age by producing Voter Identity Card and they had taken decision to provide insurance policy knowing fully well that the age of the life assured was mentioned as 43 years in the Voter Identity Card prepared in the year 1994 in that situation, there was no reason to start further investigation and inquiries regarding age of the life assured. The Insurance Company cannot be allowed to blow hot and cold in the same rhythm. We feel the agent and officers of the Insurance Company also did not act honestly and with good intention. If they were not satisfied regarding age of the life assured after going through the Voter Identity Card, the opposite parties should have declined prayer of the life assured to provide her insurance policy.

14.              Apart from it, the Insurance Company raised the plea that wrong information had been given regarding age of the life assured after more than a period of two years. The insurance policy was provided mentioning date of commencement as February 12^th, 2013 and the life assured died on February 05^th, 2015. In these circumstances, keeping in mind the provisions of Section 45 of the Insurance Act, 1938 the opposite parties cannot be allowed to raise plea that wrong age was mentioned in the Proposal Form by the life assured, after a period of two years. Section 45 of the Insurance Act, 1938 is reproduced as under:-

“45. - Policy not to be called in question on ground of mis-statement after two years, -

No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy-holder and that the policy-holder knew at the time of making it that the statement was false or that it suppressed facts which it was material to disclose :

Provided that nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal.”        

 

15.              As per discussions above in detail, we feel the repudiation of the insurance claim submitted by the complainant was not justified. Minor technicalities certainly cannot be allowed to stand in the way of natural justice. In this situation when everybody in public life is facing such type of difficulties, it becomes the duty of the courts as well as of this Commission also to pass some effective, meaningful, relief giving and purposeful orders which should be based on equity and helpful for providing justice that is also natural justice. We feel courts as well as this Commission should pass orders as the situation demands and should not hesitate to come out a little out of the tight cordon of rules and procedure also if the situation so demands. It is not so difficult to decide a case but certainly it is not so easy to provide justice i.e. also natural justice. It is purposely provided under the provisions of the Consumer Protection Act, 1986 that provisions of Civil Procedure Code and Evidence Act shall not be strictly applicable in the proceedings of complaints filed under this Act. 

16.              As a result, as per discussions above in detail, findings given by the learned District Forum vide order dated April 11^th, 2017 are held to be wrong, illegal and are set aside. Accordingly, the appeal filed by the appellant-complainant is allowed and the impugned order dated April 11^th, 2017 passed by the learned District Forum is set aside. Consequently, the complaint filed by the complainant is allowed. The opposite parties are directed to pay the sum assured Rs.2,40,000/- (Rs.3,00,000/- minus an amount of Rs.60,000/- already paid and transferred in the account of the nominee of the life assured on 15.09.2015) to the complainant with interest at the rate of 9% per annum from the date of filing of the complaint till the date of realisation and to pay an amount of Rs.10,000/- on account of un-necessary harassment, mental agony as well as litigation expenses.

 

Announced: 02.07.2018

(Balbir Singh) Judicial Member

(Nawab Singh) President

 

CL