| Final Order / Judgement | Complainant Mrs.Manju Sharma through the present complaint filed under Section 12 of the Consumer Protection Act, 1986 (for short, ‘the Act’) has prayed that the opposite parties be directed to pay claim of Rs.10,00,000/- alongwith interest @ 18% p.a from the date of claim due i.e. date of death till actual realization alongwith compensation Rs.50,000/- on account of mental as well as physical harassment including litigation expenses, in the interest of justice. - The case of the complainant in brief is that Sh.Sham Lal (deceased) her father in law purchased SBI Insurance Policy bearing No.44034671804 commenced on 6.2.2012 for a sum assured of Rs.10,00,000/- with single mode of premium Rs.2,00,000/-. The name of product is ‘SBI Life Smart Performer’. A sum of Rs.2,00,500/- was debited from the account no.55129533694 being maintained by late Sh.Sham Lal on 21.1.2012 and same amount was transferred to account no.09816511820 given by the opposite parties on account of single premium and the opposite parties issued the insurance policy in question in the name of Sh.Sham Lal. Unfortunately Sh.Sham Lal expired on 12.1.2015 all of sudden by leaving behind Manju Sharma as valid nominee in the policy. The claim papers as prescribed were duly filled and submitted in the branch office of the opposite parties at Pathankot i.e. opposite party no.1 with original policy bond and death certificate in the month of February, 2015. No receipt of claim papers and documents was given to the claimant but it was assured that the payment of the claim will be made very shortly. After about a month or so, the claimant again visited the branch office/opposite party no.1 and she was assured that the investigation is over, the claim payment will be made. After that the claimant contacted the opposite parties on different telephone numbers given by the opposite parties but all the opposite parties carried on lingering the matter on one pretext or the other with malafide intention. Ultimately, she approached the office of the opposite parties at Pathankot and enquired the matter. Opposite parties stated that the death claim pertaining to Sham Lal has been repudiated and repudiation letter reference no.70312/OPS/15-16/CL/D/86365 dated 24.6.2015 was still lying in the office claim file and it was not delivered. Then the photocopy of the declined letter was given to her by hand on 18.11.2015. She has further pleaded that even after about 3 years from the date of issuing the policy in favour of the life assured, the opposite parties repudiate her claim by giving flimsy ground that the deceased Sham Lal was older than the age declared by him at the time of signing proposal form and age proof is not genuine. Had the deceased life assured not died, declaration and age proof would have been true and genuine. Since he has died, the intention of opposite parties turned malafide just to grab the huge amount of single premium of Rs.2,00,500/- by giving flimsy excuse in their repudiation letter. A registered A.D. legal notice dated 27.11.2015 was issued to the opposite parties. The opposite party no.3 has given a very vague reply and did not settle the claim till date. Thus, there is deficiency in service on the part of the opposite parties. Hence this complaint.
- Notice of the complaint was served upon the opposite parties who appeared through their counsel and filed their written reply taking the preliminary objections that the complaint is not maintainable for want of territorial jurisdiction of this Hon’ble Forum; the Deceased Life Assured understated his age and hence the claim was repudiated for suppression of material facts and in the instant case the DLA did not reveal the correct information about his age in the proposal form and thus obtained the insurance policy of Rs.10,00,000/- fraudulently. On merits, it was submitted that the Deceased Life Assured, Mr.Sham Lal had applied for SBI Life Smart Performer Policy vide proposal No.44AD 460851 dated 23/01/2012 alongwith initial premium of Rs.2,00,000/-. The opposite parties issued the policy in good faith bearing no.44034671804 with date of commencement as 06/02/2012 for basic sum assured of Rs.10,00,000/-. The DLA is reported to have died on 12/01/2015 and the claim occurred within 2 years 11 months and 6 days. The opposite parties enquired into the same and in the investigation, it was found that the DLA was much older than the age declared in the proposal form and he was not eligible to take the Insurance Policy. Further the age proof submitted by the DLA alongwith the proposal form was not found to be genuine. In the proposal form, the DLA had mentioned his date of birth as 01.01.1952 which means that he was 60 years as on the date of proposal (23.01.2012) and he had submitted Driving License as age proof alongwith the proposal form. But from the Voter’s list, it is evident that the DLA was 73 years as on 2015, which means that the DLA was 70 years as on 2012. Further, on verification of the Driving License submitted by the DLA alongwith the proposal form it was found that the Driving License submitted alongwith the proposal form was fake. The District Transport Officer, Gurdaspur has certified that the Driving License bearing no.12174/NDL was issued in the name of Sri Vikram Singh and it is valid upto 15/07/2027 as per their records. It has been further submitted that as per the features of the plan opted by the deceased, the maximum age at entry for Smart Performer Policy is 65 years. Hence if the deceased had revealed his correct age in the proposal form, he would have been ineligible to get the insurance cover and his proposal would not have been accepted. The above mentioned facts clearly prove that the DLA understated his age and produced fake age proof and procured the insurance cover fraudulently. Hence, the claim was repudiated as per the terms and conditions of the policy. Age is a vital and material factor to decide the prima facie eligibility of a proposer into insurance cover. The risk increases with age. If the correct age had been mentioned, the proposal would not have been accepted at all as the maximum age at entry under the plan is 65 years. The DLA thus committed a breach of the doctrine of Utmost Good Faith. All other averments made in complaint have been denied and lastly prayed for dismissal of the complaint.
4. Complainant tendered into evidence her own affidavit Ex.C1 and of Sh.Sadhu Ram Ex.C9 along with other documents Ex.C2 to Ex.C8 and closed the evidence. 5. Counsel for the opposite parties tendered into evidence affidavit of Sh.Neelam Singh Ex.OP-1 along with other documents Ex.OP-2 to Ex.OP-13 and closed the evidence. 6. We have thoroughly examined the available documents/evidence on the records so as to statutorily interpret the meaning and purpose of each document and also the scope of adverse inference on account of some documents ignored to be produced by the contesting litigants against the back-drop of the arguments as put forth by the learned counsels for their respective contestants. We find that the present dispute has arisen on account of the impugned ‘repudiation’ (Ex.C5/Ex.OP9) of 24.06.2015 of the insurance-claim (by the opposite party insurers, hereinafter for short ‘the OP’) as filed by the present complainant pertaining to the ‘death-claim’ of her late (demised) father-in-law Sh.Sham Lal, the DLA (deceased life assured). We observe that the prime ground founding/supporting the repudiation of the impugned 'death claim' in question has been the DLA’s misstated age-declaration (as signed in the proposal form) of ‘lower’ than his ‘actual’ de-facto age allegedly evidenced by a non-genuine age-proof. Somehow, we are inclined to examine the validity & legality of the impugned repudiation (of the related insurance claim) in the back-drop of proceedings and also the succeeding acts & events in the light of the facts on records. 7. We find that the DLA had submitted his Driving License (Ex.OP5) # 12174/ NDL (date: 14.02.2007) valid up to 13.02.2013 as ‘age-proof’ (DOB: 01.01.1952) to support his proposal form Ex.OP2 of 23.01.2012 on the basis of which the Policy document Ex.OP3 # 440 34671 804 dated 06/08.02.2012 was issued. Since, the insured demised on 12.01.2015, the related insurance claim Ex.OP12 was filed by the complainant on 11.03.2015 and the appointee investigator’s report Ex.OP4 was duly submitted on 25.03.2015. The Investigator has contested the ‘age’ of the insured (DLA) as at the date of insurance taken as: 62 years on the basis of Driving License (Ex.OP5) submitted as age-proof; whereas the DLA’s age as per the voters-list (Ex.OP6) of year 2015 is indicated as: 73 years (as on 01.01.2015) i.e., 70 years as at the date of insurance (i.e., that exceeds the eligible age of 65 years). The District Transport Officer, Gurdaspur has certified that the Driving License bearing no. 12174/NDL was issued in the name of Vikram Singh as per their records. As per the features of the plan opted by the deceased, the maximum age of entry for Smart Performer policy is 65 years. Hence if the deceased had revealed his correct age in the proposal form, he would have been ineligible to get the insurance cover and his proposal would not have been accepted. Age is always a vital and material factor to decide the eligibility of a proposer into insurance cover. From the entire above discussion it is proved that the DLA understated his age and produced fake age proof and procured the insurance cover fraudulently. Hence the claim was repudiated as per the terms and conditions of the policy and we do not find any deficiency in service on the part of OP. There is no merit in the present complaint and as such the same is hereby dismissed. 8. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to records. (Naveen Puri) President. ANNOUNCED: (Jagdeep Kaur) JULY, 26, 2016 Member. *MK* | |
