BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
FATEHABAD.
Complaint Case No.: 187 of 2016.
Date of Institution: 21.07.2016
Date of order: 11.04.2017.
Vijay Kumar son of Banwari Lal resident of village Banawali Tehsil & District, Fatehabad.
….. Complainant.
Versus
- Branch Sales Manager, SBI Life Insurance Company, First Floor Malhotra Bhawan, Hisar Road, Fatehabad Tehsil & Disttrict Fatehabad Mobile No.70824-00270.
- 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.
….Opposite parties.
Complaint U/s 12 of the Consumer Protection Act
BEFORE: Sh.Raghbir Singh, President.
Smt.Ansuya Bishnoi, Member.
Present: Shri Virender Jakhar, Advocate for the complainant.
Shri Rohtash Bishnoi, Advocate for the OPs.
ORDER:
The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against the opposite parties (hereinafter to be referred as OPs).
2. In short, the case of the complainant is that the mother of complainant namely Smt.Kasturi Devi during her lifetime had obtained an insurance policy bearing No.56034660603 dated 27.01.2013 for a sum of Rs.3,00,000/- by making the premium thereof reguarly. She was medically checked up before issuance of the policy by the OPs. The complainant was appointed nominee in the above said policy. Deceased life insured had died on 05.02.2015 due to heart attack, therefore, he lodged claim with the OPs qua the benefit of said policy and also submitted requisite documents with OPs but they did not honour the claim and repudiated the same vide letter No.75246/OPS/15-16/CL/86613 dated 10.10.2015 on the ground that DLA had withheld correct information regarding her age. It has been further averred that the DLA had disclosed all the material facts to the OPs and had not withheld any information qua her age. The act and conduct of the OPs clearly amounts to deficiency in service on their part. Hence, this complaint. In evidence, the complainant has tendered his affidavit as Annexure C1 and Annexure C2 to Annexure C14.
3. Upon notice, OPs appeared through their counsel and resisted the complaint by filing joint reply. It has been further submitted that the policy was issued to the DLA on the information furnished by her in the proposal form but the Voter’s ID submitted by her at the time of filing of proposal form was found to be fake, therefore, the claim of the complainant was rightly repudiated on account of misstatement because there is an element of fraud and cheating and same cannot be decided in summary proceedings. It has been further submitted that age is a material fact which determines whether the proposer is prima facie eligible for insurance policy but when the life assured understated his/her age and avails insurance policy then the insurance company remains within its right to repudiate the claim for suppression of material facts. The DLA had obtained the policy in question with malafide intention for substantial and illegal gain, therefore, the present complaint is not maintainable. It has been further submitted that the DLA had died on 05.02.2015 (within 1 year and 11 months and 24 days from the date of commencement of the policy), therefore on submission of claim the matter was thoroughly investigated but during investigation, the DLA was found much older than the age (55 years with Date of Birth 20.06.1958) disclosed by her in the proposal form because as per Voter’s list she was 72 years of age on 2014. It has been further submitted that as per features of the plan opted by her the maximum age was 60 years but she was older than the prescribed age for obtaining of the policy in question. There is no deficiency in service on the part of OPs as the claim was repudiated on the basis of documentary evidence and as per the terms and conditions of the policy duly conveyed to the complainant. Other allegations have been controverted and prayer for dismissal of the complaint has been made. In evidence, the OPs have tendered affidavit of Mrs.Dhanya KP as Ex.R1, affidavit of Mr.Rajan Kumar as Annexure H and documents Annexure A to Annexure G.
4. We have heard learned counsel for the parties and have perused the case file carefully. In his arguments the counsel for the complainant has reiterated the submissions made in the complaint and further contended that as per Section 45 of Insurance Act, 1938 if a period of two years passed after obtaining insurance policy, the policy cannot be called in question on the ground of mis-statement or concealment of facts. The counsel further contended that provisions of Section 45 of Insurance Act, 1938 are applicable in the present case as the DLA had obtained the present policy on 27.01.2013 whereas she died on 05.02.2015 i.e. after a lapse of more than two years. Therefore, in view of Section 45 of Insurance Act, 1938, the claim of the complainant cannot be repudiated by the OPs in the present case on the ground of concealment of facts. In support of his contention the counsel has relied upon the judgment of Hon’ble National Commission titled as Devamma Vs. Life Insurance Corporation of India II (2014) CPJ 3 (NC). In support of his case the counsel for the complainant has also relied upon the judgment rendered by Hon’ble Rajasthan State Commission Rigid Global (India) Vs. IFFCO Tokio General Insurance Company Limited & Ors. II (2008) CPJ 365. On the other hand the counsel for the OPs rebutted the above said arguments of the counsel for the complainant and further in support of his contention has relied upon the judgment as incorporated in the reply of the OPs.
5. After hearing learned counsels for the parties and going through the material available on the case file we are of the considered opinion that the complainant has not been able to prove his case by leading cogent and reliable evidence rather the learned counsel for the OPs have been able to prove on the case file that the life assured had obtained the policy in question by concealing the material facts from the insurance company with a malafide intention to deceive it. In the present case the date of commencement of the policy is 12.02.2013 whereas the DLA died on 05.02.2015 i.e. within two years from the issuance of policy. Therefore, we are of the considered opinion that Section 45 of the Insurance Act, 1938 is not applicable in the present case as contended by counsel for the complainant. In the proposal form (Annexure A) the deceased life assured has mentioned her date of birth as 20.06.1958 and as age proof the DLA had submitted Voter ID (Annexure D) wherein her age as on 01.01.1994 has been shown 35 years. However, a perusal of the Voter’s list-2014 (Annexure E) reveals her age as 72 years and on the date of filing of proposal the DLA was 70 years old. It is also pertinent to mention here that in voter ID of DLA (Annexure C-12) her age as on 01.01.1994 has been shown as 43 years whereas in Annexure D her age as on 01.01.1994 has been shown as 35 years. Annexure C-12 and Annexure D is the same document but age of DLA prescribed on both documents is different. Keeping in view the documents and facts as discussed above it is evident that the DLA had suppressed her correct age at the time of filing of the proposal form and had obtained the insurance policy fraudulently. It is well proved that at time of filing of proposal form the DLA was more than sixty years old and she was not eligible to obtain the policy in question as the maximum age for obtaining the policy is sixty years. Therefore, the contract has become void.
6. It is a settled preposition of law that a contract of insurance is based on the principle of utmost good faith. The Hon’ble Apex Court in case titled as Satwant Kaur Sandhu Vs. New India Assurance Company 2009 (9) JT 82 has held when an information on a specific aspect is asked for in the proposal form, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge.
7. It is also a settled principle of law that both the parties are bound by the terms and conditions of the insurance policy. In the present case the DLA has violated the terms and conditions of insurance policy and concealed material facts with a malafide intention as such we are of the considered opinion that the OPs has committed no deficiency in repudiating the claim of the complainant. The case law titled as Rigid Global (India) Vs. IFFCO Tokio General Insurance Company Limited & Ors. II (2008) CPJ 365 relied upon by learned counsel for the complainant is not helpful to the case of the complainant, therefore same is being distinguished.
8. In view of the position as discussed above, it is well proved that the complainant has approached this Forum with uncleaned hands and has failed to prove deficiency in service on the part of the OPs. It is also evident that the DLA had concealed the material fact regarding his age with the intention to deceive the OPs. The present case of the OPs is squarely covered by the judgments titled as titled as P.C.Chacko and another Vs. Chairman, Life Insurance Corporation of India and others 2008 (1) ALL MR 408 (SC) and Satwant Kaur Sandhu Vs. New India Assurance Company Limited 2009 (9) JT 82 (supra). Therefore, the present complaint is without any merit and the same is accordingly dismissed leaving the parties to bear their own costs. A copy of this order be supplied to the parties free of costs. File be consigned to the record room after due compliance.
Announced in open Forum.
Dated: 11.04.2017
(Raghbir Singh)
President
(Ansuya Bishnoi) Distt.Consumer Disputes
Member Redressal Forum, Fatehabad.
