KUNDAN KUMAR KUMAI

This is an appeal under Section 15 of the Consumer Protection Act 1986, preferred against the order and judgment dated 28.07.2022, passed by the Ld. DCDRF, Cooch Behar, in CC No. 22/2019.

The appellants’ case in brief is that, the respondent no. 1/ complainant no. 1, is the nominee in the LIC Policy of deceased Haru Singha and respondent no. 2/complainant no. 2, is the wife of the deceased. The deceased had purchased one LIC Policy being no. 445901974 dated 14/08/2015, from the appellants’ and the deceased had paid premiums, as per terms and conditions, with accidental benefits sum assured being, Rs. 1,00,000/- (One lakh) only and the deceased had paid premiums till his death on 03/01/2017, due to heart attack. The respondent no. 1/complainant no.1, had intimated the total matter to the appellant no. 2 as well as the agent Sri. Ashok Dutta, who assured that the claim would be disbursed. But the appellant no. 2, vide letter dated 06/06/2018, repudiated the claim. As per advice, a petition had been preferred before the Insurance Ombudsman, but the same also, had been refused. Finding no alternative the respondent no. 1 and 2/ Complainant no. 1 and 2, had filed a claim case before the Ld. DCDRF, Cooch Behar, with necessary prayers.

The appellants had appeared to contest the claim, by filing written version wherein, though the purchase of Endowment Policy (table 814-16) numbering 445901974 dated 28/07/2015, with the sum assured for Rs. 1,00,000/- (One lakh) only, with quarterly premium payable at Rs. 1,760/- (One thousand seven hundred sixty) only, had been admitted. It had been further stated, that the deceased Haru Singha had submitted xerox copy of the EPIC Card bearing no. WB/01/004/333058, wherein the age mentioned was 22 years, as on 01/01/1995. The deceased had expired after one year four months and nineteen days, after taking the Policy. The nominee being the respondent no. 1/complainant no. 1, had submitted the death claim papers and the appellants had collected the copy of the Adhar Card as well as the EPIC Card, wherein the age was recorded as 32 as on 01/01/1995. From which it was evident, that the deceased had fraudulently misrepresented his age by 10 years, as the entry age on nonstandard age proof was 50 years, whereas his age was 52 years. Thus, under Section 45 of the Insurance Act, the claim had been repudiated. It was further prayed, that the case be dismissed.

After going through the evidence and materials on record, the Ld. DCDRF, Cooch Behar, had passed the impugned order directing the appellants, to pay a sum of Rs. 1,25,000/- (One Lakh twenty-five thousand) only, with interest @6% per annum, from the date of maturity of the premium, failing which the entire amount would attract interest @6% per annum, till the date of payment.

Being aggrieved by the impugned order, the appellants preferred the instant appeal on the ground, that the Ld. DCDRF, Cooch Behar, had erred in law and facts, while passing impugned order.

                                                                 Decision with reason

Ld. Advocate for the appellant, at the time of final hearing, had submitted that deceased had disclosed his date of birth as 01/01/1973, effectively making his age as 42 years and also submitted the copy of the EPIC Card which showed his age as 22 years on 01/01/1995. But the EPIC Card and the other card collected from the respondents showed that the age was 32 years as on 01/01/1995. Therefore, the deceased had fraudulently misrepresented his age, in order to obtain the Policy, which would not have made him eligible, had he mentioned his actual age. He had also relied in the judgment passed in PC Chacko & Another Vs. LICI & Others, reported in CPJ Volume III, 2008 (78) (SC), Satwant Kaur Sandhu Vs. New India Assurance Company Ltd., reported in CPJ Volume IV, 2009 (8) (SC) and Manmohan Nanda Vs. United India Insurance Company Ltd. & Anr., reported in CPJ Volume I, 2022 (20) (SC).

Ld. Advocate for the respondent on the other hand had countered, that the appellants ought to have verified the age documents of the deceased, when he had been alive, but as they failed to do so, the deceased should not be held to have acted fraudulently, for such negligence on their part, he had relied on the judgment passed by the Hon’ble NCDRC in Reliance Nippon Life Insurance Vs. Shaheb Hussain, on 03/04/2019 and Govt. of India office memorandum dated 20/12/2018, regarding usage of Adhar.

To begin with, the facts of the case are not disputed. The application for the Insurance policy by the deceased, by using nonstandard age proof, i.e., election identity card, showing the age of the deceased as 22 years on 01/01/1995 has been proved and corroborated by the date of birth mentioned in the proposal form. Therefore, with the death of the deceased, occurring within one year four months and nineteen days and the claim application being made within the statutory two year period, the appellants’ right, to invoke the provisions of Section 45 of the Insurance Act, after the Adhar Card and Voter ID Card, revealed that the deceased had been ineligible,   for obtaining such Policy, cannot be questioned. In such a scenario, the only option left before the respondent/complainants, was to have produced better evidence like Birth Certificate, School Certificate etc., in order to deflect, the allegation of fraudulent motive, against the deceased. But the failure on the part of the respondent/complainants, to produce such better evidence, resulted in the strengthening of the appellants case, against the deceased. In this regard the ruling cited on behalf of the respondents/complainants, passed by the Hon’ble NCDRC in Reliance Nippon Life Insurance Vs. Shaheb Hussain, on 03/04/2019, also do not come to the rescue, as the facts in the above ruling are quite different, for which the Hon’ble NCDRC had frowned upon the dispute being raised after the demise of a person, when better evidence of age in the form of PAN card, had been produced. In the instant case, no such better evidence, as observed above, had been produced for which the application of the above ruling could not be made, even though, the Ld. DCDRF, Cooch Behar had justified, the impugned order basing on this ruling, which appears to be erroneous. 

Under the circumstance in view of the above observations and the findings, the impugned order cannot be sustained, resulting in the success of this appeal.

It is therefore,

                                                           Ordered

That the instant appeal be and the same is allowed on contest, but without costs.

The impugned order is hereby set aside.

Copies of the order be sent to the parties, free of costs.

Copies of the order be sent to the Ld. DCDRF, Cooch Behar, for necessary information.

Statutory deposits, if any, be returned from whom received.

Joint registrar, Siliguri Circuit Bench of the WBSCDRC, to do the needful.