BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM, JALANDHAR.
Complaint No.344 of 2016
Date of Instt. 09.08.2016
Date of Decision: 29.07.2019
Rani W/o Sham Lal, aged about 42 years, R/o Dushera Ground, Shekhan Wali, Ferozeur, Tehsil Ferozepur.
..........Complainant
Versus
Star Union Dai-ichi Life Insurance Co. Ltd. T. F. 1-2, 3RD Floor, Eminent Mall, Plot No.26 L, Lajpat Nagar, Jalandhar-144001 through its Manager.
….….. Opposite Party
Complaint Under the Consumer Protection Act.
Before: Sh. Karnail Singh (President)
Smt. Jyotsna (Member)
Present: None for the Parties.
Order
Karnail Singh (President)
1. Brief facts of the complaint are that in the year 2014, agent of the OP approached the husband of the complainant for purchase of the insurance policy and being allured by the agent of the OP, husband of the complainant namely Sham Lal purchased one life insurance policy from OP and also deposited the requisite premium being first insurance premium for sum assured of Rs.9,00,000/- and accordingly the OP issued a policy No.00797604 and the premium was payable annually, but no terms and conditions ever issued to the complainant or her husband. In the said insurance policy, the complainant was appointed as nominee by her husband.
2. That unfortunately, the husband of the complainant died due to natural death on 13.10.2014, thereafter, the complainant gave intimation of the death and also submitted all the original documents required by the OP for settlement of aforesaid lawful claim. Thereafter, the OP also appointed investigator regarding the aforesaid insurance claim of the complainant and investigator of the OP approached the complainant and he too took photocopies of some documents and also got the signatures of the complainant on some blank papers and some blank printed forms and conveyed the complainant that her lawful insurance claim shall be paid to the complainant shortly, but till date the OP has not make the payment of claim of the complainant. The complainant repeatedly approached and requested OP to settle her lawful claim and to make the payment, but the complainant was astonished when the officials of the OP disclosed that her claim was rejected by the OP on the flimsy grounds that deceased/life assured i.e. Sham Lal has concealed the information of holding another previous insurance policy in his name. But no letter has been received by the complainant from the OP and for this, the complainant issued a notice to the OP through her counsel and on this the OP sent a reply of the same. The aforesaid repudiation of the claim of the complainant by OP is illegally, null and void, against the law and facts. It is further submitted that all the column of the proposal form were filled by agent of the OP of his own, at the time of obtaining the aforesaid insurance policy by Sh. Sham Lal, husband of the complainant and husband of the complainant never concealed any fact from the OP. Moreover, non disclosure of any previous policy has got no nexus with the present policy and as such, the act and conduct of the OP is tantamount to deficiency in service and unfair trade practice and accordingly, the instant complaint filed with the prayer that the complaint of the complainant may be accepted and OP be directed to make his payment of Rs.9,00,000/- as death claim with regard to death of husband of the complainant and further prayed that any other additional or alternative relief for which she may be found entitled, be also awarded.
3. Notice of the complaint was given to the OP, who appeared and filed written reply, whereby contested the complaint by taking preliminary objections that the complainant has concealed and suppressed the material facts. The complainant has with malafide and dishonest intention not only concealed the material facts as enumerated in the present reply of the OP from this Forum, but has also twisted and distorted the same to suit her own convenience and to mislead this Forum. It is further averred that no cause of action ever arose in favour of the complainant and against the OP to file the present complaint. The complaint under reply is nothing, but an abuse of the process of law and as such, the same is liable to be dismissed with exemplary cost. It is further submitted that the complainant has fabricated material facts regarding the pre-existing medical condition of deceased life assured and is resorting to unfair means and unduly pressuring the OP to settle his claim. Hence, in view of the above submission, the complaint of the complainant is liable to be dismissed. On merits, it is admitted that the complainant purchased the insurance policy and at that time, the husband of the complainant Sham Lal had submitted a duly filled and executed proposal form along with first premium cheque to the OP, but the husband of the complainant/insured has concealed his previous insurance cover of Rs.9,00,000/- from some other company prior to taking the policy and as such, the husband of the complainant had violated the provisions of Regulation 6.2 of the Insurance Regulatory and Development Authority and further submitted that the company/OP has appointed an independent investigator for investigating the matter. However, it is vehemently denied that the investigator obtained the signatures of the complainant on blank paper. It would be pertinent to mention here that during survey, it has came to knowledge of the investigator that the husband of the complainant was already having insurance cover of around Rs.9,00,000/- from some other company. It is further submitted that the husband of the complainant has clearly violated the rules of Regulatory and Development Authority and further submitted that the OP has received cause of death certificate of the life assured from two different doctors i.e. Dr. Satnam Singh as well as Dr. Iqbal Singh, but the cause of death on both the reports are different, which create a doubt. The other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
4. In order to prove the case of the complainant, counsel for the complainant tendered into evidence affidavit of the complainant Ex.CA alongwith some documents Ex.C-1 to Ex.C-12 and closed the evidence.
5. Similarly, counsel for the OP tendered into evidence affidavit Ex.OP/A and got a date for further evidence, but thereafter, the evidence of the OP was closed by order, vide order dated 23.08.2017.
6. When the case was fixed for argument and at this stage, both the parties did not come present, neither their counsel appeared and accordingly, we have gone through the case file as well as documents available on the file.
7. There is no dispute that the husband of the complainant, namely Sham Lal purchased one life insurance policy for sum assured of Rs.9,00,000/- having bearing No.00797604 from the OP and husband of the complainant was also admittedly died and whose photostat copy of death certificate is available on the file Ex.C-2 and further complainant also submitted an insurance claim of her husband, but the same was repudiated by the OP, upto this extent, the OP has not denied the fact in its written reply.
8. Now question remains on which grounds the death insurance claim of the husband of the complainant has been repudiated by the OP, for that purpose, the plea taken by the OP in written statement is only that the deceased insured concealed the material facts i.e. in regard to purchase of another insurance policy from other company and further the deceased insured was having some pre-existing disease, which was got located by the investigator and reports of the Dr. Satnam Singh and Dr. Iqbal Singh was obtained by the investigator and on these grounds, the claim of the complainant has been rightly repudiated.
9. We find that simply taking a plea in the pleading, is not sufficient until the same is not proved by way of documentary or oral evidence, in this case, the OP allegedly mentioned some document Annexure R-1 to Annexure R-4 in the written reply, but the same has not been placed on the file at the time of filing of written statement and these facts also came in the Zimni Order of that date and further if these documents have been produced on the file by the OP, then the counsel of the OP must have tendered the same on 02.06.2017, when the only one affidavit Ex.OP/A was tendered. The OP alleged that an investigator was appointed to locate some documentary evidence in regard to one policy obtained by the insured from other company as well as the insured was having some pre-existing disease, but for the best known reason, the OP has not brought on the file any report of the investigator or report of the doctors from whom the insured was taking medicine and further the insured has if concealed any facts from the OP, then it can be only proved from the proposal form, whether in that proposal form the husband of the complainant has concealed or not, but for the best known reason, the OP has not brought on the file the said proposal form and as such, we find that the plea taken by the OP is not supported by any cogent and convincing evidence. So, in the absence of evidence, the same cannot be accepted as gospel truth, rather the case set up by the complainant is fully established and as such, we find that the complainant is entitled for the relief.
10. In the light of above detailed discussion, the complaint of the complainant is partly accepted and OP is directed to pay the insured amount of Rs.9,00,000/- to the complainant within 30 days from the date of receipt of the copy of order, failing which the OP will liable to pay interest thereon @ 12% per annum from the date of filing complaint i.e. 09.08.2016, till realization. This complaint could not be decided within stipulated time frame due to rush of work.
11. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jyotsna Karnail Singh
29.07.2019 Member President
