DATE OF FILING: 23.11.2016.
DATE OF DISPOSAL: 06.04.2018.
Sri Karuna Kar Nayak, President.
The complainant Smt. Rasmita Sethi has filed this consumer complaint Under Section 12 of the Consumer Protection Act, 1986, alleging deficiency in service against the Opposite Parties ( in short the O.Ps) and for redressal of her grievance before this Forum.
2. Briefly stated the case of the complainant is that late Udayanath Sethi, the deceased father of the complainant during his life time had insured his life before the O.P.No.1,2 & 3 through their agent on dated 30.01.2012 for 10 years in M/s Reliance Nippon Life Insurance (RNLIC) in NSA plan policy number: 19765927 for sum assured Rs.1,84,500/- and deposited the premium installment sum of Rs.30,009.00 in his name and the complainant Rasmita Sethi the daughter of the said policy holder was the nominee in the said RNLIC policy. After taking of medical examination of the policy holder by O.Ps issued the RNLIC plan policy number: 19765927 for assured amount of Rs.1,84,500/- with the terms and conditions that “ On the death of policy holder at any time prior to the due dates of maturity of the said Reliance Life Insurance Policy the O.P.No.1,2 and 3 shall disburse the assured sum of Rs.1,84,500/- with vested bonus payable and additional benefits attaching of the policy to the nominee of the said deceased policy holder. Unfortunately the said policy holder Udayanath Sethi died on dated 29.04.2012. After death of the policy holder, the nominee of the said life insurance policy the complainant had submitted the death certificate of the deceased policy holder received from the competent authority and surrendered the original policy bond with claim application to the O.P.No.2 and 3 claiming for settlement of death claim of the said deceased policy holder and demanded the assured sum of Rs.1,84,500/- alongwith bonus and the other benefit but the O.Ps have not taken any action for settlement of death claim of the complainant inspite of her repeated approaches made to the O.Ps in their respective officers. The complainant issued advocate notice on dated 29.07.2016. But on 18.09.2016 the O.P.No.1 falsely and malafidely denying and repudiating the claim of the complainant stating “the age of the assured late Udayanath Sethi at the time of submission of proposal form the date of birth was 01.01.1963 i.e. 49 years of ages has been grossly under stated” and further alleged that the actual age of the assured at the time of submission of proposal form was 64 years which was not true and falsely stated that the said allegation was intimated to the complainant by the letter dated 31.01.2013. The complainant has objected such baseless and false comments. It is submitted that on 30.01.2012 when the O.Ps accepted the proposal form and deposit of first premium amount, they accepted the same by taking medical examination of the said assured policy holder Udayanath Sethi and the dates of birth of the policy holder on 01.01.1963 was disclosed in the proposal or medical examination form duly certified, approved and accepted by the O.Ps. The customer’s identity proof of the said assured policy holder Udayanath Sethi has also issued by the O.P.No.3 which disclosed date of birth of said policy holder was 01.01.1963. The O.Ps illegally and dishonestly repudiated the said genuine claim of the complainant which she is entitled to get from the O.Ps the assured sum of said policy with interest and other assured benefits. Alleging deficiency in service on the part of the O.Ps the complainant prayed to direct the O.Ps to pay assured sum of Rs.1,84,500/- with 12% interest per annum to the complainant from the dates of death of the policy holder i.e. 29.04.2012 till its payment and grant compensation towards deficiency of service, dishonest and illegal trade practice, inaction of the O.Ps in settling the genuine death claim of the complainant with best interest of justice.
3. Upon notice the O.Ps filed version through his advocate. It is stated that the present complaint is false, frivolous, vexatious and abuse of the process of this Hon’ble Forum and therefore, the same is liable to be dismissed. Basing on the information and declaration contained in the application form and believing the same to be true and also upon receipt of the duly filled form along the O.Ps issued the policy bearing No.19765927 in the name of the life assured. The O.Ps received claim intimation and for which investigation of the claim of the complainant at demise of life assured needed to take place and as in response to the same, the complainant was asked to submit necessary documents to assess the authenticity of the claim. On investigation, the O.Ps came across there is huge discrepancy with regard to true age of the life assured and the same has been grossly misrepresented and understated by the life assured. The Life Assured at the time of submission of the proposal has mentioned his date of birth as 01.01.1963, whereas the life assured was about 64 years at the time of taking of the policy and he misled the insurer to offer his insurance on the terms as stated in the policy schedule. The “Affidavit” of the life assured was the age proof submitted at the time of the proposal form. Alternately, voter list was procured which established age of life assured as approximately 64 years at the time of taking of the policy. Relevant page of the voter list has been sourced which states age of life assured as around 64 years; hence, L.A. was of 64 years at the time of his aforesaid death. It is relevant to mention that life assured has indulged in gross misrepresentation and understatement of age at the time of issue of the policy and the non-disclosure of this fact was material to the issuance of the policy and ought to have been disclosed by the life assured. The life assured had deliberately misled the O.Ps authorities by concealing the above material information by furnishing false replies in proposal form in order to grab the insurance cover to his which is clear breach of the conditions of the contract and violation of principle of good faith and shows the fraudulent and dishonest intention. If the correct age had been declared at proposal stage, the O.Ps would not have issued the policy without medical test. The said policy was repudiated on 31.03.2013 but the complainant has approached the Hon’ble Forum only in the year 2016 which is beyond 2 years from the alleged cause of action. Hence this case is barred by the period of limitation as enshrined under section 24A of the consumer Protection Act, 1986 and the complaint is liable to be dismissed.
4. On the dates of final hearing of the consumer complaint, the learned counsels for both parties are present. We heard argument at length from both parties and perused the complaint petition, version, written argument, citation and documents placed on the case record. The Hon’ble National CDR Commission, New Delhi has held in case of ICICI Prudential Life Insurance Company Limited versus Smt. Bimal Kanta Kharab reported in 2013 (1) CPR 160 that “Death claim can not be repudiated on technical grounds”. And also another decision the Hon’ble National CDR Commission, New Delhi has held in case of SBI Life Insurance Company Ltd. versus Mr. Butu Harijan reported in 2012 (1) CPR 303 that “Death claim cannot be repudiated where complainant has already submitted original policy bond and death certificate with claim form to insurance company”. After death of the policy holder, the nominee of the said life insurance policy the complainant had submitted the death certificate of the deceased policy holder received from the competent authority and surrendered the original policy bond with claim application to the O.P.No.2 and 3 claiming for settlement of death claim of the said deceased policy holder and demanded the assured sum of Rs.1,84,500/- alongwith bonus and the other benefit but the O.Ps have not taken any action for settlement of death claim of the complainant inspite of her repeated approaches made to the O.Ps in their respective officer. In our considered view, we therefore, hold that the O.Ps are not justified repudiating the claim of the complainant and due to non-settlement of genuine claim of complaint in technical ground, they are deficient in services. However, we direct the O.Ps to pay cost of this litigation since the O.Ps even after receipt of the claim form they did not prefer to settle the genuine claim of the complainant as a result she was forced to issue an advocate’s notice as well as hired the services of an advocate to file this consumer complaint in this Forum. As far as cost of litigation is concerned, in this case, the complainant has hired the services of an advocate who is attending this case. We, therefore, hold that it would be just and proper in the facts and circumstances of case to award cost of litigation against the O.Ps to the complainant.
In the result, complainant’s case is partly allowed against the O.Ps who are jointly and severally liable as such they are directed to pay the sum assured amount of policy No. 19765927 alongwith 6% interest from the date of filing of this case i.e. from 23.11.2016 alongwith Rs.2000/- towards costs of litigation to the complainant. The aforesaid order shall be complied by the O.Ps within 45 days from the date of receipt of this order failing which all the dues shall carry 12% interest per annum till final payment is made. The case of the complainant is disposed of accordingly. No order as to compensation.
The order is pronounced on this day of 6th April 2018 under the signature and seal of this Forum. The office is directed to supply copy of order to the parties free of cost and a copy of same be sent to the server of
