The complainant Ranjeet Kumar has filed this complaint petition against The Branch Manager, PNB Met Life Insurance Company Ltd. Muzaffarpur,  and one another (o.ps) for  realization  of Rs. 9,40,180/- as sum assured, Rs. 45000/-  for compensation for mental  agony and  physical harassment &  Rs. 25,000/- as litigation cost,  with 18 % interest p.a. on the sought amount since  the date of death of  life   insured person  till date of final payment/ realization.

 The, brief, facts of the case is that complainant  Ranjeet Kumar  is  son of L.A person namely Kari Shahu . The further case is that on 28-02-2014, the father of the complainant  purchased  a policy  bearing No.- 21274757  from o.p company for sum assured Rs. 9,40,180/- along with    other monetary benefits and paid Rs. 30,000/- as premium amount  through cheque no.- 915227 of United Bank of India. The further case is that the entire proposal form was filled up by company’s agent in the presence of company’s official  and the complainant’s  father   only put his signature wherever the agent and said official told him to do so, in good faith and trusting upon agent’s knowledge and   technicality about life insurance policy. The risk coverage of life of L.A was from 06-03-2014. The further case is that on  27-05-2014, all of a sudden  Kari Sahu complained about   chest pain  followed by vomiting,  to the family members who in turn consulted Dr. Afzal Ahmad (MBBS) but unfortunately L.A. person  expired after brief treatment on next day, that is on  28-05-2014 due to respiratory   failure. The further case is that the complainant filed death claim against aforesaid policy to the insurance company with all the relevant documents  but the o.p company repudiated the claim of the complainant on the ground that  official information   provided by L.A at the time of filling of proposal form was   incorrect and therefore concealed material information.                                                                                                                          

The complainant has filed the following documents with the complaint petition - photocopy of   first premium receipt -annexure-1, photocopy of  death certificate annexure-2, photocopy of certificate relating to cause of death  annexure-3, photocopy  of prescription of Dr.   annexure-4, photocopy of PAN CARD- annexure-5, photocopy of  Income- Tax Return for the Assessment year  2012-2013  annexure-6, photocopy  of income tax return for the Assessment year  2013-2014  -annexure-7, photocopy of   repudiation letter -annexure-8,  photocopy of  certificate issued by Mukhiya annexure-9,

On issuance of summon o.ps appeared and filed their w.s. on 31-05-2018 with prayer to dismiss the complaint with cost. It has been further mentioned in the w.s. that the complaint is neither maintainable in law nor on facts and is liable  to be dismissed.  It has been further mentioned that the complainant  has  no cause of action against  o.ps to file this complaint petition. It has been further mentioned that the complaint petition is false, malicious, incorrect and has been filed with malafide intent. It has been further mentioned that the complaint filed by the complainant does not fall within the definition of a ‘Consumer Dispute’  (under the Consumer Protection Act- 1986).  Filing of proposal form by deceased life insured ( hereinafter called as D.L.I ) and the issuance of  policy bond bearing no.- 212/74757 with effect of date of  overage as 06-03-2014 is an admitted fact. The o.ps have annexed application form and policy claim as annexure- o.p no.-1 . Receiving of death claim from the complainant  to o.p is an admitted fact . Death claim intimation and condonation letter has been marked as annexure- o.p 2. It has been further mentioned that since the claim was an early claim, so the o.p, as per procedure,  carried out  an investigation to  settle the claim of the claimant.  It was revealed that the D.L.I didn’t provide true and correct information while filing up his proposal form and cheated the o.p by providing false information and obtained insurance policy. It has been further mentioned that in the proposal form, the D.L.A didn’t provide correct information as regard to his annual income. The o.ps have annexed copy of relevant document regarding income of complainant as  annexure- o.p no.-3. It has been further mentioned that D.L.I has mentioned his annual income in proposal form as Rs. 4 lacs but o.p revealed that the D.L.I was very poor person having annual income of Rs. 1 lacs. It has been further mentioned that D.L.I has not filed income tax return in the relevant period and as such he suppressed the material fact. It has been  further mentioned that o.p repudiated the claim of the complainant  on the ground of providing of false information as to material facts with respect to the income of the D.L.I at the time of filling  of the proposal form, based on which the said policy was issued by o.p to him. It has been further mentioned that no I.T.R was filed by D.L.I in the assessment year 2012-2013.

On behalf of complainant, Ranjeet has examined himself of affidavit as AW-1. He has marked    annexures filed on his behalf as exhibit 1 to 9.

On behalf of o.ps,   o.p.  w-1 Ranjeet Sharma claim Management, (legal) of PNB Met Life Insurance Company Ltd. has examined himself on affidavit and he has also exhibited annexures filed on behalf of o.ps as exhibit 1 to 4.

Annexure- 8 filed on behalf of complainant and annexure op no.-4 are the same document that is repudiation letter. The claim of the complainant has been repudiated on the ground that financial information Provided at the time of proposal by Mr. Kari Sahu was incorrect and I.T.R copy submitted as the income proof was found to be fake and thus denied the opportunities to risk properly.

The complainant has stated in para-11 of has complaint petition that the father of the complainant namely Kari Sahu was healthy and wealthy business man of his locality. He has further stated that document submitted by him regarding the income proof was true and genuine and the same had been verified  by companies official  throughly  at the time of accepting the proposal. It has been further mentioned in the complaint petition that he was earning more than 4 lacs yearly. The complainant has filed photocopy of income tax return for the assessment year 2012-2013 and 2013-2014 as annexure- 6 & 7. In the  financial year the gross total income of the  Assesses  has been shown as Rs. 3,61,393/- and in the assessment year 20  13-2014 the same was of Rs. 4 lacs and something which is not visible.

O.ps has stated in their w.s. that I.T.R for the assessment year 2012-2013 is false and no I.T.R  was filed in the assessment year 2012-2013. This question has been raised  on behalf of o.ps so   the burden lies on them to prove this fact. No document has been produced by the  income tax department  to show  that no I.T.R was filed on behalf of Late L.A. Kari Sahu  in the assessment year  2012-2013. No competent  witnesse  has come  forward on behalf of o.p to prove the above fact. The .p no.-1 Ranjeet Sharma  is only a formal and hears say witness  on the fact who has come to prove the above facts in his deposition. So, it is not proved on behalf of o.ps. that the income of DLI was not upto Rs. 4 lacs in the relevant period  Relying  on the above proposal form, o.p company issued the policy bond.

Learned Lawyer for the complainant  relied on the observation made by the Hon’ble  N.C. D. R.C in the case of Life Insurance Corporation of India  V/s  Smt Chana Goni Upendra in revision  petition  no.- 519/2007 passed on         10-01-2012  

 In the above case Hon’ble N.C. has observed  as follows- “ The Life assured had clearly stated in his proposal form that his income is Rs. 40,000/- to Rs. 50,000/-. The Development officers of the o.ps ought to have verified   at this juncture itself before the issuance of policy whether the income declared in the proposal form is true or not. MRO record ought to have been  verified   that point of time. Having issued the policy  with  the death of the diseased in Motor Vehicle Accident not in  dispute at this juncture, the insurance company is not justified in repudiating  the claim”. Hon’ble National Commission has also agreed with the view taken by the State Commission and has observed that the plea taken by the petitioner company regarding the alleged  false declaration in respect of the only income declared by the D.L.I as a valid ground for  repudiation of the claim put forth complainant.

On the above discussion and observation of the Hon’ble  N.C.D.R.C, we are of the opinion that the o.p company has wrongly repudiated the claim of the complainant  and there is deficiency on their part.

In the circumstances  the claim petition  is allowed  and o.ps are  directed to pay Rs 9,40,180/- as sum assured with 7 % interest p.a since filing of complaint petition, i.e.              03-10-2016,  Rs. 20,000/- as physical and mental harassment and Rs. 10,000/-  as litigation cost within two months from the date of  order on failure to pay the aforesaid amount the o.p shall be liable to pay the same with 9 %  p.a. interest till realization. Let a copy of this order be furnished to both the parties as per rule.