The complainant Smt. Amrita Devi has filed this complaint petition against the Branch Manager, Reliance Life Insurance Company Ltd., Muzaffarpur and one another (o.ps) for realization of Rs. 5,98,000/- as sum assured, Rs. 71,000/- for physical and mental harassment and Rs. 25,000/- for litigation cost. along with 18 % p.a. interest on the total sought amount since the date of death of life assured person till the date of final payment/ realization.
The brief, facts of the case is that the husband of complainant namely Tirju Paswan (L.A) purchased policy bearing no.- 51745873 from o.p Insurance Company for sum assured Rs.5,98,000/- on 26-07-2014 by paying Rs. 12,985/- as premium amount by cheque no.- 500312 of Bank of Maharashtra DBG. The further case is that the risk coverage of the policy was from 28-07-2014. The further case is that in morning of 05-10-2014, all of a sudden Tirju Paswan died with extreme chest pain. The further case is that the complainant filed death claim against aforesaid policy to the aforesaid insurance company with all the relevant documents but the o.p company repudiated the death claim of the complainant on the ground that L.A. person namely Tirju Paswan had not disclosed his true income, occupation in the proposal form and the L.A. committed suicide on 05-10-2014.
The complainant has filed the following documents with the complaint petition- Photocopy of policy schedule–annexure-1 photocopy of Death Certificate -annexure-2, photocopy of I.T. return for the assessment year 2014-2015 annexure-3., photocopy of PAN CARD -annexure-4. photocopy of Repudiation letter annexure-5,
On issuance of notices, o.ps. appeared and filed their w.s. on 08-02-2018 with prayer to dismiss the complaint with cost. It has been further mentioned in the w.s. that the complaint is false, frivolous, and vexatious and is gross misuse of process of law. It has been further mentioned that the present complaint is not maintainable and the same does not raise any consumer dispute as defined under the Consumer Protection Act. It has been further mentioned that the L.A. concealed various material facts pertaining to his annual income and occupation and further documentary evidence were procured which shows that the L.A. has committed suicide in the proposal form against the specific questions asked with respect to it. It has been further mentioned that the present complaint is not maintainable. It has been further mentioned that the claim of the complainant is based on the policy which was obtained fraudulently, dishonestly, by misrepresentation of annual income and occupation and the complainant had also concealed the fact that the death of L.A. occurred due to suicide on 05-10-2014 whereas in the claim intimation form the complainant had mentioned cause of death as heart attack. Since the issuance of the subject policy is outcome of false hood, therefore, the complainant is not entitled for any benefit or reliance under the subjected policy and the complaint is liable to be dismissed. It has been further mentioned that there is no deficiency in service on the part of o.ps. Issuance of policy bond in the name of L.A. Tirju Paswan for Rs. 5,98,000/- (as sum assured) is an admitted fact. O.ps have annexed photocopy of policy documents as annexure-A. Receiving of claim intimation is also an admitted fact. It has been further mentioned that o.ps conducted a statutory investigation, through an Investigator under clause 8 (3) of the Insurance Regulatory and Development Authority (Protection of Policy Holders interest) Regulations, 2002 in order to verify the authenticity of the claim. It has been further mentioned that on investigation the o.ps came to know of the following shocking facts, that the L.A had misrepresented his occupation and Income, which is a material for the issuance of the policy and ought to have been disclose in the proposal form. Therefore there is huge discrepancy with regard to income and occupation of the Life Assured. It has been further mentioned that on investigation, it was also discovered that the Life Assured Mr. Tirji Paswan committed suicide on 05-10-2014 and did not die due to Heart Attack as stated by the claimant in the claim intimation form. A copy of the written proof by the Anganwadi Sevika and Ward Member has been annexed and have been marked as annexure-B & C. It has been further mentioned that since the L.A had misleaded o.p and concealed the material fact in his proposal form so the claim of the complainant was repudiated vide its letter dated 31-10-2015. The o.ps have also annexed the repudiation letter as annexure-E.
The complainant has examined herself on affidavit as Aw-1.
The o.ps have repudiated the claim of the complainant on the ground that the claimant misrepresented his occupation, income in the proposal form and L.A Mr. Triju Paswan committed suicide of 05-10-2014. The complainant has annexed the repudiation letter as annexure-5 whereas the same document has been annexed on behalf of o.ps as annexure-E.
The o.ps have raised the above facts of occupation income and committing of suicide in their repudiation letter, so burden of proof lies on them. The o.ps have not adduced any evidence on this point. The o.ps have annexed the photocopy of certificate granted by Sevika Kiran Devi and Baiju Paswan ward member as annexure B & C. They have certified that Tirju Paswan had committed suicide on 05-10-2014 at his house due to some not exchange between him and his wife. Sevika Kiran Devi and Baiju Paswan Ward member have not been examined on behalf of o.ps to prove the above facts. No explanation has been offered on behalf of o.ps for not examining the above witnesses. No register has been produced on behalf of o.ps to prove the above facts. On the other hand, the complainant has supported his version as stated in complaint petition. On behalf of complainant death certificate of Briju Paswan has been filed which has been issued by competent authority on proper form. In the above certificate in the column of names Briju Paswan has been deleted and in that place Tirju has been mentioned but the same death certificate has not been challenged on behalf of o.ps. The above death certificate has also not been cancelled by proper issuing authority. The issuing authority has put his initial signature on the above cutting. The o.ps have not denied the fact that Tirju Paswan had not died 05-10-2014 whereas their contention is that he died on the same date but by committing suicide. The o.ps have not filed postmortem report nor any other documents to prove the fact of suicidal.
The o.ps have not adduced any evidence on the point regarding the suppression of occupation and income of the L.A whereas on behalf of complainant return of income tax for the assessment year 2014-15 has been filed as annexure-3 and photocopy of Pan Card of Tirju Paswan as annexure-4. Annexure-3 shows that in the year 2014-2015, his income was Rs. 3,28,650/-. In the proposal form, annual income of Triju Paswan has been shown as Rs. 3,50,000/- from business which is in support of contention of the complainant. No other evidence has been adduced on behalf of o.p to contradict the above fact.
The Learned lawyer for complainant has relied on the observation of Hon’ble Delhi High Court observed in the case Manohar Lal Vs. Life insurance Corporation decided on 11-09-1980, AIR 1981 Delhi 2171 and another case of Life Insurance Corporation of India V/s Smt. Chanagony Upendra revision petition No.-519/2007 decided on 10-01-2012 by Hon’ble N.C.D.R.C New Delhi. In the case of Manohar Lal Vs. Life Insurance Corporation, Hon’ble Delhi High Court has observed in para-19 and the same as follows-19- “The question is whether an inaccurate description of occupation in the proposal form insurance avoids the policy. I think not. The plaintiff would have been insured at the same rate of premium, had he described himself as a factory hand or a mill worker. The same premium, would have been payable in that case. There is no fraud upon the corporation nor have they sustained any injury by plaintiff’s description of himself as a photographer and tutor. I have held that the description is not untrue because the plaintiff was in fact engaged in photography and teaching. These pursuits were not very profitable it is true.”
In the case of Life Insurance Corporation of India Vs. Smt. Chanagony Upendra Hon’ble N.C.D.R.C. New Delhi observed that the alleged false declaration in respect of the annual income declared by diseased life assured is not valid ground for repudiation of the claim put forth by the complainant.
On the basis of above discussions, we are of the considered opinion that the o.ps have failed to establish its case and as such there is deficiency on their part.
In the circumstances the complaint petition is allowed with direction to o.ps to pay Rs. 5,98,000/- as sum assured on death with 8 % interest p.a from the date of filing of complaint petition that is on 3-04-2018, 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 they shall be responsible to pay the above amount with 9 % p.a. interest till realization. Let a copy of this order be furnished to both the parties as per rule.
