This complaint petition has been filed by complainant Rambarai Rai against Branch Manager, SBI, Life Insurance Company Ltd. and one another for realizing of Rs. 2,25,000/- sum assured, Rs. 45,000/- as mental and economical loss and Rs. 25,000/- as litigation cost with 18 % interest p.a. from the date of death of (diseased life assured.)
The, brief, fact of the case is that Rambarai Rai (complainant) has filed this case in capacity of nominee and legal heir of diseased life assured ( hereinafter called us D.L.A) Panpati Devi. The further case is that the agent of SBI life Insurance Company Ltd. after being satisfied with good health, income and age of Panpati Devi ( mother of complainant ) give a proposal form for life insurance and the complainant mother put her RTI on proposal form after tendering premium amount. The further case is that the proposal form was filled by agent of the aforesaid company in presence of officers of the company. The further case is that on 20-07-2012. Life Insurance Policy of SBI, was issued in the name of Panpati Devi for Rs. 2,25,000/- and the same was valid since 03-08-2012 to 03-08-2022. The premium was of annual. The company issued bond as policy no. – 56018817404 in the name of assured person. The further case is that on 05-12-2014 insured Panpati Devi fell ill who was admitted in Roshani Seva Sadan ( Vasant Road Garkha) Saran, in the clinic of Dr. R. K. Roy for her treatment where she died on the same day during the course of her treatment. The further case is that after death of D.L.A the complainant filed death claim before o.p company for sum assured. The further case is that SBI, Life Insurance Company, deposited Rs. 45,000/- on 01-02-2015 in the account of complainant by NIFT but the same was withdrawn on 03-09-2015. The further case is that the o.p company repudiated the claim of the complainant on the ground that age of D.L.A was 78 years but she disclosed her age as 50 years by misleading the o.p.
On behalf of complainant following documents have been annexed - photocopy of First premium receipt Annexure -1, photocopy of death certificate of Panpati Devi annexure-2, photocopy of prescription report issued by Dr. R.K. Roy annexure-3, photocopy of certificate issued by Dr. R.K. Roy annexure-4-, photocopy of certificates of Sarpanch Gram Kachahari, Ferusha Panchayat annexure-5, photocopy of certificate of B.D.C of ferusha Panchayat annexure-6 , photocopy of PAN card annexure-7, photocopy of certificate of Vinay Kumar Singh agent of the company in respect of death of Panpati Devi annexure-8, photocopy of request letter of complainant Rambarai Rai in respect of death claim annexure-9, photocopy of postal receipt annexure-10, photocopy of saving account of Rambarai Rai annexure-11, photocopy of observation letter made with respect to policy no. 56018817404 of Ms. Panpati Devi deceased life assured ( D.L.A) annexure-12.
O.P company appeared on 03-05-2018 and filed his w.s. on 31-01-2019 with prayer to dismiss the complaint petition with cost. It has been mentioned in the w.s. that address of o.p no.2 is at Mumbai while the complaint is filed at Muzaffarpur, hence this forum has got no territorial jurisdiction against o.p, no.2. It has been further mentioned that the answering o.ps relied on the information furnished in the proposal form and granted insurance cover on the principle of ‘utmost good faith’. It has been further mentioned that D.L.A late Mrs.Panpati Devi had disclosed her death of birth as 04-03-1962 in the proposal form in 2012 and as such she declared her age as 50 years at the time of applying for the insurance policy. It has been further mentioned that the documents placed on record shows that D.L.A was more than 77 years at the time of availing the Insurance Policy and the Insurance cover was obtained fraudulently by suppress of material fact about the age of D.L.A. Hence the present complaint case is not maintainable and is liable to be dismissed in limine.
On behalf of o.p the following documents have been annexed - photocopy of proposal form Annexure-A, photocopy of affidavit of DLA annexure -A1, photocopy of policy document annexure-B, photocopy of claim intimation annexure-C , photocopy of voter’s card of the D.L.A annexure-D, photocopy of voters list annexure-E, photocopy of voter’s I.D card of nominee annexure-F, photocopy of Anganwadi register annexure-F1, photocopy of product features annexure-G, photocopy of repudiation letter annexure- H
The complainant has examined himself on affidavit and he has marked documents as annexed.
The claim of the petitioner has been repudiated by the o.p. on the ground that the D.L.A suppressed her age and as such committed fraud with the o.p company.
It is admitted fact that the o.p company issued life insurance bond in the name of diseased Panpati Devi (D.L.A) for sum of Rs. 2,25,000/- on her proposal form. It is also an admitted fact that the diseased died during period of validity of insurance bond.
The Learned lawyer for the complainant submits that rule of estoppels is applicable in this case because the insurance company has granted the policy bond on the proposal of D.L.A Panpati Devi so, he cannot repudiated the claim on that ground.
The learned lawyer for o.ps has submitted that the complainant has misleaded the o.p company by inserting wrong information regarding her age in the proposal form so she has violated the clause- 13.7 and 13.5.3 and other clauses also of the bond, so the o.p. company committed fraud with o.p company and o.p has rightly repudiated the claim of the complainant.
On behalf of o.p proposal form annexure-A has been annexed in which the age of D.L.A Panpati Devi has been shown as 50 years.
Complainant has filed photocopy of prescriptions of Dr. R.K.Roy in respect of age of Panpati Devi as annexure-3, photocopy of certificate issued by Dr. R.K.Roy annexure-4, photocopy of certificates of Sarpanch Gram Kachahari, Ferusha Panchayat annexure-5, photocopy of certificate of B.D.C of Ferusha Panchayat as annexure-6 and photocopy of PAN card of Panpati Devi diseased annexure-7. He has filed photocopy of certificate granted by vijay Kr. Agent in respect of death of diseased Panpati devi. These documents are consistent to each other. Annexure- 3 and 4 shows the age of as about 50 years at the time of death. Annexure-5 and 6 shows that the date of birth of diseased was on 04-03-1962 and she died on 05-02-2014 Annexure-7, PAN card of Panpati Devi also shows that her date of birth was 04-03-1962. Agent of o.p. company also certified that age of D.L.A was 50 . The documents produced on behalf of o.ps are self contradictory. O.p. has not examined any witness on this point to support either to investigation report or electoral roll -2015 so no reliance can be placed on the above documents produced on behalf of o.p. Photocopy of aganwadi register has been filed as annexure-f in which the age of diseased was shown as 105 years so all the above documents produced on behalf of o.ps are self contradictory. The photocopy of anganwadi register is not certified copy of the original and it has not been disclosed as to how the same has been obtained by the o.p, so not reliance can be placed on the above documents, produced on behalf of o.p.
Complainant has examined himself on oath on affidavit and he has supported his annexures regarding their correctness. The documents produced on behalf of complainant regarding age of diseased is consistent. On the basis of above discussions, we are of the opinion that the o.p company has wrongly repudiated the claim of the complainant and as such there is deficiency in service on part of o.ps .
Accordingly, the complaint petition is allowed and the o.ps are directed to pay Rs. 2,25,000/- sum assured with 8 % p.a., interest from the date of filing of the complaint petition Rs. 20,000/- as mental, physical harassment and Rs. 10,000/- as litigation cost. Within 2 months from the date of receipt of the copy of order, failing which they shall be liable to pay the above amount with 9 % interest till realization. Let a copy of this order be furnished to both the parties as per rule.
