SRI JIBAN KRUSHNA BEHERA, MEMBER (I/C)
The complainant has filed this complaint petition, U/s-12 of C.P.Act-1986, (here-in- after called as the “Act”) alleging a “deficiency-in-service” against the Opp. Parties, who are the office bearers of Shriram Life Insurance Company Limited located at different places.
2. The factual matrix of this case is that deceased mother of the complainant namely Gunamani Das (life assured) had purchased one policy from the Ops vide policy No.NP141400058122 wherein the complainant was the nominee. The sum assured in respect of the said policy was Rs.93,000/-. The deceased life assured deposited three annual premiums to the Ops @ Rs.10,096/-. Deceased life assured died on 29.12.2016 in her house. After the death of life assured, the complainant, being the nominee, claimed benefits. The office of the Ops issued relevant documents claim Form A, B, C in favour of the complainant and he submitted all the relevant documents along with death certificate and policy bond before the OP No.3 in the office of OP No.1. OP No.3 received all the relevant documents and assured to him to pay the claim amount within 60 days, But the Ops intentionally and deliberately did not pay the death benefit to him during the said period even after several approaches and reminders. So, the complainant and his family members are facing both financial loss and mental agony. Finding no other way out, the complainant sent legal notice on 6.9.2017 which was returned on 11.9.2017 with endorsement as “long absent”. Therefore, cause of action to file the case arose on 26.9.2017, after expiry of 15 days from return of legal notice. Hence, the complainant was constrained to file the present case with the reliefs stated in the complaint petition.
To substantiate her case, the complainant has relied on the following documents, which are placed in the record, as mentioned hereunder-
- Photocopy of First premium receipt.
- Photocopy of Second premium receipt.
- Photocopy of Third premium receipt.
- Photocopy of Death certificate of life assured.
- Photocopy of Letter dated 5.4.17 regarding repudiation of the claim.
- Photocopy of Claim form.
- Photocopy of Letter of complainant to OP No.1 dated 14.4.17.
- Photocopy of Letter of complainant to OP No.1 dated 29.8.17.
- Photocopy of Legal notice dated 29.8.17.
- Photocopy of return registered letters.
3. In the present case, the Ops made their appearance and filed a joint written version, but their written version has not been accepted as the same was filed beyond the statutory period. But the Ops are taken part in the hearing of the case and filed the following documents to substantiate their case -
- Photocopy of Proposal Form.
- Photocopy of Policy schedule.
- Photocopy of Voter ID card of deceased life assured.
- Photocopy of Electoral roll.
- Photocopy of information regarding voter ID of life assured.
- Photocopy of information regarding voter ID of Ramesh Jena.
- Photocopy of Claim Form-A.
- Photocopy of Voter ID Card of complainant.
- Photocopy of Letter regarding repudiation of claim issued to complainant.
4. In view of the above averments of parties, the points for determination in this case are as follows:-
(i) Whether the complainant is a consumer or not?
(ii) Whether the complainant has cause of action to file this case?
(iii) Whether this consumer case is maintainable?
(iv) Whether there is any deficiency in service on the part of the OPs?
(v) Whether the complainant is entitled to get the relief, as sought for?
(vi) To what other relief(s), the Complainant is entitled to?
F I N D I N G S
5. For the sake of convenience and for better appreciation of the case, Point No.(i), (ii) & (iii) are taken up together. From the averments made in the pleadings of the complainant and the documents filed by both the parties, it is clear that the complainant is the nominee of his deceased life assured mother namely Gunamani Das, who purchased the policy bond in question from the Ops. The deceased life assured died on dt.29.12.2016, as reflected from the death certificate vide Annexure-4. After the death of his life assured mother, being the nominee, the complainant filed claim form before the Ops vide Annexure-6, but the Ops without considering the same in its proper perspective, repudiated the claim on flimsy grounds. Hence, the complainant was constrained to file the present case. From the above, it is clear that the complainant is covered under the definition of a consumer as defined under the provisions of the Consumer Protection Act, 1986. Consequently, the complainant has cause of action to file the case and the case is maintainable.
6. Let us discuss as to whether the Ops are deficient in providing service towards the complainant and whether the complainant is entitled for the reliefs, as prayed for.
7. Learned counsel for the complainant submitted that the deceased life assured was the mother of the complainant, who had purchased one policy from the Ops vide policy No.NP141400058122 and the complainant was the nominee. Said policy was covered for a sum assured amount of Rs.93,000/-. The deceased mother life assured had deposited three annual premiums to the Ops @ Rs.10,096/-. After the death of life assured on 29.12.2016, the complainant claimed benefits and for that the office of the Ops issued relevant documents claim Form A, B, C in favour of the complainant and he submitted all the relevant documents along with death certificate and policy bond before the OP No.3 in the office of OP No.1. At that time, OP No.3 assured him to pay the claim amount within 60 day, but the Ops intentionally and deliberately did not pay the death benefit to him till date even after several approaches and reminders made by the complainant. So, the complainant and his family members are facing both financial loss and mental agony. It is further argued that the Ops have intentionally avoided to receive the legal notice sent by the complainant. Therefore, deficiency in service clearly attributes against the Ops.
8. On the other hand, learned counsel for the Ops submitted that on receipt of proposal form from the life assured Gunamani Das, the Ops issued policy bond which was commenced from 16.5.2014 for a sum assured amount of Rs.93,000/- for a period of 15 years with annual premium of Rs.10,096/- wherein her son, the complainant, was the nominee. After the death of the life assured on 29.12.2016, the complainant submitted his claim form. On receipt of the same, the Ops scrutinized the case and found that the life assured had declared her date of birth to be 1.1.1961 and her age to be 53 years with reference to the Voter ID card, which was accepted by the Ops on good faith. It is further submitted that on inquiry, they found that the life assured had not disclosed her correct age because as per electoral list of the year 2017 in respect of the life assured, her age is 80 years and the age of the complainant is 52. Thus, the life assured had provided her fake voter ID card at the time of proposal. Had the deceased life assured revealed her correct age in the proposal form the OP-company would have rejected the policy. The deceased life assured so also the nominee, the complainant, by suppressing the correct age has given a false information with regard to their age violating the terms and conditions of the policy bond. It is further submitted on behalf of the Ops that the life assured and the complainant-nominee have suppressed the material facts at the time of proposal, which is the basis of contract between the parties. Thus, the subject matter for the policy in question itself is proved to be initiated by fraudulent act, therefore, the Ops have rightly repudiated the claim of the complainant. Therefore, the question of deficiency in service does not attribute against the Ops.
9. On hearing from both the sides and on perusal of the documents produced on behalf of both the parties, undisputedly it is found that the deceased life assured mother of the complainant is the policy holder hearing No.NP141400058122 and the complainant was the nominee. It is also an admitted fact that the life assured died on 29.12.2016. After the death of his mother, the complainant filed claim form along with all relevant documents before the Ops for settlement of the death claim, but the Ops, without considering the matter in an approaching manner, repudiated the claim of the complainant on the ground that the life assured so also the nominee-complainant had not provided their actual age while submitting the proposal for the policy in question. It is the claim of the Ops that had they been provided their real date of birth, the matter would have been considered otherwise. Suppression of the material facts and omission of the true state of affair in respect of the age while submitting the proposal form would amounts rejection of the claim of the complainant.
10. It is the prevailing practice that one cannot directly purchased a policy bond from the concerned Insurance Company, rather, through an insurance agent. The life assured has no direct communication with the Insurance Company. The agent played a vital role between the Insurance Company and the life assured. Further, it is the plea of the Ops that the life assured and the Ops are bound by the terms of the bond and the Ops have taken decision as per the terms of the bond and rules and regulation. In this regard, on perusal of Annexure-B, nowhere it is found that the terms and condition of the proposal form were read over and explained to the life assured and understanding the terms and conditions of the policy bond so also the rules and regulations, the life assured put her signatures. That apart, the agent who is a mediator between the life assured and Ops has also recommended that she has verified the information given in the proposal by discreet enquiries and found the information true to the best of my knowledge and belief and she was of the opinion that the life proposed for insurance is insurable and she recommended the proposal for acceptance. Not a single document is filed by the Ops to satisfy the Commission that all those were in the knowledge of the life assured.
11. On perusal of the Voter ID Card vide Annexure-C, it is found that the age of the life assured as on 1.1.1994 was 33 years and thus, at the time of proposal for policy her age would be 53 years which finds place in the proposal form vide Annexure-A. On perusal of the proposal form, it is found that one Pratima Das was the agent, who supposed to have been filled in the entire proposal form in her own handwriting. On her recommendation, it is clearly mentioned that she has verified the information given in the proposal by discreet enquiries and found the information true to the best of her knowledge and belief and she was of the opinion that the life proposed for insurance is insurable and she recommended the proposal for acceptance. It is also found that the then Authorized Official (equivalent to Branch Manager) Manas Ranjan Dash approved the recommendation and thereafter policy body was issued by the Company. At this juncture, the Ops have vehemently challenged the age factor of the life assured so also the nominee-complainant by with reference to Annexure-D, E & F with that of Annexure-C. The voter ID card vide Annexure-C was prepared on the information supplied by the person concerned and it has been prepared after observing all formalities by the Election Commission of India, but the Electoral Roll vide Annexure-D, information regarding voter ID of the life assured vide Annexure-E is found to have been supplied by the Chief Electoral Officer, Odisha. There is no mention in Annexure-D & E that the same were prepared on the information supplied by the person concerned. Further, the Identity Card number as mentioned in Annexure-C is not at all tallied with the Identity Card number mentioned in Annexure-E. In the above circumstances, it cannot be said that Annexure-E is prepared in accordance with the information supplied in Annexure-C and thus, the information supplied in Annexure-C cannot override the information supplied in Annexure-E. That apart, the Ops have challenged the age factor of the life assured so also the nominee-complainant at the time of hearing of this case by collecting the information vide Annexure-D, E & F from the public offices. At the same time, what prevented them to verify the age of the life assured and the nominee-complainant when the proposal form was submitted by the Agent before the office of Ops and its approval by the Authorized Officer namely Manas Ranjan Dash on the recommendation by the Agent. As it appears from the case record, the complainant is a rustic village woman who has no knowledge about Insurance policy and whatever the documents are available with her, she had supplied to the Agent of the Insurance Company. It was the first and foremost duty of the Insurance Company to verify all the information supplied by the life assured. When the Ops are failed to perform their duties properly with regard to the age factor of the life assured so also the nominee-complainant at the time of need, they cannot agitated the same in a subsequent stage challenging that the life assured had not supplied the correct information at the time of proposal and suppression of material facts. On the other hand, the claim of the complainant cannot be said to be a false claim and not for the purpose of hood wink the sum assured in the policy in question. Therefore, the submission of the Ops that the complainant is not entitled to the sum insured amount on the grounds as discussed earlier cannot be accepted. From the above discussion, this Commission is of the considered view that the Ops have committed gross error in repudiating the claim in question, which should have been accepted in accordance with the proposal form. Therefore, withholding of death claim in favour of the complainant is illegal & arbitrary and thereby deficiency in service is clearly attributes against the Ops.
12. From the discussions made in the foregoing paragraphs, this Commission is of the opinion that the complainant is a consumer, he has cause of action to file the case and the case is maintainable. The Ops are held to be deficient in rendering their service by repudiation of the claim of the complainant in respect of the policy No.NP141400058122 and thus, the Ops are jointly and severally liable to pay the compensation, as claimed for by the complainant.
Hence, it is ordered –
O R D E R
The case of the complainant be and the same is allowed on contest against Ops. The Ops are hereby directed to pay the sum assured amount of Rs.93,000/- in respect of policy No. NP141400058122 to the complainant with interest @ 9% per annum from 29.12.2016 till its actual realization along with compensation of Rs.50,000/- towards harassment, mental agony meted out by the complainant and litigation cost, within 45 days of from receipt of this order, failing which the complainant is at liberty to realize the same through the process of law.
Pronounced in the open court of this Commission, this the 7th day of May, 2024 under signature & seal of the commission.
