The complainant Devandra Singh has filed this case for claim of payment of claim amount mentioned in his complaint petition through cheque or D.D in the District Consumer Forum, Muzaffarpur and also prayed to give any relief which ever he is found entitled is also given to him and passed necessary order against the o.p.
The case of complainant appears from his complaint petition supported with an affidavit that he is nominee and son of L.A person namely Chandradev Singh. Who has taken the policy for sum assured for Rs. 5 lakh along with monetary benefits on the premium amount of Rs. 23,782/- bearing policy No. NP141300111102 start from 28-12-2013 the premium was yearly deposit. Through the proposal form dated 30-12-2013. He has further alleged that all of sudden on 08-02-2014 the L.A complained about chest pain followed by the cold/ diarrhea then and there he was consulted with Dr. A.K.Sharma who has not saved his life, unfortunately L.A. expired within one hour on the same day that is on 08-02-2014. The Dr. Has observed that death happened due to respiratory failure. Accordingly the complainant has filed death claim for his policy before the company o.p with all the relevant papers and fulfilling the all formalities as L.A. died within risk covered period of policy but the company did not pay the death claim to the complainant and declared as false, concocted and baseless ground that L.A. had taken the policy & not revealed the prior policies in detail in his aforesaid proposal form. The entire proposal form was filled up by company agent in presence of company officials. Accordingly the company issued the premium receipt and bond in the name of L.A on 28-12-2013. The complainant has sought the amount in para – 7 of his complaint petition that he is entitle for his Rs. 5 lakh assured amount, Rs. 40,000/- for mental, physical, harassment , litigation cost Rs. 20,000/- and he has further claim the interest @ 18 % p.a on the total sought for amount till realization of claim amount.
The complainant has filed Xerox copies of first premium receipt from which papers it appears that the policy term was for 25 years and premium payment was yearly and the installment was Rs. 23,782/-, the first premium was deposited and 30-12-2013 and the certificate was issued on 31-12-2013, copy of Non ULIP policy schedule mentioning the date of birth of L.A. his 01-01-1971 aged about 42 years, occupation was agriculture, copy of death certificate issued by government of Bihar, showing his date of death is 08-02-2014 issued on 22-02-2014, copy of Dr. Prescriptions dated 08-02-2014, certificate issue by Dr. A.K. Sharma showing the cause of death by Cardial respiratory failure dated 18-04-2014, copy of land schedule in the name of L.A. , copy of repudiation letter of claim dated 24-02-2016 from which it appears from the investigation by the o.p that the L.A. was suffering from pre-existing health problem and he does not have substantial income and he had multiple policy with others insurance companies such as from reliance life insurance dated 30-12-2013 for Rs. 5 lakh, IDBI life Insurance dated 31-12-2013 for Rs. 7,35,000/- and edelweiss Tokoi life dated 31-12-2013 for Rs. 3,50,000/-. The o.p has not given the policy number of other two policies.
In this case opposite party no. 1 & 2 appeared and filed his written statement supported with an affidavit dated 04-10-2016 alleged therein and deny the all allegations of complainant and given the detail of policy and admitting the policy amount, period, premium amount (installment) and nominee the complainant of L.A., the occupation is agriculture, date of birth is also admitted and has submitted the annual income of L.A. was Rs.84,000/- . He has further alleged that the insurance is contact of almost in good faith which requires the proposal and life to be assured to discloses all material facts in response to question in the proposal from and on his declaration that he will inform company regarding the change of health occupation and financial position and after full understanding of significance of proposed contact, he is also admitted the date of death of L.A as alleged by complainant ,his policy was commenced from 31-12-2013 and L.A died within 2 month from the issuance of this policy accordingly the company has appointed the investigator from which it appears that the L.A had concealed facts regarding the pre existing disease and did not possess any substantial income and have concealed the multiple policies with other companies. He was malafide, dishonest in concealing the material fact. The o.p has pointed out the other policy taken by the L.A. from which it appears that the other policies which are not shown by the complainant was total for Rs. 1585000/- and the premium amount of suppressed policy was of about RS. 57474/- including one for Rs. 14106/- (semi annual)and the o.p has find the annual income of L.A was Rs. 84,000/- from agriculture and after calculating existing policy in the name of L.A. including the installment of this policy goes up to Rs. 57474/- more than his annual income. He has suppressed to discloses all material facts and the o.p relied on several decisions as such, published in (2001) ACJ 806, (2012) CPJ 310 (NC), appeal No. 242/2006 decided on 27-07-2006, II (2012) CPJ 272 (NC) and (2000) 1 SCC 66, and on the aforesaid ground the o.p has prayed to dismiss the case.
The o.p has filed the Xerox copy of several documents, proposal form in which it has been found mention that his income was Rs. 84000/- from the source of agriculture no other income has been shown the proposal form was dated 30-12-2013 from. It requires as per para 8 of proposal from to gives detail of his existing the insurance policy which has been cross by the proposal by not mentioning any policy which he has in existence , copy of first premium receipt, copy of Non-ULIP policy schedule, copy of repudiation letter dated 24-02-2016, copy of another letter dated 18-03-2016 indorse to the complainant from the claim dept. That his claim was repudiated , copy of insurance claim, investigation for the same policy from which it appears that on secret information it was found that L.A. was suffering from cough and had T.B. problem which was verbally conform on as no record of L.A. T.B treatment.
Further the complainant has filed his reply dated 05-06-2018 as written argument against the w.s. of o.p. in which he has only deny the allegation of o.p and has submitted that other policy is baseless and he had no any other policy accept this and the o.p has not filed any paper of the alleged policy from which it can be proved that the complainant had other policies in existence and has alleged that the o.p has wrongly having no any paper proof and on baseless ground refuses death claim of the father of the complainant which is gross misconduct with consumer.
Considering the facts, circumstances, material available with the record it appears befure us that the o.p has admitted the policy sum assured amount installment death of L.A and claim of complainant as nominee of L.A. only he has objected the case of complainant on the ground that the L.A. on no basic income to fulfil policy installment of his several policies which was beyond his income and submitted that the L.A has several other policies but on the other hand the complainant has filed his reply denying the all allegations of other policies that he has no other policy as such the burden of proof of his objection is go upon the shoulder of o.p which he has not proved and he has not filed any paper regarding the said policy as such it is absorbed to say that the installment was excess from his income
After care full scrutiny of the fact of the case it appears before us that the proposal form has been duly signed on 30-12-2013 by the complainant as well as by the agent but the policy paper shows that the policy commences from 28-12-2013 tow days before at proposal form. It is also relevant that admittedly the 1st installment was deposited on 30-12-2013 against which receipt was issued on 31-12-2013 now it was possible in our believe that something wrong has been taken place by the manipulator of the company as well as for L.A. which comes against the deficiency of company. It is gross miss conduct as well as defalcation & misuse of public money and this policy appears to be manipulated.
Accordingly after carefully scrutiny material facts with documents and allegation of the respective parties it is apparently clear that the case of complainant is not maintainable in Eye of law as well as fact.
Accordingly the case is dismissed parties bears their own cost.
Member President
