The complainant Sri Shiv Kumar Paswan has filed this complaint petition against Branch Manager,    Sri Ram Life Insurance Company Ltd. Muzaffarpur and two others (o.ps) for realization of Rs.  7 lacs/- as sum assured ,  Rs. 71,000/-  for compensation  for  mental,  agony, and physical harassment, total Rs. 25000 as litigation cost. With 18 % p.a. interest on the sought amount since date of death  of L.A. person till date of final payment/ realization.

 The brief, facts of the case is that complainant Shiv Kumar Paswan  is nominee and husband of life assured namely Phoola Devi.  The further case is that L.A. Purchased a Life Insurance Policy No.-NN141400127989   for sum assured Rs. 7 lacs/-   from Insurance Company ( o.p No.-1) and paid premium amount Rs.30,201/- on 02-09-2014 by cheque. The further case is that the entire proposal form was filled up by company’s  agent in the presence of company’s officials and complainants wife only put her signature  wherever  the agent  and officials  told her to do so in good faith and trusting upon  agent’s and official’s  knowledge  and technicality about life insurance policy. The further case is that after accepting the premium amount against the  policy  Insurance Company issued premium receipt and bond in the name of the L.A. The further case is that on 09-04-2015,  all of a sudden  the aforesaid policy holder namely Phoola Devi twanged with Snake bite. The family members of the L.A took her to  Sadar Hospital, where the doctor treated her  and referred  her to P.M.C.H. Patna for further treatment. The further case is that seeing serious condition of the patient, family members took her to Samiksha Nursing Home, Hazipur, where she was treated by Dr. A.K. Singh but during treatment she died on the same day. The further case is that the complainant filed death claim against the aforesaid policy with the relevant documents before Insurance Company but the Insurance Company repudiated the claim of the complainant on the ground that the D.L.A  had not disclosed her true income and occupation in the proposal form and  L.A. Mrs. Phoola Devi was under below Poverty Line category. It has been further mentioned that in repudiation letter,  deceased life assured (DLA) had policies with other life Insurance companies.

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  PAN Card of Phoola Devi  annexure-3, photocopy of  I.T. Return for Assessment year 2013-2014 & 2014-2015  annexure-4, photocopy of Repudiation letter annexure-5, photocopy of prescriptions  of Dr. nnexure-6, photocopy of  prescription of Dr. cum death report of Phoola Devi of Samiksha Nurshing Home -annexure-7, photocopy of  Death Certificate granted by Jaheda Bano annexure-8.

On issuance of notices o.ps appeared and filed their w.s. on 10-12-2018 with prayer to dismiss the complaint petition with cost. Issuance of policy bond in the name of L.A.  Phoola Devi without medical test is an admitted fact. O.ps have annexed photocopy of proposal form as annexure-A and photocopy of  policy document (first premium receipt)  as annexure-B. Filing of claim intimation of L.A. death by complainant is also an admitted fact. It has been mentioned in the w.s. that since the claim was an early claim so the o.p.  investigated into the claim  and found  that DLA Phoola Devi was a labour and did not possess any  substantial  income and that she belonged to  Below Poverty Line ( B.P.L.)  family. Photocopy of investigation report and B.P.L. list have been annexed as annexure C & D. It has been further mentioned that D.L.A had also applied for other two Insurance Policies. Photocopy of emails. exchange of other Insurance Company providing the information of the above Insurance policies  of L.A. has been annexed as annexure-E. It has been further mentioned that the D.L.A belonged to BPL category  citizen and she willfully concealed her actual income and falsely declared her annual income to be Rs. 2,25,000/-.  It has been further mentioned that she  belonged  to B.P.L. family but she had bought  Insurance Policies including this policy  to a tune of Rs. 19,58,057/-. It  has been further mentioned that the o.p Insurance Company repudiated the claim of the  complainant  for reason of non disclosure of actual income of DLA and obtaining of  2 more policies in a short span of time. It has been further mentioned that D.L.A wilfully  concealed the vital information at the time of  filing up of the proposal form.    Photocopy  of repudiation letter has been annexed with annexure-F.

On behalf of complainant Aw-1 Shiv Kumar Paswan                      ( complainant ) has been examined on affidavit.

On behalf of o.ps o.p.w-1, E. Sridhar G.M. in M/S Sri Ram Insurance Company Ltd. has been examined on affidavit.

The complainant has annexed the repudiation letter as annexure-5 whereas the same has been annexed on behalf of o.ps as annexure-f. O.P company has repudiated the claim of the complainant on the ground that L.A. Phoola Devi does not had substantial income and she is under Below Poverty Line category. It has been also mentioned in the repudiation letter that D.L.A had policies with other Life Insurance Company’s.

The o.ps have annexed photocopy of proposal form as annexure-A in which the L.A. has mentioned her occupation as business and nature of duties as self employees. In proposal form  ( annexure-A). The annual income of D.L.A has been shown as Rs. 2,25,000/-. On behalf of complainant, photocopy of annual income return for the assessment year 2013-2014 and 2014-2015 (annexure-4), have been filed. On perusal of  the same, it transpires that D.L.A Phoola Devi had submitted I.T. R. for annual income of Rs. 1,93,220/- in the assessment year 2013-2014 and Rs.2,08820/-  in the assessment year 2014-2015. So it transpires that she had not concealed  regarding her income in the proposal  form. The complainant  has also adduced oral evidence on this point he has also stated  in his examination- in -chief that the agent of the Insurance Company in the presence of the Sales Manager, filled up proposal form in English he has also stated that the L.A did not suppress  her income nor her occupation. On perusal of photocopy of proposal form (annexure-A.) It transpires that the same has been filled in English whereas the L.A has put her signature in Hindi. There is declaration  of agent  Braj Mohan Kumar  on page- 2 in middle portion  which is as follows.

“ Declaration for signing in vernacular or for illiterate cases.- ( The company requires that this proposal  is completed by the prosper himself. However,   if this not possible as the proposer does not read, write, or speak English, then this proposal form can be completed by another person who can read, speak and write English and who is not connected to the company either as an agent/employee or Insurance intermediary). I have explained the contents of this proposal to the proposer and done my best to ensure that the contents have been fully understood by the proposer. I have accurately recorded the proposer’s responses to the information sought by the proposal form and I have read the responses back to the proposer and he/she has confirmed that they are correct. The aforesaid Brajesh Mohan Kumar has not been examined on behalf of o.ps. Agent of the Insurance Company has also not been examined. No explanation has been offered on behalf of o.ps for their non examination so it is not proved that the information received from D.L.A was correctly mentioned in the proposal form. O.P company has only examined o.p w.1 E. Shridhar G.M. of M/S Sri Ram Insurance Company Ltd. who has formally ascertained the genuineness of the annexure filed on b ehalf of o.ps.

The o.ps have also repudiated  the claim of the complainant  on the ground that the  deceased had two other policies in her name. In para-7 the details of insurance policy has been mentioned regarding other Life Insurance Company’s whose proposal date is 15-10-2014 and 31-01-2015 whereas this policy was issued on  02-09-2014 prior to the taken of other policies  so there is no question of mentioning  regarding other Life Insurance Policies in the proposal form.

The Learned Lawyer for the complainant relied on the findings of N.C.D.R.C. New Delhi in case of Life Insurance Company Corporation of India V/s Smt. Chana Goni Upendra and other revision petition No.- 519/2007 dated 10-1-2012 and findings of Agon Religare Life Insurance Company Ltd. Vs Rajendra Rai First Appeal No.-1696/2016 passed on 31-05-2018. In the case of Life Insurance corporation  of India Vs Smt. Chana Goni Upnendra,  Hon’ble N.C.D.R.C New Delhi has observed that having accepted the premiums and issued the policies the Insurance Company cannot absolve their liability without adducing   any evidence to substantiate their contention that the insured had willfully  and fraudulently suppressed  the material facts which he ought  to have disclosed. In the another case of Aegon  Religare Life Insurance Company V/S Rajendra Rai the Hon’ble N.C.D.R.C. has observed that the Insurance Company cannot go beyond their ground of repudiation.

On the basis of above discussion we are of considered opinion that the o.p Life Insurance Company is unable to prove the facts mentioned in the repudiation letter and there is no evidence on record to show that the D.L.A. had concealed  her income and occupation  in the proposal form and as such there is deficiency on part of the o.ps Insurance Company.

Accordingly, the complaint petition is allowed and the o.ps are directed to pay Rs. 7 lacs/- as sum assured with 8 p.a. interest  from the date of filing of complaint petition that is on 29-11-2016, Rs.20,000/- for compensation for mental agony and physical harassment, 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 to be furnished to both the parties as per rule.