Sri Kamal De, President
The case of the complainant, in short, is that the deceased Mohan Maiti was her husband and her husband was a business man and sole earning member in the family. On 04.05.2012 he took an insurance policy from the OPs. The OPs after verification of the Proposal Form and documents accepted premium of schedule policy being policy no. 0266278941. The complainant was the nominee of the said policy. After demise of her husband, the complainant applied for the policy claim amounting to Rs.435000/-, sum assured of the policy and other benefits. The deceased submitted Voter I.D. card and Ration card to OP no.1. The OPs or his insurance consultant or office staff projected a school certificate as age proof by malpractice and ill intention. After verification of documents OPs issued insurance policy. The OPs repudiated the claim causing grave loss and untold hardship to the complainant. The complainant on several occasions met the OPs regarding payment of claim, but to no good. The cause of action arose on 24.05.2015. Hence, this case.
OPs entered into appearance and contested the case by filing W/V contending inter alia that the instant case is not maintainable in its present form and law. The contents of paragraph 11 to 26 of the complaint petition are alleged to be false and concocted. It is stated that the policy holder deceased Mohan Maiti was unemployed and his occupation was agriculture and he was suspected to be suffering from right Side Parotid Gland (C A positive suspected) symptom liker a cancer. The deceased intentionally purchased policy during the treatment period in collusion with his wife, complainant and son. The deceased also submitted fake age proof (School certificate) duly signed by him. The policy holder, Lt. Mohan Maiti died on 30.06.2012 due to cancer. The investigating agencies of the OPs, Ausus Services and D A Associates, investigated the matter and from their report it is transpired that the policy holder intentionally submitted fake document of age proof and suppressed the material fact and as such the claim department of the OPs repudiated the claim of the complainant on the ground of fraud and misrepresentation of material fact. The OPs have prayed for rejection of the complaint.
Points for consideration
- Whether the complainant is entitled to get the claim of the insurance amount?
- Whether the insured furnished a fake school certificate as a document of his age proof?
Decision with reasons
Both the points are taken up together for the sake of brevity and convenience of discussion.
It appears that deceased Mohan Maiti, the husband of the complainant obtained insurance policy (Invest Gain Economy Policy) on 04.05.2012. He died on 30.06.2012 i.e. after 1 month and 26 days from the date of taking the insurance policy. The demise of the insured within 2 months of his getting the policy has given rise to the entire gamut of controversy. The claim of the complainant was repudiated by the OPs on the ground that Invest Gain Economy Policy cannot be offered to the insured at the age of alleged 52 years with nonstandard age proof and the insured since deceased submitted a forged birth certificate as age proof to induce the OPs to accept the risk of his life. It is the case of the OPs that deceased was uninsurable at the time of making the proposal on the basis of nonstandard age proof i.e. Voter I.D. It is further submitted from the side of the OPs that the deceased submitted fake school certificate as proof of age showing his date of birth as 01.01.1960.
We have gone through the documents filed from the respective sides including the report of two investigating agencies, namely Ausus Services and D A Associates. From the Xerox copies of the policy papers, it appears that the deceased himself submitted school certificate (Transfer Certificate) of one Naikuri Dharanidhar Adarsha Vidyalaya showing his date of birth as 01.01.1960. During investigation it is revealed that there is no such school in the said name. In fact, the said school is a girls’ school and its name is Naikuri Dharanidhar Balika (Girls) School. The headmistress of the concerned school has endorsed that the certificate was not given from her school and the name of their school is Naikuri Dharanidhar Balika (Girls) School. So it appears that the school certificate is found fake on verification. Let us now come to Voter I.D. card. As per voter I.D. Card and proposal for insure, date of birth of the deceased is 01.01.1960 and as per his son’s date of birth proof, he is 32 years i.e. insured was fathered at the age of 18 years and at that time insured’s wife was 11 years, which is not possible. The date of birth of the claimant as per voter card is 1970 and the date of birth of her son is 1979. So it appears that the deceased gave birth to his son at the age of 18 and the complainant, Smt. Nandi Maiti became mother at the age of 9 years. The entire matter appears to be hypothetical.
It is stated by the complainant that her husband was doing business. As per proposal form the deceased was running a grocery shop and was earning Rs.140000/- p.a. But as per investigation, as it is revealed, that the deceased was an agriculturist and earned Rs.60000/- p.a. On the contrary, it is also appears that the name of the deceased was appearing in BPL list. It is also observed by one of the investigating agencies “that looking at the residence and other enquiry it is impossible to ascertain that the insured was capable to afford such huge yearly premium”. The cause of death according to the plaint case is cerebra vascular accident issued by one Homeopath practician Dr. Ashis Kumar Maiti, BHMS(Cal). According to investigation report of D A Associates, the deceased expired on 30.06.2012 at around 8.30 A.M. at home due to cancer. As per Dr. Ashis Acharya, Lahanda, Medinipur (Ph. 09732932372), the deceased was suspected to be suffering from Rt. Side Parotid Gland (CA positive suspected) symptom just like a cancer, but no test report for diagnosis is, however, filed. The complainant also did not file any document of treatment save and excepting the Certificate of Death issued by Gram Panchayat and Doctor’s certificate of death. Be that as it may, the endorsement by the school administration on the school leaving certificate, during verification makes it clear that the certificate is fake and fabricated. The investigation report confirmed that the school certificate submitted by the deceased as proof of age at the time of proposal of insurance was not issued by any Naikuri Dharanidhar Adarsha Vidyalaya and it was a fake and forged document. So it appears that the complainant has not approached this Forum with clean hands. The allegations of the complainant that the Insurance consultants or office “adjusted” a school certificate as age proof by malpractice as we find has no leg to stand. On the other hand, it appears that the deceased himself submitted proposal form with a copy of school certificate bearing his own signature. Mr. Mohan Maiti, the insured reportedly expired on 30.06.2012 giving rise to a very early death claim. Investigation by two agencies followed and during investigation, as we find, it is revealed that the school certificate as proof of age submitted by the insured was found to be fake and fabricated. It is also stated in the investigating report of AUSUS Services that age in Voter I.D. card and Adhar card do not match. Moreover, it also appears that the name of the deceased was also appearing in the BPL list. It is evident that there is ambiguity regarding age and income of the deceased. So, it appears that there was suppression of material facts by the deceased, and the claim, as such, is hit u/s 45 of the Insurance Act, 1938. Accordingly, we do not think that the OPs have committed any wrong in repudiating the claim under the policy on the ground of suppression of material fact with regard to age of the deceased. Voter card, Ration card, as we know, are nonstandard age proof. School certificate is a document of standard age proof. We find that the school certificate appears to be a fake and forged document. The endorsement by the school administration over the school leaving certificate of the deceased makes it clear that concerned school leaving certificate of the deceased is fake and fabricated. Under the above circumstances, the complaint is liable to be rejected but the complainant, in our view, is entitled to get the amount of premium of Rs. 29216/- deposited by the deceased with the Insurance Company.
Hence, it is,
ORDERED
that the consumer case being no. CC/83/2015 be and the same is allowed on contest in part. The OPs are directed to refund the deposited premium of Rs.29216/- with interest @ 9% p.a. within 40 days from the date of passing this order to the complainant, failing which the complainant will be at liberty to put this order into execution in which case, the OPs will be liable to pay an amount of Rs.50/- per diem till full and final payment.
