The Complainant has filed this case alleging deficiency-in-service by O.Ps. O.P No.1 is the AVIVA Life Insurance Company Ltd., Claim Department, Gurgaon represented by it’s Claim Manager, where as O.P No.2 is one of the branch amongst other branches situated at Balasore represented by it’s Branch Manager.

                       Petitioner’s case, in brief, is that the husband of the Claimant/Petitioner namely Dayanidhi Behera had insured his life under the Policy No.NDS6002261 before the O.Ps for a sum assured Rs.2.10 Lacs. The Complainant being the nominee of the said Policy intimated to O.Ps with relevant papers for payment of insurance claim of the said Policy only after the death of his husband on 15.05.2013 (Her husband expired on 11.03.2013). The O.Ps did not turn down in the matter followed by another visit & request to the O.Ps by the Complainant on 01.07.2013. The O.Ps issued a letter denying to settle the claim, the reason being non-submission of correct driving license, but this Policy holder had no driving license, hence question of wrong driving license may not arise. The O.Ps have sent a report to the Petitioner whimsically without considering the terms & conditions under the said Policy, so also not verifying the documents properly in order to avoid legitimate claim of the deceased/assured person namely Dayanidhi Behera.

                     The Complainant is the wife as well as nominee of the life assured under the O.Ps as per terms & conditions laid down under the said Policy, the assured is fully entitled to get all the benefits as because the LIC Agent had taken all required documents for the purpose of the Policy. The insured supplied the correct particulars to the agent of O.Ps & also to the Officer concerned of the O.Ps. Being satisfied with the papers supplied by life assured person, the O.Ps issued the Policy. There is no lacuna to supply any of the information wrong & forged for the purpose. There is no fault of the life assured or by his nominee. The O.Ps are very cunningly & intelligently avoiding to pay the legitimate claim of the life assured covered under the above scheme & harassing the Complainant, even then this Complainant/Petitioner again & again requested the O.Ps & the O.Ps delaying the matter by assuring the Complainant to wait till the end of financial year of 2013 & assured to settle the claim by the end of August, 2014 only after negotiation with O.P No.1. But surprisingly, the O.Ps did not settle the claim rather denied to give any claim, though the Petitioner is very much entitled to get her claim according to the Policy. The Petitioner has no source of income to maintain her livelihood & family survived with four daughters & one son after death of her husband.

                        That, this Complainant relies upon the filing documents in support of her claim  

(i)  The life stage Policy No.NDS6002261 issued by the Officer of O.Ps.

(ii) The letter of the O.Ps.

(iii) Any other documents may be filed in this Forum if required during hearing of this complaint petition.                    

                      Hence, prayed for O.Ps be directed to O.Ps to settle death claim of Late Dayanidhi Behera & the claim amount of Rs.2,10,000/- (Rupees Two lakhs ten thousand) only plus 12% interest per annum till disposal of this proceeding along with Rs.50,000/- (Rupees fifty thousand) only towards litigation expenses & compensation for mental agony & harassment.

                    Written statement submitted on behalf of O.Ps No.1 & 2, where they deny the averments & intentions made by the Complainant except those, which are expressly adverted to & admitted there in. The O.P craves leave to refer to the proposal form & correspondence exchanged with the Deceased Life Assured (DLA), the Complainant along with all letters & documents submitted by the Complainant. The instant complaint is false, malicious, incorrect, malafide and has been filed by the Complainant just to avail undue advantage.

                         The O.P has admitted that Late Dayanidhi Behera, the DLA in the present case, after completely understanding the terms & condition of the product “Aviva Dhan Samruddhi” plan had submitted the duly signed proposal form bearing No.NUP 16265792, dt.28.01.2013 & paid Rs.15,449/- (Rupees Fifteen thousand four hundred forty nine) only towards annual premium against sum assured of Rs.2,10,000/- (Rupees Two lakhs ten thousand) only for a period of 10 years. The Complainant is the wife of DLA, who was the nominee under the said proposal form. The DLA in the proposal form had mentioned his date of birth as 04.11.1963 & furnished a copy of Driving license to prove his age. Basing on the information provided & declaration made in the application form & believing the same to be true & upon receipt of the initial premium Policy bearing No.NDS6002261 was issued to the DLA & D.O.C is 31.01.2013.    

                         It is denied to the extent that the Policy holder has not provided the wrong D.L at the time of proposal form as alleged in Para-2 under reply. It is submitted that on 15.05.2013, the O.Ps received a death claim intimation from the Complainant, where in it was stated that the DLA had passed away on 11.03.2013 & claimed for the S.A amount. The claim being an early claim, the O.Ps had got the same investigated & upon receipt of investigator’s report, the O.Ps came to know that the age of the DLA at the signing of the proposal form was more than 50 years. DLA had mentioned his date of birth in the proposal form as 04.11.1963 i.e. 50 years. It is pertinent to mention that the DLA with the intention to defraud the O.Ps produced a fake D.L as his age proof. It is submitted that as per D.L, the DLA was 50 years at the time of taking policy. But during investigation, when the said D.L was verified from the Office of R.T.O, Balasore, it was found that no such D.L bearing No.OR012002000980027 had been issued in favour of Sri Dayanidhi Behera, S/o. Siba Prasad Behera. The R.T.O, Balasore has also given a written confirmation regarding the same. It is further revealed during investigation that as per Voter ID Card & Voter list, DLA was 35 years old in 1994 i.e. 54 years old at the time of taking Policy. Thus, there is age disparity of 4 years. It is ex-facie evident that DLA had intentionally produced fake D.L of less age for taking the Policy. Thus, it clearly proves that the DLA with the ill intention to defraud the O.Ps & to make the wrongful gain had mentioned the wrong date of birth & also produced fake document i.e. the D.L. It is further submitted that as per proposal form, LA’s annual income was Rs.1,00,000/- (Rupees One lakh) only, whereas as per investigation, it was revealed that DLA’s annual income was Rs.80,000/- (Rupees Eighty thousand) only & the same was also confirmed by the nominee in her written statement. It is also submitted that the claim was repudiated on the basis of documentary evidence & any suggestion contrary to it is denied as incorrect. It is denied that the O.Ps are wrongly repudiating the legitimate claim of the Complainant as alleged. It is also submitted that based on investigation observations, it clearly reflects that these material details affecting the decision of the insurer for the acceptance or rejection of the contract of insurance were willfully suppressed by the DLA as the same was not disclosed by him in the proposal form at the time of availing the said Policy, in spite of our specific questions in the proposal form. It is most humbly submitted that the DLA after understanding the contents of the proposal form was duty bound to provide his original date of birth. Thus, the contract of insurance being of utmost good faith, DLA was obliged to give full & correct information on all matters which will influence the judgment of a prudent insurer in determining whether it will accept the risk & if so, at what rate of premium & subject to what conditions. The material facts having a bearing on the risk in life insurance contracts viz. age, occupation, income & habits, particulars of previous insurance etc. are only within the knowledge of the proposer/ insured.   

                         The insurer, therefore, has to rely entirely on the information, which the proposer gives at the time of proposal. If a material fact is suppressed, the insurer will be misled about the risk covered & hence, the same will vitiate the contract. The insurer will then be well within its right to treat the contract as void as per the terms & conditions of the Policy document. It is therefore submitted that the said Policy was obtained by DLA by concealing the material fact as to his age. It is submitted that, had the O.Ps been aware of the forgery committed by the DLA, at the time of signing of the Proposal form by the DLA for insurance, the O.Ps would not have issued the said Policy. Thus, any non-disclosure of material facts or misrepresentation in the proposal form & providing forged documents would render the contract voidable at the option of  the Insurer. Thus, the O.Ps has rightly repudiated the claim of the Complainant on the ground of concealment of material fact as to the age of the DLA, at the time of filling up the proposal form, based on which the said Policy was issued by the O.P. The said facts & grounds for repudiation was duly communicated by the O.Ps to Complainant vide its letter dt.01.07.2013.

                         Since the Complainant has failed to make out a prima facie case against the O.Ps, the reliefs sought for by the Complainant in his complaint are denied as false, unsustainable & without any merits & the Complainant be put to strict proof of the same, It is also submitted that the Complainant has no ad-judicable grievance against the O.Ps & the Complainant has failed to prove any cause of action or prima facie in the complaint against the O.Ps & therefore, failed to set up any case for any reliefs as such, hence the complaint filed by the Complainant may kindly be dismissed with cost.

                         Here, the Complainant through his Advocate has filed xerox copy of death certificate & Voter identity card of Late Dayanidhi Behera, S/o. Siba Prasad Behera along with the complaint petition & also filed through memo dt.05.11.2014 of acknowledgement slip of death claim, xerox copy of PAN Card, first premium paid receipt & Policy documents. We observe that the said PAN Card bearing No.BQLPB3988C of Dayanidhi Behera is issued on 14.03.2013 by Income Tax Department, Govt. of India, where issuance of the Life Insurance Policy is 31.01.2013 & the death of Dayanidhi Behera (D.L.A.) is on 11.03.2013.

                         On the other hand, the O.Ps have filed the copies through their Advocate along with the written statement such as:-

1. Proposal form

2. Letter of R.T.O, Balasore dt.20.06.2013 & original also

3. Policy schedule including Policy bond

4. Claim form acknowledgement slip

5. Death Certificate

6. Investigation report dt.11.06.2013 conducted by DA Associates, Delhi

7. Driving License- OR012002000980027

8. Voter Identity card including Voter list-2010 (Odisha)

9. Letter dt.01.07.2013 addressed to Mrs. Parbati Behera (the Complainant), C/o. Late 

    Dayanidhi Behera from Aviva Life Insurance Company India Ltd.                         

                         We have gone through the documents filed by the Complainant & also by the O.Ps available on the case record & on scrutiny of all the documents filed by the O.Ps, being an early claim, the insurance Company, as per their norms took up the matter for investigation. Investigation disclosed that insured has submitted a fake D.L as a proof of his date of birth, as confirmed by Registering Authority, Balasore on 20.06.2013. It is the fundamental principles of insurance Law that utmost good faith must be observed by the contracting Parties & good faith forbids either partly from non-disclosure of the facts, which the Parties known.

                         However, the O.P.s have admitted in their written statements filed on their behalf, where they have submitted that the said Policy was obtained by DLA by concealing the material fact as to his age. Further, it is submitted that, had the O.Ps been aware of the forgery committed by the DLA at the time of signing of the proposal form by the DLA for insurance, the O.Ps would not have issued the said Policy. Hence, it is noticed that in the instant case, the O.Ps have neither taken due care nor discharged their duties and responsibilities at the time of underwriting of the said Life Insurance proposal before issuance of the Policy. Thus, premium receipt for such Policy might have been refunded to the DLA before issuance of the Policy.  The non-refund of premium of Rs.15,449/- (Rupees Fifteen thousand four hundred forty nine) only to the DLA before issuance of said Policy amounts to deficiency-in-service by the O.Ps. Hence, the Order:-

                                                   O R D E R

                         Having regards to our judgment reflected above, the Complainant is partly allowed with directions to the O.Ps to refund a sum of Rs.15,449/- (Rupees Fifteen thousand four hundred forty nine) only to the Complainant as received towards initial premium of the said Policy from the DLA, within 30 (thirty) days of communication of this Order.   

                        Both the Parties are advised to bear their own cost of litigation.  

                        Pronounced in the Open Forum on this day i.e. the 31st day of August, 2016 given under my Signature & Seal of the Forum.