This complaint is filed by the complainant Smti. Shila Jaiswal U/S 12 of Consumer Protection Act against opposite party Life Insurance Corporation of India for their deficiency of service.

Complainant is permanent resident of Nagaon Town and Opposite party is Insurance Company constituted under Insurance Act and doing Life Insurance business through its various branches all over the country including branch office situated at Nagaon. It is alleged that complainant’s husband Sukhdeu Prasad Jaiswal during his life time opened a policy on 15.02.2005 for his life bearing a nominee lodged a death complaint to opposite party under aforesaid policy. It is also stated that Sukhdeu Prasad had also opened another policy bearing number 481774436 and in the said policy complainant was appointed as nominee. Complainant also lodged death claim under the said policy. Then opposite party had repudiated the claim under policy number 483648045 vide letter number GDO/DCL/Repudiation/Nagaon dated 25.03.2010 on the ground that deceased had submitted a false school certificate in a fraudulent way to get the benefit under the policy. The allegation so made by opposite party is false and fabricated and her husband never submitted any false certificate with the proposal form. The copy of such school certificate was not submitted by her husband along with the proposal form, the agent of opposite party Mr. Prakash Chandra Sethia had prepared such certificate. Deceased husband never know English and only know how to write his name and speak Hindi. The agent of opposite party had prepared the false certificate for his own interest as PAN card clearly reflects that his date of birth was 04.07.1948 but opposite party ignored such fact repudiated the claim of complainant on a flimsy ground and whereas opposite party had accepted the death claim of claimant under the policy number 481774436 and settled the claim of complainant in which the date of birth of decease was given as 04.07.1948. the policies of complainant is not an early claim but opposite party repudiated the claim of complainant on a minor ground which is clear deficiency of service. Under the above circumstances complainant has prayed before this Forum to pass an order directing opposite party for payment of death claim amount of Rs.5,00,000.00 (Five lakhs) only with interest along with damage for mental agony and cost of litigation.

Opposite party Insurance Company contested the case by filing written statement with different plea. Opposite party contended that there is no cause of action. The petition is not tenable in law and complainant has no right to file this case. The case of opposite party is that during the life time of Sukhdeu Prasad Jaiswal opened the earlier policy number 481774436 for sum assred Rs.1,00,000.00 (One lakh) only declaring his age solemnly affirming his age in affidavit dated 20.04.1998. In the said affidavit he also stated that there is no other reliable documentary evidence and no school certificate was produced at the time. But at the time of opening other policy i.e. policy number 483648045 amount of sum assured Rs.5,00,000.00 (Five lakhs) only, he had submitted a school certificate bearing number 458 dated 23.10.1962 issued by Durgipatty Lower Primary School Udra Darbhanga Behar in support of the proposal. As the proposal under previous policy number 481774436 was accepted as per underwriting norms the policy was enforced and the claim under the said policy was settled favouring the nominee. But in case of present policy number 483648045 the life assured influenced the underwriting processed submitting a false school certificate which is admitted by the complainant petition saying the same to created certificate by the agent Mr. Prakash Ch. Sethia. So claim under the said policy was rightly repudiated. As DLA after knowing and understanding fully well the content of proposal put his signature in the same, the contract made with opposite party with DLA is void abinito because Insurance is the contract between Insurer and the insured on utmost good faith.  

Under the above circumstances the complainant petition is liable to be rejected.

In support of complaint petition, complaint examined both the witnesses. Opposite party also examined one witness and the same was cross examined by the complaint. We have heard argument from both sides of learned counsels and perused the case record. In this case point for consideration is whether there is any deficiency of service of opposite party or not.

From the evidence of complainant it appears that that complainant’s husband Sukhdeu Prasad Jaiswal during his life time opened a policy on 15.02.2005 for his life bearing number 48368045 and he made complainant nominee of the said policy. Husband of complainant died on 13.02.2009 and after his death his wife being nominee lodged a death complaint to opposite party under aforesaid policy. It is also stated that Sukhdeu Prasad had also opened another policy bearing number 481774436 and in the said policy complainant was appointed as nominee. Complainant also lodged death claim under the said policy. Then opposite party had repudiated the claim under policy number 483648045 vide letter number GDO/DCL/Repudiation/Nagaon dated 25.03.2010 on the ground that deceased had submitted a false school certificate in a fraudulent way to get the benefit under the policy. The allegation so made by opposite party is false and fabricated and her husband never submitted any false certificate with the proposal form. The copy of such school certificate was not submitted by her husband along with the proposal form, the agent of opposite party Mr. Prakash Chandra Sathiya had prepared such certificate. Deceased husband never know English and only know how to write his name and speak Hindi. The agent of opposite party had prepared the false certificate for his own interest at the time of creation of policy. The document submitted by her husband such as PAN card clearly reflects that his date of birth was 04.07.1948 but opposite party ignored such fact repudiated the claim of complainant on a flimsy ground and whereas opposite party had accepted the death claim of claimant under the policy number 481774436 and settled the claim of complainant in which the date of birth of deceased was given as 04.07.1948.

During evidence complainant Exhibited number 1 policy number 483648045, Exhibited 2 policy number 481774436 and Exhibited number 3, the repudiation letter for policy number 483648045, where sum assured Rs.5,00,000.00 (Five lakhs) only. Admittedly complainant received sum assured on the first policy after settlement. Exhibited number 3 letter issued by opposite party discloses that opposite party repudiated the claim of second policy on the ground that DLA influenced opposite party by submitting false school certificate in fraudulent way to get the benefit under the policy. In this connection complainant in her evidence at the time of cross examination stated that her husband was illiterate and proved his age through an affidavit but she cannot say who had submitted subsequent age proof school certificate for claiming subsequent policy. Public witness 2 Shri Sandip Jaiswal son of deceased has stated that his father never filled up the proposal form and visited the office of opposite party. He also in his cross examination stated that his father only know to put his signature; he cannot say who had given the said certificate. On the other hand witness of opposite party defence witness 1 Shri Hiranya Kumar Das an administrative officer of LIC India in his cross examination admitted that the policy of deceased was old one and before repudiation their office made an investigation and prepared a docket. Exhibited Ka certificate of age mentioning school was written by their agent Prakash Chand Sathiya. This certificate discloses that the date of birth of Sukhdeu Prasad Jaiswal was 04.07.1948. Exhibited 10 is the PAN card issued by Income Tax authority Government of India shows that date of birth of Sukhdeu Prasad Jaiswal is 04.07.1948. In the former policy where settlement was made by opposite party also found that his date of birth was 04.07.1948 and that policy he declared on oath through an affidavit. On the basis of that affidavit former policy was settled. It is clear that his date of birth is 04.07.1948. Admittedly agent of Insurance Company had prepared and deposited the subsequent certificate. Agent acts on behalf of Insurance Company. But Insurance Company has made no attempt to take any action against the agent. Evidence on record does not show any fraud playing by husband of complainant. During the period of 2005, when complainant husband opened the policy computerization of all branches of LICI was made. On the other hand the policy deceased is old one and he never defaulted payment of any premium. It is duty of opposite party to confirm his age or asked him for clarification. Under the such circumstances, we find no cogent reason for repudiation of subsequent claim of complainant on a flimsy ground. Insurance Act 1938, Sec.45 where second part of section 45(a) the statement must be material matter or must be suppressed fact which was to disclose; (b) the suppression must be fraudulent made by the policy holder, and (c) policy holder must have known at the time of making statement that it was false or that it suppressed facts which it was material to disclose. Mere inaccuracy of falsity in respect of some document is insufficient.

As such we find and hold that opposite party failed to see the above fact and by repudiating on the second policy caused error by harassing wife of decease. We find that there is deficiency of service of opposite party. Hence prayer of complaint is allowed. Opposite party Life Insurance Corporation of India is directed to disburse the sum of Rs.5000.00 (Five thousand) only as penalty for mental agony and harassment and Rs.5000.00 (Five thousand) only as cost of proceeding also allowed. Opposite party is to pay amount of Rs.5,10,000.00 (Five lakhs Ten thousand) only within 60 days from the date of order. In case of failing to pay the same 6% interest is required to pay from the date of order till realization on entire amount.