JUDGMENT

            The complainant has filed this complaint u/sec. 12 of the Consumer Protection Act – 1986 against the OP alleging deficiency in service in not settling the claim of the policy amount of Rs.1,50,000/-. Hence, prays for the relief to seek the policy claim with double benefits of Rs.3,00,000/- along with compensation for physical and mental agony of Rs.50,000/-, deficiency in service of Rs.50,000/- and Rs.10,000/- for cost and miscellaneous charges.  

             Brief averments of the Complaint are;

            2.  That the complainant’s father had made on policy by name Sri.Raksha during his life time in the branch of OP-Company on dated: 04.04.2013. The policy number is 031300091956. The total sum assured of the policy amount is Rs.1,50,000/-. The said policy is having the benefit of Double profit.

3.         The complainant further alleged that the complainant father on 25.09.2014 died due to Heart attack in his own hometown. As the complainant himself was nominee of the said policy had put an application for the claim amount on 06.11.2014.

4.         The complainant further alleged that the OP-Branch had intimated them on 13.01.2015 telling that the claim amount of the said policy cannot be given. The reason was given that there is an age difference in the policy of the policyholder. The complainant alleges that the reason is not satisfied. The complainant further alleged that with one are any reason, the OP has not given the claim amount of having the benefit of double the profit of Rs.3,00,000/- along with compensation of Rs.50,000/- for physical and mental agony and Rs.50,000/- for deficiency in service and Rs.10,000/- towards litigation expenses as prayed above.

5.         The Forum after admitting the complaint, a notice was issued to Opponents and the notice was served upon them. The Opponent appeared before a Forum along with his counsel and filed Vakalath and Written Version to the main petition.

6.         The objections of the OP are as under:

That the OP denied the facts of the complainant in toto. The OP submitted that the complainant filed by the complainant against OP in false, frivolous and vexatious and far away from the truth and the same is not maintainable either in law or facts. Hence, the same is fit to be dismissed.

7.         OP further submitted that the deceased Bheemappa T had proposed for insurance policy for himself and submitted a proposal forms bearing No.500613000782, dated; 04.04.2013 by paying the proposal deposit amount of Rs.16,685/- dated; 05.04.2013.

8.         After undertaking the proposal, the Company has issued the policy bearing No.NP031300091956 commencing risk from 24.05.2013 under the plain “Shri Raksha” for a period of 15 years, with a annual premium @ Rs.10,582.75 and A.R. rider Rs.93.75 and FIB Rs.112.50 for a sum assured of Rs.1,50,000/- for all for term of 15 years and the complainant being the nominee.

9.         It is further submitted that it was the primary duty of the life assured to disclose all correct information with regard to his personal details, age, health habits etc. as per the questionnaire of the proposal form at the time of taking the policies. Since the contract of insurance is based on the principles of “Uberrima Fide”, the burdens lies on the life assured to disclose all correct information with regard to his age, health at the time of taking the policies.

10.       It is further submitted that the OP on intimation of death of the life assured that he died on 25.09.2014, the claim was entrusted to an investigator as it was an early death claim, less than 2 years. On investigation it was revealed that the age of the deceased Bheemappa T was 69 years as on 01.01.2014 as per the Voter List of Karnataka.

11.       It is submitted that maximum age for applying for an insurance policy under the Plan Shri Raksha is 65 years. It is pertinent to mention here that at deceased Bheemappa T submitted a proposal form stating that he was 53 years and for proof of the same had furnished the PAN card. But on investigation it was revealed that deceased Bheemappa T was 69 years as on 01.01.2014 therefore his age as on the date of proposal would be 68 years which is not an insurable age. Had the deceased Bheemappa T revealed his correct age in the proposal form it would have influenced that underwriters in the decision of issuance of the policy, they would have rejected his proposal as he was not within the insurable age. The deceased by suppressing his correct age has given a false age and caused the OP to issue a policy covering his life therefore violated the principles of Uberrima Fide hence the compliant is liable to be dismissed.

12.       That the said policy premiums have been calculated on the age of the life assured declared in the proposal. If the age is proved to be lower than what is stated in the proposal the basic and rider premiums under the policy will be revised effective from the policy month following date of receipt of the age proof and no refund will be made by the company. But, in the instant case the deceased Bheemappa. T has given information about his age as 54 years. Whereas, his real age is 68 years as per Voter’s list. Hence, the father of the complainant has given wrong information about his age only with a view to get the amount and benefit of the insurance. As the policy is only based upon the age of the policy holder, the policy holder has given wrong information. Hence, the OP is not liable to pay any amount to the complainant.

13.       It is further submitted that the life assured died on 25.09.2014. Hence, the duration between the date of commencement of the policies and the date of death is only 1 year 4 moths 1 day. This is a clear case of early death claim. Hence, the protection of the Sec 45 of the Law of Insurance is not available to the complainant. It is submitted that as the claim of the complainant is within two years from the commencement of the risk, this OP is not liable to prove the fact that life assured had suppressed material information with regard to his age at the time of taking the policies and hence, the complaint is required to be dismissed with costs.

14.       The complainant without having any basis has made all false and concocted allegations against the company, and the same are denied in toto. The company has repudiated the claim under the above policies only after making thorough investigation. The claim is found to be a non-genuine and as such, the claimant has hatched a plan to get the huge policies amount by submitting false and baseless documents. That the company is not liable to pay any amount. 

15.       That this OP submits that there is due deliberation on the part of the policyholder i.e. father of the complainant as he has not given proper information about his age while making the life insurance policy. Hence, there is no deficiency in service on the part of the OP and OP has rightly refused repudiated claim of the complainant. Hence, on this count also, the complaint is fit to be dismissed.

16.       That the contents of Para No.2 of the complaint are true and correct. It is true that the father of the complainant has made a policy during his lifetime on 04.04.2013 and the amount of the policy is Rs.1,50,000/- and the policy number is NP 031300091956. Other contents of Para No.2 are false and baseless and hence, they are denied. Hence, the complainant put to strict proof of the same.

17.       That the contents of Para No.3 of the petition are true and correct and hence, they are admitted. It is true that the father of the complainant died on 25.09.2014 and it is well within the knowledge of the complainant that the father of complainant died due to heart attack and it is true that the complainant given application for claim on 06.11.2014. The complainant be put to strict proof of the same.

18.       That the contents of Para No.4 of the complaint are true and correct and hence admitted. It is true that the OP have rightly stated that the company is not liable to pay any claim on 13.01.2015. Because, the policyholder has wrongly shown his age while making the policy.

19.       That, the contents of Para No.5 of the complaint are false and baseless and hence they are denied. It is false to stat that there is a deficiency of service on the part of the OP as they have not given amount to the complainant. The OP were right in repudiating the claim. Hence, there is no deficiency in service.

20.       That, the contents of Para No.6 of the complaint are false and  baseless and hence they are denied. The complainant be put to strict proof of the same. Hence, prays for the dismissal of the complaint with exemplary costs.   

21.       On the basis of the above pleadings, the following points that arise for our consideration are:

POINTS

1.  Whether the complainant proves that there is deficiency in service in not settling the life insurance compensation for death of his father?

2. Whether the OP proves that the complainant’s father has failed to disclosed the true and correct materials to the insurer at the time of making the policy?

3. Whether the complainant is entitled for any relief sought for?

4. What order?

     22.    To prove the case of the complainant, the complainant himself examined as PW-1 and he has got marked the documents as per Exhibit A1 to Exhibit A5 and closed their side of evidence. The OP himself examined as RW-1 and got marked the documents as per EX B1 to EX B4 and closed their side of evidence.  

     23.     Heard the arguments of both counsel and perused the records.

24.  Our findings on the above points are as under;

Point No. 1 :  In Affirmative

Point No. 2 :   In Affirmative

Point No. 3 :  In Affirmative,

Point No. 3:   As per final Order for the following.

REASONS

25.  POINT No. 1and 2:  As these issues are interconnected each other, hence they are taken together for common discussion to avoid repetition of facts, evidence documents and arguments.

            26.  On perusal of the pleadings, evidence coupled with the documents of respective parties on record.  It is the case of the complainant alleging deficiency in service in not settling the claim of the policy amount of Rs. 3,00,000/-.  There is no disputes regarding that the complainant’s father Bheemappa.T. during his life time had obtained policy plan by name Shri Raksha with a policy No.NP 031300091956 which commences from 04.04.2013 with annual premium amount of Rs.10,582.75  and A.R. Rider of Rs.93.75 and FIB Rs.112.50 for a sum assured of Rs.1,50,000/- for a period of 15 years. There is also no dispute that the premium of the policy is not paid. On 25.09.2014 the complainant’s father died due to Heart Attack in his residence leaving the complainant as legal heirs and a nominee in the policy being a beneficiary in the policy, the complainant approached and claimed for assured amount along with the benefit of double profit and submitted the claim form and necessary documents. But, till today the OP so far has not settled the claim. Hence, the complainant alleged deficiency in service.  

            27.       On contrary, the OP had taken a contention that the policy was issued based on the details mentioned by the life assured in the proposal form and believing the same  to the true and correct it was only during the processing of death claim, it come to light that the deceased life assured (DLA) was 53 years and for the proof of the same had furnished the PAN Card. The OP also contended that on investigation it was revealed that deceased Bheemappa T was 69 years as on 01.01.2014 as per the voter list of Karnataka. Therefore, his age on the date of proposal would be 68 years while it is not an insurable age. The material fact deliberately concealed in the proposal form submitted by the DLA and the same was done with an intention to deceive the OP. Thus the claim of the complainant has been repudiated on ground of given wrong information about the age. As the policy is only based upon the age of the policyholder and the policyholder has given wrong information.

            28.       As per specific defence taken by the OP in this Written Version contending that the complainant’s father has given wrong information regarding the Age. 

29.       To prove the case of the complainant, the PW-1 has reiterated the complainant’s averments in his examination in chief and in support of her case. He has produced the policy documents pertains to the Death Certificate which is marked as EX A5, whereas EX A1 reveals the claim repudiation letter dated: 13.01.2015. ON perusal of EX A1 it is crystal clear that the OP has repudiated the claim for the reason that the age of the deceased life insured had suppressed the material fact by not disclosing his correct age in the proposal form which is ought to have been disclosed At the time of Insurance of the policy, it is admitted by the OP itself that for the age proof the deceased life assured had submitted his PAN Card as age proof for insurance policy which shows his date of birth and age as on 01.06.1959 and 53 years at the time of applying for insurance.

30.       The OP has further averred that on investigation found the discrepancy  in age and verified the Voter’s list of Karnataka which was issued on 01.01.2014 in which his age is 69 years i.e. his age as on proposal dated; 14.04.2013 was 68 years. The OP further averred that at the time of issuing the policy the DLA had submitted that PAN Card for his age proof. It is clear that the PAN card is insured by Income Tax Department to issue this Card, the IT Department compulsorily takes an Identification Card for issuing the card. ON the basis of that ID Card, the PAN Card had been issued to the DLA. After ascertaining the proof of age when the PAN Card is issued by the I.T. department, then this card is more authenticated than compared to the Voter List. Because this voter list is prepared on the information given by the family members who at that time were present. In our opinion, this voter list is not a proof of age because neither it bears the signatures nor it has been prepared by the proof of any ID Card. Comparing to Voter ID and PAN Card Pan Card is more authenticated because this PAN Card is issued by the Income Tax Department on basis of an I.D. proof given to him and this will be duly signed by the DLA. At the time of issuing the policy, the OP accepted PAN Card and insured the policy. Once the insurer has admitted the age of the insured as correct, it cannot repudiate insurance claim on this ground that on with the allegation that insured had defrauded the insurer by making false statement. The counsel for the complainant has relied the citation reported in II (2011) CPJ 17 (NC)  Life Insurance Corporation of India and Anr. V/s Gopal Singh. Where it has held by the Hon’ble National Consumer Disputes Redressal Commission, New Delhi that:

                        “Consumer Protection Act, 1986 – Sections 2 (1) (g), 14 (1) (d), 21 (b) – Insurance (Life) – Endowment Assurance Policy with Profits – Suppression of material facts – Dispute in age – Claim repudiated – Forum allowed complaint – State Commission dismissed appeal – hence, revision – Contention, assured had given his age incorrectly while filling proposal form on basis of voter’s list – Not accepted – Age given in voter’s list cannot be taken as sure test to determine exact age of a person – It is a common knowledge that frequently small mistakes regarding residence, age, parent age do occur while preparing voter’s list – No conclusive evidence on record to show that assured had mentioned his age incorrectly with mala fide intention with any ulterior motive – Assured has correctly mentioned age in proposal form.

           Result: Revision Petition dismissed.”

            The counsel for the complainant has also relied upon the citation reported in II (2014) CPJ 20A (CN) (AP) Reliance Life Insurance Ltd.,   and Another V/s B.Koti Ratnam that:

                          “Consumer Protection Act, 1986 Section 2 (1) (g), 14 (1) (d), 15 – Insurance (Life) – Deather Claim – Alleged suppression of correct age – Claim repudiated – Alleged deficiency in service – District Forum allowed complaint – Hence appeal – Entries made in ration card or voter list by themselves cannot be considered as criteria to ascertain correct age of insured more particularly when there has been discrepancy in age of insured as seen from voter’s list and ration card – Insurance Company that failed to substantiate its contention that insured was aged 68 years at time of submitting proposal form – Repudiation not justified.

            Result: Appeal dismissed.”

            It has been held that entries made in ration card or voter list by themselves cannot be considered as criteria to ascertain correct age of the insured. This lordship have held that there is no conclusive evidence on record to show that assured that mentioned his age incorrectly with a mala fide intention with any ulterior motive.

            31.       The cardinal principle that age given in Voters list cannot be taken as sure test to determine the exact age of a person. It is a common knowledge that frequently small mistakes regarding residence, age, parent age do occur while preparing voters list. No conclusive evidence on record to show that assured had mentioned his age incorrectly with mala fide intention with any ulterior motive. This lordships have held that voter’s list can be taken as conclusive evidence on record and it can be accepted to determine exact age of a person.

            32.       Therefore, in the light of principle laid down by this lordship in the aforesaid citation more specifically with respect to voters list it is crystal clear that while determining age proof voters list cannot be taken into consideration as conclusive evidence.

            33.       The counsel for the complainant has also relied upon another citation passed by the State Consumer Disputes Redressal Commission, Punjab Balwinder Singh V/s Life Insurance Corporation of India & Anr.

            “Consumer Protection Act, 1986 – Section 15 – insurance claim – Age of insured – Age of assured was quoted as 45 years whereas she was 58 years old – In view of giving wrong information about age policy of Rs.50,000/- obtained by insured was void ab initio – Claim was repudiated on this ground – Dist. Forum upheld repudiation of claim and complaint was dismissed – Appeal filed – It came into evidence that at the time of submitting of the proposal insurer/respondent had admitted that age of insured as 45 years as found in the reports of Panchayat Secretary and medical Officer – Development officer admitted that 45 years age of insured was correct – Once insurer has admitted the age of insured as correct, it cannot be repudiate insurance claim on this ground later on with the allegation that insured had defrauded the insurer by making a false statement – Impugned Order set aside – Appellant is entitled to claim with all benefits with 7.5% p.a. interest and with cost of Rs.2,000/-.”

            The facts and circumstances of the case in hand and circumstances of the said citation is same and applicable in this case.

            34.       In view of the discussion here in above, the documents now furnished EX B1 to EX B3 will no way help the OP Company to prove that the correct date of birth or age is not mentioned in the proposal form. After considering the documents, we are unable to change the view which we have earlier taken.

            35.       There is no proof that the age of DLA/Policy holder is not one mentioned in the policy of the proposal form in view of the acceptance of the same by the officer of the OP Company. There is also no proof that the age mentioned in EX B3 the Voter list is correct one and the same has been furnished by the deceased life assured. EX B3 do not contain the date of birth and therefore we cannot compare the same to the date of birth mentioned in the policy which has been accepted by the officers of the Insurance Company.

            36.       Therefore, the consideration which has been taken by the OP is vague one and therefore the said defence setup by the OP is not justifiable one.  

            37.       On the contrary, as per the oral evidence coupled with the documentary evidence, the complainant has proved that OP Company has committed deficiency in service in not settling the claim. Hence, in the light of above observations, we constrained to hold Point No.1 and 2 in affirmative.  

            38.       POINT NO.3:  IN the light of observations made by us on points No.1 and 2, since complainant has filed this complaint for the deficiency in service on the part of the OP Company in not settling the claim amount of the policy. In the light of observations made by us while answer the Point No.1 and 2 in the affirmative and in the light of the observations made by us the complainant is entitled for the policy claim amount as prayed for. Accordingly, we constrained to hold point No.3 in the affirmative.

39.  POINT No. 4 :- In view of above discussion and findings we proceed to pass the following;

O R D E R

1. The complaint is partly allowed.

2. OP is directed to pay Sum Assured of the policy of Rs.1,50,000/- (Rupees one lakh fifty thousand) along with Rs.5,000/- (Rupees five thousand) for deficiency in service and Rs.2,500/- (Rupees two thousand five hundred) towards litigation expenses to the complainant within one month from the date of receipt of this Order, failing which 12% p.a. interest will be charged from the date of filing of the complaint, till realization.

3. Send the free copies of this order to both parties.

Dictated to the Stenographer, transcribed, typed by her, typescript, corrected by me and then pronounced in the Open Fora on 22^nd day of March, 2016.

// ANNEXURE //

List of Documents Exhibited for the Complainant.

Witnesses examined for the Complainant

List of Documents Exhibited for the OP.

Witnesses examined for the OP