Sri A.K. Bhattacharyya

The complainant’s case in short is that the complainant’s husband had a Life Insurance Policy under the OP no. 1 and 2 through the OP no.3 (agent) bearing no.000152243 dtd.15.06.2012. At the time of making the said policy, it was written erroneously in the application form that the applicant had a proprietorship business having annual income Rs.2,00,000/-, but actually he was a worker under a shop-owner having monthly income as worker @ Rs.4000/- per month and he was a BPL Ration Card holder at that time. The complainant’s husband (policy holder) died on 30.06.2012 at the residence by heart attack. The complainant after the death of her husband as nominee claimed the death benefit for the said insurance from the OP no.1 and 2 but they repudiated the claim by a letter dtd. 30.11.2012, hence the instant case for relief as prayed for.

The OP no.1 and 2 did not appear even after service of notice upon them. The OP no.3 has appeared and filed W/V as also WNA, where it is stated that he has in no way  connection with the instant policy and he is not an agent under the OP no.1 and 2, hence he prays to expunge his name from the cost title.

Point for discussion

Whether the complainant is entitled to any relief as prayed for?

Decision with reason

It appears from the Xerox copies of the documents of the policy that the complainant’s husband had the said policy. Admittedly, the complainant’s husband had no proprietorship business or annual income of Rs.2,00,000/- from such alleged business. It was averted in the petition of the complainant that it was erroneously written as business man and having annual income of Rs.2,00,000/-, but actually he was a worker under a shop of another person having monthly income of Rs.4000/- .

As per Sec 11 (Misc.) (c) & (f) of terms and condition of the said policy, ‘if the policy holder makes any claim knowingly it to be false, fraudulent, misleading or dishonest in any respect, then the policy and any riders in force shall be void and any amount actually paid or potentially payable shall be forfeited and that the policy documents cannot changed or altered unless the company approves it in writing by endorsement on the schedule …..’

As per Clause G i.e. Sec 45 of the Insurance Act 1938 states that ………….. a statement made in the proposal /application for insurance leading to the issue of the policy was inaccurate or false, unless the insurer shows that such statement was on a material or suppressed facts which it was material to disclose and that it was fraudulently made by the policy holder and that he, policy holder knew at the time of making it that the statement was false or that it suppressed facts which was material to disclose and for such ground the said policy shall not be affected.

The complainant or her Ld. Advocate did not appear on 23.10.2013 and 25.10.2013 without any step when these dates fixed for filing of WNA and hearing of argument. It is to be noted that the complainant did not file any WNA and any cogent document to show that her husband (the policy holder) erroneously made such statement in the application for Insurance Policy that he had a business having earning of annual income of Rs.2,00,000/-. It cannot be altered or changed without any consent of Insurance Co. having its endorsement in writing as per Sec 11(f). Therefore we find that the complainant’s husband (the policy holder) had suppressed the material fact of his source of income and also amount of income by mentioning false statement made in the proposal of the application for insurance.

We find that there is no material on record to show that the OP no.3 was an agent of the OP no. 1 and 2 or took any part for policy of the complainant.

In such circumstances as aforesaid and having regard to the discussions made above we are of the view that there is no deficiency in service on the part of the OP no.1 and 2 in repudiating the claim and for the above reasons, therefore, the complainant is not entitled to get any relief as sought for.

Hence, it is,

ORDERED

that the instant case be and the same is dismissed on merit /ex parte against OP no.1 and 2 and on contest against OP no.3, without any cost.