The complainant Sri Raj Kumar Das has filed this complaint petition against Managing Directors, Max New York Life Insurance Company Ltd. New Delhi and two others (o.ps) for realization of Rs. 4,24,394/- as sum assured, Rs. 50,000/- for compensation for mental, agony and physical harassment and Rs. 25,000/- as litigation cost with 18 % p.a. interest on the sought amount since the date of death of L.A. person till date of final payment/realization.
The brief, facts of the case is that the complainant is nominee and husband of L.A. person namely Mala Devi. The further case is that the wife of complainant namely Mala Devi (L.A) purchased a policy bearing No.-277288213 for sum assured Rs. 4,24,394/- along with other monetory benefits from o.ps insurance company after paying premium amount Rs. 31,164/- by cheque. The policy was purchased through AXIS Bank as the AXIS Bank is corporate agent of the Max Life Insurance Company. The further case is that entire proposal form was filled up by company’s agent(officials) and the complainant’s wife only put the signature wherever the agent and the company’s officials told her to do so, in good faith and trusting upon agent’s knowledge and technicality about life insurance policy. The further case is that the risk coverage of the Life of Mala Devi starts from 21-08-2015. The further case is that on 15-12-2015, the L.A. felt some chest pain and died due to heart attack. The further case is that after death of L.A., the complainant filed death claim on 22-09-2016 against above policy to aforesaid company with all relevant documents. The further case is that the insurance company has neither settled the claim nor repudiated the same. As per I.R.D.A. circular the insurance company has either to settle the claim or repudiate it within 6 month from the date of filing of death claim.
The complainant has filed the following documents with the complaint petition - Photocopy of Insurance premium receipt -annexure-1, photocopy of death certificate of Mala Devi -annexure- 2, photocopy of proposal form -annexure-3, photocopy of death claim application form Annexure-4.
On issuance of notices, o.p no. 1 & 2 appeared and filed his w.s. on 14-12-2018 with prayer to dismiss the complaint petition with exemplary cost. It has been mentioned in the w.s. that the complaint is false, frivolous vexatious and abuse of the process of this forum. It has been further mentioned that the complaint does not disclose any cause of action. It has been further mentioned that the complaint does not raise any ‘’Consumer Dispute” as defined under the Consumer Protection Act-1986 as there is no deficiency in service or negligence on the part of answering parties. It has been further mentioned that the insurance contract as agreed between the parties is void-ab-intio to the reason that the L.A. had died prior to the date of filing of application form. It has been further mentioned that the proposal form was fraudulently signed in the name of L.A. who was pre- deceased at the time of proposal of the subject policy. It has been further mentioned that the complainant suppressed the material fact regarding death of Life assured prior to the issuance of policy document it has been further mentioned that the claim of the complainant was repudiated on the ground that L.A had passed away prior to the date on which a complain was submitted for the subject of life insurance policy. The issuance of policy No- 277288293 in the name of D.L.A Mala Devi is an admitted fact. The receiving of death claim intimation from the complainant to the o.ps is also an admitted fact. It has been further mentioned that on receiving of the claim o.ps started investigation because it was a early claim and during the investigation it was revealed that the proposal form was signed on 21-08-2015 and the D.L.A actually died on 15-02-2015 i.e 6 month prior to the filing of proposal form.
following documents have been annexed on behalf of o.ps – photocopy of proposal form annexure-A, photocopy of policy document including first premium receipt policy schedule and terms and condition - annexure-B, photocopy of death claim -intimation annexure-C, photocopy of death claim acknowledgment dated 05-10-2016 -annexure-D, Copies of certificate from village Anganbari Kendra and cancelled death certificate annexure - D&E, photocopy of repudiation letter annexure-F.
On issuance of summon o.p no.-3 also appeared before the forum but didn’t filed his w.s., so he has been debarred from filing w.s. vide order dated 06-02-2019.
On behalf of complainant, AW-1 Raj Kumar Das has been examined on affidavit who has exhibited the annexures filed on his behalf as exhibit 1 to 4.
Photocopy of repudiation letter has been mentioned in w.s. as annexure-F but the same has been marked on the document as annexure-E. Photocopy of death certificate has been also marked as annexure-E. So, the repudiation letter will be read as annexure-F for convience. It has been mentioned in the repudiation letter (annexure-F) that the proposal form was signed on 21-08-2015, and policy was issued on 21-08-2015, however during claim evaluation it has been confirmed that Late Mrs. Mala Devi had also expired prior to Signing on “proposal form”. Death certificate received at initial stage has been cancelled by issuing authority” It has also been mentioned in the repudiation letter that deliberate fraud has been committed against company to get policy, issued on dead person.
It has been mentioned in the w.s. filed on behalf of o.ps 1 & 2 that the proposal form was signed on 21-08-2015 and D.L.A actually died on 15-02-2015 i.e 6 month prior to the issuance of policy. On behalf of o.ps photocopy of cancelled death certificate and handwritten certificate issued by Aganbari Sevika of Kendra-Dih-Barai. It has been filed as annexure- D& E. The above documents shows that Mala Devi died on 05-02-2015 and the certificate already issued has been cancelled by the aforesaid said Aaganbari Sevika whereas on behalf of complainant photocopy of death certificate has been filed as annexure-2 (exhibit-2) in which death of Mala Devi has been mentioned on 15-12-2015. During course of hearing, we noticed the above facts and asked the parties to submit the original documents regarding the death of D.L.A, already produced on their behalf. The complainant produced the original death certificate, issued by aforesaid Aganbari Sevika, the photocopy of which has already been filed as annexure-2. (exhibit-2). In the death certificate, death of Mala Devi has been mentioned on 15-12-2015. On the other hand on providing 3 opportunities the o.ps didn’t file the original documents . On behalf of o.ps No. 1 & 2, a petition was filed on 14-10-2019 of the effect that they have already filed Xerox copy of the same and the case may be disposed on that basis.
The o.ps didn’t disclose the reasons as to why they are not producing original documents. The question of prior death of D.L.A has been raised by the o.ps, so burden lies on their shoulder to prove the above facts. They have not adduced any evidence on this point. On direction of the forum they also did not produce the original document of cancelled death certificate and hand written paper of death of Mala Devi, so the varacity of the documents produced as annexure-D & E becomes suspicious and presumption may be drawn that the o.ps. are escaping themselves to produced the real truth. So, It appears that there is deficiency on their part by not paying insured amount to the complainant on the ground of suspicious document.
Issuance of policy certificate and receiving of death claim intimation is an admitted fact.
The learned Lawyer for the complainant relied on the decision of Hon’ble N.C.D.R.C. New Delhi, passed in first appeal No.-1696/2016 AEGON RELIGARE life insurance Company Ltd. Vs. Rajendra Rai decided on 31-05-2018 in which Hon’ble N.C. has observed as follows.-
“In the light of the overwhelming evidence namely, the death certificate issued by the Directorate of Economics and Statistics; the proposal form wherein the copy of PAN Card was taken as requisite identification, and was witnessed by the Agent himself, the stand of the Insurance Company that the policy was issued to a dead person and that the policy was fraudulently obtained, cannot be sustained. Further, when a policy for Rs.30,00,000/- was being taken and the process of issuance of policy includes the filing of proposal form to be witnessed/signed by the agent himself the question of issuance of a policy or filing up of the proposal form by a dead person cannot arise.”
On the basis of above discussions, we are of the considered opinion that there is deficiency on the part of o.ps no.- 1 & 2 and they are liable to pay the insured amount.
O.P. No.-3 has no role in repudiation of claim, so they are not liable to pay the amount as claimed for.
Accordingly, the complaint petition is allowed and the o.p No.1 & 2 are directed to pay Rs. 4,24,324/- as sum assured with 8 % interest p.a from the date of filing of complaint petition that is 04-04-2018, Rs. 20,000/- as physical and mental harassment and Rs. 10,000/- as litigation cost within two months from the date of order, /, on failure they shall be responsible to pay the above amount with 9 % p.a. interest till realization. Let a copy of this order be furnished to both the parties as per rule.
