State Consumer Disputes Redressal Commission
Edelweiss Tokio Life Insurance Company ... vs Gurpreet Singh on 26 November, 2024
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH
1) First Appeal No.276 of 2023
Date of institution : 12.04.2023
Date of Reserve : 08.11.2024
Date of Decision : 26.11.2024
Edelweiss Tokio Life Insurance Company Limited, Registered Office at
6th Floor, Tower 3, Wing B, Kohinoor City, Kirol Road, Kurla (W)
Mumbai-400070 through its Authorized Person/Authorized Signatory.
.......Appellant/Opposite Party No.1
Versus
Gurpreet Singh (aged about 45 years) son of Niranjan Singh, Resident
of Village Sotha, Tehsil and District Sri Muktsar Sahib. Mobile
No.82838-46180.
......Respondent/Complainant
Present :-
For the appellant : Sh.Bhupender Singh, Advocate
For the respondent : Sh.H.S.Sidhu, Advocate
First Appeal under Section 41 of the
Consumer Protection Act, 2019
against the Order dated 24.02.2023
passed by the District Consumer
Disputes Redressal Commission Sri
Muktsar Sahib in CC No.21 of 2021.
2) First Appeal No.277 of 2023
Date of institution : 12.04.2023
Date of Reserve : 08.11.2024
Date of Decision : 26.11.2024
Edelweiss Tokio Life Insurance Company Limited, Registered Office at
6th Floor, Tower 3, Wing B, Kohinoor City, Kirol Road, Kurla (W)
Mumbai-400070 through its Authorized Person/Authorized Signatory.
.......Appellant/Opposite Party No.1
Versus
Gurpreet Singh (aged about 45 years) son of Niranjan Singh, Resident
of Village Sotha, Tehsil and District Sri Muktsar Sahib. Mobile
No.82838-46180.
......Respondent/Complainant
F.A.No.276 of 2023
2
Present :-
For the appellant : Sh.Bhupender Singh, Advocate
For the respondent : Sh.H.S.Sidhu, Advocate
First Appeal under Section 41 of the
Consumer Protection Act, 2019
against the Order dated 24.02.2023
passed by the District Consumer
Disputes Redressal Commission Sri
Muktsar Sahib in CC No.22 of 2021.
Quorum:-
Hon'ble Mrs. Justice Daya Chaudhary, President
Ms. Simarjot Kaur, Member
Mr. Vishav Kant Garg, Member
1) Whether Reporters of the Newspapers may be allowed to see the Judgment? Yes/No
2) To be referred to the Reporters or not? Yes/No
3) Whether judgment should be reported in the Digest? Yes/No SIMARJOT KAUR, MEMBER By this common order of ours, the above said two First Appeals i.e. First Appeal No.276 of 2023 titled as "Edelweiss Tokio LIC Ltd. Vs. Gurpreet Singh", filed by the Appellant/OP No.1 and First Appeal No.277 of 2023 titled as "Edelweiss Tokio LIC Ltd. Vs. Gurpreet Singh", filed by the Appellant/OP No.1 shall be disposed off/decided by the common order as same questions of law and facts involved therein.
2 FA No.276 of 2023 has been filed by the Appellant/OP No.1 under Section 41 of the Consumer Protection Act, 2019 (in short 'The Act') being aggrieved by the impugned Order dated 24.02.2023 passed by the District Consumer Disputes Redressal Commission, Sri Muktsar Sahib (in short 'the District Commission') whereby the Complaint of the Complainant had been F.A.No.276 of 2023 3 allowed in CC No.21 of 2021. FA No.277 of 2023 has been filed by the OP No.1 being aggrieved by the order dated 24.02.2023 passed in CC No.22 of 2021.
3. The facts are being extracted from FA No.276 of 2023 titled as "Edelweiss Tokio LIC Ltd. Vs. Gurpreet Singh", filed by the Appellant/OP No.1.
4. It would be apposite to mention that hereinafter the parties will be referred, as had been arrayed before the District Commission. F.A.No.276 of 2023
5. Briefly, the facts of the case as made out by the Complainant before the District Commission are that the son of the Complainant namely Sherbaj Singh had obtained policy bearing No.400272971E dated 15.03.2020 from OPs. The father of the insured i.e. Mr.Gurpreet Singh was the proposer in the said Policy. A premium for an amount of Rs.57,829/- was deposited on 16.03.2020 for the said policy. The OP No.2 had disclosed that in case of death of original policy holder, an amount of Rs.10,00,000/- would be paid by Insurance Company as per the terms and conditions of the policy. The term of policy was for 15 years. The term for payment of premium was for 12 years. The maturity date of said policy was 16.03.2032. The Insurance Company had issued the Policy Certificate after accepting premium amount. The Complainant was the nominee in said policy. Unfortunately, Sherbaj Singh son of complainant had expired on 15.06.2020. After his death, the Complainant had lodged a claim with the OPs for payment of an amount of Rs.10,00,000/-. He had submitted all the requisite documents along with original documents F.A.No.276 of 2023 4 policy certificate etc. with the OPs. However, the OPs had refused to pay any claim amount to the Complainant. Therefore, the Complaint was filed by the Complainant. He had sought the following directions to be issued to the OPs :
i. to pay an amount of Rs10,00,000/- along with interest @18% per annum;
ii. to pay an amount of Rs.20,000/- as compensation for causing mental tension and harassment; and iii. to pay an amount of Rs.11,000/- as cost of litigation
6. Upon issuance of notice OP No.1 had appeared and filed its written reply by raising certain preliminary objections that the claim of Complainant was not maintainable. It was rejected by the Insurance Company after careful scrutiny on the ground that the Complainant had obtained the said policy by impersonation. He had provided false and misleading information to the Company. The issue of impersonation in a Consumer Complaint was not maintainable. A proper remedy in such cases is by way of approaching Civil court. It was further submitted that this Commission had no jurisdiction to try the Complaint in hand. The Complainant had concealed certain material facts from the Insurance Company. The Life Assured had obtained the Policy by signing Proposal Form on the basis of which, Policy No.400272971E dated 14.3.2020 had been issued and the same was valid w.e.f. 16.03.2020.
The insurance coverage for the said policy was for an amount of Rs.10,00,000/-. The Complainant being the nominee in said policy had submitted the death claim intimation to Insurance Company on 21.09.2020. On receipt of claim intimation of Life Assured, OP Company had conducted an investigation and evaluation of the said F.A.No.276 of 2023 5 claim. The answering OP had reviewed the documents and concluded that the said policy had been obtained by impersonation by providing false information. The Life Assured had reported to have expired within three months i.e. on 15.6.2020 from the date of commencement of policy. The PAN cared was issued by tax authorities on 04.03.2020 and the policy was issued on 16.03.2021. At the time of purchase of the policy, on the PAN card a photograph of minor child was affixed. However, when the said PAN card was provided along with the Claim Form it was bearing the photograph of an adult. Besides, the said photograph of the adult on PAN card did not match with the photograph taken during the video verification done on 04.05.2020. The annual income of LA as specified in proposal was Rs.4,00,000/- per annum. However, during the course of video verification his annual salary was stated to be Rs.72,000/- per annum. Hence, OP No.1 had rejected the claim vide letter dated 22.01.2021. It is a matter of common knowledge that the insurance policy is issued on the basis of information so provided by the insured. Therefore, Life Assured was required to provide the OPs with correct details. By providing wrong/false information the insured had misled the Insurance Company. As per Section 45 of Insurance Act, 1938, the Insurance Company could have challenged the policy on the ground of fraud committed by any Insured within three years from date of commencement of the policy. In this case, the policy was issued on 16.03.2020 and Life Assured was reported to have expired on 15.06.2020 i.e. within three months from the date of commencement of the subject policy. Since, the insured had provided wrong information, accordingly, the claim of the Complainant had rightly been rejected as per the terms & conditions of F.A.No.276 of 2023 6 the policy. The other allegations mentioned in the Complaint had categorically been denied. OP No.1 had prayed for dismissal of the Complaint with costs.
7. The Complaint against OP No.2 had been withdrawn and the name of OP No.2 had been deleted from the array of parties by the District Commission vide order dated 15.07.2021.
8. By considering the averments made in the Complaint as well as in the reply thereof, the Complaint filed by the Complainant was allowed vide order dated 24.02.2023 passed by the District Commission. The relevant part of said order is reproduced as under:-
"12. In view of the aforesaid discussion, the complaint is allowed and opposite party No.1 is directed to pay Rs.10,00,000/- i.e. Guaranteed Death Benefit to the deceased, to the complainant alongwith interest @9% per annum from 22.01.2021 i.e. date of rejection of claim. The opposite party No.1 is also directed to pay Rs.15,000/- as compensation for mental agony & harassment with Rs.10,000/- as litigation expenses. This order is directed to be complied by opposite party No.1 within a period of forty five days from the date of receipt of copy of this order, failing which, opposite party No.1 will pay enhanced rate of interest @ 12% per annum on the whole awarded amount."
9. The Appellant/OP No.1 has filed the present Appeal being aggrieved by the order dated 24.02.2023 passed by the District Commission by raising a number of arguments.
10. Mr.Bhupender Singh, Advocate, learned Counsel for the Appellant/OP No.1 has submitted that the information provided in Proposal Form was material for assessment of risk of the insured. The F.A.No.276 of 2023 7 Life Assured was required to provide the correct and true details. The District Commission had failed to consider that the act of the Respondent/Complainant in obtaining the policy in the name of LA by way of impersonation was a case of Fraud, which has been played on the Appellant Company. Had the correct facts been in the knowledge of the Appellant Company, the policy would not have been issued in the name of Life Assured. The Respondent being aware of the said facts, had opted not to disclose the same, to prejudice the District Commission.
11. Learned Counsel has further submitted that the contract of Insurance is based on the foundation of utmost good faith i.e. Principle of Uberrima Fides. The deceased was under solemn obligation to supply material facts which might be relevant to the Insurer as to whether the Proposal had been be accepted or not. In case the Life Assured had failed to disclose the correct facts, then the Policy obtained would stand vitiated and the Complainant or any person lodging a claim under it is not entitled for any benefits under the said policy.
12. Learned Counsel has also submitted that while evaluating the said claim, the Appellant had reviewed the documents submitted by the Respondent/Complainant. The OPs had conducted detailed enquiry. It was concluded that the policy had been obtained by impersonation as the Life Assured had provided false and misleading information to the Appellant Company. The Policy in question was issued on 15.03.2020 and the Life Assured was reported to have F.A.No.276 of 2023 8 expired on 15.06.2020, i.e. within 3 months from the date of commencement of the subject policy.
13. The District Commission had failed to consider the discrepancies in the PAN Card submitted by the Life Assured at the time of issuance of policy and PAN Card submitted by the Claimant at the time of submission of claim. The District Commission had also failed to consider that the photograph on the PAN Card submitted with the claim intimation was not matching with the photograph taken during the video verification carried out on 04.05.2020 (i.e. after issuance of subject policy).
14. Learned Counsel has further submitted that at the time of purchase of the policy the PAN Card bearing the photograph of minor child was provided to the Appellant Company. However, the PAN Card which was provided to the Appellant along with the Claim Form was having the photograph of an adult. It was reiterated that again the photograph of the adult was not matching with the photograph taken during the video verification done on 04.05.2020. The said video verification was a part of the risk analysis process undertaken by the OPs.
15. Learned Counsel has further submitted that the annual income of the LA as specified in the proposal was Rs.4,00,000/- per annum. However, during the course of video verification, the LA had stated that his annual salary was Rs.72,000/-. Thus it was revealed in abovementioned investigation/findings, that subject policy was obtained by impersonation of LA and by providing false information to the Appellant.
F.A.No.276 of 20239
16. Learned Counsel has also submitted that as per Section 45 of the Insurance Act, 1938, the Insurance Company could have challenged the policy on the ground of fraud by the insured within a period of three years from the date of commencement of the policy. In the present case, the policy was issued on 15.03.2020 and the Life Assured was reported to have been died on 15.06.2020, i.e. within a period of 3 months from the date of commencement of the subject policy. The OP was well within its rights to reject the claim as per the terms and conditions of the policy on the ground of fraud. Learned Counsel for the Appellant has relied upon the judgment of Hon'ble National Commission in case titled as "Shalini Srivastava Vs. Aviva Life Insurance Co. Ltd. & Anr", FA No. 1295 of 2014 decided on 23.04.2024, in support of his arguments.
17. Sh.H.S.Sidhu, Advocate, learned Counsel for the Respondent/Complainant has submitted that the OP No.1 had failed to prove alleged fraud, impersonation or any false, misleading information supplied by the Respondent/Complainant before the District Commission.
18. Learned Counsel has further submitted that it is an admitted fact that as per the case of the Insurance Company, the video verification was done. It has further been stated that Section 45 of the Insurance Act, does not support the case of the Insurance Company as till date the Insurance Policy has not been cancelled.
19. Learned Counsel has also submitted that the PAN card which was bearing the photograph of a child was got prepared when the LA was minor and subsequently the photograph had been changed F.A.No.276 of 2023 10 by the Life Insurance. All the other details on the PAN were same. There was no change in any other particular of the PAN card. Moreover, with regard to video verification it was stated that at the time of purchasing the policy, the insurance agent had verified the income status of the life insured and got the same issued in favour of the son of the Complainant. The OP Company had further received a premium amount more than Rs.50,000/- which was to be paid annually. It was impossible for a person who was allegedly earning Rs.72,000/- annually had paid an amount of premium which was more than fifty thousand. No such proof had been placed on record by the Insurance Company in their written statement as well as in evidence. Learned Counsel has also submitted that the District Commission had passed a well-reasoned order and the same be upheld. He has relied upon the judgment of in case titled as "Sunil Sharma Vs. National Insurance Co. Ltd.", 2015 (2) CPJ 46 in support of his arguments.
20. We have heard the oral arguments raised by learned Counsel for the parties. We have also perused the order dated 24.02.2023 as well as all the relevant documents available on the file.
21. Facts relating to the filing of the Complaint by the Complainant before the District Commission, reply thereof, the oral arguments raised by learned Counsel for the parties and passing of impugned order dated 24.02.2023 by the District Commission, thereafter filing of present appeal before this Commission by the Appellant/OP No.1 are not in dispute.
22. Admittedly, the Insurance Policy bearing No.400272971E was issued to the son of the Complainant namely Sherbaj Singh by the F.A.No.276 of 2023 11 OP Insurance Company. Mr.Sherbaj Singh-insured had expired on 15.06.2020 i.e. within three months. Thereafter, the Complainant i.e. father of the insured had lodged the claim with OP Insurance Company and the same was rejected vide letter dated 22.01.2020 on the ground that the said policy was obtained by impersonation.
23. The issues for adjudication before us are as under:
a) As to whether the Respondent/Complainant is entitled for the claim filed by him after the death of his son Mr.Sherbaj Singh or not?
b) As to whether the Respondent/Complainant had supplied wrong and misleading to the Insurance Company or not?
24. To deal with the aforesaid issues we have carefully gone through the documents tendered by the parties i. Copy of Policy,(Ex.C-1) ii. Premium receipt, (Ex.C-2) iii. Terms and Conditions, (Ex.C-3) iv. Aadhar Card, (Ex.C-4) v. Death Certificate of Sherbaj Singh, (Ex.C-5) vi. Blank cheque, (Ex.C-7) vii. Treating Doctor Certificate (Without prejudice), (Ex.C-8) viii. Aadhar Card of Gurpreet Singh, (Ex.C-9) ix. Aadhar Card of Sherbaj Singh, (Ex.C-10) x. Death Certificate, (Ex.C-11) xi. Death claim intimation sent to the Bank, (Ex.C-12) xii. PAN Card of Gurpreet Singh, (Ex.C-14) xiii. Jamabandi, (Ex.C-15) xiv. Declaration Form (Ex.OP-1/2) xv. CKYC Annexure Form (Ex.OP-1/3) xvi. Customer Suitability Form (Ex.OP-1/4) xvii. Sales Confidential Report (Ex.OP-1/5) xviii. PAN Card of Gurpreet Singh (Ex.OP-1/6) F.A.No.276 of 2023 12 xix. Aadhar Card of Sherbaj Singh (Ex.OP-1/7) xx. Aadhar Card of Gurpreet Singh (Ex.OP-1/8)
25. We have carefully perused the copy of PAN card of the deceased Mr.Sherbaj Singh which has been annexed as Annexure 6 and 7 respectively by OP Company in its grounds of Appeal. Admittedly in Annexure A-6 the photograph on PAN card is that of Minor, whereas on Annexure A-7, the photograph on PAN card is that of an adult. Further on perusal of contents of the Appeal shows that the said card was issued on 04.03.2020. The subject policy was issued on 15.03.2020 and the Life Assured had expired on 15.06.2020 after a period of three months.
26. To deal with the aforesaid dispute regarding different photographs of the insured on PAN card i.e. as minor and as a major. Accordingly, we have dealt with the contentious issue as to whether the minor could have been issued a PAN card or not? Accordingly, we have researched the said matter on google search engine and it has been discovered that a PAN card issued to a Minor is for an individual who is under 18 years of age and Major PAN Card is for individual above 18 years of age. A PAN card can be applied for minors by the parents or guardians. Meaning thereby no minimum age is prescribed for applying for a PAN card. However, when a Minor PAN card holder becomes major (i.e. upon attaining age of 18), the same needs to be modified/updated.
27. In light of above, we have analyzed the issue involved in the present the case, it has been observed that the fact that both the F.A.No.276 of 2023 13 PAN cards (Annexure 6 and 7) bear the Photograph of a minor and adult is correct. The contention of learned Counsel for the Respondent/Complainant that the PAN card bearing the photograph of minor was got prepared when LA was minor and subsequently photograph has allegedly been changed by the life Insurance. Furthermore, all other details on the PAN card are same. However, it has not been on record by Respondent/Complainant as to when the PAN card for minor was got prepared and how the photograph on the PAN card which was subsequently submitted to OP Company got changed. Furthermore it has been observed that the PAN Card in question which has been annexed in the case file has been issued on 04.03.2020. No earlier date with respect to the preparation of PAN card is there when the deceased insured was minor has been mentioned in the case file/documents tendered by the Respondent/Complainant. In absence of any such proof as to when the PAN card of minor Sherbaj Singh was applied for by the parents and how the photograph on the document submitted with OP Company got changed, the said factual matrix cannot be verified. The said issue involves disputed question of law which cannot be adjudicated in summary trial before this Commission.
28. Furthermore, with regard to the issue of impersonation on the ground that the photographs do not match in PAN card and photograph taken during course of video verification of the deceased insured can also not be verified as the Respondent/Complainant has failed to submit any other photograph which can be compared to conclude that the photographs on the said documents submitted with F.A.No.276 of 2023 14 OPs are of the same person. This issue also involves disputed facts which cannot be tried in Consumer complaints.
29. The fact that the Respondent/Complainant had mentioned a different income i.e. Rs.4 lac in Proposal Form (Annexure A-3) and Rs.72,000/- during course of video verification by OP Company has not been substantiated by any document. In absence of any such document the authenticity of the said fact cannot be established as this too involves disputed facts.
30. The claim of the Respondent/Complainant had been repudiated (Annexure 8) on the ground of impersonation. The relevant part of the letter is reproduced below:
"Sub: Death Claim intimation dated September 22, 2020 under the life insurance Policy Number 400272971E and 4002296E ('Polices') issued on the life of Mr.Sherbaj Singh Claim Reference No.: ETLI202009214170478 and ETLI202009214170561 ('Death Claims') This is with reference to the Death Claims under the Policies intimated by you.
Please note that the investigation into the Death Claims has revealed that the Policies were obtained by impersonation of Mr.Sherbaj Singh and by providing false and misleading information to the Company.
Insurance is a contract of outmost good faith and the information provided by the Policy Holder/Life Insured in the Proposal Form and related documents is the basis of the assessment and acceptance of risk by the Company. However, in the present case the insurance cover was opted on the life of the Life Insured named in the Policy by impersonation and by providing false and misleading information to the Company. Thus, without prejudice to our rights to initiate appropriate legal action against you, we are unable to register the Death Claims under the Policies and the same stands rejected.
Therefore, the Policies being void ab-initio we are not liable to pay any claim under the said Policies and all monies that have been received by the Company under the Policies stands forfeited."F.A.No.276 of 2023 15
31. All the aforesaid contentious issues mentioned in the preceding paragraphs involve to disputed question of law which require elaborate evidence/cross-examination/re-examination of the witnesses and expert witness to settle the controversy involved in the case. As such the adjudication of the said issues is not within the ambit of CP Act.
32. The Apex Court has held in case titled as "Oriental Insurance Company Ltd. versus Munimahesh Patel reported in 2006(4) CivCC 203" that proceedings before Commission are essentially summary in nature and issue which involves disputed factual questions should not be adjudicated by the Commission. We find that complex factual matrix in the case in hand requires that the matter should be examined by an appropriate court of law in regular proceedings and not in summary manner by this Commission.
33. Hon'ble National Commission has also held in "M/s Singhal Swaroop Ispat Ltd. versus United Commercial Bank"
reported in 1992(3) CPJ 50 that where the allegations of fraud has been raised by the parties against one another requiring elaborate oral or documentary evidence, the matter be relegated to civil court for adjudication.
34. In view of the above, since there are allegations of fraud, impersonation and misrepresentation of facts, which require elaborate cross examination of witness and documentary evidence, the same cannot be decided in summary trial. Such allegations can be decided F.A.No.276 of 2023 16 by the Civil Court. We are of the view that facts involved in the case in hand are of complex in nature and they cannot be adjudicated in a summary manner before this Commission.
35. In light of above mentioned facts, reasons and observations, the present Appeal is allowed and the order dated 24.02.2023 passed by the District Commission is is set aside. The Complaint is disposed off. However, a liberty is granted to the Respondent/Complainant to approach the appropriate Fora/Court for redressal of his grievance/claim.
36. The Appellant had deposited an amount Rs.6,10,883.56 at the time of filing the appeal with this Commission. The said amount, along with interest which has accrued thereon, if any, shall be remitted by the Registry to the Appellant by way of a crossed cheque/demand draft after the expiry of limitation period in accordance with law. First Appeal No.277 of 2023
37. This Appeal has been filed by the Appellant/OP No.1 for setting aside the order dated 24.02.2023 passed by the District Commission. The issues involved in this case are also the same as in FA No.276 of 2023. Accordingly, this Appeal is also allowed in the same terms as passed in FA No.276 of 2023 and the order dated 24.02.2023 passed by the District Commission is set aside with the aforesaid liberty to the Respondent/Complainant.
38. The Appellant had deposited an amount Rs.4,09,292.33 at the time of filing the appeal with this Commission. The said amount, along with interest which has accrued thereon, if any, shall be remitted F.A.No.276 of 2023 17 by the Registry to the Appellant by way of a crossed cheque/demand draft after the expiry of limitation period in accordance with law.
39. Since the main cases have been disposed off, so all the pending miscellaneous applications, if any, are accordingly, disposed off.
40. The Appeals could not be decided within the statutory period due to heavy pendency of court cases.
(JUSTICE DAYA CHAUDHARY) PRESIDENT (SIMARJOT KAUR) MEMBER (VISHAV KANT GARG) MEMBER November 26, 2024 (Rupinder 2)