State Consumer Disputes Redressal Commission
Bhavnaben P Solanki vs Hdfc Life Ins Co Ltd on 31 March, 2023
Details DD MM YY
Date of disposal 31 03 2023
Date of filing 17 10 2014
Duration 14 05 08
BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION
GUJARAT STATE AHMEDABAD.
COURT NO: 04
Complaint No.247 of 2014
1. BHAVNABEN P SOLANKI
Add:- 140-2, LAXMIPURA, PETA
PARU, CHATURPURA-KODRALI, TA
DEHGAM GUJARAT-3820305 ....Complainant
V/S
2. HDFC LIFE INSURANCE CO. Ltd
Add: 1st Floor, Prayosha,
81, Jagabhai Park Opp New
Swaminarayan Mandir,
Maninagar, Ahmedabad -380 008
3. HDFC LIFE INSURANCE CO. LTD.
Add: Ramon House, H T Parekh
Marg 169, Backbay Reclamation,
Churchgate, Mumbai - 400 ....Opponents
BEFORE: Dr. J. G. Mecwan, Presiding Member.
APPERANCE: Mr. V M Pancholi, L.A. for the Appellant,
Mr. P.R. Jani, L.A. for the Respondent no 1 & 2
ORDER BY DR. J. G. MECWAN, PRESIDING MEMBER
JUDGMENT
1. The facts giving rise to the present Complaint are as set out herein under 1.1 It is the case of complainant that the Complainant's Husband Mr. Prahladsinh Solanki had applied for the life insurance coverage by filling the proposal form of opponent insurance company and after careful consideration of all the papers submitted with proposal form and through medical check-up of the life to be assured Mr. Prahaladsinh, the RUTVIK C.C.-247-14 Page 1 of 15 opponent insurance company has issued life insurance policy bearing no.16349813 on 30/11/2013 for the face value of Rs.25,00,000/. It is the submission of complainant that under policy terms and condition of the policy the opponents have assured to pay Rs.25,00,000/- to the complainant being nominee upon happening of an unfortunate event of death of his life insured husband.
1.2 It is the further case of complainant that complainant's husband was died on 01-02-2014 due to diarrhea and dehydration and opposite party was intimated about the sad demise of life assured and complainant has submitted the claim form with all the requisite documents. Thereafter the investigator appointed by the opponent insurance company has visited the complainant's residence and demanded documents which were provided to investigator. It is further submission of complainant that after few visits the investigator has stated that investigator has evidences issued by 'Asha Worker' to show that the life assured was died due to suicide prior to issuance of the policy and if complainant wish that this evidences will not be handed over to the company then she has to pay Rs. 3,00,000/- to investigator and it was also asked that Rs.50,000/- is required to be paid as an advance and the balance amount to be paid after getting the claim amount but complainant has refused to pay the any amount stating that her husband was died on 01/02/2014 due to dehydration and not prior to 01-02-2014. Thereafter complainant has requested to opponent insurance company to pay genuine claim. It is RUTVIK C.C.-247-14 Page 2 of 15 further case of complainant that investigator has also threatened the complainant that he will furnish evidences to the opponent company and complainant will not be able to get any amount from the opponent however, Complainant has refused to pay any amount as complainant's husband was died on 01- 02-2014.
1.3 It is the further case of complainant that opponent insurance company had rejected the claim vide their letter dated 02/06/2014 stating that the policy was issued on the life of a dead person, death date being September 09, 2013 i.e. prior to the date of policy issuance November 30, 2013.
1.4 It is the submission of complainant that complainant has inquired with 'Asha Worker' Ms. Ashaben Solanki about what type of evidences she had handed over to the investigator of the opponent insurance company but Asha Worker has informed complainant that she heard that the husband of the complainant has committed suicide on 09/09/2013 by jumping into the canal and therefore the entry was made. The complainant has asked her that on what basis she had made such entry and provided to the investigator, she had replied that some people of the village had informed her that the husband of the complainant has committed suicide therefore she had made entry but when Mr. Mansinh Ambalal Solanki had came to register the death of Mr. Prahladsinh she came to know about real facts that on 09/09/2013 Mr. Prahladsinh has quarrel with her wife and in angry state of mind her husband had RUTVIK C.C.-247-14 Page 3 of 15 jumped in to the canal but he was not died on that date but on the basis of rumor the entry was made by her. It is submitted that the 'Asha worker' had apologized and asked complainant that in what manner she can help her, the complainant has requested her to make affidavit in this regards and then the Asha Worker Ms. Ashaben Solanki had made affidavit stating the truth about making entry of death on 09/09/2013 with mistake. It is further submission of complainant that opponent was informed the mistake committed by the Asha Worker but opponents have not considered the representation made by the complainant. 1.5 It is the case of complainant that opponent is not able to establish that no complaint with the concern police station was lodged or police has not made any entry about the so called unnatural death (suicide) by the life assured on 09-09- 2013. Opponent is not able to establish the authenticity of the certificate issued by Asha Worker without any authentic supporting documents. If opponents are sure that opponent have issued the policy after the death of the life assured, opponents must have to initiate legal action including filing of FIR against all the responsible person including complainant as well as officer of the opponents but opponents have not done any legal procedure to conclude that life assured was died before the issuance of the policy. It has been further stated by complainant that the above act of the opponent is nothing but deficiency of service, negligence and unfair trade practice hence, the present complaint has been filed get Rs. 25,00,000/- with RUTVIK C.C.-247-14 Page 4 of 15 12% interest from the date of repudiation of the claim and also to get Rs. 50,000 as compensation for mental torture and also Rs.25,000 for the cost of litigation.
2. In this complaint complainant has submitted following Documents:-
(I) Copy of repudiation latter dtd. 2.6.14
(II) Copy of affidavit of Ashaben Solanki
(III) Copy of affidavit of Bhavnaben Solanki
(IV) Copy of Policy Document
(V) Copy of statement death claim
2.1 In this complaint opponent party has also submitted following
Documents:-
1. Copy of electronic proposal form dated 07-10-2013
2. Copy of language declaration form
3. Copy of Addendum to electronic proposal form dated 09-10-2013
4. Copy of Most Important document
5. Copy of Agriculture Questionaire
6. Copy of School leaving certificate of Prahladbhai
7. Copy of Insurance Policy bearing no.16349813
8. Copy of Claim form given by nominee received on 01-04-2014
9. Copy of school leaving certificate of complainant
10. Copy of bank account details of complainant
11. Copy of APL-1 Ration card of Prahladbhai Solanki, complainant and their family members
12. Copy of Investigation report of Yuva Consultancy
13. Copy of certified copy of reply from medical officer, PHC, Bahiyal to the investigator under RTI,21-04-2014
14. Copy of certified copy of letter of Female Health Worker (FHW)N.A. Thakker to the medical officer, Bahiyal PHC dated 12-04-2014
15. Copy of certified copy of extract of death register bearing entry no.3/5 dated 11-09-2013 about death of Solanki PrahladsinhMansinh on 09-09- 2013
16. Copy of Affidavit of investigator in support of his investigation report
17. Copy of Form No.7 of agricultural land of old Survey no.221 of Moje Kodrali Ta. Dehgam admeasuring 23902 sq. mtrs
18. Copy of Form no.7 of new Survey no.296 of Moje Kodrali Ta. Dehgam admeasuring 244402 sq.mtrs
19. Copy of Form no.12 of new survey No.296 of Moje Kodrali Ta. Dehgam admeasuring 24402 sq.mtrs
20. Copy of Form no.8A of Survey No. 296 khata no.262 of Moje KodraliTa.Dehgam admeasuring 24402 sq.mtrs
21. Copy of mutation entry no.885 dated 18-05-2008
22. Copy of mutation entry no.923 dated 04-05-2009
23. Copy of mutation entry no.793 dated 27-04-2005
24. Copy of newspaper extract of Divya Bhaskar daily dated 23-03-2016
25. Copy of news paper of Sandesh News Paper dated 24-03-2014 RUTVIK C.C.-247-14 Page 5 of 15
26. Copy of repudiation latter dated 02-06-2014
3. In this case opponent has submitted written statement which is on record from page, 36-50. Complainant has also filled rejoinder affidavit which is on record from 106-114.
4. Argument of Complainant:
4.1 Ld. Adv. Mr. V M Pancholi for the complainant argued out that opponent has issued the life insurance policy after due verification. Opponent is not able to establish that no complaint with the concern police station was lodged or police has not made any entry about the so called unnatural death (suicide) by the life assured on 09-09-2013. Opponent is not able to establish the authenticity of the certificate issued by Asha Worker without any authentic supporting documents. If opponents are sure that opponent have issued the policy after the death of the life assured, opponents must have to initiate legal action including filing of FIR against all the responsible person including complainant and against the officer of the opponents but opponents have not done any legal procedure to conclude that life assured was died before the issuance of the policy.
4.2 Ld. Adv. Mr. V.M. Pancholi for the complainant further argued out that opponent insurance company has repudiated the claim of the complainant on the basis of wrong information and only with a view to avoid the liability under the policy. The above act on the part of opponent is nothing but deficiency in service as well as unfair trade practice as RUTVIK C.C.-247-14 Page 6 of 15 defined under the Consumer Protection Act and therefore complainant is entitle to get Rs.25,00,000/- with 12% interest from the date of repudiation of the claim and also to get Rs. 50,000 as compensation for mental torture and also Rs.25,000 for the cost of litigation.
5. Argument of Opponent:
5.1 Ld. Adv. for the opponent Insurance Company Argued out that the death register kept in Primary Health centre is a Government record about birth and death of persons and the entry at serial no.3/5 shows "Prahladsinh Mansinh Solanki -date of registration of death 11/09/13, Date of Death 09/09/13 cause of death Suicide". In this entry, date of death has been deleted and written 1/2/14. and in last column it has been endorsed that it is obtained from death certificate issued by Talati. 5.2 Ld. Adv. for the opponent insurance company further argued out that in this regard it is respectfully submitted that death certificate issued by Talati is not a conclusive proof. Because as per Section 15 of Registration of Births and Deaths Act, 1969 there is specific provision about correction or cancellation of entry in the register of births and deaths. 5.3 Ld. Adv. for the opponent insurance company further argued out that female Health worker Ms. N.A. Thakker of the village has corrected the date as per certificate of Talati of village gram panchayat. Health worker, a government employee correcting/altering her record after it had been recorded and issuing a letter about the alteration is highly improper and raises serious doubts on the alteration in the record. The death register RUTVIK C.C.-247-14 Page 7 of 15 being a legal document it is the District Health officer who is authorized to validate any correction in the death register and not the health worker. 5.4 It is further submission of the Ld. Adv. for the opponent insurance company that it is respectfully submitted that Hon'ble Commission is competent to find out the truth and do the Justice. But in view of the fact that policy holder had jumped in canal; and committed suicide on 09/09/2013 i.e. before the date of proposal that there is a registration of death of policy holder on 11/09/2013 in Primary Health Centre, wherein as per legal provision, such entry of death of a person is made in Health Centre only if the person has been brought to the Health centre and also affer the Medical officer of the Health Centre, certifies cause of death of such a person and not orally. Also in view of the facts that opponent has produced copy of reply received under RTI which confirms the date of death of policy holder on 09/09/2013 along with duly signed and stamped letter of FHW and extracts of death register which is duly stamped and signed by the medical officer. Bahiyal, and in view of the facts that there are two different and contradictory entries about date of death of policy holder, there are documents showing different dates of death of policy holder, there are suspicious issues and doubtful circumstances like village health worker tampering the death register and issuing letter stating in the form of note that the alterations have been made about date of death. In view of serious allegations of fraud and fabrication of documents, and other complicated issues of facts and RUTVIK C.C.-247-14 Page 8 of 15 law, the documents produced by both the parties are also required to be authenticated and verified by proper scrutiny process would involve a massive exercise to be done by a full fledged Court and police and therefore in view of above facts, the present complaint is not maintainable under summary trial by the Hon'ble Commission.
6. Merit of the Case:
I have carefully gone through the record of the case the Insurance Company has repudiated the claim on 2.6.2014 wherein it is stated as under:
This has reference to the death claim under the above mentioned Policy on the life of (Late) Mr.Prahladbhai Solanki.
The policy was issued on the basis of an proposal of (Late) Mr.Prahladbhai Solanki dated October 07, 2013 to HDFC Standard Life Insurance Co. Ltd. (herein after referred to as "the Company") for purchase of HDFCSL HDFC LIFE CLICK 2 PROTECT Policy No. 16349813 for a sum assured of Rs. 25,000,00/- towards death benefits.
This case was accepted at standard rates based on the information provided in the Proposal Form and the Policy was issued November 30, 2013.
On April 01, 2014 we have received a duly signed intimation from you confirming the death of Mr. Prahladbhai Solanki on February 01, 2014 In your "Statement" - Death claim dated April 01, 2014 you had made a declaration that the statement made in the said form is true in each & every Aspect".
However our investigation has established that the Policy was issued on the life of a dead person, death date being September 09, 2013 i.e. prior to the date of Policy issuance November 30, 2013. We hold indisputable proof to show that the death of Life Assured Mr. Prahladbhai Solanki had taken place on September 09, 2013 and not on February 01, 2014 as conveyed in your death intimation letter.
6.1 In the instant case it is an averment of opponent insurance company that DLA died on 9/9/2013 before the date of proposal i.e. 7/10/2013.
Insurance co. has appointed investigator. Report of Yuva Consultancy is RUTVIK C.C.-247-14 Page 9 of 15 submitted in this matter which is on record at page 82-88 wherein following has been shown.
Discreet Checks During our checks in the locality we came to know that LA had died 11/2 years back by committing suicide. He had jumped in Narmada Canal and died due to drowning, Insured had a quarrel with his father and he was slapped by his father and lastly he went to the Narmada River Canal and jumped off, In this regards we visited Firstly Kodrall Gram Panchayat and verified the Death Certificate of LA. As per the records LA's Date of death is 01.02.2014, The Sarpanch has provided us with a certificate confirming that LA had died due to sudden chest pain on 01.02.2014. There is a fair amount of involvement of the Sarpanch and the Talati of the village in setting the case and manipulating the records and hiding the real date and cause of death of LA.
Later on we visited Bahiyal PHC and met the Ashaworker of the village, she checked the records and confirmed that LA had died on 09.09.2013 due to drowning.
We have asked for the extract to the death register maintained by the PHC, Bahlyal, but the asha worker denied providing it. She asked us to apply at Bahiyal PHC and she would be sharing the records with the PHC MO. We visited the Bahiyal PHC and discussed the case with the Medical officer and he checked the records and confirmed that real date of death and assured that he would be providing us with the certificate. We have applied an RTI at the Bahiyal PHC and the revert is expected within a weeks' time.
We then visited Dahegam Police Station and checked with the station Incharge regarding the reporting of such suicide case to them from Kodrall Village. The incharge 'checked his records and confirmed that no such case has been reported to them.
We then called up 108 ambulance service and inquired with them if they had ever attended any such patient on 09.09.2013, but their records feature no such death,.
From the records on hand it's proved that LA had died by committing suicide and hence the suicide clause is applicable.
Insured's Past Health Details During our checks we came to know that LA was not found to be suffering from any major Illness. We have not across any history of TB. Records of Chandarni PHC were checked but no history of TB or HIV noted. But it was quite evident from the surveys carried out that LA was chronic alcoholic person. The entire village was of the opinion that LA was heavily addicted to consumption of alcohol.
We have not come across any reason as to why LA had committed suicide. RUTVIK C.C.-247-14 Page 10 of 15
Sequence of LA's Death As per our investigation findings, LA had fight with his father and he was slapped by his father. In anger he went to the Narmada canal near the village and jumped from the bridge and committed suicide. LA had died due to drowing on 09.09.2013 Observations & Conclusions
1. LA was a farmer by occupation
2. LA was earning around Rs.1 Lac pa
3. LA was holding APL-1 Ration Card
4. LA was chronic alcoholic person
5. Due to some family dispute and quarrel LA had committed suicide on 09.09.2013
6. The insured had committed suicide and the same is established from the PHC Register
7. The death was not reported to the Police
8. No Post Mortem was done in the case.
6.2 During the course of investigation investigator has gathered following information through RTI Act:
(A) Latter dated 21.4.2014 of medical officer PHC Bahiyal Taluko Dehgam is on record at page no. 89 wherein it has been mentioned by medical officer that as per death certificate date of death of DLA is 1.2.2014 where as the FHW registered it's 9.9.2013 (B) Latter dated 12.4.2014 of medical officer PHC Bahiyal wherein it has been shown that DLA died on 9.9.2013 (Suicide by jumping in canal) and his death is register in the registered of birth and death on 11.9.2013.
Furthermore the copy of death register is also on record at page no.91 wherein it has been shown that DLA died on 9.9.2013 due to suicide but said date of death is corrected and written 1.2.2014 on the basis of Gram sevak (Talati) certificate.
In support of above investigation, Mr. Viren Ghamande of Yuva Consultancy has filled affidavit which is on record at page no. 92 6.3 Looking to the above investigation report following information is come out in this case I. DLA had committed suicide on 9.9.2013 II. Policy was taken on 30.11.2013 III. As per complainant her husband died on 1.2.2014 IV. In birth and death register of PHC date of death of DLA is 9.9.2013 which has been deleted and written as 1.2.2014 RUTVIK C.C.-247-14 Page 11 of 15 6.4 In this matter as per record of birth and death register entry at serial no.
3/5 shows name of Prahladsinh Mannu Solanki (DLA) and the said entry of date of death is 09.09.2013 and it has been deleted and written/corrected as 1.2.2014. Furthermore in last column it is an endorsement that correction is made as per death certificate issued by talati.
6.5 Ld. Adv. for the insurance company has drawn attention of this commission to the section 8 and 15 of register of birth and death act 1969 which is reproduced below Section-8: Persons required to register births and deaths:-
(1) It shall be the duty of the persons specified below to give or cause to be given, either orally or in writing, according to the best of their knowledge and belief, within such time as may be prescribed, information to the registrar of the several particulars required to be entered in the forms prescribed by the state Government under sub-section (I) 16-
(b) in respect of births and deaths in a hospital, health centre, maternity home or or other like institution, the medical officer in charge or any person authorized by him in this behalf.
Section-15 Registration of Birth and Deaths Act, 1969 "If it is proved to the satisfaction of the Registrar that any entry of a birth or death in any register kept by him under this Act is erroneous in form or substance, or has been fraudulently or improperly made, he may, subject to such rules as may be made by the State Government with respect to the conditions on which and the circumstances in which such entries may be corrected or cancelled, correct the error or cancel the entry by suitable entry in the margin, without any alteration of the original entry and shall sign the marginal entry and add thereto the date of the correction or cancellation."
Looking to the above provision it is crystal clear that DHO is authorized a validation and correctness in death register but not a health worker. RUTVIK C.C.-247-14 Page 12 of 15 6.6 In this case, entry has been made in the register of PHC and as per legal provision such entry of death of person is made in health center only if the person has been brought to the health center and after the physical verification by concerned medical officer. Reply under RTI act confirms that date of death of DLA is 9.9.2013 which was signed by FHW while extract of death register which is duly stamped and signed by medical officer bahiyal showing corrected date of death of DLA that is 01/02/2014. Thus there are two different and contradictory entries about date of death of policy holder (DLA).
Furthermore in this case there are some allegation and counter allegation about fraud fabrication of documents by both party against each other and to arrive at the truth, cross examination of many people involved in issuing of the policy/death certificate etc need to be done. Further the documents produced by both the party are also required to be authenticated and verified by proper scrutiny process would involved a massive examination to be done by full fledge court. Hon'ble Supreme Court in Oriental Insurance vs. Munni Mahesh Patel held as under:
The Commission noted that the specific stand of the appellant was that there was mis-declaration in the proposal form and the false claim that the respondent's wife was a teacher which as now appears is not the correct position. It also accepted that she was really not a teacher. Proceedings before the Commission are essentially summary in nature and adjudication of issues which involve disputed factual questions should not be adjudicated. It is to be noted that Commission accepted that insured was not a teacher. Complainant raised RUTVIK C.C.-247-14 Page 13 of 15 dispute about genuineness of the documents (i.e. proposal forms) produced by the appellant.
The Commission having accepted that there was wrong declaration of the nature of occupation of the person insured, should not have granted the relief in the manner done.
The nature of the proceedings before the Commission as noted above, are essentially in summary nature. The factual position was required to be established by documents. Commission was required to examine whether in view of the disputed facts it would exercise the jurisdiction. The State Commission was right in its view that the complex factual position requires that the matter should be examined by an appropriate Court of Law and not by the Commission.
In the light of above observation of Hon'ble Supreme Court Consumer Commission being a quasi judicial body does not have the machinery and power to adjudicate complex question of fact and therefore in the opinion of this commission present complaint is not maintainable in this commission as it involves complex question of facts which require ELABORATE overall document evidence and such question cannot be adjudicate under summary trial by this State Commission under Consumer Protection Act and hence following order is passed.
ORDER
1. The Present Complaint No. 247/2014 is dismissed as not maintainable under the Consumer Protection Act-1986
2. As complaint is not maintainable in this Commission and therefore complainant is entitled to redress before a court of competent jurisdiction subject to provision of Limitation Act
3. No Order as to cost RUTVIK C.C.-247-14 Page 14 of 15
4. Office is directed to forward a free of cost certified copy of this judgement and order to the respective parties.
Pronounced in the open court today on 31st March 2023 [Dr. J.G. Mecwan] Presiding Member.
RUTVIK C.C.-247-14 Page 15 of 15