State Consumer Disputes Redressal Commission
Aviva Life Insurance Company India ... vs Balveer Singh on 15 October, 2020
FIRST ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH.
First Appeal No.96 of 2019
Date of Institution: 06.08.2019
Order reserved on: 11.09.2020
Date of Decision : 15.10.2020
1. Aviva Life Insurance Company India Limited, having its Head
Office at Aviva Tower Sector Road, Opposite Golf Course, DLF
Phase V, Sector 42, Gurgaon, Haryana, through its Chairman,
Managing Director, Principal Office Service.
2. Aviva Life Insurance Company India Limited, having its
registered office at 2nd floor, Prakashdeep Building, 7 Tolstoy
Marg, New Delhi, through its Managing Director, Chairman
.....Appellants/Opposite Party nos.1&2
Versus
Balveer Singh aged 52 years son of Kasam, resident of Village Killi,
Jhok Tehal Singh, Tehsil and District Ferozepur, Mobile No.73476-
95015.
.....Respondent/Complainant
First Appeal against order dated
20.12.2018 passed by District Forum,
Ferozepur.
Quorum:-
Mr. Rajinder Kumar Goyal, Presiding Member.
Ms. Kiran Sibal, Member.
Present:-
For the appellants : Sh. Ranjeesh Malhotra, Advocate For the respondent : Sh. P. K. Bansal, Advocate ..................................................................................First Appeal No.96 of 2019 2
KIRAN SIBAL, MEMBER:-
This appeal has been preferred by the appellants against order dated 20.12.2018 passed by District Consumer Disputes Redressal Forum, Ferozepur (in short now, "the District Commission"), whereby the complaint filed by respondent/complainant was accepted and opposite parties (in short "OPs") were directed to pay Rs.9,30,000/- as insurance claim along with interest at the rate of 9% per annum from the date of filing of complaint till realization. The opposite parties are further directed to pay a sum of Rs.5000/- as consolidated compensation for mental agony, pain and harassment as well as litigation expenses to the complainant/respondent. It would be apposite to mention that hereinafter the parties will be referred, as have been arrayed before the District Forum.
Facts of the Complaint
2. Brief facts, as averred in the complaint, are that the deceased Jagseer Singh son of the complainant got his life insured from OP no.1. OPs issued policy No.10154315 to Jagseer Singh since deceased. Deceased Jagseer Singh had nominated the complainant i.e. his father in his life insurance policy as nominee. During the currency of life insurance policy, the Jagseer Singh died on 09.08.2014. Complainant intimated the OPs about the death of Jagseer Singh insured. The representative of OPs visited the house First Appeal No.96 of 2019 3 of the complainant and he submitted all the required documents to the representative. The representative of OPs assured him that the claim would be settled at the earliest and the documents would be returned. Thereafter, the complainant received a letter dated 24.06.2016 stating that the amount paid by the deceased son as premium has been refunded and deposited in the account of the complainant. The complainant inquired about the same from OPs and it was told him by the officials that his insurance claim had been repudiated by OPs. The complainant alleged deficiency in service and unfair trade practice on the part of OPs. The complainant prayed that OPs be directed to settle the insurance claim and to pay all the insured amount with interest alongwith benefits from the date of lodging of claim till its realization; to pay Rs.1,00,000/- as compensation for mental agony, pain and harassment; and to pay Rs.15,000/- as litigation expenses.
Defence of the Opposite Party
3. Upon notice, OPs appeared and filed their joint written raising preliminary objections that the complaint was barred by limitation as the complainant's claim had already been repudiated by the OPs on 09.02.2015. The Forum had no territorial jurisdiction being the policy purchased from Amritsar Branch office of OPs and the complainant lodged the claim under the policy at Gurgaon. The complainant suppressed the material facts of his income and occupation of the Life Assured before purchasing the policy. The First Appeal No.96 of 2019 4 policy was issued on 22.07.2014 and the life assured had expired on 09.08.2014 just within 18 days. The policy had continued for a period of 18 days since its issuance. After investigation, it was revealed that the life assured concealed the status of his income and occupation. The complaint was contested by OPs even on merits. It was averred that deceased life assured (DLA) purchased policy from the OP for a sum assured Rs.9,30,000/-. DLA opted the Dhan Samridhhi Plan, Basic half yearly Premium Rs.30,212/- of total sum assured amount of Rs.9,30,000/-. After receiving the claim, OPs conducted the enquiry to finalize the claim under the policy being the early claim. After going through the entire facts, OPs found that the deceased life assured concealed the facts regarding his income Rs.2,00,000/- PA and occupation, whereas he was a poor person, hence the OPs repudiated the claim of the complainant on 09.02.2015. OPs denied any deficiency in service and unfair trade practice on their part and prayed for dismissal of the complaint.
Evidence of the parties and finding of the District Forum
4. In support of his case, the complainant tendered in evidence affidavit and documents Ex.C-1 to Ex.C-11.
5. To rebut the aforesaid evidence, OP tendered in evidence affidavit and document Ex.OP-1 and Ex.OP-2
6. The District Forum, after going through the record and hearing learned counsel on their behalf, allowed the complaint, vide impugned order. Hence, this appeal.
First Appeal No.96 of 2019 5Contentions of the Parties
7. We have heard learned counsel for the parties and have carefully gone through the record of the case.
8. Learned counsel for the appellants vehemently contended that the DLA applied for Dhan Samridhi Plan and filled up the proposal form. On the basis of information furnished by him, policy was issued to him with a sum assured of Rs.9,30,000/-.The DLA stated that his income was Rs.2,00,000/- per annum, but later the same was found to be false. Had the DLA disclosed his income correctly the proposal would not have been accepted. The DLA died within 18 days of taking the policy. After investigation it was found that DLA concealed the status i.e. income and occupation and had taken the policy fraudulently. The District Commission has failed to appreciate the facts that DLA did not disclose the material fact regarding his income and occupation in the proposal forms. The complainant sent a request letter for review the claim. The same was reviewed the declined. It was found that no such company by the name of Kamboj Fruit Company existed that had issued the form J. There was one shop by the name of "M/s Sher Singh Kamboj & Co.", but the owner of the shop denied any knowledge about the Kamboj Fruit Company Shop (Annxure A5 and A6 colly). The District Commission has overlooked the fact that the policy in question was taken by fraud and misrepresentation and as per condition no.14 and 16 of the policy, nothing is payable to the respondent. The District First Appeal No.96 of 2019 6 Commission also failed to take into consideration the fact that complaint was barred by limitation. The claim was repudiated on 09.02.2015, the cause of action was arisen on 09.02.2015, the complaint had been filed on 20.07.2017 i.e. after the expiry of the limitation period. The District Commission had not territorial jurisdiction to adjudicate the matter, as the appellants did not have any office in the jurisdiction of the District Commission Ferozepur. Learned counsel for appellants prayed for setting aside the order of the District Commission.
9. Learned counsel for respondent strongly contended that cause of action accrued to the complainant firstly on 24.06.2016 when he received a letter of OP stating the return of premium, which had been paid by the DLA. The cause of action had arisen at Ferozepur as firstly the adviser of OPs represented the details of policy to the policyholder at Ferozepur, the DLA died at Ferozepur and the letter dated 24.06.2016 rejecting the claim was sent at Ferozepur. The OPs had wrongly and illegally repudiated the claim of complainant. The findings of the District Forum are factually cored and no interference is required in it. The OPs had not placed on record the affidavit of investigator who conducted the investigation nor filed the certified copy of the report. Secondly the report mentioned that people had confirmed that DLA was a private student and a labourer, but it is conspicuous by its silence with regard to the name, address or identity etc. from whom the investigator had made First Appeal No.96 of 2019 7 enquiries. Thirdly, the investigator reported that DLA had expired on 06.07.2014 and he had taken the photographs of the death register of the Anganwari Worker, but no photograph has been produced on record. As per the death register of ANM, the DLA had expired on 09.08.2014. Also the death certificate proves that DLA expired on 09.08.2014. Also as per the certificate of Doctor, the DLA had expired on 09.08.2014. The investigator appointed by the insurance company is not an independent investigator. It cannot be expected that the investigator appointed by the insurance company will not give biased report. No opportunity was ever granted to representatives of DLA to present their version and evidence by the investigator. There was no such pleading before the District Forum that owner of M/s Sher Singh Kamboj & Company denied the knowledge about the Kamboj Fruit Company shop. The investigator also had not mentioned in his investigation report that there exists no Kamboj Fruit Company. No statement of owner of M/s Sher Singh Kamboj & Company has been placed on the record. The OPs merely claimed that repudiation letter was sent, however no proof of sending the repudiation letter has been intentionally placed on record by them. It would be apparent from the various documents of the OPs that documents were antedated by the OPs only to make evidence to show that the claim was time barred. In this regard reference can be made to alleged rejection of review committee which has been dated as 31.03.2014, whereas the DLA expired on 09.08.2014. Not First Appeal No.96 of 2019 8 only the above said document but also reference can be made to letter allegedly sent on 23.01.2014, by which the insurance company had demanded some documents from the complainant, whereas the deceased had expired on 09.08.2014. Similarly, viewing the page no.145, 147 and 161 of the District Commission the manner of working of the OPs can be ascertained. Learned counsel for respondent prayed for dismissal of the appeal.
Consideration of Contentions
10. We have given thoughtful consideration to the contentions raised by the learned counsel for the parties and have also gone through the record of the case.
11. It is admitted facts of the case that DLA purchased the policy in question. After the death of DLA, complainant, being nominee lodged the claim with OPs for its payment. Appellants/OPs contended that they repudiated the claim on the ground that DLA mentioned the wrong facts about his income and occupation at the time of filling up the proposal form. The onus is on the appellants to prove that DLA had wrongly stated the facts in the proposal form. We have perused the record of the case and find no single evidence, which proves that DLA had given the wrong information in the proposal form. There no affidavit of investigator and statement of other witnesses, who recorded their statements with investigator that the DLA had given the wrong information in the proposal form at the First Appeal No.96 of 2019 9 time of taking the policy. Para number 7 of the impugned order is reproduced as under:
"7. It is the admitted case of the parties that deceased Jagseer Singh son of the complainant purchased life insurance policy bearing after paying requisite premium for sum assured of Rs.9,30,000/-. It is also the admitted case of the parties that the complainant is nominee of the above said insurance policy. The reason for withholding the insured amount i.e. Rs.9,30,000/- by the insurance company due to mis- representation of the fact of income and occupation. But the opposite parties have not pleaded in what regard the complainant has misrepresentation regarding the occupation or income of deceased Jagseer Singh. They have not produced on record any evidence or any documents in support of their allegation that Jagseer Singh made any mis-representation regarding his income and occupation. The opposite party is wrongly and illegally retaining the amount on the false ground. The opposite party is guilty of rendering deficient services to the complainant. The opposite party is also liable to pay litigation expenses to the complainant."
In view of above and in absence of any documentary evidence in support of this contention, we reject the same.
12. Learned counsel for appellants/OPs further contended that District Commission Ferozepur had no territorial jurisdiction to try the complaint. The OPs mentioned the address of DLA on the policy documents of Ferozepur i.e. Village Killi, 263, Jhok Tehal Singh, Ferozepur and sent the policy documents on the same address and also the repudiation letter dated Ex.C-6 on the same First Appeal No.96 of 2019 10 address. Moreover, the representative of OPs approached the DLA at Ferozepur alluring the DLA for purchasing the policy. In view of this, the District Commission Ferozepur rightly decided the complainant. Finding no force in this contention, we reject the same.
13. Learned counsel for appellants further contended that the complaint was time barred by limitation, as the claim was repudiated on 09.02.2015. The appellants/OPs have not produced on record any documentary evidence i.e. postal receipt that they dispatched the letter dated 09.02.2015 to the complainant. It is also pertinent to mention that OPs after considering the claim of the complainant, refunded the amount of Rs.32,093/- only vide letter dated 24.06.2016. Hence, the complainant filed the complaint within limitation. There is no force in this contention of OPs and we reject the same.
14. As a result of our above, we are of the view that there is no flaw in the order of the District Commission Ferozepur. There is no merit in the appeal and the same is hereby dismissed.
15. The appellants/OPs had deposited a sum of Rs.25,000/- at the time of filing of the appeal and further deposited the amount of Rs.7,93,373/- in compliance with order of this Commission. These amounts along with interest, which has accrued thereon, if any, be remitted by the registry to the District Commission Ferozepur forthwith. The complainant/respondent may approach the District Commission for the release of the above amount and the District First Appeal No.96 of 2019 11 Commission may pass the appropriate order in this regard after the expiry of limitation period in accordance with law.
16. The appeal could not be decided within the statutory period due to heavy pendency of work and less staff.
(RAJINDER KUMAR GOYAL) PRESIDING MEMBER (KIRAN SIBAL) MEMBER October 15, 2020.
(MM)