State Consumer Disputes Redressal Commission
Smt Pinki Jain vs Met Life Insurence Company on 10 November, 2023
BEFORE THE RAJASTHAN STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, CIRCUIT BENCH, JODHPUR
COMPLAINT CASE NO: 14/2012
Smt. Pinky Jain w/o. Rajendra Kumar Jain, R/o. Hawala Gali,
Sumerpur, Distt.- Pali (Raj.) Pin: 306902
Vs.
1. MetLife Insurance Company Ltd., Brigade Seshamahal, 5,
Vani Vilas Road, Basanvangudi, Banglore- 560004
2. Mr. K.R. Anil Kumar, Chairman, Claims Committee, MetLife
Insurance Company Ltd., Brigade Seshamahal, 5, Vani Vilas
Road, Basanvangudi, Banglore- 560004
Date of Order 10.11.2023
Before:
Hon'ble Mr. Justice Devendra Kachhawaha- President
Hon'ble Mr. N.S. Meratwal- Member (Judicial)
Hon'ble Mr. Liyakat Ali- Member
Present:
Mr. Anil Bhandari learned counsel for the complainant Mr. M.Y. Khan learned counsel for the non-complainants BY THE STATE COMMISSION (PER HON'BLE MR. N.S. MERATWAL, MEMBER JUDICIAL) Smt. Pinky Jain has made this complaint against non-
complainants Met Life Insurance Co. ltd. etc. against rejection of death claim of her father Late. Sh. Sardar Mal in policy No. 20483782 vide letter dated 14-08-2012 alleging that her father Late. Sh. Sardar Mal had taken a policy from non-complainant's company for a assured sum of Rs. 19,00,000/. All the necessary details were mentioned in proposal form of Life Insurance Plan i.e. Met100. After scrutinizing proposal form the same was accepted and above policy was issued. At the time of submitting of proposal form complainant's father had gone through necessary medical checkups and respective reports were supplied to non-complainant company. Her father had never suffered any critical or chronicle disease and was never admitted in hospital for any ailment even for a single day. Her father took his last breath on 12-06-2012 at Gram Panchayat, Badgaon, Tehsil Sheoganj, District Sirohi, Rajasthan. He died due to chest pain and respiratory problem which is natural death. Dr. Rajneesh Choubey was immediately called who examined her father and certified natural death of her father. The certificate in this behalf was issued by Dr. Choubey. Gram Panchayat also issued death certificate of her father on 12-06-2012. Complainant being legal heir of Late. Sh. Sardar Mal submitted death claim in non- complainant's office along with necessary documents. A survey was conducted by officers of non-complainant company regarding death of her father. The claim of the complainant was refused alleging that age of complainant's father at the time of submission of proposal i.e. 10- 09-1962, has been grossly understated, in view of the fact that he was 65 years old thereby policy holder mislead the insurer as such claim was repudiated on the ground of non-discloser or misrepresentation.
The complainant sent a legal notice to non-complainant No.2 through registered post on 22-08-2012 with documents relating to age of her father in which the date of birth of deceased was mentioned as 10-09- 1962 but non-complainant did not respond. It is further alleged that policy holder submitted school certificate with regard to the proof of age which is correct one and on that basis policy was issued. It is submitted that non-complainant wrongly relied upon voter list which cannot be relied for a purpose of life insurance for more than 1 Lac rupees. Voter ID with correct date of birth was issued to complainant's father in his lifetime. It is therefore, prayed that an amount of Rs. 24,10,000/- plus interest @ 24% p.a. may be awarded as per details in the complaint while allowing the complaint.
Non-complainant No.1 and 2 have submitted reply of the complaint while denying allegations mentioned in the complaint. Preliminary objections regarding non maintainability of the complaint have been raised stating that policy was issued relying upon information provided in proposal form regarding various aspects including the personal, professional and other details. The non- complainant company appointed the Eagle Eye Solutions to investigate and assess the claim of the complainant and during the process it was revealed that the actual age of deceased is 65 years at the time of filling of proposal form, while the deceased proposer submitted copy of voter ID and school certificate in which date of birth was 1962. It was found during the investigation that proposer tempered with the voter ID as original voter ID revealed the age of proposer of 65 years as on 01-01-2007. The school certificate given by proposer was also found fake because the school which issued the certificate is a girl's school and certificate belongs to Ms. Sheela which was orally confirmed from school authorities. The neighbors of the proposer also confirmed that the age of proposer was 65 years and he was suffering from heart and breathing problems. The proposer understated his age to be 48 years in proposal form dated 03-01-2011 seeking insurance under this policy. Had the opposite party aware of the actual age of proposer, it would not have issued policy to the proposer as the maximum age required for applying to this policy is 60 years. The proposer by misrepresenting the material facts obtained the policy and thus played a fraud with opposite party. The proposer was obliged to give full and correct information on all the matters which would influence the judgment of a prudent insurer in determining whether he will accept the risk, and if he would, at what rate of premium and subject to what conditions. The insurer has to rely on the information which the proposer gives at the time of proposal. If a material fact is suppressed the insurer will be misled about the risk covered and hence, the same will vitiate the contract. The insurer will then be well within its right to treat the contract as void as per the terms and conditions of the policy.
While replying to the facts mentioned in complaint para-wise it has been prayed to dismiss the complaint as complainant has failed to make out a prima facie case against the opposite party. Complainant has also filed rejoinder to reply filed by non-complainant denying allegations made in reply.
Complainant Smt. Pinky Jain has submitted her affidavit of evidence in support of complaint while no affidavit in the form of evidence has been submitted by non-complainants.
Non-complaints have submitted written submission. The complainant has submitted following citations for perusal. Saurashtra Chemical Ltd. vs. National Insurance Company ltd. I (2020) CPJ 93 (SC) Galada Power and Telecommunications Ltd. vs. United India Insurance Company Ltd. and ors. IV (2016) CPJ 5 (SC) Life Insurance Corporation of India LIC and others. vs. Gopal Singh II (2011) CPJ 7 (NC) The advocate for non-complainant has submitted citations of Amar Singh vs. Union of India writ petition (civil no. 39/2006) decided on 11/05/2011.
We have heard arguments of both the parties and perused the document placed on record besides giving thoughtful consideration on the citations submitted by both the parties.
Annexure 1 is application form of Late. Sh. Sardar Mal having cuttings in date of birth which has been mentioned as 10-10-1962, this proposal form was filled on 3-01-2011 at Shivganj. School certificate & voter ID card have been submitted for age proof and identity proof. In this application form age of father and mother of proposer has been mentioned as 70 years and 64 years respectively As per the application form the age of Sh. Sardal Mal as on 30-01-2011 was between 48 to 49 years.
Annexure 2 is the first premium receipt issued under the policy to Late. Sh. Sardar Mal by non-complainant Company. Annexure 3 is medical certificate of Dr. Rajneesh Choubey in which Dr. Choubey has mentioned the age of Late. Sardal Mal as 50 years and the cause of death is probably due to cardiac respiratory failure as per history of chest pain in early morning. This certificate has been issued on 12-06- 2012.
Annexure 5 is repudiation letter dated 14-08-2012 by which complainant has been informed that while assessing her claim it was observed that late Sh. Sardar Mal's actual age as per voter ID, ration card and voter ID list is 65 years. It has also been stated that Late. Sh. Sardar Mal has under stated his age to be 48 years old in his application form dated 03-01-2011 seeking insurance cover under this policy. It further states that they would not have issued the policy for the applied product and term, if correct age was disclosed by Late. Sh. Sardar Mal. It has therefore been regretted to unable to admit liability for claim due to non-disclosure of material facts and treated policy as void.
In reply to repudiation letter dated 14-08-2012 an undated legal notice has been sent to non-complainant inter-alia stating that along with application form late Sh. Sardar Mal submitted school certificate which is correct one and on that basis policy has been issued. It has been stated that date of birth mentioned in school certificate is also mentioned in documents like passport, UID, voter ID and ration card but the age mentioned in voter ID has no sanctity as it comes within the definition of standard age proof category 4th. His father has also applied for correction in date of birth in voter ID which is pending consideration before authorities.
Annexure 8 is passport of Sh. Sardar Mal, the date of issue is 06-01-2012 and date of birth has been mentioned as 10-09-1962. Pan card of Late. Sh. Sardar Mal also depicts date of birth as 10-09-1962 and other Pan card of Late. Sh. Sardar Mal states date of birth as 06- 05-1962. UID card of Sh. Sardar Mal states year of birth as 1962. Voter ID of Sh. Sardar Mal issued on 03-04-2012 states the date of birth of Sh. Sardar Mal as 10-09-1962. Ration card of Sh. Sardar Mal states the age of Sh. Sardar Mal at 51 years. The date of issue of this Ration card is 10-06-2011.
Annexure 9 is Voter ID for election year 2013 which states date of birth of Sh. Sardar Mal at 51 years. The letter issued by Principal Govt. Medical School, Badgaon (Sirohi) dated 05-02-2014 states that the school is for boys but at present the school is conducted as Co-ed education.
Non-complainant has submitted annexure OP-1 FIR Police Station, Sumerpur which has been got registered by complainant Pinky Jain, along with Final Report dated 02-05-2014 submitted by police in a ACJM Court, Sumerpur in which a charge sheet against Sh. Sanjay alias S.K. Sharma under section 420, 467, 468, 471, 193, 205/201 B of the Indian Penal Code has been submitted. Other final report dated 19-11-2020 has also submitted in which charge sheet against Sudhisth Kumar Shukla has been filed. This FIR and charge sheet is related to policy taken from Birla Sun Life Insurance Company. Copy of death claim filed in Birla Sun Life Insurance Company is also on record with regard to the policy no. 004791326 in which under writing department has commented that as per medical report attached Sh. Sardar Mal used to consume half bottle of alcohol per day for last 6 to 7 years.
Annexure OP-3 contains voter ID of Sh. Sardar Mal issued on 13-03-2007 in which age of Sardar Mal is 60 years.
Annexure OP-4 is reply to notice of complainant Pinky Jain is also on record which alleges the fact mentioned in the reply and repudiation letter.
The Learned Counsel for complainant has argued that there is no evidence of the fact that Late. Sh. Sardar Mal has manipulated his voter ID and on the basis of tempered voter ID he has fraudulently obtained the policy under consideration and misrepresented the insurance company. It has been argued that all the documents produced in this complaint shows that date of birth of Sh. Sardar Mal was 10-09-1962 which has been stated in application form, as such the repudiation of claim of complainant is without any legal basis. On the other side the Learned Counsel for non-complainant has vehemently argued that Late. Sh. Sardar Mal was suffering from serious illness and the fact of this was concealed in the proposal form besides, understatement of age of Sh. Sardar Mal is proved by the voter ID submitted in the file which clearly shows that the age of Sh. Sardar Mal at the time of his submitting proposal form was 65 years.
In this case, the burden of proving of understatement of age of late Sh. Sardar Mal in application form is of non-complainants company, the non-complainants company has not produced any cogent evidence to show that Late. Sh. Sardar Mal has wrongly stated his age to be between 48 to 49 years in the application form. In the Policy document, age or date of birth of Late. Sh. Sardar Mal has not been stated. In the investigation report, annexure 3/OP-3, age of Late Sh. Sardar Mal has been ascertained from the neighbourhood and locality checks. Voter ID has also been collected for confirmation. In the voter ID the age of Late. Sh. Sardar Mal is edited as 44 years as on 01/01/2007 whereas, in original Voter ID card age is mentioned as 60 years as on 01/01/2007. The school certificate is fake as the certificate belongs to Miss. Sheela as per the verbal confirmation of school authority.
In the light of investigation report, the non-complainant has failed to prove that Late. Sh. Sardar Mal tempered his age in the voter ID as no such evidence of tempering has been put forward to prove the age of Late. Sh. Sardar Mal. The investigator had also interrogated neighbours, the statement of whom have not been presented in the file. Besides it, the ground on which school Certificate has been termed as fake, has not been proved that certificate actually belongs to Miss. Sheela, as the school has not provided any written statement in this regard. The documents enclosed with the investigation report shows that in voter list the age of Late. Sh. Sardar Mal has been mentioned as 65 years and in voter ID it is 60 years. One Ration Card of Late. Sh. Sardar Mal issued in the year 2011 depicts age of Sri Sardar Mal as 51 year & in other Ration card, the date of issue has not been mentioned, depict the age of Sh. Sardar Mal 65 years. No other document has been produced, which have been mentioned as enclosures in the investigation report. The non-complainant has half-heartedly tried to put a case that Late Sh. Sardar Mal was of the age of 65 years at the time of making of application for issuing the policy under consideration.
On the other side the documents submitted by complainant shows that the year of birth of Sh. Sardar Mal was 1962. However, there is difference in date of birth in two Pan Cards and there is cutting in the application form which shows the date of birth of Sh. Sardar Mal at 10-10-1962 but the other documents shows it at 10-09-1962. In light of these pieces of evidence we are convinced that at the time of making of application Late. Sh. Sardar Mal was between age of 48 years to 51 years and he was not of the age of 65 years.
It is pertinent that date of birth mentioned in voter ID is not conclusive proof of date of birth of voter as there may be various mistakes while entering the details in it. Hon'ble National Consumer Disputes Redressal Commission in II (2011) CPJ 7 (NC) propounded similar principles. As such we are of the view that the non- complainant insurance company has wrongly came to the conclusion that deceased Late. Sh. Sardar Mal concealed his true age at the time of filling of application form and therefore, the claim of the complainant has wrongly been repudiated.
The Insurance Company in its reply has raised other ground for dismissal of complaint which have not been mentioned in the repudiation letter which is relating to some disease & living habits from which Late. Sh. Sardar Mal was suffering at the time of filling up of application form for insurance and which were suppressed and not disclosed in the application form. In this connection no document any evidence has been produced to support the claim of insurance company that the insured had suppressed his previous illness and obtained the policy by fraud.
It is submitted that the insurance company is estopped from taking a new ground for dismissal of complaint which has not mentioned in the repudiation letter dated 14-08-2012. The citations submitted by learned counsel for complainant supports the arguments of learned counsel for complainant in this regard. Hence, the plea of counsel for non-complainant that Late. Sh. Sardar Mal had concealed the information of his previous illness cannot also be considered for dismissal of this complaint.
After perusal of record of the case and after consideration of arguments given by both the parties, we came to a conclusion that the non-complainant's insurance company has wrongly repudiated the claim of complainant on the basis of not disclosing true date of birth of Late. Sh. Sardar Mal in the application form. In these circumstances the complaint of complainant is allowed and non-complainant insurance company is directed to disburse the claim of the claimant of policy no. 20483782 of Rs.19,00,000/- along with interest @ 6% from the date of presentation of this complaint on 08-11-2012 till realization. The complainant is also entitled to receive the sum of Rs. 50,000/- as compensation for undergoing mental agony. The complainant is also entitled to receive Rs. 10,000/- as litigation cost.
ORDER The complaint of Smt. Pinky Jain against non-complainant MetLife Insurance Co. Ltd. and Mr. K.R Anil Kumar is allowed. Non- complainants are directed to make payment of Rs.19,00,000/- to complainant with interest @ 6% from the date 08-11-2012 till realization. Non-complainants are also directed to make payment of Rs. 50,000/- for mental agony and Rs. 10,000/- for litigation expenses. All the sums shall be paid by Non-complainant to complainant within a period of 2 months else complainant shall be entitled to receive interest @ 9% from the date of this order till realization of the entire amount.
(Liyakat Ali) (N.S. Meratwal) (Devendra Kachhawaha) Member Member Judicial President