State Consumer Disputes Redressal Commission
Dhfl Premerica Lic vs Gurmeet Kaur on 13 January, 2016
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, DAKSHIN MARG, SECTOR 37-A, CHANDIGARH.
First Appeal No.1474 of 2014
Date of Institution : 05.11.2014.
Date of Decision : 13.01.2016.
1. DHFL Pramerica Life Insurance Co. Ltd. (Erstwhile known as
DLF Pramerica Life Insurance Co. Ltd.), 4th Floor, Building
No.9B, Cyber City, DLF City, Phase-III, Gurgaon -122002,
Haryana.
2. DHFL Pramerica Life Insurance Co. Ltd. (Erstwhile known as
DLF Pramerica Life Insurance Co. Ltd.), 1st Floor, Plot No.13,
Shastri Nagar, Jalandhar Road, Batala, Gurdaspur.
.....Appellants/Opposite Parties
VERSUS
Gurmeet Kaur w/o Beer Singh resident of Village Shankerpura, Tehsil
Batala, District Gurdaspur, Punjab.
.....Respondent/Complainant
First Appeal against order dated
26.08.2014 passed by District
Consumer Disputes Redressal
Forum, Gurdaspur.
Quorum:
Hon'ble Mr. Justice Gurdev Singh, President
Sh. Vinod Kumar Gupta , Member
Sh. Upjeet Singh Brar, Member Present:
For the appellants : Sh. Vaibhav Jain, Advocate For the respondent : Ms. R.K.Manaise, Advocate VINOD KUMAR GUPTA, MEMBER This appeal has been preferred by the appellants/opposite parties against the order dated 26.08.2014 passed by the District Consumer Disputes Redressal Forum, Gurdaspur (in short "District Forum"), vide which the complaint filed by the complainant/respondent was partly accepted and the opposite parties First Appeal No.1474 of 2014 2 were directed to settle and pay the full assured sum of the repudiated claim alongwith all the accrued benefits (if any) to her with accrued interest @ 9% p.a. w.e.f. filing of the present claim, besides Rs.5,000/- as cost of litigation. The compliance of the order was ordered to be made within 30 days from the receipt of copy thereof.
2. Brief facts of the case are that complainant, Gurmeet Kaur, filed the complaint under the Consumer Protection Act, 1986 (in short "the Act") against the Opposite Parties (in short 'OPs') on the averments that her husband Sh.Beer Singh got himself insured with OP No.2, vide insurance policy No.000032077 dated 26.07.2010 for a sum assured of Rs.2,40,000/-. She was the nominee in the said policy. Her husband died on 29.12.2012 at Guru Nanak Hospital, Amritsar. She filed the claim with OP No.2 and all the requirements were fulfilled by her. OP No.1 issued cheque No.038588 dated 11.04.2013 for Rs.44,092.42p to her instead of paying full insurance amount of Rs.2,40,000/-. It was alleged that OP No.1 repudiated the balance claim amount, vide letter dated 11.04.2013, on the ground that her husband was around 59 years old prior to the date of application and this information was not disclosed in the said application. It was pleaded that her deceased husband, had mentioned his age correctly and the entire documents were fully checked by the OPs at the time of issuance of the policy. This act and conduct of the OPs in repudiating her claim amounted to deficiency in service on their part. She prayed for issuance of the following directions to them :-
First Appeal No.1474 of 2014 3
i) to pay claim of Rs.2,40,000/- along with vested bonus and damages to the tune of Rs.50,000/- along with interest @ 18% p.a. from the date of filing the complaint;
and
ii) to pay Rs.10,000/- as litigation expenses.
3. The complaint was contested by the OPs by filing the joint written reply, before the District Forum. Preliminary objections were taken that complaint was not maintainable; complainant had not approached the District Forum with clean hands and suppressed the material facts; the complaint was false, malicious and incorrect and was liable to be dismissed under Section 26 of the Act; and no cause of action had arisen to her. On merits, it was replied that after duly deliberating upon it and understanding all the terms and conditions of the "DLF Pramerica Super Wealth Plus" and after being satisfied with the plan and with the intention to purchase the policy, the DLA submitted duly filled and signed proposal form No.AF000000307 dated 21.07.2010 and the sum assured was Rs.2,40,000/-. Under the said policy, a model premium of Rs.12,000/- was to be paid half yearly for the period of 20 years. The DLA after understanding all the terms and conditions had signed the proposal form and also signed the Declaration and Authorization. The policy was issued to the DLA with the commencement date of 26.07.2010. It was admitted that on 24.01.2013, they received the death certificate of DLA. It was further alleged that as per terms and procedure, they investigated the matter and during the investigation, it was revealed that the age proof given by the DLA i.e. driving license bearing No.10034/NDL was fake and First Appeal No.1474 of 2014 4 same was confirmed by the District Transport Office under Punjab Government. Further, as per the document obtained during the investigation, it was found that as per the voter's ID Card, the DLA was 46 years old as on 01.01.1994 i.e. 62 years old at the time of death i.e. in the year 2012 and there was a difference of about 10 years in the age of DLA as appearing in his Voter's ID Card and Driving license. The DLA had misrepresented them by concealing the above material facts at the time of taking the insurance policy. The claim was rightly repudiated by OPs, vide letter dated 11.04.2013. Thereafter, being the Customer Centric Organization, they refunded the fund value under the said policy amounting to Rs.44,090.42p towards the full and final settlement of the claim, vide cheque bearing No.038588 dated 11.04.2013. Other allegations contained in the complaint were denied by them and they prayed for dismissal of the complaint with cost.
4. Both the parties produced evidence in support of their respective averments before the District Forum, which after going through the same and hearing learned counsel on their behalf, partly accepted the complaint, vide impugned order dated 26.08.2014.
5. We have heard the learned counsel for both the sides and have also carefully gone through the record of the case.
6. It was submitted by the learned counsel for the appellants/OPs that the District Forum has failed to appreciate the fact that the claim of the complainant was repudiated on the ground that the DLA gave false and fabricated documents i.e. driving license bearing No.10034/NDL/LL5970/GSP08 with regard to his age at the First Appeal No.1474 of 2014 5 time of signing the proposal form. It was found fake and the same was confirmed by the DTO, Gurdaspur. Further, as per Voter's ID Card, the DLA was 46 years old as on 01.01.1994 i.e. 62 years old at the time of death in the year 2012. There was a difference of around 10 years in the age of DLA as appearing in his Voter's ID Card and driving license. The policy was issued on the misrepresentation made in the proposal form regarding the age of DLA; which rendered the contract of insurance voidable at the option of the insurer. The District Forum failed to appreciate the point that the policy contract was entered between the insurance company and policy holder and not with the agent, even if the agent was related to the DLA and it was the duty of the policy holder to disclose true and correct facts regarding his age in the proposal form. The District Forum failed to appreciate that as per Discharge Certificate of the Army, the date of birth of the DLA was mentioned as 21.10.1951 and he joined army on 20.10.1969, when he was 18 years of age. But, the DLA mentioned, in the proposal form, his date of birth as 02.01.1959; which clearly shows that he concealed the above material facts at the time of issuance of the policy. The District Forum failed to appreciate that the instant complaint is false, malicious and was liable to be dismissed under Section 26 of the Act. It was prayed that the appeal be accepted and the order of the District Forum be set-aside.
7. On the other hand, it was submitted by the learned counsel for respondent/complainant that correct findings were recorded by the District Forum. There is no merit in the appeal and dismissal of the same was prayed for.
First Appeal No.1474 of 2014 6
8. It is an admitted fact that the husband of the complainant purchased "DLF Pramerica Super Wealth Plus" policy bearing No.00032077 for the period 26.07.2010 to 25.07.2030 for sum assured of Rs.2,40,000/- after paying the half yearly premium of Rs.12,000/- vide Ex.OP-3. She was appointed as nominee under the said policy. The DLA died on 29.12.2012. At the time of filling-up the proposal form, the DLA mentioned his date of birth in the proposal form as 02.01.1959 and signed the Declaration and Authorisation, which is reproduced as under :-
"I/We declare that I/We have answered the questions in the application form after being explained by the sales personnel of the DLF Pramerica Life Insurance Company Limited, (hereinafter referred to as "the Company") and have fully understood the nature of the questions including health related questions and the importance of disclosing all material information while answering such questions. I/We further declare that the answers given by me/us to all the questions in the application form and the information given to the Medical Examiner appointed by the Company as to the state of health and habits of the Life to be insured are true and complete in every respect and that I/We have not withheld any material information or suppressed any material fact. I/We have made no statement to the sales personnel/Life Conmsultant, Medical Examiner, or any other person associated with DLF Pramerica Life Insurance Company Limited, which in any way modifies the answer and statements on this application. I/We undertake to notify the Company of any change in the state of health of the Life to be insured or as to his occupation subsequent to the signing of this application and before the acceptance of the risk by the Company. I/We also understand that in case of any mis- statement or suppression of material information the Company has the right to repudiate the claim under the Policy. The Policy shall become void where it is found that the Policy was issued on the basis of fake/tampered documents and/or proofs or failure to disclose any material information relevant for underwriting the risk. I/We also certify that I/We have read and understood the Benefits illustrations as published by the Company that were handed over to me/us along with this application form. I/We also understand that the terms and conditions including the premium and benefits under the Policy are First Appeal No.1474 of 2014 7 subject to taxes/duties/charges in accordance to the application laws.
I/We hereby authorize DLF Pramerica Life Insurance Co. Ltd. to conduct screening/confirmation /reconfirmation of overall status of the Life to be Insured including the health status, through medical examinations which may include Laboratory tests, Cardiac, Radiological investments and other Medical tests including blood tests to detect bacteria/viral/fungal Infections. I/We hereby give my/our consent to undergo HIV 1/2 test. I/We am/are aware that this test is only for screening purpose and not confirmatory for HIV/AIDS. The Company reserves the right to accept, decline or offer alternative terms on my/our application of Life Insurance.
In order to enable the Company to assess the risk under this application and any time therafter, I/We, hereby, authorize the past and present employer(s)/business associates/medical practitioner/ hospital and medical source/any life and non-life insurance company/or organization or Life Insurance Association's medical register to release to the Company and the Company to release to any medical source/any life and non-life Insurance company/or Life Insurance Association or medical register, such details and provide the records of employment/business or other details as may be considered relevant."
The proposal form so filled in by the insured at the time of obtaining the policy was proved as Ex.OP-2; which contained the above said declaration duly signed by DLA. As per that declaration, the statements and the answers were given by the DLA after fully understanding the questions and the contents were declared to be true and complete in every particular. He had also stated that those statements and declaration would be the basis of the contract of insurance between him and company and that if any untrue averment is contained therein, the contract shall become absolutely null and void.
9. The claim of the DLA was repudiated, vide letter dated 11.04.2013 Ex.OP-8 by the OPs. The relevant portion of the letter provides as under :-
First Appeal No.1474 of 2014 8
"With reference to your claim under the above policy on the life of the above mentioned deceased, we have to inform you that all liability under the Policy has been repudiated by us on account of the deceased having misrepresented his age at the time of affecting the assurance with us.
It was found that late Mr.Beer Singh was around 59 years old prior to the date of the application this information was not disclosed in the said application.
Our liability as an insurer is subject to the terms and conditions of the policy of insurance under which such non-disclosure makes the Contract Void. In light of the above, we regret to inform you that no claim is admitted against the Company.
We have also like to inform you that Fund Value for this policy is being refunded. The Fund Value is Rs.44,090.42 (Rupees Forty Four Thousand Ninety & Forty Two Paise only) towards the full and final settlement for policy No.000032077."
10. The OPs issued the cheque No.038588 dated 11.04.2013 Ex.OP-7 for Rs.44090.42p towards full and final settlement of policy No.000032077 in favour of the complainant, which was accepted by her.
11. We have perused the investigation report Ex.OP-5 dated 07.02.2013. The relevant portion of the investigation report provides as under :-
7- Relationship, if any of the Yes, Parminder Kaur the person life assured with the STM, IC, from whom insurance was taken Medical examiner and whether is cousin of Mr.Beer Singh (LA). any of them has a pecuniary Parminder Kaur is an advisor in interest in the claim amount. If DLF Life Insurance Company yes, provide details. Limited Batala and his code is SE005258. Now he is promoted to Assistant Sales Manager.
Part-F (Miscellaneous/General) 6- Investigative findings Discrepancy in Age:- As per that need to be Driving License (fake) his D.O.B is highlighted. shown as 02/01/1959. As per this date of birth his age is being calculated as 52 years at the time of death. But, as per voter ID Card his age as on 1.1.1994 (date First Appeal No.1474 of 2014 9 of preparation of voter ID Card) is 46 years which when calculated comes up to be 62 years at the time of death that is in 2012.
Now as per voter List 2013 his age appears as 57 years.
Lastly to conclude we can say that there is a difference of around 10 years in the age of LA as appearing in voter ID Card and Driving License (Fake). This discrepancy can easily be figured out by looking at the Voter ID Card and Driving License which we are attaching herein.
Discrepancy in Age Proof (DRIVING LICENSE):- As per investigation, the driving license prepared for LA Mr. Beer Singh is fake. We have checked the authenticity of driving license (License No.10034/NDL) with District Transport Office under Punjab Govt. and they have declared it to be fake driving license. We are attaching the paper herein for detailed clarification.
THE MOST IMPORTANT THING IS :- The basis on which the insurance is taken that is Driving License, is in itself proved to be fake.
Discrepancy in Date of Birth:- As per Army Certificate he joined army on 20/10/1969 as per this date his age comes to be 10 years (Date of Birth 02/01/1959). It is not possible for a kid of 10 years to join army. Hence we can see that there is some discrepancy in age as well as date of birth. THE STANDARD AGE OF JOINING ARMY IS 18 YEARS.
First Appeal No.1474 of 2014 10
12. The report of investigator Ex.OP-5 also contains driving license, voter identity card and army discharge certificate, etc. The documents forming part of investigation report can be relied upon by us. The driving license No.10034/NDL dated 13.01.2008, was issued by the office of DTO, Gurdaspur. After verification from that office, it was found fake, as is clear from the report of the DTO, Gurdaspur, made on the application Ex.OP-6. It is evident from the Discharge Certificate of Army that the date of birth of the DLA was 21.10.1951 and date of enrolment in army was 20.10.1969. But, the DLA had mentioned his date of birth as 02.01.1959 in the proposal form at the time of obtaining the insurance policy. A perusal of the Identity Card No.PB/02/003/192942 issued by Election Commission of India shows that the age of the DLA was 46 years as on 01.01.1994 and in the voters' list of 2013 at serial No.979, the age of DLA was mentioned as 57 years. It is very much clear from the above documents that the DLA suppressed the material information with regard to his exact age in the proposal form at the time of obtaining the policy. The insured deliberately gave his false date of birth to obtain the benefit of insurance policy from OPs. The contract of insurance is based on utmost good faith and if the insured deliberately suppresses any material fact about his age fraudulently, it renders the contract of insurance void. The findings recorded by the District Forum are contrary to the evidence brought on record by the OPs and it wrongly allowed the complaint. The claim of the complainant was rightly repudiated by the OPs. So, the order of the District Forum cannot be sustained in this appeal.
First Appeal No.1474 of 2014 11
13. Sequel to the above discussion, the appeal filed by the appellants is accepted and the order passed by the District Forum is set aside. Consequently, the complaint filed by the complainant is dismissed.
14. A sum of Rs. 25,000/- was deposited by the appellants at the time of filing of the appeal before this Commission. Another amount of Rs.1,32,612/- was deposited by them, vide receipt No.644924 dated 09.12.2014 as per directions of this Commission. Both these amounts along with interest, which has accrued thereon, if any, shall be remitted by the registry to the appellants by way of a crossed cheque/demand draft after the expiry of 45 days.
15. The arguments in this case were heard on 06.01.2016 and the order was reserved. Now, the order be communicated to the parties.
16. The appeal could not be decided within the stipulated time frame due to heavy pendency of court cases.
(JUSTICE GURDEV SINGH)
PRESIDENT
(VINOD KUMAR GUPTA)
MEMBER
January 13, 2016 (UPJEET SINGH BRAR)
Lb/- MEMBER