State Consumer Disputes Redressal Commission
Pnb Metlife India Insurance Co. vs Roshini on 24 July, 2025
STATE CONSUMER DISPUTES REDRESSAL COMMISSION
HARYANA
FIRST APPEAL NO. SC/6/A/1535/2017
PNB METLIFE INDIA INSURANCE CO.
PRESENT ADDRESS - 1ST FLOOR, TECHIPLEX 1, TECHNIPLEX COMPLEX OFF VEER
SAWARKAR FLYOVER, GOREGAON. MUMBAI. ,HARYANA.
.......Appellant(s)
Versus
ROSHINI
PRESENT ADDRESS - VILLAGE BHODIA KHERA FATEHABAD. ,HARYANA.
.......Respondent(s)
BEFORE:
MR. NARESH KATYAL , PRESIDING MEMBER
MR. SURESH CHANDER KAUSHIK , MEMBER
FOR THE APPELLANT:
MR. ROHIT GOSWAMI PROXY COUNSEL FOR MR. VAIBHAV JAIN, COUNSEL FOR
APPELLANT.
FOR THE RESPONDENT:
NONE FOR RESPONDENT.
DATED: 24/07/2025
ORDER
STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA Date of Institution: 05.12.2017 Date of final hearing: 07.07.2025 Date of pronouncement: 24.07.2025 First Appeal No.1535 of 2017 IN THE MATTER OF:-
1. PNB MetLife India Insurance Co. Ltd. (Formally known as MetLife), Registered office at: Unit No. 701, 702 & 703, 7th Floor, West Wing, Raheja Towers, 26/27, MG Road, Bangalore-560001, Corporate Office at 1st Floor, Techiplex 1, Techniplex Complex Off Veer Sawarkar Flyover, Goregaon West, Mumbai-
400062 through Mr. Rajeev Sharma, Senior Manager-legal.
2. PNB MetLife India Insurance Co. Ltd. (Formally known as MetLife), Branch Office at Punjab National Bank Fatehabad, Tehsil and District Fatehabad through Mr. Rajeev Sharma, Senior Manager-legal.
...Appellants Versus Smt. Roshini Wd/o Ishal Mohammad S/o Karmudin, R/o Village Bhodia Khera, Fatehabad. .....Respondent CORAM: Sh. Naresh Katyal, Judicial Member.
Sh. S.C. Kaushik, Member.
Argued by:- Mr. Rohit Goswami proxy counsel for Mr. Vaibhav Jain, counsel for appellant.
None for respondent.
ORDER NARESH KATYAL, JUDICIAL MEMBER:
In this appeal No.1535 of 2017; legality of order dated 07.11.2017 passed by learned District Consumer Disputes Redressal Forum-Fatehabad (In short "District Commission") in complaint case No.147 of 2017; vide which complainant's complaint has been allowed, has been assailed.
2. Factual matrix: Complainant's husband-Ishal Mohammad got himself insured with OPs vide insurance policy No.21621881 valid form 14.07.2015 to 11.07.2035 for assured sum of Rs.9,10,000/-. He paid insurance premium of Rs.12,143/- to OPs. Complainant, being nominee in insurance policy, after death of her husband/life assured on 08.02.2016, intimated his death to OPs and submitted death claim with OPs for settlement under policy and completed requisite formalities. As per plea; she was assured that insurance claim will soon be released to her. However, OPs repudiated death claim on false and flimsy grounds vide its letter dated 03.01.2017 alleging that late Mr. Ishal Mohammad had already died, prior to obtaining insurance policy. She had written to OPs for re-investigation of matter, but OPs vide its letter dated 28.03.2017 intimated her that decision to repudiate claim is upheld. It is alleged that repudiation of her genuine insurance claim amounts to deficiency in service and also unfair trade practice on OPs' part.
Complaint has been filed seeking directions against OPs/appellants to pay her:
assured sum of Rs.9,10,000/- with interest @12% p.a. with effect from due date till actual payment; to pay her compensation of Rs.50,000/- on account of mental agony, harassment and humiliation.
3. In response, OPs/insurer/appellants raised contest and pleaded in its defense that: complaint is false, malicious, incorrect and filed with mala fide intention; complainant does not fall within definition of consumer; complaint is not maintainable. It is pleaded that during the course of investigation and assessment of claim, it was revealed that death certificate submitted by complainant was a forged death certificate. DLA had already expired on 26.06.2015 and policy in question was issued with effect from 14.07.2015 i.e. DLA had expired prior to issuance of policy. As per plea; date of death of DLA has been recorded as 26.06.2015 in Social Worker (ANM) Register. This fact has been affirmed by investigator through affidavit stating therein that DLA had expired on 26.06.2015. Insurance policy was taken in fraudulent manner by complainant with ill-intention of making wrongful gain and causing wrongful loss to OPs.
4. Parties to this lis led evidence, oral as well as documentary.
5. On analyzing the same; learned District Consumer Commission-Fatehabad has allowed the complaint vide order dated 07.11.2017 and directed OPs/insurer to pay sum insured of Rs.9,10,000/- with 6% p.a. interest from the date of repudiation till realization, to complainant within one month.
6. Feeling aggrieved; insurer/OPs has filed this appeal. Learned counsel for appellants has been heard at length. With his able assistance; record too has been perused. Respondent remained unrepresented in this appeal, consecutively since last four dates.
7. Learned counsel for the appellants/insurer has urged that subject insurance policy is void ab-initio having been obtained fraudulently. On the day when risk under policy commenced (11.07.2015); insured was not alive, as he died earlier on 26.05.2015 as per death certificate issued by Office of Registrar, Birth and Death, Municipal Committee-Bhiwani. It is urged that insurer's investigator had conducted investigation on this angle and consequently repudiation of death claim submitted by complainant to insurer was legally justified. Learned District Consumer Commission has erred in law in not appreciating this fact in a proper legal perspective. It is urged that death certificate-Ex.C-1 relied upon by complainant showing date of death of life assured as 08.02.2016, and so issued by Sub-Registrar, Primary Health Centre- Agroha is forged. Basically on these submissions, counsel for appellants has urged that insurer has no ensuing liability towards complainant under subject policy.
8. The nucleus of controversy regarding subject insurance policy revolves around date of death of life assured. Risk under policy had commenced from 14.07.2015 and it was having currency of 20 years till 11.07.2035. Sum assured under policy was Rs.9,10,000/- and premium paid under policy was Rs.12,143/-. First premium receipt indicates that amount of Rs.12,568/- was paid on 14.07.2015 which included premium amount of Rs.12,143/-. As per complainant's stance, life assured had expired on 08.02.2016 i.e. after inception of risk under policy which began from 14.07.2015. Proposal form also indicates that Ishal Mohammad-deceased life assured had signed it on 10.07.2015 and same is witnessed by agent of appellants too. It would legally imply that life assured was alive on 10.07.2015. Death certificate Ex. C-1 issued by Registrar, Birth and Death-cum-MO I/c PHC, Agroha under Section 12/17 of Registration of Birth and Death Act, 2002 and Rules 8/13 framed therein indicates about date of death of deceased life assured as 08.02.2016. This certificate bears signature of an official namely Charu, and also carries scanner/QR Code on it. As per this certificate, life assured had died in Dayal Hospital-Agroha and there is supporting document (one page) showing indoor hospitalization of life assured in this hospital. To controvert above substantive evidence, insurer/appellants has set up a case that deceased life assured expired on 26.06.2015 i.e. before the inception of risk under policy and to stimulate its stance, insurer/appellants has laid stress upon its investigator's report and his affidavit whereby he has proved contents of his report to the effect that decease life assured had expired on 26.06.2015. Though, no death certificate substantiating date of death of deceased as 26.06.2015 was produced as evidence by OPs/appellants during the proceedings before learned District Consumer Commission, yet certificate to this effect was produced along with this appeal. A glance of this certificate reflects that it was issued under Section 17 of Birth and Death Registration Act, 1969. It does not carry any QR Code/scanner. It only carries short initial of an official issuing the same with no head and tail. It remained a mysterious circumstance as to who had issued the same. The counsel for insurer/appellants could not unveil this mystery during hearing of this appeal. More so, the place of death therein of deceased life assured has been mentioned as Bhiwani and his permanent address is mentioned as Village: Bhodia, District-Fatehabad. How come a resident of District Fatehabad happened to be at Bhiwani at the time of his death remained an explained circumstance. There is no link evidence on record showing that deceased life assured had obtained some medical treatment at some hospital in Bhiwani, in or around the proximity of 26.06.2015. More so, insurer has created policy in favour of deceased life assured on 14.07.2015 and received premium under it on same day as it is so evident on record. Therefore, it has to be presumed at legal pedestal that premium had been received by insurer from life assured on 14.07.2015 in order to set the insurance policy into motion. In wake of above facts and circumstances; when death certificate Ex.C-1 showing the date of death of life assured as 08.02.2016, is pitted against death certificate showing date of death of life assured as 26.06.2015 then credibility and legal sanctity flowing from death certificate Ex.C-1 prevails. Hence, poser put before this Commission by insurer/appellant that deceased life assured had died on 26.06.2015 i.e. before inception of risk under policy is answered against insurer. This being so; this Commission observes that there is no fallacy in the impugned order dated 07.11.2017 passed by learned District Consumer Disputes Redressal Commission-Fatehabad, which is hereby maintained, affirmed and upheld. Insurer/appellants have been rightly non-suited. Present appeal is hereby dismissed being devoid of merits.
9. Statutory amount of Rs.25,000/- deposited by appellant at the time of filing of this appeal be refunded to it, after due identification and verification as per rules and on expiry of period meant for further appeal /revision, if any.
10. Application(s) pending, if any stand disposed of in terms of the aforesaid judgment.
11. A copy of this judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986/2019. The Judgment be uploaded forthwith on the website of the Commission for the perusal of the parties.
12. File be consigned to record room.
Date of pronouncement: 24th July, 2025.
S.C. Kaushik Naresh Katyal
Member Judicial Member
Addl. Bench Addl. Bench
..................
NARESH KATYAL
PRESIDING MEMBER
..................
SURESH CHANDER KAUSHIK
MEMBER