National Consumer Disputes Redressal
Yash Constructions & Land Development ... vs Metlife India Insurance Co. Ltd. on 15 January, 2016
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI CONSUMER CASE NO. 119 OF 2011 1. YASH CONSTRUCTIONS & LAND DEVELOPMENT CO. Through Its Partner, Mr. Sanjay Shinde.,
Anand Vijay Sankul "C" Wing,
Room No. 38, Jail Road, Nashik Road, Nashik - 422 101, Maharashtra. ...........Complainant(s) Versus 1. METLIFE INDIA INSURANCE CO. LTD. Brigade Seshamahal, 5, Vani Vilas Road, Basavanagudi, Bangalore - 560 004. ...........Opp.Party(s)
BEFORE: HON'BLE MR. JUSTICE J.M. MALIK, PRESIDING MEMBER HON'BLE DR. S.M. KANTIKAR, MEMBER
For the Complainant : Mr. Sukumar Pattjoshi, Sr. Advocate with
Mr. Vikas Nautiyal, Advocate For the Opp.Party : Mr. D. Vardarajan, Advocate
Dated : 15 Jan 2016 ORDER
PER JUSTICE J.M. MALIK, PRESIDING MEMBER
The complainant through Sanjay Shinde and wife of insured Mrs. Meena Sanjay Bare have filed four complaints in respect of four policies against different insurance companies. Therefore, we will decide this case separately.
2. Mr. Sanjay Sawaliram Bare the insured since deceased paid a premium of Rs.2 lakhs to the MetLife India Insurance Co. Ltd., the OP in this case and received the Met Smart Premier insurance policy bearing No.20020983 for the period 30.5.2009 to 30.5.2075 for the sum assured of Rs.1 crore. Mr. Sanjay Sawaliram Bare was merely 12th pass and was not well-versed with English language. The opposite party asked him to put his signature on the proposal form and the needful was done. On 16.9.2009, the deceased Mr.Sanjay Sawaliram Bare applied for endorsement for changing the name of beneficiary from Mrs. Meena Sanjay Bare to Yash Construction & Land Development Company. The OP accepted the endorsement and confirmed the change by addressing two letters dated 24.10.2009.
3. Unfortunately, Mr. Sanjay Sawaliram Bare met with an accident and passed away on 2.1.2010. The claim made by the nominee was repudiated by the OP vide letter dated 30.12.2010. The relevant extract of the repudiation letter run as follows:-
"We wish to bring to your attention that during the course of assessing the claim, we were not able to establish the financials of late Mr. Sanjay Bare which were mentioned in the Application Form and Financial Annexures submitted for the above policy. It was noted that as per the above documents Late Mr. Sanjay Bare had Land worth of Rs.16 crores, Office worth of Rs.80 lakhs and Bank deposits worth Rs.60 lakhs and also agricultural income. But as per our investigation and from the documents submitted for the purpose of processing the claim, the existence of the Assets as mentioned above were not established.
As you may be aware, Insurance contracts are based on the principle of "utmost good faith" and the policies are issued based on the representations made in the application form and any non-disclosure or misrepresentation in the application form renders the contract voidable at the option of the insurer.
Had the above facts were known to us at the application stage, we would not have offered the said life cover to Late Mr. Sanjay Bare. Hence we are unable to admit liability for the above claim and have treated the said policy as void ab-initio.
We however refund the Fund Value as mentioned below:
Fund Value:Rs.1,85,006.00
Find enclosed, a cheque/DD bearing No.688292 dated 30.12.2010, for Rs.1,85,006.00/- drawn on the Axis Bank Ltd., being the full and final payment of the above mentioned claim."
4. The complainant was called into question the instant repudiation letter and filed the instant complaint before this Commission on 3.6.2011 with the following prayers:-
"a. To hold and declare the Opposite Party to be guilty of deficiency in service and unfair trade practice as per the provisions of the Consumer Protection Act, 1986.
b. To direct the Opposite Party to pay to the complainant the sum of Rs.1,00,00,000/- which is the claim amount as per the policy issued by the opposite party.
c. To direct the Opposite party to pay the interest @ 18% on the sum of Rs.1,00,00,000/- from the date of death i.e. from 02.01.2010 till the date of realization of the same.
d. To direct the Opposite party to pay to the complainant Rs.15,00,000/- (Rupees Fifteen Lakhs only) being the compensation for the mental agony and stress suffered by the Complainant.
e. To direct the Opposite party to pay to the complainant Rs.1,00,000/- (Rupees One Lakh only) towards the Legal and incidental charges incurred by the Complainant.
f. For such other and further reliefs as the nature and circumstances of the above numbered complaint may deem fit and proper."
5. The OP could not file the written statement within time prescribed by the law. Therefore, its right to file the written statement was forfeited on 22.5.2013. The Hon'ble Supreme Court has upheld the authority of Dr. J.J. Merchant & Ors. Vs. Srinath Chaturvedi-III (2002) CPJ 8 (SC) 8, in the latest authority by the Hon'ble Supreme Court reported in New India Assurance Co. Ltd. Vs. Hilli Multipurpose Cold Storage Pvt. Ltd., Civil Appeal Nos. 10941-10942 of 2013, decided on 04.12.2015. Consequently, the right to file the written statement by the OP, stands forfeited.
6. We have heard learned counsel for the parties.
7. Counsel for the OP has raised few objections. He submitted that all these complaints are similar in nature and cut and paste method has been applied. It was argued that that the case of the insured is contradictory. Some time he submits that he is 12th pass and on the other instances, he submits that he is a Graduate. He contended that the complainant is playing fraud with these proceedings and with this Commission as well.
8. We have perused the proposal form. This is an admitted fact that there was no column regarding disclosing of the fact that how many insurance policies the insured has got. The proposal form is conspicuously silent about the same. The OP vide letter dated 19.3.2010 wrote specific letter directing the complainant to fill the claim form dated 25.5.2010 and submit the necessary documents for assessment of claim. Accordingly, the complainant filed the claim form along with all necessary documents and requested the OP to process the claim. The intention of the complainant was good. The record reveals that he has been disclosing this fact to other companies as well. The OP is attempting in vain to make bricks without straw. There should be some reasonable ground for repudiation. The insurance company must act in accordance with law. They cannot and should not repudiate the claim of each and every insured. All the the arguments advanced by the counsel for the OP are breadth of merit.
9. These arguments pale into insignificance due to the law laid down by the Apex Court. We are able to locate the authority of the Supreme Court in the case of CEO, Sahara India Life Insurance Company Limited & Anr. Vs. Rayani Ramayanjneyulu, decided by the Apex Court while dismissing the Special Leave to Appeal (Civil) No. No.30740 of 2014, decided on 21.11.2014 upholding the order of this Bench in Revision Petition No.1117 of 2014 decided on 1.8.201. In which, in para No.3, we observed as under:-
"We are of the considered view that these authorities rather go to help the complainant/respondent. The Para 17 of the Apex Court order is crucial and significant. It is difficult to fathom as to why these facts would influence the judgment of a prudent insurer in fixing the premium or determining the cover or whether he would like to take the risk. This appears to be a mistake committed by the agent. Agent is the villain and for his omissions and commissions, the insured or her LRs should not suffer. On the contrary, the repudiation on this ground alone smacks of malafide intention on the part of the OP. By no stretch of imagination it can be held to be a material fact. It rather puts the insured in a solid and impregnable position."
10. Counsel for the complainant also cited authorities reported in M/s Modern Insulators Ltd. Vs. Oriental Insurance Co. Ltd. [I (2000) CPJ 1 (SC) and National Insurance Co. Ltd. Vs. D.P. Jain [III (2007) CPJ 34 (NC) in support of his case.
11. Consequently, we allow the present complaint and direct the opposite party to pay a sum of Rs.1,00,00,000/- minus the amount already paid with interest @ 4% p.a. from the date of filing of this complaint till its realisation. The complainant is also awarded costs of the litigation at Rs.10,000/- which be paid within 90 days from the date of receipt of the copy of the order otherwise, it will carry interest @ 6% p.a. till its realisation.
12. The complaint stands disposed of accordingly.
......................J J.M. MALIK PRESIDING MEMBER ...................... DR. S.M. KANTIKAR MEMBER