State Consumer Disputes Redressal Commission
Jasbir Kaur vs Bajaj Allianz Life Insurance Co. on 18 June, 2020
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB,
CHANDIGARH.
Consumer Complaint No.807 of 2018
Date of institution : 11.10.2018
Reserved on : 10.06.2020
Date of decision : 18.06.2020
Jasbir Kaur w/o Shri Rachpal Singh, R/o Village Dubli, Post Office
Dubli, Tehsil Patti, District Tarn Taran, Punjab-143 401.
.......Complainant
Versus
1.Bajaj Allianz Life Insurance Company Limited having its registered office at GE Plaza, 5th Floor, B Wing, Airport Road, Yerawada, Pune, Maharashtra-411 006, through its Authorised Signatory.
2. Bajaj Allianz Life Insurance Company Limited having its Branch Office at First Floor, Navdeep Complex, opposite to Income Tax Office, Patiala, Punjab-147 001, through its Branch Manager/Authorised Signatory.
e-mail: [email protected] ........Opposite Parties Consumer Complaint under Section 17(1)(a)(i) of the Consumer Protection Act, 1986.
Quorum:-
Hon'ble Mr. Justice Paramjeet Singh Dhaliwal, President
1) Whether Reporters of the Newspapers may be allowed to see the Judgment? Yes/No
2) To be referred to the Reporters or not? Yes/No
3) Whether judgment should be reported in the Digest? Yes/No Consumer Complaint No.807 of 2018 2 Argued by:-
For the complainant : Shri Shubham Mehta, Advocate. For the opposite parties: Shri Nitin Thatai, Advocate. JUSTICE PARAMJEET SINGH DHALIWAL, PRESIDENT:
The complainant, Jasbir Kaur, has filed this consumer complaint under Section 17(1)(a)(i) of the Consumer Protection Act, 1986 (in short, "C.P. Act") for issuance of following directions to the opposite parties:-
i) to pay ₹19,80,000/- (sum assured) along with interest @ 18% per annum;
ii) to pay ₹5,00,000/-, as compensation, for deficiency in service and adoption of unfair trade practice;
iii) to pay ₹5,00,000/-, as compensation, for mental stress and agony undergone by the complainant;
iv) to pay a sum of ₹50,000/-, as litigation charges; and
v) to grant interest @ 18% on the above amounts.
Facts of the complaint:
2. Brief facts as averred in the complaint are to the effect that the son of the complainant; namely, Sandeep Singh, had purchased an insurance policy known as "Bajaj Allianz Invest Assure" bearing No.0329403663 from opposite party No.2; being Branch Office of opposite party No.1-Bajaj Allianz Life Insurance Company Ltd. and she was the nominee under the said policy. It is further averred that the date of commencement of the policy was 14.7.2016 and the date of maturity was 13.7.2046. The total term of the policy was 30 years Consumer Complaint No.807 of 2018 3 and term for the payment of entire premium was 20 years. The premium of the policy was ₹20,031/- payable half-yearly including taxes. The total sum assured under the policy, payable on the occurrence of the death of the policy holder is ₹19,80,000/- and the amount payable on maturity is ₹9,90,000/-. It is further averred that the son of the complainant was a hale and hearty man and had no history of any ailment or infirmity. Unfortunately on 25.7.2016 during the subsistence of the said policy the son of the complainant was bitten by a poisonous snake and thereafter the deceased policy holder was immediately rushed to Baba Bidhi Chand Multi Specialty Hospital, Chuslewar, Patti Morh, District Tarn Taran. However, he died on the same day. The complainant; being the nominee, lodged the insurance claim under the said policy. However, the claim of the complainant was not decided and the same was delayed on one pretext or the other for the reasons best known to the opposite parties. A legal notice dated 23.8.2018 was served upon the opposite parties for releasing the claim amount, which was due since last two years. It is further averred that on 17.9.2018 reply to the said legal notice was received from the opposite parties in which the bona fide death claim was wrongly and erroneously repudiated on the sole baseless ground that the profile of deceased life assured was mis-represented during the proposal stage. It was also stated that the Company had already intimated its decision of repudiation of the death claim of the complainant, vide repudiation letter dated 13.11.2017. However, as a matter of fact no such intimation letter Consumer Complaint No.807 of 2018 4 for repudiation of the death claim was ever received by the complainant or her any other family member. Now in order to save their skin and with an ulterior and oblique motive the opposite parties are concocting false facts. It is further averred that if there was mis-
representation at the proposal stage, then the opposite parties ought not to have issued the policy and should have refunded the premium amount paid by the deceased son of the complainant. After the commencement of the policy and subsequent to the death of the life assured, the genuine claim has been repudiated on the basis of false and frivolous grounds, which are not supported by any documentary evidence with the sole intention of avoiding their liability. The fact of the death of the policy holder is supported by the authentic report of a reputed hospital. Alleging deficiency in service and adoption of unfair trade practice on their part the present complaint was filed for issuance of above mentioned directions to the opposite parties. Defence of Opposite Parties:
3. Upon notice opposite parties appeared and filed their joint reply taking preliminary objections to the effect that the complainant has attempted to misguide and mislead this Commission. The complaint is not maintainable and no cause of action has ever arisen in favour of the complainant to file the same. The complaint is an abuse of process of law. The deceased life assured submitted a proposal/application dated 11.7.2016 for the purchase of "Invest Assure Gold Plan", which was accepted on the standard rates based on the information provided by him. Consequently the policy in Consumer Complaint No.807 of 2018 5 question was issued with the date of commencement 14.7.2016 with the premium of ₹20,080/- payable semi-annually for a total sum assured of ₹19,80,000/-. The term of the policy was 30 years and the premium paying term was 20 years in which the complainant was appointed as nominee. The complaint is an afterthought and has only been filed with the ulterior motive to harass and humiliate the opposite parties. There are some fundamental principles of insurance particularly the principle of utmost good faith, which are binding on the part of both the parties i.e. insurer and the insured, who are expressly bound to disclose all relevant material facts pertaining to the contract. The said doctrine is applicable in the insurance law and both the parties are expected to adhere to a high degree of honesty. Based on such faith the insurer and the insured execute the contract of insurance. Non-compliance by either party or any non-disclosure of the relevant facts rendered the contract null and void. Since the so called executant of the proposal form i.e. Sandeep Singh, DLA, was not alive at the time of purchasing/applying for the policy and the policy was obtained by the nominee and her other family members in collusion with the agent i.e. Advisor who sold the policy on behalf of the opposite parties and the policy was issued in the name of dead person, therefore, the same was null and void and cannot be enforced as per law. The nominee and other family members had obtained the said policy fraudulently by misrepresentation of the facts in the name of Sandeep Singh, DLA, who in fact died on 16.6.2016 much prior to Consumer Complaint No.807 of 2018 6 the submission of the proposal form and issuance of the policy regarding which DDR No.17 dated 17.6.2016, Ex.OP-7, was recorded in PS-Sadar, Patti. Since the policy was purchased in the name of a dead person i.e. Sandeep Singh, DLA, who died much prior to the execution of the proposal form and issuance of the policy, fraudulently with the intention to cheat and defraud the opposite parties, therefore, the opposite parties have rightly and legally repudiated the claim of the complainant, vide repudiation letter dated 13.11.2017, Ex.OP-8. On merits also similar averments have been made as made in preliminary objections. Denying any deficiency in service or adoption of unfair trade practice on their part a prayer for dismissal of the complaint was made; being false and frivolous.
Evidence of the Parties:
4. In order to prove her case the complainant annexed with the complaint her own affidavit dated 9.10.2018 along with documents i.e. copy of policy along with proposal form dated 14.7.2016 and 11.7.2016 as Ex.C-1 (Colly), copy of death certificate dated 25.7.2016 as Ex.C-2, copy of Report of Hospital dated 25.7.2016 as Ex.C-3, copy of acknowledgement of receipt of the Death Claim dated 16.6.2017 as Ex.C-4, copy of legal notice dated 23.8.2018 as Ex.C-5 and copy of reply to the legal notice/repudiation letter dated 17.9.2018 as Ex.C-6.
5. On the other hand, opposite parties annexed with the reply self-attested affidavit of Nitin Arora, Assistant Manager (OPs) and Consumer Complaint No.807 of 2018 7 documents i.e. copy of Authorization dated 19.3.2019 as Ex.OP-1, copy of Proposal Form dated 11.7.2016 as Ex.OP-2, copy of Insurance Policy dated 14.7.2016 as Ex.OP-3, copies of letters dated 17.10.2017, 25.11.2017 and 12.12.2017 as Ex.OP-4 to Ex.OP-6, copy of DDR dated 17.6.2016 as Ex.OP-7 and copy of repudiation letter dated 13.11.2017, as Ex.OP-8.
6. I have heard the learned counsel for the parties and have carefully gone through the record of the case. I have also gone through the written arguments submitted by both the sides. Contentions of the complainant:
7. The sum and substance of oral as well as written arguments of the learned counsel for the complainant is that the deceased life assured was bitten by a snake on 25.7.2016 and was rushed to Baba Bidhi Chand Multi Speciality Hospital, Patti Morh, District Tarn Taran, where he died on the same day. Reference was made to the death certificate of the deceased life assured and the report of Dr. Narvail Singh of the concerned Hospital, Ex.C-2 and Ex.C-3, respectively. It was further argued by the learned counsel for the complainant that the opposite parties repudiated the legal and valid claim in respect of the death of the deceased life assured on the ground that the deceased life assured had already died on 17.6.2016 before taking of the policy in question, vide repudiation letter dated 13.11.2017, Ex.OP-8. However, both the documents i.e. Ex.C-2 and Ex.C-3 are public documents and its authenticity cannot be doubted. It was prayed that this complaint is liable to be allowed and all the Consumer Complaint No.807 of 2018 8 directions as prayed for are liable to be issued to the opposite parties.
8. Per contra, the sum and substance of the oral as well as written arguments of the learned counsel for the opposite parties is that in fact Sandeep Singh, deceased life assured, had already died on 17.6.2016 much prior to the submission of the proposal form and issuance of the policy in question in respect of which DDR No.17 dated 17.6.2016 was recorded in PS-Sadar, Patti, Ex.OP-7. Since the policy was purchased in the name of a dead person, who died much prior to the execution of the proposal form and issuance of the policy, fraudulently with the intention to cheat and defraud the opposite parties, therefore, the opposite parties have rightly and legally repudiated the claim of the complainant after taking into consideration the provisions of Section 45 of the Insurance Act, 1938, vide repudiation letter dated 13.11.2017, vide Ex.OP-8. It was further argued that the case involves complicated and disputed questions of facts and law, which require voluminous evidence oral as well as documentary including examination and cross- examination of witnesses. The same can well be examined in the Civil Court of competent jurisdiction. Reference was made to the following judgments:-
i) "Oriental Insurance Company Ltd. v. Munimahesh Patel" 2006(7) SCC 655;
ii) "Citimake Builders Pvt. Ltd. v. Samata Sahakari Bank Ltd." 2012(4) CPR (NC) 376;Consumer Complaint No.807 of 2018 9
iii) "Vishamber Sunderdas Badlani And Anr. v. Indian Bank And 3 Ors." 2008(1) CPR 76; and
iv) "United India Insurance Co. Ltd. v. Dwarika Dhees Industries" 2008(3) CLT 481.
It was prayed that since the complaint involves allegations regarding fraudulently taking of the policy in question in respect of a dead person and as such the parties may be relegated to Civil Court of competent jurisdiction for the resolution of such disputed and complicated questions of facts and law involved therein. Consideration of Contentions:
9. I have given my thoughtful consideration to the contentions raised by both the learned counsel for the parties oral as well as written and have gone through the records of the case very carefully.
10. According to the complainant Sandeep Singh son of Shri Rachpal Singh, deceased life assured, was bitten by a poisonous snake on 25.7.2016 during the subsistence of the insurance policy in question and was brought to Baba Bidhi Chand Multi-Speciality Hospital, Patti Morh, District Tarn Taran, where he died on the same day. The complainant produced on record a copy of death certificate of Sandeep Singh, deceased life assured, as Ex.C-2, issued by Local Registrar, Births and Deaths, Chuslewar, Patti Morh, District Tarn Taran. A perusal of Ex.C-2 reveals that Sandeep Singh son of Rachpal Singh died on 25.7.2016 at Baba Bidhi Chand Hospital, Tarn Taran. In addition to this, the complainant also produced on record a Certificate issued by Dr. Narvail Singh, M.B.B.S., Consumer Complaint No.807 of 2018 10 Ex.P.C.M.S.-1, Medical Superintendent of B.B.C. Multispeciality Hospital, Chuslewar, Patti Morh, Tarn Taran as Ex.C-3 and the same reads as under:-
"It is certified that Mr. Sandeep Singh 32Y/M s/o Rashpal Singh R/o VPO Dubli, Tehsil Patti, District Tarn Taran was brought (wrongly written as broad) in our hospital in gasping condition on dated 25.7.2016 and died on same day due to snake bite."
The only dispute raised by the opposite parties is with regard to the date of death of the deceased life assured and made reference to DDR No.17 dated 17.6.2016 registered at PS-Sadar, Patti, District Tarn Taran, Ex.OP-7, at the instance of Gurjant Singh son of Rachpal Singh, Caste Jat Sikh, resident of Village Dubli, PS-Sadar, Patti, in which the date of death of the deceased life assured is mentioned as 17.6.2016 due to bite by some poisonous living thing. A perusal thereof reveals that Sandeep Singh, deceased life assured had gone to fields at about 8.00 P.M. in the night of 16.6.2016 and it came to light at 6.00 to 7.00 A.M. in the morning that Sandeep Singh was lying dead due to bite by some poisonous living thing in the fields. In these circumstances the dispute is with regard to the date of death of the deceased life assured. Both the documents i.e. Death Certificate, Ex.C-2 and the DDR, Ex.OP-7, are public documents and have been issued by the respective authorities in due course of their official duties. To find out the real and true facts voluminous evidence by way of examination and cross-examination Consumer Complaint No.807 of 2018 11 of witnesses i.e. villagers and relatives of the deceased life assured and the officials of the above said two authorities would be required. The proceedings before this Commission are summary in nature and elaborate evidence is required to be led for the purpose of proving the actual date of death, which is crucial for just decision of this complaint.
11. In view of all these facts, I am of the considered view that there are allegations and counter allegations of fraud and fabrication against both the parties, which are complex and very serious. It is true that where there are mere allegations of fraud, Fora under the C.P. Act can decide the same but where there are allegations which are very complex and serious as in the present case, the same can only be decided in Civil Court proceedings, as the parties shall have opportunity to examine and cross-examine the witnesses and may be in a position to find out the truth in the respective averments.
12. In Munimahesh Patel's case (supra) the specific stand of the appellant before the Commission was that there was mis-declaration in the Proposal Form, in which it was mentioned that the respondent's wife was a teacher; which appeared to be not correct position and it was also accepted that she was really not a teacher. It was held that the proceedings before the Commission are essentially summary in nature and the adjudication of issues, which involved disputed factual question, should not be adjudicated upon. Hon'ble Supreme Court has made the following observations:- Consumer Complaint No.807 of 2018 12
"The Commission noted that the specific stand of the appellant was that there was mis-declaration in the proposal form and the false claim that the respondent's wife was a teacher which as now appears is not the correct position. It also accepted that she was really not a teacher.
Proceedings before the Commission are essentially summary in nature and adjudication of issues which involve disputed factual questions should not be adjudicated. It is to be noted that the Commission accepted that the insured was not a teacher. The complainant raised a dispute about the genuineness of the documents (i.e. proposal forms) produced by the appellant.
The Commission having accepted that there was wrong declaration of the nature of occupation of the person insured, should not have granted the relief in the manner done.
The nature of proceedings before the Commission as noted above, are essentially in summary nature. The factual position was required to be established by documents. The Commission was required to examine whether in view of the disputed facts it would exercise the jurisdiction. The State Commission was right in its view that the complex factual position requires that the matter should be examined by an appropriate Court of law and not by the Commission."
The ratio of above judgment fully applies to the facts of the present case. The dispute involved in this complaint is such that the same cannot be decided in the summary proceedings and a thorough inquiry is liable to be conducted and such an inquiry can be Consumer Complaint No.807 of 2018 13 conducted only by the Civil Court. Other judgments relied upon by the learned counsel for the opposite parties are also fully applicable to the facts of the present case.
13. In view of my above discussion, the complainant is relegated to Civil Court to avail her remedy in accordance with law, if she is so advised and she may be entitled to the benefit of the observations of the Hon'ble Supreme Court in "Laxmi Engineering Works v. P.S.G. Industrial Institute" reported in II(1995) CPJ 1 (SC): (1995) 3 SCC 583, for the purpose of exclusion of time spent before this Commission for the purpose of computation of limitation. The consumer complaint is disposed of accordingly.
14. The above observations made by me are only for the purpose of disposal of the present complaint and shall not be construed as an expression of final opinion on the merits of the claim made by the complainant. The suit shall be decided on its own merits, uninfluenced by any observations made above.
15. The consumer complaint could not be decided within the statutory period due to heavy pendency of court cases.
(JUSTICE PARAMJEET SINGH DHALIWAL) PRESIDENT June 18, 2020 Bansal Consumer Complaint No.807 of 2018 14