National Consumer Disputes Redressal
Paramjit Kaur vs Aviva Life Insurance Co. India Ltd. on 14 March, 2016
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI FIRST APPEAL NO. 1173 OF 2014 (Against the Order dated 04/07/2014 in Complaint No. 96/2011 of the State Commission Punjab) 1. PARAMJIT KAUR W/O. LATE SH. KULDEEP SINGH GILL, R/O. STREET NO. 2, MATA GEE VEE NAGAR, BARNALA BYE PASS, BATHINDA PUNJAB ...........Appellant(s) Versus 1. AVIVA LIFE INSURANCE CO. INDIA LTD. THROUGH ITS BRANCH NMANAGER, NEAR AXIS BANK, TH MALL, BATHINDA PUNJAB ...........Respondent(s)
BEFORE: HON'BLE MR. JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER
For the Appellant : Mr. Gagan Gupta, Advocate For the Respondent : MS. NEERJA SACHDEVA
Dated : 14 Mar 2016 ORDER
PER JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER
This appeal has been filed by the appellant against the order dated 04.07.2014 passed by the Punjab State Consumer Disputes Redressal Commission, Chandigarh (in short, 'the State Commission') in Complaint Case No.96/2011 - Paramjit Kaur Vs. Aviva Life Insurance Co. India Ltd. by which, complaint was dismissed as not maintainable.
2. Brief facts of the case are that opposite party/respondent, through its advisor Jyoti, approached the deceased Kuldeep Singh husband of Complainant/appellant for the sale of Unit Like Plan with the principal basic sum insured for Rs.14,00,000/-, along with double accidental benefit. On the assurance given by the said advisor he purchased unit linked policy with effect from 25.5.2007 with the regular premium amount of Rs.1,00,000/- per annum. He was not aware of the technicalities of the insurance and signed the blank proposal form in Punjabi on 27.4.2007. Under the policy, he was covered for a basic sum of Rs.14,00,000/-, along with accidental benefit of the same amount. On 20.6.2010 he died in a motor vehicular accident leaving behind her as his widow and two minor children; namely, Harmanpreet Singh Gill and Akashpreet Kaur Gill and mother Hardial Kaur, regarding which DDR No.12 dated 20.6.2010 was registered in PS-Sadar, Rampura and post mortem examination was conducted on his dead body in Civil Hospital, Rampura Phul. She, being the nominee, submitted the death claim form along with the documents to the opposite party, vide registered letter dated 16.9.2010. She enquired about her claim from the opposite party many a times, but it failed to give any satisfactory reply. Ultimately, her claim was rejected, vide letter dated 4.10.2010 on the ground that the deceased did not disclose that he was having policies of Rs.13,00,000/- with the LIC. Only a sum of Rs.2,47,969/- was paid to her, being the unit fund value, against the sum of Rs.3,00,000/- deposited by way of premiums. The rejection of her claim by the opposite party is illegal and arbitrary, against the facts and circumstances and is not binding on her rights. She filed a representation through her counsel before the Claim Review Committee in November 2010 but she did not receive any reply from that Committee. Alleging deficiency on the part of OP, complainant filed complaint before State Commission. OP resisted complaint, but admitted that the policy in question was obtained by Kuldeep Singh deceased in respect of which premium of Rs.1,00,000/- was paid and the sum assured was Rs.14,00,000/-; in addition to another sum of Rs.14,00,000/- for accidental death. It also admitted the repudiation of the claim made by the complainant after the death of the deceased/insured. It also admitted that the complainant filed her representation before the Claims Review Committee. While denying other allegations made in the complaint, it was pleaded that at the time of filling up of the proposal form the insured suppressed the material facts regarding previous policies. He was duty bound to reveal all the relevant material facts in order to obtain the insurance policy. A detailed investigation was made by it and it came to its notice that the insured had obtained life insurance policies from other Life Insurance Companies for a total amount of Rs.13,00,000/-, before obtaining the policy in question and still in the proposal form he mentioned that he was not holding any such life insurance policy. The details of the insurance policies, which he had obtained from the other Life Insurance Companies, are given in para no.2 of the preliminary objections. The non-disclosure of the material facts amounts to violation of the terms and conditions of the insurance policy. It's liability is governed by those terms and conditions and by virtue of those terms and conditions the claim made by the complainant was repudiated and was declared as void without any benefit. However, as a special case the fund value has been paid as an ex-gratia. The sum of Rs.2,47,969/- was paid as such, vide cheque dated 4.10.2010. The payment of that amount does not amount to admission of its liability. On account of non-disclosure of the previous policies the contract of insurance is void ab initio and nothing more is payable under the insurance policy to the complainant. The representation made by the complainant before the Claims Review Committee was put up before it on27.1.2011 and her claim was finally not approved for payment. It was also pleaded that intricate and disputed questions of facts have been raised in the complaint, which cannot be decided under the summary jurisdiction of the Consumer Courts; as the same requires extensive evidence to be led and prayed for the dismissal of the complaint. Learned State Commission after hearing both the parties dismissed complaint as not maintainable as under the policy money was invested for speculative business against which, this appeal has been filed.
3. Heard learned Counsel for the parties finally at admission stage and perused record.
4. Learned Counsel for the appellant submitted that as policy was obtained for life along with accidental benefits and not for speculative purpose, learned State Commission committed error in dismissing complaint as not maintainable on the ground of investment for speculative business; hence, appeal be allowed and impugned order be set aside and mater may be remanded back to the learned State Commission to decide complaint on merits. On the other hand, learned Counsel for the respondent submitted that order passed by learned State Commission is in accordance with law; hence, appeal be dismissed.
5. Perusal of disputed policy reveals that it was named as Life Long Unit Linked Fund and sum insured was Rs. 14,00,000/- and regular annual premium amount was Rs.1,00,000/-. It also covered accidental benefits of Rs.14,00,000/-. Learned State Commission observed that complaint was not maintainable in the light of judgment of this Commission in III (2013) CPJ 203 (NC) - Ram Lal Aggarwalla Vs. Bajaj Allianz Life Insurance Co. Ltd. & Anr. whereas, perusal of aforesaid judgment reveals that in the aforesaid case Unit Gain Super Diamond Policy was taken with Rs. 2,00,000/- annual premium for 24 years. Policy in the aforesaid case was for investment purpose whereas, disputed policy is for covering life as well accidental benefit and this policy cannot be equated with policy in the case of Ram Lal Aggarwalla (Supra). Learned State Commission has committed error in dismissing complaint as not maintainable as policy was for investment in speculative business. Learned Counsel for the petitioner has placed reliance on judgment of this Commission in 2012 Law Suit (CO) 606 - Met Life India Insurance Co. Ltd. Vs. Addanki Satyanarayana in which claim for unit linked policy with life insurance was held maintainable before Consumer Fora, though, in that policy maturity value was 2,51,73,756/- and death benefit was only Rs.5,02,000/- whereas in the case in hand, sum assured was Rs.14,00,000/- along with accidental benefits of same amount. Thus, it becomes clear that complaint filed by the complainant was maintainable before learned State Commission and learned State Commission committed error in dismissing complaint as not maintainable and appeal is to be allowed.
6. Consequently, appeal filed by the appellant is allowed and impugned order dated 04.07.2014 passed by the learned State Commission in Complaint Case No.96/2011 - Paramjit Kaur Vs. Aviva Life Insurance Co. India Ltd. is set aside and it is held that complaint is maintainable before learned State Commission and learned State Commission is directed to decide complaint on merits as per law.
7. Parties are directed to appear before learned State Commission on 26.4.2016.
......................J K.S. CHAUDHARI PRESIDING MEMBER