State Consumer Disputes Redressal Commission
Reliance Life Insurance Co. vs Prem on 26 February, 2018
Daily Order STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA First Appeal No : 1236 of 2017 Date of Institution: 16.10.2017 Date of Decision : 26.02.2018 Reliance Life Insurance Company Limited, SCO 55-56, Scheme No.6, Gandhi Nagar, Jind District Jind, through its Manager. Appellant-Opposite Party Versus Prem son of late Shri Rupa, Resident of Village Dharma Kheri, Tehsil Hansi, District Hisar. Respondent-Complainant CORAM: Hon'ble Mr. Justice Nawab Singh, President. Mr. Balbir Singh, Judicial Member.
Argued by: Shri Rohit Goswami, Advocate for appellant. Shri Sansar Kundu, Advocate for respondent. O R D E R BALBIR SINGH, JUDICIAL MEMBER
This appeal has been preferred against the order dated July 14th, 2017 passed by District Consumer Disputes Redressal Forum, Jind (for short 'the District Forum') in Complaint No.172 of 2015.
2. Smt. Lilam (since deceased) wife of complainant-Prem (respondent herein) during her life time purchased a Life Insurance policy bearing No.50562972 mentioning the total sum assured as Rs.6,00,000/- from Reliance Life Insurance Company Limited (for short 'the Insurance Company') - Opposite Party (appellant herein. The policy commenced from December 05th, 2012 and date of maturity was December 05th, 2042. The premium payable was Rs.18,288.60 yearly. The complainant being husband of the life assured - Lilam was mentioned as nominee in the insurance policy. During the insured period on January 04th, 2013 the life assured died due to heart attack at Village Dharam Kheri, District Hisar. The complainant being nominee submitted insurance claim alongwith all relevant documents with the opposite party. The insurance claim of the complainant was repudiated on the plea that the life assured concealed material facts and represented that she was running a Karyana shop and Boutique in her Village at the time of submitting proposal form. In fact, the proposal form was filled up by agent of the Insurance Company and signatures of the life assured were obtained on the proposal form. It is pleaded that no wrong information was given to the opposite party by the complainant and the insurance claim of the complainant has been wrongly repudiated.
3. The present complaint has been filed by the complainant under Section 12 of the Consumer Protection Act with a prayer to direct the opposite party to pay the total sum assured amount of Rs.6.00 lacs to the complainant with interest at the rate of 18% per annum from the date of default and to pay an amount of Rs.50,000/- on account of unnecessary harassment and mental agony.
4. The Opposite Party - Insurance Company in its written version has taken plea that the complaint is barred by limitation; that the complaint is not maintainable in the present form; that the District Forum has no jurisdiction to decide this complaint and that the life assured Lilam concealed material facts and represented regarding her income stating that she used to earn income by running a Karyana shop and boutique. It is pleaded that the application alongwith proposal form regarding providing the insurance policy was received in the office of the opposite party through Rajinder Singh agent. She applied for providing insurance policy in Reliance Endowment Plan. Believing the information regarding income, state of health as provided in the proposal form as correct, the insurance policy was issued on December 05th, 2012 mentioning the total sum assured as Rs.6.00 lacs. After receiving information regarding death of the life assured, M/s Rapid India Limited, New Delhi was appointed as surveyor. The surveyor after proper investigation and recording statements of the witnesses gave opinion that the life assured was a household lady and she was not earning any income and the insurance policy was obtained by her with an ulterior motive just to cause wrongful loss to the Insurance Company. The Insurance Company rightly repudiated the insurance claim of the complainant. The opposite party has prayed that the complaint filed by the complainant be dismissed with cost.
5. Parties led evidence in support of their respective claims before the District Forum.
6. After hearing arguments, vide impugned order dated July 14th, 2017, the complaint filed by the complainant was allowed directing the opposite party - Insurance Company to pay an amount of Rs.6.00 lacs being total sum assured to the complainant with interest at the rate of 9% per annum from the date of filing of the complaint and to pay an amount of Rs.5,000/- in lump sum as compensation on account of un-necessary harassment and mental agony. If the awarded amount is not paid within 30 days from the date of receipt of the order, the complainant shall be entitled to receive interest at the rate of 12% per annum.
7. Aggrieved with the impugned order dated July 14th, 2017 the Insurance Company - Opposite Party has filed the instant First Appeal No.1236 of 2017 with a prayer to set aside the impugned order and to dismiss the complaint.
8. We have heard learned counsel for the parties and perused the case file.
9. During the course of arguments there was no controversy of any type that Smt. Lilam (since deceased) wife of the complainant during her life time obtained an insurance policy (Annexure-1) under Reliance Endowment Plan (Regular) mentioning total sum assured as Rs.6.00 lacs and date of commencement as December 05th, 2012 on payment of Rs.18,506.71 as premium. The life assured was required to make payment of an amount of Rs.18,288.60 every year. It is admitted fact that the life assured - Smt. Lilam died on January 04th, 2013 due to heart attack. The complainant, being nominee, submitted his insurance claim along with relevant documents but the insurance claim of the complainant was repudiated by the opposite party mentioning that the life assured submitted wrong information while submitting the proposal form regarding her income and source of income. The Insurance Company was informed that the life assured was running a Karyana Shop and Boutique at Village whereas an independent investigator appointed by the Insurance Company in his report opined that Smt. Lilam was a household lady and she was not earning any income during her life time. On the basis of the report of the investigator, the insurance claim of the complainant was repudiated.
10. In the written version, the plea has also been taken by the opposite party that Smt. Lilam obtained another insurance policy bearing No.19768793 mentioning the total sum assured as Rs.3,30,000/-. The complainant filed an application under Section 22-C of the Legal Services Authorities Act, 1987 before the Permanent Lok Adalat for Public Utility Services, Jind, Haryana. In that case, the insurance claim of the complainant was repudiated on the basis of the report of the surveyor and affidavit of Jagdish Kharab, Sarpanch of Village Panchayat Dharam Kheri. On the basis of affidavit of the complainant (Annexure R-3) and affidavit of Sarpanch Jagdish Kharab (Annexure R-4), the application for acceptance of the insurance claim was rejected. The complainant filed Civil Writ Petition No.6123 of 2016 (Q&M) which is still awaiting decision before the Hon'ble Punjab and Haryana High Court, as is evident from the order dated August 23rd, 2016 (Annexure-3). Copy of the application filed before the Permanent Lok Adalat for Public Utility Services, Jind (Annexure A-4) has been placed on the file. It is mentioned in the report of the investigator (Annexure-5) that Smt. Lilam was a housewife and was not earning any income on the basis of statements of Jaipal Pandey, Bansi Ram and Jagdish Kharab, the then Sarpanch, all residents of Village Dharam Khari, Hisar. The copy of the order passed by the Permanent Lok Adalat has not been adduced in evidence. In these circumstances, any finding regarding annual income and source of income of the life assured cannot be given on the basis of any such order passed in another case by the permanent Lok Adalat for Public Utility Services.
11. It will be pertinent to mention here that when this complaint was pending before the learned District Forum, the complainant tendered in evidence his own duly attested affidavit, a duly attested affidavit of Smt. Mukesh Devi-Village Sarpanch and a duly attested affidavit of Jagdish Kharab, Ex-Sarpanch of Village Dharam Kheri. The complainant as well as the above mentioned two other witnesses, residents of the same village supported the version of the complainant as per statements in their duly attested affidavits (Annexure C-1 and C-3). In these circumstances, findings can be safely given that the life assured Smt. Lilam was running a Karyana shop in her Village and used to earn income. The investigator in his report has mentioned the income of the nominee husband of the life assured as Rs.60,000/- per annum. After close perusal of the entire record placed on the file, we have no hesitation in holding that the life assured Lilam during her life time used to run a Karyana shop in her village and she did not give any wrong information. There is no reason to disbelieve the statement of the complainant as well as Jagdish Kharab, Ex-Sarpanch and Smt. Mukesh Devi, Sarpanch of Village Dharamkheri in the shape of duly attested affidavits Annexures C-1 to C-3. We feel the income of the deceased during her life time was sufficient to save an amount of Rs.18,288.60 every year to deposit annual premium amount with respect to the insurance policy obtained by her. Moreover, this fact also cannot be over looked that deceased Smt. Lilam used to live with her husband and her family members jointly in a small Village. Considering surrounding circumstances and status of the family it can be easily presumed that the complainant-husband of the insured was in a capacity to earn sufficient income to meet the total household expenses. Moreover, both husband and wife were income earning and findings cannot be given that there was any possibility of any problem in future for the insured regarding payment of annual premium amount of Rs.18,288.60. Keeping in mind the income of the husband and wife, the insured was in a position to save an amount of Rs.18,288.60 to make payment of annual premium amount and even of both the insurance policies. Moreover, when husband and wife are living jointly with other family members, saving for such type of investment can be made from the joint family income also. In India females in large number are not doing any income earning work and in these circumstances, findings cannot be given that the insurance policy cannot be provided to those females who are doing only household work. In fact, in a family there is value of household work also. Even on female's contribution to the family by doing household work, certainly the income earned by other family members can be utilized for her also.
12. Moreover, it is strange that when Smt. Lilam life assured submitted the proposal form mentioning her annual income stating that she was running a Karyana shop, any officer of the Insurance Company or the agent did not take trouble to verify regarding profession and annual income of the life assured. It is strange that when the Insurance Company was to increase its income by raising premium amount, the Insurance Company through its agent did not think it appropriate to verify regarding income of the life assured. Unfortunately, as and when the life assured died the Insurance Company started investigation regarding income and profession of the deceased. Keeping in mind all these circumstances, we feel regarding income and age of the life assured, it is not so difficult rather very easy for the Insurance Company to obtain correct information by asking the life assured to provide documents in this regard.
13. Moreover, information is to be received regarding income of the life assured only with the purpose that there should not be any default regarding payment of premium amount in future. In this case, there was no default regarding payment of the premium amount. The insurance claim of the complainant cannot be allowed to be repudiated mainly because the life assured died after a short time from the date of commencement of the insurance policy. On the basis of the statements of Jagdish Kharab Sarpanch recorded by the investigator, findings cannot be given in favour of the opposite party. Statement of Jagdish Kharab, Ex-Sarpanch corroborated by the present Sarpanch of the Village submitted before the District Forum certainly can be given more weight than the alleged statements recorded before the investigator.
14. Apart from it, it is provided under Section 45 of the Insurance Act, 1938 also that no contract shall be avoided by reason of the inaccuracy of a statement in the proposal leading to the issue of a policy unless it is material to the contract. Keeping in mind all the circumstances mentioned above, equity certainly from any angle is in favour of the complainant. Findings can be safely given that Smt. Lilam during her life time used to run a Karyana Shop and she was having sufficient income to make payment of annual premium amount of Rs.18,288.60 to the opposite party.
15. As per discussion above in detail, we find no illegality in the impugned order dated July 14th, 2017 passed by the learned District Forum. Findings of the learned District Forum stand affirmed and the appeal stands dismissed.
16. The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the complainant against proper receipt and identification in accordance with rules, after expiry of period of appeal/revision, if any.
Announced:
26.02.2018 (Balbir Singh) Judicial Member (Nawab Singh) President CL