JUSTICE AJIT BHARIHOKE, PRESIDING MEMBER

This appeal is directed against the order of the State Commission Punjab dated 01.06.2017 in complaint case no. 309/2016.

2.         Briefly stated, the facts relevant for the disposal of the appeal are that Sukhdev Singh ( since deceased), husband of the complainant purchased life insurance policy from the appellant / insurance company in August 2015.  The basic sum assured was Rs.24,00,000/-. The agreed premium was Rs.15,000/- per quarter.  The first premium was paid on 18.08.2015 upon which cover note was issued on the same day which was followed by insurance policy no.21657741 having commencement date as 23.08.2015.  The husband of the respondent/ complainant died on 19.10.2015 due to heart attack.  The respondent / complainant being nominee and widow of deceased Sukhdev Singh approached the opposite party / insurance company and submitted the insurance claim.  The appellant / opposite party, however, rejected the claim vide letter dated 26.05.2016 on the premise that insurance policy was purchased by practicing fraud by concealing the fact that Sukhdev Singh had already died prior to applying for insurance policy.  Being aggrieved of the repudiation of the insurance policy, the respondent Balwinder Kaur filed consumer complaint in the State Commission.

3.         The opposite party upon notice filed written statement taking the objection that complainant is not a consumer. There is no legally valid insurance contract  between the parties because the life assured had expired on 09.08.2015 prior to the submission of proposal form for the insurance cover dated 18.08.2015 purported to have been submitted by Sukhdev Singh.  It is submitted that on receipt of death claim, as it was a case of early death within two months of the issuance of the policy, the appellant / opposite party got the investigation carried out which revealed that death certificate submitted alongwith insurance claim by the complainant was forged and the said death certificate was cancelled by the Registrar of Birth and Death, who confirmed that the insured died on 09.08.2015.

4.         The  State Commission on evaluation of the pleadings and evidence allowed the insurance claim and directed as under:

“1. to pay Rs.24,00,000/- as the basic sum assured under the policy Ex.C-3 along with interest at the rate of 9% per annum from the date of repudiation of the claim i.e. 26.05.2016 till realization.  It is made clear that if the above said amounts of Rs.12,1999.63P and Rs.6.40P were transferred to the account of the complainant, then the same be deducted form the basic sum assured of Rs.24,00,000/- otherwise the entire amount shall be payable by the opposite parties as mentioned above;

2.  to pay Rs.2,00,000/- as compensation for harassment and mental agony suffered by the complainant, and;

3.  to pay Rs.20,000/- as litigation expenses.”

The opposite parties shall comply with this order within 30 days of the receipt of certified copy of the same, failing which the compensation amount shall also carry interest at the rate of 9% per annum from the date of passing of this order till realization.”

5.         Being aggrieved of the order of the District Forum, the appellant / insurance company has preferred this appeal.

6.         Mr. Ritesh Khare, Advocate for appellant / insurance company has taken me through the proposal form purportedly submitted by late Sukhdev Singh for purchase of insurance policy as also copy of the insurance policy.  It is submitted that from the perusal of the aforesaid documents, it would be seen that as per the stand of the complainant, late Sukhdev Singh applied for insurance policy on 14.08.2015 and policy was issued subsequently mentioning the commencement date of the insurance cover w.e.f. 23.08.2015.  It is argued that since the death of Sukhdev Singh took place within a short period from the date of the issue of insurance policy, investigation was got conducted by the appellant and investigation revealed that insurance policy has been obtained by practicing fraud on the insurance company by concealing the fact that on the date of submission of proposal form, Sukhdev Singh was already dead as he died on 09.08.2015. 

7.         Learned counsel for the respondent / complainant on the contrary has argued in support of the impugned order.  From the pleadings and submissions made on behalf of the parties, it is clear that core question which needs to be answered in this appeal is as to the date of death of Sukhdev Singh. It is to be seen whether Sukhdev Singh died on 09.08.2015 or on 19.10.2015 as claimed by the respondent / complainant.

8.         Annexure OP-3 is the copy of report of investigating agency SA Associates.  The relevant observations in the investigation report pertaining to date of death of the life assured Sukhdev Singh are reproduced as under:

“Vicinity Survey:

Kundra Medical Store, Main Bazar Poonga – As per submitted written statement LA was brought dead in store. LA was declared dead in store.  We met owner of medical store and asked him to verify his written statement. We discussed the matter with him as LA died on dated 09.08.2015 and he issued written statement of dated 19.10.2015.  He stated that he issued written statement on advise of LA’s family member.  He did not verify his written statement.

Medical stores of Amritsar

1.         Badrinath Medical Store

2.         Guru Nanak Medical Store

3.         Arun Medical Store

We visited above mentioned medical stores and checked record but no information of LA was found

Hospitals of  Amritsar

1. Bajwa Hospital, Ajnala

2.  Dr. Bhangu Hospital, Ajnala

3.  Mundh Hospital, Ajnala

We visited above mentioned hospitals and checked record but no record of LA was found

MPHC Ramdas Dist-Amritsar-We visited MPHC and met ANM-Parmjeet Kaur and discussed the matter with her.  As per vicinity survey LA died in Aug 2015 and she issued DC of dated 19.10.2015. After long discussion and pressure she admitted that LA died on dated 09.08.2015. She cancelled DC. Cancelled DC enclosed.

Interviews from neighbours / friends and workmates:

During the vicinity survey in residential area of LA we asked from several villages. They stated that LA had died in August 2015. LA was alcoholic person.  LA died due to severe chest pain.  LA had no land.  LA was labourer and he was earning around Rs.70,000/- p.a.

We met nominee-Mrs. Balwinder Kaur and asked about LA.  She stated that she has no any paper related to LA. She stated that they have no insurance policy in any company.  We visited nominee’s home 3-4 times but she showed us inability providing any paper.  We took photograph of LA’s home and nominee.

In this case Sarpanch, Aganwari worker and other persons are involved.  The adviser of case is doctor who did  not meet us.

Also, we collected ITR of LA.  In ITR LA’s income is given Rs.2,99,060/- p.a.

9.         On reading of the above, it is evident that report of Investigator is purported to be based upon the investigation done in the neighbourhood but no concrete evidence in the form of statement of neighbours or the proprietor of Kundra Medical Store, Main Bazar Poonga have been annexed with the report of the investigator nor any such evidence has been produced by the opposite party.  The main plank of argument of the appellant / insurance company is that when the investigator visited MPHC Ramdas District-Amritsar and discussed the matter with ANM Parmjeet Kaur, who admitted that life assured died on 09.08.2015 and cancelled the death certificate showing the date of death of the life assured as 19.10.2015.  Photocopy of cancelled death certificate is also placed on record but it is illegible.  It is pertinent to note that in the cancelled death certificate, the date of death of life assured Sukhdev Singh is not mentioned.   On the contrary, respondent complainant had produced the death certificate of late Sukhdev Singh purported to have been issued by concerned authority wherein date of death of Sukhdev Singh is shown as 19.10.2015.  It may be noted that respondent has filed attested copies of death register in Punjabi containing relevant entry pertaining to date of death of Sukhdev Singh on 19.10.2015. The respondent has also placed on record original death certificate issued by the concerned authority on 19.12.2017 showing the date of Sukhdev Singh as 19.10.2015.  From the aforesaid document, it stands established that Sukhdev Singh died on 19.10.2015 more so because of the fact that appellant / insurance company has failed to lead cogent evidence to prove otherwise.

10.       In view of the discussion above, I do not find any fault with the well reasoned order of the State Commission.  Appeal is accordingly dismissed and appellant / opposite party is directed to comply with the order of the State Commission within one month.