Palwinder Kaur Aged 38 years wife of Late Sh. Sukhdev Singh S/o Kabal Singh resident of H.No. 22, Village Mulakot, P.O. Bachiwind, Tehsil Ajnala District Amritsar 98761 82455
Complainant
Versus
- Future Generali India Life Insurance Company Limited, Corporate Office India Bulls Finance Centre, Tower 3, 6th Floor, Senapati Bapat Marg, Elphinstone (W) Mumbai 400 013 (Maharashtra) through its Authorized Signatory/Manager/Principal Officer
- Future Generali India Life Insurance Company Limited Branch Office 3rd Floor, SCO 128, Nagpal Tower, Ranjit Avenue, Amritsar through its Branch Head/Manager/Principal Officer
Opposite Parties
Complaint under section 11, 12/13 of the Consumer Protection Act, 1986
Present: For the Complainant : Sh. Amit Monga,Advocate
For the Opposite Parties No.1 & 2 : Sh.Pardeep Arora,Adv.
Coram
Sh.Anoop Sharma, Presiding Member
Ms.Rachna Arora,Member
Order dictated by:
Ms.Rachna Arora, Member
1. Palwinder Kaur, complainant has brought the instant complaint under section 11, 12/13 of the Consumer Protection Act, 1986 on the allegations that opposite party No.1 is Future Generali Life Insurance Company Limited is dealing in the Life Insurance Policies and opposite party No.2 is its branch office situated at Amritsar. The husband of the complainant had obtained a Life Insurance policy i.e. Future Assure from the opposite parties vide policy No. 01157118 and client ID 58113597. The said police was commenced w.e.f. 10.10.2013 and the sum assured was Rs. 12,50,000/- (Rs. 6,25,000/- as a sum assured + Rs. 6,25,000/- as a term rider total comes to Rs. 12,50,000/-) and half yearly premium to be paid fixed for Rs. 13,402/-. The complainant was nominee in the said Insurance policy which was taken by her husband Sukhdev Singh. On 27.10.2013 the husband of the complainant died due to spray pesticides inhale in field. After the death of the husband of the complainant on 4.3.2014 the complainant submitted his claim alongwith all the requisite documents with the opposite party and submitted the death claim form. Now vide impugned communication dated 13.2.2015 the death claim for the policy purchased by the husband of the complainant was rejected by the opposite party by holding that the driving license of the life assured Sukhdev Singh is fake document. At the time of filing the information related to the husband of the complainant the true ad detailed facts as enquired by the opposite parties were provided and all the necessary information related to the applicant and his family members were taken by the officials, who collected the information and relevant documents. Hence, the ground on the basis of which the opposite parties have refused to honor the claim is absolutely baseless and is a clear cut unfair trade practice and deficiency in services. Thereafter the complainant approached the opposite parties many a times for reconsideration of the death claim of her husband Sukhdev Singh, but the opposite parties have done nothing in this respect. Thereafter the complainant approached the Insurance Ombudsman, Chandigarh on 31.12.2015, but till date nothing has been done. The action of the opposite parties No.1 & 2 is absolutely unfair and opposite parties No.1 & 2 are guilty of deficiency in service . Vide instant complaint, complainant has sought for the following reliefs:-
(a) Opposite parties No.1 & 2 be directed to pay the amount of Rs. 12,50,000/- to the complainant being the sum assured as per Insurance policy alongwith interest @ 18% p.a. ;
(b) Compensation to the tune of Rs. 2,00,000/- alongwith litigation expenses to the tune of Rs. 11000/- be also awarded to the complainant.
Hence, this complaint.
2. Upon notice, opposite parties No.1 & 2 appeared and filed a joint written version taking certain preliminary objections therein inter alia that the complainant has not approached this Forum with clean hands. The matter in question is pending before the Ld. Insurance Ombudsman at Chandigarh wherein a hearing was conducted on 12.1.2017 which was duly attended by the opposite party but the complainant has failed to appear before the Insurance Ombudsman. As a result, the Insurance Ombudsman is yet to pass an award and hence there is no question of the same issue being raised before a different Forum ; that the policy in question bearing No. 01157118 is an outcome of a fraud which has been played on the company . That on 27.2.2014, the complainant preferred death claim intimation which was received by the company on 4.3.2014, intimating that the Life Assured had passed away on 27.10.2013 i.e. exactly two days after the risk commencement date of the policy. Subsequently, it came to the knowledge of the company that the Life assured had submitted a fabricated document as age proof while proposing for the policy in question and the same being his driving license and the company was misled to issue the aforesaid policy on the basis of forged documents, as such the present complaint is not maintainable before this Forum ; that this Forum has no jurisdiction to entertain the present complaint. In the present case there are serious issues of forgery, fabrication and criminal conspiracy. Such serious allegations require a proper trial by a civil/criminal court . As such the matter in question involves complicated questions of facts and law requiring voluminous evidence which can only be dealt with by a civil court. On merits, it was submitted that Late Mr.Sukhdev Singh through a duly filled and signed proposal form bearing application No. TNA0026969 dated 9.10.2013 proposed for a basic sum assured and term assurance rider sum assured of Rs. 6,25,000/- each under the Future Generali Assure with Profit Endowment Assurance Plan alongwith which the life assured had submitted a copy of his driving license as Age proof. It was submitted that through the proposal form, the life assured had signed and submitted a declaration. It was submitted that the company relying upon the statements made, answers given and declarations submitted by the Life assured in the proposal form, issued Life Insurance policy bearing No. 01157118 to the life assured on 23.10.2013 with risk commencement dated 25.10.2013. On 4.3.2014 the opposite party company received death claim intimation dated 27.2.2014 from the complainant i.e. exactly two days after the risk commencement date of the policy. It was submitted that since the death of the life assured had occurred within 2 days from the risk commencement date of the policy, hence, the company commenced an investigation into the death claim through an independent investigation agency by the name of “A-ONE INVESTIGATION SERVICES”. It is pertinent to note that the said investigation agency informed the company that the driving license submitted as age proof by the Life assured alongwith the proposal form was a fabricated document. The said investigation agency obtained a certificate from the District Transport Officer of Amritsar which categorically states that the said driving license has not been issued by their office and is a fake document. Considering the abovesaid facts , a crystal clear fraud against the company had been made out and hence the company had repudiated the claim of the complainant and intimated the same to the complaint. It was submitted that being aggrieved by the said decision of the company, the complainant preferred a complaint before the Ld. Insurance Ombudsman at Chandigarh wherein a hearing was conducted on 12.1.2017 which was duly attended by the opposite party but the complainant has failed to appear before the Insurance Ombudsman. As a result, the Insurance Ombudsman is yet to pass an award and hence there is no question of the same issue being raised before a different Forum. It was submitted that the present complaint is an abuse of the process of law and is liable to be dismissed u/s 26 of the Consumer Protection Act. While denying and controverting other allegations, dismissal of complaint was prayed.
3. In his bid to prove the case Sh.Amit Monga,Adv.counsel for the complainant tendered into evidence duly sworn affidavit of the complainant Ex.CW1/A, copy of proposal form Ex.C-1, copy of death certificate of Sukhdev Singh Ex.C-2, copy of repudiation letter Ex.C-3, copy of statement of Sarpanch Ex.C-4, copy of letter dated 13.9.2014 Ex.C-5, copy of certificate issued by Sohal Clinic Ex.C-6, copy of complaint sent to Insurance Ombudsman Ex.C-7, copy of Aadhar card of Palwinder Kaur Ex.C-8, copy of voter card of Palwinder Kaur Ex.C-9 , copy of PAN card of Sukhdev Singh Ex. C-10, copy of Border Fencing Gate Pass Ex.C-11, copy of order of Insurance Ombudsman Ex.C-12 and closed the evidence on behalf of the complainant.
4. To rebut the aforesaid evidence Sh.Pardeep Arora,Adv.counsel for opposite parties No.1 & 2 tendered into evidence affidavit of Sh.Amol Apte, Vice President Legal Ex.OP1/A, copy of proposal form Ex.OP1, copy of driving license Ex.OP2, copy of policy schedule Ex.OP3, copy of claimant statement Ex.OP4, copy of e-mails Ex.OP5, copy of driving license verification Ex.OP6, copy of driving license verification Ex.OP7, copy of repudiation letter dated 13.2.2015 Ex.OP8, copy of e-mail Ex.OP9 and closed the evidence on behalf of opposite parties No.1 & 2.
5. We have heard the ld.counsel for the parties and have carefully gone through the record on the file.
6. The complainant has submitted her affidavit Ex.CW1/A in which she has reiterated the facts as narrated in the complaint and contended that her husband namely Sukhdev Singh had obtained a Life Insurance policy namely Future Assure from the opposite parties vide policy No. 01157118 and client ID 58113597 which was commenced w.e.f. 10.10.2013 and the sum assured was Rs. 12,50,000/- (Rs. 6,25,000/- as a sum assured + Rs. 6,25,000/- as a term rider total comes to Rs. 12,50,000/-) by paying half yearly premium to be paid fixed for Rs. 13,402/-. The complainant was nominee in the said Insurance policy. It was the case of the complainant that on 27.10.2013 her husband died due to spray pesticides inhale in field. After the death of the husband of the complainant , on 4.3.2014 the complainant submitted his claim alongwith all the requisite documents with the opposite party and submitted the death claim form. However, opposite party vide letter dated 13.2.2015 rejected the death claim for the policy purchased by the husband of the complainant by holding that the driving license of the life assured Sukhdev Singh is fake document. It was submitted at the time of filing the information related to the husband of the complainant the true ad detailed facts as enquired by the opposite parties were provided and all the necessary information related to the applicant and his family members were taken by the officials, who collected the information and relevant documents. Now on the false ground the opposite parties have refused to honor the claim which is a clear cut unfair trade practice and deficiency in service on the part of the opposite parties. It was submitted that thereafter she approached the opposite parties many a times for reconsideration of the death claim of her husband Sukhdev Singh, but to no avail. Thereafter the complainant approached the Insurance Ombudsman, Chandigarh on 31.12.2015, but till date nothing has been done. Ld.counsel for the complainant submitted that there is deficiency in service on the part of the opposite parties.
7. On the other hand, ld.counsel for the opposite parties has repelled the aforesaid contention of the ld.counsel for the complainant on the ground that Late Mr.Sukhdev Singh through a duly filled and signed proposal form bearing application No. TNA0026969 dated 9.10.2013 proposed for a basic sum assured and term assurance rider sum assured of Rs. 6,25,000/- each under the Future Generali Assure with Profit Endowment Assurance Plan alongwith which the life assured had submitted a copy of his driving license as Age proof. It was submitted that through the proposal form, the life assured had signed and submitted a declaration. It was submitted that the company relying upon the statements made, answers given and declarations submitted by the Life assured in the proposal form, issued Life Insurance policy bearing No. 01157118 to the life assured on 23.10.2013 with risk commencement dated 25.10.2013. It was submitted that on 4.3.2014 death claim intimation of life assured Sukhdev Singh dated 27.2.2014 was received from the complainant i.e. exactly two days after the risk commencement date of the policy. It was submitted that since the death of the life assured had occurred within 2 days from the risk commencement date of the policy, hence, the company commenced an investigation into the death claim through an independent investigation agency by the name of “A-ONE INVESTIGATION SERVICES”. It is pertinent to note that the said investigation agency informed the company that the driving license submitted as age proof by the Life assured alongwith the proposal form was a fabricated document. The said investigation agency obtained a certificate from the District Transport Officer of Amritsar which categorically states that the said driving license has not been issued by their office and is a fake document. Considering the abovesaid facts , a crystal clear fraud against the company had been made out and hence the company had repudiated the claim of the complainant and intimated the same to the complaint. It was submitted that being aggrieved by the said decision of the company, the complainant preferred a complaint before the Ld. Insurance Ombudsman at Chandigarh wherein a hearing was conducted on 12.1.2017 which was duly attended by the opposite party but the complainant has failed to appear before the Insurance Ombudsman. As a result, the Insurance Ombudsman is yet to pass an award and hence there is no question of the same issue being raised before a different Forum. Ld.counsel for the opposite parties submitted that there is no deficiency in service on the part of the opposite parties and a prayer for dismissal of complaint was made. The ground on which the claim of the complainant has been rejected is for obtaining the Life Insurance policy document i.e. the driving license submitted as age proof by the Life assured alongwith the proposal form was a fabricated document and this fact came to the notice of the opposite parties when on 4.3.2014 death claim intimation of life assured Sukhdev Singh dated 27.2.2014 was received from the complainant i.e. exactly two days after the risk commencement date of the policy and as such then the company commenced an investigation into the death claim through an independent investigation agency by the name of “A-ONE INVESTIGATION SERVICES”, which agency informed the company that the driving license submitted as age proof by the Life assured alongwith the proposal form was a fabricated document. But the ground on which the opposite parties have rejected the claim of the complainant is not genuine as the life assured died died due to spray pesticides inhale in field and in this regard the complainant has produced on record statement of Sarpanch Gurmail Singh which was witnessed by Charanjit Kaur, Jagdip Kaur and Jasbir Singh, Panch as well as Jarnail Singh,Nambardar of the village , who certified that Sukhdev Singh died due to spray pesticides inhale in field on 27.10.2013 and neither FIR was got registered nor postmortem on the body of Sukhdev Singh was got conducted . The copy of statement of Sarpanch is Ex.C-4 on record. This fact was also fortified by the certificate issued by Sohal Clinic , copy of which is Ex.C-6 ,who also confirmed the death of Sukhdev Singh due to spray pesticides inhale in field. As such the ground taken by the opposite parties that driving license submitted as age proof by the Life assured alongwith the proposal form was a fabricated document is not a valid ground as the life assured Sukhdev Singh has not died while driving the vehicle for which the driving license was got issued from the DTO, Amritsar. As such there is no link of the death of life assured Sukhdev Singh with the driving license on which the opposite parties have rejected the genuine claim of the complainant. Moreover it was the duty of the opposite party to check the documents provided by the consumer whether these are legal or not before issuing the policy to the prospective consumer and not after that when the consumer claims under that policy his/her right the Insurance company cannot taken such types of pleas. Moreover the contention of the opposite party that the life assured Sukhdev Singh was not having effective driving license has no relevancy with the death of life assured Sukhdev Singh because the life assured died due to spray pesticides inhale in field. The other contention of the opposite party as the complainant has preferred a complaint before the Ld. Insurance Ombudsman at Chandigarh and the complainant has no right to lodge the said complaint before this Forum is not tenable because as per section 3 of the Act i.e. Consumer Protection Act is not in derogation of any other law because the provisions of this Act shall be in addition to and not in derogation of the provisions of any other law for the time being inforce. On this point we are supported with ruling of Hon’ble National Commission in case Kalawati and Others Vs. M/s. United Vaish Co-operative Thirft and Credit Society Ltd. 2002(1) CLT 101 (NC). Moreover the alleged matter , if any , pending before the Insurance Ombudsman has not been decided till date by the said Agency for the reasons best known to them and in such a situation the pendency of the matter before the Insurance Ombudsman has no impact on the decision of this complaint.
8. Regarding quantum of claim, since the life assured had died due to accidental death i.e. due to spray of pesticides inhale in the fields and not by natural death and perusal of policy Ex.OP3 shows that Sukhdev Singh, life assured was assured with Future Generali Assure (Basic policy) to the sum of Rs. 6,25,000/- besides Future Generali Term Assurance Rider amounting to Rs. 6,25,000/- and paid the total instalment premium of Rs. 12,806/-+ service tax Rs. 596/- total premium Rs. 13,402/-, in this way as the life assured had died due to accidental death, so the claimant is entitled to Term Assurance Rider amount also which comes total amounting to Rs. 12,50,000/-
9. From the aforesaid discussion, it emerges that the complainant has been able to prove her case and the complainant is entitled to Rs. 12,50,000/-. Hence, we direct the opposite parties to make the payment of Rs. 12,50,000/- ( Twelve Lakh Fifty Thousand Only) to the complainant within one month from the date of receipt of copy of this order ; failing which complainant shall be entitled to interest @ 6% p.a. from the date of filing of the complaint until full and final recovery. The opposite parties are also directed to pay litigation expenses to the tune of Rs. 2000/- to the complainant. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room.
Announced in Open Forum
Dated : 14.11.2017
