BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FEROZEPUR
C.C. No.163 of 2014 Date of Institution: 16.4.2014
Date of Decision: 18.12.2014
Inderjit Kaur, aged 29 years, wife of Jaspal Singh, resident of House No.78-A, V. Noorpur, Tehsil and District Ferozepur.
....... Complainant
Versus
1. Max New York Life Insurance Company Limited, registered office Max House, 3rd Floor, 1 Dr. Jha Marg, Okhla, New Delhi-110020, through its Authorized Signatory.
2. Max New York Life Insurance Company, 90-A, Sector 18, Udyog Vihar, Gurgaon-122015, Haryana.
3. Max New York Life Insurance Company, Branch Office at Near Udham Singh Chowk, Ferozepur City, through its Branch Manager.
........ Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986.
* * * * *
PRESENT :
For the complainant : Sh. Nitish Duggal, Advocate
For the opposite parties : Sh. Shivdeep Singh, Advocate
QUORUM
S. Gurpartap Singh Brar, President
S. Gyan Singh, Member
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ORDER
GURPARTAP SINGH BRAR, PRESIDENT:-
Brief facts of the complaint are that opposite party No.1 deals in providing Insurance under the name and style of Max New York Life Insurance, having its Registered Office at New Delhi and claim settlement Office at Gurgaon i.e. opposite party Nos.1 and 2 and a Branch Office at Ferozepur City i.e. opposite party No.3. On 16.1.2013, Jaspal Singh, husband of the complainant, got himself insured from opposite party No.3 under Shiksha Plus-II Policy for a sum of Rs.6,00,000/- and a Proposal Form was got signed from him by the Authorized Representative of opposite party No.3 and further a sum of Rs.15,000/- as premium of the said policy was paid by Jaspal Singh. After getting verification of the policy proposal documents by the officials of the opposite parties, the Proposal Form of Jaspal Singh was duly accepted by them, without raising any kind of objection and original policy was issued on 24.1.2013. As per policy terms and conditions, husband of the complainant was to get fund value of the policy at the expiry of the same i.e. after 20 years and in case the death of the insured, the nominee of the said policy was entitled to get the insured amount of Rs.6,00,000/- as death claim. Jaspal Singh had expired on 2.6.2013 due to cardiac arrest. Intimation regarding death of Jaspal Singh was duly given to the opposite parties. The complainant, who
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is the nominee/legal heir of Jaspal Singh deceased, approached the opposite parties and submitted all the required documents for settlement of the claim. Thereafter, the complainant approached the opposite parties and requested them to make the payment of the insurance claim. The opposite parties assured the complainant that the amount of claim would be released in due course, but thereafter, vide letter dated 31.12.2013, the opposite parties repudiated the claim of the complainant on the ground that in the Death Certificate of Jaspal Singh, date of death has been mentioned as 2.6.2013, but during the claim evaluation, it was found that Jaspal Singh had already expired prior to issuance of the policy. Thereafter, the complainant immediately approached opposite party No.3 and sought specific clarification of the above said letter dated 31.12.2013, but opposite party No.3 failed to give any justification. The complainant also made a written representation dated 29.1.2014 to the opposite party, wherein she specifically disclosed that the date of death of her husband was 2nd June 2013 and sought specific documentation/evidence qua wrong observation of date of death of her husband by the opposite parties, but while giving reply dated 31.1.2013 to the said representation of the complainant, opposite party No.2 had written that as per company’s policy, they cannot share the evidence. The complainant has pleaded that the death certificate has been issued by the competent authority at Sub Centre, Norpur
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(Ferozepur) under Chief Registrar, Birth & Death, Punjab, Health & Family Welfare Department in due course. Therefore, the said death certificate is a legal document to prove the genuineness of the death claim of the complainant. Not only this, even the Sarpanch of Gram Panchayat, Village Nurpur, Block Zira (Ferozepur), where Jaspal Singh was residing with the complainant, has also certified that Jaspal Singh had died on 2.6.2013. But the opposite parties have declined the insurance claim in question vide letter dated 31.12.2013 qua death of her husband. Pleading deficiency in service and unfair trade practice on the part of the opposite parties, the complainant has prayed that the opposite parties be directed to make payment of insurance claim of Rs.6,00,000/- alongwith interest @ 2% per month till realization. Further a sum of Rs.20,000/- has been claimed as compensation for causing mental tension and harassment besides Rs.10,000/- as litigation expenses.
2. Upon notice, the opposite parties appeared and filed their written reply to the complaint, wherein it has been pleaded that on submission of Proposal Form bearing No.404937658, the policy holder Jaspal Singh was issued Max Life Shiksha Plus II Plan by the opposite parties commencing from 24.1.2013 for a Sum Assured of Rs.6,00,000/- at annual premium of Rs.30,000/-. On 22.11.2013, the opposite parties received death claim intimation from the complainant, whereby it was
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intimated that life insured had died on 2.6.2013 due to Cardiac Arrest. The claim of the complainant was also sent for investigation to M/S Savvy Management Private Limited. Thereafter, on 14.12.2013 the investigation report was received. DLA’s name was not found in Voter List. Normally name is deleted post death and it is an annual exercise and if DLA had expired in June, 2013, then his name should have been in the voter list. The policy was signed by an impersonator with intention to defraud the opposite parties. Moreover, the complainant had not submitted any supporting document with respect to the prior medical history of the life assured. The claim of the complainant was rightly repudiated vide letter dated 31.12.2013. Other allegations of the complaint have been denied and dismissal of the complaint has been prayed for.
3. Learned counsel for the complainant tendered into evidence Ex.C-1 to Ex.C-19 and closed evidence on behalf of the complainant. On the other hand, learned counsel for the opposite parties tendered into evidence Ex.OP-1 to 3/1 to Ex.OP-1 to 3/5 and closed evidence on behalf of the opposite parties.
4. We have heard the learned counsel for the parties, considered the written arguments filed by the opposite parties and have also gone through the file.
5. The claim of the complainant on account of death of her
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husband deceased insured Jaspal Singh has been repudiated by the opposite parties vide letter dated 31.12.2013 Ex.C-9 on the ground that in the Death Certificate submitted with the death claim under the policy, date of death has been mentioned as 2.6.2013, but during claim evaluation, they came to know that Jaspal Singh had already expired prior to issuance of insurance policy. The opposite parties have repudiated the claim of the complainant relying upon the report of M/S Savvy Management Private Limited Ex.OP-1 to 3/3 vide which the said Investigator has concluded that on the basis of information gathered during their investigation they have come to know that LA was unhealthy from long time and was undergoing treatment at a hospital at Ferozepur but inspite of the treatment he couldn’t recover from his sufferings and died in 2012; the policy has been taken by the family after the demise of LA but the policy agent, Angrej Singh, has managed all the relevant people; they searched some of the hospitals at Ferozepur, but without proper information about the date of admission or treatment documents, they are incapable to procure anything regarding LA’s treatment. But report of the Investigator is without any basis. As per report of the Investigator himself, he had visited different medical halls and hospitals and no information regarding treatment of the life assured was available. But strangely enough, when no information was available to the Investigator, then on which basis he has concluded that the life assured was
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unhealthy from long time and was undergoing treatment at a hospital at Ferozepur and died in 2012. The Investigator has also given note that all the Agent/Advisor/Sales Manager/Medical Examiner are surely involved in the policy. But no action against any of these persons has been pleaded or proved to be taken by the opposite parties, which further leads to the conclusion that the insurance policy in question has not been taken by any impersonator, as alleged by the opposite parties. In the investigation report Ex.OP-1 to 3/3, it has also been mentioned that LA’s name is missing in the voter list, whereas, in the Voter List of Gram Panchayat elections for the year 2013, copy of which has been placed on the file by the complainant as Ex.C-16, the name of life assured Jaspal Singh duly finds figured at serial No.94 of this list, which itself reveals that said Jaspal Singh was alive till 2.6.2013. The complainant has also placed on the file Certificate/Writing of Sarpanch of Gram Panchayat, Village Noorpur, Block Zira, Ferozepur as Ex.C-12 to the effect the insured Jaspal Singh had died on 2.6.2013. The complainant has also placed on the file affidavit of said Sarpanch Jagsir Singh as Ex.C-14 vide which he has deposed that insured Jaspal Singh had died on 2.6.2013 and that Jaspal Singh is enrolled as a Voter in the Voter List of Gram Panchayat elections for the year 2013, which itself is a better piece of evidence to prove that Jaspal Singh was alive till 2.6.2013. Certificate/Writing Ex.C-12 and affidavit of Jagsir
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Singh, Sarpanch has not been controverted by the opposite parties in an unequivocal terms nor the said Jagsir Singh has been subjected to cross-examination by the opposite parties. Moreover, as per Death Certificate issued by Sub Centre, Noorpur, Ferozepur under Chief Registrar, Birth & Death, Punjab, Government of Punjab, Health & Family Welfare Department, copy of which has been placed on the file as Ex.C-8, insured Jaspal Singh had died on 2.6.2013. The said Death Certificate has been issued by the competent authority and as such cannot be declined in any manner. Investigation Report Ex.OP-1 to 3/3 has been issued by M/s Savvy Management Private Limited on the basis of presumption only and seems to be procured by the opposite parties only to justify the repudiation of the claim of the complainant. Such like investigation report cannot be made a base for repudiation of the claim of the claimant. Therefore, it is held that the opposite parties were not justified in repudiating the insurance claim of the complainant on account of death of her husband deceased life assured Jaspal Singh. The opposite parties are guilty of rendering deficient services to the complainant. The complainant, being nominee and legal heir of deceased life assured Jaspal Singh, is entitled to insurance claim admissible under the insurance policy in question on account of death of said Jaspal Singh.
6. In view of what has been discussed above, this complaint is
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accepted and the opposite parties are directed to pay to the complainant sum assured of Rs.6,00,000/- on account of death of her husband deceased life assured Jaspal Singh alongwith interest at the rate of 9% per annum from the date of repudiation of the claim i.e. 31.12.2013 till realization, alongwith other benefits accrued under the policy, if any. The opposite parties are further directed to pay a sum of Rs.5000/- as litigation expenses. This order is directed to be complied with within a period of thirty days from the date of receipt of a copy of this order. File be consigned to the record room.
Announced
18.12.2014 (Gurpartap Singh Brar)
President
(Gyan Singh) Member
