Order by:

Sh.Amrinder Singh Sidhu, President

1.       This Consumer Complaint has been received by transfer vide order dated 26.11.2021 of Hon’ble President, State Consumer Disputes Redressal Commission, Punjab at Chandigarh under section 48 of CPA Act, vide letter No.04/22/2021/4 C.P.A/38 dated 17.1.2022 from District Consumer Commission, Ludhiana to District Consumer Commission, Moga to decide the same in Camp Court at Ludhiana and said order was ordered to be affected from 14^th March, 2022.

2.       The  complainant  has filed the instant complaint under section 12 of the Consumer Protection Act, 1986 (now section 35 of Consumer Protection Act, 2019) on the allegations that on the allurement of the agent of the Opposite Parties, the husband of the complainant namely Malook Singh had purchased Life Insurance Policy bearing No.00809255 for a sum assured of Rs.6,20,000/- and the premium of which was payable semi annually, but no terms or conditions were ever supplied  to the insured by the Opposite Parties. The complainant is the nominee of said insured Malook Singh. Thereafter, life insured Malook Singh died on 25.11.2014 as a natural death. Thereafter, being nominee, the complainant lodged the claim with the Opposite Parties for the death claim of her husband, but the Opposite Parties did not pay any heed to the request of the complainant.  As such, there is deficiency in service on the part of the Opposite Parties.  Vide instant complaint, the complainant has sought the following reliefs.

a)       The Opposite Parties may be directed to pay the insured amount of Rs.6,20,000/- alongwith interest @ 18% per annum from the date of death of the insured till its actual realization and also to pay Rs.50,000/- as compensation for causing her mental tension and harassment or any other relief to which this District Consumer Commission may deem fit be also granted.   

3.       Opposite Parties appeared through counsel and contested the complaint by filing  the written version taking preliminary objections therein inter alia that the complaint filed by the complainant is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead this District Consumer Commission.  It is submitted that admittedly, Malook Singh  submitted duly filled and signed proposal form after understanding all the features and terms of the plan and accordingly policy in question was issued  on 14.10.2014 under Plan SUD Life_Jeevan Safar Plus with Base Sum Assured of Rs.6,20,000/-  against the premium and frequency of Rs.19,748/- half yearly with premium payment terms 20 years. Thereafter,  on 27^th February, 2017 the Opposite Parties received death claim intimation dated 21^st February, 2017 from the complainant intimating that the Life Insured had passed away on 14.10.2014 due to heart attack.  Since the death of the life Insured had taken place within a span of approximately 1 year 11 days from the date of the commencement of the policy, hence the Opposite Parties with a bona fide intention of processing of claim commenced an investigation into the death claim preferred by the complainant in order to  verify the authenticity of the said claim. The Opposite Parties  upon enquiry conducted by the Investigation Agency, it was revealed that the complainant had submitted a fake death certificate at the time of death. The death certificate issuing authority Mrs.Poonam (ANM) stated that the death certificate (Date of Birth 25.11.2014) Regd.No.2, Regd.Date 13.12.2014) was not issued by the Health and Family Welfare Department, Government of Punjab and in this regard, the report o said ANM dated 16.3.2017 is enclosed. As the insurance contracts are based on the principle of ‘Utomost good faith’ and the policies are issued based on the representation made in the application form and any non disclosure or misrepresentation in the application form renders the contract violable at the option of the insurer. Accordingly, the complainant of the complainant was repudiated after due application of mind.  On merits, Opposite Parties took up the same and similar pleas as taken up by them in the preliminary objections. Hence, the instant complaint is not maintainable and the same  may be dismissed with costs.  

4.       In order to  prove  her  case, the complainant has tendered into evidence affidavit Ex.CW/1 alongwith copies of documents Ex.C1 to Ex.C6 and closed his evidence.

5.       On the other hand,  to rebut the evidence of the complainant,  Opposite Parties also tendered into evidence the affidavit  Ex.DA  alongwith copies of documents Ex.D1 to Ex.D6 and closed their evidence.

6.       We have heard the ld.counsel for the parties  and also  gone through the documents placed  on record.

7.       Ld.counsel for the Complainants as well as ld.counsel for the Opposite Parties have mainly reiterated the facts as narrated in the complaint as well as in their written statements respectively. We have perused the rival contention of the ld.counsel for the parties. The only contention of the complainant is that on the allurement of the agent of the Opposite Parties, the husband of the complainant namely Malook Singh had purchased Life Insurance Policy bearing No.00809255 for a sum assured of Rs.6,20,000/- and the premium of which was payable semi annually, but no terms or conditions were ever supplied  to the insured by the Opposite Parties. The complainant is the nominee of said insured Malook Singh. Thereafter, life insured Malook Singh died on 25.11.2014 as a natural death. Thereafter, being nominee, the complainant lodged the claim with the Opposite Parties for the death claim of her husband, but the Opposite Parties did not pay any heed to the request of the complainant.  As such, there is deficiency in service on the part of the Opposite Parties. 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 admittedly, Malook Singh  submitted duly filled and signed proposal form after understanding all the features and terms of the plan and accordingly policy in question was issued  on 14.10.2014 under Plan SUD Life_Jeevan Safar Plus with Base Sum Assured of Rs.6,20,000/-  against the premium and frequency of Rs.19,748/- half yearly with premium payment terms 20 years. Thereafter,  on 27^th February, 2017 the Opposite Parties received death claim intimation dated 21^st February, 2017 from the complainant intimating that the Life Insured had passed away on 14.10.2014 due to heart attack.  Since the death of the life Insured had taken place within a span of approximately 1 year 11 days from the date of the commencement of the policy, hence the Opposite Parties with a bona fide intention of processing of claim commenced an investigation into the death claim preferred by the complainant in order to  verify the authenticity of the said claim. The Opposite Parties  upon enquiry conducted by the Investigation Agency, it was revealed that the complainant had submitted a fake death certificate at the time of death. The death certificate issuing authority Mrs.Poonam (ANM) stated that the death certificate (Date of Birth 25.11.2014) Regd.No.2, Regd.Date 13.12.2014) was not issued by the Health and Family Welfare Department, Government of Punjab and in this regard, the report o said ANM dated 16.3.2017 is enclosed. As the insurance contracts are based on the principle of ‘Utomost good faith’ and the policies are issued based on the representation made in the application form and any non disclosure or misrepresentation in the application form renders the contract violable at the option of the insurer and contended that accordingly, the complainant of the complainant was repudiated after due application of mind since the complainant has lodged the claim on the death of her husband on the basis of forged death certificate. Perusal of the copy of death certificate Ex.D5 on which the endorsement of Ms.Poonam, ANM dated 16.03.2017  has specifically mentioned that this certificate is wrongly prepared and this certificate is duly cancelled.  During the course of arguments, ld.counsel for the complainant also placed on record the copy of death certificate in respect of death of Mr.Malook Singh, but we fail to understand which of these two documents is true. To prove such assertion,  there requires sufficient evidence, witnesses etc. but before this District Consumer Commission in summary procedure, it is not possible because this matter is already pending from the last about 5 years for adjudication. We are of the view that it clearly becomes a case replete with the elements of fraud, cheating and such disputes are certainly not adjudicable before the Consumer Disputes Redressal Agencies because the proceedings before the Consumer for a (now Commission) are summary in nature. In the case in hand extremely complicated questions of fact and law are involved, as has been discussed in an elaborate manner in the preceding paragraphs, as such the parties are required to take their dispute to the Civil Court of competent jurisdiction where the parties can lead elaborate oral and documentary evidence and where they will get an opportunity to examine their witnesses and cross examine the witnesses of other party in order to elicit the truth. Reliance in this regard is placed upon Oriental Insurance Company Ltd. Vs. Munimahesh Patel 2006(IV) CPJ page 1, wherein the Hon'ble Supreme Court has held that :-

Proceedings before the commission are essentially summary in nature and adjudication of issues which involve disputed factual questions should not be adjudicated. It is to be noted that commission accepted that insured was not a teacher. Complainant raised dispute about genuineness of the documents (i.e. proposal forms) produced by the appellant.”

Their lordships have further held that :-

“The nature of the proceedings before the commission as noted above, are essentially in summary nature. The factual position was required to be established by documents. Commission was required to examine whether in view of the disputed facts it would exercise the jurisdiction. The State Commission was right in its view that the complex factual position requires that the matter should be examined by an appropriate court of Law and not by the Commission.”

8.       The nature of the dispute, in the present complaint, is squarely covered by the law laid down by their lordships of the Hon'ble Supreme Court in the judgement supra. A similar view has been taken by the Hon'ble National Consumer Disputes Redressal Commission in 1(2004) CPJ page 101 wherein it has been held by the Hon'ble National Commission in a revision petition titled as R.D. Papers Ltd. Vs. New India Assurance Co. Ltd. & Ors. in para No.7 of the judgement  which reads as under:-

“After going through the complaint and the written version, it appears to us that the complaint raises complicated questions of facts which cannot be decided by us in our summary jurisdiction. It may be though the amount in this case is in few lacs and when we are receiving complaints involving crores of rupees, but then enormous evidence would be required in the present case especially in respect of allegation of forgery made by the complainant and denied by the Insurance Company.”

9.     Keeping in view the aforesaid facts and circumstances of the case, the instant complaint is not maintainable in this District Consumer Commission for its proper adjudication and the same stands dismissed. However, the complainant can get redressal of his grievance from the Civil Court/ or any other  competent authority, in accordance with law, for which the time spent before this District Commission shall stand excluded under Section 14 of the Limitation Act in the light of the judgment of the Hon'ble Supreme Court in case titled 'Lakshmi Engineering Works vs PSG Industrial Institute reported in 1995(3) SCC 583'. However, keeping in view the peculiar circumstances of the case, the parties are left  to bear their own costs.  Copies of the order be furnished to the parties free of cost by District Consumer Commission, Ludhiana and thereafter, the file be consigned to record room after compliance.

10.     Reason for delay in deciding the complaint.

This Consumer Complaint was originally filed at District Consumer Disputes Redressal Forum (Now Commission) at Ludhiana and it keep pending over there until Hon’ble State Consumer Disputes Redressal Commission, Punjab vide letter No.04/22/2021/4 C.P.A/38 dated 17.1.2022 has transferred the instant Consumer Complaint alongwith Other Complaints to District Consumer Commission, Moga with directions to work on this file onward from 14^th March, 2022 and accordingly District Consumer Commission, Moga has decided the present complaint at Camp Court, Ludhiana, as early as possible as it could decide the same

Announced in Open Commission at Camp Court, Ludhiana.