Present Revision Petition has been filed by the Petitioner/ Complainant against the impugned order dated 04.08.2011, passed by Haryana State Consumer Disputes Redressal Commission at Panchkula (for short, ‘State Commission’) in (First Appeal No.1010 of 2010).
2. Brief facts of the case as per the Petitioner/Complainant are that life assured Ravinder Kumar had a savings bank account with the Respondent No.4/Opposite Party No.4—Punjab National Bank, Rewari and he had taken the insurance policy from the Respondents No.1 to 3/Opposite Parties No.1 to 3 in respect of the above said bank account. Unfortunately, the life assured died on 02.02.2007 and the claim submitted by the Petitioner to the Respondents was rejected on the ground that the life assured had died due to cancer which he was suffering for the last one year. It was further stated in the repudiation letter that ‘during the processing of the claim, we have noticed that Mr. Ravinder Kumar’s signature in the application form at the time of applying for the policy does not match with the signature in the account application form with Punjab National Bank”. The Petitioner approached the Insurance Ombudsman Chandigarh where the repudiation of insurance claim was upheld to be justified vide order dated 01.07.2008. Under these circumstances, the Petitioner filed a consumer Complaint before the District Forum seeking several reliefs.
3. The District Consumer Disputes
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edressal Forum, Rewari (for short, ‘District Forum’) vide its order dated 23.04.2010, while allowing the complaint, observed as under:“As per the investigation report Ex.OP7, the life assured was suffering from cancer and treated from PGIMS, Rohtak and AIIMS, New Delhi and there is no cogent or reliable supporting evidence regarding the said findings of the investigator and as such, the report Ex.OP7 cannot be relied upon by tis Forum. Similarly, Ex.OP8 is the report of G.P. Mathur, Investigator, but the same is also not accompanied with relevant medical record regarding on cancer.The perusal of the repudiation letter, Ex. C5, reveals that the claim has been rejected only on the ground that “Mr. Ravinder Kumar’s signature in the application form at the time of applying for the policy does not match with the signature in the account opening form with Punjab National Bank.”We have perused the application form filled by the deceased ,life assured for opening an account in his favour. The said form is duly attested by the Respondent No.4 official of the Bank. Ex. C2 is the insurance proposal form which has been submitted by the deceased life assured on 18.12.2006. it is revealed that the Form is duly signed by the deceased life assured and has been duly attested by the manager, PNB, Rewari on 18.12.2016 itself. Judicial notice of the things that the Deceased Life Assured was duly insured and certificate of insurance has been issued vide Ex. C3 in favour of Ravinder Kumar and it can be safely presumed that the certificate of insurance has been issued after complete verification of the facts by the respondent company and at this stage, when the complainant has filed the claim, the said version of the Respondents no.1 to 3 regarding identify of signature of the deceased Life Assured is of no avail to the respondents. The version of the signature has also been admitted by the Respondent No. 4, PBB, Rewari in the written statement while giving reply on merits in Para No.1 of the written statement. As per reply, it has been specifically admitted that the proposal form dated 18.12.2006 was attested by the then manager of the bank. The decision given by the insurance ombudsman vide Ex.C-16 has also been given on the same findings i.e. the deceased life assured was suffering from cancer and signature of deceased life assured in the application form at the time of applying for the policy does not match with the signature in the account opening form with Punjab National Bank. This Forum has already discussed and observed that there is no evidence regarding the allegations of having cancer. It has also been observed that the allegation of identify of signature of the deceased life assured is also tenable since the signature of the deceased life assured have been duly attested by the Manager, PNB, Rewari on the account opening form as well as proposal form for taking insurance policy.In view of the aforesaid discussion and findings, it is observed that the respondents No.1,2 and 3 shall pay a sum of Rs.3,00,000/- (Rs.three lacs) to the complainant along with interest at the rate of 9% per annum from the date of filing of the present complaint i.e. 5.8.2008 till its actual realization. Te present complaint stands allowed.”4. Aggrieved by the order of the District Forum, the Respondents No.1 to 3 filed an appeal before the State Commission. The State Commission, while allowing the appeal observed;“We have perused para 3, 4 and 5 of the Order dated 01.07.2008 passed by Insurance Ombudsman, Chandigarh, which are reproduced as under:-“3) Parties were called for hearing on 01.07.08 at new Delhi. Complainant was present in person. She was accompanied by Sh. Jai Singh, Insurer was presented by Sh. Harinder Pal Singh. The complainant stated that her husband late Sh. Ravinder Kumar had taken a policy bearing No. 32000500000250. He died on 01.02.07. Claim papers were submitted to the insurer through PNB, Reweari. However, the claim was repudiated on the ground that the signatures of the deceased L.A. in the application form at the time of applying the policy did not tally with the signature in the account opining form of Punjab National Bank. He stated that the signatures were attested by Punjab National Bank, Rewari.4) The insurer clarified that the position by stating that the DLA opened an account in Rewari Branch of PNB on 18.12.2006 and the proposal for insurance was made on the same day. The account opened was for Rs.1,000/- only, out of which Rs.696/- was withdrawn for the first premium. The death took place on 02.02.07 within two months of commencement of the policy. There was a doubt where the account was opened genuinely by the deceased especially when he already had Bank account with PNB earlier which was 4 Km from his home town. There appears to be a moral hazard in getting the policy.5) After hearing both the parties and going through the records, I am of the opinion that the contention of the insurer that there was a moral hazard and impersonation at the time of proposal is in order. The reason for opening a new account and taking a policy of 3.00 Lakhs on the same day does not stand to reason especially when there was no other insurance policy taken by the complainant at any other time. Taking an overall view I am of the opinion that the repudiation of the claim is in order. No further action is called for. The case is closed.”Taking into account the facts and circumstances of the case and the findings recorded by Insurance Ombudsman, Chandigarh, we are agree with the opinion in the order dated 01.07.2008 by Insurance Ombudsman, Chandigarh and as such the impugned order passed by the District Forum is not sustainable in the eyes of law. Hence, this appeal is accepted, the impugned order is set aside and the complaint is dismissed.”5. Hence, this Revision Petition.6. I have the learned counsel for the parties. The counsel for the Petitioner contended that the State Commission had not exercised its jurisdiction by merely depending on the report of the Insurance Ombudsman. The State Commission did not apply its mind to the facts of the case and also to deal with the findings of the District Forum while setting aside the order of the District Forum. The counsel for the Petitioner drew my attention towards the repudiation letter, relevant para of this letter reads as under;-“ With reference to the above mentioned policy. We wish to inform you that we have decided to repudiate the claim on the ground of suppression of material information.During the processing of the claim we have noticed that Mr. Ravinder Kumar’s signature in the application form at the time of applying for the policy does not match with the signature in the account opening form with Punjab National Bank.We wish to state that the company was induced to enter into a contract on the basis of forged signature. Therefore not disclosing the correct identity of the insured. In view of this, the above policy becomes void and no benefits are payable.”7. Admittedly, the claim of the Petitioner was repudiated only on the ground that signature of the applicant on the account opening form with the PNB and specimen signatures did not match with that on the proposal form for insurance policy. It is only thereafter that in the written statement, the Respondents No.1 to 3 had taken the plea that the Petitioner’s husband had concealed the facts that he had suffering from cancer for one year. This reason has not been given in the repudiating letter and it seems that the plea of the Respondents No.1 to 3 regarding the Deceased Life Assured was suffering from a cancer is an after-thought and is also not supported by any evidence.8. The learned counsel for the Respondents No1 to 3 contended that it was revealed that the signatures of the applicant on the insurance proposal form did not match with the specimen card, which was clearly proved by the report of Handwriting Expert Mr. C.V. Jayadevi, who was hired by them. He however, admitted that the Respondents. No.1 to 3 had no medical record/evidence to support of their contentions that Petitioner’s Husband had been suffering from cancer.9. Mr. Ajay Shankar, Advocate for the Respondent No.4—Punjab National Bank contended that Respondent No.4 was not a necessary party in this case. He however, confirmed that as mentioned in the written statement that the signature of the insured had been countersigned/attested on the insurance proposal form by the then Manager of the Bank.10. On 24.07.2012, this Commission had directed the Petitioner to file an affidavit with regard to the latest health status of the life assured at least two years before taking the insurance Policy. In the affidavit Shakuntla Devi, which was filed on 27.11.2012, she has categorically stated that;“3. It is stated that the deceased/life assured was the husband of the Petitioner. The life insured expired o 02.02.2007 in village Bharangi, Teh. Kosli Dist. Rewari and died a natural death. It is stated that the same has also been stated I the complaint preferred before the District Commission against the illegal repudiation of the policy by the respondents.4. It is further stated that the deceased/life assured was not suffering from any life threatening disease, two years prior to taking of insurance policy(Policy No. 3050000250 dated 18.12.2006) and neither did he undergo any treatment for cancer in the two years prior to taking of insurance policy as illegally alleged by the respondents.5. It is reiterated that the Life Assured died a natural death and was not suffering from any life threatening disease at the time of taking of the insurance policy or within the period of two years prior to taking of insurance policy.”11. I have heard the learned counsel for the parties and gone through the record very carefully.12. On-going through the record of the District Forum, it is seen that Investigator had concluded that the life assured had been suffering from cancer on hearsay and he had given his report on the basis of statement of Babu Lal, brother of Ravinder Kumar, Life Assured that his brother had been suffering from cancer and he had taken treatment of 10 months from PGI, Rohtak and two months from AIIMS, New Delhi. However, the statement of Babu Lal is neither signed nor attested by him. In fact, there is another statement on record duly signed by Babu Lal, brother of the deceased-life assured Ravinder Kumar stating that his brother died after suffering from stomach pain. This statement is also supported by the statements of other witnesses who were residents of the village.3-D Investigating Agency in its report recorded the treatment given to Ravinder Kumar—Life Assured and also mentioned that he was suffering from stomach pain and gastroenteritis. In the report of 3-D investigating Agency they have clearly mentioned that life assured was not previously hospitalized for any kind of illness. The certificate of Dr. R.S. Yadav of Daya Hospital has also certified that the Deceased—Life Assured was suffering from gastroenteritis.13. In his affidavit Mr. Bhagat Singh, Manager of Punjab National Bank, Rewari has categorically stated that Ravinder Kumar son of s/o Sh. Basti Ram R/o Village Bharangi, Distt. Rewari had taken the alleged policy from Respondents No.1 to 3 on 18.12.2006 under the Saving Bank Account No. 040500010547090 and proposal form dated 18.12.2005 had been attested by the then Manager of the Bank.14. Coming to the report of the Insurance Ombudsman, which was relied upon by the State Commission to set aside the order of the District Forum, it is seen that it is based merely on the surmises, conjecture and hearsay. The Insurance Ombudsman had concluded that the contention of the insurer that there was a moral hazard and impersonation at the time of proposal form for insurance is in order. The only reason for that was that a new account was opened on 18.12.2006 and the proposal for insurance was made on the same day and the account was opened for Rs.1,000/- only out of which Rs.696/- was withdrawn for first premium.15. The Insurance Ombudsman surprisingly came to the conclusion that “The reason for opening a new account and taking a policy of 3.00 lakhs on the same days does not stand to reason especially when there was no other insurance policy taken by the complainant at any other time. Taking an overall view I am of the opinion that the repudiation of the claim in is order.” Learned Insurance Ombudsman has failed to go through the facts of the case before concluding the repudiation of the claim of the Petitioner was in order.16. In view of this, it is clear that the State Commission had not exercise its jurisdiction while setting aside a well-reasoned detailed order passed by the District Forum merely on the report of the Insurance Ombudsman which in itself is doubtful. Hence, the Revision Petition is allowed. The impugned order passed by the State Commission is hereby set aside. Consequentially, order passed by the District Forum is confirmed.