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Sumitra Samantray v/s Birla Sun Life Insurance Co. Ltd. & Another


    Consumer Case No. 74 of 2013

    Decided On, 26 February 2019

    At, National Consumer Disputes Redressal Commission NCDRC

    By, THE HONOURABLE MR. JUSTICE V.K. JAIN
    By, PRESIDING MEMBER

    For the Complainant: Samaresh Jena, Advocate. For the Opposite Parties: Niraj Singh, Jyoti Nagpal, Advocates & Authorised Representative.



Judgment Text


1. Late Shri Prakash Kumar Samantray, husband of the complainant obtained three life insurance policies for a total sum assured of Rs. 1,40,00,000 from the opposite party. The first policy was taken on 30.11.2010 and had an annual premium of Rs. 2,00,000, the second policy was taken on 31.12.2010 and it also had an annual premium of Rs. 2,00,000. The third policy was taken on 30.6.2011 and had an annual premium of Rs. 53,250. He having died on 20.7.2011, within eight months of taking the first policy, claims in terms of the insurance policy were lodged by the complainant with the opposite party, the said claims were repudiated vide letter dated 31.3.2012, which to the extent it is relevant, reads as under:

“The above policies were issued on the basis of applications for insurance by late Mr. Prakash Kumar Samantary (the Life Assured) on his own life. In the said applications, in reply to Question No. 1 on Annual Income and Occupation of the Life Assured, he had stated that he was a contractor with an Annual Income of Rs. 20 lakh for Policy No. 004536367 and policy No. 004550123 and Annual Income of Rs. 24 lakh for Policy No. 004932436.

We may, however, state that we hold indisputable proof to show that the Life Assured had vastly overstated his annual income in the applications for insurance under all the policies, but for which the company would not have issued the captioned policies on the existing terms.

Since the company has been misled to issue the policies, we are hereby repudiating your claims for the benefits under the policies.”

2. Being aggrieved from the repudiation of the claims, the complainant is before this Commission, seeking payment of Rs. 1,40,00,000 from the opposite party.

3. The complaint has been resisted by the opposite party primarily on the grounds on which the claim had been repudiated and it is inter alia stated in the written version filed by the opposite party that in the proposal forms the deceased insured had declared his annual income to be Rs.20.00 lakh, whereas on inquiry, they found that his annual income in the year 2009-10 was Rs.1,23,930 whereas in the year 2010-11 his income was Rs. 4,12,470. It is also stated in the written version filed by the opposite party that in investigations, the investigator found that in the Income Tax Returns submitted to the insurer, the income had been shown to be Rs. 19.00 lakh in the year 2009-10 and Rs. 24,12,474 in the year 2010-11 whereas on verification from the concerned Income Tax Officer it was found that the income disclosed in the Income Tax Returns for the years 2009-10 and 2010-11 was only Rs. 1,23,930 and Rs. 4,12,470 respectively. Thus, forged and fabricated Income Tax Return Acknowledgements were submitted to the insurer in order to project highly inflated income of the deceased insured.

4. A perusal of the letter dated 18.1.2012 sent by Income Tax Officer, Khurdha to the investigator clearly shows that the Annual Income of the deceased insured in the Assessment Years 2009-10 and 2010-11 was Rs. 1,23,930 and Rs. 4,12,470 respectively and not Rs.19,00,000 and Rs. 24,12,474 as reflected in the Acknowledgements submitted to the insurer. As noted earlier, the annual premium payable in respect of the first two insurance policies taken by the deceased in the year 2010 itself was Rs. 4.00 lacs. His Annual income in the assessment year 2009-10 being Rs. 1,23,930 and his total income in the assessment year 2010-11 being Rs. 4,12,470, the said income was not sufficient to pay the premium even in respect of the first two policies taken by him. The total premium payable by him after issuance of the third insurance policy increased to Rs. 4,53,250 per annum. Considering his income, he could never have afforded to pay the said premium, out of his income. More importantly, no insurer would accept the proposal for grant of an insurance cover requiring payment of annual premium of Rs.4,00,000 or more when the total income of the insured is only Rs. 1,23,930 in one year and Rs.4,12,470 in the other year. Therefore, it can be safely said that had the deceased insured disclosed his correct income to the insurer, the proposals given by him would not have been accepted and the insurance cover taken by him by misrepresentation with respect to his income would not have been issued. In fact, forged documents were submitted to the insurer showing highly inflated income of Rs. 19,00,000 in the assessment year 2009-10 and Rs. 24,12,474 in the assessment year 2010-11. Thus, the insurance policies were obtained by playing a fraud upon the insurer by submitting forged Income Tax Return Acknowledgements. The insurer was entitled to repudiate the claim obtained on the basis of forged Income Tax Return Acknowledgements.

5. It was submitted by the learned Counsel for the complainant that the deceased had substantial agricultural income and owned agricultural land as detailed in Annexure P-1 to the rejoinder. No such averment was made in the complaint, despite the complainant having known from the repudiation letter that the insurer had repudiated the claim on account of a false statement with respect to the income of the deceased from him. Annexure P-1 to the rejoinder only gives some of Khaata number, plot number and area of the land. However, no revenue record such as Jamabandi or Khasra Girdawari has been filed to prove that the deceased insured was the owner of the land mentioned in Annexure P-1. Even the Income Tax Return of the deceased have not been filed to show that he was having agricultural income though the said income was exempt from payment of Income Tax. Even the income exempt from payment of tax is required to be disclosed in the Income Tax Return, if the assesse has other taxable income. In other words, there is absolutely no authentic proof of any agricultural income of the deceased insured.

6. Since the insurance policies were obtained by the deceased by misrepresentation based upon forged documents, with respect to his income and the said misrepresentation influenced the decision of the insu

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rer on a material aspect, as no insurer would have granted such a substantial insurance cover to a person having the income which the deceased was actually making in his life-time, the repudiation of the claim was fully justified, in the facts and circumstances of this case. If the insurer finds that the income of the proposer is not adequate to service the premium during the tenure of the policy, or that the Income Tax documents submitted by him are forged documents, it would as a prudent insurer, reject such a proposal. 7. For the reasons stated hereinabove, the complaint is hereby dismissed, with no order as to costs. Complaint dismissed.
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