MEHRUNNISA vs LIC OF INDIA

THIS appeal is directed against the order of the State Commission in original complaint no. 56/98 whereby the State Commission in principal dismissed the complaint filed by the appellant. However, taking note of the fact that Claims Review Committee of the Insurance Company had recommended ex gratia payment of Rs.2,50,000/ - to the appellant, directed the insurance company to pay ex gratia amount of Rs.2,50,000/ - to the complainant besides Rs.25000/ - as compensation for mental agony and Rs.5000/ - for litigation cost.

BRIEFLY put the facts relevant for the disposal of the revision petition are that Taufeeq Ahmad, husband of the appellant had taken two life insurance policies of Rs.1,00,000/ - and Rs.5,00,000/ - respectively from the opposite party. The insurance policy for Rs.5,00,000/ - also carried additional accident benefit of amount equal to the sum assured in the event of death of the life assured in an accident. The life assured unfortunately died in road accident on 02.08.1993. The appellant being nominee in the insurance policies submitted her insurance claims under both the policies. The insurance company allowed the insurance claim of Rs.1,00,000/ - but repudiated the claim of subsequent policy of Rs.5,00,000/ - on the premise that the said policy was obtained by the life assured by giving false information about his date of birth supported by a forged Transfer Certificate. The appellant made a representation against repudiation to Zonal Claim Review Committee of the Insurance Company and the Committee held the repudiation to be proper but recommended Rs.2,50,000/ - as ex gratia payment to the appellant provided the amount is accepted as full and final settlement of the claim.

THE respondent / opposite party in the written statement admitted that insurance policy of Rs.5,00,000/ - was issued in favour of Taufeeq Ahmad with accident death benefit of equivalent amount. It was also admitted that Taufeeq Ahmad died in a road accident. The respondent, however, pleaded that the insurance claim was rightly repudiated because life assured had obtained the insurance policy by giving false information about his age supported by a forged transfer certificate. The State Commission on consideration of record found repudiation of insurance claim in order. However, the State Commission directed the insurance company to honour the recommendation of the Claims Review Committee by paying ex gratia payment of Rs.2,50,000/ - to the appellant complainant besides Rs.25000/ - as compensation for mental agony and Rs.5000/ - for litigation cost.

WE have heard learned counsel for the parties at length and perused the record. The short point which requires determination in this appeal is whether the life assured Taufeeq Ahmad had obtained the subject insurance policy by giving wrong date of birth in the proposal form supported by forged transfer certificate?

IN order to find answer to this question, it is necessary to have a look on the Transfer Certificate submitted by the life assured alongwith proposal form and the Transfer Certificate purported to have been obtained by the respondent / corporation during investigation. We have seen and compared those two transfer certificates respectively dated 07.10.1991 and 07.09.1993. On comparison, we find that both the transfer certificates are in respect of Taufeeq Ahmed s/o Abdul Rauf issued under the signatures of Head Master Prathmik Vidyalya, Rani Ki Sarai, Azam Garh. The only difference in these two transfer certificates is that in the Transfer Certificate dated 07.10.1991, the date of birth of student is mentioned as 11.07.1956 whereas in the Transfer Certificate purportedly obtained by respondent insurance company, the date of birth of the student is mentioned as 01.01.1956. Now, the question is as to which of these Transfer Certificates is genuine? Without any cogent evidence in this case, it cannot be said that the Transfer Certificate submitted by the life assured Taufeeq Ahmad showing his date of birth as 11.07.1956 is a forged document. Since the respondent opposite party is challenging the authenticity of the transfer certificate submitted by life assured, the onus of proving the same was upon the opposite party and this could be done not by merely placing on record another transfer certificate but by summoning the record of the admission register of the concerned school. The opposite party has failed to do so. Therefore, if there is some suspicion regarding the authenticity of the transfer certificate submitted alongwith the proposal form by the life assured, it cannot be held to be a forged document in absence of proof.

FURTHER , it is admitted case of the parties that prior to the submission of proposal form for the subject insurance policy, Taufeeq Ahmed had taken one policy for Rs.1,00,000/ - and information about existence of said policy was given in the proposal form, meaning thereby that at the time of consideration of the subject insurance policy, the opposite party had information about the date of birth of Taufeeq Ahmad given in the form of proposal form submitted for obtaining the earlier policy of Rs.1,00,000/ -. After having sought such information about previous policy in the proposal form , the opposite party was expected to verify the genuineness of age by comparing the same with the earlier proposal form before accepting the proposal. From this, it is evident that opposite party had an opportunity to compare the proposal form pertaining to the subject policy with the information given while obtaining earlier policy but it failed to do so. Now, after accepting the insurance premium, the opposite party is estopped from raising a plea of having been misled by mis -representation pertaining to age on the part of the life assured.

IN view of the decision above, we are of the view that the State Commission has fallen in error in dismissing the claim of the appellant. We therefore, accept the appeal; set aside the order of the State Commission and direct the insurance company to pay to the appellant insurance claim of Rs.10 lakhs (Rupees Ten Lakhs only) including the accidental death benefit with 6% interest thereon from the date of filing of the complaint till realization of the amount.