Coming down heavily on Bharti Axa Life Insurance Co Ltd for submitting a fake medical certificate to deny a death claim, the Consumer Dispute Redressal Commission at Ahmedabad (city) has asked the insurer to pay Rs1 lakh as compensation for the harassment, including mental agony to the complainant besides paying full claim amount with interest.
In the order, the bench of KB Gujarathi, president and YT Mehta, member, says, "...to avoid the amount of insurance policy means insured amount the insurance companies are taken a false and frivolous plea and also dare to produce false, fake and bogus evidence or documentary evidence. They do not afraid from taking a false and frivolous plea as well as to produce fake and bogus documentary evidence in support of false plea. Therefore, this attitude of the insurance companies is required to be deprecated and in such type of cases, it is also necessary to impose the compensation of considerable amount. So, that the insurance company would fear to take such type of false and frivolous plea as well as to produce false and fake evidence including the documentary evidence."
"The opponent (Bharti Axa Life Insurance) has also produced false evidence in form of fake and bogus certificate in the name of Shifa Clinic. Therefore, in our view, the complainant is entitled for considerable amount as a compensation for the harassment including mental agony from the opponent, and if the said compensation is fixed at Rs1 lakh, then in our view, that amount of compensation would be just, proper and reasonable."
Accepting the complaint filed by Savitri Desai, mother of the insured person, the consumer court also asked Bharti Axa Life Insurance to pay Rs10 lakh for the death claim along with an interest of 8% within one month.
"The complainant is entitled for Rs10 lakh, the amount of death claim, from the opponents, along with interest at the rate of 8% per annum (pa) from the date of non-payment of the claim for that amount i.e. 27 October 2016 till the realisation of the amount of award including interest at the rate of 2% pa as stated in the guidelines of the Insurance Regulatory and Development Authority of India (IRDAI)," the consumer court says.
In November 2015, Ms Desai's son Anil bought a life insurance policy of Rs10 lakh from Bharti Axa Life Insurance. However, in August 2016, he had some health problems and a severe fever. On 30 August 2016, he went to Shifa Clinic of Dr MA Shaikh for treatment. Dr Shaikh advised some medical tests on Anil and continued his treatment till 31 August 2016. However, on 1 September 2016, Anil died at home.
His mother filed a death claim of Rs10 lakh with Bharti Axa Life Insurance and submitted all necessary documents. However, Bharti Axa rejected the claim, saying that Anil had pre-disease and that he suppressed the fact while buying the insurance policy.
Ms Desai then approached the consumer court. During the hearing, Bharti Axa contended that "Anil Desai had obtained insurance policy fraudulently, dishonestly and by making the misrepresentation and suppressing of material fact regarding the past medical history of a renal disease diagnosed prior to the insurance policy."
The bench noted that Anil Desai was educated up to standard IV and had signed in Devnagari on the proposal form in English. "...on the basis of the documentary evidence produced by the complainant, it can certainly be said that, the proposal form was prepared and duly field up by the agent of the opponent company, therefore, the averments made by the complainant regarding the proposal form and contains of it, can be said true and acceptable for the purpose of determining this complaint."
Bharti Axa also submitted a medical certificate in the name of Dr Shaikh, who had treated Anil Desai.
Dr Shaikh was called during the hearing. He was also cross-examined by the counsel for the insurer. He told the bench that he has not issued the certificate produced by Bharti Axa and it has not been written in his handwriting. "But one person of the insurance company had come in his clinic and had obtained one blank letterhead from him," the bench noted, "So, as per the evidence of the said witness, the certificate produced by the opponent has not been issued by him and it is fake and bogus."
After perusing the medical certificates submitted by Ms Desai and Bharti Axa, the consumer court observed that the handwriting of both certificates is different. "The language used in both the certificates is also different. In the certificate produced by the complainant, there is no grammatical and spelling mistake. However, in the certificate produced by the opponent, there are so many mistakes of grammar as well as spelling. The signature made in both certificates seems to be different. Therefore, it can be said that, the certificate produced by the opponent (Bharti Axa) has not been issued by Dr Shaikh of Shifa Clinic," it says.
The bench also noted that, apart from the medical certificate, the insurance company did not submit any other document, including its investigation report or statements recorded by the investigator.
Commenting on the fake medical certificate submitted by Bharti Axa, the bench noted that if the forgery is made in the record of the judicial proceedings and in the court premises, then the complaint of the false evidence of the forgery is required to be filed by the concerned court or any subordinate officer by order of the court.
However, since the fake medical certificate was prepared out of the court, the bench says, "any other person including the complainant can file a complaint for the purpose of production of false evidence in the commission as per the provisions of Section 195 read with Section 345 of Code of Criminal Procedure (CrPC).