West Bengal

Birbhum

CC/159/2015

Ajit Hembram, W/o Dhaneswar Hembram, - Complainant(s)

Versus

1) Bajaj Allianz Life Ins. Company Ltd., - Opp.Party(s)

Sanjit Acharya

09 Apr 2019

ORDER

That the brief fact of the case is that the complainant’s father Dhaneswar Hembram purchased an Insurance Policy being No.0213332305, sum assured of Rs. 75,000/- from the O.Ps. The L.A nominated the complainant Ajit Hembram as nominee of the aforesaid policy.

            That the insured worker of Railway on 04/03/2013 morning at 6 hrs. suddenly felt unwell.  Then he was shifted at Burdwan Medical College Hospital for treatment but, he expired on that day at 11.25 am.

            That the complainant being the beneficiary of the L. A intimated the O.P about the death and there after submitted the death report along with all the relevant documents for death claim of the insured, but they did not settle the claim. 

            That thereafter the complainant sent a request to know the status of the death claim but the O.P sent letters on 28/03/2013 and 12/03/2014 without giving any information about the status the claim.

            That on 27.11.2015 the complainant sent a legal notice to the O.Ps through registered post with A/D.  But no effect.

            That since 27/11/2015 the opposite party neither took any step nor they sent reply. That act of the O.P is nothing but amounting to deficiency in service.

            Hence this case for direction the O.Ps to Pay Rs. 75,000/- as claim amount with 12% interest P/A since March 2013 till realization with other relief.

            O.P No.1 and 2 Bajaj Allianz L.I.C. Co. Ltd. have contested the case by filing written version denying all material allegations of the compliant contending, inter alia, that the case is not maintainable and the plaintiff has no cause of action to bring this case.     

            It is the specific case of the O.P that said Daneswar Hembram was under treatment for DM Type 11, HTN & DL(Dylipidomia) with IVCD (inter Ventricular conduction delay) with Sequel of HTN with early Ischemia which was not disclosed by said Daneswar Hembram on 29.03.2011 at the time of making policy, so there was suppression of material facts.

            Ultimately the OP prayed for dismissed of the case with cost.

            Considering the complaint and other materials on record with think following points are to be decided in this case.

1. Whether the complainant is a consumer under Sec. 2(1)(d)(ii) of the C.P. Act.?
2. Whether this Forum has jurisdiction to try this case?
3. Whether there is any deficiency in service or unfair trade practice on the part of the O.P.?
4. Whether the complainant is entitled to get any other relief or reliefs as prayed for?

 

DECISION WITH REASONS

During trial the Complainant Ajit Hembram has been examined as PW1. He was cross-examined by the OP. He also filed same documents.

Dr. S. Chatterjee has been examined as OPw1 on behalf of the OP/Ins. Co. He was also cross-examined by the Complainant.

The OP has also filed some documents.

Heard argument of both sides.

Point No.1:- Evidently the complainant’s father Dhaneswar Hembram purchased an Insurance Policy being No.0213332305, sum assured of Rs. 75,000/- from the O.Ps. The L.A nominated the complainant Ajit Hembram as nominee of the aforesaid policy.

So, the complainant is a consumer U/S 2(i) (d) (ii) CP Act.

Point No.2:- we find that OP Bajaj Allianz Life Ins. Company Ltd. has branch at Suri.

Total valuation of the case is Rs. 85,000/- with interest, which is far less than maximum limit of the pecuniary jurisdiction of the Forum i.e. Rs. 20,00,000/-. So, this Forum has pecuniary and territorial jurisdiction to try this case.

Point No. 3 and 4:- Both points are taken up together for convenience of discussion as they are related to each other.

            Admittedly the complainant’s father Dhaneswar Hembram purchased an Insurance Policy being No.0213332305, sum assured of Rs. 75,000/- from the O.Ps. The L.A nominated the complainant Ajit Hembram as nominee of the aforesaid policy.

            According to the OP/Ins. Company said Dhaneswar Hembram was suffering from Diabetes mellitus (DM) Type 2, Hypertension (HTN) and Dylipidomia with mild Intra-ventricular conduction delay (IVCD) with sequel of HTN with early Ischemia since 2006.

            So, they legally repudiated the claim.

The letter dated 14/11/2013 issued by the OP/Ins. Co. shows that claim of the complainant was repudiated on the ground of non-disclosure of material facts in proposal form dated 29/03/2011 alleging that Dhaneswar Hembram was under treatment for DM type II, HTN & DL (Dylipidomia), with mild IVCD (Intra-ventricular conduction delay) with sequel of HTN with early Ischemia.

            We find from the copy of the proposal forum that there he stated that he was not suffering from any disease of High/Low Blood pressure, diabetes, brain disease, chest pain, heart disease, kindly disease etc.

Certainly in view of decision of Hon’ble Apex Court and Hon’ble National Commission concealment of any material fact leads to vitiate contract of insurance and fraudulent suppression of material facts entitles the Insurance Company to repudiate the claim.

            In this context reliance may be placed upon ruling reported in AIR 1962 SC 814.

            We find that in the present case the OP/Ins. Co. has claimed that insured Dhaneswar Hembram was suffering from serious disease like diabetes, Hypertension etc. but he suppressed the same in proposal forum.

            As the OP/Ins. Co. asserted that LA/ Dhaneswar Hembram had been suffering from diabetes, Hypertension, alike civil cases in this Consumer case also onus is upon them to prove such fact.

PW1 Complainant. Ajit Hembrom on oath in his cross-examination denied the allegation that his father was suffering from Hypertension and Diabetes.

 

 

To prove said fact the OP/Ins. Co. has examined Dr. S. Chatterjee as Opw1 and submitted xerox copy of some prescriptions. OPw1 Dr. Chatterjee in his evidence claimed that he treated LA/ Dhaneswar Hembram for Hypertension and diabetes.

            In his cross-examination he admitted that he has not kept any record in his chamber regarding treatment of Dhaneswar Hembram.

            He also admitted that the xerox copy of the documents/prescriptions are not genuine documents if law says so.

            Consideration over all matter into consideration we think it is very much difficult to rely upon the xerox coy of the documents filed by the OPs regarding treatment of Dhaneswar Hembram without submitting original documents.

            During hearing of argument Ld. Advocate/Agent of the Complainant submitted the forum cannot relied upon unauthenticated xerox copy of prescriptions.

            In support of his contention he cited a ruling reported in 2018(1) CPJ 301 (NC), where in case of allege suppression of pre-existing disease regarding alcoholism, Hon’ble National Commission pleased to hold that mere production of some unattested, unverified and unauthenticated photocopies, could not have been basis of holding that deceased was an alcoholic and was diagnosed with alcohol lever disease and its complications. Repudiation not justified.

            In this juncture we are constrained to hold that the OP/Ins. Co. has failed to prove that Dhaneswar Hembram was suffering from Hypertension and Diabetes and it can be safely said that there was no suppression of material facts by the deceased insured.

            Accordingly we come to conclusion that the claim of the Complainant was repudiated illegally by the OP/Ins. Co. and the case is to be allowed.

            Thus both points are decided in favour of the complainant.

            The case succeeds.

Proper fees have been paid.

Hence,

O R D E R E D

that C.F case No. 159/2015 be and the same is allowed on contest against the Ops. With costs of Rs. 2000/-.

The OPs Bajaj Allianz Life Ins. Company Ltd., are directed to pay the Complainant Rs. 75,000/- as claim amount with 6% P/A since March 2013 till realization.

The aforesaid order will be complied with by the O.P No. 1 within one month from this order failing which the complainant shall be at liberty to resort to due process of law and procedure. 

Copy of this order be supplied to the parties each free of cost.