Announced in Open Forum

Dated: 15.5.2018

Naveen Puri, President;

1        The complainant Ninder Kaur has filed the present complaint under Section 11, 12 and 13 of the Consumer Protection Act (herein after called   as 'the Act') against Bajaj Allianz Life Insurance Company Ltd. and others (Opposite parties) on the allegations of deficiency in service and negligence in service on the part of the opposite parties with further prayer to direct the opposite parties to pay the total minimum death benefit under the policy i.e. sum of Rs. 18,00,000/- besides this Rs. 20,000/- as compensation to the mental and physical harassment and Rs. 10,000/- as litigation expenses.

2        The case of the complainant in brief is that the opposite parties Bajaj Allianz Life Insurance Company Limited is dealing in the life insurance policies. The Bajaj Allianz Life Insurance Company presents the “BAJAJ ALLIANZ INVESTASSURE” policy. Under the said policy, the persons, having 0-18 years of age, can choose Silver plan variant and the person of 18 years or of above age can choose Gold plan Variant. On the maturity date, if all premiums are paid, the sum assured will be paid and the policy will terminate. In case of unfortunate death of the life assured  during the policy terms, the sum assured on death is the higher of 1.5 times of sum assured in case of silver variant plan and 2 times of sum assured in case of Gold Variant plan. The complainant Ninder Kaur is a widow & poor lady and was earlier having only son namely Gurjant Singh. The opposite parties officials of the opposite parties approached the complainant & her family and gave lucrative offers for having a life insurance policy and had told about the above policy to the complainant and her family members and the complainant & her family were attracted to the offers made by the opposite parties. The complainant had proposed to assure the life of her son Mr. Gurjant Singh, who was 18 years old at that time vide policy “BAJAJ ALLIANZ INVEST ASSURE” and chooses Gold variant plan and the opposite parties have issued the policy No.0315730595 in favour of the deceased/applicant Gujant Singh and the said policy was commenced on 28.05.2014, the date of commencement of risk was 31.05.2014, the term for the policy was 30 years, the date of maturity of the policy was 27.05.2044 and premium was to be paid up to 28.11.2033 and the half yearly premium was to be paid of Rs. 15464.00/- and installments were fixed semi-annual and the regular premium was to be paid for 20 years and the sum assured on maturity of the policy was fixed of Rs. 9,00,000/- and death benefit/ Minimum Sum assured on death was fixed of Rs.18,00,000/-  i.e 2 time of the sum assured and the above said policy was issued in favour of Gurjant Singh, whose date of  birth is 05.05.1996 and the appointed nominee of the said policy is his mother namely Ninder Kaur, the present complainant, who is fully competent to file the present complaint. The first installment of the policy was given at the time of issuing of the policy is Rs. 15941.84/- including tax etc., was paid at the time of issuance of the policy. Unluckily the applicant Gurjant Singh died a natural death due to Heart Attack on 21.06.2014 at his residence in the Village Manochahal, Tehsil and District Tarn Taran. The complainant had given the required information to the company regarding the death of the applicant Gurjant Singh for obtaining the amount of sum assured under the policy No. 03157230595. All the requisite details/documents i.e. death certificate, forms and information were produced to the officials of the opposite parties and the officials of the opposite parties kept mum for several months since the death of the applicant Gurjant Singh and thereafter, just in order to save their skin & money and opposite parties repudiated the genuine claim of the complainant vide correspondence dated 31.03.2015 on the basis of alleged false, fabricated & frivolous medical record, income proof and other documents / submissions. The complainant has requested the opposite parties to give the genuine claim of the complainant but the opposite parties refused to release the genuine claim of the complainant and it amounts to deficiency in services on the part of the opposite parties.. Hence the present complaint is filed.

3        After formal admission of the complaint, notice was issued to Opposite Parties. Opposite Parties appeared through counsel and filed written version contesting the complaint on the preliminary objections that no cause of action has arisen in favour of the complainant against the opposite parties as the deceased life assured Mr. Gurjant Singh deliberately, dishonestly, and with a malafide intention submitted fake & forged J-Form as proof on income and concealed his previous policy with Birla sun life Insurance Ltd bearing number 006511711 having DOC- 24.05.2014 and sum assured of Rs. 19, 99,998/- just of induce the opposite parties to accept the risk on his life. The various investigations, a letter dated 03.03.2015 issued by Market committee, Tarn Taran and the confirmation received from Birla Sun Life confirmed that the deceased Mr. Gurjant Singh gave wrong & false answers, statement and declaration in the proposal form insurance date 28.05.2014 knowing well that those were wrong and false just to induce the opposite parties to accept the risk on his life. Had the deceased disclosed his correct income, previous policy with Birla Sun Life and has not submitted fake  & forged documents at the time of proposals for insurance, the risk on his life would not have been accepted. Thus, the contracts of Insurance entered into by the deceased on the basis of fake & forged documents, is a vitiated contracts and the policies in question are as such null and void ab-initio. The claim under the policy has been legally and rightly repudiated.  The complainant has not approached this Forum with the clean hands and has concealed the true & material facts from this Forum just to derive illegal financial gains. The deceased life assured fraudulently and intentionally submitted fake & fabricated J-forms issued by Pamma Commission Agent, Tarn Taran as proof of income disclosed in the proposal form dated 28.05.2014 whereas the market committee, Tarn Taran vide letter dated 03.03.2015 confirmed that no such Commission agent is registered with them at Tarn Taran. Further, the deceased fraudulently did not disclose his previous life insurance policy bearing number 006511711 having DOC-24-05-2014 & sum Assured of Rs. 19, 99,998/- just to induce the opposite parties to accept risk on his life. The various investigations & other records confirmed that he deceased Mr, Gurjant Singh as well as the complainant has done acts to play fraud with the opposite parties just to drive illegal financial gains. The policies for a heavy sum assured on the life of Mr. Gurjant Singh were purchased by providing false information, fake documents and concealment of material facts known to the complainant as well as the deceased. As per investigations made by the opposite party it was revealed that Shri Gurjant Singh was of 18 years of age and was having only 1/2 acre of  land for cultivation from which he was earning merge income of Rs. 40,000/- per annum and his income was not in line with the income disclosed in the proposal form. During the detailed investigations made by the opposite parties regarding the cause of death through its investigation agency namely Total Transparency Investigation Pvt. Ltd, it was revealed that as per Anganwari death record register the date of death of deceased was 17.05.2014 whereas as per records of the Local Registrar, Births and Deaths Municipal Committee, Tarn Taran date of death was mentioned as 21.06.2014 while he was bitten by the dog allegedly on 17.05.2014 but the investigations revealed that he had died on way to the hospital and was not admitted or treated in any hospital. Thus, the policies on the life of Mr. Gurjant Singh were fraudulently obtained after his death on 17.05.2014 and date of death was fraudulently got registered as 21.06.2014 in order to play fraud with the insurance company. Moreover, no information to the nearby police station regarding the alleged death of Gurjant Singh was given by the family of the life assured and as such the investigation agency has concluded that it is a pre-planned case of fraud. On account of the aforesaid findings, the claim of the complainant was repudiated by the opposite party and the premium paid to the opposite party has already been refunded to the opposite party by crediting the same to her bank account. The complainant has not approached this Forum with clean hands and the instant complaint has been filed just to derive illegal financial gains. Mr. Gurjant Singh proposed for regular premium non linked “ Bajaj Allianz Invest Assure gold”   policy for sum assured of Rs. 900000/- and submitted proposal form dated 28.05.2014 duly filled and signed in alongwith the copy of Form-J as proof of his income as disclosed in the said proposal form. The contracts of insurance being contract of Utmost good faith, the contents of the proposal forms duly signed by the said proposer were believed to be true and the documents submitted were treated to be genuine and correct. Thus, on the basis of the documents and the answers, statements & declarations made by the said Mr. Gurjant Singh, the proposals on his life was accepted as proposed and a policy bearing number 0315730595 was issued to him believing the information and documents provided by him to be true and correct. The life assured Mr. Gurjant Singh expired on 21.06.2014 i.e. within just 21 days of acceptance of risk on his life, giving rise to a very early death claim thus, the various investigations and records confirmed that the deceased life assured Mr. Gurjant Singh  deliberately, dishonestly and with a malafide intention submitted fake & forged Form-J as proof of his income and fraudulently concealed his previous high sum assured policy with Birla Sun Life, just to induce the opposite parties to accept the risk on his life.  The deceased life assured while answering the questions of the proposal forms gave wrong answers to the questions of proposal forms dated 28.05.2014.  The consent of the opposite parties was obtained by way of fraud; misrepresentation & suppression of material facts by way of provide fake documents. The contract of insurance is as such null and void as per the provisions of section 17 and 18 of the act and the conditions of a valid contract as incorporated under section 10 of the contract Act, 1872 were therefore not fulfilled under the policy in question.  The life assured Mr.Gurjant Singh expired on with in just 21 days of acceptance of risk on his life giving rise to a very early death claim which itself is a strong ground to raise reasonable doubt over the correctness of the material representations made in the proposal Form. Thus, the claim under the policies was as such legally and rightly repudiated by the opposite parties vide letter dated 31.03.2015 after due application of mind strictly in accordance with the terms and conditions of the insurance alongwith documents Ex.  contracts and an amount of Rs.15464/- was credited to the saving bank account No.626102010002247 vide NEFT UTR No.SIN00101Q7960545 toward refund of premium. The complaint is bad for non-joinder and mis-joinder of all the necessary parties.  This Forum has no jurisdiction to entertain and try to instant complaint as the issues involved are complicated in nature and requires full scale trail before the civil court of competent jurisdiction. On merits, the opposite parties have reiterated the same stand as taken in the preliminary objections and denied all the other allegations and prayer was made for dismissal of the complaint with costs. 

4        Sufficient opportunities were granted to the parties to lead evidence in order to prove their respective case. The complainant tendered in to evidence her affidavit Ex. C-1, affidavit of Jagir Singh Ex. C-2 alongwith documents Ex. C-3 to Ex. C-17, affidavit of Satnam Singh Ex. C-18, affidavit of Ajaib Singh Ex. C-19 alognwith documents Ex. C-20 and Ex. C-21 and closed the evidence. Ld. counsel for the opposite parties tendered in evidence affidavit of Sandeep Gupta Ex. OPs/1 alongwith documents Ex. OPs/2 to Ex. OPs/40 and closed his evidence.

5        We have heard the Ld. Counsels for the complainant and opposite parties and have gone through the evidence and documents placed on the file by the parties.

6        Presently, we analytically observe herein produced evidentiary documents with the judicial precision (that the majesty of constitutional justice bestows upon Indian Courts/ Forums) and find that the OP insurers have arbitrarily rejected/ repudiated (vide Ex.C14/ Ex.OPs/2) the complainant’s impugned insurance claim so as to wriggle out of its legal liability to judiciously settle its receipted claims.

7        We find that the impugned death-claim has been repudiated by the OP insurers on account of the following prime reasons on records: i) Alleged non-disclosure of certain medical records by the DLA (Deceased Life Assured) in the Proposal Form while applying for purchase of the related policy and the same were revealed during the conduct of the claim-investigations; ii) Obtaining of one Higher Value Policy through a) An intentional suppression of the other existing/continuing policy and b) A knowingly incorrect/wrong  submission of Income Proof that were otherwise material to disclose for correct assessment of the DLA’s entitlement to the one high value policy in question. The OP insurers have also emphasized upon the elements of fraud/ deceit in the above narrated DLA’s pre-policy acts and as such justify its repudiation/ rejection of the present insurance claim. Somehow, the opposite party insurers here have failed to prove its allegations to justify its impugned repudiation through some cogent evidence necessary to be produced during the present proceedings and as such these amount to ‘bald’ statements, only.

8        We find that the purchase and validity of the related policy along with its terms (including the sum insured etc) have been duly admitted (not contested) along with the factum of the insurer’s death. The complainant has duly proved all the compliant-contented fall-outs through presentation of her evidentiary documents exhibited here as Ex. C1 to Ex.C21. The OP insurers in turn have produced its affidavit Ex.OPs/1 by its Branch official along with other evidentiary documents Ex.OPs/2 to Ex.OPs/40 to prove its allegations in rebuttal and as defense averments etc.

9        We find that the OP insurers have simply mentioned non-disclosure of past medical records by the DLA but have neither contested it further nor have produced any evidence to press it further rather its investigator has stated in his report that there has been no past medical history/record pertaining to the DLA hence the related part of claim repudiation/ rejection falls apart like a house of cards. Further, we do not find that the DLA has placed on records any inflated income to enhance his entitlement to one High Value Policy. The complainant has produced the DLA’s family owned Ag land Fard Jamanbandi to prove his cultivated land holding that is sufficient to justify the declared Ag Income besides sufficient Dairy Income from the DLA owned mulch-animals as per the accompanying affidavits of the village respectable. Further, the OP insurers have failed to prove that false fake/ Income J-Forms were submitted by the DLA and moreover there has been no fit occasion to plant the fake J-forms since sufficient and necessary income was coming in natural flow from the DLA’s known resources/ properties. Lastly, the OP insurers have failed to prove as to how the suppression of an existing/ continuing policy can adversely affects its legal rights. The learned counsel for complainant has successfully cited some landmark senior court verdicts disproving the hollow proposition supporting disclosure of existing policies by the insured. Its disclosure may not be totally unnecessary but even its disclosure may not be necessary to the extent of being mandatory for settlement of claim(s). Lastly, like many other vital legal propositions the present one shall also be case specific & presently not requisite, for certain. The OP insurers have based their above repudiation decision solely on presumptions and hearsay evidences and the same are not admissible in judicial adjudicatory.

10      In the light of the all above, we are of the considered opinion that the OP insurers have blatantly bruised the consumer rights of the present complainant by employing ‘unfair trade practice’ amounting to ‘deficiency in service’ (on their part) and that lines them up for an adverse statutory award under the applicable Consumer Protection Act’ 1986.

11      We, therefore,  partly allow the present complaint and thus ORDER the OP insurers to pay the impugned ‘death-claim’ for the full insured amount as per the governing ‘terms’ of the applicable Insurance Policy (to its full benefits) besides to pay her Rs 10,000/- as cost and compensation within 30 days of receipt of the copy of the present orders otherwise the aggregate award amount shall attract interest @ 9% PA till actual payment.

12      Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.