THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMRITSAR

Consumer Complaint No. 32-15

Date of Institution : 9.1.2015

Date of Decision : 3.11.2015

Smt. Rajni age 48 years wd/o Sh. Surinder Kumar r/o H.No. 57, Dashmesh Avenue, P.O. Sultanwind Near Amritsar Public School, Amritsar ...Complainant

Vs.

Bajaj Allianz Life Insurance Company Limited, Ranjit Avenue, Amritsar through its Branch Manager/Principal Officer

....Opp.party

Complaint under section 12/13 of the Consumer Protection Act, 1986

Present : For the complainant : Sh.Vikram Puri,Advocate

For the opposite party : Sh. S.K.Vyas,Advocate

Quorum : Sh. Bhupinder Singh, President ,Ms. Kulwant Bajwa,Member &

Sh.Anoop Sharma,Member

Order dictated by :-

Bhupinder Singh, President

1 Present complaint has been filed by Rajni under the provisions of the Consumer Protection Act alleging therein that her husband namely Surinder Kumar obtained Insurance policy bearing No. 0268983226 dated 7.6.2012 with maturity date 6.6.2022 with sum assured of Rs. 10 lacs on payment of annual premium of Rs. 10420/- from the opposite party. According to the complainant on 11.7.2012 her husband Sh. Surinder Kumar insured suffered heart attack . He was rushed to Sri Guru Ram Dass Institute of Medical Science and Research , Amritsar , where he died in the hospital on the same day. After the death of husband of the complainant, the complainant lodged claim with the opposite party alongwith all the relevant documents. But the opposite party repudiated the claim of the complainant vide letter dated 17.10.2012 on the ground that her husband was suffering from Diabetes Mellitus, hypertension with diabetic neuropathy and had not disclosed these facts to the opposite party at the time of obtaining the said policy. Complainant has alleged that before obtaining the said policy, the husband of the complainant was medically checked up and he was found perfectly all right at the time of taking policy. Complainant has alleged that her husband had not concealed any material fact from the opposite party and the opposite party is liable to pay the genuine claim of the complainant and they cannot repudiate the same on flimsy grounds. Alleging the same to be deficiency in service complaint was filed seeking directions to the opposite party to to pay the claim amount of Rs. 10,00,000/- alongwith interest @ 18% p.a. Compensation of Rs. 30000/- alongwith litigation expenses were also demanded.

2. On notice, opposite party appeared and filed written version in which it was submitted that deceased life assured Surinder Kumar deliberately , dishonestly and with a malafide intention concealed true and correct facts regarding his health at the time of proposal for insurance dated 30.5.2012 and gave wrong and false information/statements. It was submitted that Surinder Kumar was admitted in Sri Guru Ram Dass Institute of Medical Sciences & Research, Vallah, Sri Amritsar from 3.6.2012 to 4.6.2012 for the treatment of serious ailments. The first premium receipt was issued to the complainant on 7.6.2012 but he fraudulently did not disclose the said ailments though he was lying on death bed at the time when the proposal form for the aforesaid policy was filled in and signed by Surinder Kumar and accepted by the opposite party. Had he disclosed the true and correct facts at the time of proposal for insurance, the risk under the policy in question would not have been accepted by the opposite party and the policy would not have been issued in normal course of insurance business. It was submitted that Surinder Kumar was suffering from chronic renal failure as recorded on 9.6.2012 and was a known case of Type II Diabetes Mellitus for 5 to 6 years, Hypertension for 2 to 3 years, Diabetic Neuropathy and Nephropathy and as per hospital treatment record of Sri Guru Ram Dass Hospital, where he remained admitted from 3.6.2012 to 4.6.2012 . The deceased gave wrong and false answers in the proposal form dated 30.5.2012. DLA Surinder Kumar who was seriously ill, was admitted in the hospital between the date of proposal i.e. 30.5.2012 to the date of acceptance/date of first premium receipt i.e. 7.6.2012, did not report his actual state of health and his admission in the hospital well before the acceptance of proposal . Thus the ailment from which the deceased was suffering prior to the date of proposal and the dececeased did not disclose the same while obtaining the policy. Thus the claim has rightly been repudiated by the opposite party and there is no deficiency of service on the part of the opposite party.

3. Complainant tendered into evidence her affidavit Ex.C-1 alongwith documents Ex.C-2 to Ex.C-6.

4. Opposite party tendered affidavit of Sh.Sandeep Gupta, Operations Incharge Ex.OP1 alongwith documents Ex.OP2 to Ex.OP18.

5. We have carefully gone through the pleadings of the parties, arguments advanced by the ld.counsel for the parties and have appreciated the evidence produced on record by both the parties with the valuable assistance of the ld.counsel for the parties.

6. From the record i.e.pleadings of the parties and the evidence produced on record by both the parties it is clear that husband of the complainant namely Surinder Kumar obtained Insurance policy bearing No. 0268983226 dated 7.6.2012 with maturity date 6.6.2022 with sum assured of Rs. 10 lacs on payment of annual premium of Rs. 10420/- from the opposite party. Sh. Surinder Kumar insured suffered heart attack on 11.7.2012. He was rushed to Sri Guru Ram Dass Institute of Medical Science and Research , Amritsar (hereinafter to be called Sri Guru Ram Dass Hospital) where he died in the hospital on the same day. The complainant being wife of Surinder Kumar and nominee under the policy lodged claim with the opposite party regarding death of insured Surinder Kumar (hereinafter to be called DLA) alongwith all the relevant documents. But the opposite party repudiated the claim of the complainant vide letter dated 17.10.2012 on the ground that her husband was suffering from Diabetes Mellitus, hypertension with diabetic neuropathy and had not disclosed these facts to the opposite party at the time of obtaining the said policy. The complainant submitted that DLA was medically fit and then the oppsoite party issued the policy and the DLA suddenly died due to heart attack. So at no point of time DLA had concealed any material facts from the opposite party. Ld.counsel for the complainant submitted that all this amounts to deficiency of service on the part of the opposite party qua the complainant.

7. Whereas the case of the opposite party is that DLA Surinder Kumar deliberately , dishonestly and with a malafide intention concealed true and correct facts regarding his health at the time of proposal for insurance dated 30.5.2012 and gave wrong and false information/statements. DLA Surinder Kumar was admitted in Sri Guru Ram Dass Hospital from 3.6.2012 to 4.6.2012 for the treatment of serious ailments. The first premium receipt was issued to the complainant on 7.6.2012 but he fraudulently did not disclose the said ailments though he was lying on death bed at the time when the proposal form for the aforesaid policy was filled in and signed by the DLA and accepted by the opposite party. Had he disclosed the true and correct facts at the time of proposal for insurance, the risk under the policy in question would not have been accepted by the opposite party and the policy would not have been issued in normal course of insurance business. The fee i.e. first premium regarding the policy was deposited by the complainant on 7.6.2012 and before that he had already been admitted in Sri Guru Ram Dass Hospital, Amritsar from 3.6.2012 to 4.6.2012 but he did not disclose these facts to the opposite party. Not only this as per the medical record of the complainant collected during investigation it was confirmed that DLA Surinder Kumar was suffering from chronic renal failure as recorded on 9.6.2012 and was a known case of Type II Diabetes Mellitus for 5-6 years, Hypertension for 2-3 years, Diabetic Neuropathy and Nephropathy and as per hospital treatment record of Sri Guru Ram Dass Hospital, where he remained admitted from 3.6.2012 to 4.6.2012 Ex.OP18. Not only this he left the said hospital against medical advise (LAMA) on 4.6.2012 and thereafter he deposited the first premium on 7.6.2012 and got issued the policy by concealment of facts thereby he has obtained the policy by concealment of facts. As such the complainant is not entitled to the claim under the said policy. Ld.counsel for the opposite party submitted that opposite party has rightly repudiated the claim of the complainant and there is no deficiency of service on the part of the opposite party qua the complainant.

8. From the entire above discussion we have come to the conclusion that complainant got insurance policy bearing No. 0268983226 dated 7.6.2012 with maturity date 6.6.2022 with sum assured Rs. 10 lacs on payment of annual premium of Rs. 10420/- from the opposite party. Sh. Surinder Kumar DLA suffered heart attack on 11.7.2012 . He was taken to Sri Guru Ram Das Hospital,Amritsar , where he died on the same day . The complainant being widow and nominee of DLA Surinder Kumar lodged claim with the opposite party regarding the death of DLA Surinder Kumar by submitting all the relevant documents, but the opposite party repudiated the claim of the complainant vide letter dated 17.10.2012 on the ground that her husband was suffering from Diabetes Mellitus, Hypertension, Diabetic Neuropathy and he remained admitted in Sri Guru Ram Das Hospital,Amritsar from 3.6.2012 to 4.6.2012 and he left the said hospital against medical advice as is evident from the record of Sri Guru Ram Das Hospital, Amritsar Ex.OP18. The DLA while filling in and signing the proposal form Ex.OP2 did not disclose these facts to the opposite party and he paid the first premium for obtaining the policy on 7.6.2012 and the policy was issued to the complainant on 7.6.2012. At the time of depositing the first premium on 7.6.2012 on the basis of which the D LA was issued policy in question, he had already been admitted in Sri Guru Ram Das Hospital, where he remained admitted from 3.6.2012 to 4.6.2012 and he left that hospital against medical advice as is evident from the record of said hospital Ex.OP18. But the DLA did not disclose these ailments facts to the opposite party. All this shows that he was lying on death bed at the time when he filled in and signed the proposal form Ex.OP2 . Had the DLA disclosed these true and correct facts to the opposite party at the time of proposal for insurance, the risk under the policy in question would not have been accepted by the opposite party and the opposite party would not have issued the insurance policy in normal course of its business. The opposite party has also produced the medical record of DLA Surinder Kumar from Sri Guru Ram Das Hospital, Amritsar which proves that DLA was suffering from chronic renal failure as recorded on 9.6.2012 and was a known case of Type II Diabetes Mellitus for 5 to 6 years, Hypertension for 2 to 3 years, Diabetic Neuropathy and Nephropathy . No doubt DLA Surinder Kumar managed to submit the proposal form Ex.OP2 on 30.5.2012 but he deposited the first premium with the opposite party on 7.6.2012 mischievously because policy cannot be issued unless and until the insured deposits first premium with the Insurance company . So on 7.6.20123 the DLA got issued the policy in question by concealment of facts. It has been held by the Hon'ble Supreme Court of India in case Satwant Kaur Sandhu Vs. New India Assurance Company Ltd 2009(3) Apex Court Judgements 244 (SC) that non disclosure of existence of chronic disease at the time of taking of policy, Insurance company is justified in repudiating the claim. Same view has been taken by the Hon'ble National Commission in their latest rulings in Revision Petition titled as LIC of India & Others Vs Ramamani Patra & Anr. 2015(3) CLT 487 as well as in Revision Petition titled as Sulochana Devi Vs. LIC of India & Ors 2015(3) CLT 353 that where life assured suppressed the facts and not diclosed the pre-existing disease in proposal form , the plea of the complainant that there is no nexus between the death and disease suppressed ,held that the duty of the Consumer fora is not to find out whether there is any nexus between death and disease suppressed by the insured that has nothing to do with the grant of compensation. Non disclosure of existence of chronic disease at the time of taking of policy, Insurance company is justified in repudiating the claim of the complainant. Under these circumstances , we are of the opinion that opposite party was justified in repudiating the claim of the complainant vide letter dated 17.10.2012.

9. Resultantly we hold that complaint is without merit and the same is hereby dismissed with no order as to costs. Copies of the orders be furnished to the parties free of costs. File is ordered to be consigned to the record room. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum.

3.11.2015 ( Bhupinder Singh )

President

( Kulwant Kaur Bajwa) (Anoop Sharma)