Haryana

Panchkula

CC/217/2015

JASWINDER KAUR. - Complainant(s)

Versus

BAJAJ ALLIANZ INSURANCE CO.LTD. - Opp.Party(s)

AMANDEEP BINDRA.

18 Apr 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, PANCHKULA.

                                                    

Consumer Complaint No	:	217 of 2015
Date of Institution	:	06.10.2015
Date of Decision	:	18.04.2016

                                                                                          

Smt.Jasvinder Kaur w/o Late Sh.Ranjeet Singh, R/o Village Khanahmepur, Post Office Alipur, Tehsil Barara, District Ambala.

 

                                                                                      ….Complainant

Versus

 

1.       Bajaj Allianz Life Insurance Company Ltd., Plot No.271, Phase-II, Industrial Area, Panchkula-1311015, Haryana through its Manager.

2.       Bajaj Allianz Life Insurance Co. Ltd., SCO 215-217, 4^th Floor, Sector 34-A, Chandigarh.

                                                                       ….Opposite Parties

 

COMPLAINT UNDER SEC. 12 OF THE CONSUMER PROTECTION ACT, 1986.

 

Before:                 Mr.Dharam Pal, President.

              Mr.S.P.Attri, Member.

 

For the Parties:     Mr.Amardeep Bindra, Advocate, for the complainant. 

Mr.Varun Chawla, Advocate, for the Ops.

 

ORDER

 

(Dharam Pal, President)

 

1. The complainant being legal heir of deceased Ranjeet Singh has filed this complaint under Section 12 of the Consumer Protection Act, 1986 against the Ops with the averments that the deceased-Ranjeet Singh purchased a policy from the Op No.1 bearing policy No.0110421538 dated 06.10.2008 for Rs.2,50,000/-. At the time of issuing the policy, the deceased was medically examined by the company’s doctor and the company i.e. Ops after satisfying themselves on all the scores as per their norms issued the policy. The deceased also paid the first premium to the tune of Rs.25,000/- against the policy. But thereafter, before paying the second premium, unfortunately on 10.09.2009, the deceased passed away due to sudden heart attack. The mother of the deceased-Smt.Dalip Kaur was nominated in the abovesaid policy who left for her heavenly abode on 18.07.2009 and the complainant became entitled for the death claim against the abovesaid policy. Being legally wedded wife of the deceased, the complainant lodged death claim with the Ops by completing all the necessary formalities alongwith a letter and duly sworn affidavit dated 01.10.2009. But the Ops repudiated the claim of the complainant vide letter dated 05.04.2010 addressed to the deceased mother Smt.Dalip Kaur on the ground that the deceased had not disclosed certain ailments from which he was suffering with at the time of purchase of policy. The complainant requested several times to Ops to settle the death claim but to no avail. Thereafter, the complainant issued legal notice dated 26.08.2011 which was duly replied by the Op No.1 vide letter dated 28.09.2011 in which they had enunciated that they have treated the notice of the complainant as representation and would present the same before the review committee for reconsideration of the case and would convey their decision shortly but the Ops did not convey any message. The complainant issued reminders dated 13.10.2011 and 15.11.2011 but to no avail. This act of the opposite parties amounts to deficiency in service on their part. Hence, this complaint.
2. The Ops appeared before this Forum and filed written statement by taking some preliminary objections and submitted that the deceased-Sh.Ranjeet Singh had concealed the facts regarding his health at the time of proposal for insurance dated 12.08.2008 which was received on 30.09.2008. It is submitted that various investigations, medical reports, documents and treatment records of Dr.Vikram Bharti confirmed that the deceased life assured had history of Medication and psychiatric illness. It is submitted that the deceased gave wrong and false answers, statements and declarations in the proposal form dated 12.08.2008 received on 30.09.2008. It is submitted that from the investigation, it transpired that the death of deceased-life assured was caused due to suicidal hanging and not due to heart attack. It is submitted that the claim of the complainant was rightly repudiated vide letter dated 05.04.2011 for non disclosure of material facts. It is submitted that the legal notice of the complainant was placed as representation before the Claims Review Committee to review the decision to repudiate the claim and the said Committee upheld the decision of the Ops and the intimation thereof sent to the complainant vide letter dated 14.11.2011.  It is submitted that the deceased expired on 10.09.2009 i.e. within just 11 months of acceptance of risk under the policy. It is submitted that the relevant clause of the policy bonds under the heading “Non-Disclosure” read as under:-

“Non-disclosure”

          In case of non-disclosure or fraud or misrepresentation in the Proposal Form/personal statement, declaration or in any other connected documents leading to the acceptance of the risk or if the Policy Holder or any one acting at its discretion or with its knowledge make or advances any claim under this Policy knowing it to be false or fraudulent in any respect, the company shall, at its discretion, declare the Policy null and void and shall repudiate the claim and no benefit shall be payable there under, subject to Section 45 of the Insurance Act.”

It is submitted that the contract of insurance is a contract of “UTMOST GOOD FAITH” technically known as “UBERIMMA FIDES”. Thus, there is no deficiency in service and untrade practice on the part of OPs and prayed for dismissal of the complaint with costs.

3. In order to prove his case, the counsel for the complainant has tendered the evidence by way of affidavit Annexure C-A alongwith documents Annexure C-A to C-14 and closed the evidence. On the other hand, the counsel for the Ops has tendered the evidence by way of affidavit Annexure R-A alongwith documents Annexure R-1 to R-18 (R-2 & R-7 to R-16 in original) and closed the evidence.
4. We have heard learned counsel for the parties and have gone through the record carefully and minutely.
5.  Initially, the complainant had filed a complaint before the District Consumer Disputes Redressal Forum, Yamuna Nagar at Jagadhari which was dismissed for want of jurisdiction. However, DCDRF, Yamuna Nagar at Jagadhari vide order dated 23.06.2015 has exempted the period of limitation spent by complainant.
6. Learned counsel for the complainant has argued that her husband Ranjeet Singh during his life time had obtained an insurance policy bearing No. 0110421538 dated 06.10.2008 for Rs.2,50,000/-/- from OPs.  It has been further argued that the life assured had died on 10.09.2009 during the subsistence of the policy but despite that the insurance company has not settle the genuine claim of the complainant rather repudiated the same vide letter of repudiation dated 05.04.2010 wrongly and illegally on the ground that material information regarding the health of assured was withheld at the time of taking insurance policy he was having history of Medication & Psychiatric illness. 
7. Per contra, learned counsel for the OPs has argued that insurance is totally based on utmost good faith but the policy taken by the deceased is vitiated by fraud committed by him upon the insurance company. The assured was under obligation to disclose all the material facts within his knowledge about the state of his health at the time of taking up the policy.  It has been argued that the DLA in insurance proposal Form Annexure R1 was asked about his prior disease but he had replied ‘NO’  and he also affixed his signatures by admitting the facts written therein as correct.  It has been further argued that proposal form was submitted by concealing the real facts because at the time of taking insurance policy he was having history of Medication & Psychiatric illness.  It has been further argued that  if this Forum reaches at the conclusion that the DLA was not having any pre-existing disease even then the complainant is not entitled for any claim as Ranjeet Singh, DLA had committed suicide and this fact has been authenticated by the relatives of Ranjeet Singh.
8.  After hearing the arguments advanced on behalf of both the parties and going through the material available on the case file it transpires that the insurance company has wrongly and illegally repudiated the claim of the complainant. The fact that the deceased Ranjeet Singh had obtained a policy from the OPs is not disputed. It has also not been disputed that he died during the subsistence of the policy. The main objections on behalf of the OPs are that the assured Ranjeet Singh had intentionally withheld the information regarding his state of health from the insurance company at the time of taking insurance policy and he had committed suicide. The OPs have placed on case file documents Annexure R8 to Annexure R16 (prescription slips) in order to show that the DLA was having Medication & Psychiatric illness but the insurance company has not produced on file affidavit of the doctor to prove the fact that the life assured was having pre-existing disease and due to the same he had died. On this point reliance can also be taken from case law titled as Life Insurance Corporation of India Vs. Badri Nageswaramma (Deceased) & Ors. II (2005) CPJ 9 (NC) wherein Hon,ble National Commission has held that Section 21-Life Insurance-Repudiation of claim-Deceased on old TB patient, having diabetes, not known on date of proposal-Burden to prove false representations and suppression of facts, on insurer-Doctor’s certificate without affidavit in support, no basis for repudiating the claim-No conclusive evidence produced to suggest suppression on part of deceased-Company liable under policy.  Further learned counsel for the OPs-insurance company has failed to explain whether any preliminary investigation has ever been made by the insurance company at the time of issuance of policy to Ranjeet Singh. Another plea taken by the Ops that DLA had committed suicide is also not tenable because it has been made on the hearsay evidence. Though during investigation the investigator had got recorded the statement of  one Jasbir Kaur i.e. sister of the DLA but it was the duty of the insurance company to bring her into the witness box to show that DLA had committed suicide due to illness.  The insurance company has no direct evidence to show that DLA had committed suicide as it has also failed to even bring any affidavit/evidence of the person living in that area confirming cause of death was suicide. On this point reliance can also be taken from case law titled as Surjan Singh Saini Vs. Life Insurance Corporation of India  I (2001) CPJ 316. The insurance company is not suppose to get only premium but it also liable to act fairly without taking the benefits of the weaknesses of the assured and it is also liable to indemnify all the responsibilities for which the premium has been received. The act and conduct of the OPs-insurance company reveals that they instead of acting fairly the insurance company is trying to befool their customers. In the present case instead of acting fairly the insurance company is trying to avoid from its liability by making one pretext or the other, which cannot be allowed to do so.  The complainant has been able to prove deficiency in service on the part Ops.
9.  In view of the above, we are of the considered opinion that the complaint deserves to be succeeded and the same is allowed. The Ops are directed as under:-
   1. To make the payment of Rs.2,50,000/- alongwith interest @ 9% interest from the date of repudiation i.e. 05.04.2010.
   2. To pay a sum of Rs.20,000/- for mental agony and harassment.
   3. To pay a sum of Rs.5000/- as litigation expenses.

 

10. Let the order be complied with within 30 days from the receipt of the certified copy of this order. A copy of this order be sent to the parties free of costs and file be consigned to the record room after due compliance.

 

Announced

18.04.2016                    S.P.ATTRI             DHARAM PAL

                                       MEMBER             PRESIDENT

 

 

Note: Each and every page of this order has been duly signed by me.

 

    

                                 

                                                         DHARAM PAL

                                                            PRESIDENT