Haryana

Karnal

331/2012

Bir Mati W/ Harpal Singh - Complainant(s)

Versus

Bajaj Allianz Insurance Company Limited - Opp.Party(s)

Sh. D.S. Mann

19 Sep 2014

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL  FORUM KARNAL.

 

                                                          Complaint No.331 of 2012

                                                          Date of instt.10.07.2012

                                                          Date of decision:01.04.2015

 

Bir Mati widow of Sh. Harpal Singh  son of Shri Rajbir Singh resident of village Goghripur tehsil and district Karnal.                                                               

 

                                                                  ……..Complainant.

                                  Vs.

Branch Manager, Bajaj Allianz Insurance Co.Ltd.SCO No.226 Sector 12, Urban Estate, Karnal.

 

                                                                        …..Opposite Party.

 

                                      Complaint u/s 12 of the Consumer

                                      Protection Act.

 

Before        Sh.Subhash Goyal……..President.

                   Smt.Shashi Sharma……Member.

 

Present:-    Sh.D.S.Mann  Advocate for the complainant.

                   Sh.N.K.Zak  Advocate for the OP.

ORDER

           

                        The complainant has filed the present complaint u/s 12 of the Consumer Protection Act  against the OP on the allegations that deceased Harpal husband of the complainant had purchased a life insurance policy on 29.9.2008 and he used to pay a sum of Rs.10,000/ as premium  per annum and the said policy  commenced from   15.10.2008  which was to mature on  15.10.2028.  The husband of the complainant deposited a sum of Rs.20,000/  on 13.11.2011 on account of remaining installments  and as such the said policy was in existence at the time of death of her husband who died on 23.11.2011 and the complainant lodged the claim   under the said policy but the OP has paid a  sum of Rs.17107/ in January, 2012 to the complainant. The complainant requested the OP to pay all the benefits under the said policy but in vain.  Thus, the complainant has filed the present complaint against the OP alleging deficiency in services and has prayed that the OP be directed to make the payment of the claim alongwith compensation for the harassment caused to him and the litigation expenses. He has also tendered his affidavit in support of the averments made in the complaint alongwith some other documents which would be discussed at the relevant stages.

 

2.                On notice the OP appeared and filed its written statement raising the preliminary objections that the present complaint was not maintainable; that the complainant has no locus standi to file the present complaint; that the complainant has no cause of action to file thepresent complaint; that the complaint was bad for mis joinder and non joinder of the parties and that there was no deficiency in services on the part of the OP.

 

                   On merits, it was contended that the complaint was liable to be dismissed because deceased  Harpal Singh husband of the complainant  had obtained the said policy w.e.f. 15.10.2008 for a sum of Rs.one lakh by suppression of true  and material facts.  The s aid policy was lying lapsed on account of nonpayment of premium and the said policy was revived on 13.1.2011 on the basis of declaration of good  health given by  deceased Harpal Singh and the death has taken place within approximately ten months of 1.11.2011 (revival of the said policy and during investigation it has come to the3 notice of the OP that he was getting  treatment of acute gastroenteritis with abdominal Koch,s since 10.7.2009. and Harpal who was a driver in Haryana Roadways also remained  on  leave  w.e.f.  10.7.2009 to 24.7.2009 and 2.12.2009 to 20.3.2010 continuously and thus the policy holder had concealed the true and material facts at the time of revival of the said policy  and as such there was  lack of principle of Uberrima fide  and as such the claim has rightly been repudiated.

 

3.                We have heard the learned counsel for the parties and have gone through the case file very carefully.

 

4.                 Therefore, from the facts and circumstances of the case, evidence on the file and the arguments advanced by the learned counsel for the parties, it emerges that the complainant has filed the present complaint against the OP alleging deficiency in services on the allegations that Harpal husband of the complainant had purchased a life insurance policy on 29.9.2008 and he used to pay a sum of Rs.10,000/- as premium  per annum and the said policy was commenced from   15.10.2008  which was to mature on  15.10.2028.  The husband of the complainant deposited a sum of Rs.20,000/  on 13.11.2011 on account of remaining  renewal installments  and as such the said policy was in existence at the time of death of her husband who died on 23.11.2011 and the complainant lodged the claim   under the said policy but the OP has paid a  sum of Rs.17107/ in January, 2012 to the complainant. The complainant requested the OP to pay all the benefits under the said policy but in vain.  In support of his complaint, the complainant has tendered affidavit Ex.C1, receipt Ex.C2 and Ex.C3, death certificate Ex.C4, legal notice Ex.C5, postal receipts Ex.C6 and Ex.C7.

 

5.                 However, as per the contention of the OP, the complaint was liable to be dismissed because deceased  Harpal Singh husband of the complainant  had obtained the said policy w.e.f. 15.10.2008 for a sum of Rs.one lakh by suppression of true  and material facts.  The s aid policy was lying lapsed on account of nonpayment of premium and the said policy was revived on 13.1.2011 on the basis of declaration of good  health given by  deceased Harpal Singh and the death has taken place within approximately ten months on 1.11.2011  after revival of the said policy and during investigation it has come to the notice of the OP that he was getting  treatment of acute gastroenteritis with abdominal Koch,s since 10.7.2009. and Harpal who was a driver in Haryana Roadways also remained  on  leave  w.e.f.  10.7.2009 to 24.7.2009 and 2.12.2009 to 20.3.2010 continuously  and thus the policy holder had concealed the true and material facts of the time of revival of the said policy  and as such there was  lack of principle of Uberrima fide  and as such the claim has rightly been repudiated. The OP has submitted affidavit of Branch Manager Ex.OP1,  proposal form Ex.OP2 and repudiation letter Ex.OP3, statement of Manish Ex.O4, Certificate from Haryana roadways showing the leave of deceased Harpal Ex.O6 and medical certificate and slips  bills Ex.O6 to Ex.O24 and declaration form Ex.O25.

 

6.                      Therefore, after going through the evidence  it is evident that Harpal son Rajbir obtained the life insurance policy  for a sum  of Rs.one lakh which was commenced on 15.10.2008 and the complainant was disclosed as nominee being his wife and the insurer was  under an obligation to  pay an amount of Rs.one lakh under the said policy in case of death. The said policy was lying lapsed on account of  non payment of the subsequent premium and the said policy was revived on 13.1.2011. It has come in evidence that assured Harpal died on 1.11.2011 i.e. during the subsistence of the  policy. The OP has not placed on record copy of the policy issued in favour of the assured Harpal Singh. However, the claim of the complainant has been repudiated on account of death of insured Harpal Singh   vide Ex.O3 on the ground that insured had not disclosed the  factum of  suffering from acute gastroenteritis with abdominal Koch,s since 10.7.2009 and  thereafter . In Ex.O3 it has also been mentioned that that  premium has been refunded to the extent of Rs.17107/-  as there was suppression of medical illness at the time of revival of the policy. The OP has drawn our attention  towards medical evidence which was collected during the investigation of the case as Ex.O2 to Ex.O25.   No doubt as per medical leave history  Ex.O6 it emerges that deceased had obtained medical leave from time to time  since 2004. It is also evident that Harpal Singh assured was suffering from acute gastroenteritis with abdominal Koch,s as shown in Ex.O7 which is a certificate issued by Dr.Tushar Kalra on 30.1.2006. Therefore, there is no doubt that assured was suffering from acute gastroenteritis prior to obtaining of the insurance policy. However, gastroenteritis  was not the cause of death of the assured Harpal Singh rather it has come in evidence that Harpal Singh was suffering from HIV Positive as shown in Ex.O20 but the said disease was detected on 5.4.2011  i.e. much after policy  which was  obtained in the year of 2008  as well as much after the revival of the lapsed policy which was revived on 13.1.2011. Therefore, even  if Ex.O20 is taken into consideration even then the same cannot be made a ground  to repudiate the claim because there is nothing on the file that assured Harpal Singh was suffering from HIV positive  which is only cause of death of life assured. Is not in dispute and moreover gastroenteritis was not the cause of death of the life assured as held in Branch Manager, LIC of India and others Versus Harjinder Singh 2013(1) CLT 449.

7.

                   It is pertinent to mention here that return of Rs.17107/- as mentioned in Ex.O3 is after the death of Harpal Singh life assured who died on 1.11.2011.

 

                    The law laid down in the authorities National Insurance Co.Ltd. and Anr. Versus Girin R.Shah  2012(4) CLT page 625, New India Assurance Co.Ltd. Vs.Arun Krishan Prui 2009)2) CPC page 720,  National Insurance Co.Ltd. Versus Bipul Kundu II(2005) CPJ 12 (NC)  Ashwani Gupta and Ors. Vs.United India Insurance Co.Ltd. 2009)1) CPC page 561 and  V.Kishan Rao Versus Nikhil Super Specialty Hospital and another  2010(2) CRC (Civil) 929 is not in dispute because  gastroenteritis  was not the cause of death of the assured Harpal Singh and as such the complainant is entitled to sum insured and it has to be held that there was deficiency in services on the part of the OP.

 

8.                Therefore, as a sequel to our above findings, we accept the present complaint and direct the OP to make the payment of sum insured to the complainant alongwith interest @ 9% per annum from the date of filing of the present complaint i.e.  10.07.2012 till its actual realization.  The complainant shall also be entitled  for a sum of Rs.10,000/- for the harassment caused to him and for the legal fee and litigation expenses. The OP shall make the compliance of this order within a period of thirty days from the date of receipt of the copy of this order.  The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated: 1.04.2015                                                                            

                                                              (Subhash Goyal)

                                                             President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

                   (Smt.Shashi Sharma)

                             Member.

 

 

 

Present:-      Sh.D.S.Mann  Advocate for the complainant.

                   Sh.N.K.Zak  Advocate for the OP.

         

                   Arguments in part heard. For remaining arguments, the case is adjourned to 01.04.2015.

 

Announced
dated: 19.03.2015                                                                           

                                                              (Subhash Goyal)

                                                             President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

                   (Smt.Shashi Sharma)

                             Member.

 

 

Present:-      Sh.D.S.Mann  Advocate for the complainant.

                   Sh.N.K.Zak  Advocate for the OP.

         

                   Remaining arguments heard.  Vide our separate order of the even date, the present complaint has been accepted. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated: 1.04.2015                                                                            

                                                              (Subhash Goyal)

                                                             President,

                                                         District Consumer Disputes

                                                           Redressal Forum, Karnal.

                   (Smt.Shashi Sharma)

                             Member.