Haryana

Ambala

CC/152/2020

Veera Devi - Complainant(s)

Versus

Bajaj Allianz Life Inss Co Ltd - Opp.Party(s)

Sanjeev

10 Oct 2022

ORDER

 BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

 

                                                          Complaint case no.         :    152 of 2020

                                                          Date of Institution           :     17.08.2020

                                                          Date of decision    :     10.10.2022.

Veera Devi Wd/o Late Sh. Subhash Chander R/o H.No.1183, Village Ugala, Tehsil Barara, District Ambala. 

                                                                             ……. Complainant.

                                                Versus

1. Bajaj Allianz Life Insurance Company Limited, Registered Office Bajaj Allianz House, Airport Road, Yerawada Pune through its Managing Director.
2. Bajaj Allianz Life Insurance Company Limited, 1, Pary Hotel, Opposite G.P.O, First Floor, Staff Road, Ambala Cantt District Ambala through its Branch Manager

 ….…. Opposite Parties.

Before:        Smt. Neena Sandhu, President.

                   Smt. Ruby Sharma, Member,

Shri Vinod Kumar Sharma, Member.

 

Present:        Shri Sanjeev Gauri, Advocate, counsel for the complainant.

                      None for the OPs.

 

Order:        Smt. Neena Sandhu, President.

1.                Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’) praying for issuance of following directions to them:-

i) To make payment of Rs.7,00,000/- (Seven Lacs only) along with    interest @ 18% per annum from 18.12.2018, till realization

ii) To pay Rs.2,00,000/-, as compensation for the mental agony and physical harassment suffered by the complainant.  

iii) To pay Rs.35,000/- as cost of litigation.

                                      OR

Grant any other relief, which this Hon'ble Commission deems fit and proper as per the facts and circumstances of this case.

2.             Brief facts of the case are that the complainant is the widow of late Sh. Subhash Chander who expired on 18.12.2018. At the time, when Sh. Subhash Chander was alive, he purchased Certificate of Insurance vide Membership No.0354415241 under the Group Insurance Scheme namely Group Credit Protection Plus duly administered by Yes Bank Limited, for an amount of Rs.7 lacs. As per the said policy, the OPs covered various types of loans given by the Employers and also covered Borrower's/Co-Borrower's of various types of financial institutions, co-operative etc. Date of commencement of risk was 15.12.2018. Premium was duly received by the OPs for a term of 5 years. The complainant is the nominee of the insured-Subhash Chander. Moreover she is also one of legal heir of deceased Subhash Chander who has every right to collect the insurance amount of the said policy being nominee of the insured person as per law. On death of the insured, the complainant filed Claim no. 81819003126 under the aforesaid policy with the OPs. Earlier the OPs assured that the payment of insurance will be paid but to her utter surprise, the said claim was repudiated by the OPs, without any justified reason. However, it is important to mention here that Subhash Chander electrocuted on 08.12.2018 but at the time of issuing aforesaid policy, he was alive. The OPs were aware that Subhash Chander was electrocuted on 08.12.2018 but as he recovered therefore the OPs issued a Cover Note commencing w.e.f 15.12.2018 but unfortunately he did not recover and expired on 18.12.2018. Subhash Chander did not conceal anything from the OPs at the time of taking the aforesaid policy but the OPs repudiated the claim of the complainant without any reason and against the provisions of policy as well as law. Under those circumstances, the complainant served a Registered Post Legal Notice dated 24.01.2020 through her advocate which was duly received by the OPs but they gave a false and frivolous reply to that legal notice. By not reimbursing the claim amount, the OPs have committed deficiency in service. Hence, the present complaint.
3.           Upon notice, the OPs appeared and filed written version and raised preliminary objections with regard to maintainability, estoppal, not come with clean hands and concealed the true and material facts etc. On merits, while admitting factual matrix of the case with regard to the fact that the insured-Subhash Chander had purchased the insurance policy in question from the OPs, it has been stated that the insured wilfully and fraudulently concealed the material facts regarding his health condition at the time of purchase of the insurance policy. The insurance Company had covered the risks under the policy on the basis of proposal form submitted by the insured. On the claim being raised, since it was a case of early death where the Life Assured had passed away within a duration of 3 days from issuance of policy, an investigation was conducted. During enquiry of the history of life assured, the investigator attained life assured's medical reports/docs related to the treatment which he received in M.M. Institute of Medical Science & Research, Mullana, Ambala, Haryana and as per these medical docs it was evident that he suffered electrocution shock approx 2 weeks prior to taking this insurance cover. The observation & analysis of medical documents clearly indicates that the insured had been under serious observation and medical management of the said medical centre. Further, the investigator of the OPs- M/s. Universal Investigation Agencies also verified medical records & Post mortem report ("PMR) from the concerned medical centre. On post mortem report, it was mentioned that the life assured passed away due to electric shock while working on transformer and he was brought to the emergency on 08.12.2018 and discharge on the same day on written request. He was again brought on 19.12.2018 and after examining he was declared brought dead. It is also important to note that the post mortem report stated cause of death due to electric burns which are ante mortem and sufficient to cause death in ordinary course of nature. Since proposal form was signed on 15.12.2018, it is pertinent to draw attention to the fact that life assured was electrocuted and admitted to the hospital on 08.12.2018 i.e. before signing the proposal form and this fact was concealed by the life assured. Rest of the averments of the complainant were denied by the OPs and prayed for dismissal of the present complaint with costs.
4.           Complainant tendered his affidavit as Annexure C-A alongwith documents as Annexure C-1 to C-7 and closed the evidence of the complainant. On the other hand, despite opportunities given to the OPs to tendered affidavit, they failed to do so, as a result of which, the evidence of the OPs was closed by this Commission, vide order dated 31.08.2022. Even none put in appearance on behalf of the OPs on the date of arguments.
5.           We have heard the learned counsel for the complainant and carefully gone through the case file.
6.           Learned counsel for the complainant submitted that since the insured (now deceased) was insured under the policy in question, as such, the OPs were liable to make payment of insurance claim after his death to the complainant being nominee. At the time of obtaining the policy in question on 15.12.2018, the insured was healthy but the OPs arbitrarily repudiating the claim of the complainant, the OPs are deficient in providing service, negligent and adopted unfair trade practice. 
7.           None put in appearance on behalf of the OPs at the time of arguments, and accordingly, the arguments of learned counsel for the complainant were heard at length and also the record of this case was gone through, very minutely.
8.           Admittedly, the claim filed by the complainant was repudiated by the OPs, vide letter dated  01.04.2019, Annexure C-2  as under:-

“…….Sub: Repudiation of claim under policy no. 0354415241 on the life of Late Mr.Subhash Chander,

We deeply regret to note the sad demise of Late Mr Subhash Chander... Please accept our sincere heartfelt condolences.

We would like to inform you that the company had covered the risk for the above said policy on the basis of the facts mentioned in the proposal form. However, on receiving the death claim intimation for the above said policy, the various investigations done, the various medical records received reveal certain facts, which were known to the deceased life assured and were not disclosed to us. Hence the death claim under above mentioned policy has been declined for the following reason/s:

Electrocution on 8/12/2018 was proposal suppressed in the enrolment form dated 15/12/2018 to Induce the insurer to issue the policy resulting in to fraud. Had these facts been disclosed the company would not have covered the risk for the above said policy under the same term and conditions.

Hence, the claim has been repudiated due to misrepresentation of material facts.

In case you are not satisfied with our decision, you may write to the claims review committee for reconsideration within 30 days of receipt of this letter….”

9.           The claim filed by the complainant was repudiated by the OPs, on the ground that the insured died due to electrocution on 8/12/2018, yet, in the enrolment form dated 15/12/2018 this fact was concealed by him, as a result of which he died on 18.12.2018. 
10.           Since, the facts with regard to issuance of the policy in question to the insured-Subhash Chander (now deceased) on 15.12.2018; payment of premium made by him to the OPs; his death on 18.12.2018 due to electrocution are not in dispute, as such, the only question that falls for consideration is, as to whether, the OPs were justified in repudiating the claim filed by the complainant, being nominee of the insured-Subhash Chander (now deceased) or not?

It may be stated here that the only base made for repudiation of claim filed by the complainant was that while filling up the proposal form at the time of issuance of the policy in question on 15.12.2018, the insured-Subhash Chander (now deceased) had concealed the material fact with regard to electrocution on 8/12/2018. It is significant to mention here that to prove the fact that at the time of issuance of the policy in question on 15.12.2018, the insured-Subhash Chander (now deceased) had concealed the material fact with regard to electrocution on 8/12/2018, the OPs were required to place on record material evidence in the shape of the said proposal form which they miserably failed to do so. Even no such document in the shape of evidence has been placed on record by the OPs to prove that any such question, as to whether, he suffered electrocution or not, was put to the insured-Subhash Chander (now deceased) at the time of issuance of the said policy on 15.12.2018. It may be stated here that evidence has not been led by the complainant despite the fact that number of opportunities were available with the OPs, as a result whereof, their evidence was closed vide order dated 31.08.2022. Under these circumstances, an adverse inference could easily be drawn against the OPs that had the said proposal form being placed on record, it would have gone against them.

          From the perusal of certificate of insurance Annexure C-1, it is evident that the OPs issued the insurance policy in question, on 15.12.2018, merely on the basis of enrolment form received from the Yes Bank Limited, without going into further investigation of the insured-Subhash Chander (now deceased) and infact ignored to carry out his medical tests or his physical appearance before it for the purpose, later on, they cannot wriggle out of the claim filed in respect of the said policy, on the ground that there is a concealment of material facts regarding any alleged concealment of facts, especially, when proposal form has not been placed on record, even to establish that fact. In this view of the matter, it is held that by repudiating the claim filed by the complainant on bald grounds to the effect that there was concealment of facts on the part of the insured-Subhash Chander (now deceased) while obtaining the insurance policy in question, on 15.12.2018 the OPs have committed deficiency in service. In the certificate of Insurance Annexure C-1 it is mentioned that Mr. Subhash Chander (now deceased) was insured under the policy in question for sum assured of Rs.7,00,000/-, therefore, OPs are liable to pay Rs.7,00,000/-, to the complainant alongwith interest. OPs are also liable to compensate the complainant for the mental agony and physical harassment suffered by her and is also liable to pay litigation expenses.

11. In the aforesaid discussion, we hereby allow the present complaint against the OPs and direct them, in the following manner:-

                   (i) To pay Rs.7,00,000/- (Rs. Seven Lacs), to the complainant  alongwith interest @ 4% per annum from the date of repudiation      i.e. 01.04.2019, till realisation.

                   (ii) To pay Rs.5,000/-, as compensation for the mental agony and    physical harassment suffered by the complainant.

                   (ii) To pay Rs.3,000/- as litigation expenses.  

                   The OPs are further directed to comply with the aforesaid direction within the period of 45 days from the date of receipt of the certified copy of this order, failing which it shall pay interest @ 5% per annum on the awarded amount except the litigation costs, from the date of default, till realisation. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

Announced on: 10.10.2022.

 

          (Vinod Kumar Sharma)  (Ruby Sharma)               (Neena Sandhu)

              Member                         Member                       President