Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. : 422
Instituted on : 27.07.2022
Decided on : 22.08.2023
Sikender Singh s/o Satyawan Singh, Resident of 1488/A Bohar Melwan Rohtak.
………..Complainant.
Vs.
- Bajaj Allianz Life Insurance Company Limited Through its Manager, office at Ground Floor, Dalal Complex, Delhi Road, Near Raj Motors, Rohtak.
- AXIS Bank, Rohtak through its Branch Manager, Bank situated at Ashoka Chowk, Rohtak.
…….Opposite party.
COMPLAINT U/S 35 OF CONSUMER PROTECTION ACT,2019.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
DR.VIJENDER SINGH, MEMBER.
Present: Sh. Sameer Gambhir, Advocate for complainant.
Sh. Nitin Goyal, Advocate for the opposite party No. 1.
Opposite party no. 2 already exparte.
ORDER
NAGENDER SINGH KADIAN PRESIDENT:
1. Brief facts of the case as per complainant are that Satyawan Singh(since deceased) father of the complainant had availed the life insurance policy through AXIS Bank Rohtak from the opposite party vide policy no.0449175183 with sum insured of Rs.2000000/- w.e.f. commencement of risk 17.04.2021 to 16.04.2058 and last premium date was 17.04.2030 and yearly premium Rs.200000/-. Complainant is son and nominee in the above said policy. The name of the policy is Bajaj Allianz Life Long Life Goal Limited Premium and renewal premium payment method was opted as Auto Debit Instruction to AXIS Bank, Rohtak. Satyawan Singh the father of the complainant was admitted to Kainos Super Specialty Hospital, Rohtak on 11.11.2021 on account of fever, cough, difficulty in breathing. Treatment was conducted by the doctor of Kainos hospital from 11.11.2021 to 23.11.2021 but during treatment he was expired on 23.11.2021. The complainant had intimated to AXIS Bank as well the opposite party No.1 regarding the death of Satyawan Singh for life insurance claim. Complainant had submitted all the treatment documents of Kainos Hospital to the opposite party No.1 for insurance claim but the opposite party No.1 vide its letter dated 09.03.2022 has repudiated the claim of the complainant on the basis of false facts that Satyawan Singh was diagnosed with cerebrovascular accident in 2011 and 2016, with seizure in Feb 2021. Insurance company has also submitted false facts that Satyawan Singh was suffering from hypertension since 10 years. Satyawan Singh was hale and hearty and was physically fit in all respect at the time of availing the insurance policy. The respondent doctor had medically and physically examined the Satyawan Singh before issuance of insurance policy and he was not suffering from any illness or disease. Hence the repudiation of the claim by the opposite party is illegal and amounts to deficiency in service. Hence this complaint and it is prayed that opposite party kindly be directed to pay Rs.2000000/- alongwith interest @12% per annum and also to pay Rs.300000/- as compensation on account of deficiency in service, Rs.200000/- towards harassment and Rs.15,000/- as litigation expenses to complainant as explained in relief clause.
2. After registration of complaint, notices were issued to the opposite parties. Opposite party No.1 in its reply has admitted that the father of the Complainant (Deceased life assured/DLA) i.e. Late Mr.Satyawan Singh purchased the policy through Bajaj Allianz Life Insurance Company. He submitted an online proposal/application form dated 07.04 2021 for the purchase of BAJAJ ALLIANZ LIFE LONG LIFE GOAL POLICY having annual premium of Rs 200000/-, policy term of 37 years, premium paying term of 10 years and having sum assured of Rs 2000000/-. The proposal form was an electronic proposal form wherein the consent of the proposer/applicant had been taken through OTP. The proposal was accepted by the answering opposite party based on the basis of information provided by the DLA in the proposal form and consequently a policy bearing Policy No.0449175183 was issued on 20.4.2021 with risk commencement date 17.04.2021. However, the deceased life assured expired due to the complications which arose due to pre existing diseases from which he was suffering from. The complainant approached the answering opposite party and lodged a death claim on 12.01.2022. Since it was an early claim, therefore, the answering opposite party hired an investigation agency by the name of DELVER to know the history of the Deceased Life Assured. On 24.02.2022, the investigation agency submitted its report and interestingly it came to the notice of the opposite party that the Deceased Life Assured was suffering from many ailments which included Hypertension, CVA, seizures and was under medication. It was also discovered that the DLA was a chronic smoker, he had taken treatments from Kainos hospital prior to the application of the Insurance. Since the DLA had concealed the material information that he was suffering from Cerebrovascular Attack (CVA), Hypertension and seizures, therefore, the answering opposite party has rightly repudiated the claim of the complainant. The DLA had adopted unethical practices to play fraud on the answering opposite party by not disclosing the material information regarding his health. All the other contents of the complaint were stated to be wrong and denied. There is no deficiency in service on the part of opposite party and opposite party No.1 prayed for dismissal of complaint with costs. However, none appeared on behalf of opposite party No.2 despite service and opposite party No.2 was proceeded against exparte vide order dated 04.10.2022 of this Commission.
3. Ld. counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.P18 and has closed his evidence on dated 10.03.2023. Ld. counsel for the opposite party No. 1 has tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R7 and thereafter failed to adduce any evidence despite availing sufficient opportunities. As such evidence of opposite party No.1 was closed by the court order dated 28.07.2023.
4. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
5. In the present case it is not disputed that father of the complainant Mr.Satyawan Singh(since deceased) purchased the policy through Bajaj Allianz Life Insurance Company on dated 07.04.2021 having annual premium of Rs 200000/-, policy term of 37 years, premium paying term of 10 years and having sum assured of Rs 2000000/-. Meaning thereby complainant has been covered under the Bajaj Allianz Life Insurance Policy for the period of 37 years and he will deposit the premium amount only for 10 years and the remaining period i.e. 27 years of the policy, complainant will not pay any premium amount for the sum assured i.e. Rs.20 lacs. Date of commencement of policy is 17.04.2021. Date of death of policy holder is 23.11.2021 i.e. within 7 months and 6 days. Complainant submitted all the documents with the opposite party on dated 12.01.2022. As per the investigation of the respondent officials some relevant information has been concealed by the deceased LA. As per investigation report, the deceased LA was suffering from hypertension and he was also suffering from Cerebrovascular Attack (CVA) in the year 2011 and 2016. He was also suffering from seizures since February 2021. It is further submitted that the deceased LA was taking medicines prior to taking the insurance policy and he was a chronic smoker. As per investigation report, DLA was taking treatment from various hospitals prior to his death. He was taking treatment from Kainos Super Specialty Centre, Rohtak vide registration no KHI20529 & KHI22343. It is further submitted that a false statement has been made in the proposal form by the deceased LA. In fact he has not disclosed the past history of his ailment to the opposite party and disclosed the incorrect information in the proposal form and the same is violation of terms and conditions of the policy. After considering the investigation report and other relevant documents, the respondent officials repudiated the claim of the complainant vide letter dated 09.03.2022. We have perused the documents placed on record by both the parties. Ex.R5 is the investigation report, Ex.R6 is the discharge summary of Kainos hospital. Ex.R7 is repudiation letter. As per investigation report deceased LA took treatment from Jind Heart Hospital, Metro Hospital Jind, Oscar Heart Care, Jind, Civil Hospital, Jind, Narayana Hospital Jind, Balaji Hospital Jind and Kainos Hospital Rohtak. The insurance company failed to placed on record any document of the above mentioned hospital whereas they have only produced the discharge summary of Kainos Hospital as Ex.R6. Perusal of discharge summary shows that at the time of admission the deceased LA was suffering from Chief complaint of chronic cough for last 2-3 months fever on and off for few days, difficulty in breathing for last 2 or 3 hrs., depressed sensorium for one day. No other chronic ailment/disease has been mentioned in the discharge summary. It is also mentioned that patient was a k/c/o COPD chronic pulmonary disease(recently admitted with LRTI) and K/C/O HTN/CVA but duration of COPD of HTN has not been mentioned in the treatment record. Hence it is not proved that at the time of inception of policy, he was suffering from COPD. The date of admission to the hospital is 11.11.2021 and date of discharge is 23.11.2021. No history of COPD has been established from the document Ex.R6 that he was suffering from any chronic disease at the time of inception of policy. We have also perused the documents placed on record by the complainant Ex.C3 to Ex.C12 i.e. medical examination reports of the deceased LA Satyawan Singh. Ex.C3 is the medical examination report of Bajaj Allianz Life Insurance Co. Ltd., as per which deceased Satyawan Singh was examined by Dr. Balkishan, D.T.C.D, M.D(Medicine) Heart & Medical Specialist. Ex.C4 to Ex.C8 are the test report of deceased Satyawan Singh issued by Sai Diagnostic Centre and signed by Dr. Reena Singla, M.D.(Pathology). Ex.C9 is ECG report, Ex.C10 is the Electrocardiogram report which is issued by Dr. Vinanti Pol DIP. Diabetology(M.Hsc.) Dip. Cardiology. Ex.C11 is the confirmation of medical examination issued by Dr. Balkishan D.T.C.D, M.D(Medicine) Heart & Medical Specialist for the purpose of insurance policy from Bajaj Life Insurance Company. Hence from the alleged documents, it is proved that at the time of issuance of policy, the deceased Satyawan was got medically examined by the doctors of opposite party No.1 and he was found hale and hearty. We have also perused the judgment cited by ld. counsel for the complainant of Hon’ble National Consumer Disputes Redressed Commission, New Delhi in Revision Petition no.842 of 2016 titled as Divisional Manager, LIC of India & Anr. Vs. R.Viji Akila & Anr. dated 09.06.2022, as per which it is observed by the Hon’ble National Commission that : “It is admitted that the premium was paid, the policy was valid and the policy was issued after a medical examination of the insured was got conducted by the insurance co. from a doctor on its own panel. The sum and substance of the appraisal made by the State Commission is that the insurance co. had not been able to conclusively establish that there was in fact suppression of material information(“we find that the appellants/opposite parties have not adduced any evidence to substantiate their contention that the claim was repudiated due to suppression of material facts by the insured.”). In view of the aforesaid law which is fully applicable on the facts and circumstances of the case it is observed that in the present case also, opposite party No.1 has failed to establish that the deceased Life assured has suppressed any material information at the time of proposal of policy. Hence the repudiation of claim on this ground is illegal and amounts to deficiency in service. As such opposite party No.1 is liable to pay the sum assured to the L.Rs of deceased Satyawan Singh. As per Ex.R5 investigation form, in the column of family history, there are four L.Rs of deceased i.e. 1.Santra Devi(wife), 2.Sikander Singh(son), 3. Sunita(daughter) and 4. Sarita(daughter).
6. In view of the facts and circumstances of the case we hereby allow the complaint and direct the opposite party no.1 to pay an amount of Rs.2000000/-(Rupees twenty lacs only) alongwith interest @9% p.a. from the date of filing the present complaint i.e. 27.07.2022 till its realization and Rs.10000/-(Rupees ten thousand only) as compensation on account of deficiency in service and Rs.5000/-(Rupees five thousand only) as litigation expenses to L.Rs. of deceased Satyawan Singh i.e. 1.Santra Devi(wife), 2.Sikander Singh(son), 3. Sunita(daughter) and 4. Sarita (daughter) in equal share. Order shall be complied within one month from the date of decision.
7. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
22.08.2023.
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Nagender Singh Kadian, President
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Tripti Pannu, Member.
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Vijender singh, Member
