BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM, JALANDHAR.
Complaint No.38 of 2016
Date of Instt. 19.01.2016
Date of Decision: 10.01.2018
Smt. Balbir Kaur wife of Late Shri Gurdev Singh son of Shri Pritam Singh, resident of village Naugajja, Tehsil and District Jalandhar.
..........Complainant
Versus
1. Bajaj Allianz Life Insurance Co. Ltd. Regd. & HO GE Palaza, Air Port Road, Yerawada, Pune 411006 through its Authorized Signatory.
2. Bajaj Allianz Life Insurance Co. Ltd., Branch Office, Grand Malls, 5th Floor, Near BMC Chowk, Jalandhar through its Branch Manager.
….….. Opposite parties
Complaint Under the Consumer Protection Act.
Before: Sh. Karnail Singh (President)
Smt. Harvimal Dogra (Member)
Present: Sh. BS Chahal, Adv Counsel for the Complainant.
Sh. SC Sood, Adv Counsel for the OP No.1 and 2.
Order
Karnail Singh (President)
1. The instant complaint filed by the complainant, wherein alleged that Sh. Gurdev Singh was the husband of the complainant, who purchased Master Policy No.0293656438 in his name and deposited the due premium during his life time. The said Gurdev Singh died on 24.01.2015 and thereafter, the complainant submitted insurance claim, which was entered as claim notification No.71516003580 in the office of the OP No.1. The complainant also deposited intimation letter, original death certificate, original policy bond, KYC and Bank Passbook copy-nominee and the said documents were duly acknowledged by the OP No.1, vide acknowledgment letter dated 15.04.2015. Even after deposit of the requisite documents, the insurance claim of the Gurdev Singh has not been paid to the complainant. The complainant approached the office of the OP No.2 several times with a request to settle her claim, but to no effect. Non settlement of the claim of the complainant is clear cut negligence and deficiency in service on the part of the OPs, for which the complainant is also entitled to claim damages to the tune of Rs.1,00,000/- from the OPs. The complainant served a legal notice dated 10.11.2015 calling upon the OPs to settle the claim, but no action was taken by the OPs and as such, there is a deficiency in service on the part of the OPs and accordingly, the instant complaint filed with the prayer that the complaint of the complainant may be accepted and OPs be directed to settle and pay the insurance claim of the complainant in respect of death of her husband Sh. Gurdev Singh and also be directed to pay a compensation of Rs.1,00,000/- on account of mental tension, undue harassment, unfair trade practice, negligence and deficiency in service.
2. Notice of the complaint was given to the OPs and accordingly, both the OPs appeared and filed their joint written reply, whereby contested the complaint by taking preliminary objections that the complainant has no locus standi to file the instant complaint against the answering OPs as there is no privity of contract between the complainant or the deceased. It is pertinent to add here that the contract of insurance was entered into between the Master Policy Holder i.e. Punjab Gramin Bank and the answering OPs. The deceased was enrolled as a member of the said master policy. Thus, the contract of the insurance was never entered into between the complainant and the answering OP and thus, the complainant is not a consumer, therefore, the complaint is liable to be dismissed. It is further averred that no cause of action has arisen in favour of the complainant to file the present complaint. Moreover, the OP has already paid permissible fund value amounting to Rs.16,082/- to the complainant as per rule and as such, there is no deficiency in service on the part of the answering OP and further alleged that the insured deceased Gurdev Singh deliberately and intentionally concealed the materiel facts relating to his health and gave wrong and false answers, information, statements and declaration in the Enrollment Form dated 30.01.2013. The deceased insured Gurdev Singh was a known case of Cerebro Vascular Accident (CVA) with history of Atrial Fibrillation and remained admitted in Handa Neuro Hospital, Jalandhar from 31.03.2012 to 08.04.2012 for the treatment of the said diseases even prior to the date of filling up the enrollment form and further submitted that the deceased got himself enrolled as insured member of the Group Master “Sarve Shakti Suraksha” policy administered by Punjab Gramin Bank by way of fraud and the consent of the answering OPs was obtained by way of mis-representation and suppression of material facts by the deceased and further alleged that the complainant has filed the present complaint by concocted a false story and as such, the present complaint is liable to be dismissed and even the complainant has no locus-standi or cause of action to file the present complaint against the answering OP and further alleged that the issues involved in the complaint are complex in nature and needs full scale trial enabling all the parties to examine number of witnesses thus, the instant complaint is liable to be dismissed. On merits, it is admitted that the master policy was obtained by the bank and Gurdev Singh is the member of the said master policy, but the other contents of the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits and the same may be dismissed.
3. In order to prove the case of the complainant, complainant Balbir Kaur tendered into evidence her own affidavit Ex.CA alongwith documents Ex. C1 to Ex.C7 and also examined Satish Chander, whose affidavit is Ex.CA/1 and photostat copy of his Passport Ex.C-8 and further examined Sukhdev Singh, whose affidavit is Ex.CA2 and Photostat copy of Ration Card Ex.C-9 and then examined Raghubir Singh, whose affidavit is Ex.CA3 and Photostat Copy of the Driving License Ex.C-10 and then examined Kamaljit Kaur, whose affidavit is Ex.CA4 and Photostat Copy of the Passport Ex.C-11 and then examined Gurdev Kaur, whose affidavit is Ex.CA5 and Photostat Copy of the Passport Ex.C-12 and then examined Santokh Singh, whose affidavit is Ex.CA-6 and Photostat copy of the Identity Card Ex.C-13 and then complainant closed the evidence.
4. In order to rebut the evidence of the complainant, counsel for the OP No.1 and 2 tendered into evidence affidavit Ex.OPW1/A alongwith certain documents Ex.OP-1 to Ex.OP-9 and closed the evidence.
5. We have heard the learned counsel for the respective parties and also gone through the case file very minutely.
6. The factum in regard to get an insurance policy by the deceased Gurdev Singh from the OPs, is not in dispute because the OPs have brought on the file copy of proposal form, filled by Gurdev Singh deceased and copy of the proposal form is Ex.OP-1, no doubt, the copy of insurance policy is not brought on the file by either of the party, but it is admitted fact that the deceased Gurdev Singh purchased an insurance policy bearing No.0293656438 and after the death of insured deceased Gurdev Singh, the insurance claim was admittedly submitted by the wife of Gurdev Singh i.e. Complainant and insurance claim alongwith documents have been duly acknowledged by the OP, vide acknowledgment letter Ex.C-1 and thereafter, the claim of the complainant was repudiated by the OPs, vide repudiation letter Ex.OP-8 dated 29.06.2015, on the ground that the deceased Gurdev Singh remained admitted in the hospital from 31.03.2012 to 08.04.2012, which shows that he was having a disease prior to purchase of the policy, but these factum had been concealed by Gurdev Singh from the Insurance Company, at the time of filling of the proposal form and copy of the proposal form is Ex.OP-1.
7. Now question remains whether deceased Gurdev Singh had concealed any material facts in regard to any disease from the OPs, no doubt, the counsel for the complainant submitted that the deceased Gurdev Singh never concealed any material facts, but in order to establish these factums, the OP has brought on the file discharge card of Handa Neuro Hospital i.e. Ex.OP-3, wherein categorically mentioned that the deceased Gurdev Singh was remained admitted in the aforesaid hospital from 31.03.2012 to 08.04.2012 and further OP brought on the file medical test reports of deceased Gurdev Singh Ex.OP-4 and Ex.OP-5 and further discharge summary, issued by Tagore Hospital and Heart Care Centre, copy of the same is available on the file Ex.OP-6, wherein the date of the admission has been made 02.10.2013 and date of discharge 08.10.2013 and further, OP brought on the file investigation report Ex.OP-9, which contains 20 pages including “Prosi Panchnama”, from the above documents i.e. Hospital Reports and Investigation Reports, itself established that the deceased Gurdev Singh was having a disease for which he got a treatment from the hospital i.e. Handa Neuro Hospital in the year 2012, whereas the insurance policy was obtained on 03.01.2013 as per proposal form Ex.OP-1 and information in regard to previous ailment has been furnished by the deceased Gurdev Singh in the proposal form by stating that he was not having any disease, so it means there is apparently concealment of material facts, which are required to disclose by the deceased Gurdev Singh, at the time of filling a proposal form, but he intentionally and deliberately did not disclose his previous ailment, thus, the plea taken by the OP having much substances in the argument. So, with these observations, we are of the considered opinion that the case of the complainant is not proved and therefore, the complaint is dismissed with no order of cost. Parties will bear their own cost. The complaint could not be decided within stipulated time frame due to rush of work.
8. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Harvimal Dogra Karnail Singh
10.01.2018 Member President
