Haryana

StateCommission

CC/23/2015

CHANNO DEVI AND OTHER - Complainant(s)

Versus

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

ANITA SHARMA

16 Aug 2018

ORDER

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

                  

                                                Complaint  No.23 of  2015

Date of the Institution:11.03.2015

Date of Decision: 16.08.2018

 

1.      Channo Devi W/o Sh.Harikesh Kumar,

2.      Seema Devi widow of Late Sh.Sunil Kumar

3.      Nisha minor daughter of Late Sh.Sunil Kumar

4.      Isha minor daughter of Late Sh.Sunil Kumar

5.      Dev minor S/o Late Sh.Sunil Kumar

Complainants No.3 to 5 are minor so through their mother and natural guardian Smt.Seema Devi. 

All resident of VPO Jakhouli,Tehsil and District Kaithal (Haryana).

                                                                   .….Complainants

Versus

 

1.      Bajaj Allianz  Life Insurance Company Limited, 5^th Floor, GE Plaza, Airport Road, Yerwada, Pune 411006 through its Managing Director.

2.      Bajaj Allianz Life Insurance Company Limited, SCO No.  Sector 34, Chandigarh.

                                                .….Opposite Parties

CORAM:    Mr.Ram Singh Chaudhary, Judicial Member.

 

Present:-    Ms.Anita Sharma, Advocate for complainants.

Mr.Varun Chawla, Advocate counsel for opposite parties.

 

O R D E R

RAM SINGH CHAUDHARY, JUDICIAL MEMBER:

 

          The brief facts of the case are that deceased (Sunil Kumar) had taken life insurance policy from the opposite parties.  The sum insured was Rs.44,70,000/- vide policy No.0283048246 dated 25.10.2012.  Unfortunately, Sunil Kumar was died on 17.12.2012.  Complainant No.1 being nominee of deceased filed claim, which was repudiated vide letter dated 25.11.2013 on the ground that he was chronic alcoholic.  Complainant filed claim in the office of Ombudsman, which was rejected vide order dated 24.03.2014.  Complainants also verbally requested the Ops for refund of the insured amount, but, no action has been taken till date.    Thus there was deficiency in service on the part of the O.Ps.

2.      Notice being issued, opposite parties contested the claim with the averments that deceased-Sunil Kumar was having pre-existing disease.  He was admitted in the Shah Hospital from 14.12.2012 to 16.12.2012.  Complainants did not produce hospital treatment record when he was referred to PGI from Shah Hospital, Kaithal.  At the time of taking insurance policy, he concealed the material facts from them.    Deceased life assured was suffering from Anorexia, weakness from last 3-4 months and had past history of Chronic Alcoholic. The claim was repudiated on 06.09.2013  due to non disclosure of material facts. Thus there was no deficiency in service on the part of the O.Ps. and prayed for dismissal of the complaint.

3.                When the complaint was posted for recording evidence of the parties, the complainant in her evidence has tendered the affidavit Ex.CA vide which she has reiterated all the averments taken in the complaint and further tendered the documents Ex.C-1 to Ex.C-7 and closed her evidence.

4.                On the other hand in order to rebut the evidence led on behalf of the complainant the O.Ps. had also tendered the affidavit Ex.RA that of Mr. Yogesh Kumar authorised representative, Unitech Ltd., and also tendered documents Ex.R-3 to R-17 and closed its evidence.

5.                The arguments have been advanced by Ms.Anita Sharma learned counsel for the complainants as well as Mr.Varun Chawla learned counsel for the opposite parties.  With their kind assistance the entire records as well as whatever the evidence had been led during the prosecution of the complaint had also been properly perused and examined.

6.                The basic and foremost question which has been raised by the learned counsel for the complainant was that it is the admitted fact that opposite parties had issued an insurance policy for a total sum of Rs.44,70,000/- commencing w.e.f. 25.10.2012 and it was valid for a period of 15 years.  One installment was also paid.  Thereafter, the insured had expired and when the claim was lodged it was repudiated by the opposite parties on the ground that he was suffering from the serious medical ailments.  Contrary to it, it has been argued by Sh.Varun Chawla, learned counsel for the opposite parties that since the insured had  concealed the material facts about the serious medical ailments, in that eventuality the opposite parties were  well within their  legal rights to repudiate the claim submitted by the present complainant.

7.                In view of the facts and circumstances, the basic and foremost question is as to whether the complainants being legal heirs of the deceased-Sunil Kumar are legally entitled to get the assured amount in pursuance of the insurance policy issued by the opposite parties. 

8.                In order to prove this material question, one of the complainant namely Channo Devi-CW-1 had tendered his affidavit Ex.CA and the documents Ex. C-1 to C-7.  The witness was examined wherein during the cross-examination the document Ex.R-1 which is basically proposal form was also put up upon which she has identified the signatures of her son Sunil-deceased.

9.                On the other hand, the O.Ps. have examined Mr.Yogesh Kumar, Manager Legal of Bajaj Alliance Life Insurance Company as RW-1 who had also tendered his affidavit Ex.RA with a similar prayer which may be read as part of my statement, the document Ex.R-1 to R-17 had also been tendered in the evidence.  Similarly the opposite parties have further examined Sh.Mahesh Singh, Investigator, who had also tendered his affidavit EX.R-B with a similar prayer which may be read as part of my statement, the document Ex.R-18 to R-23 has also been tendered in evidence.  The deceased life assured had obtained the policy by way of fraud & mis-representation.

10.              After going through the entire documentary evidence as well as the testimony of the witness examined on behalf of the complainants as well as opposite parties.  As far as issuing the policy is concerned, it is not in dispute.  It is true that before obtaining the policy, the deceased had submitted the proposal form Ex.R-1, which bears his signatures, as identified by CW-1, who happens to be the eldest member of the family and his passport size photograph has also been pasted.  It has denied every fact suffering from disease or consumption of the alcohol.  Contrary to it, the proposal form was submitted on 05.10.2012,  whereas he was admitted in Shah Hospital from 14.12.2012 to 16.12.2012 wherein as per the history given by Sunil-Deceased life assured he was a chronic alcoholic, as a result thereof, he was suffering from these kind of serious medical ailments.  After giving the necessary treatment or conducting the test etc., on page second of the reference of Shah Hospital, Kaithal he has been referred to PGI, Chandigarh.  Instead of taking him to PGI, Chandigarh he was kept at home and ultimately, since he was suffering from very serious kind of diseases, he was expired as is evident by death certificate Ex.CWA/2 and ultimately, the claim submitted by complainants on account of death of the insured-Sunil, it was repudiated vide letter dated 06.09.2013 EX.CWA/3 on the grounds of non-disclosure  of pre-proposal health condition of Anorexia & Weakness and also his personal habit of alcoholism.

11.              Now in this back-drop this Commission has to see as to whether the deceased had concealed the material pre-existing disease or he has not given the true version or he has concealed the material facts about his health or the other factual information which he has suppose to disclose.  As per the proposal form, he has denied each and every fact about his pre-existing disease or consumption of alcohol.  He was taken to Shah Hospital, Kaithal just after two months from obtaining the insurance policy and he was diagnosed to be a chronic alcoholic and was suffering from pre-existing disease, which amounts to concealment of material facts.  Not taking to PGI Chandigarh as was referred by the treating doctor also shows that the deceased was suffering from serious ailments and the complainant was  well aware of the facts or they have presumed that he was no longer survive .  It is well settled proposition of law that a person who conceals the material facts is not entitled to get any relief from the Court of law.  Since in the present case the deceased-Sunil Kumar himself had not disclosed the pre-existing disease or was suffering from serious nature of medical ailments and this proposition has been dealt with by the Hon’ble National Commission in a celebrated authority titled as  HDFC Standard Life Insurance Co. Ltd. Vs. Jayalaxmi 2011 (1) CPJ 231. The fact of the present case are squarely covered by the ratio laid down by Hon’ble National Commission and resultantly the complainants are not entitled to get any insured amount  and consequence thereof the question is answered in negation and the complaint being devoid of merits and deserves for dismissal and stands dismissed.

 

August    16th, 2018                                                  Ram Singh Chaudhary                                                                                                        Judicial Member                                                                                                                   Addl.Bench               

S.K.