DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BARNALA, CAMP COURT, AT AMRITSAR, PUNJAB.

 

Complaint Case No : RBT/CC/2018/422

Date of Institution   : 11.06.2018/29.11.2021

Date of Decision    : 15.09.2022

Harjit Kaur wife of Late Sh. Tarsem Singh resident of Village Bachiwind, Tehsil Ajnala, District Amritsar.  

                …Complainant Versus

1.Bajaj Allianz Life Insurance Company Limited, 3D, Floor Balaji Chambers, SCO-3, District Shopping Complex, B-Block, Ranjit Avenue, Amritsar through its Branch Manager/Person Overall Incharge.

2.Bajaj Allianz Life Insurance Company, having its office GE Plaza, 5th Floor, B Wing, Airport Road, Yerawada Pune, Maharashtra-411006 through its Branch Manager/person overall incharge.  

                  …Opposite Parties

Complaint Under Section 12 & 13 of Consumer Protection Act.

 

Present: Sh. Amit Bhatia Adv counsel for complainant.

Sh. Sumit Sharma Adv counsel for opposite parties.

Quorum:-

1. Sh. Ashish Kumar Grover : President

2.Sh. Navdeep Kumar Garg : Member 

 

(ORDER BY ASHISH KUMAR GROVER, PRESIDENT):

1. The present complaint has been received by transfer from District Consumer Commission, Amritsar in compliance of the order dated 26.11.2021 of the Hon'ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh. The complainant has filed the present complaint Under Section 12 and 13 of the Consumer Protection Act. against the Bajaj Allianz Life Insurance Company Limited and others (hereinafter referred as opposite parties)

2. Brief facts of the case are that the husband of the complainant namely Late Sh. Tarsem Singh had obtained a life insurance policy namely Bajaj Allianz Invest Assure from the opposite parties vide policy No. 0316986726 by paying a premium of Rs. 12,876/- and the sum assured of the policy was Rs. 14 lacs on the event of the death of insured. It is further alleged that the policy of the complainant commenced from 28.7.2014 and commencement of risk was 30.7.2014 and the maturity date is 27.7.2044. Thereafter, the policy documents was received which includes proposal form, age proof, identity proof, permanent address and terms and conditions. It is further alleged that the complainant was nominee in the said policy which was taken by her Late husband Sh. Tarmem Singh. On 6.8.2014 the husband of the complainant had died due to electric current and in this regard one application dated 19.9.2014 was also moved to the concerned Police Station and thereafter after making proper enquiry by the police one report dated 26.9.2014 has been prepared. It is further alleged that after the death of her husband the complainant approached the opposite parties and submitted the claim along with all the requisite documents and also submitted the death claim form. The complainant has received one letter dated 2.4.2018 vide which the claim of the complainant was rejected by the opposite parties on flimsy grounds by stating that it is pre-proposal death, fake death certificate submitted and policy has been obtained on a predeceased life fraudulent act fitted to deceive. It is further submitted that on the said day the deceased was taken to Arora Hospital, where Dr. Rakesh Arora had declared the person as dead. Even in this regard one certificate has also been given by the Sarpanch.   The above said acts of the opposite parties amounts to deficiency in service and unfair trade practice on their part. Hence, the present complaint is filed for seeking the following reliefs.- 

i) To pay an amount of Rs. 14 lacs being sum assured  as per policy alongwith interest @ 18% per annum.

ii) To pay Rs. 1,00,000/-  as compensation and Rs. 11,000/- as litigation expenses alongwith interest @ 18% per annum on the amounts above mentioned. 

3. Upon notice of this complaint, the opposite parties appeared and filed written reply by taking preliminary objections interalia on the ground of maintainability. It is further alleged that the complainant filed another complaint before the Hon'ble State Commission, Punjab, Chandigarh which tantamount that policy bears sum assured above Rs. 20,00,000/- and the same was withdrawn with liberty to file again. It is alleged that the complainant is bound to produce the policy alongwith other documents related to another policy and such conduct clearly showed the malafide intention of the complainant to grab the amount for which she is not entitled. It is further alleged that the policy was issued on 28.7.2014 and the life assured had expired on 6.8.2014, the policy has continued for a period of 10 days since its issuance. On investigation it was revealed that the LA was dies already and policy purchased by the complainant fraudulently. 

4. On merits, it is submitted that the opposite parties received proposal/application form bearing No. 5933765173 duly filled and signed by the Life Assured seeking insurance on his life under the “Invest Assure Gold Plan” and on the basis of information and declarations provided in the said application form the company issued policy bearing No. 316986726. It is further alleged that the opposite parties received duly filled and signed application form wherein the Life Assured was informed that he is required to pay a semi-annual premium of Rs. 12,877/-. The claim under the policy is an outcome of a fraud which has been played on the opposite party. On 2.6.2017 the company received claim intimation from the complainant i.e. nominee of the policyholder and in the claim it was stated the policyholder expired on 6.8.2014 within 10 days from the date of issuance of the policy. It is further alleged that during investigation it was found that the complainant concealed the factum that Tarsem Singh was died much earlier and got the insurance after his death by her and it was also found that the life assured was died pre-purchase the policy while filing the proposal form. The complainant should approach the Civil Courts in order to challenge the veracity of the decision of the opposite party to repudiate the claim. As such, the company has rightly repudiated the claim vide letter dated 2.4.2018. All other allegations are denied by the opposite parties and prayed for the dismissal of complaint.   

5. In order to prove the case the complainant filed her affidavit Ex.CW1/A, and documents Ex.C-1 to Ex.C-8.  

6. To rebut the case of complainant the opposite parties filed affidavit of Dinesh Kumar Ex.O.P1/A, alongwith documents Ex.O.P1 to Ex.O.P12.

7. We have heard the Ld. Counsel for the parties and have gone through the documents placed on record by the parties. 

8. The complainant alleged in the complaint that her husband Late Sh. Tarsem Singh had obtained a life insurance policy from the opposite parties vide policy No. 0316986726 by paying a premium of Rs. 12,876/- and the sum assured of the policy was Rs. 14 lacs and the policy was commenced from 28.7.2014 and commencement of risk was 30.7.2014 and the maturity date is 27.7.2044. The complainant further alleged that the husband of the complainant died on 6.8.2014 due to electric current and in this regard one application dated 19.9.2014 was also moved to the concerned Police Station. The complainant further alleged that the complainant approached the opposite parties for getting the claim under the above said insurance policy and submitted the entire documents to the opposite parties. The complainant further alleged that the complainant has received one letter dated 2.4.2018 vide which the claim of the complainant was rejected by the opposite parties on flimsy grounds by stating that it is pre-proposal death and fake death certificate submitted and policy has been obtained on a predeceased life fraudulent act fitted to deceive.

9. On the other hand, the opposite parties filed written version and taken the legal objection that the complainant is not maintainable. The opposite parties alleged that the complainant filed another complaint before the Hon'ble State Commission, Punjab, Chandigarh, and the same was withdrawn with liberty to file again. It is alleged that the complainant is bound to produce the policy alongwith other documents related to another policy and the conduct clearly showed the malafide intention of the complainant to grab the amount for which she is not entitled. It is further alleged that the policy was issued on 28.7.2014 and the life assured had expired on 6.8.2014, the policy has continued for a period of 10 days since its issuance. It is further alleged by the opposite parties that on investigation it was revealed that the LA was died already and policy purchased by the complainant fraudulently. It is further alleged that the claim under the policy is an outcome of a fraud which has been played on the opposite parties. It is further alleged that on 2.6.2017 the company received claim intimation from the complainant i.e. nominee of the policyholder and in the claim it was stated that the policyholder expired on 6.8.2014 within 10 days from the date of issuance of the policy. It is further alleged that on investigation it was found that the complainant concealed the factum that Tarsem Singh was died much earlier and got the insurance after his death by her and it was also found that the life assured was died pre-purchase the policy while filing the proposal form. It is further alleged that the complainant should approach the Civil Courts in order to challenge the veracity of the decision of the opposite parties to repudiate the claim, as such the company has rightly repudiated the claim vide letter dated 2.4.2018.

10. Ld. Counsel for the complainant argued that the risk of the policy was commenced on 30.7.2014 and insured Tarsem Singh was died on 6.8.2014 due to electric current and in this regard the complainant has produced the copy of insurance policy Ex.C-1 and the death certificate of Tarsem Singh Ex.C-6. The complainant has also produced certificate of Arora Hospital, G.T. Road, Amritsar as Ex.C-7, vide which Dr. Rakesh Arora certified that Tarsem Singh son of S. Hardev Singh age 25 male sought dead on 6.8.2014 and he was not admitted in this hospital and no record is available for the same. The complainant also produced the copy of report issued by the Police Station dated 19.9.2014 as Ex.C-3 and also produced the claim intimation letter Ex.C-4. The complainant also produced the certificate issued by the Sarpanch of her village as Ex.C-8 vide which he certified that Tarsem Singh died on 6.8.2014 due to electric current. Ld. Counsel for complainant argued that Tarsem Singh died on 6.8.2014 after the commencement of the policy, therefore the complainant is entitled for the insurance amount. 

11. On the other hand, Ld. Counsel for the opposite parties argued that the claim of the complainant was rightly repudiated by the insurance company. Ld. Counsel for the opposite parties further argued that on investigation it was found that the husband of the complainant was died Pre-proposal death, Fake death certificate submitted, Policy obtained on a Pre-deceased life fraudulent act fitted to deceive. The opposite parties produced the repudiated letter dated 2.4.2018 as Ex.O.P11. Ld. Counsel for opposite parties further argued that as per terms and conditions of the policy the claim should be filed within 180 days from the death of the insured. Ld. Counsel for opposite parties further argued that in the present case Tarsem Singh insured was died on 6.8.2014 and the claim intimation was received by the opposite parties on 2.6.2017. Ld. Counsel for opposite parties also tendered the claim intimation letter as Ex.O.P6, vide which it is established that the complainant intimated the insurance company on 2.6.2017. Ld. Counsel for opposite parties further argued that the present complaint is time barred and the complainant is legally not entitled to get any claim from the insurance company. Ld. Counsel for opposite parties further argued that the complainant has violated the terms and conditions of the policy. The claim intimation was received by the opposite parties almost after three years, therefore the right to investigation the matter of the opposite parties is forfeited. Ld. Counsel for opposite parties further argued that the present complaint is time barred as the complainant alleged that Tarsem Singh was died on 6.8.2014 and the intimation for the same was given to the insurance company on 2.6.2017. The cause of action was arisen on 6.8.2014. 

12. From the above discussion and the evidence produced by both the parties it is established that the complainant has violated the terms and conditions of the policy and intimated to the insurance company after almost three years. Therefore, we find no merits in the present complaint and the same is dismissed. There is no order as to costs or compensation. Copy of the order will be supplied to the parties free of costs by the District Consumer Commission, Amritsar as per rules. File be sent back to District Consumer Commission, Amritsar. 

ANNOUNCED IN THE OPEN COMMISSION:

       15th Day of September, 2022 

 

            (Ashish Kumar Grover)

            President             

 

(Navdeep Kumar Garg)

Member