Haryana

Yamunanagar

CC/432/2013

Gurmeet Singh S/o Gurdayal Singh - Complainant(s)

Versus

Bajaj Allianz Life Insurance Company Ltd. - Opp.Party(s)

M.C Gupta

07 Aug 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA   NAGAR

                                                               Complaint No. 432 of  2013.

                                                               Date of institution: 07.06.2013.

                                                               Date of decision: 07.08.2017.

 

Gurmeet Singh, aged 32 years, son of Sh. Gudayal Singh, resident of Village & P.O. Village Mussimble Hinduan, Tehsil Jagadhri, Distt. Yamuna Nagar.                                                                                                                                                                                                                                                                               

                                                                                                …Complainant.

                                      Versus

1. Bajaj Allianz Life Insurance Company Ltd. 3^rd Floor, Block No. 2, Sri Vari Shopping Mall, Old No., 2/91, New No. 258-5, Meyyanur, Near Bus Stand Road, Salem, PIN 636004 Tamilnadu through its Authorized Signatory.
2. Bajaj Allianz Life Insurance Company Ltd., Opp. Madhu Petrol Pump, Yamuna Nagar, Haryana through its Branch Manager/Authorized Signatory.  

…. Respondents.

                  

BEFORE    SH. DHARAMPAL, PRESIDENT

                   SH. S.C.SHARMA, MEMBER.

                   SMT. VEENA RANI SHEOKAND, MEMBER.          

 

Present:       Sh. M.C. Gupta, Advocate, counsel for complainant.   

                   Sh. Rajiv Gupta, Advocate, counsel for respondents. 

 

ORDER      (DHARAMPAL PRESIDENT)

 

1.                Complainant Gurmeet Singh has filed this complaint under section 12 of the Consumer Protection Act 1986 as amended up to date. 

2.                Brief facts of the complaint, as alleged by the complainant, are that the OPs Insurance Company is providing the insurance polices to its customers after taking due premium and assures that they will provide the sum assured along with upto date interest to the family members of the insured person in case of death of the insured person. The agents of the OPs make understood all this and believing upon the version of the agent of the OPs, Sh. Gurdial Singh son of Sh. Punna Ram who was father of complainant had purchased a policy “Bajaj Allianz Super Cash Gain Regular premium, and paid premium and after receipt of the said premium the OPs have issued a policy bearing No. 0274692987 dated 13-07-2012 to the father of the complainant and the complainant was made nominee in the said policy by his father. At the time of obtaining the said policy, the father of the complainant was medically fit and prior to issuance of insurance policy he was got examined by the officials of the OPs also and no disease was found after satisfying themselves the OPs have issued the said policy to the father of the complainant. It is further submitted that unfortunately the father of the complainant suffered some problem where he was got admitted in Kapil Hospital Yamuna Nagar and had died on 12-09-2012. It is further submitted that after death of his father the complainant being nominee approached the OP No. 2 and submitted him all the documents as desired by them and requested them to release the benefits of the said policy to the complainant being nominee, which documents in original have been duly received by the OP No. 2 and assured the complainant that his claim would be processed shortly. On 16-02-2013, the complainant again approached the OP No. 2 and gave them representation in writing and requested them to release his claim, which has been duly accepted by the OP No. 2. When upto March 2013, the OPs have not taken any initiative to make payment to the complainant then he again approached the OP No. 2 on 06-03-2013 with the request to release the benefit of the said policy, but the officials or the OP No. 2 flatly refused to listen the complainant and stated that they will not make payment to the complainant against the said policy. Upon which, complainant requested them to issue him a letter in this regard, but they flatly refused to do so and orally stated that his claim will not be released. In this way there is gross negligence and deficiency in services and unfair trade practices on the part of the OPs. As such, the complainant prayed that his complaint may kindly be accepted and OPs be directed to release the claim amount along with interest and also to the to pay a sum of Rs. 50,000/- as compensation for causing mental agony, harassment and financial loss to the complainant due to their deficient and negligent services, Rs. 11,000/- for dragging the complainant in unwanted litigation.   

 3.               Upon notice, OPs appeared and filed their written statement by taking some preliminary objections such as complaint is not maintainable and there is concealment of the facts. It is submitted that deceased life assured Mr. Gurdial Singh deliberately dishonestly and with a malafide intention submitted fake and forged school leaving certificate as proof of his age and maliciously understated his age by 6 years at the time of proposal for insurance. On merit, it is submitted that no assurance was made to the complainant or life assured, as alleged. The contract of insurance was maliciously entered into by the deceased by way of fraud, misrepresentation and submission of fake & forged documents. The deceased willfully and intentionally concealed the material facts regarding his age and understated the age by 6 years when age as mentioned in the proposal form is compared with other non standard documents of age. Forged documents in support of age was submitted to induce the answering OPs to accept risk on his life. The contract of insurance is as such, null and void ab-initio and nothing is liable to be paid as per provisions of the Indian Contract, 1872. The deceased life assured after fully understanding the terms and conditions of the regular premium “Super Cash Gain Silver” policy, proposed for the said policy vide proposal dated 13-07-2012 and submitted a School Certificate mentioning his date of birth to be 05-02-1955. The risk on his life was accepted by the OP believing the information and documents provided by him to be true and correct and a policy bearing number 0274692987 was issued to him for sum assured of Rs. 1,08,664/- with date of commencement as 13-07-2012. Had he disclosed true facts & information and provided true & correct documents at the time of proposals for insurance, the risk under the policy in question would not have been accepted by the OPs as per the board approved underwriting guidelines. As per the Board approved underwriting guidelines of the Op insurance company, the maximum age at entry under traditional polices on the basis of non standard age proof like Voter Card/Ration card  is 50 years whereas the deceased was not less than 64 years at the time of proposal for insurance. Since the deceased was not insurable on the basis of the Non Standard Age Proofs submission of fake School Leaving Certificate has adversely affected the decision of the insurance company to underwrite the proposal and accept the risk. The forged school leaving certificate was submitted just to induce the OPs to accept risk on his life. It is further submitted that the life assured Mr. Gurdial Singh reportedly expired on 12-09-2012 i.e. within just two months of acceptance of risk on his life giving rise to a very early death claim and the claim lodged by the complainant was expeditiously processed by the answering OPs. Being a very early death claim, the investigation of the claim was got conducted to ascertain the bonafide of the claim and various documents and reports confirmed that the deceased maliciously submitted fake school certificate in the shape of standard age proof which was forged. Thus the claim under the policy was legally and rightly repudiated vide letter dated 23-11-2012 and the question of making any payment to the complainant or assuring him to process the claim does not arise and the intimation thereof was duly sent to the complainant vide letter dated 23-11-2012 through speed post No. EA937903927IN. Lastly, prayed for dismissal of complaint.

4.                To prove his case, counsel for the complainant tendered into evidence complainant’s affidavit as Annexure CX and documents such as photocopy of the policy as Annexure C1, photocopy of death certificate as Annexure C-2, photocopies of letter of claim as Annexure C3 and C4 and closed the evidence on behalf of complainant.

5.                On the other hand, counsel for the OPs Insurance Company tendered into evidence affidavit of Sh. Daljit Singh, Customer Support Executive, Bajaj Allianz Life Insurance Company as Annexure RA and documents such as certificate of non-availability of the name of deceased Gurdial Singh in Govt. Model Sanskriti Sr. Sec. School, Bilaspur, Distt. Yamuna Nagar issued by the Principal of the said School as Annexure R1, photocopies of certificate of Matriculation of the deceased as Annexure R-2 and R-3, photocopy of investigation report as Annexure R-4, photocopy of matriculation certificate as Annexure R-5, photocopy of Voter card of deceased as Annexure R-6, photocopy of rejection of claim as Annexure R-7, photocopy of  terms and condition of the policy regarding age proof as Annexure R-8, photocopy of policy as Annexure R-9, photocopy of proposal form as Annexure R-10 and the OPs also examined one witness namely Sh. Shakumbri Nandan, Lecturer in English in G.M. S.S.S.S Bilaspur (Govt. Model Saraswati Sr. Sec. School) Bilaspur, Distt. Yamuna Nagar and closed the evidence on behalf of OPs. 

6.                We have heard the learned counsel for both the parties and have gone through the pleadings as well as documents placed on file very minutely & carefully. 

7.                 On perusal of the record, it is found that the father of the complainant deceased Gurdial Singh obtained an insurance policy of the OP-Bajaj Allianz Life Insurance Company Ltd. effective from 13-07-2012 to 12-07-2032. At the time of taking the policy, the insured submitted the proposal form (Annexure R-10). In the proposal form, the date of birth has been shown as 05-02-1955 (57 years). In support of his age proof, he had submitted photocopy of his matriculation certificate. The complainant is the nominee under the said policy. Deceased Gurdial Singh expired on 12-09-2012. The claim form was submitted by the complainant. Since the insured expired in just 61 days of the acceptance of risk under the policy, the OP got the case investigated from the Panther Group (India, Office:9, Vasant Nagar, Vasant Vihar, New Delhi) (Annexure R-4). The investigator Sanjeev Kumar in his report has mentioned that “Standard School Certificate” age proof found fake in this investigation. To prove their contention, the OPs examined one witness namely Shakumbri Nandan, Lecturer in English in G.M. S.S.S.S Bilaspur (Govt. Model Sanskriti Sr. Sec. School) Bilaspur, Distt. Yamuna Nagar in his evident and he has stated that he has brought the summoned record, vide which earlier the name of school of GM S.S.S.S. was Govt. High School, Bilaspur. As per record, no student named as deceased Gurdial Singh son of Sh. Punna Ram has ever passed out or admitted in the said school in the year from 1970 to 1973. The claim was repudiated by the OP vide letter dated 23-11-2012 (Annexure R-7).  The said witness was cross-examined by the counsel for the complainant. The complainant has not produced any document to controvert the contention of the OPs. The complainant has also not filed the rejoinder to rebut the contention of OPs. The OPs have fully proved that the certificate submitted by the complainant is false. It is settled position of law that insurance is contract based on utmost good faith. It requires no emphasis that where any information on specific aspects is asked for in the proposal form and insured is under the solemn obligation to make the true and full disclosure of the information. It is expected of the contracting parties on either side to give truthful account of detail in contract.

8.                In view of the above, we are of the considered view that the present complainant deserves to be dismissed. Accordingly, the complaint is, hereby, dismissed with no order as to costs. Copies of this order be sent to the parties concerned as per rules. File be consigned to the record room after due compliance.

Announced in open court. 07.08.2017

 

 

                                                     ( DHARAMPAL)

                                                     PRESIDENT

                                                     D.C.D.R.F.YAMUNA NAGAR

                                                     AT JAGADHRI

 

(VEENA RANI SHEOKAND)    (S.C.SHARMA)

MEMBER                                    MEMBER

 

Note: Each and every page of this order has been duly signed by me.

 

( DHARAMPAL)

                                                            PRESIDENT

                                                            D.C.D.R.F.YAMUNA NAGAR

                                                           AT JAGADHRI