Haryana

Yamunanagar

CC/6/2012

Sarika Bhargava W/o. Suraj Bhargava - Complainant(s)

Versus

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

Atul Jaiswal

01 Mar 2017

ORDER

      BEFORE THE PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR AT JAGADHRI.

                                                                                                Complaint No. 06 of 2012.

                                                                                                Date of institution: 02.01.2012

                                                                                                Date of decision: 01.03.2017

 

      Sarika Bhargava aged about 38 years w/o Sh. Suraj Bhargava r/o House No. 1125, Sector-17, HUDA, Jagadhri, District Yamuna Nagar.

                                                                                                                                                                  

                                                                                                                     …Complainant.

                                     Versus

1. Bajaj Allianz Life Insurance Company Ltd. Opp. Madhu Cinema, Jagadhri Road, Yamuna Nagar.
2. Bajaj Allianz Life Insurance Company Ltd. 5^th Floor G.E. Plaza, Airport Road, Yerawada, Pune, Maharashtra.

                                                                                                                     …Respondents.

 

BEFORE:         SH. ASHOK KUMAR GARG, PRESIDENT.

                         SH. S.C.SHARMA, MEMBER.

 

Present: Sh. Atul Jaiswal, Advocate, counsel for complainant. 

              Sh. Rajiv Gupta, Advocate, counsel for respondents.  

 

ORDER (Ashok Kumar Garg, President)

 

1.                     The present complaint has been filed by Smt. Sarika Bhargava widow of late Sh.Suraj Bhargava being LR under section 12 of the Consumer Protection Act 1986 praying therein that respondents (hereinafter respondents will be referred as OPs Insurance Company) be directed to pay sum insured of Rs. 3,00,000/- as additional benefits given under the policy on account of accidental death and also to pay compensation as well as litigation  expenses.

2.                     Brief facts of the present complaint, as alleged in the complaint, are that deceased Suraj Bhargava had purchased life insurance policy from the OPs Insurance Company bearing No. 0041480135 for a sum of Rs. 3,00,000/-. Unfortunately, on 16.02.2011, the husband of the complainant Sh. Suraj Bhargava alongwith his brother Sh. Kushpal Shashi and with his one cousin were going to Sri Ganga Nagar in marriage by car bearing registration No. HR-02Q-6003 and met with a road side accident. In the said accident, the husband of the complainant Sh. Suraj Bhargava and Shashi Bhargava expired on the spot and other persons received multiple grievous injuries and car was also badly damaged. After that, complainant lodged her claim with the OPs Insurance Company against the policy bearing No. 0041480135. Upon which, the OPs Insurance Company had paid Rs. 3,00,000/- as insured amount to the complainant on account of death of Suraj Bhargava and informed the complainant vide their letter dated 30.07.2011 but the OPs Insurance Company did not pay the accidental benefits of Rs.3,00,000/- which was to be given in addition to the same equivalent to the sum insured under the accidental death. The complainant made so many requests to release the additional amount of Rs. 3,00,000/- assured under the accidental death in addition but the OPs lingered on the matter on one pretext or the other, in this way, the Ops Insurance Company has been harassing the complainant mentally and physically and financially by not paying the genuine claim. As such, there is a deficiency in service on the part of the OPs. Hence, this complaint.

3.                     Upon notice, OPs Insurance Company appeared and filed its written statement by taking some preliminary objections such as complaint is not maintainable as the complainant has no cause of action to file the present complaint; the complainant has not come to this Forum with clean hands and has suppressed the true and material facts from this Forum. The true facts are that the husband of the complainant namely Suraj Bhargava purchased a policy bearing No. 0041480135 for a sum of Rs. 3,00,000/- vide proposal Form No. 0086384118 from the OPs Insurance Company and after death of the life assured, the complainant applied to get the claim of the life assured. On this, the OPs Insurance Company paid Rs. 3,00,000/- as insured amount to the complainant and complainant has got the claim amount of Rs. 3,00,000/- which has been credited in her account No. 3701000102211231 maintained at Punjab National Bank, Yamuna Nagar and to this effect the OPs Insurance Company informed her vide letter dated 30.07.2011 but now the complainant has lodged the claim on account of accidental death benefits of Rs. 3,00,000/- whereas there is no such provision in the said policy and under the proposal form the deceased husband of the complainant has not opted for “accidental death benefits: rider benefits, which has to be specifically opted by the proposer at the time of making the proposal for insurance. So, the complainant is not entitled to get any such claim towards accidental death benefits as prayed. On merit, contents of the complaint were denied for want to knowledge and matter of record and reiterated the stands taken in the preliminary objections. Lastly, prayed for dismissal of complaint.

4.                     In support of her case, counsel for the complainant tendered into evidence affidavit of complainant as Annexure CX and documents such as Photo copy of DDR No. 24 as Annexure C-1, Photo copy of postmortem report as Annexure C-2, Photo copy of death certificate as Annexure C-3, Photo copy of ration card as Annexure C-4, Photo copy of intimation letter dated 30.07.2011 as Annexure C-5, Photo copy of request letter dated 22.09.2011 written by complainant as Annexure C-6, Photo copy of claim form as Annexure C-7, Photo copy of receipt of insurance premium as Annexure C-8, Photo copy of notice dated 22.09.2011 as Annexure C-9, Photo copy of premium receipt as Annexure C-10, Photo copy of claim form submitted by the complainant as Annexure C-11, Photo copy of death claim discharge form as Annexure C-12, Photo copy of Literature/ Pamphlet of the OPs Insurance Company as Annexure C-13 and in additional evidence tendered photo copy of receipt of premium as Annexure C-14 and closed the evidence on behalf of complainant.

5.                     On the other hand, counsel for the OPs Insurance Company tendered into evidence affidavit of Shalini Guglani, as Annexure RW/A and documents such as photo copy of proposal form for life insurance as Annexure R-1, Photo copy of forwarding letter with insurance policy, receipt, terms and conditions of the insurance policy consisting pages 1 to 20 as Annexure R-2 and closed the evidence on behalf of OPs Insurance Company.

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 and carefully.

7.                     It is not disputed that deceased Shri Suraj Bhargava had purchased Bajaj Allianz Capital Unit Gain Life Insurance Policy bearing No.0041480135 for a sum of Rs.3,00,000/- vide proposal Form No.0086384118 from the OPs Insurance Company with the date of commencement 04.03.2007 and paying the premium of Rs.12,000/- regularly with the date of maturity of 04.03.2027 for a period of 20 years. It is also not disputed that on 16.02.2011, the husband of the complainant Shri Suraj Bhargava met with an road side accident, while driving the car bearing Registration No.HR02-Q-6003 and died at the spot. It is also not disputed that OPs Insurance Company had already paid Rs.3,00,000/- as Insurance amount to the complainant on account of death her husband Shri Suraj Bhargava.

8.                     The only version of the complainant is that she is also entitled to get his accidental benefit i.e. Rs.3,00,000/- which was to be given in addition to the sum insured under the accidental death, which has been illegally and wrongly withheld by the OPs Insurance Company. Learned counsel for the complainant draws our attention towards literature (Annexure C-13) under the head by Bajaj Allianz in which under the head “Death Benefits” it has been mentioned that “Accidents are always sudden and sometimes fatal. You can’t lessen the emotional shock, but you can certainly soften the financial one. Bajaj Allianz Accidental Death Benefit gives your loved ones something to start with after the permanent loss of your income by paying double the basic Sum Assured. The total Accidental Death Benefit shall however be subject to a maximum of Rs.10,00,000/-  under all policies taken with Bajaj Allianz together”.

            And argued that as per this literature, complainant is entitled to get accidental benefit amounting to Rs.3,00,00/- from the OPs Insurance Company, which has been wrongly and illegally withheld.

9.                     On the other hand, learned counsel for the OPs Insurance Company argued at length that claim of the complainant has been rightly settled by the OPs Insurance Company and draw our attention towards Clause 4 of the Proposal Form (Annexure R-1) in which no riders has been opted by the deceased and argued that deceased husband of the complainant Shri Suraj Bhargava, had not opted in the Accidental Death Benefit rider benefit which was to be specifically opted by the proposer at the time of making the proposal for Insurance. Learned counsel for the OPs further draws our attention towards back portion premium of the receipt (Annexure C-14) and argued that even on this receipt also it has been specifically mentioned that “Accidental Death Benefit, Accidental permanent total/Partial Disability, Critical illness (CI), Hospital Cash Benefit (HC) available as Riders”. But, the deceased Shri Suraj Bhargava had not opted any riders, so the complainant was not entitled to get any such claim towards Accidental Death Benefit and lastly prayed for dismissal of the complaint.

10.                   After hearing both the parties, we are of the considered view that there is no deficiency in service or unfair trade practice on the part of the OPs Insurance Company. From the perusal of back portion of premium receipt (Annexure C-14), it is clearly evident that accidental death benefit were available as rider and further from perusal of proposal form (Annexure R-1) it is also duly evident that deceased Shri Suraj Bhargava husband of the complainant had not opted any riders as the column at Sr. No.4 of the proposal form has been left as blank. So, after going through the proposal form as well as receipt (Annexure C-14), we are of the considered view that claim of the complainant has been rightly settled by OPs Insurance Company. The argument advanced by the counsel for the complainant that as per literature (Annexure C-13), the Accidental Death Benefit were automatically covered under the policy is not tenable as  in this literature (Annexure C-13)  it is no where mentioned that without opting any rider, the policy holder is entitled to get the accidental benefit and further it is also not clear that this literature (Annexure C-13)  is/was applicable to all the insurance policies issued by the OP Insurance Company including the present unit capital gain Insurance policy in question.

11.                   Resultantly, in the circumstances noted above, we are of the considered view that there is no merit in the present complaint and the same is hereby dismissed with no order as to costs. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced: 01.03.2017.        

                                                                                    (ASHOK KUMAR GARG )

                                                                                    PRESIDENT,

                                                                                    DCDRF, Yamuna Nagar.

 

                                                                                     

                                                                                    (S.C.SHARMA )

                                                                                     MEMBER.