Haryana

Karnal

CC/64/2017

Roshni - Complainant(s)

Versus

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

Virender Kumar

19 Aug 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

                                                       

                                                        Complaint no.64 of 2017

                                                        Date of instt. 13.02.2017

                                                        Date of Decision 19.08.2019

                                                       

Roshni wife of Parmod Kumar, resident of village and Post Office Chulkana, Tehsil Samalkha and District Panipat.                                     

…….Complainant

                                        Versus

 

1. Bajaj Allianz Life Insurance Company Ltd. through its GM, West Hub, 2^nd Floor, Bajaj Fineserv, Survey # 208/1-B, Behind Weikfield IT Building, Viman Nagar, Nagar Road, Pune, Maharastra-411014.

2. Bajaj Allianz Life Insurance Company Ltd. through its Manager, SCO 226, Sector 12, Urban Estate, Karnal-132001.

                                                                         …..Opposite Parties.

 

           Complaint u/s 12 of the Consumer Protection Act. 

         

Before    Sh. Jaswant Singh……President. 

                Sh. Vineet Kaushik………Member

                Dr. Rekha Chaudhary……Member

 

 Present:  Shri Virender Kumar Advocate for complainant.

                  Shri N.K.Zak Advocate for opposite party.

 

                   (Jaswant Singh President)

ORDER:                    

 

                        This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986 on the averments that husband of complainant namely Parmod Kumar got insured his life with the opposite parties (OPs), vide policy no.0315699590 under Bajaj Allianz Invest Assure Plan no.249, vide product pin no.116N121V01 on 28.05.2014 for a sum assured of Rs.9,00,000/- (in case of accident or death for sum of Rs.18,00,000/-) for the term of 25 years for the said scheme/plan the husband of complainant has to pay premium for 15 years and for the same husband of complainant deposited premium of Rs.26,164/-, vide receipt no.6603299 dated 28.05.2014 as half yearly premium. After getting the abovesaid policy unfortunately on 13.06.2014 the husband of complainant was working in the fields and caught by an electric wire and due to that electric shock he was taken to the hospital and from where he was referred to the medical college, Khanpur where he remained admitted and then discharge but while reaching home Shri Parmod Kumar, husband of complainant died on 13.06.2014 due to Heart Attack and the information about his death was also recorded with the office of the OPs. At the time of death the husband of complainant was having good health and having no disease and paid the premium of the policy as per terms and conditions of the policy. The complainant requested the OPs so many times for settlement of the claim but claim of the complainant has not been paid till date. In this way there was deficiency in service on the part of the OPs. Hence complainant filed the present complaint.

2.             Notice of the complaint was given to the OPs, who appeared and filed written version raising preliminary objections with regard to concealment of true and material facts; cause of action and complainant is estopped to file the present complaint by his own act and conduct. On merits, it is pleaded that complainant in connivance with some other persons fraudulently purchased life insurance policy on the life of a pre-deceased person just to cheat and deceive the OPs and to claim insurance benefits on life of a dead person. The husband of the complainant had expired in the month of May, 2014 and his last rites were performed on 26.05.2014 i.e. even prior to submission of a proposal form dated 28.05.2014. It is further alleged that the complainant maliciously submitted a fake and forged Death Certificate indicating the date of death of Mr. Parmod Kumar son of Mr. Baljeet Singh as 13.06.2014 whereas said Mr. Parmod Kumar had already expired even prior to 28.05.2014. The complainant fraudulently submitted proposal whereby heavy risk cover to the tune of Rs.9,00,000/- was proposed on the life of Mr. Parmod Kumar without disclosing the fact that the said Mr. Parmod Kumar had already expired even prior to date of proposal. OPs accepted the proposal in the normal course of insurance business on the basis of documents fraudulently submitted by the complainant. Had the complainant disclosed that said Mr. Parmod Kumar pre-deceased even prior to the date of proposals, the policy in question would not have been issued in the name of a pre-deceased person. The complainant has done acts of submitting the proposals and other documents for inducing the company to accept risk cover on the life of a dead person and OPs accepted the proposal under the bonafide belief that the proposer Mr. Parmod Kumar was alive on the date of proposals.

3.             Further, It is denied that the life assured died due to electric shock on 13.06.2014. The complainant fraudulently forged the death certificate in connivance with the other persons and lodged the death claim with the OPs. The various investigations revealed that Mr. Parmod Kumar son of Mr. Baljeet Singh had expired in the month of May, 2014 and his last rites were performed on 26.05.2014 but fraudulently submitted a proposal form dated 28.05.2014 to get an insurance policy in the name of a pre-deceased person. Further, the death certificate was got issued by providing false information of death in connivance with some other persons just to cheat the OPs. It is further alleged that the complainant has indicated different cause of death while lodging death claim with some other insurance companies which are sufficient to prove the fraudulent intentions of the complainant to cheat the life insurance companies. Thus, the claims under the policy have legally and rightly been repudiated, vide letter dated 20.06.2016 being fraudulent claim and nothing is liable to be paid under the policy. There is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

4.             Complainant tendered into evidence her affidavit Ex.CW1/A and documents Ex.C1 to Ex.C14 and closed the evidence on 16.04.2018

5.             On the other hand, OPs tendered into evidence affidavit of Rajeev Kumar Ex.OW1/A and documents Ex.O1 to Ex.Ex.O3, Mark-A and closed the evidence on 22.10.2018.

6.             We have appraised the evidence on record, the material circumstances of the case and the arguments advanced by the learned counsel for the parties.

7.             The case of complainant, in brief, is that her husband got insured with OP on 28^th May, 2014 for the sum assured of Rs.9,00,000/- for the terms of 25 years. On 13.06.2014 her husband was working in  the fields and caught by an electric wire and due to that he was taken to Medical College, Khanpur but he died on 13.06.2014 due to heart attack. The complainant lodged her claim with OPs, but same was not paid by OPs without any reason.

8.             On the other hand, the case of the OPs is that life assured had expired in the month of May, 2014 and his last rites were performed on 26.05.2014 i.e. even prior to submission of the proposal form dated 28.05.2014. The complainant has done acts to deceive the OPs by inducing the insurance company to accept risk on the life of a person, who had already expired even prior to the date of proposal which is a clear case of insurance fraud.

9.             The complainant relied upon the outdoor ticket Ex.C7. As per Ex.C7 the life assured was referred to Medical College, Khanpur. In this regard Gram Panchyat Chulkana issued certificate Ex.C8. Neither treatment record nor any other proof has been placed on the file to prove the version of the complainant. No post mortem was even got conducted of the deceased life assured. The complainant also failed to examine the doctor who has issued outdoor ticket Ex.C7. Neither any member of Panchyat who issued certificate Ex.C8 examine nor any affidavit of them tendered during the course of evidence by the complainant.

10.            On the other hand, OPs relied upon the document Mark-A, issued by Purohit of Haridwar. As per said certificate, last rites were performed on 26.05.2014. The proposal form was submitted on 28.05.2014. Thus, we are of the considered view that the husband of the complainant had expired before submission the proposal form. Thus, there is no force in the complaint.

11.            Thus, as a sequel to abovesaid discussion, we do not find any merits in the complaint and the same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:19.08.2019

                                                                       

                                                                  President,

                                                           District Consumer Disputes

                                                           Redressal Forum, Karnal.

 

        (Vineet Kaushik)     (Dr. Rekha Chaudhary)

            Member                     Member