Haryana

Karnal

CC/369/2016

Paramvir - Complainant(s)

Versus

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

Rajbir Sharma

13 Jul 2018

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

 

                                                         Complaint No.369 of 2016

                                                         Date of instt. 06.12.2016

                                                         Date of decision:13.07.2018

 

Paramvir son of Sh. Moti Ram, resident of village Barthal, Tehsil Nigdhu District Karnal.

                                                                                                                                                                        …….Complainant.

                                                Versus

 

1. Bajaj Allianz Life Insurance Company, 5^th floor, GE Plaza, Airport Road Yardwada, Pune-411006.

2.  Bajaj Allianz Life Insurance Company, Sector-12, Karnal

 

                                                                     …..Opposite Party.

 

           Complaint u/s 12 of the Consumer Protection Act. 

 

Before   Shri Jagmal Singh……President.

                Shri Anil Sharma……Member

 

Present: Shri Rajbir Sharma Advocate for complainant.     

                Shri N.K.Zak Advocate for opposite parties.

 

ORDER:                    

         

                   (JAGMAL SINGH, PRESIDENT)

 

                 This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986 on the averments that complainant got insured his life with OPs by obtaining a life insurance policy 2818617 in the month of September, 2003 for an amount of Rs.2,00,000/- from the OPs and the tenure of the said policy is for 20 years. The complainant was paying the premium amount regularly. At the time of granting the insurance policy, the officials and agent were conducted his some medical tests and he was found fit at that time. On 5.5.2008 the complainant was met with an accident while he was working in the field due to electricity current. He was admitted in the hospital and treated and operation was conducted. To save his life, his both hands/arms were carve by the Doctor due to which he become the 100% disabled. In the month of September, 2015 it came to the knowledge of the complainant that the aforesaid injuries and disability covered in the abovesaid policy and as such he is entitled the disability claim. Complainant submitted the requisite documents to this effect with the OP alongwith his disability certificate for getting the claim from the OP. But the OP rejected the claim of the complainant vide letter dated 16.08.2016, with excuse that the claim will be reconsidered on the receipt of Hospital treatment and record and FIR report. The complainant approached to the OP no.2 several times and requested for getting the claim but OP always lingered the matter on one pretext or the other. 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 statement raising preliminary objections with regard to maintainability; locus standi and cause of action; mis-joinder and non-joinder of necessary parties; jurisdiction; barred by limitation and concealment of true and material facts. The true facts are that the policy bearing no.0002818617 was obtained by the complainant and the date of commencement is 06.09.2003 with accidental benefit for a term of 20 years. The complainant was intimated to met with an accidental, in the month of May/2008 and lodged  his claim with the OPs on 4.9.2015 i.e. after lapsation of a sufficient long period much to say more than 8 years. After receiving the intimation of the said disability, the OP asked the complainant, vide letters dated 26.09.2015 and 7.7.2016 to kindly submit complete treatment record, related to disability, FIR (if available) PAN card (if available) and case sheet/ discharge summary, but the complainant has not cooperated with the Ops and never submitted the required documents/particulars, till date, for the reason best know to him. After not receiving the required documents/particulars, the OPs refused to accept the claim of the complainant and repudiated the same and instead of completing the required formalities the complainant filed the present complaint. In this way there was deficiency in service on the part of the OP. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Complainant tendered into evidence his affidavit Ex.CA and documents Ex.C1 to Ex.C5 and closed the evidence on 13.10.2017.

4.             On the other hand, OPs tendered into evidence affidavit of Shahid Ali Operation Manager Ex.RW1/A and documents Ex.O1, Ex.O2, Ex.R3 to Ex.R7 and closed the evidence on 23.5.2018.

5.             We have heard the learned counsel for both the parties and have gone through the record available on the file carefully

6.             The undisputed facts of the case are that the complainant has obtained a life insurance policy from the OPs bearing policy no. 000281861 in September, 2003 for an amount of Rs.2 lakhs for the tenure of 20 years. The OPs also conducted the medical tests of the complainant.

7.             The learned counsel for complainant argued that the complainant met with an accident on 5.5.2008 while working in the field due to electricity current and was admitted in the hospital. It is further argued that to save the life of complainant, operation was conducted and his both hands/arms were carved by the doctor due to which he became 100% disabled person. It is further argued that the complainant is an illiterate person and studied upto 8^th standard and had no knowledge about the fact that aforesaid disability was covered under the policy as the same was in English. Due to this reason the complainant could not lodge the claim of disability. It is further argued that in September, 2015 the complainant came to know that the said disability was covered under the policy and the complainant was entitled to disability claim, so the complainant lodged the claim with the OPs alongwith disability certificate. It is further argued that the OPs have wrongly rejected the claim of the complainant, vide letter dated 16.08.2016 with excuse that claim will be reconsidered on receipt of hospital treatment record and FIR report. It is further argued that no FIR was lodged at that time, so the copy of same could not be produced. The treatment record being old one is also not available with the complainant. As already stated above the complainant had no knowledge about the cover of disability under the policy, so the treatment record was not kept by the complainant and being old the same was not available with the concerned hospital. The complainant has submitted the disability certificate issued by the competent authority which is sufficient to prove that both hands of the complainant had been carved and he is 100% disabled person. It is further argued that if the complainant had the  knowledge about the disability cover under the policy then why he had paid the premium for 8 more years i.e. upto March, 2016 which was exempted in the case of 100% disability.  

8.             On the other hand, the learned counsel for OPs contended that the complaint is hopelessly time barred as the complainant had met with the accident in May, 2008 and the claim was lodged on 4.9.2015 after the lapse of more than 8 years. After the lodging of claim, the OPs asked the complainant vide letters dated 26.09.2015 and 7.7.2016 to submit the complete treatment record related to disability, FIR (if available) PAN card (if available) and case discharge summary but the complainant has failed to submit the same, so the OPs refused to accept the claim of the complainant for want of completion of required formalities vide letter dated 16.08.2016 and it has been specifically mentioned in the repudiation letter that claim will be reconsidered on receipt of hospital treatment record and FIR. The complainant instead of submitting the said record, filed the present complain. It is further submitted that the complainant has put his signature in English on the proposal form as well as on revival dated 31.12.2014, which was not possible in case if both hands of complainant were carved.

9.             From the pleadings and evidence of the parties, it is clear that the complainant has obtained the policy in question in the year 2003 for the tenure of 20 years. The said policy was valid and effective uptill March, 2016 as the complainant has deposited the premium uptill March, 2016 and this fact is admitted by the OPs. According to the complainant, he met with an accident on 5.5.2008 due to electricity current while working in the fields but the complainant has not produced any evidence on the file vide which it can be said that the complainant met with an accident on 5.5.2008. The complainant also alleged that in the said accident his both hands were carved due to said accident and he became 100% disabled person. To prove the both hands of the complainant were carved and he became 100% disabled person, the complainant produced the copy of disability certificate Ex.C-5 on the file, which was issued by board of doctors of the General Hospital, Karnal vide certificate no.1115 dated 6.8.2008. From the copy of this certificate Ex.C-5, it has been prove on the file that the complainant had become 100% disabled person in the year 2008.

10.            As stated above the complainant alleged that he met with an accident on 5.5.2008, therefore, the possibility of the fact the complainant met with an accident on 5.5.2008 cannot be ruled out. It is pertinent to mention here that a case cannot be decided on the basis of possibilities. As stated above that the complainant paid the premium upto March 2016, therefore,  policy in question was valid and effective upto March, 2016  but it was immaterial that whether the same was effective due to deposit of premium regularly or due to revival after depositing the revival premium. The argument of complainant that it was not in his knowledge that the disability was also covered under the policy has force because, if he knows about the same, he might lodged the claim for his disability instead further depositing the premium for 8 years. This fact clearly indicates that the complainant had no knowledge about the covering of disability under the policy. It is pertinent to mention here that on the contrary, if the complainant knows about the disability benefit of the policy then he not only kept the treatment record with him rather applied for the claim. So the argument of complainant that he had not the treatment record with him being old one has force.

11.            From the above, it is clear that the complainant is 100% disabled person since 6.8.2008 and if the complainant applied for the disability benefit in 2008, then the OPs were duty bound to give the insured sum in 2008 but due to mistake or ignorance of the complainant, the OPs have received premium for 8 more years but inspite of the fact that the complainant lodge the abovesaid claim for the disability benefit in the year 2015, they denied the same. The OPs can get the matter investigated by appointing investigator and also by getting the verification of the disability certificate from the concerned hospital as well as by getting the physical examination of the complainant from their doctor but the OPs have not done so the reasons are best known to them. So far the question of signature on revival is concerned, the complainant stated that he has signed by holding the pen in his elbow and moreover it was the duty of the OPs at the time of revival also that whether the insured is alive or not and whether the signature were put by the insured or not. But without getting any investigation in the matter, the OPs have repudiated the claim of the complainant.  In the above facts and circumstances of the case, we are of the considered view that the OPs have committed a mistake in denying the benefit of disability under the policy in question. Hence the OPs are deficient in providing services to the complainant.

12.            It is further pertinent to mention here that the complainant himself has not applied for the disability benefit under the policy in the year 2008 though due his ignorance and the complainant himself deposited the premium upto March, 2016, so in our view the complainant is not entitled for the refund of premium paid by him after 2008.

13.            Thus, as a sequel to above discussion, we allow the present complaint and direct the OPs to pay Rs.2,00,000/- ( two lakhs only) the insured amount to the complainant with interest @ 8% per annum from the date of filing of the complaint i.e.6.12.2016 till its realization. We further direct the OPs to pay Rs.11,000/- as compensation for harassment, mental agony and litigation expenses. This order shall be complied with within 30 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 13.07.2018

                                                                       

                                                                       President,

                                                           District Consumer Disputes

                                                           Redressal Forum, Karnal.

 

                        (Anil Sharma)

                            Member