Orissa

Cuttak

CC/262/2022

Susobhan Bose - Complainant(s)

Versus

Bajaj Allianz Life Insurance - Opp.Party(s)

A K Bose & associates

16 Oct 2023

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL COMMISSION,CUTTACK.

C.C. No.262/2022

 

Susobhan Bose,

S/o: Late Mrityunjoy Bose,

At:Mahidas Bazar,P.O:Chandini Chowk,

P.S:Lalbag,Dist:Cuttack,

Odisha-753002.                                                                                   ... Complainant.

          Vrs.

 

The Bajaj Allianz Life Insurance Company Limited,

Bajaj Allianz House,5^th Floor,B Wing,

Airport Road,Yerawada,Pune,

                  Maharastra-411006                                                                    … Opp.Party

 

Present:         Sri Debasish Nayak,President.

                      Sri Sibananda Mohanty,Member.

 

Date of filing:    09.12.2022

Date of Order:  16.10.2023

 

For the complainant:           Mr. A.K.Bose,Adv. & Associates.

For the O.P                 :                      None.

         

Sri Debasish Nayak,President                   

Case of the complainant as made out from the complaint petition bereft unnecessary details in nutshell is that Mr. Mrityunjoy Bose, the father of the complainant was a policy holder bearing policy no.0472524741 on 31.8.2021 under the scheme “Bajaj Alliance Life Smart Protect Goal Term Plan” with an annual premium of Rs.1,36,133.06 wherein the complainant was the nominee.  The first premium of Rs.1,36,133.06 was paid on 7.9.2021 and the next premium was due on 7.9.2022.  But unfortunately, on 29.10.2021 Mrityunjoy Bose died due to cardiac arrest at Ashwini Trauma Centre,CDA,Cuttack.  After obtaining the death certificate and other necessary documents, the complainant had made the insurance claim on 24.1.2022 but unfortunately on 2.4.2022 the repudiation letter as issued to the complainant by the O.P mentioned therein that the claim of the complainant was repudiated due to non-disclosure of medical ailments since because Late Mrityunjoy Bose was diagnosed with chronic Kidney Disease and Diabetes Meletus in the month of May,2021.   The complainant had tried to persuade the O.P about the ignorance of such disease of his father by him as well as by his late father, but the O.P did not listen to such submissions of the complainant for which the complainant has filed this complaint petition before this Commission seeking direction to the O.P to pay him the assured amount of  Rs.50,00,000/- and further an amount of Rs.5,00,000/- towards compensation for his mental agony and harassment including cost of his litigation.  He has also prayed for interest over the said money @ 10% per annum till its realisation.

          In order to substantiate his case, the complainant has filed copies of a bunch of documents alongwith his complaint petition.

2.       Having not preferred to contest this case, the O.P has been set exparte vide order dt.23.3.2023.

3.       The points for determination in this case are as follows:

i.          Whether the case of the complainant is maintainable?

ii.         Whether there was any deficiency in service on the part of the O.P ?

iii.        Whether the complainant is entitled to the reliefs as claimed by him?

 

Point no.ii.

  Out of the three points, point no.ii  being the pertinent one, is taken up  first for consideration here in this case.

After perusing the averments of the complaint petition, the copies of documents as filed by the complainant, the written notes of submission of the complainant, it is noticed that Late Mrityunjoy Bose was a policy holder with the “Bajaj Alliance Life Smart Protect Goal Term Plan”.  He had paid the first premium on 7.9.2021 to the tune of Rs.1,36,133.06 to the O.P.  During validity of the said insurance policy, the insured Mrityunjoy Bose had died due to cardiac arrest at Ashwini Trauma Centre,CDA,Cuttack on 29.10.2021.  As it appears from the averments made by the complainant in his complaint petition that the claim was repudiated by the O.P on the ground that the insured though was diagnosed of having chronic Kidney Disease and Diabetes Meletus in the month of oMay,2021, the same was not disclosed while the insured had filled up the proposal form for the said policy.  Due to such suppression of fact, the O.P had repudiated the claim when made by the nominee/complainant after the death of his father.  Be that as it may, having not preferred to contest this case, the O.P has not led any evidence in order to apprise this Commission that due to having chronic Kidney Disease and Diabetes Meletus, the insured Mrityunjoy Bose had died.  When the cause of death is not substantiated by the O.P properly and when the complainant had filed documents that the death of his father Mrityunjoy Bose was due to cardiac arrest, it cannot be simply concluded here that the father of the complainant was suffering from chronic Kidney Disease and was having Diabetes Meletus which led to be the cause of his death.  Accordingly, this Commission finds that, by whimsically repudiating the claim of the complainant without proper justification, the O.P is found to be deficient in his service.  This point thus goes in favour of the complainant.

Points no.i & iii.

From the discussions as made above, the case of the complainant is undoubtedly maintainable and the complainant is entitled to the reliefs as claimed by him.  Hence, it is so ordered;

                                                                        ORDER           

The case is allowed exparte against the O.P.  Thus, the O.P is directed to pay a sum of Rs.50,00,000/- towards the insured value of the policy bearing no. 0472524741 to the complainant alongwith interest thereon @ 8% per annum from 24.1.2022 till the total amount is quantified.  The O.P is also directed to pay a sum of Rs.5,00,000/- to the complainant towards compensation for his mental agony and harassment alongwith his litigation expenses. This order is to be carried out within a period of 30 days from the date of receipt of copy of this order.

Order pronounced in the open court on the 16^th day of   October,2023 under the seal and signature of this Commission.         

                                                                                    Sri Debasish Nayak

                                                                                              President

                     

                                                                                                              

                                                                                    Sri Sibananda Mohanty

                                                                                                     Member