BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 29 of 2012
Date of Institution : 06.02.2012
Date of Decision : 29.9.2016
Vishnu Dutt son of Sh. Manphool Ram, aged 44 years, resident of village Abubshahar, Tehsil Dabwali, Distt. Sirsa.
…Complainant.
Versus.
1. Bajaj Allianz Life Insurance Company Ltd., GE Plaza, Airpor Road, Yarwada, Pune- 411006.
2. Branch Manager, Bajaj Allianz, Mandi Dabwali, Distt. Sirsa.
3. Branch Manager, Bajaj Allianz, Sirsa, Distt. Sirsa, Insurance Company Ltd. through its Branch Manager, Sirsa.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SHRI S.B.Lohia …………………PRESIDENT
SHRI RANBIR SINGH PANGHAL ……MEMBER.
Present: Sh. Jagwant Singh, Advocate for the complainant.
Sh. Manav Goyal, Advocate for the opposite parties.
ORDER
In brief, the case of the complainant is that brother of the complainant namely Mahi Ram son of Manphool Ram had taken unit gain protection plus-II policy bearing No.184492464 with date of commencement 6.9.2010 for a sum assured of Rs.3,00,000/- (Rs. Three lakhs) from opposite party no.2. The complainant was made nominee in the said policy. The brother of the complainant paid amount of Rs.30,000/- to the ops. After the death of the life assured, the complainant submitted claim within time and also submitted all the relevant papers but the ops repudiated the claim vide order dated 30.3.2011 and 7.10.2011 which is wrong and illegal. The life assured Mahi Ram died on 10.12.2010 due to sudden heart attack and disease is duly mentioned in Medical ailment certificate issued by Dr. Satya Narayan Sharma. At the time of proposal of taking insurance policy, the brother of the complainant was in good health and he had never suffered from any ailment in the past. He was medically examined by the doctor of the ops. Mahi Ram was an illiterate and rural rustic person and this fact was within the knowledge of ops when proposal form was filled and was also in the knowledge of doctor who examined him and nothing was concealed by the life assured regarding his age. The age of the life assured was mentioned by the authorized person of the company in proposal form as 42 years instead of actual age as per voter ID card and ration card, copies of which were supplied by life assured in proof of his age. His age was mentioned by the ops and no question regarding age was asked from life assured. Now the act and conduct of the opposite parties is arbitrary, illegal and wrong as they have repudiated the claim of the complainant on the ground that deceased life assured had understated his age by 10 years by submitting forged documents. The complainant has suffered harassment and as such he is entitled to compensation of Rs.1,00,000/- besides insurance claim of Rs.3,00,000/- alongwith interest @18% per annum from the date of repudiation of claim and also litigation expenses to the tune of Rs.10,000/-. Hence, this complaint.
2. Upon notice, opposite parties appeared and filed written statement asserting therein that after submission of claim by the complainant, investigation was made and Investigator reported that “As per our investigation LA was 52 years, there is variations of 10 years and annual income comes Rs.150000/- only. So on the basis of this, the claim of the claimant was rejected by the company vide its letter dated 30.3.2011 in which it was categorically written that had the correct age proof been submitted, company would not have covered the risk for the policy. Hence, the claim has been repudiated due to under statement of age through submission of forged documents. After the rejection of claim under the policy, the complainant moved an application before the Claim Review Committee vide application dated 25.4.2011 and the said committee had given patience hearing and after going through the proposal form including the documents came to the conclusion that earlier decision of the company was correct and the same was confirmed for under statement of age by 10 years by submitting forged documents and the claim was rejected vide order dated 7.10.2011. The complainant was having an opportunity to make an appeal before the office of the Insurance Ombudsman, Chandigarh but he has not availed that remedy. Remaining contents of the complaint have also been denied.
3. The complainant tendered his affidavit Ex.C1, copy of first premium receipt Ex.C2, copy of letter dated 7.9.2016 Ex.C3, copy of death certificate of deceased life assured Mahi Ram Ex.C4, copy of his voter card Ex.C5, letter dated 7.10.2011 Ex.C6, repudiation letter dated 30.3.2011 Ex.C7, copy of verification of Sarpanch Ex.C8 and documents Ex.C9 to Ex.C29. On the other hand, ops have tendered affidavit Ex.RW1/A.
4. We have heard learned counsel for the parties and have gone through the case file carefully.
5. There is no dispute that deceased life assured Mahi Ram obtained insurance policy from the opposite parties on 6.9.2010 and the sum assured in the policy is Rs.3,00,000/-. He paid premium of Rs.30,000/- to the opposite parties as is evident from copy of first premium receipt dated 7.9.2010 Ex.C2. The complainant Vishnu Dutt who is brother of said Mahi Ram was made nominee in the policy which fact is also not in dispute. After the death of Mahi Ram on 10.12.2010, the claim submitted by the complainant has been repudiated by the ops vide letter dated 30.3.2011 Ex.C7 on the ground that the various investigations confirm that deceased life assured had understated his age by 10 years by submitting forged documents. The Claim Review Committee on the application of the complainant also given the same decision vide letter dated 7.10.2011 Ex.C6. However, we are of the considered opinion that opposite parties have wrongly and illegally repudiated the claim of the complainant. The opposite parties have not placed on file any investigation report on file to justify their stand. The opposite parties have reached to the above said conclusion on the basis of ration card and voter card as in the ration card as on 5.1.2005 the age of Mahi Ram deceased life assured is mentioned as 36 years meaning thereby that he was of the age of about 42 years on the date of proposal for insurance but in the voter card he is shown to be the age of 36 years on 1.1.1994 meaning thereby that he was of the age of about 52 years on 6.9.2010 but the above said two documents were already submitted by the life assured to the opposite parties at the time of proposal as is evident from letter dated 7.9.2010 Ex.C3 in which it is clearly mentioned that regarding age proof, voter identity card was submitted by Mahi Ram to the ops. It is also clearly mentioned that ration card was also submitted to them and then the opposite parties received huge amount of Rs.30,000/- as premium from said Mahi Ram thereby accepted the proposal and written a letter dated 7.9.2010 to him that his proposal for life insurance has been accepted by Bajaj Allianz Life Insurance Company. So, now it does not lie in the mouth of the opposite parties that life assured had stated his age as 42 years wrongly by submitting forged documents. When the insurance company has accepted the proposal form on the basis of above said two documents, now the insurance company cannot turn around.
6. Keeping in view of our above discussion, we allow the present complaint and direct the opposite parties to pay a sum of Rs.3,00,000/- i.e. sum assured to the complainant alongwith interest @ 9 % per annum from the date of filing of the complaint till actual payment. Compliance of this order should be made within a period of 45 days from today, failing which the complainant will at liberty to initiate proceeding against the OPs under Section 25/27 of the CP Act. A copy of this order be supplied to the parties free of costs. File be consigned after due compliance.
Announced in open Forum. President,
Dated:29.9.2016. District Consumer Disputes
Redressal Forum, Sirsa.
Member
