BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FATEHABAD.
Complaint No.: 15 of 2018
Date of Institution: 08.01.2018
Date of order: 23.07.2018.
Shishpal son of Rijhi Ram, resident of village Banmandori, Tehsil and District Fatehabad.
….. Complainant.
Versus
- Bajaj Allianz Life Insurance Company Limited, 5th Floor, B Wing, Airport Road, Yerawada, Pune-Maharashtra through its Chairman-cum-Managing Director.
- Bajaj Allianz Life Insurance Company Limited, Divisional Office, 127, Opp. GPO, Staff Road, Ambala Cantt, Ambala through its Divisional Manager.
….Opposite parties.
Complaint U/s 12 of the Consumer Protection Act
Before: Sh.Raghbir Singh, President.
Sh. M.K. Khurana, Member.
Present: Sh.Sukhbir Dhaka, counsel for the complainant.
Sh.Suraj Kiran, counsel for the OPs.
ORDER:
Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against the opposite parties with the averments that his wife namely Smt. Raj Bala had got her life insured with the OPs vide policy No. 0331750231 valid from 24.1.2017 to 24.1.2031 for a sum assured of Rs. 3,51,000/-. The life assured also made a payment of premium amount of Rs. 15083/- to the OPs and the complainant was appointed as nominee in the abovesaid insurance policy. Therefore, Smt. Rajbala during her life time and after her death the complainant is consumer of the OPs as defined in the Consumer Protection Act, 1986.
2. It is further submitted that Smt. Raj Bala died on 7.2.2017 at her home in village Banmandori, Tehsil and District Fatehabad. After her death the complainant intimated the OPs regarding the death of life assured and the complainant submitted all the requisite documents with the OPs for settlement of the insurance claim. Upon this, the OPs assured the complainant that his claim would be settled very soon and the insurance benefits will be released to him thereafter immediately. However, in spite of repeated requests made by the complainant the OPs did not release the insurance benefits and finally rejected the claim of the complainant vide letter dated 25.3.2017 on false and flimsy grounds of non-disclosure of the correct information whereas the entire correct details were furnished to the OPs. It is further submitted that rejection of the insurance claim by the OPs vide letter dated 25.3.2017 is against law, against facts and in violation of the terms and conditions of the insurance policy. Therefore, the abovesaid act on the part of OPs amounts to deficiency in rendering service to the complainant. The complainant has further prayed that the OPs may be directed for making a payment of Rs. 3,51,000/- to the complainant along-with a sum of Rs. 25,000/- as compensation. Hence, the present complaint.
3. On being served OPs appeared through their counsel and resisted the complaint by filing a joint written statement wherein various preliminary objections with regard to maintainability, cause of action, estoppel, concealment of true and correct facts and locus standi etc. have been raised.
4. In reply on merits, it is submitted that the claim of the complainant was duly considered and it was found that the policy holder obtained the policy in question on 24.1.2017 and died on 7.2.2017 i.e. just after 13 days from the date of issuance of policy which created doubt. Therefore, the matter was got investigated by the OPs and during investigation it was found that the complainant had manipulated the things and prepared a fake death certificate of the policy holder namely Rajbala. During investigation, it was also found that the policy holder had also concealed the true and material facts regarding her previous illness. Therefore, the claim was rightly repudiated as per terms and conditions of the policy. It is further submitted that had these facts been disclosed, the company would not have issued the abovesaid policy to the life assured. It is also further submitted that the complainant had played fraud with the OPs and as such the complainant is neither entitled for insurance benefits nor any compensation. It is further prayed that the present complaint may be dismissed being devoid of merits.
5. The learned counsel for the complainant tendered in evidence affidavit of the Shishpal as Exhibit CW1/A along-with documents as Exhibit C-1 and Exhibit C-2 and Annexure C-1 to Annexure C-3 and closed the evidence of the complainant. On the other hand, Shri Yogesh Kumar, Legal Manager tendered his affidavit as Exhibit RW1/A on behalf of OPs. The OPs also tendered in evidence documents as Annexure R-1 to Annexure R-5 and closed the evidence.
6. We have duly considered the arguments advanced by learned counsel for the parties and have also perused the entire material placed on record. It is not disputed that the insurance on the life of Smt. Rajbala wife of complainant was issued by the OPs for an amount of Rs.3,51,000/- and the same was valid from 24.1.2017 to 24.1.2031. It is also not disputed that a premium amounting to Rs. 15,083/- was paid by the life assured to the OPs at the time of issuance of the insurance. It is also not disputed that the complainant was nominated as nominee in the abovesaid insurance policy. The claim of the complainant was repudiated by the OPs vide letter dated 25.3.2017. A perusal of repudiation letter dated 25.3.2017, reveals that the insurance claim of the complainant was repudiated by the OPs inter alia on the ground that certain facts regarding the illness of the life assured which were known to her were not disclosed by her at the time of filing of the proposal form. As per law the onus was upon the OPs to prove that the life assured was suffering from any illness prior to the filing of the proposal and the same was in her knowledge. However, the OPs have not produced any evidence or medical treatment history of the life assured to prove that she was suffering from any illness or disease prior to filing of the proposal form. Therefore, the abovesaid ground taken by the OPs to repudiate the insurance claim of the complainant is not tenable.
7. The other ground taken by the OPs vide letter dated 25.03.2017 for repudiation of the claim is that the claim in the present case has been preferred by the complainant with a fake death certificate resulting into a fraud with dishonest intention to deceive the insurer. To decide the issue as to whether the death certificate submitted by the complainant regarding the death of life assured is fake or not, this Forum on the request of learned counsel for the OPs summoned the concerned official of Primary Health Centre village Pili Mandori along-with the original record. Sh. Sunil Kumar Pharmacist PHC Pili Mandori appeared before this Forum on 16.7.2018 with the original record regarding death of the life assured Smt. Rajbala wife of the complainant. In his statement the witness deposed that he has brought the original record and as per the registration no. 41 dated 23.2.2017 the life assured Smt. Rajbala had died on 7.2.2017. The witness also further deposed that the certificate Annexure R-1 was issued by him and he identifies the signature of Inder Kumar Medical Officer, PHC Pili Mandori on Annexure R-1 as he had worked with him. The witness also submitted that the document i.e. death certificate of Smt. Rajbala Exhibit C-2 was issued by him. It is also further submitted by the witness that the document Annexure R-5 was prepared by him but the entry point from A to A was not written by him.
8. From statement of the abovesaid witness, it is evident that the life assured Smt. Rajbala had died on 7.2.2017 and the death certificate Exhibit C-2 issued by Registrar Birth and Death is genuine. Therefore, the second ground taken by the OPs vide letter dated 25.3.2017 for repudiation of the insurance claim of the complainant is also not tenable.
9. In view of the aforesaid discussion, we are of the considered opinion that the complainant has been able to prove that there is a deficiency on the part of OPs in rendering service to him. Therefore, the repudiation of the insurance claim of the complainant vide letter dated 25.3.2017 is hereby set aside. The present complaint is accordingly allowed and the OPs are directed for making a payment of Rs. 3,51,000/- (Rs.Three Lacs fifty one thousands only) to the complainant along-with interest at the rate of 8% per annum from the date of filing of the present complaint till its realization. The OPs are further directed for making compliance of the abovesaid order within a period of 45 days from the date of receipt of the certified copy of this order, in case of failure the rate of interest will be 10% for the default period. Copy of this order be supplied to the parties free of costs. File be consigned to record room after due compliance.
Announced in open Forum. Dated:23.07.2018
(Raghbir Singh) President (M.K.Khurana) Distt. Consumer Dispute
Member Redressal Forum, Fatehabad.
