BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SIRSA.
Consumer Complaint no. 707 of 2019.
Date of Institution : 17.12.2019.
Date of Decision : 31.10.2023.
Surjit Singh aged about 62 years son of Shri Atma Ram, resident of H. No. 301, Himachal Nursing Home, Shiv Chowk, Sirsa.
……Complainant.
Versus.
1. The Claims Review Committee Bajaj Allianz Life Insurance Co. Ltd. Bajaj Allianz House, 5th Floor, Airport Road, Yerwada, Pune- 411006.
2. Bajaj Allianz Life Insurance Co. Ltd., 1st Floor, Kar House Building Opposite Hotel Aroma Inn, Dabwali Road, Sirsa through its authorized person.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act, 1986.
BEFORE: SH. PADAM SINGH THAKUR, ……………PRESIDENT
SMT. SUKHDEEP KAUR,………………… MEMBER.
Argued by: Sh. Narendra Sharma, Advocate for the complainant.
Sh. Ashish Goyal, Advocate for opposite parties.
ORDER
The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 (after amendment under Section 35 of the C.P. Act, 2019) against the opposite parties (hereinafter referred as Ops).
2. In brief, the case of complainant is that wife of complainant namely Smt. Anjila Rani Sethi had purchased a life insurance policy bearing no. 0347661193 from Bajaj Allianz Life Insurance Company Ltd. and as per the terms and conditions of the policy all the risks were covered under the said policy. That wife of complainant died natural death. The complainant has deposited Rs.50,000/- as first installment of the premium under policy no.0347661193 under which the risk covered was 10 times to the sum assured. It is further averred that after death of the wife of complainant on 12.02.2019 complainant lodged a claim bearing no. 1819012405 with the insurance company under the said policy but the insurance company vide its letter dated 22.03.2019 repudiated the claim of complainant and had refused to indemnify the same alleging therein that wife of complainant did not disclose certain facts and had deliberately concealed the same. That through the said repudiation letter it has further been alleged by the insurance company that wife of complainant was suffering from a number of diseases (as mentioned in the repudiation letter) and she had committed fraud by way of concealment of the same intentionally and deliberately. It is further averred that said repudiation is totally illegal, unlawful and against law and facts and against the terms and conditions of the policy as at the time of issuance of said policy, the wife of complainant was duly medically examined by the insurance company. She was found totally physically and mentally fit and only after their due satisfaction, the insurance company had issued the said policy to the wife of complainant and insurance company is legally liable to indemnify the claim of complainant. That complainant moved an application dated 09.04.2019 to the insurance company and requested to withdraw the aforesaid repudiation letter and further requested to indemnify the claim of complainant with an immediate effect but to no effect. So it is a clear cut case of deficiency in service as well as unfair trade practice on the part of ops due to which complainant has suffered unnecessary harassment and mental agony. That complainant also got issued a legal notice on 20.05.2019 to the ops but of no avail. That an earlier complaint filed by complainant was got withdrawn on 03.12.2019 due to technical fault with permission to file a fresh complaint. Hence, this complaint.
3. On notice, opposite parties appeared and filed written statement taking certain preliminary objections regarding non disclosure of facts, maintainability and locus standi etc. It is submitted that factual position in the present case are that wife of complainant Smt. Anjila Rani Sethi now deceased during her life time had approached the ops and had shown her desire to purchase one life insurance policy of the ops’ company and had processed duly filled proposal form wherein the life assured had represented to the ops that the information as supplied in the proposal form are true and correct and the life assured further represented to the op’s company to be fit and fine and was not suffering from any disease. The ops after in receipt of proposal form from the life assured and considering all the declarations as made by the life assured in the proposal form true in its entirety had issued one life insurance policy bearing no. 0347661193 for a sum assured amount of Rs.50 lacs on 26.06.2018 and the said policy has been issued strictly on the basis of information as supplied by the life assured to the op company. That after issuance of a policy, the wife of complainant within a very short span of time has passed away on 12.02.2019. It is further submitted that being an early claim, the op with a view to check the sanctity of the same has processed the case for conducting necessary investigation into the death claim and during the said course it has been revealed to the op company that the life assured has malafidely concealed about her true health status at the time of entering into the proposal form and the life assured much prior to purchase of policy was seriously ill and was under medical treatment of Diabetics, Rheumatic Heart disease, severe Mitral Stenosis Moderate Aartic Stenosis and Regularization since 04.06.2018. The life assured as well as the complainant very well knows the fact that the LA on account of her chronic diseases will not survive for a long time and the LA in collusion with the complainant has managed to purchase the present policy by concealing the material fact regarding her health. It is further submitted that op’s company upon being appraised itself with regard to such an astonishing fact does not found it feasible to adhere to the death claim so submitted by the complainant and accordingly the same stands repudiated vide letter dated 22.03.2019. That insurance policy is a contract and both the parties are bound by the terms and conditions of the same. It is further submitted that it is deemed that the life assured had gone through the features of the policy proposed. It is the mode of providing information to the insurer, so as to enable them to exercise a lawful right to evaluate the life before providing its service of covering the life. The company has been induced to issue the insurance cover on the life of the Member as they were made to believe that the Member do not have any other insurance cover and was having a sound health which is a necessary phenomenon before issuance of insurance covers. It is further submitted that since the subject matter viz. the insurance cover was obtained fraudulently, dishonestly and by misrepresentation therefore, the same is null and void and no benefit is payable there under. It is further submitted that contract of insurance is based on the principle of Doctrine of Uberrimafides i.e. utmost good faith. Hence, the insured is under legal and solemn obligation to disclose all material facts correctly, honestly and truthfully to the insurer company at the time of obtaining the policy, failing which the contract of insurance shall be declared void ab-initio, illegal, invalid and unenforceable. On merits, the plea of preliminary objections are reiterated. It is submitted that had the true picture of the actual health status of the wife of complainant been brought into the knowledge of op’s company, then op company would not have issued like such policy with such a heavy sum assured. The mere payment of premium does not ipso facto leads to an entitlement of the nominee to get the sum assured amount and as per policy contract every claim is to be judged in the light of terms and conditions of the policy contract. It is further submitted that ops’ company has rightly repudiated the claim so filed by complainant. The complainant has moved one representation for reviewing of repudiation order and the competent management of the ops’ company has minutely scrutinized the same and has found the same not feasible to accept and accordingly has communicated their decision to the complainant. All other contents of complaint are also denied to be wrong and prayer for dismissal of complaint made.
4. The complainant in evidence has tendered his affidavit Ex.C1 and copies of documents i.e. letters regarding policy number 0354491520 with policy schedule etc. Ex.C2, receipt of the premium amount of Rs.50,000/- dated 20.06.2018 Ex.C3, death certificate Ex.C4, legal notice Ex.C5, copy of postal receipt Ex.C6 and policy certificate of ICICI Prudential Life Insurance Ex.C7.
5. On the other hand, ops have tendered affidavit of Ms. Swati Seth, Zonal Legal Head as Ex. RW1/A and copies of documents i.e. proposal form Ex.R1, key features of the plan Ex.R2, discharge summary of All India Institute of Medical Science, New Delhi Ex.R3, death certificate Ex.R4, repudiation letter dated 22.03.2019 Ex.R5, request for indemnification of the claim Ex.R6, letter Ex.R7, office note- CRC case Ex.R8 and investigation report Ex.R9.
6. We have heard learned counsel for the parties and have gone through the case file carefully.
7. There is no dispute of the fact that on 26.06.2018 Smt. Anjila Rani Sethi had purchased a life insurance policy bearing no. 0347661193 from the ops against the payment of annual premium amount of Rs.50,000/- and the sum assured amount of the said policy was of Rs. fifty lacs. It is also not in dispute that life assured Smt. Anjila wife of complainant died on 12.02.2019 and as such she paid only one premium of the said policy in question. At the time of obtaining said insurance policy from ops, the ops in the proposal form Ex.R1 put specific questions to the deceased Smt. Anjila about diseases to her to which she replied that she is not suffering from any such diseases. However, as she died on 12.02.2019 i.e. within short period after purchasing of the policy in question, therefore, the claim submitted by complainant being nominee of deceased has been repudiated by the ops on the ground that much prior to purchase of policy was seriously ill and was under medical treatment of diabetics, Rheumatic heart disease, severe Mitral Stenosis Moderate Aartic Stenosis since 04.06.2018 and the lift assured concealed about her true health status at the time of entering into the above said proposal form for purchasing the policy in question. In this regard to prove the said plea, the ops have placed on file discharge summary of All India Institute of Medical Science, New Delhi as Ex.R3, the perusal of which reveals that she was admitted in the said hospital on 04.06.2018 and was discharged on 08.06.2018 and she was suffering from Diabetes Mellitus, Rheumatoid Arthritis as well as heart disease. It is also revealed from record placed on file by ops that on 05.11.2018 she was prescribed medicines by Cardiothoracic & Neurosciences Centre, AIIMS, New Delhi. So, it is proved on record that she was already under medical treatment for the above said diseases and by concealing the her ill health from ops she obtained the policy in question from ops. As such ops have rightly repudiated the death claim of wife of the complainant to him. However, as the policy in question was issued by the ops without verifying about the ill health of Smt. Anjila and before issuance of policy she was got medically examined by ops and ops could verify the said fact before issuance of the policy in question but only verified the said fact after her death and ops have not shown anything regarding forfeiture of premium amount, therefore, complainant is entitled to refund of the premium amount of Rs.50,000/- paid by complainant to the ops alongwith interest besides compensation for harassment in this regard as ops have not refunded the premium amount to the complainant after termination of policy in question. Since the ops have also retained the premium amount of complainant who was already under mental trauma due to ailment of his wife and her death and there is general tendency of the insurance companies to issue policies for earning premium amounts only without verifying the actual position at the time of issuance of policies, as such complainant is also entitled to compensation of Rs.50,000/- from ops for unnecessary harassment and for above said lapses on the part of ops.
8. In view of our above discussion, we partly allow the present complaint against the ops and direct the ops to make refund of the premium amount of Rs.50,000/- to the complainant alongwith interest @6% per annum from the date of filing of present complaint i.e. 17.12.2019 till actual realization. We also direct the ops to further pay a sum of Rs.50,000/- as compensation for harassment to the complainant and Rs.10,000/- as litigation expenses to the complainant. The ops are liable to comply with this order within a period of 30 days from the date of receipt of copy of this order, failing which ops will be liable to pay the above said principal amount of Rs.50,000/- alongwith interest @9% per annum for the defaulted period. A copy of this order be supplied to the parties as per rules. File be consigned to the record room.
Announced. Member President,
Dated: 31.10.2023. District Consumer Disputes
Redressal Commission, Sirsa
