Before the District Consumer Disputes Redressal Forum, Room No. 208 2^nd Floor, District Administrative Complex, Tarn Taran

Consumer Complaint No  :   43 of 2019

Date of Institution               :   08.07.2019

Date of Decision                :   15.10.2019

Gurinder Singh son of Dilabg Singh resident of village Jhamke Khurd, Tehsil and District Tarn Taran.                                                …..Complainant

                             Versus

1. Bharti Axa Life Insurance Company Ltd. Office at 2^nd floor, Pal Plaza, SCO-32, B Block Ranjit Avenue Amritsar, (Punjab), through its branch Manager.
2.  Bharti Axa Life Insurance Company Ltd. Registered Office at Unit 601 & 602, 6^th Floor Raheja Titanium, Off Western Express Highway, Goegaon, (E) Mumbai-400 063 through its authorized officer.                                                  …Opposite Parties

Complaint Under Section  11, 12 and 13 of the Consumer Protection Act .

Quorum:                Sh. Charanjit Singh, President

Smt. Jaswinder Kaur, Member

For Complainant                       Sh. M.P. Arora Advocate.

For Opposite Parties                 Exparte.

ORDERS:

Charanjit Singh, President;

1        The complainant Gurinder Singh has filed the present complaint under Section 11, 12 and 13 of the Consumer Protection Act (herein after called   as 'the Act') against Bharti Axa Life Insurance Company Ltd. Office at 2^nd floor, Pal Plaza, SCO-32, B Block Ranjit Avenue Amritsar, (Punjab), through its branch Manager and another (Opposite parties) by alleging that the opposite parties i.e. the company Bharti Axa Life Insurance company Ltd. is dealing in the life insurance policies and for that purpose, they had spread out number of agents in the field for covering the like risks of common man and the opposite parties in order to secure the business and for having monetary gains, usually allures and gives attractive offers to the common man at the time of giving policies and further assures the family members of the applicants that if any un-towards incident occurred the opposite parties will give all the benefits and the sum assured at the door step as the family will have to go nowhere and the services will be availed while sitting at home and the agents of the opposite parties as well as its officials as per the directions issued by the higher officials, use to give lucrative offers to common people, just in order to secure their business. The company presents the Bharti Axa Life supper endowment plan policy i.e. a life insurance policy. The company’s officials and agents approached the complainant and his family and gave lucrative offers for having an insurance policy and had told about the above policy to the family members of the complainant and they were attracted to the offers made by the opposite parties agents. The family members of the complainant had proposed to assure the life of Baljit Kaur @ Baljeet Kaur w/o Dilbagh Singh vide the life insurance policy of the company that is Bharti Axa Life Supper Endowment Plan and the company has issued the policy in favour of the deceased Baljit Kaur vide policy No. 501-6967688 and said policy was issued in the year 2018 and basic premium per semi annual was fixed of Rs. 15,285.02 paise and the basis sum assured was fixed of Rs. 4,72,022/- and the survival benefit was fixed as Rs. 2,36,011 and the premium paying term was fixed up to 20 September 2032 and the complainant is nominee of the policy. Afterwards unluckily, Baljit Kaur died a natural death on 20^th May, 2018 at her residence at District Tarn Taran. The complainant had given the required information to the company regarding the death of Baljit Kaur for obtaining the amount of sum assured on death under the policy. All the requisite details, that is death certificate, forms and information were supplied to the officials of the opposite parties i.e. the company and the officials of the opposite parties. The company kept mum for several months since the death of the applicant Baljit Kaur  and thereafter just in order to save their skin and money and above all to decline the genuine claim of the complainant, repudiated the claim in a highly arbitrary manner vide its correspondence dated 30.1.2019 on the basis of alleged incomplete, false and self-interpreted medical report other policy and other alleged  documents/ submissions, which had never seen the light of the day and were never within the knowledge of the complainant as well as of the deceased and without showing any of the alleged documents to the complainant. All the alleged facts mentioned by the opposite party in the above said correspondence regarding the deceased life assured are false and based upon the baseless and frivolous documents, if any would produce by the company later on. The deceased life assured had given all the correct facts before purchasing of the policy but the agents of the company have got the signature of the applicant on all the documents without dictating the contents of the clauses to the applicant/ deceased as such, there is no fault on part of the applicant in this respect. The disease as mentioned by the insurance company is not such a fatal disease, which can cause death of a human being and moreover, the deceased was not suffered with any of the alleged disease. The authorized doctor of the insurance company had examined the insured, assessed the fitness and after complete satisfaction, then the policy was being issued and if the deceased life insured could have been suffered with such kind of serious disease, then it must came to the knowledge of the insurance company at that time. The above said act of the opposite parties is a very shameful and un-businesslike act as the company has declined the genuine right/ legal claim of the complainant. The complainant has sent legal notice dated 6.3.2019 through postdated 7.3.2019 for obtaining claim under the policy but the company had neither replied to the same nor had given any consideration to the claim of the complainant. The complainant has prayed that the opposite party be directed to pay total minimum Death Benefit under the policy i.e. sum of Rs. 4,72,022/- and the complainant has also prayed Rs. 10,000/- as compensation and Rs.10,000/- as litigation expenses and pendent elite interest @ 12% P.A from the date of filing of the complaint.  Alongwith the complaint, the complainant has placed on record affidavit of complainant Ex. C-1, Self attested copy of Policy Schedule Ex. C-2, Self attested copy of Premium receipt Ex. C-3, Self attested copy of death certificate Ex. C-4, Self attested copy of claim repudiation Ex. C-5, Self attested copy of legal notice Ex. C-6, Self attested copy of Postal receipt Ex. C-7, Self attested copy of 10^th Certificate Ex. C-8, Self attested copy of Adhar Card Ex. C-9.

2        Notice of this complaint was sent to the opposite parties but no one appeared on behalf of opposite parties and consequently, the opposite parties were proceeded against exparte vide order dated 27.8.2019 of this Forum.

3        We have heard the Ld. counsel for complainant and have also carefully gone through the evidence and documents on the file.

4        The complainant has produced on record affidavit of Guridner Singh complainant and declared that the opposite parties i.e. the company Bharti Axa Life Insurance company Ltd. is dealing in the life insurance policies and for that purpose, they had spread out number of agents in the field for covering the like risks of common man and the opposite parties in order to secure the business and for having monetary gains, usually allures and gives attractive offers to the common man at the time of giving policies and further assures the family members of the applicants that if any un-towards incident occurred the opposite parties will give all the benefits and the sum assured at the door step as the family will have to go nowhere and the services will be availed while sitting at home and the agents of the opposite parties as well as its officials as per the directions issued by the higher officials, use to give lucrative offers to common people, just in order to secure their business. The company presents the Bharti Axa Life supper endowment plan policy i.e. a life insurance policy. The company’s officials and agents approached the complainant and his family and gave lucrative offers for having an insurance policy and had told about the above policy to the family members of the complainant and they were attracted to the offers made by the opposite parties agents. The family members of the complainant had proposed to assure the life of Baljit Kaur @ Baljeet Kaur w/o Dilbagh Singh vide application vide the life insurance policy of the company that is Bharti Axa Life Supper Endowment Plan and the company has issued the policy in favour of the deceased Baljit Kaur vide policy No. 501-6967688 and said policy was issued in the year 2018 and basic premium per semi-annual was fixed of Rs. 15,285.02 paise and policy schedule is Ex. C-2 and premium receipt is Ex. C-3 and the basis sum assured was fixed of Rs. 4,72,022/- as per Ex. C-3 and the survival benefit was fixed as Rs. 2,36,011 and the premium paying term was fixed up to 20 September 2032 and the complainant is nominee of the policy. Afterwards unluckily, Baljit Kaur died a natural death on 20^th May, 2018 at her residence at District Tarn Taran and death certificate of Baljit Kaur is Ex.  C-4. The complainant had given the required information to the company regarding the death of Baljit Kaur for obtaining the amount of sum assured on death under the policy. All the requisite details, that is death certificate, forms and information were produced to the officials of the opposite parties i.e. the company and the officials of the opposite parties i.e. the company kept mum for several months since the death of the applicant Baljit Kaur  and thereafter just in order to save their skin and money and above all to decline the genuine claim of the complainant, repudiated the claim in a highly arbitrary manner vide its correspondence dated 30.1.2019 Ex. C-5 on the basis of alleged incomplete, false and self-interpreted medical report other policy and other alleged  documents/ submissions, which had never seen the light of the day and were never within the knowledge of the complainant as well as of the deceased and without showing any of the alleged documents to the complainant. the complainant further stated in his affidavit that all the alleged facts mentioned by the opposite party in the above said correspondence regarding the deceased life assured are false and based upon the baseless and frivolous documents, if any would produce by the company later on. The deceased life assured had given all the correct facts before purchasing of the policy but the agents of the company have got the signatures of the applicant on all the documents without dictating the contents of the clauses to the applicant/ deceased as such, there is no fault on part of the applicant in this respect. The disease as mentioned by the insurance company is not such a fatal disease, which can cause death of a human being and moreover, the deceased was not suffered with any of the alleged disease. The authorized doctor of the insurance company had examined the insured, assessed the fitness and after complete satisfaction, then the policy was being issued and if the deceased life insured could have been suffered with such kind of serious disease, then it must came to the knowledge of the insurance company at that time. The above said act of the opposite parties is a very shameful and un-businesslike act as the company has declined the genuine right/ legal claim of the complainant. The complainant has sent legal notice dated 6.3.2019 Ex. C-6 through postal receipt dated 7.3.2019 Ex. C-7 for obtaining claim under the policy but the company had neither replied to the same nor had given any consideration to the claim of the complainant and prayed that the present complaint may be allowed.`

5        From the combined and harmonious reading of pleadings and documents going to prove that the complainant has purchased the Bharti Axa Life Supper Endowment Plan Policy and as per Ex. C-2 the maturity date of policy is March 20^th, 2038. During the currency of insurance policy DLA was died on 20^th Mary 2018 and as per pleadings of the complainant all the relevant documents were submitted to the opposite party and after the long time, as per Ex. C-5 opposite party has repudiated the claim by alleging that as per the medical documents procured by us at claims stage it has been established that the Life insured was a known case of Atrial Septal Defect since January 2015. This history is prior to her proposal for insurance and that all the aforesaid replies were false.  The complainant has pleaded in his complaint that before the inception of policy the DLA was examined by the authorized doctor of opposite party and assessed the fitness of DLA to the satisfaction and at that time DLA was not suffering from any kind of serious disease. But at this stage opposite party cannot take plea of pre-existing disease. As the DLA was examined by the authorized doctors of the opposite party to the satisfaction. The evidence led by the complainant on the file goes unchallenged and un-rebutted as Opposite Parties are proceeded against exparte in the present complaint and there is no reason on the file as to why the evidence produced by the complainant be not believed. Otherwise also, due notice was issued to the Opposite Parties and opposite parties did not appear in the Forum in order to contest the complaint which shows that the Opposite Parties have nothing to say upon the allegations leveled against them by the complainant. As such, the complainant is entitled to the relief claimed in the complaint and it stands established on record that the complainant is approaching the opposite parties several times but the opposite parties did not care to resolve the matter, not only committed deficiency in service, but also indulged in an unfair trade practice.    

6        The observation of the opposite parties to ensure whether DLA was suffering from any disease and in this case DLA was examined by the authorized  doctors of opposite parties, so at this stage opposite parties cannot raise any objection of pre-existing disease. 

7      In case M/s ICICI Prudential Life Vs Veena Sharma 2014(4) CLT  507 (NC), the Hon’ble National Commission held that it was for the insurance company to prove that complainant was suffering from pre-existing disease and has knowingly failed to disclose the same. The Hon’ble National Commission has also relied upon a case decided by the Hon’ble Supreme Court titled Balwinder Kaur Vs Life Insurance Corporation of India, Civil Appeal No. 7969 of 2010 decided on 13.9.2010, wherein it was held that the onus to prove that deceased had obtained policy by suppressing the material facts relating to his illness, was on the corporation at the time of taking policy and he deliberately suppressed the facts.

8        It is usual with the insurance company to show all types of green pastures to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation. This, take it or leave it‟, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible. It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-

“It seams that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy. The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5,000/- for luxury litigation, being rich. 

9        In light of the above discussion, the complaint succeeds and the same is hereby allowed with costs in favour of the complainant and against the Opposite Parties. The opposite parties are directed to pay Rs. 4,72,022/- (Rs. Four Lacs Seventy Two thousand and twenty two only) to the complainant.  The complainant is also entitled to Rs.10,000/- ( Rs. Ten Thousand only) as compensation on account of harassment and mental agony and Rs 5,000/-  (Rs. Five Thousand only) as litigation expenses. Opposite Parties are directed to comply with the order within one month from the date of receipt of copy of the order, failing which the complainant is entitled to interest @ 9% per annum, on the awarded amount, from the date of complaint till its realisation.  Copy of order be supplied to the parties free of costs as per rules. File be consigned to record room.

          (Charanjit Singh)

    President

   (Jaswinder Kaur)

         Member