West Bengal

Birbhum

CC/137/2015

Kumkum Hembram,W/o Dhaneswar Hembram - Complainant(s)

Versus

Branch Manager, Bajaj Allianz Life Insurance Co Ltd - Opp.Party(s)

Sanjit Kr Acharya

09 Apr 2019

ORDER

That the brief fact of the case is that the complainant’s Husband Dhaneswar Hembram purchased an Insurance Policy being No.0213332014, sum assured of Rs. 2,00,000/- from the O.Ps. The L.A nominated the complainant Kumkum Hembram as nominee of the aforesaid policy.

            That the insured worker of Railway on 04/03/2013 morning at 6 hrs suddenly he felt unwell.  Then he was sifting at Burdwan Medical College Hospital for treatment but, he expired on that day at 11.25 am.

            That the complainant being the beneficiary of the L. A intimated the O.P about the death and there after submitted the death report along with all the relevant documents for death claim of the insured, but they did not settle the claim. 

            That thereafter the complainant sent a request to know the status of the death claim but the O.P sent a letter on 12/03/2014 without giving any information about the status the claim.

            That since 12/03/2014 the opposite party neither took any step nor they sent reply. That act of the O.P is nothing but amounting to deficiency is service.

            Hence this case for direction the O.Ps to Pay Rs. 2,00,000/- with 12% interest P/A since August 2013 till realization with other relief.

            O.Ps Bajaj Allianz L.I.C. Co. Ltd., has contested the case by filing written version denying all material allegations of the compliant contending, inter alia, that the case is not maintainable and the plaintiff has no cause of action to bring this case.     

            It is the specific case of the O.P that said Daneswar Hembram was under treatment for DM Type 11, HTN & DL(Dylipidomia) with IVCD (inter Ventricular conduction delay) with Sequel of HTN with early Ischemia which was not disclosed by said Daneswar Hembram on 29.03.2011 at the time of making policy, so there was suppression of material facts.

            Ultimately the Ops prayed for dismissed of the case with cost.

Considering the complaint and other materials on record with think following points are to be decided in this case.

1. Whether the complainant is a consumer under Sec. 2(1)(d)(ii) of the C.P. Act.?
2. Whether this Forum has jurisdiction to try this case?
3. Whether there is any deficiency in service or unfair trade practice on the part of the O.P.?
4. Whether the complainant is entitled to get any other relief or reliefs as prayed for?

DECISION WITH REASONS

During trial the Complainant Kumkum Hembram has been examined as PW1. She was cross-

 

examined by the OPs. She also filed same documents.

Dr.S. Chatterjee has been examined as OPw1 on behalf of the OP/Ins. Co. He was also corss-examined by the Complainant.

The Ops have not filed evidence but filed some documents.

Heard argument of both sides.

Point No.1:- Evidently the complainant’s husband Dhaneswar Hembram purchased an Insurance Policy being No.0213332014, sum assured of Rs. 2,00,000/- from the O.Ps. The L.A nominated the complainant Kumkum Hembram as nominee of the aforesaid policy.

So, the complainant is a consumer U/S 2(i) (d) (ii) CP Act.

Point No.2:- we find that OP Bajaj Allianz Life Ins. Company Ltd. has branch at Suri.

Total valuation of the case is Rs. 2,00,000/- with interest, which is far less than maximum limit of the pecuniary jurisdiction of the Forum i.e. Rs. 20,00,000/-. So, this Forum has pecuniary and territorial jurisdiction to try this case.

Point No. 3 and 4:- Both points are taken up together for convenience of discussion as they are related to each other.

            Admittedly the complainant’s husband Dhaneswar Hembram purchased an Insurance Policy being No.0213332014, sum assured of Rs. 2,00,000/- from the O.Ps. The L.A nominated the complainant Kumkum Hembram as nominee of the aforesaid policy.

            According to the OPs/Ins. Company said Dhaneswar Hembram was suffering from Diabetes mellitus (DM) Type 2, Hypertension (HTN) and Dylipidomia with mild Intra-ventricular conduction delay (IVCD) with sequel of HTN with early Ischemia since 2006.

            So, they legally repudiated the claim.

Certainly in view of decision of Hon’ble Apex Court and Hon’ble National Commission concealment of any material fact leads to vitiate contract of insurance and fraudulent suppression of material facts entitles the Insurance Company to repudiate the claim.

            In this context reliance may be placed upon ruling reported in AIR 1962 SC 814.

            We find that in the present case the OPs/Ins. Co. have claimed that insured Dhaneswar Hembram was suffering from serious disease like diabetes, Hypertension etc. but he suppressed the same in proposal forum.

            But such proposal forum is not forthcoming.

            As the OPs/Ins. Co. asserted that LA/ Dhaneswar Hembram had been suffering from diabetes, Hypertension, alike civil cases in this Consumer case also onus is upon them to prove such fact.

PW1 Complainant. Kumkum Hembrom on oath in her evidence denied the allegation that her husband was suffering from Hypertension and Diabetes.

 To prove said fact the OP/Ins. Co. has filed xerox copy of some prescriptions regarding treatment of Dhaneswar Humbram.

            But none appeared to depose in this case regarding said documents.

            During hearing of argument Ld. Advocate/Agent of the Complainant submitted the forum cannot relied upon unauthenticated xerox copy of prescriptions.

            In support of his contention he cited a ruling reported in 2018(1) CPJ 301 (NC), where in case of allege suppression of pre-existing disease regarding alcoholism, Hon’ble National Commission pleased to

hold that mere production of some unattested, unverified and unauthenticated photocopies, could not have

 

 been basis of holding that deceased was an alcoholic and was diagnosed with alcohol lever disease and its complications. Repudiation not justified.

            Considering over all matter into consideration and materials on record and relying upon the ruling cited above we are unable to rely upon unathetitcaled xerox copy of those prescriptions regarding Dhaneswar Humbram and constrained to hold that the OPs/Ins. Co. have failed to prove that Dhaneswar Hembram was suffering from Hypertension and Diabetes and it can be safely said that there was no suppression of material facts by the deceased insured.

            Accordingly we come to conclusion that the claim of the Complainant was repudiated illegally by the OP/Ins. Co. and the case is to be allowed.

            Thus both points are decided in favour of the complainant.

            The case succeeds.

Proper fees have been paid.

Hence,

O R D E R E D

that C.F case No. 137/2015 be and the same is allowed on contest against the Ops. With costs of Rs. 2000/-.

The OPs Bajaj Allianz Life Ins. Company Ltd., are directed to pay the Complainant Rs. 2,00,000/- as claim amount with 6% P/A since August 2013 till realization.

The aforesaid order will be complied with by the O.P No. 1 within one month from this order failing which the complainant shall be at liberty to resort to due process of law and procedure. 

Copy of this order be supplied to the parties each free of cost.