Haryana

StateCommission

A/824/2015

BAJAJ ALLIANZ LIFE INSURANCE CO.LTD. - Complainant(s)

Versus

FURKAN - Opp.Party(s)

VARUN CHAWLA

09 Feb 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

                                                         First Appeal No.824 of 2015

Date of Institution: 14/28.09.2015

                                                               Date of Decision: 09.02.2016

 

1.      Bajaj Allianz Life Insurance Company Ltd. Head office, GE-Plaza Airport Road Yarvada, Pune-411006 through its Managing Director/Incharge.

2.      Bajaj Allianz Life Insurance Company Ltd. Branch Sector-11, Panipat, through its Pos/Incharge.

(through Mr.Rajinder Singh Kalsi, Zonal Legal Manager (North) Bajaj Allianz Life Insurance Co. Ltd., SCO 215-217, Sector-34, Chandigarh).

…..Appellants

Versus

 

Furkan S/o Kurban resident of House NO.1166/2, Purewal Colony, Kacha Camp, Panipat, Haryana.

                                      …..Respondent

 

CORAM:             Mr. R.K.Bishnoi, Judicial Member.

                             Mrs. Urvashi Agnihotri, Member.                                                                                                                                        

Present:              Mr.Varun Chawla, Advocate counsel for appellant.

                             Mr.Davinder Gorsi proxy counsel for Mr.Rajesh Bansal, Advocate counsel for the respondent.

 

                                                   O R D E R

R.K.BISHNOI, JUDICIAL MEMBER:

          Complainant’s wife Anisha (since deceased) was insured by the opposite parties (O.Ps.)-appellants for the insured value of Rs. 60,000/- for the year 2011-2012. The first premium of Rs.5953.07 paise was paid  on 26.04.2011.  She died on 13.03.2012 in Guru Teg Bahadu Hospital, Shahdara Delhi. Being nominee, he was entitled for insured amount. Claim was submitted with the O.Ps., but, was rejected vide letter dated 21.05.2012 on the ground that history of abdominal hysterectomy with Bilateral salpingo orphoerctomy 1.5 years back, as recorded on 28.02.2012 was not disclosed in the proposal form.

2.      O.Ps. filed reply controverting his averments and alleged that deceased life assured (DLA) Mrs. Anisha obtained insurance policy by fraud, mis-representation and suppression of material facts. The medical report of hospital confirmed that DLA had abdominal hysterectomy with bilateral salpingo Oophorectomy, 1 ½ year prior to her admission in the said hospital on 28.02.2012. She was taking regular treatment and chemotherapy from PGI & Delhi State Cancer Institute. DLA was suffering from this ailment prior to the date of proposal i.e. 23.04.2011.  They rightly rejected the claim of the complainant on the above-said ground.  Objections about jurisdiction, cause of action, mis-representation and suppression of material facts etc. were also raised and requested to dismiss the complaint.

3.      After hearing both the parties, learned District Consumer Disputes Redressal Forum, Panipat ( In short “District Forum”) allowed the complaint  vide impugned order dated 05.08.2015 and directed  the opposite parties to pay sum of Rs.60,000/- alongwith interest @ 9% per annum from the date of filing the complaint till its realization alongwith Rs.2200/- as litigation charges.

4.      Feeling aggrieved therefrom, the O.Ps.(appellants) have preferred this appeal.

5.      Arguments heard. File perused.

6.      Learned counsel for the complainant vehemently argued that there is no evidence on the file to presume that life assured was having any previous ailment. Dr. Kunal Chaudhary was produced by O.P. and he categorically stated in his cross-examination that DLA did not make any statement in his presence, so it cannot be presumed on the basis of treatment record EX.DW1/A that she was having any previous ailment.  Learned district Forum rightly discarded this plea of the appellants-O.Ps. and allowed the complaint.  Impugned order dated 05.08.2015 is well reasoned based on law and facts and cannot be set aside.

7.      This argument is devoid of any force.  If we sift the statement of Dr. Kunal Chaudhary it will be clear that DLA was having previous ailment.  It was specifically stated by him in cross-examination that the patient stated about previous history to the concerned doctor. Though, she did not give anything in writing personally to him.  It is not necessary that when a patient is admitted in any hospital he or she will give all the details in writing to each doctor.  It is also stated by him that she was suffering from that disease since one and a half year.   She was admitted at  Guru Teg Bahadur Hospital on 28.02.2012 and if we calculate one and a half year from this date then it comes to 28.08.2010, whereas she obtained insurance policy on 28.04.2011 as mentioned in Ex.R-1. It means that she was aware about this problem, but, concealed from the insurance company.

8.      The medical report of hospital confirmed that DLA had abdominal hysterectomy with bilateral salpingo oophorectomy 1 ½ year prior to her admission.  Thus DLA concealed the above said fact from them.

9.      While dealing with the contention raised on behalf of the appellant, we have to follow the observations made by the Hon’ble National Commission in case cited as Kokilaben Narendrabhai Patel Vs. Life Insurance Corporation of India 2010 CTJ  920 (CP) (NCDRC), which are reproduced under:-

“Insurance-Deficiency in service- Consumer Protection Act, 1986-Section 2(I) (g)- Section 2(I) (o)-Insured died due to heart attack- His wife nominated to receive the insured amount in the event of his premature death-  Repudiation of her claim-Allegedly correct answers not given by the deceased regarding his health in the proposal form- Complaint by his wife allowed by the District Forum-State Commission accepted the appeal and set aside the order passed by the Forum-Hence, the present revision petition-Admittedly the insured suffered from Enteric fever eleven months prior to the taking of the policy-Further, for getting it treated, he even took leave for seventeen days-These two facts not disclosed by him in the proposal form-Non-disclosure thereof was clearly a material fact having a bearing on the risk involved-Repudiation of the claim fully justified-View taken by the Sate Commission upheld-Revision Dismissed.”

 

          Another  observation made by Hon’ble Supreme Court  in case titled Satwant Kaur Sandhu Vs. New India Assurance company Limited (2009) 8 SCC 316, holding as under:-

“ When information on a specific aspect is asked for in the proposal form, held, the assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge-Obligation to disclose extends only to facts which are known to the applicant and not to what he ought to have known-Whether the information sought for is material for the purpose of the policy is a matter not to be determined by the proposer.”

It has further been held that  a mediclaim policy is a non-life insurance policy meant to assure the policy-holder in respect of certain expenses pertaining to injury, accidents or hospitalizations.  Nonetheless, it is a contract of insurance falling in the category of contract uberrimae fidei, meaning a contract of utmost good faith on the part of the assured.  Thus, when an information on a specific aspect is asked for in the proposal form, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge.  It is not for the proposer to determine whether the information.”

 

In Para 29, the Hon’ble Supreme court has observed as under:-

 

“Judged from any angle, we have no hesitation in coming to the conclusion that the statement made by the insured in the proposal form as to the state of his health was palpably untrue to his knowledge.  There was clear suppression of material facts in regard to the health of the insured and, therefore, the respondent insurer was fully justified in repudiating the insurance contract.  We do not find any substance in the contention of learned counsel for the appellant that reliance could not be placed on the certificate obtained by the respondent from the hospital, where the insured was treated.”

10.    The foresaid case laws are fully applicable in this case.  When DLA concealed material fact complainant is not entitled for compensation.

11.    The District Consumer Forum  passed the impugned order by ignoring all these aspects and as such the impugned order being an illegal one cannot be sustained.

12.    In view  of the above discussion, appeal is allowed and the impugned order dated 05.08.2015 of the District Forum is set aside. No other point is urged before us.

13.    The statutory amount of Rs.25000/- deposited at the time of filing of the appeal be refunded to the appellants against proper receipt and identification.

 

February 09th, 2016   Urvashi Agnihotri                                R.K.Bishnoi,                                                               Member                                              Presiding Judicial Member                                         Addl. Bench                                        Addl.Bench