NCDRC

NCDRC

RP/965/2022

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

Versus

GENDA SINGH - Opp.Party(s)

MR. VIKRAMADITYA SINGH & MR. SHREYANK TIWARI

11 Sep 2024

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 965 OF 2022
(Against the Order dated 22/06/2022 in Appeal No. 2225/2010 of the State Commission Madhya Pradesh)
1. BAJAJ ALLIANZ LIFE INSURANCE COMPANY LTD.
...........Petitioner(s)
Versus 
1. GENDA SINGH
...........Respondent(s)

BEFORE: 
 HON'BLE MR. JUSTICE RAM SURAT RAM MAURYA,PRESIDING MEMBER
 HON'BLE MR. BHARATKUMAR PANDYA,MEMBER

FOR THE PETITIONER :
MR. VIKRAMADITYA SINGH, ADVOCATE
MR. SEJAL SANGHAI, ADVOCATE
MS. PURNIMA OJHA, ADVOCATE

Dated : 11 September 2024
ORDER

Heard Counsel for the Petitioner.

 

The above revision has been filed against the Order of State Consumer Disputes Redressal Commission dated 22.06.2022 whereby the First Appeal No.2225/2010 arising out of the Order of District Consumer Disputes Redressal Forum, Satna, Madhya Pradesh dated 25.06.2010 passed in CC/146/F/2010 has been dismissed on the ground that the investigation report which has been relied upon by the appellant for repudiation of the claim was investigated by some other person and report has been submitted by another person i.e.                   Mr. B. Swaminathan.

 

In the present case Mr. Raj Kumar Singh (deceased life assured) has taken Capital Unit Gain Policy from the petitioner on 08.10.2007.  Thereafter Mr. Raj Kumar Singh fell ill and admitted to Govt. hospital, Satna on 23.08.2008 and died on 25.08.2008.  The cause of death was kidney failure. 

 

-2-

The complainant submitted the insurance claim under the policy issued by the opposite party which was repudiated by the opposite party by the letter dated 25.05.2009 on the ground that although the deceased life assured was suffering from hyper tension, renal ailment but at the time of filling the proposal form.  He has concealed this decease.

 

The District Commission after hearing the parties by the Order dated 25.06.2010 found that it has been denied by the complainant that the deceased life assured had ever been diagnosed with hyper tension before taking the policy on 08.10.2007 and the report of investigator relating to his suffering from hyper tension was incorrect report.  The District Commission therefore allowed the complaint and directed the opposite party to give the benefit under the insurance policy to the complainant alongwith cost of Rs.5000/- .

 

The petitioner filed First Appeal no.2225/2010 from the aforesaid order. The appeal was heard by the State Commission who by its judgment dated 22.06.2022 found that although investigation report was submitted under the signature of Mr. B.Swaminathan but the investigation report was prepared by Mr. Jeevan Kumar Aharwal.  Therefore, this report was not admissible and was not reliable.  On this ground, the appeal has been dismissed. 

 

We have considered the argument of the Counsel for the Petitioner and examine the record.  The insurance claim has been denied on the basis of investigator report dated 08.05.2009.  In this investigation report investigator found that from the prescription slip of Dr. A.K. Agarwal, MS, Satna dated 20.07.2008, it is proved that the deceased life assured was suffering from hyper tension and renal ailment for last three years.  Therefore, on the date of issuing policy on 08.10.2007, he had concealed his ailment.  Alongwith report, the certified medical prescription issued by Dr. A. K. Agarwal has not been filed nor Mr. B. Swaminathan had filed his affidavit that he had ever met with

 

 

-3-

Dr. A.K. Agarwal who had treated the deceased on 20.07.2008.  Therefore this report is of no value.  The deceased life assured died due to kidney failure and hyper tension and acute renal deceases have no co-relation with it.  If the deceased life assured was suffering from chronic hyper tension and renal deceased then certainly there must be some record relating to the treatment but record has not been produced.  In such circumstance, the District Forum has not committed any illegality in relying upon the affidavit of complainant and rejecting the repudiation letter of opposite party and holding that there was reliable evidence to prove that the deceased life assured had ever diagnosed with the diseases hypertension and renal failure before taking policy.  The revision has no merit and it is dismissed.

 
..................................................J
RAM SURAT RAM MAURYA
PRESIDING MEMBER
 
 
.............................................
BHARATKUMAR PANDYA
MEMBER

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