Chandigarh

StateCommission

A/146/2023

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

Versus

KIRAN CHAUDHARY & ANR - Opp.Party(s)

NITIN THATAI

28 May 2024

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

 

Appeal No.	:	146  of 2023
Date of Institution	:	27.06.2023
Date of Decision	:	28.05.2024

Bajaj Allianz Life Insurance Co. Ltd., SCO Nos. 156-159, 2nd Floor, Sector 9, Madhya Marg, Chandigarh (UT)-160009 (Wrong Address) SCO Nos 215-216-217, 4th Floor, Sector- 34A, Chandigarh-160022 (Correct Address) through its Branch Manager.

 

Presently filed through Ms. Swati Seth, Zonal Legal Head-North-1, Legal & Compliance, Bajaj Allianz Life Insurance Co. Ltd., SCO Nos.215-216-217, 4th Floor, Sector-34A, Chandigarh-160022.

   …Appellant

 

V e r s u s

1. Kiran Chaudhary wife of Late Sh.Ashok Chaudhary, R/o Flat No.1415, Ground Floor, Rosewood Estate Phase-2, Derabassi, District SAS Nagar (Mohali) Punjab.
2. Bajaj Housing Finance Limited through its Branch Manager, SCO 156-159, 2^nd Floor, Sector-9, Madhya Marg, Chandigarh (UT)-160009.

….…..Respondent

BEFORE:    JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT.

                    MR.RAJESH K. ARYA, MEMBER.

 

Present:-  Sh.Nitin Thatai, , Advocate for the appellant.

                Sh.Ashwani Arora alongwith Sh.Devinder Kumar, Advocate for the respondent no.1

                 Sh.Gaurav Bhardwaj, Advocate proxy for Sh.Mohit Sareen                        Advocate for the respondent no.2

 

PER RAJESH K. ARYA, MEMBER.

 

                   Opposite party no.2 (now appellant before this Commission), have assailed the order dated 08.05.2023 passed by the District Consumer Disputes Redressal Commission-I, U.T., Chandigarh (in short the District Commission), whereby the consumer complaint bearing no.722 of 2021 filed by the complainant (respondent no.1) was allowed as under:-

“….In view of the above discussion, the present consumer complaint succeeds and the same is accordingly allowed. OP No.2 is directed as under:-

1. To pay insured amount of ₹12,57,020/- to the complainant alongwith interest @ 9% per annum from the date of repudiating the claim till realization. The said amount shall be paid by the complainant to the OP No.1 towards adjustment of loan amount.
2. to pay an amount of ₹50,000/- to the complainant as compensation for causing mental agony and harassment to her;
3. to pay ₹20,000/- to the complainant as costs of litigation.

This order be complied with by the OP No.2 within thirty days from the date of receipt of its certified copy, failing which, it shall make the payment of the amounts mentioned at Sr.No.(i) & (ii) above, with interest @ 12% per annum from the date of this order, till realization, apart from compliance of direction at Sr.No.(iii) above.

Complaint against OP No.1 stands dismissed..…”

2.           Before the District Commission, following facts were narrated by the complainant:-

“..that the husband of the complainant had died on 20.04.2021. He had taken a home loan amounting Rs.22,60,000/- from the OP No.1. The tenure of the loan was for 126 months and the monthly EMI was of Rs.26,597/-. The said loan was insured with OP No.2 under the scheme of Group Credit Protection Single (GCPL) for a sum of Rs.12,57,020/- at a total premium of Rs.80,000/- vide policy No.035067874 dated 12.10.2018 for a period of seven years (Annexure C-1 to C-3). After availing the loan, the deceased was assured by the OPs that in case anything happens to him during the policy period, the OP No.2 will pay the insured loan amount. The complainant was the nominee under the said policy. As per the insurance certificate, the policy holder was covered under the critical illness cover with Rs.12,57,020/-. After the death of Sh.Ashok Kumar Chaudhary, the Ops were informed and provided all the medical records by the complainant and were being requested to adjust the insured amount from the home loan amount and also to start charging revised EMI after necessary adjustment. But the OP NO.2 repudiated/rejected the claim of the complainant vide letter dated 19.08.2021 on the ground that the deceased Sh.Ashok Kumar Chaudhary was old case of DM (diabetes Mellitus) single disease and chronic kidney disease stage V which was pre-proposal and he had concealed the facts from the OP resulting into fraud (Annexure C-6). It is also submitted that the OP No.2 has repudiated the claim of the complainant in arbitrary manner which is against the guidelines issued by the IRDA from time to time…”

 

3.           The complaint was contested by the opposite parties and they filed written version. Opposite party No.1 (Bajaj Housing Finance Limited) in its written statement and stated as under

“……..that the present complaint is liable to be dismissed on the ground that the rendition of accounts by the bank, recovery of amount or reconciliation and/or settlement of accounts are reliefs that can be obtained in a Civil Court and not in Consumer Courts. It is further submitted that it has no role to play in this entire complaint filed by the complainant. It has just provided the finance facility to late husband of the complainant and complainant on their approaching the officials of OP No.1. It is the complainant’s late husband who has opted for insurance from OP No.2 and the grievance qua the policy/insured amount is in the regard to dispute with OP No.2. The complainant while taking the insurance policy from OP No.2 singed the acknowledgement-cum-consent letter dated 12.09.2018 executed and signed at Chandigarh by husband of the complainant (Annexure R-4). On these lines, the case is sought to be defended by OP No.1….”

 

4.           Opposite party No.2 (Bajaj Allianz Life Insurance Co. Ltd.,) contested the consumer complaint and filed its written statement, wherein it was stated as under:-

 

“…..that the DLA had not given a correct information regarding his pre-existing disease i.e. Type II Diabetes, Coronary Artery Disease alongwith eye problem and also kidney problems because of which he was under treatment of dialysis. The DLA also used to smoke 20 cigarettes per day and had a family history of diabetes mellitus. It would not have issued the insurance policy on the existing terms and conditions, hence, no illegality has been confirmed by the answering OP while repudiating the claim of the complainant. From perusal of the medical documents, it was evident that the DLA hd a past history of diabetes, coronary artery disease alongwith eye problems and also kidney problems because of which he was under treatment of dialysis since 2014 i.e., before the inception of the insurance policy. It is further submitted that the answering OP decided to investigate the matter and hired an investigation agency by the name of Guru Associates who submitted its report on 31.07.2021. It is relevant to mention here that the DLA was suffering from various ailments like diabetes mellitus type2, Pseudophakia, coronary artery disease, eye problems prior to issuance of the insurance policy. The DLA was taking the medical treatment from Command Hospital, Chandimandir. These facts were not disclosed and also concealed by the DLA to the answering OP at the time of issuing the insurance policy. Copy of investigation report and medical record of the DLA is annexed as Annexure OP-2/4 & OP-2/5. On these lines, the case is sought to be defended by OP No.2. All other allegations made in the complaint were denied being wrong….”

 

5.           In the rejoinder filed, the complainant reiterated all the averments contained in her complaint and controverted those, contained in the written version of opposite parties.
6.           The contesting parties led evidence before the District Commission.
7.           The District Commission after hearing the contesting parties and on going through the material available on record, allowed the consumer complaint, in the manner stated above. 
8.           Hence this appeal.
9.           We have heard the contesting parties and gone through the material available on the record very carefully.
10.           It may be stated here that since perusal of contents of the order impugned reveals that all  the issues and objections raised by the appellant has been properly adjudicated by the District Commission, as such, the short question which needs to be decided by this Commission is, as to whether, the appellant can be given any benefit of the treatment record of the complainant pertaining to the year 2014 i.e., before the inception of the insurance policy or not. It may be stated here that admittedly the policy in question was obtained by the insured in the year 2018.  However, it has not been justified by the appellant as to why no exercise to verify the treatment taken by the insured before issuance of the policy in question was carried out by it and it has been carried out only when the claim has arisen out of the same. It is significant to mention here that the  insured had paid hefty amount of Rs.80,000/- as single premium to the appellant. Thus, once after taking premium from the insured without getting his thorough medical checkup by team of expert doctors and the policy in question was issued, now the appellant cannot wriggle out of the claim by relying upon some treatment record of the insured pertaining to the year 2014 i.e. more than 3 ½ years old.  The District Commission was also right in holding so.   
11.           Keeping in view the above discussion, we are of the considered view that the impugned order passed by the District Commission, allowing the consumer complaint, being based on the correct appreciation of evidence and law on the point, does not suffer from any illegality or perversity, and did not need interference of this Commission. 
12.           Resultantly, this appeal stands dismissed with no order as to cost.
13.           Pending application(s) if any stands disposed of, accordingly.
14.           Certified copies of this order be sent to the parties, free of charge, forthwith.
15.           The concerned file be consigned to Record Room, after completion and the record of the District Commission, after annexing the additional documents, if any, submitted before this Commission in this appeal, be sent back immediately.

 

Pronounced

28.05.2024

 

Sd/-

 [JUSTICE RAJ SHEKHAR ATTRI]

PRESIDENT

 

 

Sd/-

(RAJESH K. ARYA)

 MEMBER

Rg.