Oral

State Consumer Disputes Redressal Commission

U.P. Lucknow.

Appeal No. 751 of 2011

Bajaj Allianz Life Insurance Company Limited,

G.E. Plaza Airport Road, Yerwada, Pune

through Branch Office, Bajaj Allianz Life

Insurance Company Ltd., 4- Sjhahnajaf Road,

Hazratganj, Lucknow (U.P.) through its

Officer In-charge.                                                …Appellant.

Versus

1- Smt. Kusuma Devi w/o Late Manmohan Das,

    R/o House no.287/01, Rajendra Nagar, Orai, Jalaun.

2- Pradeep Kumar s/o Late Manmohan Das,

    R/o House no.287/01, Rajendra Nagar, Orai, Jalaun.

3- Smt. Manju Lata Gupta w/o Mr. Rajeev Gupta,

    Advocate, 406, Gandhi Nagar behind Sankata

    Mandir, Orai, Jalaun.                                 .…Respondents.

Present:-

1- Hon’ble Sri Sushil Kumar, Presiding Member.

2- Hon’ble Smt. Sudha Upadhyay, Member.

Sri Dinesh Kumar, Ld. counsel for the appellant.

Sri A.K. Srivastava, Ld. Counsel for the respondents.

Date  13.6.2024

JUDGMENT

Per Sri Sushil Kumar,  Member-   This appeal has been directed against the judgment and order dated 2.2.2011 passed by the Ld. District Forum, Jalaun in complaint case no.174 of 2008, Smt. Kusuma Devi & ors. vs. Bajaj Allianz Life Insurance Company Ltd. & ors., whereby the ld. District Forum allowed the complaint and directed the insurance company/appellant to pay insured amount of Rs.1,25,000.00 to the complainants.  

As per case of the complainants, the husband of the complainant no.1 took an insurance policy for Rs.1,25,000.00 on payment of premium amount of Rs.25,000.00 on 8.8.2007. The policy holder Manmohan Das died on 15.8.2007 due to cardiac arrest. The opposite party was informed immediately. The complainant are the nominee on behalf of the deceased policy holder. The insurance claim was submitted before the insurance company/opposite party but the insurance claim was repudiated on the ground that the insured person was suffering from Angina on exertion class-2 since last 2 years.

The opposite party/appellant filed their written statement. The fact of issuance of policy was admitted but contended that the policy holder died within 7 days. Upon investigation this fact reveals that the insured person was suffering from Angina on exertion since last 2 years. Therefore, the insured claim is not payable.

Upon appreciation of the evidence submitted by the parties, the ld. District Forum concluded that the insurance claim is payable and accordingly allowed the complaint land directed the appellant to pay the insured amount to the complainants.

Ld. counsel for the appellant submitted that the deceased concealed the fact regarding disease of heart since last 2 years back at the time of filing proposal form i.e. on 24.7.2007 because the death of the insured has occurred within 7 days. So as per section 45 of the Insurance Act, the insurance company may reject the death claim on the ground of non-disclosure of the material facts known to the proposer. The ld. District Forum failed to appreciate the facts of pre-existing disease at the time of taking the insurance policy.

The fact of pre-existing disease and knowledge to the insured of this disease is to be proved by the insurance company. The documents regarding admission of the insured in the hospital filed by the insurance company reveals the date of admission 15.8.2007 and as per death certificate the insured died on the same date. There is no any other document which can establish that the insured person took treatment of Angina prior to the fate of submitting the proposal form. So this fact is not proved by the insurance company/appellant that the insured concealed the fact of pre-existing disease on the date of submission of the proposal form for taking the insurance policy.

As per discussions made above, the judgment and order passed by the ld. District Forum need no interference.  The appeal deserves to be dismissed.    

ORDER

          Appeal is dismissed.

If, any amount, is deposited by the appellants at the time of filing of this appeal under section 15 of the Consumer Protection Act, 1986, may be remitted to the ld. District Consumer Forum concerned for satisfying the decreed, as per rules alongwith accrued interest upto date.

The stenographer is requested to upload this order on the Website of this Commission today itself. 

          Certified copy of this judgment be provided to the parties as per rules.        

        (Sudha Upadhyay)                       (Sushil Kumar)                             

                Member                              Presiding Member

Jafri, PA I

Court 2