BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

CACHAR :: SILCHAR

Con. Case No. 32 of 2013

Musstt. Kalpana Begum Laskar ………………………………………………….     Complainant.   

                                                                        -V/S-

            Bajaj Allianz Life Insurance Co. Ltd.

            Represented by:-

            1.         The Manager,

                        Bajaj Allianz Life Insurance Co. Ltd.

                        GE Plaza, Airport Road, Yerawada,

                        Pune – 411006.

            2.         The Manager,

                        Bajaj Allianz Life Insurance Co. Ltd. 

                        Hospital Road, Near Jagannath Travels

                        Building Complex, Silchar, Dist. Cachar, Assam     …………………Opp. Party

Present: -                                Sri Bishnu Debnath,                             President,

District Consumer Forum,

                                                Cachar, Silchar.                                            

             Mrs. Chandana Purkayastha,                 Member,

                                                            District Consumer Forum,

                                                            Cachar, Silchar.                                            

                                                             Shri Kamal Kumar Sarda,                       Member,

                                                            District Consumer Forum,

                                                            Cachar, Silchar.                                            

            Appeared :-                 Sri   Dhrubajyoti Nath, Advocate for the complainant.

                                                Sri   Joydeep Biswas, Advocate for the O.Ps.

                           Date of evidence……………………………….           25-04-2014

                         Date of written argument…………………….    30-06-2015

                          Date of judgment……………………………...             29-05-2017

JUDGMENT AND ORDER

(Sri Bishnu Debnath)

1. The Complainant Musst. Kalpana Begum being nominee of the deceased insured Sikandar Ali brought this complaint U/S 12 of the Consumer Protection Act 1986 for award of sum assured of Rs.6,00,000/-and other relief on the ground of disservice on the part of the Insurance in respect of insurance policy No. 0283220354 dated 11/10/2012.

2. The fact brought by the Complainant is as:- Her father late Sikander Ali @Lt.Shikander Ali of Vill- Didarkhush Part- III, P/S- Kachudaram, Cachar purchased Insurance Policy No. 0283220354 on 11/10/2012 for sum assured Rs.6,00,000/- from Bajaj Alliance Life Insurance Co. Ltd. Silchar Branch ( refered as O.P No.2). The Complainant was nominee. The O.P No. 2 received the first half yearly premium amount of Rs.14,933 on 11/10/2012. But very unfortunately the Insured died on 10/12/2012 on Conjestige Cardiac Failure (C.C.F). Accordingly, the Complainant submitted claim Form. The O.Ps appointed investigator, the investigator submitted investigation report in course of process and subsequently on 09/05/2013 repudiated the claim on the ground that the insured suppressed the disease at the time of purchasing Insurance Policy as well as death certificate is false.

3. However, Notice issued. The O.P No. 1, the Manager Bajaj Alliance Life Insurance Co. Ltd. Pune and O.P No. 2 received the Notice and submitted Joint W/S. In their W/S they stated inter alia that the Insured suppressed the disease in the proposal form and death certificate was false. However, during hearing the Complainant deposed and exhibited some document including Insurance Policy, Death Certificate, cause of death certificate letter regarding issued by the Registrar of Birth and death, Sonai P.H.C, Rejection of claim etc. The O.Ps took adjourned dates for evidence but did not submit deposition of any witness.

4. Ultimately, the Complainant submitted written argument. O.P took adjourned dates for written argument but did not submit written argument.

5. We have perused the evidence on record and written argument of the complainant including W/S of the O.P. From those documents it is concluded without hesitation that Insurance Policy and death of the Insured are not denied but the O.P repudiated the claim on 2 (two) grounds as below:-(i). Death certificate of the insured is false. (ii)The disease Conjestige Cardiac Failure (C.C.F) was suppressed in the proposal form.

6. However, the Complainant on her deposition exhibited rejection letter, vide Ext. 1. In that letter it is clearly mentioned the above 2 (two) grounds for rejection of the claim. But the claimant exhibited not only cause of death certificate vide Ext. 4 in addition of Ext-1, but also exhibited Death Certificate Vide. Ext. 5. So, prim-facially the Complainant has established the fact of death caused due to Conjestige Cardiac Failure (C.C.F). The O.P took a defense plea that the insured knowingly suppressed the above disease at time of purchasing the insurance Policy. But no convincing material are available in the record to conclude that the insured had knowledge about his disease Conjestige Cardiac Failure (C.C.F) at the time of purchasing the insurance Policy. Hence, the defense plea is not established.

7. So far as the defense plea about false death certificate of the insured is concerned, we do not find any convincing material available in the record in favour of the defense plea. Rather Ext. 3 disclosed a fact that Complainant asked the O.P to make proper inquiry about the death Certificate and the O.P did not collect any reliable information to establish the plea. Hence, in our considered view he cause of death of the insured and death certificate vide Ext. 4 & 5 are reliable documents, and the deceased insured had no knowledge about his disease Conjestige Cardiac Failure (C.C.F) at the time of purchasing the Insurance Policy.

8. So, it is opined that the O.Ps without any justified ground repudiated the claim. So the said repudiation is amounting to disservice. Therefore, the O.Ps are directed to pay sum assured of the Insurance policy No. 0283220354 mentioned in the Annexure-I, i.e Rs.6,00,000/-(Rupees Six Lakh) only with compensation of disservice of Rs.7,000/-(Rupees Seven thousand) only and cost of the proceeding of Rs.1,000/-(Rupees One thousand) only.

9. The said awarded total amount of Rs.6,08,000/-(Rupees Six lakh eight thousand) only to be deposited within 45 days from today before this Forum through Account payee cheque in favour of the Complainant. In default, the O.Ps are to pay interest at rate of 10% per annum on awarded amount till realization of the full amount. The Complainant is to receive the cheque from the District Forum on receipt of notice subject to submission of legal heirs certificate of the deceased and on receiving the cheque she is to encash the same in time and distribute the amount among legal heirs as per law & rule.

10. With the above the case is disposed of on merit.

        Given under the hand of the President and Members of this District Forum and seal of the Office of the District Forum on this the 29^th day of May, 2017.