BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FATEHABAD.
Complaint No.:362 of 2017.
Date of Instt.: 18.12.2017.
Date of Decision: 30.05.2018.
Vinod Kumar son of Manphool Singh, resident of Dhani Issar, tehsil and district Fatehabad.
…Complainant.
Versus
1. M/s Bajaj Allianz Life Insurance Company Limited, GE Plaza,
5th Floor, Airport Road, Yerawada, Pune-Maharashtra through its Chairman-cum-Managing Director/Managing Director.
2.The Divisional/Branch Manager, M/s Bajaj Allianz Life Insurance Company Limited, 127 OPP GPO Staff Road, Ambala.
…Opposite Parties.
Complaint U/s 12 of the Consumer Protection Act, 1986
Before: Sh.Raghbir Singh, President.
Sh. M.K. Khurana, Member.
Present: Sh.Sukhbir Dhaka, counsel for the complainant.
Sh.Suraj Kiran, counsel for the opposite parties.
ORDER:
The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant against the Opposite Parties (hereinafter to be referred as OPs) with the averments that Mahender Singh, brother of the complainant had got himself insured with the OPs vide insurance policy no. 0325551228 valid from 5.11.2015 to 4.11.2035 for a sum assured of Rs. 5,00,000.00 and he made the payment of a sum of Rs. 32,130.00 to the OPs as insurance premium and he also got himself insured with the OPs vide another insurance policy no. 0327920961 valid from 26.3.2016 to 25.3.2038 for sum assured of Rs. 4,75,000.00 and he made the payment of insurance premium of Rs. 25,391.00. The complainant is nominee in respect of both the above policies. It is submitted that the Mahender Singh died on 24.1.2017 and after his death the complainant submitted the claim forms complete in all respects and duly signed by the complainant in the office of OPs and complainant also completed all the formalities as directed by the OPs for settlement of the claim of the complainant and for release of benefits under the above mentioned policies to the complainant. The complainant has been released the benefits of insurance policy no. 0325551228 valid from 5.11.2015 to 4.11.2035 but in respect of another insurance policy i.e. insurance policy no. 0327920961 valid from 26.3.2016 to 25.3.2038 no payment has been released to the complainant and no reason has been assigned for not releasing to the complainant the benefits of the above policy. The complainant has been told by the OPs that the claim of the complainant in respect of the insurance policy has been repudiated. It is further submitted that repudiation of insurance claim of the complainant by the OPs is against law, against facts and against terms and conditions of the policy. His genuine claim has been repudiated on false and flimsy grounds. The above said act on the part of OPs amounts to deficiency in rendering service to the complainant. The complainant further prayed that the OPs may be directed for making a payment of Rs.4,75,000/- i.e. the insurance claim and an amount of Rs.20,000/- as compensation. Hence, the present complaint.
2. On being served, the OPs appeared through their counsel and resisted the complaint by filing a joint written statement wherein various preliminary objections with regard to maintainability, cause of action, estoppel and concealment of true and correct facts etc., have been raised.
3. In reply on merits, it is submitted that the claim of the complainant was duly considered and it was found that policy was fraudulently obtained without disclosing the coverage with other insurers i.e. TATA, HDFC, PNB Met Life, Reliance and declined status of the coverage with other insurers, with an intention to deceive the insurer and induce the insurer to issue the policy, resulting into fraud as this amounts to (i) Active concealment of a fact by the insured having knowledge or belief of the fact (ii) an act fitted to deceive. It is further submitted that the repudiation letter is legal, valid and has been issued as per term and condition of the policy and the complainant has not suffered any mental agony, harassment and humiliation. It is further submitted that the complainant has not come to this Forum with clean hands. Therefore, there is no lapse on the part of Ops in rendering service to the complainant and the present complaint is without any merits and as such liable to be dismissed.
4. Learned counsel for the complainant tendered in evidence affidavit of the complainant as Exhibit CW1/A alongwith the documents as Exhibit C-1 to C-3. On the other hand, learned counsel for the Ops tendered in evidence affidavit of Yogesh Kumar, Legal Manager as Annexure RW1/A in support of the case of Ops alongwith documents as Annexure R-1 to Annexure R-3.
5. The learned counsel for the complainant in his arguments reiterated the averments made in the complaint and further contended that the genuine claim of the complainant has been repudiated by the OPs on false and flimsy grounds. The learned counsel further prayed that the present complaint may kindly be accepted and the OPs may be directed for making a payment of insurance claim along-with compensation.
6. On the other hand, the learned counsel for the OPs vehemently rebutted the arguments advanced by learned counsel for the complainant and further contended that the claim of the complainant was duly considered by the OPs and it was found that the policy in question was obtained by the life assured fraudulently without disclosing the coverage with other insurer i.e. Tata, HDFC, PNB Met Life, and Reliance. In the proposal form the life assured did not disclose the status of other insurance policies obtained by him and this amounts to active concealment of a material fact knowingly to deceive the Ops. It is further contended that had this fact been disclosed by the complainant in the proposal form the company would not have issued the insurance policy in question. The learned counsel further contended that repudiation of the insurance claim of the complainant by the Ops is perfectly in accordance with the terms and conditions of insurance policy and the same is sustainable in the eyes of law. The learned counsel further prayed that the present complaint may be dismissed being without any merits.
7. We have duly considered the arguments advanced by learned counsel for the parties and have also perused the entire material placed on record. In the present case the insurance claim of the complainant has been repudiated by the Ops vide repudiation letter (Annexure R-1) on the ground that the policy was fraudulently obtained by the life assured without disclosing the coverage with other insurer i.e. Tata, HDFC, PNB Met Life, and Reliance. The onus was upon Ops to prove that the life assured had obtained insurance policies from the other insurers. However, the Ops did not produce any document or any evidence to prove that the life assured had purchased insurance policies from other insurers prior to filing of the proposal form. Therefore, the ground of repudiation of the insurance claim of the complainant is without any substance and the same is not tenable. Moreover, the investigator/ surveyor in his investigation report has observed that the life assured was a healthy person and he was not suffering from major disease prior to his death. It has also been observed that the life assured had died a sudden death. In view of the above an inference can be drawn that the life assured had obtained the policy in question without any malafide intention.
8. In view of aforesaid discussion, the repudiation of insurance claim of the complainant vide Annexure R-1 is set aside and the present complaint is hereby accepted. The Ops are directed for making a payment of Rs.4,75,000/- (Rs.Four Lac seventy five thousand only) to the complainant alongwith interest @ 8% per annum from the date of filing of present complaint till its realization. The Ops are further directed for making a payment of Rs.7,000/- (Rs.Seven thousand only) to the complainant as compensation and litigation charges. This order should be complied with within 45 days from the receipt of the copy of the present order failing which the above said amount will carry an interest @ 12% per annum for the default period. Copy of this order be supplied to the parties free of costs. File be consigned to record room after due compliance.
Announced in open Forum. Dated:30.05.2018
(Raghbir Singh)
President M.K Khurana
Distt. Consumer Disputes Member
Redressal Forum, Fatehabad.
