ORDER

Per : Md. Shamim Akhtar, Judicial Member

Dated- 18.04.2024

1. The Appellants/Opposite-parties have filed the Appeal against the order dated  08.05.2018 passed by  the Learned District  Consumer Commission,  Nawada, in consumer complaint case no- 34 of 2010  whereby and where under the Appellant/O.P. no-1 has been directed to pay the Respondent no-1/complainant the sum  assured Rs. 5,00,000/- and also to pay Rs. 25,000/- as physical, mental and monetary compensation with interest @ 7% p.a. from 27.07.2009 within one month  from  the date of the order failing which the aforesaid sum will be payable with interest @ 9 % p.a.
2. The case of the Respondent/complainant in brief as stated in the petition of complaint is that the complainant’s father taken  an personal accident policy of Rs. 5,00,000/- of Bajaj  Allianz Company  Limited on 29.10.2005 bearing policy no- 09-05-240/- 8960-0000041 and the complainant  was nominee of the said policy. On 23.01.2009 at about  6 p.m the complainant’s father fell in his house and he  was brought to  Nawadah Sadar Hospital and for  better treatment on 29.01.2009 he was referred to PMCH where he died in course of  treatment on 10.02.2009 and on 11.02.2009 an UD Case no- 09/2009 was  instituted in  Pirbahore P.S. and Post mortem was also done  and the  complainant informed about  the  mishappening to GTFS Branch (O.P. no-3) on 24.02.2009  and on 21.07.2009 deposited all papers with  the O.P. no-3 but the claim  was rejected on 29.07.2009 by saying that no paper has been submitted. Prayer was made to allow the payment of the insured amount with interest @ 9 % with compensation.
3. The O.P. no-1 (Appellant) appeared before the Learned  District Forum, Nawadah and filed its written statement  in which it has denied and disputed the claim of the complainant. It  is stated in the  written statement that the O.P. no-1 issued notice vide letter dated 13.03.2009,07.05.2009,08.06.2009 and 07.07.2009 asking the claimant to send the documents with respect to the verification of the claim but the claimant failed to  submit required papers. Further case is that the O.P. no-1 also appointed investigator and his report dated 17.06.2009 reveals that the  age of the claimant’s  father Late Lato Mistry was beyond the  age limit at the time  of filling of policy paper dated 29.10.2005 where the  Late Lato Mistry concealed  his  real  age at  the    time of filing the proposal form  of Insurance paper of the company. According to general guidelines the person who are having age limit between 5 to 58 years are eligible for Insurance by the company. Further case is that from the perusal of F.I.R., P.M. report and certificate of death issued by PMCH clearly prove that Late Lato Mistry was 65 years of age  at the time of death. Further  case  is that at  the  time of filling of Personal Accident Insurance Form, the claimant’s father written his age 49 years and according to  this  his age at the time of death should be 53 years as the   accident claim covers for a  period of five years only i.e. from 29.10.2005 to 28.10.2010 and  taking into consideration of the  F.I.R.,P.M. report, death  certificate  issued by PMCH clearly states that   Late Lato Mistry was 65 years of age  and the O.P. no-1 is not liable to  pay any compensation to the claimant and on this  score the claim petition  is fit to be  dismissed.
4.  In  the impugned order it is written  that O.P. no-3 also filed its  written statement in which   it is  mainly stated that it acts  as an agent of the Bajaj Allianz Company  on the basis of   an agreement and instead  it   receives  commission and the O.P.  No- 3 is not an insurer.
5. After hearing the Learned District Forum, Nadawah passed order dated 06.07.2011 by which the Appellant were directed to pay the Respondent a sum of Rs. 5, 00,000/- with 7 % interest since 27.07.2009 and Rs. 10,000/- for harassment and Rs. 5,000/- for litigation cost.
6.  After hearing this Commission vide its order dated 09.07.2015 passed in appeal no.- 688 of 2011 set aside the order dated 06.07.2011  passed by  the Learned District Consumer Forum, Nawadah and remanded the matter back to the  District Consumer Forum, Nawadah for fresh hearing giving opportunity to both the parties to adduce evidence, if any and for  passing a  reasoned order and the appeal was allowed  as above.
7.    After hearing the parties the impugned order dated 08.05.2018 passed.
8.   Being aggrieved and dissatisfied  with  the impugned order the present appeal has been filed by the Appellant/opposite-parties mainly on the grounds that the  Learned District Consumer Forum has  failed to appreciate that the policy was  for a particular age  group as per  MOU signed by the appellants and GTFS and the insured obtained the policy by concealing  his  real age and the learned District Consumer Forum failed the appreciate that the complainant has failed to prove that the  insured age was within the  age limit  prescribed under the policy. Further ground is that the Learned Forum failed to appreciate the documents such as Fardbayan, Voter list, P.M. report and Death certificate of the insured and gave a wrong finding and also failed to appreciate that complex questions of facts cannot be decided by it. Further ground is  that the Learned Forum erred in  interpreting  the order of the State Commission  whereas the Respondent no-1  did not produce any documentary evidence to prove the age of the  deceased  except oral evidence  and the Learned  District  Forum  passed  the impugned order without any evidence/ basis and ignored materials/documents produced  before it. Prayer is made to set aside the impugned order   and allow the appeal.
9.     We have heard the learned counsel for the appellants and the Respondent no-1.Also gone through the records including the written notes of arguments filed by them.
10.       From the materials on records it is an admitted fact t hat late Lato Mistry (Deceased Life Assured) was got insured with the Appellants on 29.10.2005 with a Personal Accident Policy through the GTFS. (Respondent no-1). The deceased life assured fell down in his house  on 29.01.2009 and was  brought to Nawadah Sadar Hospital from where he was referred to PMCH, Patna where in course of treatment he died on 10.02.2009.
11.      The root cause of dispute  as  per the Appellants is that  on the day of the obtaining  Insurance Policy the  deceased  was not entitled for an Insurance cover and he procured  the Insurance Policy by concealing his real age  whereas as per  the  P.M. Report, Death Certificate of  the PMCH. Fardbayan his age was 65 years as on the date of death.
12.      In the instant case the Insurance Policy was taken on 29.10.2005 which was valid till 28.10.2010 and the life assured Late Lato Mistry died on 10.02.2009 i.e.  after three years and three months from the  date of the policy. Section 45 of the Insurance Act says that no  policy of  life insurance shall be called  in question on  any ground what so ever after expiry of three years  from the date of  policy. Thus we fail to understand as to why the Appellants are making hue and cry in discharging their lawful obligations. Section 45 of the Insurance Act serves as a critical safe guard for policy holders, ensuring they are not unfairly denied their rightful claims. It is aimed to protect policy holders from potential delays, unfair practices or unjust repudiation of claims by insurers.
13.    Thus, in the light of above discussions we find ourselves unable to interfere with the impugned order. We therefore, dismiss the appeal. However, in the circumstances of the case parties to bear their own costs.
14.    A copy of this order be supplied to both the parties free of cost as mandated by the Consumer Protection Act, 2019. The order be uploaded forthwith on the confonet of the State Commission.

Let the file be consigned in the record room along with copy of this order.

(Md. Shamim Akhtar)                                                                           (Gita Verma)

Jud. Member                                                                                         Jud. Member

Anita