Rajasthan

StateCommission

A/219/2018

Bajaj Allianz Life Ins. Co. Ltd. - Complainant(s)

Versus

Reena Jain w/o Lat. Sanjay Jain - Opp.Party(s)

Gopal Sharma

02 Aug 2019

ORDER

BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION,RAJASTHAN,JAIPUR BENCH NO.1

 

FIRST APPEAL NO: 219 /2018

 

Bajaj Allianz Life Insurance Co. Ltd. Nagaur Bhaskar Hospital premises, Nagaur.

Vs.

Smt. Reena Jain w/o late Sanjay Jain r/i village Post Chitava, Tehsil Kuchaman city Distt. Nagaur.

 

 

Date of Order 2.8.2019

 

Before:

Hon'ble Mrs. Justice Nisha Gupta- President

Mrs. Meena Mehta -Member

 

Mr. Gopal Sharma counsel for the appellant

Mr.Pramod Kumar counsel for the respondent

 

BY THE STATE COMMISSION ( PER HON'BLE MRS. JUSTICE NISHA GUPTA,PRESIDENT):

 

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This appeal is filed against the order of the learned District Forum, Nagaur dated 1.2.2018 whereby the claim is allowed against the appellant. The matter has come upon application u/s 5 of the Limitation Act as the appeal is filed with delay of 25 days.

 

The contention of the appellant is that earlier FDR was made in the name of District Consumer Forum only. Thereafter another FDR was prepared in the name of District Consumer Forum, Nagaur hence, delay occasioned which may be condoned.

 

The contention of the respondent is that the application has been filed in casual manner. It was prepared on 27^th March 2018 but appeal has been filed on 2^nd April 2018 and reliance has been placed on 1 (2017) CPJ 65 (NC) Himachal Pradesh Housing and Urban Development Authority Vs. Tara Wati. Looking at the facts mentioned in the application the delay is condoned.

 

The contention of the appellant is that insured was

 

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suffering from chronic myloid leukemia prior to filling of the proposal form hence, the claim should have been dismissed.

 

Per contra the contention of the respondent is that only one appellant has filed the appeal and the Forum below has rightly allowed the claim. Treating doctor has not been called for the evidence inspite of the application.

 

Heard the counsel for the parties and perused the impugned judgment as well as original record of the case.

 

There is no dispute about the fact that the policy was purchased by the insured where the questions as regard to health details were answered in negative but admission and discharge ticket of SMS Medical College & Hospital, Jaipur shows that he was admitted to the hospital on 27.5.2012 and he was suffering from the disease chronic myloid leukemia from last four years. Hence, the treatment documents clearly shows that material facts have been suppressed. The insurance company has also submitted the affidavit of investigator and so

 

 

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also their medical officer.

 

It is true that treating doctor has not been called but when respondent has not disputed the discharge ticket, it can rightly be presumed that previous history has been submitted by the family members of the deceased. It may also be noted that admission and discharge ticket of the hospital contains the signature of brother of the deceased and reliance has rightly been placed on IV (2016) CPJ 264 (NC) LIC of India Vs. Geeta Devi , I (2017) CPJ 161 (NC) Chand Ratan Lahoti Vs. Aviva Life Insurance Co., I (2016) CPJ 57 (NC) LIC of India Vs. Bimla Devi and II (2016) CPJ 132 (NC) Bajaj Allianz General Insurance Vs. Patel Vitthalbhai Shivabhai and further after the judgment of the Hon'ble apex court in Satwant Kaur Sandhu Vs. New India Assurance Co. (IV (2009) CPJ 8 (SC) there was no requirement to call the treating doctor. In view of the above material facts have been suppressed and the appeal is liable to be allowed.

 

The contention of the respondent that only one appellant has preferred the appeal is technical one as this is only branch

 

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office of the appellant.

 

In view of the above , the appeal is allowed and the order of the Forum below dated 1.2.2018 is set aside.

 

(Meena Mehta) (Nisha Gupta)

Member President

 

 

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