ORAL
State Consumer Disputes Redressal Commission
U.P. Lucknow.
Appeal No.1508 of 2010
Bajaj Allianz Life Insurance Company Limited,
G.E. Plaza Airport Road, Yerwada, Pune through
Bajaj Allianz Life Insurance Company Ltd., 4,
Shahnajaf Road, Hazratganj, Lucknow(U.P.)
Through its Officer in-charge. …Appellant.
Versus
Rekha Pandey w/o Late Shiv Shyam Pandey,
R/o J.F-164, Bhagitathi Kunj, Ganga Nagar,
Mawana Road, Meerut. .…Respondent.
Present:-
1- Hon’ble Sri Sushil Kumar, Presiding Member.
2- Hon’ble Smt. Sudha Upadyay, Member.
Sri Dinesh Kumar, Advocate for appellant.
Sri Ashok Sinha, Advocate for the respondent.
Date 1.5.2024
JUDGMENT
Per Sri Sushil Kumar, Member- This appeal has been directed against the judgment and order dated 30.3.2010 passed by the Ld. District Consumer Forum, Meerut in complaint case no.587 of 2008, Rekha Pandey vs. Bajaj Allianz Life Insurance Company Limited, whereby the ld. District Consumer Forum allowed the complaint and directed the appellant to pay insured amount of Rs.3,25,000.00 alongwith interest @12% p.a. It further directed to pay Rs.10,000.00 as compensation and Rs.5,000.00 as cost of lis.
As per the complainant’s case, her husband took an insurance policy no.0062852461 on 24.9.2007 for Rs.3,25,000.00. At the time of taking insurance policy her husband was in a good health and a medical examination was conducted by the insurance company before issuing the insurance policy. On 19.10.2007, the complainant’s husband died due to kidney failure. The insurance company was informed and the insurance claim was submitted but denied by the insurance company on the ground of exclusion ground in the insurance policy.
Upon consideration the evidence submitted by the parties the ld. District Consumer Forum concluded that the insurance company is liable to pay the insured amount to the complainant. Hence, directed accordingly.
The ld. counsel appearing for the appellant submitted that according to the condition of clause no.8(a), the company is not liable if any treatment of illness diagnosed or hospitalization taking place during the first 30 days of the policy commencement date. In the case in hand, policy was issued on 24.9.2007 and the policy holder died on 19.10.2007 due to kidney failure as per the allegation of the complaint itself. Therefore, as per condition find place in para no.8(a) of the insurance policy, insurance company is not liable to pay insured amount to the nominee of the insured person.
In para 1 of the complaint, it is clearly mentioned that the insurance company was informed regarding disease of kidney of the insured person. Whether this information was given or not to the insurance company, is not proved. Therefore, condition no.8(a) of the insurance policy is fully applicable in this case. The insured person having sufficient knowledge of kidney disease and he died within 30 days of taking insurance policy, therefore, as per condition mentioned in clause 8(a) of the insurance policy, insurance company is not liable to pay the insurance claim to the complainant.
The ld. District Consumer Forum allowed the complaint against the provision and conditions of the insurance policy. Hence, the judgment and order deserved to be set aside and the appeal is liable to be allowed.
ORDER
Appeal is allowed. The judgment and order dated 30.3.2010 passed by the Ld. District Consumer Forum, Meerut in complaint case no.587 of 2008 is set aside.
If any amount is deposited by the appellant at the time of filing of this appeal under section 15 of the Consumer Protection Act, 1986, may be remitted to the appellant 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
