Rajasthan

StateCommission

A/488/2016

Bajaj Allianz Ge. Ins. Co. Ltd. through its Authorised Signatory - Complainant(s)

Versus

Sanjeev Kumar Mago s/o Rajendra Pal - Opp.Party(s)

Vizzy Agarwal

09 May 2017

ORDER

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

 

FIRST APPEAL NO: 488 /2016

 

Bajaj Allianz General Insurance Co. Ltd. Head office & regd.office GE Plaza, Airport Road, Yerwada, Pune (Mah.) & ors.

Vs.

Sanjeev Kumar Mago s/o Rajendra Pal r/o 114 Model Town, Ambala Haryana.

 

Date of Order 9.5.2017

 

Before:

Hon'ble Mrs. Justice Nisha Gupta- President

 

Mr. Vizzy Agarwal counsel for the appellants

Mr. Ajayraj Tantia counsel for the respondent

 

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

 

This appeal has been filed against the order passed by the District Forum, Jaipur 3^rd dated 16.3.2016 whereby the

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claim has been allowed against the appellant.

 

The contention of the appellant is that policy was purchased on 14.11.2009 but no claim was filed before them. Dengue was diagnosed on 19.11.2009 but the insured was suffering from fever since 15.11.2009 and as symptoms used to appear within 3-14 days the mosquito bite was caused prior to filling of the proposal form hence, the claim is not payable and further more illness or sickness is not covered under the policy and the claim should have been rejected.

 

Per contra the contention of the respondent is that claim was filed with the appellant through letter dated 28.11.2009 and prior to it information was given to the employee of the appellant Sh. Vijay Kumar Jain but claim has not been decided by the appellant. Prior to filling of the proposal form the insured was not suffering from any disease and mosquito bite is an accident hence, covered under the policy and claim has rightly been allowed.

 

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

 

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The first contention of the appellant is that the claim was never filed to them but respondent has submitted letter dated 28.11.2009 and UPC receipt has also been submitted which is more than clear to show that the claim was submitted to the appellants. The contention of the appellant is that Anx. 19 notice was sent to the appellant on 27.1.2010 and there is no mention of the claim information dated 28.11.2009 in Anx. 19 hence, the letter dated 28.11.2009 is prepared after words. But these all arguments are in vein as the respondent in his reply has admitted the fact that on 28.11.2009 through advocate claim was made and the objection regarding non filing of the claim is not sustainable.

 

The other contention of the appellant is that as per discharge summary of Santokba Durlabhji Memorial Hospital the insured was suffering from Dengue fever of high grade since 15.11.2009 and as per study of World Health Organization the symptoms of Dengue appeared in 3-14 days after the bite of mosquito infected with dengue virus. Hence, it should have been presumed that the insured was suffering from fever prior to filling of the proposal form and when accident has occurred prior to filling of the proposal form, the insurance company cannot be held liable.

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The contention of the appellant is interesting one but cannot be fruitful as studies are of general nature and no definite evidence has been submitted which could show that at the time of filling of the proposal form the insured was suffering from fever. Hence, it cannot be said that accident has occurred prior to filling of the proposal form and contention is not acceptable.

 

The other contention of the appellant is that as per definitions incorporated under terms and conditions bodily injury exclude illness or sickness and admittedly the insured was suffering from illness hence, the claim is not admissible but counsel for the respondent has rightly submitted that in accidental cases there is no exclusion clause for illness. If loss is incurred as a result of accident then injury whether it is disease, illness or sickness is admissible and there is no dispute about the fact that mosquito bite is an accident and it caused injury by external and visible means. Hence, in view of the fact that the insured has suffered injury in the nature of dengue fever which caused by mosquito bite, the insurance company is liable and he cannot rest his case on the exclusion clause.

 

 

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Hence, in view of above discussion there is no merit in this appeal not worth acceptance and liable to be dismissed.

 

(Nisha Gupta )

President

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