Order No.  15  dt.  09/01/2020

             It is the case of the complainant that Late Dr. Somnath Chakravarty took a housing loan of Rs.34 Lakh on 31/01/2016 from the o.p. no.3 i.e. Bajaj Finance Limited. It was decided that the housing loan would be paid in monthly installments comprising of principal and interest @10.26% per annum. Late Dr. Somnath Chakravarty paid Rs.3,14,524/- to o.p. no.3 during the period from 01/04/2016 to 02/11/2016 i.e. he paid principal amount of Rs.1,17,225/-. During the life time of Dr. Somnath Chakravarty he purchased a life insurance policy from the o.p. no.2 being the Bajaj Allianz Life Insurance Co. Ltd., sum assured in this life insurance was Rs.15,18,879/- and total premium paid was Rs.1,77,106.31. This policy was taken to cover up the part of the housing loan taken by Late Dr. Somnath Chakravarty of Rs.34 Lakh from Bajaj Finance Limited (o.p. no.2) on 26/01/2016 but unfortunately Dr. Somnath Chakravarty died on 20/03/2018 at Birla Heart Research Centre leaving behind sons and daughter. After the death of Dr. Somnath Chakravarty the complainant informed to o.p. no.2 regarding the death of  Dr. Somnath Chakravarty and requested the claim amounting to Rs.15,18,898/- but the o.p. no.2 vide his letter dated 31/05/2018 rejected the claim. The complainant thereafter requested to reconsider the rejection of the claim of above policy before the claim review committee of Bajaj Allianz Life Insurance Co. Ltd. The o.p. no.3 sent some unscrupulous persons in the house of the ex-wife named as Kalpana Chakravarty  of Dr. Somnath Chakravarty and demanded the repayment of the loan amount. On the basis of the said fact the complainant filed this case praying for direction upon the o.ps to pay Rs.15,18,878/- towards sum assured in terms of policy no. 027076755 and also prayed for compensation and litigation cost.

                O.p.nos. 1 and 2 contested the case by filing w/v and denied all the material allegations of the complainant. It was stated that policy no. 0327076755 “Group Credit Protection Single” was issued to the complainant after filling up the proposal form dated 28^th January,2016 and thereafter the policy was received by the complainant along with all the policy documents. The policy has commenced on 05/02/2018 and receipt of the said policy document has not been denied by the complainant. The policy was having a single premium paying term year which amounted to Rs.1,77,107/- and insured would enjoy the life risk cover for a period of 7 years. The said premium was paid by the complainant’s father on 04/02/2018 the sum assured on the death of the insured was Rs.15,18,897/-. The complainant after demise of his father made claim to the o.p. no.2 but the o.p. no.2 rejected the claim vide email dated 31/05/2018 wherein it was categorically stated that the said claim was in violation of Section 45 of the Insurance Act,1938. Since the complainant at the time of its obtaining policy suppressed the material fact of his myocardial infraction which occurred in the year 2005 the said disease was the antecedent cause of death of the insured as per the medical report given by the C.K. Birla hospital where the insured was admitted. On the basis of the said fact the o.p. stated that as per the terms and conditions of the policy agreement the claim of the complainant was repudiated. The complainant also filed some documents including the annexures whereby the application for obtaining policy was also filed, wherefrom it is evident that the insured at the time of applying for the policy did not disclose any prior disease which he had suffered at the time of obtaining policy. On the ground of the said fact the claim of the complainant was rejected as per the terms and conditions of the policy and accordingly, the insurance company prayed for dismissal of the case.

On the basis of the pleadings of the respective parties the following points are to be decided :-

1. Whether the complainant’s father had suffered myocardial infraction in the year 2005?
2. Was there any suppression of material fact?
3. Where there was any deficiency in service on the part of the o.ps?
4. Whether complainant is entitled to get any relief as prayed for?

Decision with reasons :-

                All the points are taken up together for the sake of brevity and avoidance of repetition of facts.               

                Ld. Lawyer for the complainant argued that Late Dr. Somnath Chakravarty took a housing loan of Rs.34 Lakh on 31/01/2016 from the o.p. no.3 i.e. Bajaj Finance Limited. It was decided that the housing loan would be paid in monthly installments comprising of principal and interest @10.26% per annum. Late Dr. Somnath Chakravarty paid Rs.3,14,524/- to o.p. no.3 during the period from 01/04/2016 to 02/11/2016 i.e. he paid principal amount of Rs.1,17,225/-. During the life time of Dr. Somnath Chakravarty he purchased a life insurance policy from the o.p. no.2 being the Bajaj Allianz Life Insurance Co. Ltd., sum assured in this life insurance was Rs.15,18,879/- and total premium paid was Rs.1,77,106.31. This policy was taken to cover up the part of the housing loan taken by Late Dr. Somnath Chakravarty of Rs.34 Lakh from Bajaj Finance Limited (o.p. no.2) on 26/01/2016 but unfortunately Dr. Somnath Chakravarty died on 20/03/2018 at Birla Heart Research Centre leaving behind sons and daughter. After the death of Dr. Somnath Chakravarty the complainant informed to o.p. no.2 regarding the death of  Dr. Somnath Chakravarty and requested the claim amounting to Rs.15,18,898/- but the o.p. no.2 vide his letter dated 31/05/2018 rejected the claim. The complainant thereafter requested to reconsider the rejection of the claim of above policy before the claim review committee of Bajaj Allianz Life Insurance Co. Ltd. The o.p. no.3 sent some unscrupulous persons in the house of the ex-wife named as Kalpana Chakravarty  of Dr. Somnath Chakravarty and demanded the repayment of the loan amount. On the basis of the said fact the complainant filed this case praying for direction upon the o.ps to pay Rs.15,18,878/- towards sum assured in terms of policy no. 027076755 and also prayed for compensation and litigation cost.

           The Lawyer of the o.p. nos. 1 and 2 argued that policy no. 0327076755 “Group Credit Protection Single” was issued to the complainant after filling up the proposal form dated 28^th January,2016 and thereafter the policy was received by the complainant along with all the policy documents. The policy has commenced on 05/02/2018 and receipt of the said policy document has not been denied by the complainant. The policy was having a single premium paying term year which amounted to Rs.1,77,107/- and insured would enjoy the life risk cover for a period of 7 years. The said premium was paid by the complainant’s father on 04/02/2018 the sum assured on the death of the insured was Rs.15,18,897/-. The complainant after demise of his father made claim to the o.p. no.2 but the o.p. no.2 rejected the claim vide email dated 31/05/2018 wherein it was categorically stated that the said claim was in violation of Section 45 of the Insurance Act,1938. Since the complainant at the time of its obtaining policy suppressed the material fact of his myocardial infraction which occurred in the year 2005 the said disease was the antecedent cause of death of the insured as per the medical report given by the C.K. Birla hospital where the insured was admitted. On the basis of the said fact the o.p. stated that as per the terms and conditions of the policy agreement the claim of the complainant was repudiated. The complainant also filed some documents including the annexures whereby the application for obtaining policy was also filed, wherefrom it is evident that the insured at the time of applying for the policy did not disclose any prior disease which he had suffered at the time of obtaining policy. On the ground of the said fact the claim of the complainant was rejected as per the terms and conditions of the policy and accordingly, the insurance company prayed for dismissal of the case.

             Considering the submissions of the respective parties it is an admitted fact that the complainant’s father Dr. Somnath Chakravarty obtained house building loan for purchasing a flat from the o.p. no.3 which has not been disputed by the o.ps. It is also admitted fact that at the time of obtaining loan Dr. Somnath Chakravarty purchased a life insurance policy being no. 0327076755 from the o.p. no.2 being Bajaj Allianz Life Insurance Co. Ltd. on 26/01/2016. The sum assured in this policy was Rs.15,18,879/- and the total premium amount was Rs.1,77,106.31. The policy was taken to cover up part of the housing loan taken by  Dr. Somnath Chakravarty of Rs.34 Lakh from Bajaj Finance Limited on 26/01/2016. In the terms of the policy the o.p. no.2 will bear the liability of repayment of the housing loan in the event of death of insured person (Dr. Somnath Chakravarty). Here in this case admittedly Dr. Somnath Chakravarty, the policy holder died on 20/03/2018 at B.M. Birla Heart Research Centre. After his demise the son of Dr. Somnath Chakravarty claimed sum assured from the o.p. no.2 so that the complainant could repay the loan amount in respect of the house building loan obtained from o.p. no.3. The complainant’s son after demise of his father applied to o.p. no.2 for claiming the amount but the claim of the complainant was repudiated on the ground as mentioned as historical record diagnosed case of myocardial infraction, since 2005 was pre-proposal. This fact deliberately and fraudulently suppressed in the proposal form dated 28/01/2016 with an intention to deceive the insurer and induce the insurer to issue the policy resulting into fraud (active concealment of a fact by the insured having knowledge or belief of the fact). The Ld. Lawyer for the complainant in support of his contention pointed out some defects in the medical records wherefrom it is evident that the patient expired on 20/03/2018 at 8.40 Hrs. but in the admission form it was mentioned time of admission was 9.52 Hrs., if that be the so how the patient died in the said hospital before his admission at B.M. Birla Hospital. In order to clarify that the complainant did not make C.K. Birla Hospital as a part to this case for clarification of the matter. It appears from the materials on record that the insurance company had no role to record the timing in the hospital record. Therefore, such anomaly cannot go in favour of the complainant or against the insurance company. It is an admitted fact and from the materials on record that at per Section 45 of the Insurance Act,1938 whereby it was categorically stated that in case of suppression of any previous illness the insurance company will be at liberty to cancel the policy and also the insured or his legal heirs will not be entitled to get any relief in respect of the sum assured as mentioned in the policy. The Ld. Lawyer for the complainant has highlighted the provisio of Section 45(4) of Insurance Act,1938 whereby it has been categorically stated that in case of cancellation of the policy the insured or the legal heirs of the insured will be entitled to get back the refund of the said amount as well as compensation and litigation cost.  Thus all the points are disposed of accordingly. 

                   Hence, it is ordered,

                that the case no.CC/240/2019 is allowed on contest with cost against the o.p. nos. 1 and 2 and dismissed against o.p. no.3 ex parte. O.p. nos. 1 and 2 jointly and/or severally directed to refund the amount of the premium of the policy to tune of Rs.1,77,106.31 (Rupees One Lakh Seventy Seven Thousand One Hundred Six and Thirty One Paisa) only along with compensation of Rs.10,000/- (Rupees Ten Thousand) only for harassment and mental agony and Rs.5,000/- (Rupees Five Thousand) only within 30 days from the date of communication of this order, i.d. an interest @ 8% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.