District Consumer Disputes Redressal Forum
Dakshin Dinajpur, W. Bengal
(Old Sub-Jail Municipal Market Complex, 2nd Floor, Balurghat Dakshin Dinajpur Pin - 733101)
Telefax: (03522)-270013
Present
Shri Sambhunath Chatterjee - President
Shri Siddhartha Ganguli - Member
Consumer Complaint No. 42/2015
Smt. Debi Kundu
W/o Late Kamal Kumar Kundu
Vill.: Balupara, PO &PS: Hili
Dist.: Dakshin Dinajpur, W.B. 733126 …………………Complainant(s)
V-E-R-S-U-S
1. The Branch Manager,
Bajaj Allianz Life Insurance Company Ltd.
Balurghat Branch, Dackbanglowpara
Near Town Club, PO & PS: Balurghat
Dist.: Dakshin Dinajpur, W.B. -733101
2. Gneral Manager,
Bajaj Allianz Life Insurance Company Ltd.
5th Floor, G.E. Plaza, Air Port Road,
Yeawada, Pune – 411006.
3. Tarun Swarnakar, Local Agent of
Bajaj Allianz Life Insurance Company Ltd.
Vill.: Balupara, PO: Fatepur,PS: Hili
Dist.: Dakshin Dinajpur, W.B. 733126 ……………Opposite Parties
Ld. Advocate(s):
For complainant …………… - Shri Bidyut Kr. Roy & Shri Avijit Roy
For OP Nos.1 & 2 …………… - Shri Debasish Karmakar
For OP No.3 …………… - Ex-parte
Date of Filing : 30.11.2015
Date of Disposal : 19.02.2016
Contd…P/2
Judgment & Order dt. 19.02.2016
Fact of the case in brief is that one Kamal Kumar Kundu was the policyholder of Bajaj Allianz Life Insurance Company Ltd. and the certificate was issued in favaour of the husband of the complainant and the complainant being the widow of insured person was cited as nominee. All on a sudden on 11.11.2014 the husband of the complainant died and after death of the husband of the complainant, the complainant submitted a claim application as per requirement of Bajaj Allianz Life Insurance Company Ltd. all the documents were provided but the OPs adopted dilatory tactics and after lapse of several months the complainant was informed that the claim of the complainant cannot be entertained.
After getting such information an appeal was made to the appellate authority whereby repudiation as made earlier was confirmed. Finding no other alternative the complainant filed this case praying for giving necessary direction upon the OPs for releasing the maturity of the policy amounting to Rs.8,02,000/- with accrued interest and also prayed for Rs.5,000/- as compensation for mental pain and agony.
OP Nos. 1 & 2 have contested the case by filing a written objection whereby the OPs denied all the material allegations of the complaint. It was stated that husband of the complainant being policyholder intentionally concealed the facts that he had serious nature of disease and at the time of filling up the policy form did not disclose the illness. Subsequently, with the death of the policyholder the OPs made investigation coupled with the medical reports and documents and hospital treatment record wherefrom it was evident that Mr. Kamal Kumar Kundu had the history of hospitalization / treatment from 01.12.2008 as known case of chronic obstructive pulmonary disease and alcoholic liver disease, deformity of thoracic bony case and spine
Contd…P/3
was pre-proposal. During the lifetime of said policyholder he was treated by Dr. Atanu Acharya and through prescription dated 1.12.2008 and 13.12.2008 life assured was prescribed not to consume alcohol. The deceased, however, gave wrong and false answers, statements and declarations in the proposal form dt. 10.7.2014 knowing fully well that those were false and incorrect. Thus, the deceased intentionally and fraudulently concealed the material facts and that he was suffering from diseases prior to the date of proposal. In view of the said fact that OPs prayed for dismissal of the case.
On the basis of pleadings of the respective parties following points are to be determined :-
- Whether husband of the complainant was the policyholder of Bajaj Allianz Life Insurance Company Ltd.?
- Whether husband of the complainant suppressed the material facts of his illness?
- Whether after death of the policyholder the OPs repudiated the claim of the complainant without any cogent reason?
- Whether there was any deficiency in service on the part of OPs?
- Whether the complainant will be entitled to get relief as prayed for?
DICISION WITH REASONS
All the points are taken together for the sake of brevity and avoidance of repetition of facts.
Ld. Counsel for the complainant argued that husband of the complainant insured with the OPs and the policy was opened on 11.3.2014 and he paid an amount for opening the policy and the policy was issued being the policy No. 0316576741 and the complainant was cited as nominee. After death of policyholder the complainant being the nominee of the deceased policyholder claimed the death benefit of the policyholder and same was repudiated on 11.3.2015. Against the said
Contd…P/4
order an appeal was preferred for reconsidering the decision of the company but the appellate authority affirmed the observation of the company and repudiated the claim of the complainant. Being baffled to have any relief from the OPs the complainant filed this case. In order to prove that death of the policyholder had taken place suddenly, some documents have been filed including some medical reports wherefrom it is evident as argued by the Ld. Lawyer for the complainant that the death of husband of the complainant took place suddenly and there was no suppression of disease by the policyholder at the time of filling in the form for opening of the said policy and the said company after being satisfied with answers given by the applicant the policy was opened and the complainant paid the premium as per the requirement and after death of the policyholder OPs cannot deny the claim of the complainant.
Ld. Lawyer for the OPs argued that death had taken place within 118 days of the opening of the policy and the company whenever found that the claim was made by the complainant an investigation was made and found that the complainant’s husband had serious nature of diseases and he was treated by Dr. Atanu Acharya and he found that the complainant’s husband had history of hospitalization treatment on 1.12.2008 due to chronic obstructive pulmonary disease and alcoholic liver disease, deformity of thoracic bony case and spine was pre-proposal. Since the proposer (life assured) is bound to disclose everything affecting the judgement of the insurer and the contract of insurance is a contract of utmost good faith but herein this case the proposer of life assured failed to discharge the obligation of good faith at the time of opening the policy and therefore, the complainant will not be entitled to get any claim as made by her due to death of the her husband and the company rightly repudiated the claim of the complainant.
Contd…P/5
Considering the submission of the respective parties it is an admitted fact that the complainant was the policyholder and he died on 11.11.2014. It is found from the materials on record that the policyholder Kamal Kumar Kundu died within 118 days acceptance of policy which caused the OPs to make further investigation regarding the death of the said policyholder. The OPs filed some documents including the medical reports wherefrom it is found that Kamal Kumar Kundu underwent treatment for chronic obstructive pulmonary disease and alcoholic liver disease, deformity of thoracic bony case and spine was pre-proposal. The complainant though, filed some medical reports but those medical reports were relating to after hospitalization of said Kamal Kumar Kundu for his medical tests only, but no medical prescription was filed to prove that Kamal Kumar Kundu had no other history or concealment of an disease at the time of getting admission in the Kothari Medical Centre in Kolkata, on the contrary, the OPs filed a document including death certificate, on the basis of which death certificate was issued by Kolkata Municipal Corporation and in the said death certificate issued by the Kothari Medical Center in the column of cause of death of said Kamal Kumar Kundu, it was mentioned that septic shock with acute on chronic renal failure, intracerebrall, haemorrhage and alcoholic liver disease, those diseases were preexisting diseases which culminated into death of deceased. It is also relevant to mention here that the policyholder was fully aware regarding his physical condition and he also presumed that death was inevitable due to those diseases for which in order to provide some financial advantage to his legal heirs suppressed the materials facts of his illness at the time of filling the proposal form without disclosing any preexisting disease. Since, concealment of any material fact leads to a vitiated contract and fraudulent suppression of material facts entitles the insurance company to repudiate the claim and therefore no benefit can be drawn from same by the complainant.
Contd…P/6
Having regard to the facts and circumstances of the case and from the discussion as made herein above we hold that the complainant will not be entitled to get any relief as prayed for.
Hence, it is
O R D E R E D
that the petition of complaint C.C. No. 42/2015 is dismissed on contest without any cost.
Let plain copies of this order be furnished to the parties forthwith free of cost.
Dictated & corrected
………….….…….
(S. N. Chatterjee)
President
I concur,
………....……
(S. Ganguli)
Member
- Date when free copy was issued ……………………
- Date of application for certified copy ……………………
- Date when copy was made ready ……………………
- Date of delivery ……………………
FREE COPY [Reg. 18(6)]
- Mode of dispatch ……………………
- Date of dispatch ……………………
-x-
