Bihar

Muzaffarpur

CC/151/2014

Sunil Kumar, - Complainant(s)

Versus

The Branch Manager, Bajaj Allianz Life Insurance Company Ltd. & Others - Opp.Party(s)

Sri Anil Kumar Singh

22 Feb 2016

ORDER

                                                                  District Consumer Forum, Muzaffarpur

Complain Case No. – 151/2014

1. Sunil Kumar, S/O- Mr. Janardan Pd. Roy R/o- Village-Dharmagat Tolapur, P.S.- Dariyapur, Dist.- Saran, at Present Moh.-Anandpuri, P.s-Brahmpura, Dist.-Muzaffarpur (Bihar) ………………………………………..…...…...….. complainants 

                               V/s

1. The Branch Manager, Bajaj Allianz Life Insurance Company Ltd, near Juba Sahni Park, P.s-Mihtanpura, Dist. Muzaffarpur.

 

2. The Chief Managing Director, Bajaj Allianz Life Insurance Company Ltd., G.E. Plaza Airport Road, Yerawada, Pune-411006, Maharashtra

 

3. The Branch Manager, Bajaj Allianz Life Insurance Company Ltd. 1^st Floor, Ram Raja Complex, Katchary Road, Hajipur, Vaishali - 844101. ………………………………………………...….……………..….Opposite Party.

Date of order- 22-02-2016

                                                                                                 

1. Shri Govind Prasad Singh

                                                                                                                        President,

       Consumer Forum Muzaffarpur

2.  Smt. Archana Singh

               Member,

       Consumer Forum Muzaffarpur

For complainants- Sri Anil Kumar Singh, Advocates

For opposite party- Sri Priya Ranjan, & Sumit Kumar Suman Advocates.

 

                            Order

           

                    The complainant has filed his case on 13-10-2014 for claim of Rs. 50,0000/-  sum assured amount, Rs. 50000/- for mental and physical harassment, Rs. 21000/- for litigation cost along with interest @ 18% on total sought amount since the date of death of life insured till the final payment.

The case of complainant reveals from his complaint petition supported with an affidavit that his mother Kusum Devi had taken life insurance policy from the O.P bearing policy no. 0294590212 issued on      23-02-2013. In which policy the complainant is nominee. Due to severe pain in abdomen & fever the mother of the complainant went under the treatment of Dr. Z. Ahmed and unfortunately she died on 23-09-2013. The gram panchayat Raj Mujauna issued death certificate on 29-09-2013 after that the complainant filed death claim under the said policy No. 0294590212 before the O.P insurance company but the O.P had repudiated the said claim by letter dt. 21-07-2014 on the ground of false investigation that the L.A. was under treatment during 03-12-2012 to 04-02-2013 for liver related problems.

The complainant has filed the Xerox copy of repudiation letter, Xerox of first premium receipt, Original death certificate, Xerox of certificate issued by Dr. Z. Ahmad, Xerox of prescription, Xerox of certificate issued by sarpanch, Member of panchayat sammetee and vice Mukhiya pertained that DLA was died on 23-09-2013 due to pain in abdomen, Xerox of pass book bearing A/c no. 940215

O.P. no 1,2 & 3 appeared and filed their w.s. supported with an affidavit on 28-05-2015 alleging there in para no. 5 the ground of repudiation in that policy is that the policy holder had suffering from liver cirrhosis since 2012 and the said fact was not disclosed while making proposal for obtaining insurance policy on 09-02-2013 and hence prayed to reject the present complaint case with cost. The O.Ps has filed w.s along with Xerox copy of claim repudiation letter dt. 29-05-2014, proposal form, report of Laxmi Janchghar, Prescription report by Dr. Y. K. Thakur, and investigator report.

The complainant filed a petition on 12-08-2015 in which the present case challenging all the photo copy filed by O.Ps are false & fake. The complainant has raised an objection on the authencity of document filed by O.Ps on 08-07-2015 and asked the O.Ps to prove the authencity of document filed by them.

The complainant has filed written argument on 06-11-2015 in which he argued that the prescription report given by doctor to the patient. which has never kept in the possession of doctor. Thus the prescription report filed by O.P. appears that it is false & fake. The complainant explained that D.L.A used to reside at chapra if she could fall ill she would contact the doctors at chapra not at Hazipur and if she would come Hazipur why she would not go to contact doctors at Patna where the super medical facilities are available. The complainant referred section 102 and 115 of evidence act. As per sec 102 of evidence the onus lies upon the O.P Company to prove the ground on which it has repudiated the death claim and as section 115 of evidence the O.Ps are estoppeled by rules to decline the death claim on the concocted story.

The O.Ps argues in the light of their w.s as it is very early claim and the deceased life assured was suffering from liver problems by suppressing the fact. If the O.Ps would know that DLA had liver problems then they would not issued policy in name of deceased. It is the relation of utmost good faith between the insurer and the insured. But the insured did not do so and suppressed the material facts.

Considering the facts, circumstances material available with record as well as allegation of respective parties the insurance policy has been admitted by the O.Ps The O.Ps has only raised the objection that the DLA was suffering from liver problems and in favour of that, the O.P.’s have filed the Xerox copy of prescription report of Dr. Y.K Thakur. The Xerox copy has no evidencery value. Neither Dr. Y.K. Thakur was produced as witness nor the affidavit has been filed by Dr. Y.K. Thakur. It is questionable for the O.Ps to substantiate the fact. It is the duty of O.Ps to substantiate their objection which they have not done.      

Accordingly we are of the opinion that the complainant has been found able to prove his case and the case is maintainable. As such the O.Ps are directed to pay Rs. 5,00000/- assured sum @ 8% from the date of death of the deceased along with mental-physical harassment & litigation cost Rs. 45000/- by Cheque or D.D. in the name of complainant bearing account no. 940215. within 30 days of the order. Otherwise the complainant is entitled to get recovered from the O.Ps by process of law.     

 

Member                                                                                  President