Consumer Complaint No. : 245 of 2013
Date of Filing : 21.10.2013
Date of Final Order : 13.3.2015
Present:
i) Sri Asoke Kumar Mandal Hon’ble President
ii) Smt. Silpi Majumder Hon’ble Member
Prabhati Bauri,
D/o. Narayan Bauri,
resident of Vill. & PO. Gopalpur, (near Bakul Tala),
Police Station: Kanksa,
District: Burdwan. Complainant
VERSUS
- The Branch Manager,
Bajaj Allianz Life Insurance Company Limited,
Burdwan Branch, 2nd Floor, Gopal Bhaban, Parbirhata,
PO. Sripally,
PS. & District: Burdwan.
- Bajaj Allianz Life Insurance Company Limited,,
5th Floor, G.E. Plaza,
Air Port Road, Yerawada,
Pune – 411 006.
- Biplab Hazra,
S/o. Late Kartick Chandra Hazra,
Vill. Ayama, PO. Shilampur,
PS. Kanksa, District: Burdwan
as I.C. Bajaj Allianz Life Insurance Company Limited Opposite Parties
On behalf of the Complainant: Jayanta Konar, Ld. Adv.
On behalf of the Opposite Party No. 1&2: Deb Krishna Sinha, Ld. Adv.
On behalf of the Opposite Party No. 3: Subhajit Mondal, Ld. Adv.
J U D G E M E N T
This complaint is filed by the complainant u/S. 12 of the C .P. Act, 1986 alleging deficiency in service and unfair trade practice against the Ops as the Ops did not pay her legitimate insurance claim after the death of insured to her being a nominee.
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The brief fact of the case of the complainant is that during her lifetime Mrs. Nayantara Bauri obtained an insurance policy from the Ops through the OP-3 being an agent of the OP-1&2. The sum assured of the said policy is of Rs. 3, 00,000=00 and the date of maturity is 21.01.2022. The present complainant was declared as nominee by the deceased policy holder in respect of the said policy. At the time of filing proposal form the deceased policy holder being the grandmother of the complainant after perusal of the papers put her signature, deposited bank statement, PAN card etc. to the OP-3. The insured used to pay premium in respect of the said policy regularly. Be it mentioned that at the time of filing proposal form the insured also submitted her voter ID card. But the insured died on 16.05.2012. After the death of the insured, being nominee, the complainant lodged the claim application for getting death claim benefit in respect of the policy, but the OP-1 did not pay any heed to her request and denied for making payment of the claim amount. The complainant issued an advocate’s notice against the Ops but till filing of this complaint no amount has been paid by the Ops to her. The complainant knocked at the office of the Ops, but to no effect. According to the complainant such action on behalf of the Ops clearly reveals deficiency in service of the Ops. As the Ops did not pay her the claim amount in respect of the policy in question, finding no other alternative she has approached before this ld. Forum by filing this complaint praying for direction upon the Ops for making payment of Rs. 3, 00,000=00 towards the sum assured, Rs. 80,000=00 towards unfair trade practice, Rs. 90,000=00 due to deficiency in service and Rs. 20,000=00 as litigation cost.
The POC has been contested by the OP-1&2 by filing written version wherein it is contended that the material allegation as made out in the POC are not at all true, valid and binding upon the Ops. The OP-1&2 have stated that the deceased life assured during taking out the policy had submitted fake school leaving certificate disclosing her age and also she did not disclose that she was a patient of hypertension and remained under the treatment of Dr. Shyamsundar Manna. The medical certificate reveals that the cause of death of the life assured was cardio respiratory failure due to uncontrolled hypertension. From the records and the statements of the complainant, as well as the doctors it can safely be held and presumed that the deceased life assured submitted fake school leaving certificate and she was a chronic heart patient. The deceased life assured was under an obligation to mention the correct age and
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details of previous aliment from which she was suffering from in the proposal form at the time of submission of the same to obtain the insurance policy from the Insurance Company. As she did not disclose her state of health, no occasion arose for making any medical tests of the life assured. The Ops have further submitted that due to such non- disclosure of the material fact in the proposal form by the life assured, the Ops are very much entitled to repudiate the insurance claim on the ground that false statement and information was given by the assured. As the contract of insurance based on utmost good faith and the life assured had intentionally breached the condition, hence the nominee is not entitled to get any amount and repudiation has made by these Ops properly and correctly on the ground of non-disclosure of material facts and submission of fake school leaving certificate. The contact of insurance will be concluded when the policy holder provides all the material details in the proposal form, such as, correct age, income details, state of health, as well as, nomination details. As the life assured had suppressed some material facts in the proposal form and specially as the assured declared her age falsely and in support of such declaration false document was provided, hence, the claim has been repudiated by the Ops. As the Ops have repudiated the claim properly, legally and as per the terms and conditions of insurance policy, such repudiation cannot be termed as deficiency in service, as well as, unfair trade practice of the Ops. The Ops have stated that while the life assured have the knowledge of her actual age and existence of the pre-existing disease, she was obliged to disclose the same particularly in her reply in the proposal form. As the life assured had taken an illegal path for obtaining insurance policy by adducing false and fake document, hence the instant complaint is liable to be dismissed with cost.
Both parties have filed several papers and documents in support of their contentions. The OP-1&2 have relied on some judgments. But the said Ops have submitted only some portions of the said judgments and the same has been mentioned in the written version. Full extract of the judgment has not been provided by the Ops.
Be it mentioned that inspite of receipt of valid notice the OP-3 chose not to turn up before this ld. Forum to contest the POC. So this complaint has been taken for argument ex parte against the OP-3.
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We have carefully perused the record, several documents filed by the parties, as well as, some portion of Rulings filed by the OP-1&2. It is seen by us that there are some admitted facts in the case in hand, i.e. the grandmother of the present complainant obtained one life insurance policy during her life time from the OP-1&2 through the OP-3 being an agent of the OP-1&2, the said policy was obtained from the OP-1&2 on 09.01.2012, the life assured died on 16.5.2012, in the said policy assured sum is of Rs. 3,00,000=00, the date of maturity is 21.01.2022, premium payable for 10 years, due date of last premium 21.12.2021, the present complainant was declared as nominee in the said policy, during taking out the policy the life assured submitted Bank statement, PAN card, voter ID card and school leaving certificate to corroborate her age, address, education etc., after the death of the life assured the complainant being the nominee lodged the claim form with the OP-1&2 for getting the death claim benefit in respect of the said policy. The allegation of the complainant is that though her claim is justified and legal, the Ops have repudiated her insurance claim illegally and whimsically. For this reason the complainant has approached before this Ld. Forum for redressal of her grievance.
The contention of the OP-1&2 is that as the life assured had concealed the material fact in the proposal form at the time of filing the same to the extent that she was suffering from hypertension disease, on that score the claim has been repudiated. Moreover, as the life assured had also filed fake school leaving certificate to corroborate her age and educational qualification, on that ground also the claim has been repudiated and according to the Ops such repudiation was made properly and legally, which cannot be termed as deficiency in service as well as unfair trade practice. It is seen by us from the record that upon receipt of the claim application one investigation was done on behalf of the OP-1&2. From the investigation report it is revealed that at the time of death of life assured she was 66 years old. It is further mentioned in the said investigation report against question no. 4 that the Panchayet Secretary has written in the election ID card of the life assured that the age of the life assured was 49 years in 1995. In respect of question no. 12 it is written in the said report that the life assured was approximately 65 to 66 years old lady. The Ops have stated that the life assured had submitted a fake school certificate mentioning her education and age for taking out the policy whereby she had concealed her actual age.
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Therefore, the crux of the instant complaint is that whether the life assured had submitted a fake school leaving document to corroborate her educational qualification and actual age or not. According to the OP-1&2 as the contract of insurance based on utmost good faith, if there is any breach of contract on behalf of the life assured, hence the Insurance Company is under obligation to close the claim of any claimant as per the terms & condition of the insurance policy. During argument the ld. Counsel for the complainant has drawn our notice to the document given by the Headmaster of Sunur High School, Vill. & P.O. Sunur, Burdwan, dated 16.4.2001 wherein it is written that ‘this is to certify that Nayantara Bauri, D/o. Lalu Bauri of Gopalpur, Bakultala, Burdwan was a student of our Institution. She was student of class five in our Institution on 07.3.1967. Her date of birth as per our record is 01.01.1956’. The complainant has filed a Xerox copy of the voter ID card of the life assured from where it is evident that the life assured was 39 years old on 01.01.1995. We have carefully tallied the school leaving certificate given by the Headmaster of the concerned school on 16.4.2001 with the electoral card issued by Election Commission of India in the name of the life assured and it is found that 01.01.1956 the date of birth of the life assured was 39. But the ld. Counsel for the Op-1&2 has raised vehement objection stating that the certificate dated 16.4.2001 is a fake one. In this connection the ld. Counsel has attracted our notice to the document wherein it is written by the Headmaster of Sunur High School, Burdwan which was issued in the year 2012. But it is curiously enough that from that writing it is very difficult to ascertain on which month the certificate was issued as under the column of month there is written as “00”, which according to any calendar does not mean anything. Whatever it may be, concerned Headmaster has written that ‘this is to certify that the Reg. no. 226/4/2105 not found Nayantara Bauri name as per our record. Certificate issued register 2001 not found Reg. no. 226/04/2105 issued to Nayantara Bauri. This certificate is false’. In respect of such averment made by the Headmaster of the concerned school, we are of the view that the said certificate has not been given in the proper letterhead and moreover there is no stamp of the concerned school or Headmaster. It is more curious to us that within the said averment there is one signature of Nayantara Bauri is showing, which cannot be possible because prior to that date Nayantara Bauri had already expired. Therefore, in our view the later certificate is not proper and legal, which does not bear
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any weightage for proper assessment of any insurance claim whether the nominee of the life assured is entitled to get the benefit or not. During hearing the ld. Counsel for the Ops has also attracted our notice to the certificate given by the Secretary of Gopalpur Gram Panchayet on 16.06.2012 wherein it is mentioned by him that the age as mentioned in the electoral card of the life assured i.e. the life assured was 39 years old on 01.01.1995 is wrong as per the record of the concerned Gram Panchayet. It is seen by us that one Mr. Asim Chakraborty said to be the Secretary of GP has given the said certificate, but no separate certificate has been issued by him in the proper letter head. He has declared the age of the life assured as mentioned in the electoral card as wrong simply in a plain paper, in our view the said evidence cannot be accepted as true in the eye of law. So we have noticed that OP-1&2 have tried their best not to make payment of death claim benefit to the nominee as per the terms and the conditions but such action of the OP-1&2 cannot be termed as proper and legal because as the nominee is a major one she is entitled to get the benefit as per the terms and the conditions of the insurance policy. Moreover where the insurance company after accepting all the documents at the time of taking out the policy by the life assured as true, at the time of settlement of the claim the Ops cannot raise objection or unnecessary harassment to the nominee stating the documents filed by the life assured in support of her statement are false or fake one. Therefore, as the repudiation was made illegally and not properly being dissatisfied with such illegal repudiation, the complainant being the nominee in respect of the insurance policy has approached before this Ld. Forum praying for redressal of her grievance. As the OP-1&2 harassed the complainant for a quite considerable period, such action of the Ops can easily be termed as deficiency in service and for this reason the complainant is entitled to get some compensation from the OP-1&2 and as the complainant has approached before the court of law for redressal of her grievance and incurred some legal expenses, she is also entitled to get some litigation cost from the OP-1&2.
The OP-1 and2 have relied on some judgments, though the full extract of the same have not been supplied. The Ops have mentioned to the judgment passed by the Hon’ble Supreme Court in the case of Ravneet Singh Bagga vs. KLM Royal Dutch Airlines (2000) I SCC 66, Satwant Kaur Sandu vs. New India Assurance Company Limited IV (2009) CPJ 8 (SC), United India Insurance Company limited vs. MKJ Corporation, III
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(1996) CPJ 8 (SC). We have carefully perused the portions of the judgments as mentioned by the said Ops in the written version and in our opinion the same are not applicable in the case in hand because the subject matter of those cases are totally different from the instant complaint. So we are not inclined to discuss elaborately.
Going by the foregoing discussion hence, it is
O r d e r e d
that the OP-1&2 shall pay either severally or jointly the sum assured to the tune of Rs. 3, 00,000=00 to the complainant along with interest @6% per annum from the date of filing of this complaint till realization of the entire amount within 45 days from the date of passing of this order, in default, the sum assured of Rs.3, 00,000=00 shall carry interest @9% per annum instead of 6%. The OP-1&2 are further directed to pay either jointly or severally Rs. 3,000=00 as compensation for harassment, mental pain and agony and litigation cost Rs. 1,000=00 to the complainant within 45 days from the date of passing of this order, in default, the complainant will be at liberty to put the entire order into execution as per provisions of law. With the above-mentioned observation the complaint is thus disposed accordingly.
