DISTRICT CONSUMER DISPUTES REDRESSAL FORUM: BHADRAK
Dated the 15th day of Sept, 2017
CD Case No. 88 of 2014
Sri Jitendranath Rout
S/O Sri Shibaprasad Rout
At/po-Bandhagaon
Ps-Bhadrak R-®
District- Bhadrak ,Odisha. ……………………. Complainant
(Versus)
1. The Branch Manager
BAJAJ ALLIANZ LIFE INSURANCE COMPANY Ltd.
At- Chandabali Bypass, (Above S.P Electronics)
Po- Bhadrak, Dist- Bhadrak, Odisha
2. The Chief Manager
BAJAJ ALLIANZ LIFE INSURANCE COMPANY Ltd.
G.E Plaza, Airport Road, Yarawada
Pune- 411006
…………………………..Opp. Parties
For the Complainant: Sri Gadadhar Bal, Adv & Associates
For the Opp.Parties : Md. Akhtar Khan, Adv & Associates
Date of hearing : 12.09.2016
Date of order : 15.09.2017
SRI RAGHUNATH KAR,PRESIDENT
The dispute arises out of the complaint filed by the complainant against the O.Ps alleging unfair trade practice & deficiency in service.
The back ground facts disclosed in the complainant are effect that insured deceased Late Arati Rout, the wife of the complaint, insured under the “INVEST GAIN” insurance policy from the O.Ps on dt. 24.06.2013 for an amount of Rs 1, 00,000/- & Rs 10,145/- has been deposited towards the monthly premium. But unfortunately after one day i.e on dt. 25.04.2013 the policy holder suffered with sudden illness & during time of treatment she had taken her last breath. The deceased insured raised claim & submitted all the required documents before the O.Ps for settlement of claim. But the O.Ps did not take any step for
settlement of the claim taking some flimsy grounds. Lastly repudiated the claim for grounds that the deceased suppressed her previous treatment & committed the fraud by violating the terms of policy norms. The complaint being the husband & nominee filed this case seeking direction against the O.Ps to pay the claim amount of Rs 1,00,000/- with interest & to pay Rs 10,000/- for the deficiency in service committed by the O.Ps & Rs 10,000/- for mental, physical and financial along & Rs 5,000/- towards cost of the complaint.
The OP No. 1 & 2 jointly filed written version challenging the maintainability of the dispute on the ground of jurisdiction of this Forum to entertain this dispute. According to them the policy in question was maliciously obtained by way of fraud & Mis-representation & the consent of the insurance company was not free as defined in Sec-14 of Indian Contract Act as because the complainant was undergoing for treatment from dt. 14.05.2013 to dt. 16.05.2013 with history of operation in 2012 for parietal SOL (Space Occupying Lesion= Tumor). These facts were deliberately concealed during issuance of insurance policy.
The O.Ps also further alleged that there is no cause of action arose to file the complainant & the complainant has not come with clean hands & has not disclosed the true states of affairs as per principle “Allegatio contra factum non est admittenda”.
Undoubtedly & undisputedly the complainant being the nominee & husband of the deceased insured the Arati Rout is a ‘Consumer’ within the meaning of Sec- 2 (1) (d) (ii) of C.P Act, 1986. The O.Ps have resisted the claim of the complainant in the grounds that the complainant obtained the policy in question with maliciously by way of fraud, Mis-representation & the consent of the insurance company was not free as defined in Sec- 14 of India Contract Act. The O.Ps filed their written version denying the claim on the ground that the policy terms & conditions are provided by the Insurance regulatory and Development Authority (IRDA) which is the regulatory authority for all insurance companies. It needs no relation that in case, suppression or concealment of any material facts, which the insured knows or have knowledge prior to the proposal, if detected the future vitiates the contract and the insurance company has the option to unilaterally repudiate the same as being void contract. In other hand the written version filed by the O.Ps jointly discloses that the complainant was undergoing treatment from dt. 14.05.2013 to dt. 16.05.2013 with history of operation in 2012 for “Partial SOL (Space Occupying Lesion= Tumor)” & the deceased Arati Rout expired on dt. 25.06.2013 & the medical report issued by Dr. Chinamaya Behera (MD) on the same day disclose that she was suffering with “Cerebral Malaria”.
The complainant has filed some documents in the shape of Xerox copies as follows:-
Annexure No.1 Insurance plan issued by the O.Ps
Annexure N. 2 Death certificate of the Arati Rout
Annexure N. 3 Prescription of Dr. Chinmaya Behera
Annexure No.4 Deposit slip
Annexure No. 5 Representation made by the complainant submitted before the OP.
Annexure No. 6 Bajaj Allianz Invest gain economic regular premium
On the other hand the OP has also filed some documents in the shape of Xerox copies such as follows:-
No. 1 Proposal form of life insurance of Bajaj Allianz (4 sheets)
No. 2 Bed head tickets in the shape of form No. 9 (Khha) issued by N.S.W (3 Sheets)
No. 3 Death claim (Claimants statements of Bajaj Allianz 3 sheets)
OBSERVATION
We have already perused the facts of the complaint, the written version as well as the documents filed by both the parties. We have observed that the wife of the complainant Smt. Arati Rout (Insure) on 24.06.2013 made a proposal to get herself insure with the OP economic under “INVESTMENT GAIN ECONOMIC” scheme for a sum assured of Rs 1,00,000/-. The policy holder deposited Rs 10,134/- cash of the first premium amount, mentioning her medical information & declaration of good health including other statement of the insure as mentioned in the proposal form, believing the information to be correct & true in good faith. The insure issued policy bearing No. 0302232720 & the policy commencement date was 25.06.2013.
On 24.02.2014 the present complainant submitted a death claim mentioning there in that the insured died on 25.06.2013 at about 11.40 PM and the cause of death as “Fever” and there by claiming the insured amount as a beneficiary. It is not out of place to mention here that the said policy was commenced on the very day of the alleged death of insure. As soon as the claim was received the O.Ps company investigated the matter and during the investigation it was revealed that the insured was hospitalized at S.C.B Medical Collage, Cuttack during 14.05.2013 to 16.05.2013 with the history of operation in 2012 for parietal SOL. The said policy was proposed just one and half month before. But it was a matter of astonishment that she had not been formally discharged for the said hospital. As patient was absent on the bed on dt. 16.05.2013 it was written in the bed head ticket to be otherwise discharged. So the facts were non to insured before the submission of the insured and insurance of the policy & the complainant has got the knowledge of the facts. The same fact was deliberately concerned by the insured and the correct status of health & disease was not disclosed in the proposal form by the insured during the issuance of the policy. Had the facts been disclosed to the O.Ps he would not have accepted her proposal & would not issue the aforesaid policy. According to the statute that when facts material to be disclosed in the proposal form, concealment of material facts are prove the contract of insurance obtained by fraud is vitiated a cause of death become irrelevant.
Secondly according to the complainant in his complaint the cause of action arose on 11.09.2014 when the O.Ps lastly refused to pay the insured amount under the death policy plan after due information both the O.Ps, but the complaint has been filed 28.10.2014 after one and half months before the date of cause of action. It is the settled principle of law is that the cause of action is the framework of the proceeding. In the present case the date of cause of action is completely false & fabricated. Without cause of action the complaint is vague. The description of the cause of action in the complaint is quite imaginary.
The Sec- 45 of insurance Act says the suppression of facts is the primary barrier for the complainant to be entitlement amount of life assured along with the bonus. According to bed head ticket filed by the O.Ps manifested that the complainant had got admitted in the medical on 14.05.2013 at about 2 .00 PM and she was found absent on 16.05.2013. The complainant’s wife made a proposal to get her insure with OP company on 24.06.2013 having deposited Rs 10,134/- cash has first premium amount mentioning her medical information and declaration of good health. The sum assured was Rs 1,00,000/- but she was under treatment in the medical from 14.05.2013 to 16.05.2013. This facts leads the learned Forum to the obscurity of the darkness of believe. So the complainant has come to the Forum for the reliefs sought for. She is not at all entitled to her reliefs sought for.
It is also settled principle of law is that the deficiency of service caused by the O.Ps shall provide scope to the complainant for challenging the matter in this Forum but the complainant has failed to described the deficiency of service in his complaint as well as he has also prove his case with clean hands. Hence the complainant has failed to prove his case. He is not entitled the reliefs he has sought for.
On the other hand there is no any condition in the contract or in the policy bond that if any premature death would be occurred of the policy holder just after one day of registration of the policy the O.Ps have no right & liberty to forfeit the deposited amount of the complainant. In this instant case the complainant is at a liberty to be refunded her deposited amount Rs 10,145/- as the first premium. Hence ordered;
ORDER
The complaint is & the same be allowed on part against the O.Ps. The O.Ps are here by directed to refund back Rs 10,145/- to the complainant within 30 days on passing of this order. No cost or compensation has been awarded against the O.Ps.
This order is pronounced in the open Forum on this day of 15th Sept, 2017 under my hand and seal of the Forum.
