STATE CONSUMER DISPUTE REDRESSAL COMMISSION

BIHAR, PATNA

Appeal No. 254 of 2014

Reena Kumari, Daughter of Sheojee Poddar, Resident of Village- Pattarghatti, PO- Thalha, Police Station- Triveniganj, District- Supaul

                                                                                                                                                          …  Complainant/ Appellant

Versus

1.  The General Manager, Bajaj Allianz Insurance Co. Ltd. G.E. Plaza, Air Port Road, Gherabara Pune, Maharashtra-411066

2.  The Branch Manager, Bajaj Allianz Insurance Co. Ltd. IInd Floor, Chiranji Vihar, N.H-31, Biharsharif- Barh Marg, Patna- 803213

3.  The Branch Manager, Bajaj Allianz Insurance Co. Ltd. Near Vijay Bharti Hotel, PO & PS- Supaul, District- Supaul

                                                                                                                                                  …. Opposite Parties/ Respondent

Counsel for the appellant: Adv. Irshad Ahmad Khan

Counsel for the Respondent: Adv. Shambhu Nath Choubey & Adv. Vinay Kumar Choubey

Before,

Hon’ble Mr. Justice Sanjay Kumar, President

Mr. Ram Prawesh Das, Member

Dated 20.03.2023

As per Sanjay Kumar, President.

O r d e r

Sufficient cause has been shown to condone the delay in filing this appeal. Accordingly, delay in filing appeal is condoned.

Present appeal has been filed on behalf of Complainant Reena Kumari for setting aside the order 27.05.2014 passed by District Consumer Forum, Supaul in Complaint Case no. 56 of 2013 whereby and whereunder the Ld. District Consumer Forum has dismissed the Compliant case filed by complainant appellant for payment of sum assured amount from Bajaj Allianz Insurance Company Ltd.

Briefly stated the facts of the case is that grandfather of complainant-appellant namely Dev Narayan Poddar purchased three Life Insurance Bajaj Allianz Policies for sum assured amount of Rs. 5,00,000/-each and period of insurance was 15 years and annual premium amount was paid with respect to all the three policies in which appellant -complainant who is granddaughter of the insured was made nominee.

Before acceptance of proposal of policy insured was examined by the panel doctors of insurance company and thereafter proposal was accepted and policy bond was also issued.

Insured on 22.04.2011 on complaining vomiting and stomach pain was rushed to Nursing Clinic for treatment, however, he died during treatment on same day i.e 22.04.2011. After his death the nominee filed her claim before the insurance company but no action was taken by the insurance company on her claim, as such she approached the District Consumer Forum, Supaul for payment of sum assured amount.

Notices were issued by the District Consumer Forum but inspite of valid service of notice they did not appear and proceedings continued ex-parte against them.

The District Consumer Forum in its impugned order dated 27.05.2014 has held that complainant has filed evidence by way of affidavit in which she has supported her contention as made in complaint petition. Documentary evidence were also produced by the complainant which included death certificate issued by the Nursing Home where insured was being treated (marked as exibit-1), certificate granted by treating doctor (marked as exibit-2) death certificate issued by statistical department, Govt. of Bihar (marked as exibit-3) and income tax return filed by insured for the period 2010-2011 (marked as exibit-4).

The District Consumer Forum has further observed that apart from said documents complainant has not produced any other documentary evidence from which it can be gathered that insured Dev Narayan Poddar was policy holder of all the three policies, and complainant was made nominee in those three policies. After death of insured complainant had filed claim before the insurance company, but no decision was taken by the insurance company and even after death, insured amount was not paid to the complaint. Under such circumstances and in absence of relevant evidence, the District Consumer Forum dismissed the Complaint petition on the ground that complainant has failed to establish her case.

Aggrieved by dismissal of her claim case by order dated 27.05.2014 passed by the District Consumer Forum present appeal has been filed on behalf of complainant.

In memo of appeal complainant-appellant has enclosed three claim petition dated 07.09.2011, 18.10.2011 & 09.11.2011 along with relevant documents, but claim was not settled. Thereafter, complainant also sent a legal notice to the insurance company but still no steps were taken by the insurance company to settle her claim.

Although, insurance company did not appear before the District Consumer Forum, Supaul, but on notice they have appeared before this Commission and they filed their affidavit in which it was stated that after claim was lodged insurance Co. made several investigation and various medical certificate confirm that the deceased insured was under hospitalization for treatment of TB of spine in the year 2010 and these facts were deliberately concealed by the policy holder. There is dispute with respect to age of policy holder Complainant /nominee was not the granddaughter of deceased insured.However, no letter of repudiation and reason for repudiation has been enclosed with the affidavit filed by insurance Company.

Since, the claim has been repudiated by the insurance company on ground of suppression of material facts at the time of filling the proposal form of insurance policy, as such it is an admitted position that insured had purchased three policies of life insurance company against which first premium amount was also paid and policy bond was issued by the insurance company.

In said view of the matter the order dated 27.05.2014 passed by District Consumer Forum, Supaul is set aside and the matter is remanded to the District Consumer Forum to hear the matter afresh after granting adequate opportunity to both the parties. As the complaint petition is part of memo of appeal as such Insurance company shall file its written statement on day of its appearance. Both parties shall appear before the District Consumer Forum on 10.04.2023. Reasonable opportunity shall be granted to both the parties to lead evidence in accordance with prescribed procedure and District Consumer Forum shall decide the matter within 3 months from the date of filing of written statement by insurance company.

(Ram Prawesh Das)                                                                                                (Sanjay Kumar,J)

       Member                                                                                                                  President

Md. Fariduzzama