BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
CACHAR :: SILCHAR
Con. Case No. 17 of 2017
Md. Situl Ahmed Laskar,
S/O. Late Enus Ali Laskar
Vill- Gabindapur Part-III, P.O- Gabindapur East.
Silchar, Cachar, Assam…………………………… Complainant.
-V/S-
1. The Manager, Bajaj Allianz Life Insurance Co. Ltd.
2nd Floor, Jagannath Apartment, Hospital Road, Silchar. O.P No.1.
2. The Manager, Bajaj Allianz Life Insurance Co. Ltd
G.E. Plaza, Airport Road, Yerawada O.P No.2.
Present: - Sri Bishnu Debnath, President,
District Consumer Forum,
Cachar, Silchar.
Shri Kamal Kumar Sarda, Member,
District Consumer Forum,
Cachar, Silchar.
Appeared: - Mr. Dhrubajyoti Nath, Advocate for the complainant.
Mr. Rahul Nath, Advocate for the O.Ps.
Date of Evidence 13-12-2017, 19-02-2018
Date of written argument 11-05-2018, 17-05-2018
Date of oral argument 08-06-2018
Date of judgment 02-07-2018
Sri Bishnu Debnath,
- The case has been brought by son of deceased life assured Eunus Ali Laskar for award of receiving the sum assured in view of life Insurance Policy No.0320943962 and other relief. The Complaint brought against the insured i.e Bajaj Allianz Life Insurance Co. Ltd. because the insurance co. repudiated the claim on 31/10/2015.
- Brief facts is as below:
Eunus Ali Laskar purchased his life Insurance policy aforesaid on 31/01/2015 from the O.P. Insurance Co. The sum assured was Rs.4,00.000/-. The O.P. received yearly premium of Rs.17,970/- but the life assured died on 10/02/2015 due to Cardio Respiratory Failure. Accordingly, the complainant being the son & nominee of the deceased Enus Ali Laskar submitted the claim to the O.P. The O.P after investigation found that deceased life Assured was suffering from Peripheral vascular disease with gangrene since 20/12/2014 i.e prior to the date of purchasing the insurance policy but suppressed that material fact. That is why, the claim has been repudiated.
- During hearing the Complainant submitted his deposition, supporting affidavit and exhibited documents. After closing evidence also submitted written argument. The O.P. side also submitted evidence Sri Uttam Kumar Paul, the Sr. Branch Manager and exhibited investigator’s report, employer’s certificate, medical certificate etc. The Ld. Advocate of the O.P. also submitted written argument.
- I have heard oral argument of both sides counsels, perused the written argument and evidence on record.
- It is admitted fact that the Life Assured Eunus Ali Laskar died due to Cardio respiratory failure on 10/02/2015. To establish the said fact the Complainant not only exhibited Insurance Policy but also Annexed Death Certificate and medical attendant certificate. The Complainant also by adducing oral evidence tried to establish the fact that the O.P. Insurance Company deliberately without any reasonable ground repudiated the legitimate claimant. The O.P. admitted the fact of repudiation and D.W by adducing evidence tried to established the allegation that the deceased life Assured Eunus Ali Laskar was suffering from Peripheral Vascular disease with gangrene prior to the date of purchasing the Insurance Policy and intentionally suppressed the aforesaid ailment in the proposal form vide Ext.A. Anyhow, to establish the aforesaid alleged pre-existing ailment of Cardio vascular disease, the O.P. exhibited investigator’s report vide Ext.C.As per the said Report the deceased Life Assured was an outdoor patient of Silchar Medical College & Hospital, since, 01/01/2015 and on that date the disease of peripheral vascular disease was diagnosed. Accordingly, the D.W. deposed that the deceased Life Assured suppressed the material fact.
- I have gone through the exhibited documents meticulously and observed as below after hearing both sides counsels.
- The Insurance Claim has been repudiated with a plea that the Life Assured Late Eunus Ali Laskar suppressed his heart disease at the time of execution of the proposal Form for purchasing Insurance Policy No.0320943962 on 31/01/2015. Accordingly, during hearing the O.P. Insurance Co. exhibited medical papers to establish the concealed fact of Pre-existing heart disease of the Life Assured, vide Ext.E. In addition of the Ext.E. medical certificate also submitted employer’s certificate vide Ext.D.
- In the Ext.D it is revealed that deceased was suffering from Gangrane in lower limb since 20/12/2014 and died on 10/02/2015. But in Ext.E medical certificate it is revealed that the deceased Life Assured Enus Ali Laskar was treated as outdoor patient under Silchar Medical College & Hospital from 01/01/2015 to 01/04/2015 for peripheral vascular disease along with gangrane.
- Thus, the Ext.E is an undoubtful & unreliable document because a deceased who admittedly died on 10/02/2015 cannot be treated till 01/04/2015 for peripheral vascular disease with gangrene.
- No more reliable and authentic document or medical papers or certificate submitted by the O.P. to establish the fact that deceased was really knowing the fact of his heart ailment on or prior to the date of purchasing the insurance policy. More over the employer’s certificate vide Ext.D is not sufficient to establish the fact that the deceased life assured was knowing the fact of his heart disease prior to the date of purchasing the Insurance Policy.
- As such in this case in my considered view, the claim of the Complainant has been repudiated without any justified and cogent ground. Thus, the legal heirs of the deceased life assured are entitled to get sum assured of Rs.4,00,000/- with cost of the proceeding of Rs.3000.
- In this case, considering all aspect I do not find any justification for granting compensation in addition of awarding sum assured because awarding of sum assured with cost of the proceeding will meet the ends of justice.
- Of course, all the legal heirs of the deceased are entitled to get equal share of awarded amount with up to date interest. Hence, the Insurance Co. is directed to make payment of awarded amount within 45 days, by issuing cheque infavour of the President District Consumer Forum and District Consumer Forum will distribute the said amount to all legal heirs of the deceased life assured. If the Insurance Co, is fail to make payment of the awarded amount within the stipulated period, the insurance co. will be liable to pay interest at rate of 10% per annum from the date of defaulter.
- With the above, this case is disposed of on contest. Supply free certified copy of Judgment to the parties. Given under my hand and seal of this District Forum on this the 2nd day of July, 2018.
