Tamil Nadu

North Chennai

12/2014

S. Gayathri, - Complainant(s)

Versus

The Manager, Bajaj Alliance Insurance Co., Ltd, - Opp.Party(s)

m/s.T.Kumara Vijayan

30 Jan 2017

ORDER

                                                            Complaint presented on:  10.01.2014

                                                                Order pronounced on:  30.01.2017

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)

    2^nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3

 

PRESENT: THIRU.K.JAYABALAN, B.Sc., B.L.,        PRESIDENT

                    TMT.T.KALAIYARASI, B.A.B.L.,           MEMBER II

 

MONDAY THE 30^th   DAY OF JANUARY 2017

 

C.C.NO.12/2014

 

Mrs.S.Goverthini,

W/o Late Mr.C.Ravindran,

No.5, Veerasamy Street,

Royapuram,

Chennai – 600 013.

                                                                                    ….. Complainant

 

..Vs..

1. The Manager,

M/s. Bajaj Alliance Life Insurance Company Ltd.,

Old.No.276 & 277, New No.497 & 498,

4^th Floor, Isana Kalthima Building,

Poonamallee High Road,

Chennai – 600 106.

 

2. The Manager,

M/s. Bajaj Alliance Life Insurance Company Ltd.,

No.1078, II Floor,

United Chambers, Sathy Road,

Coimbatore, Pin – 641 006.

 

3.The Chief Operating Officer,

M/s.Bajaj Alliance Life Insurance Company Ltd.,

G.E.Plaza, Airport Road,

Yerwada, Pune,Pincode – 411 006

 

.....Opposite Parties

Date of complaint                                 : 21.01.2014

Counsel for Complainant                      : M/s T.Kumaravijayan, M.D.Leelavathi

Counsel for Opposite Parties                  : M/s.S.Namasivayam,J.Ravindranath

                                                                    singh, R.Balambigai Gowri &

                                                                    T.Saminathan

 

O R D E R

 

BY PRESIDENT THIRU. K.JAYABALAN B.Sc., B.L.,

          This complaint is filed by the complainant u/s 12 of the Consumer Protection Act.1986.

1.THE COMPLAINT IN BRIEF:

          The Complainant is the wife of Late Mr.C.Ravindran, who was a practicing Advocate at High Court of Madras. While so, he availed 3 Life Insurance Policies bearing policy Nos. viz (1) policy No.0021608312 (2) policy No.0237339336 and (3) policy No.184220823 believing the fanciful assurance given by the Opposite Parties. The Complainant’s name was assigned as his nominee.The said Ravindran also availed a fourth policy and in respect of the said policy he nominated his son as nominee. On 20.07.2012 the Complainant’s husband Mr.C.Ravindran suddenly got giddiness and hence he was immediately admitted into a hospital on the same day. However on 24.07.2012 he was dead.   The cause of death was stated as “Cardio Respiratory Arrest” due to Carcinoma Lung with Bone Metastasis. The Complainant has submitted all the 3 original Life Insurance Policies as stated above to the 1^st Opposite Party, wherein the Complainant claimed the sum assured amount as the Complainant is the lawful nominee. Out of 3 original policies duly received by the 1^st Opposite Party, only one policy bearing No.216083312 was honoured and a sum of Rs.2,47,139-85/- was paid by way of cheque. But on 03.05.2013 the 1^st Opposite Party replied in respect of policy No.184220823 the policy is repudiated, however, a cheque for a sum of Rs.8518/- was sent along with the reply. But no reply was sent by the Opposite Parties in respect of other policy bearing No.237339336. Hence the Complainant was shocked and enquired personally with the Opposite Parties, but the Opposite Parties never replied anything to the Complainant. Therefore the Complainant returned back the cheque of Rs.8518/- which was sent by the 1^st Opposite Party. Having received back the returned cheque, the Opposite Party never informed anything to the Complainant. The Complainant submits that stating all the reasons and facts, caused a lawyer notice to the Opposite Parties on 13.09.2013. Having received the lawyer notice, they never replied anything to the Advocate notice, however the 1^st Opposite Party replied to the Complainant with an unacceptable reasons. At any point of time the Opposite Parties never told any reasons only at the time of claim made by the Complainant the Opposite Parties quoting various kind of arbitrary reasons. The Complainant’s husband Late Mr.C.Ravindran were availed three Life Insurance Policy from the Opposite Party under similar terms and conditions, whereas only one policy was honoured by the Opposite Parties and failed to honour the remaining 2 policies. It is crystal clear that the Opposite Parties trying to evade from the legal liability is deficiency on their part. Hence the Complainant filed this Complaint for the claim  to pay the sum assured amount of Rs.3,00,000/- together with bonus and interest thereon for two policies and also compensation for mental agony with cost of the Complaint.

 

 

2. WRITTEN VERSION OF THE  OPPOSITE PARTIES IN BRIEF

          The Complainant’s husband Mr.C.Ravindran gave a proposal for 3 Life Insurance Policies (including 1 Group Insurance Policy) of the Bajaj Allianz Life Insurance on various dates. Based on the Information provided in the proposal forms 3 policies Nos. 0021608312, Group Policy No.184220823 with client Identification No.191334988, and 02373339336 were issued to him. The said Complaint Ravindran aged 60 years died on 24.07.2012. When claim was made by the Complainant, wife of the deceased, during February 2013 for the sum assured, it was found that there had been series and deliberate non-disclosures. The suppression of material information is violative of the elementary and universal insurance principle of uberima fide or utmost faith. Investigations of the Opposite Party after the death of the policy holder and various medical records received. Clearly informed that the late Mr.C.Ravindran the policy holder, had taken treatment from M/s V.S.Hospitals, Chetpet for Carcinoma Lung (NSCLC)  with Bone Metastasis and got admitted on 03.06.2010 and discharged on 04.06.2010.  Further the discharge certificate clearly elaborates that the late Ravindran was taking treatment with Santosham Hospital for chest pain and weight loss and x-ray showed pleural effusion. Further upon Brochoscopy and Bronchial Biopsy it was diagnosed as carcinoma. The discharge summary further says that the policy holder prior to this was under treatment with M/s.Life Line hospitlal and received 3 cycles of Chemotherapy from 11.03.2010 to 10.05.2010. The said treatment and disease details though pre-proposal had been conveniently suppressed by Late Ravindran while availing policy No.191334988 and 0237339336.  Non disclosure of material facts in the insurance proposal negates the claim at the threshold and ought not to be entertained. The claim was repudiated by the Opposite Parties under clause 9 of the terms of the policy for non disclosure of material facts. This was informed to the Complainant on 03.05.2013.  Having deliberately suppressed vital information which is prerequisite for acceptance or rejection of the policy the Complainant is not entitled to any relief. Due to non disclosure of material facts, in respect of preexisting disease of the deceased in the proposal form is tantamount to fraud under clause 45 of Act. Hence fraud in policy of insurance makes the contract of insurance void ab initio. However, the Complainant was further informed that she may write to the Review committee for reconsideration within 30 days or receipt of letter. However, the policy No.0021608312 availed by Late Ravindran was prior to suffering from above referred disease and treatment. Hence the Opposite Party given benefit of doubt and settled this claim alone and the claim amount had been duly credited to the Complainant’s bank Account which demonstrates the bonafide of the Opposite Party. The Opposite Party had duly complied all terms and conditions of policy and repudiation of claim based out of investigations  are as per the inherent rights of the insurer and the same cannot be attributed as negligence or cheating as alleged and prays to dismiss the Complaint with costs.

3. POINTS FOR CONSIDERATION:

          1. Whether there is deficiency in service on the part of the opposite parties?

          2. Whether the complainant is entitled to any relief? If so to what extent?

4. POINT NO :1 

          The Complainant husband Mr.C.Ravindhran, Advocate obtained 4 numbers of Life Insurance policies form the Opposite Parties and in one of the policy, his son R.Chander was assigned as his nominee and other 3 policies the Complainant wife was assigned as his nominee. The Complainant made claim for all the 3 policies. One of the policy amounts of Rs.2,47,189.85/- under Ex.A2. The Opposite Parties rejected the claim under Ex.A3 that the policy has been repudiated for the reason that Hospitalization/Treatment during 03/06/2010 to 04/06/2010 for Carcinoma Lung (Non Small Cell Lung Carcinoma) with Bone Metastasis. This fact was not disclosed in Enrollment Form dated 18.11.2010.

          5. The Complainant contended that having allowed one of the claims was not justified. They ought to have awarded the claim for other 2 policies also and further the discharge summary collected and filed in Ex.B3 is not acceptable, since the same did not  bear the signature of the Doctor and further the Opposite Parties have not filed  any affidavit of the doctor to prove their case and further the investigator is not a licensed surveyor and therefore all the document collected by him in Ex.B3 have to be rejected and consequently the Complaint has to be allowed.

          6. The Opposite Parties would contend that the Complainant herself admitted in the Complaint that her husband was died as cardio respiratory arrest due to Carcinoma lung with been metastasis  and further in Ex.B5 declaration that the deceased was suffering from lung cancer and he died on 24.07.2012 and the said illness duration period was 2 years and therefore previous to his death her own document reveals that the deceased was suffering from lung cancer for 2 years and such fact was suppressed by the Complainant husband in Ex.B2 proposal form submitted to the Insurance which was dated on 29.10.2011 and therefore prays to dismiss the Complaint for suppression of fact.

          7. Ex.B2 is the proposal form made by the Complainant’s deceased husband   for obtaining policy from the Opposite Parties. The said application was dated 29.10.2011. The policy holder C.Ravindhran was died on 24.07.2012 and the cause of death of was cardio respiratory arrest due to carsinoma with bone  metastasis as pleaded by the Complainant in her Complaint itself. This was supported by a death certificate issued by the V.S.Hospital which is available at page 41 Ex.B3. Further the Complainant’s own document Ex.B5 claim statement filed by her to the Opposite Parties in which she has stated that her husband was suffering from cancer for a period of 2 years.

          8. The date of death was on 24.07.2012. Duration of illness for 2 years means, he should have been suffering with lung cancer from 24.07.2010 to till the date of the death for 2 years. In the Ex.B2 proposal application, the deceased nowhere stated about that he was suffering from Lung cancer even though he submitted the proposal application in the year 2011 itself prior to 1 year he was suffering from Lung cancer as arrived from Ex.B5 claim statement. Therefore as contended by the Opposite Parties, it is a clear case of suppression of material fact namely the lung cancer in the proposal form.

          9. As per sec. 64 UM the licensed surveyor or assessor should posses a valid license to assess the loss. As contended by the Complainant counsel, the Opposite Parties  surveyor who has collected the discharge summary and the death certificate of C.Ravindhran collected from the V.S.Hospital and marked as Ex.B3 document along with other documents. On perusal of discharge summary, it does not bear the signature of the doctor who has treated the document in that hospital. Therefore, as contended by the counsel for the Complainant we reject the discharge summaries filed in Ex.B3, since the same does not bear the signatures.

          10. Even though the death certificate was rejected the Complainant herself admits that her husband was died due to Carcinoma lung with bone metastasis and Ex.B2 and Ex.B5 proves that as discussed earlier the Complainant deceased husband suppressed the materials fact that he was suffering from Lung Cancer from the year 2010 onwards. The counsel for Complainant relied on the judgments reported in AIR 2013 Jammu & Kashmir 2005 (III) CPJ 6 (SC) and III 2007 CPJ 471 (NC)  have no application to the facts of the case in hand. Therefore we hold that due to suppression of material fact the Opposite Parties have rightly rejected the claim of the Complainant and therefore we do not find any deficiency on the part of the Opposite Parties and hence, it is held that the Opposite Parties 1 to 3 have not committed any Deficiency in Service.

11. POINT NO:2

Since the Opposite Parties have not committed any Deficiency in Service, the Complainant is not entitled for any relief and the Complaint is liable to be dismissed.

          In the result the Complaint is dismissed. No costs.

          Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 30^th   day of January 2017.

 

MEMBER – II                                                               PRESIDENT

LIST OF DOCUMENTS FILED BY THE COMPLAINANT:

Ex.A1 dated 02.02.2013                   Death claim  made by the Complainant in respect

                                                     of policy No.21608312

 

Ex.A2 dated 10.02.2013                   Settlement made on policy No.21608312

 

Ex.A3 dated 02.02.2013                   The Opposite Party replied with a cheque against

                                                    the claim made in policy No.184220823

 

Ex.A4 dated 25.07.2013                   The Arbitrary manner cheque returned by the

                                                    Complainant

 

 

Ex.A5 dated 02.02.2013                   Death claim made by the Complainant in respect

                                                    of policy No.237339336 and acknowledged by the

                                                    Opposite Party

 

Ex.A6 dated 13.09.2013                   Advocate notice to the Opposite Parties

 

Ex.A7 dated 27.09.2013                   Reply from the 1^st Opposite Party

 

 

LIST OF DOCUMENTS FILED BY THE OPPOSITE PARTIES :

 

Ex.B1 dated NIL                     To whomsoever it may concern

 

Ex.B2 dated  NIL                    Proposal Form for Life Insurance

 

Ex.B3 dated 15.03.2013                   Service Bill

 

Ex.B4 dated 10.02.2013                   Claim payment under policy

 

Ex.B5 dated  NIL                    Death Claim (Claimant’s Statement)

 

 

 

MEMBER – II                                                               PRESIDENT