Rajasthan

StateCommission

A/316/2022

Jay kumar - Complainant(s)

Versus

The Oriental Insurance Company - Opp.Party(s)

S.P. Agarwal

29 Aug 2023

ORDER

BEFORE THE RAJASTHAN STATE CONSUMER DISPUTES REDRESSAL COMMISSION,JAIPUR

 

FIRST APPEAL NO: 316/2022

 

Jai Kumar Mayachh s/o Sh. Ramjeevan Mayachh r/o House No. 1545 Chaura Rasta Jaipur now deceased

His Heirs-

1.Rajendra Kumar s/o Late Sh.Jai Kumar Mayachh

2.Ashok Kumar s/o Late Sh.Jai Kumar Mayachh

3.Smt. Manju Devi w/o Sh.Vijender Singh d/o Late Sh.Jai Kumar Mayachh all r/o House No. 1545, Chaura Rasta, Jaipur.

…..Appellants/complainants

Vs.

The Oriental Insurance Co. Ltd. Br. Office Sarraf House, Opp. All India Radio, M.I.Road, Jaipur through Chief Manager.

…..Respondent/ Opposite party

Navratan Mayachh s/o Late Sh.Jai Kumar Mayachh r/o House No. 1545, Chaura Rasta, Jaipur-302003

…..Respondent/complainant

 

 

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Date of Order 29.08.2023

Before:

Hon'ble Mr. Atul Kumar Chatterjee- Member(Judicial)

Hon'ble Mr. Ramphool Gurjar- Member

Present:

Mr. Surya Prakash Agarwal learned counsel for the appellants

Mr. Prashant Mantri learned counsel for respondent no.1

None present on behalf of respondent no.2

 

BY THE STATE COMMISSION ( PER HON'BLE MR.ATUL KUMAR CHATTERJEE, MEMBER (JUDICIAL)

 

This appeal has been filed by the appellant/complainant against the judgment of learned District Consumer Commission, Jaipur 1^st Jaipur dated 6.5.2022 passed in its Complaint Case No 1350/2014 whereby the complaint of the appellants/complainants was dismissed.

 

In this case there are contradictory averments of the either side because the appellant/complainant has averred in

 

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his complaint that his date of birth was 25.1.1934 whereas the case of respondent /opposite party insurance company is that in the proposal form received by the insurance company through the banker Punjab National Bank, the date of birth of the complainant Jai Kumar was mentioned as 25.4.1934 and age was shown to be 78 years at the time of submission of the proposal form. It is admitted that the complainant Jai Kumar procured a medi claim policy named PNB Oriental Royal Medi Claim Policy from the respondent/opposite party insurance company. This policy could be procured by an account holder of Punjab National Bank (PNB). As per the respondent/opposite party insurance company this policy could be procured by any person of the age between 3 months & 80 years and upon attaining the age of 80 years the policy would become ineffective and the benefits under the policy would seize.

 

The appellant/complainant's case is that he had revealed his date of birth to be 25.1.1934 from the very beginning and in the proposal form the date of birth of complainant Jai Kumar shown to be 25.4.1934 has been forged by any of the

 

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officials of the insurance company. In this case the appellant had undergone his treatment and his medi claim under the was forwarded through the hospital to TPA of the insurance company for providing cash less facility but the same was declined on the ground that the policy has not completed three years. According to complainant on 20.9.2014 he received a message regarding cancellation of policy alongwith refund of Rs. 3107/-. The medi claim of the complainant was declined and the policy was cancelled on the ground that prior to the date of undergoing treatment and incurring expenses thereupon, since the insured/complainant had attained 80 years as such the claim was not permissible under the policy and the policy was liable to be cancelled. In the complaint the complainant has questioned the cancellation on the ground that from the very beginning he revealed his date of birth to be 25.1.1934 meaning thereby that from the very beginning it was known to the insurance company that the insured/complainant was above 80 years despite that policy has been issued but as stated above the case of insurance company is that in the proposal form received through bank, the date of birth of complainant Jai /insured has been shown to be 25.4.1934 and age of 78 years has been mentioned.

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During the course of arguments the learned counsel for the appellant/complainant has drawn the attention of this Commission towards the documents adduced alongwith application u/o 41 rule 27 CPC which includes the account opening form of complainant Jai Kumar in PNB, copy of his voter ID card, PAN card, Passport etc. and on the basis of these documents the learned counsel tried to emphasize that his date of birth is 25.1.1934 and he could not mention his date of birth to be 25.4.1934. He has further reiterated that the copy of proposal form submitted by the insurance company shows forged date of birth of the insured complainant.

 

The learned counsel for the complainant has disputed the impugned judgment of learned DCC Jaipur 1^st Jaipur dated 6.5.2022 saying that it has been based on wrong facts and averments and has prayed for allowing the appeal and giving relief in terms of the complaint filed by the appellant/complainant before the learned DCC.

 

Per contra the learned counsel for the respondent insurance company vehemently opposed the contentions of learned counsel for the appellant/complainant & has contended

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that it is undisputed that insured complainant, at the time when he had undergone treatment and incurred expenses thereupon he ,was above 80 years of age and as per clause 3.18 of the Prospectus appended with the policy, the benefits under the policy would seize. Therefore, in no circumstances the appellant/ insured complainant can be allowed the relief claimed in the complaint. He has referred to following judicial precedents :-

1. III (2020) CPJ 236 (NC) (Satya International Vs. New India Assurance Co. Ltd. & ors.),

2. IV (2012) CPJ 148 (NC) ( IND Swift Ltd. Vs. New India Assurance Co. Ltd. & ors.) &

3. II (2017) CPJ 102 (NC) (IFFCO Tokio General Insurance Co. Ltd. Vs. Bhabani Prasad Basu & MS.Snigdha Basu & ors.).

 

As revealed from the above discussion admittedly at the time of undergoing treatment the appellant/insured was above 80 years of age. The appellant/insured has tried to emphaize that if as per clause 3.18 of the Prospectus of the policy the benefits under the policy could not be provided to persons of above 80 years of age, in that case why insurance

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policy was issued. So far as the documents submitted alongwith application u/o 41 rule 27 CPC are concerned, these documents have not been submitted before the learned DCC. Moreover the complainant had not impleaded the Punjab National Bank(PNB) as opposite party despite the fact that as per the policy terms the policy could be provided to the account holder of PNB. From the documents submitted by the respondent/opposite party insurance company which includes copy of the proposal form and prospectus, repudiation letter dated 24.9.2014 and PNB-Oriental Royal Mediclaim Policy Schedule Ex. 1 to 4 respectively. In the proposal form it is revealed that date of birth was shown to be 25.4.1934 and in the age column 78 was written. Since the complainant did not submit any document before the learned DCC which would show that from the very beginning he had revealed his date of birth to be 25.1.1934 and not 25.4.1934.

 

From the above discussion, so far as the medi claim in respect of the expenses incurred by the appellant/complainant in his treatment in the month of August-September 2014, it was not payable in any case because at that time the appellant/complainant was above 80 years of age.

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Moreover if the case of appellant/complainant is that he revealed his date of birth to be 25.1.1934 from the beginning, it means that he himself had crossed 80 years of age at the time of filling the proposal form and since as per clause 3.18 of the Prospectus appended with the policy, the period of policy is limited upto 80 years i.e. upon attaining the age of 80 years the benefits under the policy would seize as such as per the complainant the insurance policy contract shall be treated to be a contract void ab initio and as per law under the contract which is void ab initio no benefit can be claimed or provided.

 

On the basis of above discussion, we arrive at a conclusion that in no case the appellant/complainant can be awarded the relief claimed in the complaint and in our humble view the impugned judgment dated 6.5.2022 passed by the learned DCC Jaipur 1^st Jaipur does not suffer from any illegality and infirmity so as to enable this Commission to interfere in the judgment. As such the appeal deserves to be dismissed which is hereby dismissed. No costs.

 

(Ramphool Gurjar) (A.K.Chatterjee)

Member Member (Judicial)

 

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