Reserved

State Consumer Disputes Redressal Commission

U.P. Lucknow.

Appeal  No.460 of  2011

Bajaj Allianz Life Insurance Company Limited,

G.E. Plaza, Airport Road, Yerwada, Pune through

Branch Office, Bajaj Allianz Life Insurance

Company Ltd., 4, Shahnajaf Road, Hazratganj,

Lucknow (U.P.) through its Officer In-charge.   ….Appellant.                                                                         

                                       Versus

Smt. Uma Srivastava widow of Late Pradeep

Kumar Srivastava, R/o House no.1469, Mohalla

Khairabad, Allahabad Road, Sultanpur.           …Respondent.

Present:-

1- Hon’ble Sri Rajendra  Singh, Presiding Member.

2- Hon’ble Smt. Sudha Upadhyay, Member.

Sri Dinesh Kumar, Advocate for the appellant.

None for the respondent.

Date 2.7.2024

JUDGMENT

Per Mr. Rajendra Singh, Member: This appeal has been filed against the judgment and order dated 3.11.2010 passed by Ld. District Forum, Sultanpur in Complaint case no.31 of 2009, Smt. Uma Srivastava vs. Bajaj Allianz Life Insurance Company Ltd.

The brief facts of the appeal are that, that the deceased concealed the facts regarding disease pertaining to liver since 2005 at the time of filing the proposal form on 13.5.2006 by submitting that he had no disease at the time of taking the policy. Thereafter, the company issued the policy.  

The diseased was under treatment since 2005 which fact although known to the deceased/life assured at the time of making the proposal was deliberately and with a malafide intention not disclosed in the proposal form only with a view to dishonestly induce the insurance company to accept the proposal for insurance and issue the policy of insurance which the insurance company would never have done in case the true and correct facts as regards illness and treatment of the deceased life assured since 2005 was disclosed in the proposal form. It is clear from the death summary report issued by SGPGI, wherein it clearly shows that the deceased was chronic alcoholic during the period of 1982-88 and 1989 and thereafter he was suffering from jaundice from April 2005. As result of that it is very clear that the deceased was having chronic liver disease at the time of taking the policy and the death was caused due to liver cirrhosis cryptogenic, hence insured was died due to liver cirrhosis on 23-3-2008. The son of insured has submitted before the insurance company that his father was habitual of taking liquor prior to taking policy but after jaundice in the year 2005 he gave up to drink the wine after knowledge of jaundice in February 2006. Therefore, it is clear that the deceased concealed the fact in proposal form.

The consumption of alcohol may not be a disease but it is fatal for liver disorder. The deceased life assured had history of cryptogenic, cirrhosis portal HTL, ascites since 2005. He was chronic alcoholic during 1992 to 1999 but learned forum has failed to appreciate the evidence on record and decided the case in arbitrary manner without any evidence being produced by the Complainant/Respondent. It is further stated in this regard that the damage caused due to the consumption of alcohol is permanent and irreversible and knowing the same the deceased life assured deliberately concealed the same in the proposal form and the Complainant/Respondent has not produced any medical evidence even to suggest that the liver disorder was due to reasons not connected with alcohol consumption as inferred by the learned District Forum and hence the order dated 3-11-2010 is liable to be set aside. Hence it is most humbly prayed that this appeal be allowed and the impugned judgment and order be set aside.

We have heard the learned counsel for the appellant Sri Dinesh Kumar.  None appeared for the respondent. We have perused the pleadings, evidences and documents on record.

In this case, the deceased insured Pradeep Kumar Srivastava took a policy of Rs.3 lacs in 2006 from Bajaj Allianz Life Insurance Company Ltd. and deposited the premium regularly. In February, 2007 he fell ill and his treatment was done but on 23.3.2008 he expired. The complainant submitted the claim before the insurance company but the company did not give any satisfactory reply after that the claim was repudiated on the ground of concealment of disease. She filed a complaint before the ld. District Forum who passed the following order.

          “परिवाद विपक्षीगण के बिरुद्ध स्वीकार किया जाता है। विपक्षीगण को आदेश दिया जाता है कि वह आदेश पारित होने के एक माह के अन्दर परिवादिनी को बीमित धनराशि 300000/- रुपये (तीन लाख) एंव उस पर परिवाद संस्थित करने की तिथि तक 9% साधारण ब्‍याज एवं 2000/-रुपये क्षतिपूर्ति एवं 1000/-रुपये परिवाद व्यय अदा करें।”

In this case, it is clear that the insured person died on 23.3.2008 and the policy was taken in 2006. The discharge summary of SGPGI has been filed in which the date of admission has been mentioned as 29.6.2007 and discharge 7.7.2007. This period is after taking of the policy. The appellant’s counsel drew our attention towards the word chronic alcoholic 1982-98.

Now the question arises as to when the patient was firstly admitted in any hospital for his treatment before the date of taking the policy. The burden is on the insurance company to prove that the deceased had full knowledge regarding liver cirrhosis whatever written by the doctor in the discharge summary is not a gospel truth because if the patient had no knowledge about his disease and he had no problem before it why did he say that he is suffering from liver cirrhosis. In the proposal form tick is made by the agent.

The doctor has not been produced in evidence. No affidavit has been filed by the doctor to verify the disease and also to verify that the treatment was going on before the date of insurance policy. The insurance company has not put forward any concrete evidence regarding the disease prior to the date of taking the policy. All the prescription are after the date of taking the policy.

The ld. District Forum has discussed all the things and pronounced the judgment which  needs no interference by this Commission. The appeal is liable to be dismissed.

ORDER

         The appeal is dismissed.

If any amount is deposited by the appellant at the time of filing of this appeal under section 15 of the Consumer Protection Act, 1986, may be remitted to the concerned District Consumer Commission for satisfying the decree as per rules alongwith accrued interest upto date.

The stenographer is requested to upload this order on the Website of this Commission today itself. 

          Certified copy of this judgment be provided to the parties as per rules.      

      (Sudha Upadhyay)                     (Rajendra Singh)         

               Member                             Presiding Member

Judgment dated/typed signed by us and pronounced in the open court.

Consign to record.

      (Sudha Upadhyay)                     (Rajendra Singh)         

               Member                             Presiding Member

Dated    2.7.2024

Jafri, PA I

Court  2