State Consumer Disputes Redressal Commission
Bajaj Alliance Life Insurance Company ... vs Vansh Alias Eklavia Through Videshi Lal on 10 October, 2017
STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND, DEHRADUN
FIRST APPEAL NO. 157 / 2015
1. Bajaj Allianz Life Insurance Co. Ltd.
Branch-First Floor, Durga City Centre
P.O. Bhotiapadav, Haldwani, Nainital
2. Review Committee
Bajaj Allianz Life Insurance Co. Ltd.
Fifth Floor, G.E. Plaza, Airport Road, Yarwada, Pune
Both through Authorized Signatory
Sh. Naveen Chandra Srivastava S/o Sh. Prakash Srivastava
Divisional Manager
Bajaj Allianz Life Insurance Co. Ltd.
30 - East Canal Road, Dehradun
......Appellants / Opposite Parties
Versus
Sh. Bansh alias Eklavya (Age 12 years)
Through Guardian - Grand Father Sh. Videshi Lal S/o Late Banwari Lal
R/o H. No. 434 Awas Vikas Colony, Haldwani
P.O. Bhotiapadav, Haldwani, Nainital
.......Respondent / Complainant
Sh. Vijay Pal Tiwari & Sh. Rajesh Devliyal, Learned Counsel for the Appellants
Sh. Pradeep Bartwal & Sh. K.C. Pant, Learned Counsel for Respondent
Coram: Mr. D.K. Tyagi, H.J.S., Member
Mrs. Veena Sharma, Member
Dated: 10/10/2017
ORDER
(Per: Mr. D.K. Tyagi, Member):
This appeal, under Section 15 of the Consumer Protection Act, 1986, has been preferred by the appellants-Insurance Company against the order dated 12.05.2015 passed by the District Forum, Nainital in consumer complaint No. 55 of 2013, whereby the District Forum has partly allowed the consumer complaint and directed the opposite parties-Insurance Company to pay the complainant a claim amount of Rs. 3,71,000/- together 2 with interest @ 6% per annum on the said amount, from the date of filing the consumer complaint till the date of actual payment, within one month from the date of order and it is also directed to pay Rs. 5,000/- to the complainant towards litigation expenses. The complainant is directed to make FDR of the claim amount and submit this FDR with the District Forum and will receive the said FDR only after being mature the minor.
2. Briefly stated the facts of the case, as mentioned in the consumer complaint are that the complainant-Sh. Videshi Lal had purchased a policy No. 066083703 receipt No. 6060924 after a payment of Rs. 10,000/- as annual premium and the maturity amount was Rs. 1,00,000/- in the name of his daughter Smt. Ramawati w/o Sh. Jitendra Devnatak on 22.09.2007 from the opposite party No. 1- Bajaj Allianz Life Insurance Co. Ltd. After few years, officials of the opposite party No. 1 apprised the complainant about a new plan policy, which was better than the existing policy and the existing policy was closed and after obtaining Rs. 31,928.72ps. a new policy No. 0202045621 dated 11.01.2011 was prepared and Rs. 25,712/- were charged from the complainant, but without charging Rs. 712/- only Rs. 25,000/- were charged. It was told to the complainant by the office of opposite party No. 1 that the maturity value of the new policy will be of Rs. 3,71,000/-. Officials of the Insurance Company had obtained signatures of the daughter of complainant on different papers. In the documents, the son of Smt. Ramawati named Vansh alias Eklavya date of birth 04.08.2003 was made nomine through guardian - complainant (Nana). The office of the opposite party No. 1 had apprised the complainant that insurance bond shall be provided to the complainant, when it shall come from the office of the opposite party No. 2 after one month and complainant was advised to collect the same. Unfortunately, Smt. Ramawati, daughter of the complainant, died a natural death on 22.01.2011. The complainant sent required documents such as death certificate of the insured alongwith claim form supported with an affidavit for settlement of claim and the complainant-Nana of the minor also sent his 3 account No. 11178474910 of SBI, Branch Haldwani in the office of opposite party No. 1. It was told by the office of the opposite party No. 1 after obtaining certain signatures on the documents that claim amount shall be deposited in the account of complainant in SBI, after sanction of the same from the office of opposite party No. 2. The complainant time and again visited the office of the opposite party No. 1 to obtain the information regarding insurance claim amount, for which office of opposite party No. 1 assured him, but on 25.07.2012, suddenly a letter of repudiation of claim was received from the office of opposite party No. 2. The opposite party No. 1 advised the complainant to file review application before the opposite party No. 2. In this way, the opposite parties have repudiated the claim of the complainant on account of death of daughter of the complainant without mentioning any reason and thereby committed deficiency in service. By repudiating the claim without mentioning valid reason, the complainant as well as nominee Master Vansh alias Eklavya suffered mental agony and physical and financial loss. The opposite parties did not provide valid bond so far and caused harassment to the complainant to visit the office of the opposite party No. 1 time and again. After repudiating the claim, the complainant had sent a legal notice to the opposite parties through their advocate Sh. K.C. Pant on 18.09.2012, which was duly served on the opposite parties. The complainant again sent a registered letter to the opposite parties, after rectifying certain points, which was also received by the opposite parties. Even then, neither the opposite parties did not reply the notice of the complainant, nor settled the claim of the complainant. The complainant is a consumer of the opposite parties and the opposite parties have committed deficiency in service as well as unfair trade practice and the complainant suffered mental agony.
3. The opposite parties-Bajaj Allianz Life Insurance Co. have filed written statement before the District Forum and have admitted the fact that the complainant had purchased an insurance policy on 22.09.2007, but it was not maturity amount, rather Rs. 1,00,000/- was insured amount. It is 4 denied that answering opposite parties ever requested the complainant to take other insurance policy. Insured-Late Smt. Ramawati concealed the material fact regarding her ailments, gave proposal for new policy after surrender of her previous policy. This new proposal was never executed, therefore, complainant is not entitled to get any claim amount. Para No. 3 of the complaint is denied, because the claimant has never deposited any proposal form in the office of opposite party no. 1, rather disputed proposal was deposited in the office of Om Sai Om Associate. This fact is clear from column No. 25 of the proposal form, in which place of filling proposal form is shown as Dehradun. It is admitted to the answering opposite parties that insured Late Smt. Ramawati had died on 22.01.2011. It is denied that the claim was repudiated without mentioning reasons. It was told to the complainant that insured Late Smt. Ramawati had concealed her ailment and due to that ailment she died. It is confirmed that she died only after 10 days from 11.01.2011. This is clear cut violation of terms and conditions of the insurance policy. It is denied that insured was called in the office of answering opposite parties. It is proved that proposal form of the insured was not filled at her permanent address at Kashipur or Haldwani, rather it was filled at Dehradun with wrong facts. It is admitted that notice was sent by the complainant to the answering opposite parties, which was received and reply was sent to the complainant. It is wrong to say that policy No. 066083703 was surrendered on the advice of answering opposite parties, because proposal form for new policy was filled at Dehradun, which indicates that the complainant has not come before the District Forum with clean hands. In the additional pleas, the answering opposite parties have pleaded that the insured had died after 11 days from the date of filing a new proposal form on 04.01.2011. Previously there was insurance of Rs. 1,00,000/- vide policy No. 066083703 and she had disclosed her income as Rs. 40,000/- per annum and address was shown at Haldwani, while in the second application she had disclosed her source of income through boutique and annual income was shown as Rs. 3,00,000/-. After enquiry and investigation by the insurance company, it was found 5 that she was a house wife and her residence was at Dehradun, which was shown in the form as address. Driving licence was filed for verification of address, which was found fake. The insured had tried to obtain insurance policy through fake documents. Before execution of the second policy, she died and on the basis of fake documents, claim was repudiated.
4. The District Forum, on an appreciation of the material on record, partly allowed the consumer complaint vide impugned order dated 12.05.2015 in the above manner. Aggrieved by the said order, the insurance company-appellants have filed the present appeal.
5. We have heard Sh. Vijay Pal Tiwari & Sh. Rajesh Devliyal, learned counsel for the appellants and Sh. Pradeep Bartwal & Sh. Sh. K.C. Pant, learned counsel for respondent. We have also gone through the entire record of the District Forum and have also perused the material placed on record.
6. Learned counsel for the appellants has submitted before this Commission that the impugned judgment and order dated 12.05.2015 is against law, facts and evidence on record. The District Forum has failed to appreciate that according to the repudiation letter dated 25.07.2012, facts mentioned in the proposal form by claimant and documents produced for the claim, are different. In the proposal form, name of insured is Ramawati, whereas in the death certificate Smt. Rama is mentioned. In the proposal form name of husband of the insured is Dinesh, whereas in the death certificate name of the husband is Jitendra Kumar. Similarly, in the proposal form permanent address of the insured is Avas Vikas Colony, Haldwani, Nainital, whereas in death certificate permanent address is Maheshpura Balmiki Basti, Kashipur. In the death intimation letter dated 10.01.2012 date of death is mentioned as 20.01.2011, whereas in the death certificate date of death is 22.01.2011. The District Forum has failed to appreciate that the insurance policy is a contract between insured and the insurance company and the terms and conditions of the policy are 6 regularized by Insurance Regulatory and Development Authority (IRDA). Contract of insurance policy is based on utmost good faith and it is the duty of the insured to explain the correct facts at the time of filling of proposal form. The insured has violated the terms and conditions of the insurance policy by concealing the material facts regarding her illness. The District Forum has failed to appreciate that the insured had obtained a new policy for more amount by concealing material fact of her illness and by cancelling the previous policy. The impugned order passed by the District Forum is against the terms and conditions of insurance policy. The District Forum, Nainital had no jurisdiction to hear and decide the matter, because in the proposal form of policy in question place of filling column was Dehradun. In this way, this policy was obtained or purchased from Dehradun. There is no branch office of the appellants-insurance company at Dehradun. There is no branch office of the appellants-insurance company in Nainital.
7. There is no dispute with regard to the fact that the insurance policy No. 066083703 was purchased in the name of Smt. Ramawati W/o Sh. Jitendra Devnatak on 22.09.2007 from the opposite party No. 1- insurance company for value of Rs. 1,00,000/-. It is also undisputed that the previous policy was surrendered by the insured and a new proposal was given by the insured. It is also undisputed that new proposal form was never deposited by the claimant in the office of opposite party No. 1, rather the proposal in question was deposited in the office of Om Sai Associates, Dehradun. It is evident from the column No. 25 of the proposal form in which place of filling the proposal form is mentioned as Dehradun.
8. We have gone through the documents filed by the complainant- respondent before the District Forum. In intimation of death (paper No. 5/12 on the District Forum's record) under policy No. 0202045621 date of death is mentioned as 20.01.2011, whereas in death certificate (paper No. 5/13 on the District Forum's record) name of insured is 7 Smt. Rama and not Ramawati, whereas date of death is mentioned as 22.01.2011. Therefore, there is great discrepancy in the two above-noted documents regarding death of insured. In the death certificate name of husband of the insured is mentioned as Sh. Jitendra Kumar R/o Maheshpura Balmiki Basti, Kashipur, whereas in the proposal form for new policy, name of husband is mentioned as Dinesh. In the proposal form for new policy, current address of insured is mentioned as C/o Anil Kumar, Near Panwar Petrol Pump, Maitrey Vihar, Haridwar Road, Dehradun, Uttarakhand, whereas the complainant-Sh. Videshi Lal, father of deceased Ramawati, has categorically mentioned in the consumer complaint as well as in the affidavit that there is no relation of insured Smt. Ramawati with Dehradun and respondent-Sh. Videshi Lal never visited Dehradun for obtaining second policy after surrender of first policy. Sh. Videshi Lal- respondent has deposed in para 5 of the affidavit (paper Nos. 17/1 to 17/3 on the District Forum's record) that he had never visited Dehradun regarding filling of proposal form for second policy. In the proposal form (paper Nos. 5/16 to 5/19 on the District Forum's record) witness Sh. Yogesh Kumar, 26 Balbir Road, Dehradun has signed over the form, but Sh. Yogesh Kumar has never come forward in support of new policy, which was prepared at Dehradun on 11.01.2011 and was submitted in Oms Sai Associates. We have also gone through the investigation report prepared by Sharp Eagle and Probe India (paper Nos. 14/1 to 14/13 on the District Forum's record). In the investigation report, the investigator has mentioned that he visited neighbours of the address mentioned in the proposal form at Dehradun and discussed about Smt. Ramawati from Sh. Anoop Chandel (Landlord), Sh. R.S. Kandari, Sh. B.S. Negi and Sh. J.S. Rawat, but all of them have told the investigator that Sh. Anoop Chandel (Landlord) has never rented his building to anybody for the last 10 years and it was orally told by the neighbours that they have never saw this lady residing in their locality. It is mentioned in the investigation report that Sh. Anoop Chandel is working as an Insurance Agent with Sai Associate. So far, driving licence of Smt. Ramawati-insured is concerned, 8 driving licence is filed in original (paper No. 20/3 on the District Forum's record). It is very strange that date of birth of Smt. Ramawati is 17.12.1972 as per the school records, whereas this driving licence was prepared and issued to Smt. Ramawati on 30.06.1989. Meaning thereby, she was only 16½ years of age at the time of issuing of this driving licence. Moreover, in the year 1989 in the State of Uttar Pradesh, there was no provision of issue driving licence in the form of smart card. There is no legible signatures as well as seal of any officer of RTO, Dehradun or RTO/ARTO, Kathgodam, Haldwani, Nainital on this card. Therefore, this driving licence also looks to be a fake driving licence. In investigation report (paper No. 14/4 on the District Forum's record) respondent-Sh. Videshi Lal has given statement to the investigator that his daughter had taken the policy from the office of Bajaj Allianz Company of the annual premium of Rs. 24,996/- and she made him appointee in the policy. He came to know after 4-5 months from the date of death of his daughter that he is the appointee in the insurance policy. This shows that Sh. Videshi Lal-respondent has never purchased the policy in question, i.e. 0202045621 in the name of his daughter Ramawati by reaching and filling proposal form on 11.01.2011 at Dehradun. So far concealment of fact is concerned, the appellants-insurance company has not raised this question in the repudiation letter dated 25.07.2012. In the case of Sunita Devi vs. The Oriental Insurance Co. Ltd.; 2016 2 CPR (NC) 883, the Hon'ble National Commission has held that it is well settled law that the insurance company cannot travel beyond their grounds of repudiation. Furthermore, the appellants have not filed any cogent and convincing evidence regarding ailment of the insured-Ramawati that she had died due to suffering from a long ailment of Asthma.
9. As we have discussed above, we are of the view that there are so many discrepancies regarding filling of proposal form for policy No. 0202045621 at Dehradun in the presence of respondent-Sh. Videshi Lal, whereas according to the investigation report as well as affidavit of 9 Sh. Videshi Lal-respondent that he had never visited Dehradun on 11.01.2011 for the purchase of new policy and there was no reason to visit by Smt. Ramawati at Dehradun for the filling of new proposal form. There is also a discrepancy in date of death and name in the intimation of death under policy as 20.01.2011, whereas in the death certificate date of death of Smt. Ramawati is 22.01.2011. Name of husband of Smt. Ramawati in the Ration Card is Sh. Jitendra Kumar, whereas name of husband is Dinesh in proposal form. Address in the proposal form is C/o Sh. Anil Kumar, Near Panwar Petrol Pump, Maitery Vihar, Haridwar Road, Dehradun, whereas according to the neighbour of such address, she (Ramawati) never resided at this place at Dehradun. The driving licence filed in support of her address also seems to be fake and has never issued from the office of either RTO, Dehradun or RTO/ARTO, Kathgodam, Haldwani, Nainital. The witness of the proposal form named Sh. Yogesh Kumar, 26 Balbir Road, Dehradun has also never came forward and has not filed any affidavit in support of respondent-complainant.
10. The District Forum has not properly considered the facts and circumstances of the case and has erred in allowing the consumer complaint per impugned order, which cannot legally be sustained and is liable to be set aside. Consequently, the appeal is fit to be allowed.
11. For the reasons aforesaid, appeal is allowed. Impugned judgment and order dated 12.05.2015 passed by the District Forum, Nainital is set aside and the consumer complaint No. 55 of 2013 is dismissed. No order as to costs. Amount deposited by the appellants be released in appellants' favour.
(MRS. VEENA SHARMA) (D.K. TYAGI)