State Consumer Disputes Redressal Commission
Bajaj Allianz General Insurance Co. ... vs Major Singh on 4 May, 2017
FIRST ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
First Appeal No.1203 of 2015
Date of Institution: 18.11.2015
Order reserved on:21.04.2017
Date of Decision : 04.05.2017
Bajaj Allianz Life Insurance Company Ltd., The Mall, Ferozepur
City through its Authorised Signatory. (through Mr. Rajinder
Singh Kalsi, Zonal Legal Manager (North), Bajaj Allianz Life
Insurance Co. Ltd., SCO-215-217, Sector-34, Chandigarh)
.......Appellant/Opposite Party No.2
Versus
1. Major Singh s/o Sh. Munsha Singh resident of Village
Kamale Wala, Tehsil & District Ferozepur.
.......Respondent/complainant
2. Punjab Gramin Bank Limited, Near LIC Office, Malwal
Road, Ferozepur City through its Authorized signatory.
.......Respondent/Opposite Party No.1
Appeal against order dated
28.08.2015 passed by the District
Consumer Disputes Redressal
Forum, Ferozepur.
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member.
Smt. Surinder Pal Kaur, Member Present:-
For the appellants : Sh. Varun Chawla, Advocate For respondent No.1 : None For respondent No.2 : Ex-parte ............................................ F.A. No. 1203 of 2015 2 SURINDER PAL KAUR, MEMBER :-
Order Appellant/ Opposite Party No2 has filed this appeal against order dated 28.08.2015 of District Consumer Disputes Redressal Forum Gurdaspur (in short the 'District Forum'), vide which, complaint was allowed and OP No.2 was directed to pay Rs.2,50,000/- along with @6% P.A. from the date of filling the claim till realization and also to pay Rs.5000/- as compensation within 30 days from the receipt of the copy of the order.
2. The complaint was filed by the complainant/ respondent (hereinafter referred as "complainant") U/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the opposite parties (in short "OPs") on the averments that Deceased Life Insured ( in short "DLA") Munsha Singh had purchased Group Master Policy i.e. "Sarve Shakti Surakhsa" for the period from 28.09.2013 to 27.09.2018, after paying the premium of Rs, 10,000/- Opposite party No.2 had issued policy bearing No.0177675666 for the sum assured Rs. 2.5 lac with Rider ADB of Rs.2.5 lac. At the time of issuing the policy insured was medically checked by OPs. During the subsistence of the policy DLA died on 18.3.2014 and being the nominee complainant filed claim and submitted all the required documents as demanded by the OPs. But OPs repudiated the claim on the ground of pre- existing disease of DLA .However, OP No.2 sent a cheque bearing No.103882 dated 18.10.2014 for an amount of Rs.6,457/- of fund value of the policy which was received by the complainant F.A. No. 1203 of 2015 3 under protest. At the time of obtaining the insurance policy DLA was hale & hearty and was not suffering from any disease. Pleading deficiency in service on the part of OPs, complaint was filed before Distt Forum seeking fowling directions against OPs:
i) to pay the genuine claim along-with interest @24% per annum from the date of filing of claim till actual realization;
ii) to pay Rs.2,00,000/- as compensation for harassment ; and
iii) to pay Rs.11,000/- as litigation expenses.
3. Upon notice, OP No.1 filed written reply, taking the preliminary objections that the complainant had not approached the District Forum with clean hands and had suppressed the material facts from this Forum as complainant never informed this OP regarding death of insured; Moreover It was a matter of insurance company i.e. OP No.2 to consider -the claim of the complainant. This OP got issued the policy to DLA from OP No.2. On merits, it was pleaded that DLA was bound by the terms and conditions of the policy. Only OP No.2 was liable to pay the claim. There was no deficiency in service on its part. Other allegations made in the complaint were denied.
4. OP No.2 filed separate written reply by taking the preliminary objections that contract of insurance was only between this OP and Master Policy Holder i.e. OP No.1 and Group Master "Sarve Shakti Suraksa" Policy No.0177675666 was issued to OP No.1. DLA was enrolled as member of said F.A. No. 1203 of 2015 4 master policy. There is contract between the complainant and this OP, therefore, complainant is not a consumer of this OP; complainant had no locus standi to file the present complaint as no cause of action had arisen against this OP and that fund value to the tune of Rs.6,457/- already paid to master policy holder vide cheque No.103882 dated 18.10.2014 favouring Punjab Gramin Bank to the account of DLA under membership number 0306757871 in accordance with the terms and conditions of the policy; DLA had concealed the material facts of his health as he was suffering from cirrhosis of liver and remained admitted in France Newton Hospital Ferozepur Cantt from 19.05.2013 to 20.05.2013 before filling up the enrollment form under the policy; Had he disclosed the true facts regarding his health, this OP might have not issued the membership No. 0306757871 dated 28.09.2013 for the sum assured Rs.2,50,000/- to him; Contract of insurance is a contract of Utmost Good Faith (Uberrima Fides) and that complicated question of law and facts were involved in the complaint which required voluminous evidence, which was not possible in summary procedure, therefore, matter should be relegated to civil court. On merits, it was pleaded that DLA enrollment as member of Group Master "Sarve Shakti Suraksa"
Policy. Enrollment form was duly signed by the DLA. Believing the statements of the DLA, he was enrolled as member of the above said policy for the period from 28.09.2013 to 27.09.2018 for a sum assured Rs.2,50,000/-. DLA died within six months from F.A. No. 1203 of 2015 5 the subsistence of the policy. Medical reports, investigations and hospital record confirmed that the DLA was suffering from Cirrhosis of Liver and remained admitted in Frances Newton Hospital, Ferozepur Cantt. from 19.05.2013 to 20.05.2013 prior to the date of filling up the enrolment form & date of acceptance of risk on his life. DLA had suppressed the material facts regarding his illness, which were known to him prior to signing and submitting the enrolment form just to induce the opposite party to enroll him as a member of the Master Policy. Claim of the complainant was rightly repudiated for non discloser of material facts vide letter dated 01.11.2014 and the permissible fund value amounting to Rs.6457/- was paid to the policy holder. Other allegations made in the complaint were denied.
5. Both the sides produced evidence in support of their respective averments before the District Forum, which after going through the same and hearing learned counsel on their behalf allowed the complaint, vide aforesaid order.
6. Aggrieved with the order of the District Forum, Appellant/OP No.2 filed the present appeal before this Commission.
7. We have heard learned counsel for both the sides and have gone through the records of the District Forums.
8. It was submitted by the Learned Counsel for the OP No.2 that the District Forum committed an illegality by issuing directions to pay the insurance claim of Rs.2,50,000/- along with interest @6% p.a. from the date of filing the claim till realization F.A. No. 1203 of 2015 6 and to pay Rs.5000/- as compensation. The District Forum failed to appreciate the fact that DLA deliberately/intentionally concealed the status of his health at the time of enrolment as he was suffering from Cirrhosis of Liver and remained admitted in Frances Newton Hospital, Ferozepur Cantt. from 19.05.2013 to 20.05.2013 i.e. prior to filling up the enrolment form on 29.9.2013. The insurance policy is based upon the principle of uberrima fides which was violated by the DLA. Therefore, OPs rightly repudiated the claim on suppression of material facts. It prayed for acceptance of the appeal and dismissal of the complaint.
9. It is not in dispute that Master Policy (Ex.OP-3) was issued under the name of Punjab Gramin Bank and DLA was enrolled as a member with membership No. 0306757871 dated 28.09.2013. It is specific plea of the OPs that DLA was suffering from cirrhosis of liver and remained admitted in France Newton Hospital Ferozepur Cantt. from 19.05.2013 to 20.05.2013 and to prove this fact they placed on record discharge summary (EX.OP- 2/9) of France Newton Hospital Ferozepur Cantt. OPs repudiated the claim of the complainant vide letter dated 01.11.2004 on the ground of pre-existing disease. However, a cheque of Rs.6457/- was refunded to Gramin Bank as fund value and the same was issued to the complainant.
10. It is a fact that the enrollment form was filled up by DLA for obtaining the enrollment under the master policy. The agent, who filled up the enrollment form, is considered as the F.A. No. 1203 of 2015 7 agent of the proposer. A perusal of enrollment form Ex.OP-2/3 reveals that the insured marked his thumb impression on the declaration of good health. It means insured was illiterate and language of the declaration was in English. However, declaration was duly witnessed by one Sanjeev Handa. But it was specifically mentioned in next clause in the proposal form "if the answer and/or signature herein above are/is in vernacular then he/she should declare above his/her signature in own handwriting that the replies were given after fully and properly understanding the questions".
A perusal of this clause makes it clear that it was necessary to endorse that the proposer has given the answers after fully understanding in vernacular, which he understands. The onus was on the OPs to prove that the contents of the form were explained to the insured in the vernacular language which he understood. They could have examined that Mr. Sanjeev Handa in order to prove that the contents of the proposal form were explained to the insured. OPs failed to discharge the onus that contents were explained to the insured in the vernacular language which he understood. Had the OPs explained the contents of the enrollment form in vernacular language, insured might have disclosed the factum of his health. Therefore, the reputation of claim by OPs on the ground of suppression of the factum of pre- existing disease is not justified. The District Forum after considering all the facts rightly allowed the complaint of the F.A. No. 1203 of 2015 8 complainant. The order of the District Forum is justified and upheld.
11. In view of the above discussion, the appeal of the appellant/OP No.2 is dismissed with no order as to costs.
12. The appellants/OP No.2 deposited the sum of Rs.25,000/- at the time of filing the appeal on 18.11.2015 and another amount of Rs.1,82,062/- in compliance of the order dated 18.12.2015. These amounts along with interest accrued thereon, if any, be remitted by the Registry to the respondent/complainant by way of Cross Cheque/Demand Draft after expiry of 45 days and under intimation to the District Forum.
13. Now, the order be communicated to the parties as per rules.
14. The appeal could not be decided within the statutory period due to heavy pendency of court cases.
(Gurcharan Singh Saran)
Presiding Judicial Member
(Surinder Pal Kaur)
May 04, 2017 Member
DB