State Consumer Disputes Redressal Commission
Bajaj Allianz Lic Ltd vs Dalbir Kaur on 11 January, 2019
Daily Order FIRST ADDITIONAL BENCH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB SECTOR 37-A, DAKSHIN MARG, CHANDIGARH First Appeal No.392 of 2018 Date of Institution : 09.07.2018 Order Reserved on : 09.01.2019 Date of Decision : 11.01.2019 1. Branch Manager, Bajaj Allianz Life Insurance Company Ltd., 3D Floor, Balaji Chambers, SCO-3, District Shopping Complex, B-Block, Ranjit Avenue, Amritsar- 143001. 2. Authorized Officer, Bajaj Allianz Life Insurance Company Ltd., Sarhai Road, Tarn Taran. 3. Executive Head/Authorized Officer, Bajaj Allianz Life Insurance Ltd.,East Hub, 3rd Floor Eco Space Plot No.II/F/116, Rajarhat, New Town, Kolkata, West Bengal 700156. 4. Executive Head/Authorized Officer, Bajaj Allianz Life Insurance Company Ltd., 5th Floor, GE Plaza Airport Road, Yerawada, Pune 411006. (Through Sh. Nitin Arora, Manager, Bajaj Allianz Life Insurance Co. Ltd., SCO 215-217, Sector 34,Chandigarh) Appellants/Opposite parties Versus Dalbir Kaur w/o Late Sh.Bakshish Singh, resident of House no.4, VPO Chak Sikandarpur, Tehsil and District Tarn Taran. Respondent/Complainant First Appeal against order dated 01.05.2018 passed by District Consumer Disputes Redressal Forum, Tarn Taran. Quorum:- Shri J. S. Klar, Presiding Judicial Member
Sh.Rajinder Kumar Goyal, Member.
Present:-
For the appellants : Sh.Varun Chawla, Advocate For the respondent : Sh.Bikramjit Aroura, Advocate . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J.S KLAR, PRESIDING JUDICIAL MEMBER :-
Challenge in this appeal by appellants is to order dated 01.05.2018 of District Consumer Disputes Redressal Forum Tarn Taran, directing the appellants to pay the death claim for full insured amount of the insured by accepting the complaint of the respondent of this appeal and further directing them to pay Rs.10,000/- as compensation and cost of litigation to respondent herein. The respondent of this appeal is complainant in the complaint before District Forum below and appellants of this appeal are opposite parties therein and they be referred as such hereinafter for the sake of convenience.
2. The complainant has filed the complaint U/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against OPs on the averments that as per Bajaj Allianz Life Insurance policy, the persons having 0-18 years or of above age could choose Gold Plan variant. On the maturity date, if all premiums were paid, then policy would terminate. In case of unfortunate death of life assured during the policy term, the sum assured on death was the higher of 1.5 times of the assured amount in case of Silver variant plan, whereas it was two times higher amount in case of Gold Variant Plan. The complainant and her family members proposed to assure the life of her son Kulwant Singh from OPs under Bajaj Allianz Allianz Invest Assure. OPs/company issued policy in favour of Kulwant Singh, vide policy no.0317274551 and said policy was issued in the year 2012 and its premium was to be paid under half yearly plan and premium to be paid as fixed was Rs.25712/- and installments fixed for semi-annual and sum assured on maturity of the policy were fixed of Rs.8,50,000/- and death benefit minimum sum assured was Rs.17 lac being two time of the sum assured. The above policy was issued to Kulwant Singh and designated his mother as his nominee therein. Kulwant Singh died a natural death on 12.09.2014 at his residence in the village Chak Sikander Tehsil of District Tarn Taran. The complainant gave required information to insurance company regarding death of Kulwant Singh for obtaining the insured amount under the policy no.0317274551. All documents like death certificate and information were given to official of OPs by complainant for claiming the insurance claim regarding death of Kulwant Singh. OPs dilly-dallied over this matter. OPs also conducted medical examination and personal investigation regarding any ailment of the assured before issuance of the policy. Repudiation of claim of the complainant is arbitrary and baseless by OPs. The complainant has filed complaint praying that OPs be directed to pay the total minimum death benefit under the policy i.e. Rs.17 lac on account of death of Kulwant Singh with interest on the above referred amount, besides compensation of Rs.20,000/- for mental harassment and Rs.10,000/- as cost of litigation.
3. Upon notice, OPs appeared and filed written reply and contested the complaint of the complainant by raising preliminary objections that Kulwant Singh deliberately, dishonestly and with malafide intention concealed the true and correct facts regarding his health condition at the time of filling up the proposal form for taking the policy on 05.08.2014. He gave fraudulent and wrong information regarding his state of health and OPs would not have issued the policy to him, had correct facts been disclosed by him. Various investigations, hospital treatment records and medical certificate issued by Baba Budha Ji Charitable Hospital Bir Sahib Village Thatha Tarn Taran confirmed the fact that Kulwant Singh was suffering from vomiting of blood before taking the policy. The deceased gave wrong and false answers, statements and declarations in the proposal form dated 05.08.2014 knowing well that those were false and incorrect. The ailments from which the deceased was suffering prior to the date of proposal were knowingly not disclosed by him just to induce the OPs to accept the risk on his life in a fraudulent manner. The deceased knowingly gave answers, statements and declarations, which were not true and thereby deliberately suppressed the material facts from OPs, which were not in the knowledge of the company. He violated the principle of "Umberrima Fides" by suppressing the material information fraudulently from OPs. He deliberately gave wrong answers to OPs in the proposal form regarding his state of health. OPs prayed for dismissal of the complaint.
4. The complainant tendered in evidence her affidavit Ex.C-1, affidavit of Sukhjinder Kaur wife of Nishan Singh, resident of VPO Chak Sikandarpur Tehsil and District Tarn Taran as Ex.C-2 along with copies of documents Ex.C-3 to Ex.C-10 and closed the evidence. As against it; OPs tendered in evidence affidavit of Nirmal Singh Branch Manager of Bajaj Allianz as Ex.OPs1 to4/1 along with copies of documents Ex.OPs1to4/2 to Ex.OPs1to4/24 and closed the evidence. On conclusion of evidence and arguments, the District Consumer Forum Tarn Taran accepted the complaint of the complainant by virtue of order dated 01.05.2018. Aggrieved by above order of the District Forum Taran Tarn, opposite parties now appellants have carried this appeal against the same.
5. We have heard learned counsel for the parties and have also examined the record of the case.
6. The evidence on the record coupled with pleadings of the parties have been carefully scanned by us in this case. Dalbir Kaur complainant in evidence her affidavit Ex.C-1. Affidavit of Sukhjinder Kaur is Ex.C-2 on the record. They deposed regarding the fact of taking of insurance policy by Karnail Singh, regarding his death and denial of OPs to make the payment to complainant as his nominee and legal representative without any valid reason after his death. Ex.C-3 is rejection of claim by OPs dated 12.05.2015. Ex.C-4 is the death certificate of Kulwant Singh recording his date of death as 12.09.2014. Her Aadhar card is Ex.C-5 on the record. Letter Ex.C-6 dated 15.09.2015 addressed to complainant. The complainant sought information under RTI Act by moving an application to OPs vide Ex.C-7 about this insurance claim. Legal notice was sent to OPs through her counsel Mohinder Pal Arora, vide Ex.C-8 on the record.
7. In rebuttal of this evidence, OPs relied upon affidavit of Nirmal Singh Branch Manager of Bajaj Allianz Life Insurance Company Ex.Ops 1to 4/1 on the record. This witness has deposed in his testimony that Kulwant Singh (deceased) fraudulently and willfully gave wrong answers in the proposal form with regard to his state of health to OPs and thereby misled them in issuing the policy. He further stated that he has not disclosed the fact of his pre-existing ailment of vomiting of blood in the proposal form and thereby breached the principle of good faith underlying the contract of insurance and thereby violated the principle of "Uberrima Fides" in the contract of insurance. It has appeared in his deposition that the specific questionnaire with regard to his state of health or previous ailments were fielded to him in the proposal form by OPs, but he replied then in negative willfully. Ex.Ops1to4/2 is repudiation of the insurance claim on 12.05.2015 by OPs. Ex.OPs1to4/3 is also repudiation of claim. Ex.OPs1to4/5 is death certificate of Kulwant Singh. Ex.OPs1to4/6 is certificate of hospital treatment of late Sh. Kulwant Singh by authorized signatory of Total Transparency Investigation Pvt. Ltd and certificate of hospital treatment is Ex.OPs1to4/7. Investigation report is Ex.OPs1to4/8 submitted by Rahul Business Manager. Similarly, we have also examined other documents Ex.OPs1to4/9 to Ex.OPs1to4/25 which are also placed on record.
8. From hearing respective submissions of counsel for the parties and perusal of , the only point which emerges for consideration before us in this appeal is as to whether life assured Kulwant Singh (since deceased) suppressed the material fact of his pre existing ailment fraudulently from OPs, while filling up the proposal form for taking insurance policy and thereby induced OPs to issue the policy. There is no denial of this fact by OPs that he was insured with OPs under the policy. OPs repudiated the claim of the complainant primarily on the ground that he suppressed the material facts of his pre-existing ailment of vomiting with blood in this case. The complainant has not admitted this fact on the record. We have to refer to material documents on the record to decide this controversy brewing between the parties. The main reliance of OPs is on the report of investigator Ex.OPs1to4/8 dated 09.01.2015 has been scrutinized by us with the able assistance of counsel for OPs now appellants. The investigator based his report on the documents prepared by him from Baba Budha Ji Charitable Hospital Bir Sahib Village Thatha Tarn Taran Punjab. This is the sole document on the basis of which investigator founded his report in this case. The investigator recommended his observation "deliberate concealment of material facts leading to breach of principle of utmost good faith in the contract of insurance" by the assured. The counsel for OPs now appellants relied upon copy of certificate of medical officer Baba Budha Ji Charitable Hospital Ex.OPs1to4/9 on the record. This certificate is attested by Medical Officer, but there is no affidavit of the concerned Medical Officer on the record who issued it. Even name of the doctor is not mentioned on it and only initials of his name of first letter is put on it. Whatever the case may be, no specific ailment wherefrom Kulwant Singh was suffering has been described in it. Vomiting of blood could be on account of many reasons, which might not be within the knowledge of the assured Kulwant Singh (since deceased). The contract of insurance can be repudiated, if fact of pre- existing ailment was within the knowledge of the insured and he has fraudulently and deliberately concealed the same. Nothing could be made out form this certificate Ex.OP1to4/9 that the fact of vomiting of blood was due to any specific disease which was within the knowledge of the life assured. Vomiting of blood could be on account of many factors, which could not be supposed to be in the knowledge of life assured. This certificate has been issued on the basis of document Ex.OPs1to4/7 the certificate of hospital treatment. It has only recorded blood in vomiting in this certificate. It is not recorded as to what was the specific disease which caused it. Vomiting of blood could be due to many reasons and it cannot be said that he suffered from preexisting disease, which was in his knowledge and he fraudulently and deliberately concealed it from insurer. He was not an old person and vomiting of blood cannot be presumed to be within the knowledge of life assured on account of any specific disease or reason. There is no medical record on the file either by any tertiary hospital or by that hospital to establish this fact that it was on account of any specific ailment only. Consequently, repudiation of claim on this ground by OPs is unsustainable and merits to be set aside. The District Forum has correctly not relied upon this certificate relied upon by OPs to prove the fact of pre-existing disease of life assured. The element of knowledge of pre-existing disease by the assured is a sine qua non for rejection of the claim by insurance company, which he fraudulently suppressed in the proposal from insurer. Consequently, this Fora agrees with the findings of the District Forum recorded under challenge in this appeal to the effect that the repudiation of the claim by OPs is unjust and unsustainble.
9. As a result of our above discussion, there is no merit in this appeal of the appellants and same is hereby dismissed.
10. The appellants had deposited an amount of Rs.25,000/- in this Commission at the time of filing the appeal and further deposited the amounts of Rs.17,63,970/- as per compliance of the order of this Commission. Both these amounts with interest, if any, accrued thereon, be remitted by the registry to the respondent /complainant of this appeal by way of crossed cheque/demand draft within 45 days, subject to stay order, if any. Remaining amount, if any, due shall also be paid to respondent/complainant by the appellants within 45 days from the date of receipt of the copy of this order.
11. Arguments in this appeal were heard on 09.01.2019 and the order was reserved. Certified copies of the order be communicated to the parties as per rules.
12. The appeal could not be decided within the statutory period due to heavy pendency of court cases.
(J. S. KLAR) PRESIDING JUDICIAL MEMBER (RAJINDER KUMAR GOYAL) MEMBER January 11 , 2019 (ravi)