State Consumer Disputes Redressal Commission
Chandan Jain Wife Of Late Sh. Satish ... vs Bajaj Allianz Life Insurance Company ... on 13 January, 2014
2nd Additional Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
First Appeal No. 417 of 2012
Date of institution: 04.04.2012
Date of Decision : 13.01.2014
Chandan Jain wife of Late Sh. Satish Kumar Jain, C/o Mahavir Book
Depot, Chaura Bazar, Ahmedgarh, Tehsil Malerkotla, District Sangrur.
.....Appellant/complainant
Versus
1. Bajaj Allianz Life Insurance Company Limited, GT Plaza, Airport
Road, Yerwada, Pune 411006, through its Authorized Signatory.
2. The Branch Manager, Bajaj Allianz Life Insurance Company Limited,
Telephone Exchange Road, Sangrur.
.....Respondents/O.Ps
First Appeal against the order dated
16.02.2012 passed by the District Consumer
Disputes Redressal Forum, Sangrur.
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member
Sh. Vinod Kumar Gupta, Member Argued By:-
For the appellant : Sh. Sanjeev Goyal, Advocate
For the respondents : None
Order
VINOD KUMAR GUPTA (MEMBER)
This appeal was filed by the appellant/complainant (hereinafter called as "complainant") under section 15 of Consumer Protection Act, 1986, (hereinafter called as "Act") against the impugned order dated 16.02.2012 passed by the District Consumer Disputes Redressal Forum, Sangrur (in short 'District Forum') in consumer complaint No. 441 of 2011 vide which the complaint was dismissed. First Appeal No. 417 of 2012 2
2. Brief facts of the case are that Chandan Jain complainant has filed the complaint under section 12 of the Act against respondents/Opposite Parties (hereinafter called as "O.Ps") making the averments that her husband namely Sh. Satish Kumar Jain (deceased) had taken the life insurance policy (Max Advantage) bearing number 189780942 from O.Ps on 14.10.2010 and paid first instalment of the premium amounting to Rs. 25,000/- on 14.10.2010 through a cheque. It was pleaded that in the event of death of Satish Kumar Jain, the O.Ps were liable to make the payment of an assured amount of Rs. 1,75,000/-. The complainant being a beneficiary/nominee of her husband is a consumer of the O.Ps. It was alleged that Sh. S.K. Jain felt a severe pain in his chest on the night of 30.12.2010 at his residence at Ahemdgarh and was taken to his family doctor Sh. Rajiv Sood where he was declared brought dead at the hospital and the cause of death was told to be heart attack (cardiac arrest) by the doctor. The information was given to the O.Ps and lodged the claim on 13.01.2011. It was alleged that the claim of the complainant was rejected by the O.Ps vide letter dated 26.02.2011 on the ground that the deceased was diagnosed and treated for pulmonary tuberculosis in September, 2008 and this fact was not disclosed in the proposal form. It was pleaded that husband of the complainant was fully fit and was not suffering from any pulmonary tuberculosis disease. Dr. K.C. Goyal from Sangrur had visited the house of the complainant for pre-policy complete check-up on behalf of the O.Ps and declared in his report that Sh. Satish Kumar Jain was fit and no such problem was diagnosed by him during check up. It was further pleaded that the husband of the complainant had also taken the life insurance policy from the O.Ps on 13.07.2007 and during that period he had a minor problem of pulmonary tuberculosis which was cured after undertaking the treatment of DOTS First Appeal No. 417 of 2012 3 from civil hospital for 10 months. The O.Ps had also released the policy amount of that policy to the complainant vide letter dated 08.02.2011. It was alleged that the O.Ps have rejected the claim of the complainant illegally which shows unfair trade practice on the part of the O.Ps. The complaint was filed seeking directions to the O.Ps to release insurance amount of Rs. 1,75,000/- alongwith interest @ 18% p.a. from the date of death till realization and Rs. 50,000/- on account of mental torture, agony and Rs. 22000/- as litigation expenses.
3. Upon notice, O.Ps filed the written version by taking preliminary objections that the complainant has not come to the court with clean hands and has suppressed the material facts. On merits, it was admitted that Late Sh. Satish Kumar Jain deceased life insured had taken the life insurance policy number 189780942. It was denied that the deceased died due to severe pain in his chest on the night of 30.12.2010 at his residence at Ahmedgarh. It was admitted that the complainant lodged the claim with the O.Ps. It was further submitted that the matter was investigated by the O.Ps and it was confirmed that the deceased was diagnosed and treated for pulmonary tuberculosis in September 2008 and this fact was deliberately and with malifide intention not disclosed by the deceased life insured at the time of making the proposal of insurance, on the basis of which insurance was issued. It was further submitted that the claim of the complainant was rightly repudiated. It was pleaded that the life insured gave the proposal form on 01.11.2010 and he died on 30.12.2010 i.e. after about 59 days after commencement of the risk. In respect of the medical examination of the deceased prior to issuance of the policy, it has been stated that the same was only a preliminary examination of the health of the deceased life insured on the basis of First Appeal No. 417 of 2012 4 disclosure made in the proposal form and prayed for dismissal of the complaint.
4. Parties were allowed by the District Forum to lead their evidence.
5. In support of his allegations, the complainant had tendered into evidence his affidavit Ex. C-1, newspaper cutting Ex. C-2, certificates Ex. C-3 and Ex. C-4, premium receipts Ex. C-5 and Ex. C-6, copy of cheque Ex. C-7, letters Ex. C-8 and Ex. C-9 and closed the evidence.
6. On the other hand, O.Ps tendered into evidence investigation report Ex. R-1, treatment cards Ex. R-2 and Ex. R-3, affidavit Ex. R-4, proposal form Ex. R-5, letter dated 26.02.2011 Ex. R-6, affidavit Ex. R-7 and closed the evidence.
7. After going through the allegations in the complaint, written statements, evidence and documents on the record, the learned District Forum vide impugned order dated 16.02.2012 dismissed the complaint.
8. Aggrieved by the impugned order dated 16.02.2012 passed by the learned District Forum, the appellant/complainant has come up with the appeal and filed the present appeal on the grounds that the order of the District Forum is unjust, unfair, improper, illegal, without jurisdiction and is against the law and facts on record. The District Forum wrongly and illegally dismissed the complaint on the ground that the complainant did not disclose about taking of treatment of pulmonary tuberculosis in the proposal form and the said fact was deliberately suppressed by the deceased as such the claim was rightly repudiated by the O.Ps due to non disclosure of material facts. This finding of the learned District Forum on this ground is totally erroneous because the District Forum failed to appreciate that the deceased had died due to heart attack and pulmonary tuberculosis has no way any concerned with the death of the insured. First Appeal No. 417 of 2012 5 District Forum has also failed to appreciate the fact that before taking the insurance policy, insured Satish Kumar Jain was duly examined by the doctor of the O.Ps and nothing wrong was found. Consequently the policy was issued and as such now the O.Ps cannot take the benefits of the exclusion clause. The learned District Forum also failed to appreciate the fact that the insured took the treatment for pulmonary tuberculosis till 28.02.2009 and the policy in question was issued on 01.11.2010 after the gap of more than 20 months and at the time of getting the policy, the insured was heal and heart and was not suffering from any disease. There was no deficiency in service on the part of the O.Ps. It was prayed the appeal be accepted and the order of the District Forum may kindly be set- aside.
9. Neither counsel for the respondents/OPs nor anybody on behalf of the respondents/OPs was appeared at the time of arguments. 10 We have gone through the pleadings of the parties, perused the record of the learned District Forum and heard the arguments of the learned counsel for the appellant.
11. It is admitted fact that Sh. Satish Kumar Jain now deceased took the life insurance policy (Max Advantage) from the O.Ps on 14.10.2010 and paid the first premium of Rs. 25,000/- on 14.10.2010. The policy number 189780442 was issued by the O.Ps for sum assured of Rs. 1,75,000/-. Ex. R-2 and Ex. R-3 are the copies of the treatment record coupled with the report investigation report by SA associates and affidavit Ex. R-4 of Sh. Vipul Goyal of S.A. associates proved that the life insured was suffering from T.B. in 2008 and was taking the treatment from DOTS centre at Ahmedgarh. There is no medical evidence to substantiate that the cardio respiratory failure in case of the deceased life insured was due to T.B. but there is definite evidence to this effect that that the deceased First Appeal No. 417 of 2012 6 life insured was diagnosed and treated for pulmonary tuberculosis in September 2008 and this fact was known to him.
12. We have also perused the proposal form Ex. R-5. Column 14
(c) and 14 (l) which reads as under:-
14 (c) Any diseases and disorders of the respiratory system such as but not limited to blood in sputum, tuberculosis, asthma, infected respiratory disease or any respiratory system disease including frequent bleeding fever and dyspnoea?
14 (l) In the last 5 years, have you ever had, or been advised to have, or are likely within the next 30 days to undergo medical examination or any investigations such as but not limited to blood test, urine test, x-ray, ECG or biopsy, CT scan or test by any other special instrument?
In this proposal form, the deceased replied in negative to the above query.
13. We have also perused the investigation report Ex. R-1 dated 18.02.2011 in which it was mentioned that the cause of death (as per the death intimation) is heart attack. In the investigation report in Part (F) miscellaneous general in coloumn No. 9 reasons that the above conclusion is as under:-
Yes. LA was suffering from T.B. in 2008 and was taking the treatment from DOTS centre at Ahmedgarh. Copy of DOTS treatment chart is enclosed with the report dated 04.09.2008 and in column No. 9 conclusive remark, this case is of T.B. before the date of commencement of the policy and diabetes. As per record Ex. C-5 the earlier policy taken by the complainant vide policy number 71583892 dated 13.10.2007 for a sum of Rs. 1 lac and the amount has been paid by cheque dated 01.02.2011 Ex. C-7 by the O.Ps. When the deceased had taken the First Appeal No. 417 of 2012 7 previous policy on 13.10.2007, he was not being treated for T.B. therefore the insurance amount of that policy was rightly paid. However at the time of filling up of the proposal form Ex. R-5 on 1.11.2010. The material facts in respect of the health of the deceased life insured were suppressed. In case the deceased died within 59 days after taking the policy shows that he was having pre-existing disease which he failed to disclose. Judgment of Hon'ble Supreme Court in "Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd (2010) ACJ(265) can be referred. In the revision which was accepted setting aside the judgment of State Commission, on the ground of concealment. So for as check up by the doctor at the time of taking the policy was general check up not exhaustive. Therefore the claim of the complainant was rejected by the O.Ps against policy number 189780942 on the ground due to non closure of the material facts. The deceased deliberately suppressed the facts relating to his health and the claim was rightly repudiated due to non closure of the material facts. The mere fact that the disease of T.B. is curable and furthermore the payment of the insurance amount of the earlier policy was paid does not warrant that the O.Ps were aware of DOTS treatment taken by the deceased for 10 months in civil hospital. We do not find any unfair trade practice and deficiency in service on the part of the O.Ps.
14. Sequel of the above discussion, we are of the opinion that the impugned order of the learned District Forum is just and proper and does not call for any interference. The order of the District Forum is affirmed and is upheld. There is no merit in the appeal and the same is dismissed.
No order as to costs.
15. The arguments in this appeal were heard on 08.01.2014 and the order was reserved. Now the order be communicated to the parties as per rules.
First Appeal No. 417 of 2012 8
16. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
(Gurcharan Singh Saran) Presiding Judicial Member (Vinod Kumar Gupta) Member January 13, 2014.
RK