HEADING OF JUDGMENT IN CONSUMER CASES : BEFORE THE PRESIDENT, DISTRICT CONSUMER FORUM, GOLAGHAT. Consumer Protection Case No. 2/2010.

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1 HEADING OF JUDGMENT IN CONSUMER CASES : BEFORE THE PRESIDENT, DISTRICT CONSUMER FORUM, Consumer Protection Case No. 2/2010. Mrs. Manju Gohain.... Complainant. Vs. 1. The General Manager, Bajaj Allianz Life Insurance Co. Ltd., GE PLAZA Airport Road, Yerwada, Pune The Branch Manager, Bajaj Allianz Life Insurance Co. Ltd., 2 nd B 2 nd Floor NH Centre Point, Opposite Bora Service, G.S. Road, Ulubari, Guwahati The Deputy Area Manager, Bajaj Allianz Life Insurance Co. Ltd., Jorhat Branch, Jorhat, Assam.... Opposite parties. Date of final hearing Date of judgment & Order APPEARANCES : For the complainant... AND For the opposite party... Mr. L. Tamuly, Advocate, Golaghat. Mrs. R. Duwarah, Advocate, Golaghat.

2 2 P R E S E N T : SHRI T. LOHAR, PRESIDENT, DISTRICT FORUM, SRI A. BARUAH, MEMBER, DISTRICT FFOFRUM, JUDGMETN & ORDER : 1. Smti. Manju Gohain, wife of Late Prodip Gohain, resident of Pulibor Bhagagaon, P.S. and district Golaghat, Assam (hereinafter called as complainant) submitted a petition u/s 2(i)(O) of the Consumer Protection Act, 1986 against the General Manager, Branch Manager and the Deputy Area Manager, Bajaja Allianz Life Insurance Co. Ltd. in connection with death claim against the policies bearing Policy No and respectively in the name of policy holder Prodip Gohain, the husband of the complainant, seeking for awarding of compensation with bonus, interest and other financial benefits accrues therefrom till the date of realization of the policy amounts. 2. The facts giving rise to this proceeding, in brief, is that the husband of the complainant Sri Prodip Gohain is the policy holder of Bajaj Allianz Life Insurance Co. Ltd. bearing Policy No and respectively and thereby sum assured Rs.1,50,000'00 and Rs.50,000'00 respectively. The date of commencement of the aforesaid policies were and and the yearly premium payable Rs.10,000'00 each. The complainant being the legally married wife of the policy holder, has been duly nominated as his nominee. The policy holder during his life time has regularly paid the yearly premium of both the policies till his death on without lapse. The policy holder was an employee of UAEDCL, ASEB and was serving as Deputy

3 3 Area Manager under Jorhat Electrical Division-1,Jorhat. After the death of policy holder, the complainant being the legal wife, as well as the nominee of both the aforesaid policies, has duly made the death claim in respect of the aforementioned policies addressing to the Branch Manager-cum-Deputy Area Manager of Bajaj Allianz Company Ltd., Jorhat branch. The said Branch Manager on receipt of the claim application, vide its letter dated informed the applicant that the death claim of above mentioned policies has been repudiated on the ground of concealment of material fact regarding the health of the policy holder at the time of making proposal for Life Insurance. On advice of the Branch Manager, the complainant vide its letter dated , communicated with the Claim Review Committee, YEROWADA, PUNE, but the said Claim Review Committee did not make any response. It is also mentioned in the claim petition that the O.P. No.3, the Deputy Area Manager, Bajaj Allianz Life Insurance Co. Ltd., Jorhat branch has duly made an enquiry at the office of the deceased, wherein, the policy holder was serving and has obtained the necessary employers certificate and leave certificate of the deceased policy holder. In those certificates issued by the Senior Manager, ASEB, it is clearly stated that the deceased policy holder was a very much regular in the office and was in service till and there was no record of his availing leave for last 5 years until his death. The petitioner finding no other alternative, has served the registered legal notice through her Lawyer addressing to the General Manager, Bajaj Allianz Life Insurance Co. Ltd., GE PLAZA Airport Road, YEROWADA, Pune with its Copy to the Branch Manager, Ulubari, Guwahati and Deputy Area Manager, Jorhat branch demanding to make payment of the policy amounts of the aforesaid policies along with interest. But the opposite party on receipt of the legal notice, neither served any reply nor have made any attempt to settle the matter. The aforesaid policies have acquiring its status of continuity till the date of death of the policy holder. The decision taken by the Deputy Area Manager along with Bajaj Alianz L.I.C. Group is illegal, arbitrary, intentional with ulterior

4 4 motive to misappropriate the policy amount of Rs.1,50,000'00 and Rs.50,000'00 respectively and the interest, bonus and other financial benefits accrued therefrom as per Table Policies announced by the Company. The Deputy Area Manager negligently, illegally with ulterior motive by withholding the payment of the insured amount, vested bonus along with the interest accrued therefrom of the aforementioned policies to the nominee/petitioner/claimant has failed to maintain the utmost good faith as required in this case. 3. On receipt of the notices, the opposite parties contested the case by submitting the written statement, wherein, it is stated that the complaint petition filed by the complainant is not maintainable under the provisions of Consumer Protection Act,1986. That the complainant seeking relief by way of death claim against the answering opposite party is not tenable in the eye of law, as well as on fact. That there is no cause of action in the instant case. The opposite party had admitted the opening of aforesaid policies in the name of the policy holder, who was the husband of the complainant. The answering opposite party has stated in the written statement that it is clearly mentioned in the history of the patient recorded at Aditya Diagnostic & Hospital, Dibrugarh that the husband of the complainant was suffering from pre-existing diabetes at the time of taking both of the policies mentioned above. The life assured was a diabetic was deliberately concealed in the proposal of both the insurance policies made by him to these answering opposite parties. It is further stated that as per the medical certificate of Death issued by the said hospital, Diabetes Mellitus was one of the cause of death. According to the opposite party, the cause of death of the deceased as per medical certificate of Death issued by Aditya Diagnostic & Hospital, Dibrugarh was CVA (Hemorrhagic) with DM & HTN. The answering opposite party has further stated that the representation of the complainant was considered by the Review Committee and the decision was communicated to the complainant in terms of letter dated Under the aforesaid ground, the opposite parties pray for dismissal of the claim petition of the complainant.

5 5 4. In order to prove the case of the complainant, the complainant has submitted her affidavit evidence U/O 18 Rule 4 of CPC. The opposite party has also submitted the affidavit evidence U/O 18 Rule 4 of CPC to prove their defence plea. Both the witnesses, i.e., the witness from the side of the complainant and witness from the side of the opposite party has been thoroughly cross examined by their rival parties. Both parties exhibited various numbers of documents to prove their respective cases. 5. Heard argument of both the sides. 6. Perused the evidence of the witnesses of both the parties. 7. For the purpose of deciding the case, we framed the following issues - (1)Whether there is any deficiency in service on the part of the opposite parties in this case? (2)Whether the complainant is entitled to get the relief as claimed for? DISCUSSIONS, DECISION AND REASONS THEREOF : Issue No. 1 : 8. From the pleadings of the parties, we find that life of the husband of the complainant was insured by O.P./Insurance Company by issuing two policies vide No and , and thereby sum assured at Rs. 1,50,000'00 and Rs. 50,000'00. The date of commencement of the first policy was and another from Ext-1 and Ext-3 are the said policies. The policy holder regularly paid the yearly premium of both the policies till his death. The policy holder died on It is also found that the opposite party repudiated the claim when the complainant submitted the death claim on the ground that the policy holder was a known diabetic patient,who was suffering from last 3/ 4 years and at the time of taking the policy, he

6 6 concealed the said fact in the proposal form vide Ext-1 and Ext-2. The opposite party exhibited the photo copy of the certificate issued by Aditya Diagnostic & Hospital, Dibrugarh as Ext-3. Ext-3 the medical certificate showed that the policy holder was admitted at Aditya Diagnostic & Hospital on for his treatment. There is no medical document on record evidencing the policy holder that he was suffering from the said disease prior to the opening of the policy with the opposite party. There is no evidence that the policy holder at the time of opening the policy, concealed the aforesaid disease. There is no evidence that the policy holder has the knowledge about the said disease suffered by him at the time of opening the policy. The law was settled by the Hon'ble Supreme Court in the case of Life Insurance Corporation of India and others Vs. Sharda Devi, reported in 2008 CTJ 510 (CP) (SCDRC) STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, CHANDIGARH, wherein it is stated as follows- The law was settled by the Hon'ble Supreme Court in the judgment reported as Mithoolal Nayak Vs. Life Insurance Corporation of India, AIR 1962 Supreme Court 814 in which it was held in Para 8 as under : The three conditions of the application of the second part of Section 45 are : (a) the statement must be on material matter or must suppress facts which it was material to disclose ; (b) the suppression must be fraudulently made by the policy-holder ; and (c) the policy holder must have known at the time of making the statement that it was false or that it suppressed the facts which it was material to disclose. Commenting on these conditions, the Hon'ble Supreme court held in its subsequent judgment reported as LIC Vs. G.M. Channabasemm AIR 1991 Supreme Court 392 as

7 7 under : It is well settled that a contract of insurance is contract uberrima fides and there must be complete good faith on the part of the assured. The assured is thus under a solemn obligation to make full disclosure of material facts which may be relevant for the insurer to take into account while deciding, whether the proposal should be accepted or not. While making a disclosure of the relevant facts, the duty of the insured to state them correctly can not be diluted. Section 45 of the Act has made special provisions for a life insurance policy if it is called in question by the insurer after the expiry of two years from the date on which it was effected. Even the National Commission in the judgment reported as 'LIC of India V. Kantaben', 1996 CTJ 573 (CP)=1(1996) CPJ 115 (NC) was pleased to hold as under - The contracts of insurance are utmost good faith. The proposer for Life Insurance is under an obligation to disclose all material facts within his knowledge relating to the state of his health at the time of making the proposal. The averments made as to the state of health of the insured in the proposal form and the personal statements there in are the basis of the contract between the parties. The terms of the policy make it abundantly clear that L.I.C. Has acted upon it by entering into the contract of insurance with the deceased. From the law discussed above, it is abundantly clear that the insurer can always allege and prove that the insured has concealed the material facts and had committed breach of

8 8 trust and thereby challenge the existence of a legal and valid contract between the parties. 9. In the instant case, the complainant exhibited the acknowledgment receipts vide Ext-1, Ext-2 and Ext-3. Ext-4 is the medical certificate, Ext-5 is the employer certificate in printed form, Ext-6 is the repudiation letter, Ext-7 is the copy of the letter addressing the Claim Review Committee, Pune, Ext-8 is the duplicate copy of Lawyer's notice, Exts-9, 10 and 11 are postal receipts, Ext-12 and Ext- 13 are the acknowledgment receipts and Ext-14 is the death certificate(proved in original). The policy holder was working in his office prior to his death. He was very much regular in his office and that there was no record of his availing leave during last 5 years immediately before his death. Ext-5 is the employer certificate issued by the Senior Manager, Jorhat Electrical Division UAEDCL, Jorhat. This fact has not been challenged or scrutnised by the opposite parties. 10. From the said exhibits, it appears that the policy holder was not suffering from any disease prior to the opening of the policies with the opposite parties. The opposite party repudiated of death claim under the aforementioned two policies on the life of policy holder on the ground that the life assured prior to making of the proposal for insurance, the policy holder was a known case of diabetic mellitus since 3/ 4 years. But the opposite party has failed to prove that the policy holder was a known case of aforesaid disease since 3/ 4 years prior to the accepting of the proposal of insurance by the opposite party. This plea of the opposite party without any cogent and convincing evidence can not be accepted. Hence, it is found that this is the clear case of deficiency of duties on the part of the opposite parties by repudiating the legitimate claim of the complainant. Hence, the Issue no.1 is decided in affirmative.

9 9 Issue No. 2 : 11. From the discussions made in Issue No.1, it is decided that the complainant is entitled to get the relief as prayed for. Issue No. 2 is decided accordingly. O R D E R : 12. The claim petition of the complainant is allowed on contest. The opposite parties are directed to pay the sum assured in both the aforementioned two policies, i.e. Policy Nos and to the complainant along with bonus and interest as per present rate against the aforesaid policies within a period of one month from today. 13. Inform the parties accordingly. Given under my hand and seal of the Forum, on this the 3 rd day of August, Dictated & Corrected by me. ( T. Lohar ), PRESIDENT, DISTRICT FORUM, ( T. Lohar ), ( A. Baruah ), PRESIDENT, MEMBER, DISTRICT FORUM, DISTRICT FORUM, Dictation taken & transcribed by me :- S. Borpatra, Steno.

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