Respected sir,
I am Shyampal Singh Father of Late. Rohit Shyampal Singh. My son expeired on 16th November2009 in a road accident held at chakan-talegoan road at pune. He was heading towards chakan a truck traveling towards talegoan came tried to overtake came on wrong side, an smashed my son(who was riding the bike) from front an took him down the road, due to heavy rain the truck got stuck in the mud down the truck my son was trapped under the heavy load . My son died on the spot due to speed impact and extremely heavy load. He was riding the bike with two pillion(two person total 3person on bike including the driver) the reason for riding two person was due to lack of proper transportation in that area the accident occured at 20:30hr in night. They were going to have some food from a near by hotel as there were service engineers and stay there for night. These all reason which I have given for 3person can be proved efficiently at that sopt. My brother bike(Honda unicorn) was insured from "bajaj allianz general insurance company ltd" with a person driver cover of "100000". the company is refusing to pay any claim. His
Claim no: OC-10-2001-1802-00004681.
Policy no: OG-09-2001-1802-00093154.

I request u to do the need full for the same as my son was married, He left behind his 'Wife', '3years old Son' an '1year old daughter. for there betterment of there life I request to settel all the claim on the basis of humanity.

Thanking you,

Yours truly,

Shyampal Singh
address: House number-636/8, Panchnath colony, Kalewadi, Pune:411017.(Maharashtra)
Phone no: 020-69350463.
Cell no : 09370073846.
email-id : rahullsinghh@gmail.com

S.C. CASE NO.: FA/2009/262 DATE- 06.11.2009



DATE OF FILING: -21.07.2009



APPELLANT : Dr. Ranjit Kumar Dey,

122, Motilal Gupta Road, P.O.- Barisha,

Kolkata-700 008.



RESPONDENTS : 1. Bajaj Alliance General Insurance Company Limited,

Poddar Court, Gate no-3, 7th Floor,

18, Rabindra Sarani, Kolkata-700 001.



2. General Manager, Dewar’s Garage Limited,

4, Council House Street, Kolkata-700 001.



BEFORE: HON’BLE JUSTICE : Sri. Aloke Chakrabarti, PRESIDENT.

MEMBER : Sri. A.K. Ray.

MEMBER : Smt. Silpi Majumder.



FOR THE APPELLANT : Sri. Debesh Halder, Advocate.

FOR THE RESPONDENTS : 1. Sri. N.R. Mukherjee, Advocate.

2. Sri. Soumen Roychowdhury, Advocate.



-ORDER-



S. Majumder, Member.



This appeal has arisen out of the judgment passed by the District Forum, Kolkata, Unit-II, on 22.06.2009, in its case no-CDF/Unit-II/CC no-412/2008, wherein the Forum below has dismissed the complaint on contest against the OP-1 and exparte against the OP-2 without any cost.



The brief facts of the case of the Complainant before the Forum below were that on 06.07.2004 he booked a Maruti AC car through hire purchase and the insurance of the said car was done and he took the delivery of the car on 10.07.2004 from the OP-2. As per terms and condition the Complainant used to pay EMI regularly since its purchase. On 03.04.2008 the said car met an accident near Dankuni and the Complainant informed the said incident to the OP2 for making inspection and paid a sum of Rs.100/- and after inspection the OP-2 requested the Complainant to remove the vehicle at his garage and accordingly the vehicle was brought to the OP-2 and the OP-2 gave an estimate of cost of Rs.22,792.68/- for repairing of the vehicle.On 15.04.2008 the Complainant informed the OP-1 regarding the accident of the vehicle and made claim against the policy. But on 01.05.2008 he received a letter-dated 25.04.2008 from the OP-1 wherein the OP-1 repudiated the claim. Thereafter several requests were made on behalf of the Complainant in respect of allowing his claim, but to no effect till filing of the complaint before the Forum below. Thereafter finding no other alternative the Complainant filed the complaint before the Forum below praying for direction upon the OP to return the vehicle after proper repairing and also prayed for compensation for harassment for a long period.



Being aggrieved by the abovementioned judgment the Complainant-Appellant has preferred the present appeal before this Commission contending the same facts as stated by him in the complaint petition before the Forum below. According to the Appellant the judgment passed by the Forum below is erroneous, illegal and liable to be set aside and he has prayed for allowing the present appeal.



The OP-1 took the plea before the Forum below by filing written version that no accident has been occurred, the vehicle has been merely suffered from an internal mechanical defect and its body has not been damaged. According to the OP-1 there was engine problem in the vehicle and for this reason it could not be started properly. It has been further contended by the OP-1 that the mechanical defect is out of the scope of the policy issued. Notice of accidental loss has not given to the Company in writing immediately as per terms and conditions and hence the claim was rightly repudiated and the same was conveyed to the Complainant along with the reasons through a letter-dated 25.04.2008 and accordingly the OP-1 had prayed for dismissal of the complaint.



On careful consideration of the record it is seen by me that the Complainant has failed to make out a case of deficiency in service on the part of the Insurance Company. The Forum below has correctly held that it is undisputed that the Insurance Company is under obligation to render its service as per the contract and settled principles of law and practice of insurance and it has the power to repudiate an insurance claim if it does not fall within the scope of terms and conditions of the policy. Within the four corners of the complaint petition it has not been mentioned by the Complainant that with whom the accident occurred and it is curious to me that after the said accident no FIR has been lodged with the police station on behalf of the Complainant and the Complainant has miserably failed to establish the incident of accident by adducing any cogent evidence. In case of accident an FIR is a vital document and it is important evidence. I have perused the insurance policy, which covered only accidental loss and damages, but the Complainant has produced no such iota of evidence before the Forum below and hence the allegation of accident is not proved. Getting information of accident from the Complainant the OP-1 has appointed one surveyor for assessing the loss and damage due to accident, but before inspection the vehicle has been dismantled. It is evident from the complaint that on 03.04.2008 the accident allegedly took place, but he informed the OP-1 on 15.04.2008, there is no explanation as to why such information was given at a belated stage. As per policy conditions of it was incumbent upon the insured to inform the insurance company immediately on occurrence of an accident without any loss of time so as to enable the OP-1 to check the veracity of the allegation. But in the instant case before inspection by a surveyor the Complainant has repaired the car.



Going by the foregoing discussion it can be held that the Complainant-Appellant has failed to establish his case regarding accidental damage, which was covered under an insurance policy with the OP-1. I do not find out any deficiency in service on the part of the Respondents. In my view the judgment passed by the Ld. Forum below does not suffer from any material irregularity and infirmity and which is liable to be sustained. Hence it is ordered that the appeal be dismissed on contest without any cost the Forum’s judgment is hereby affirmed. The office is directed to send down the copy of this judgment to the Forum below and issue the same upon the recorded Advocates/parties free of cost forthwith.

FA.No.928/2006 AGAINST C.D.No.1017/2005 DISTRICT FORUM-I, HYDERABAD.

Between:

Lagisetty Pandiah

S/o.late Venkata Ramaiah

Occ:Bank Manager, R/o.Plot No.13/8

H.No.11-13-184/14/C,

Green Hills Colony, Saroornagar,

Hyderabad. Appellant/

Complainant.

And
Bajaj Allianz General Insurance Co. Ltd.,

608 & 609, II Black White House,

Begumpet, Hyderabad. Respondent/

Opp.party.



Counsel for the Appellant: Mr.Y.V.Narasimhacharyulu



Counsel for the Respondent:Mr.A.Ramakrishna Reddy.



QUORUM: SMT.M.SHREESHA, MEMBER

&

SRI K.SATYANAND, MEMBER



WEDNESDAY, THE EIGHTEENTH DAY OF NOVEMBER,

TWO THOUSAND NINE



(Typed to the dictation of Sri K.Satyanand,Hon’ble Member)
***



Not satisfied with the quantum of relief granted by the District Forum, the complainant preferred this appeal obviously to get complete relief as prayed for.

The facts that led to filing this appeal are briefly as follows:

The complainant while proceeding on a foreign tour obtained an insurance policy coverage from the opposite party obviously in order to cover any unforeseen ailment that might set in the far off lands. He obtained the policy valid from 13-5-2005 to 10-8-2005 for various packages including the one for medical expenses for a coverage upto 50,000 US dollars. It seems after going to US, he fell ill due to some Hepatitis ‘C’ for which he claimed to have taken treatment from the medical attendants there. He claimed to have spent an amount of Rs.99,600/- towards the medical expenses. After getting back to India, he filed a claim for reimbursement of the medical expenses that he incurred in U.S. by way of a claim form received by the opposite party insurance company on 22-9-2005. Though in the pleadings, he claimed to have enclosed all the bills besides other medical transcripts, claim form did not indicate any fact of such enclosure. Likewise the claim form marked as Ex.A1 and A2 did not also quantify the claim amount. The insurance company ultimately repudiated the claim on the ground that he was suffering from a pre-existing condition which he concealed without disclosing it in the proposal form. Aggrieved by the said repudiation, the complainant filed the C.C. claiming an amount of Rs.99.600/- as representing the amount he spent towards medical expenses and also other amounts by way of compensation and costs.

The opposite party did not file any counter and in fact was not represented by any counsel as observed by the District Forum.

In support of his case, the complainant filed his own affidavit and relied upon documents marked as Exs.A1 to A11.

On a consideration of the evidence adduced by the complainant, the District Forum came to the conclusion that there was no nexus between the so called hypertension which according to the insurance company was proved to be his pre-existing condition on his own showing and the disease for which he had taken treatment in the U.S. Accordingly the District Forum held that the repudiation was not justified and such unjust repudiation marked the deficiency in service, as a consequence, the District Forum granted relief to a tune of Rs.50,000/- as against the opposite party and expressed an opinion that more than could not be awarded as the complainant himself failed to prove the actual medical bills.

Aggrieved by this partial relief, the complainant filed the present appeal with the usual grounds. Along with the appeal, he also filed a petition to receive additional evidence obviously comprising the bills about which the District Forum commented even while saying that they were enclosed with the claim form and in any view of the matter, the repudiation was on that ground.

Heard both sides.

In as much as the insurance company did not file any appeal and the complainant filed the appeal only for the limited purpose of getting the balance of relief, the scope of the appeal remains very narrow as the basic findings of the District Forum would be no more under issue. In other words, the finding of the District Forum as to deficiency in service actuated by the unjust repudiation cannot be called in question in this appeal of limited scope. Therefore, the only point that arises for consideration is whether the appellant is entitled to any enhancement of the relief granted by the District Forum?

Obviously realizing the lacunae in his evidence, the appellant came forth with a petition to adduce additional evidence. In order to induct additional evidence, he averred that those documents were already enclosed with his claim form and in any view of the matter, that was not a ground of repudiation and therefore, the furnishing of those bills would cure the inadequacy in the evidence pointed out by the District Forum thereby strengthening his case for enhancement. But additional evidence cannot be readily received for mere asking. There should be proper foundation and also a very profound cause shown by such petitioner as to why he could not adduce such evidence. A close look at the claim form amply indicates that the petitioner had neither quantified the expenses of which the reimbursement was claimed nor did he mention the factum having enclosed the supportive documents, especially the bills. No doubt, the opposite party entered appearance and contested the matter. Yet the complainant had filed several documents before the District Forum but he withheld the most important bills, the copies of which now he is seeking to file for reasons best known to him. In the absence of any foundation that he ever submitted those bills to the insurance company by explicit evidence which could have been found no where else except in the claim form, the belated filing of the copies of the bills cannot be readily accepted for mere asking. The fact that the repudiation did not bank upon the non filing of the bills is all the more untenable for the simple reason that they repudiated the claim on more fundamental ground namely the concealed pre-existing condition which of-course, the District Forum brushed aside. So the absence of the opposite party bestowing attention upon the inadequacy of the supportive documents does not give any additional advantage to the appellant to fill up the lacuna at a belated stage. So we do not think that this is a fit case where the additional evidence could be allowed to be adduced. This discussion takes us to the truism that there are no merits in the appeal.

Accordingly the appeal is dismissed but without costs in the circumstances of the case.

FA.No.734/2009 AGAINST C.D.No.50/2009 DISTRICT FORUM, KADAPA

Between:

Mrs.Varanasi Vasanthi

W/o.late V.Mohan Rao,

R/at D.No.7/137, Jayanagar Colony

Kadapa-516 002 (A.P) Appellant/

complainant

A N D

1. Bajaj Allianz Life Insurance Co. Ltd.,

Rep. by its Branch Manager,

Hyderabad branch, Hyderabad.



2. Bajaj Allianz Life Insurance Co. Ltd.,

Rep. by its General Manager, Regd. And

Head Office, GE Plaza, Airport Road,

Yerawada, Pune-111006.



3. Bajaj Allianz Life Insurance Co. Ltd,

Rep. by its Branch Manager,

Dwaraka Towers, Kadapa. Respondents/

Opp.parties



Counsel for the Appellant:Mrs.V.Vasanthi, Party in person.



Counsel for the Respondents:- Mr.Karra Srinivas.



QUORUM: SMT.M.SHREESHA, MEMBER

&

SRI K.SATYANAND, MEMBER



THURSDAY, THE TENTY DAY OF DECEMBER,

TWO THOUSAND NINE



(Typed to the dictation of Sri K.Satyanand,Hon’ble Member)
***



Dissatisfied with the quantum of relief she got before the District Forum, the complainant preferred this appeal obviously seeking full relief she sought in the complaint.

The facts that led to filing this appeal are briefly as follows:

The complainant is the nominee/widow of the insured, by name, late V.Mohan Rao. It seems the insured was a medico working as Joint Director, Health Department in the Government of Andhra Pradesh. He obtained a LIC ULP policy valid from 28-4-2007 for an amount of Rs.5,00,000/-. It seems the insured taken ill being afflicted with lung cancer technically called Non small cell carcinoma of right lung with multiple bone metastasis and ultimately died on 01-4-2008 due to the said disease. Subsequently the complainant had put up her claim to the opposite party in her capacity as a nominee and the wife of the deceased insured. The opposite parties who represent the same Bajaj Allianz Life Insurance Co. Ltd., at various levels repudiated the claim on 19-6-2008 on the ground that the insured had history of extra pulmonary tuberculosis in the year 2002 (lymph glands) and was a known smoker for 17 years and that he failed to disclose the said facts in the proposal dated 28-4-2007. Thus the claim came to be repudiated on the ground of non disclosure of material facts by the insured at the time of taking the policy. The complainant asserted that the deceased was having lung cancer since one month prior to the death, that he visited Yashoda Hospital Hyderabad On 28-2-2008 for investigations and that in as much as he had taken policy calculated to give him support during the life time, no suppression of material facts could be attributed to him as if it wasotherwise, he would have taken a huge policy of term insurance instead of unit linked policy. Thus aggrieved by the repudiation, she filed the consumer complaint in question from out of which this appeal had arisen.

This claim came to be resisted by the opposite parties reiterating the grounds set out in the repudiation letter and also relying upon the medical transcripts relating to the complainant that they obtained from Yashoda Hospital disclosing the fact that he had pre-existing diseases as pulmonary tuberculosis and other ailments way back from 2002 and the cancer itself for the last one year next before he was admitted into Yashoda Hospital.

In support of her case, the complainant filed her own affidavit and relied upon documents marked as Exs.A1 to A3. The opposite parties on the other hand relied upon documentary evidence marked as Exs.B1 to B5.

On a consideration of the evidence adduced by both sides, the District Forum upheld the repudiation but found the opposite parties deficient only to the extent of not returning the premium amount of Rs.50,000/-. Accordingly it passed the order only in regard to the refund of the premium amount with interest etc.,

Aggrieved by the said order, the complainant filed the present appeal, challenging the decision of the District Forum having the effect of upholding the repudiation of the insurance claim. It is urged by the appellant that the District Forum misguided itself by accepting the medical history found in the medical transcripts relied upon by the opposite party as substantive proof of the pre-existing disease.

Heard both sides.

The point for consideration is whether there are any good grounds to interfere with the order of the District Forum?

No doubt there is a certain amount of force in the argument that the medical history cited in the medical transcripts by itself does not constitute adequate proof of the pre-existing disease which is attributed to the period right from 2002 onwards. But in the present case, the medical history that the insurance company relied upon is found very much in the medical transcripts relating to the complainant’s husband that too in respect of the period, he remained hospitalized from 28-2-2008 till he died on 01-4-2008 as per Exs.B2 and B3. Exs.B2 and B3 gave an account of his previous illness and the case history of the case record marked as Ex.B2 clearly recorded history of present illness as also past history in the following terms:

History of Persent illness: 50 year old male Mr.Mohan rao a known

case of ca. lung with bone mels presented with

low back ache since one year which is aggravated

since 1 month and H/D loss of weight.



Past History : K/H/o HTN, DM

Past H/o extrapulmonary tuberculosis in 2002

(lymph glands) took ATT

Known smoker 17 years now stopped

Occasional alcohol consumption.

which categorically disclosed that he was suffering from cancer since one year before his admission on 28-2-2008 and likewise he had extra pulmonary tuberculosis in 2002 and that he had seventeen years of smoking history and intermittent habit of consumption of alcohol. The reference to the history of present illness and past history in Ex.B2 could not have been made but for such an information having been given by the patient himself as Ex.B2 and Ex.B3 relate to the latest ailment that led to the death of the complainant’s husband in the hospital itself. Moreover, the deceased was not an ordinary person. He himself was a doctor, he was admitted into the hospital on 28-2-2008. He remained in the hospital till 1-4-2008. So it is not unreasonable to think that he was not in a position to allow wrong facts to creep into the narration of history that finds a place in Ex.B2. So if we go by the facts pertaining to the pre-existing disease of the insured available in the latest medical transcripts, surely he was ailing with the cancer that ultimately killed him since one year prior to his date of admission into Yashoda Hospital on 28-2-2008. That means he must be having such ailment since 28-2-2007. The proposal form dated 28-4-2007 marked as Ex.B1 clearly shows that the insured answered categorically in the negative for queries asking him to disclose previous ailments, if any, by way of a row of questions under item 14 of the proposal form. This clearly amounts to suppression of material facts. The insured signed up a declaration on the 4th page of the proposal form vouchsafing for the truth of the contents of the proposal form and also to bear the consequences if they turned out to be false. So the insurance company could successfully show that the repudiation was on solid grounds. Thus we do not see any merits in the appeal and consequently no reasons to interfere with the order of the District Forum.

Accordingly the appeal is dismissed but without costs in the circumstances of the case.FA.No.734/2009 AGAINST C.D.No.50/2009 DISTRICT FORUM, KADAPA

Between:

Mrs.Varanasi Vasanthi

W/o.late V.Mohan Rao,

R/at D.No.7/137, Jayanagar Colony

Kadapa-516 002 (A.P) Appellant/

complainant

A N D



1. Bajaj Allianz Life Insurance Co. Ltd.,

Rep. by its Branch Manager,

Hyderabad branch, Hyderabad.



2. Bajaj Allianz Life Insurance Co. Ltd.,

Rep. by its General Manager, Regd. And

Head Office, GE Plaza, Airport Road,

Yerawada, Pune-111006.



3. Bajaj Allianz Life Insurance Co. Ltd,

Rep. by its Branch Manager,

Dwaraka Towers, Kadapa. Respondents/

Opp.parties



Counsel for the Appellant:Mrs.V.Vasanthi, Party in person.



Counsel for the Respondents:- Mr.Karra Srinivas.



QUORUM: SMT.M.SHREESHA, MEMBER

&

SRI K.SATYANAND, MEMBER



THURSDAY, THE TENTY DAY OF DECEMBER,

TWO THOUSAND NINE



(Typed to the dictation of Sri K.Satyanand,Hon’ble Member)
***



Dissatisfied with the quantum of relief she got before the District Forum, the complainant preferred this appeal obviously seeking full relief she sought in the complaint.

The facts that led to filing this appeal are briefly as follows:

The complainant is the nominee/widow of the insured, by name, late V.Mohan Rao. It seems the insured was a medico working as Joint Director, Health Department in the Government of Andhra Pradesh. He obtained a LIC ULP policy valid from 28-4-2007 for an amount of Rs.5,00,000/-. It seems the insured taken ill being afflicted with lung cancer technically called Non small cell carcinoma of right lung with multiple bone metastasis and ultimately died on 01-4-2008 due to the said disease. Subsequently the complainant had put up her claim to the opposite party in her capacity as a nominee and the wife of the deceased insured. The opposite parties who represent the same Bajaj Allianz Life Insurance Co. Ltd., at various levels repudiated the claim on 19-6-2008 on the ground that the insured had history of extra pulmonary tuberculosis in the year 2002 (lymph glands) and was a known smoker for 17 years and that he failed to disclose the said facts in the proposal dated 28-4-2007. Thus the claim came to be repudiated on the ground of non disclosure of material facts by the insured at the time of taking the policy. The complainant asserted that the deceased was having lung cancer since one month prior to the death, that he visited Yashoda Hospital Hyderabad On 28-2-2008 for investigations and that in as much as he had taken policy calculated to give him support during the life time, no suppression of material facts could be attributed to him as if it wasotherwise, he would have taken a huge policy of term insurance instead of unit linked policy. Thus aggrieved by the repudiation, she filed the consumer complaint in question from out of which this appeal had arisen.

This claim came to be resisted by the opposite parties reiterating the grounds set out in the repudiation letter and also relying upon the medical transcripts relating to the complainant that they obtained from Yashoda Hospital disclosing the fact that he had pre-existing diseases as pulmonary tuberculosis and other ailments way back from 2002 and the cancer itself for the last one year next before he was admitted into Yashoda Hospital.

In support of her case, the complainant filed her own affidavit and relied upon documents marked as Exs.A1 to A3. The opposite parties on the other hand relied upon documentary evidence marked as Exs.B1 to B5.

On a consideration of the evidence adduced by both sides, the District Forum upheld the repudiation but found the opposite parties deficient only to the extent of not returning the premium amount of Rs.50,000/-. Accordingly it passed the order only in regard to the refund of the premium amount with interest etc.,

Aggrieved by the said order, the complainant filed the present appeal, challenging the decision of the District Forum having the effect of upholding the repudiation of the insurance claim. It is urged by the appellant that the District Forum misguided itself by accepting the medical history found in the medical transcripts relied upon by the opposite party as substantive proof of the pre-existing disease.

Heard both sides.

The point for consideration is whether there are any good grounds to interfere with the order of the District Forum?

No doubt there is a certain amount of force in the argument that the medical history cited in the medical transcripts by itself does not constitute adequate proof of the pre-existing disease which is attributed to the period right from 2002 onwards. But in the present case, the medical history that the insurance company relied upon is found very much in the medical transcripts relating to the complainant’s husband that too in respect of the period, he remained hospitalized from 28-2-2008 till he died on 01-4-2008 as per Exs.B2 and B3. Exs.B2 and B3 gave an account of his previous illness and the case history of the case record marked as Ex.B2 clearly recorded history of present illness as also past history in the following terms:

History of Persent illness: 50 year old male Mr.Mohan rao a known

case of ca. lung with bone mels presented with

low back ache since one year which is aggravated

since 1 month and H/D loss of weight.



Past History : K/H/o HTN, DM

Past H/o extrapulmonary tuberculosis in 2002

(lymph glands) took ATT

Known smoker 17 years now stopped

Occasional alcohol consumption.

which categorically disclosed that he was suffering from cancer since one year before his admission on 28-2-2008 and likewise he had extra pulmonary tuberculosis in 2002 and that he had seventeen years of smoking history and intermittent habit of consumption of alcohol. The reference to the history of present illness and past history in Ex.B2 could not have been made but for such an information having been given by the patient himself as Ex.B2 and Ex.B3 relate to the latest ailment that led to the death of the complainant’s husband in the hospital itself. Moreover, the deceased was not an ordinary person. He himself was a doctor, he was admitted into the hospital on 28-2-2008. He remained in the hospital till 1-4-2008. So it is not unreasonable to think that he was not in a position to allow wrong facts to creep into the narration of history that finds a place in Ex.B2. So if we go by the facts pertaining to the pre-existing disease of the insured available in the latest medical transcripts, surely he was ailing with the cancer that ultimately killed him since one year prior to his date of admission into Yashoda Hospital on 28-2-2008. That means he must be having such ailment since 28-2-2007. The proposal form dated 28-4-2007 marked as Ex.B1 clearly shows that the insured answered categorically in the negative for queries asking him to disclose previous ailments, if any, by way of a row of questions under item 14 of the proposal form. This clearly amounts to suppression of material facts. The insured signed up a declaration on the 4th page of the proposal form vouchsafing for the truth of the contents of the proposal form and also to bear the consequences if they turned out to be false. So the insurance company could successfully show that the repudiation was on solid grounds. Thus we do not see any merits in the appeal and consequently no reasons to interfere with the order of the District Forum.

Accordingly the appeal is dismissed but without costs in the circumstances of the case.

First Appeal No.2008/770

(Arising out of Order dated 01.05.2008 passed by the District Consumer Forum(North West) Shalimar Bagh, Delhi in Complaint Case No.569/2006)

Sh. Jai Kishan Narang …. Appellant/Complainant

WZ 615 A, Sri Nagar Colony in person.

Shakurbasti, Delhi

Versus

1. Sh. Rajeev Batra, … Respondent /OP

D-2, Sector No.15,

Rohini, Delhi .

2. M/s. Bajaj Allianz General

Insurance Company Ltd.,

C-31/32, Connaught Place,

New Delhi.

CORAM

Justice Barkat Ali Zaidi ... President

Sh. M.L. Sahni … Member

1. Whether reporters of local newspapers be allowed to see the judgment?

2. To be referred to the Reporter or not?

Justice Barkat Ali Zaidi, President(ORAL)

1. The appellant got his household insured for theft and burglary by obtaining house hold policy from respondent No.2 Bajaj Allianz General Insurance Company Ltd., while he was away to USA, the thieves broke-in and not finding anything very handy and precious they set the house of fire. An FIR in this behalf was lodged by the sons in law of the complainant at the concerned police station beside Delhi Fire Services was also placed into service. After returning from USA, the complainant filed a claim for Rs.1,68,981/- for indemnification of stolen articles. The insurance company appointed Atul Kapur & Co. Fire, Engineering, Marine and Miscellaneous Surveyors, which gave report that the complainant was entitled to Rs.35,136/-, which amount was paid by respondent No.2 to the complainant.

2. Complainant thereafter filed a complaint before the District Forum impleading the insurance agent Sh. Rajiv Batra and Insurance Company, with a prayer that another surveyor be appointed to estimate his claim and also raising claim of Rs.1,68,981/- against the OPs. Respondent No.2 appeared before the District Forum, filed written statement opposing the claim of the complainant.

3. District Forum vide impugned order held that the amount paid by respondent No.2 amounting to Rs.35,136/- was sufficient and dismissed the complaint and that is what brings the complainant appellant in appeal here.

4. We have heard the appellant in person and Sh. Sumit Sharma, Counsel for respondent No.2 in this appeal.

5. The view of the District Forum that in the circumstances the appellant has not established his claim for payment of more sum than has been given to him by respondent No.2, seems justified. It was for the appellant to show how and in what manner, the report of the surveyor is deficient and what more items should have been included and how the amount was to be fixed in the manner claimed by the appellant. The appellant has only given a general estimate that he is entitled to a sum in all Rs.1,68,981/- and has not elaborated how and in what manner there is deficiency in the sum of Rs.35,136/- fixed by the surveyor. The District Forum was therefore justified in relying upon the surveyor’s report. The mere word of the appellant against the report of the surveyor as rightly held by the District Forum, cannot be considered sufficient to establish the complainant’s claim.

6. While accepting the surveyor’s report in the circumstances of the case, we would like, however, to clarify that the contention of the Insurance Company, that since the appellant has accepted the amount paid by the Insurance Company and did not raise any objection at the time of payment, he is now barred from demanding more money is not correct. The mere fact that the appellant accepted the amount, will not act as an estopple against him, de-barring him from claiming more compensation.

7. In the result there is no occasion for interference in the award given by the District Forum.

8. The appeal fails and is accordingly dismissed.

9. A copy of this order as per the statutory requirements be forwarded to the parties free of charge and also to the concerned District Forum and thereafter the file be consigned to Record room.

Consumer Dispute Case No. 82 of 2008

Gopal Goyal, Son of Ramavatar Goyal, aged about 40(forty) years, Resident of Sanharapara, Ward No.5(five), Po/Ps/Dist. Bargarh.

... ... ... Complainant.

- V e r s u s -

Bajaj Allianz General Insurance Company Ltd., registered office, GE Plaza, Airport Road, Yerward, Pune-411006, represented through the Branch Manager, Bajaj Allianz General Insurance Company Ltd., Branch Office, At/Po. Bhubaneswar, Dist. Khurdha.

... ... ... Opposite Party.

Counsel for the Parties:-

For the Complainant:- Sri J. Sarangi, Advocate.

For the Opposite Party :- Sri A.K. Dash, Advocate.

-: P R E S E N T :-

Sri Gouri Shankar Pradhan ..... ..... ..... ..... ..... ..... ..... P r e s i d e n t.

Sri Binod Kumar Pati ..... ..... ..... ..... ..... ..... ..... M e m b e r.

Miss Bhagyalaxmi Dora ..... ..... ..... ..... ..... ..... ..... M e m b e r.

Dt.13/11/2009 -: J U D G E M E N T :-

Presented by Sri G.S.Pradhan, President .

The Complaint pertains to deficiency in service as envisaged under the provision of Consumer Protection Act-1986 and its brief fact is as follows:-

The Complainant is the registered owner of vehicle Tata Indica Car bearing Regd. No. OR-17-D-0034 which was insured with the Opposite Party under a comprehensive policy vide Policy No. OG-07-2403-1803-00002213 covering for a period from Dt.30/12/2006 to Dt.29/12/2007 and the insured value of the vehicle is Rs.2,00,000/-(Rupees two lac) only. During this period on Dt.10/09/2007, the vehicle suffered accident under Bargarh Police Station. The incident was intimated to the Opposite Party. On delayed appointment of a Surveyor, the Complainant proceeded to repair the damaged vehicle. Then Surveyor Er. Mukunda Sahu was appointed and arrived at the garage on Dt.18/09/2007 and instructed the complaint not to proceed with the repair work till his second visit. However, the surveyor inspected the vehicle and took some note and photograph of the damaged vehicle. As the Complainant was not aware of the detail procedural aspect to get reimbursement of the loss of the present nature, the matter was not reported to the police and when he could know the requirement of such report he reported the incidence before the Police Station on Dt.16/11/07. As asked by the surveyor vide his letter Dt.05/10/2007, the Complainant had also sent all original bill and voucher, money receipt and station dairy entry to the surveyor for reimbursement of the loss but even than no amount of compensation was paid by the Opposite Party. When no any claim amount was paid by the Opposite Party for a long time, the present complaint was filed by the Complainant alleging deficiency of service by the Opposite Party towards the Complainant. The Complainant claims Rs.50,000/-(Rupees fifty thousand) only as compensation towards the repair of the vehicle, Rs.10,000/-(Rupees ten thousand) only towards mental agony and harassment and Rs.2,000/-(Rupees two thousand) only towards litigation cost.

In its version the Opposite Party denied allegations of the Complainant, regarding deficiency in service and states that, the vehicle being a commercial vehicle and used for commercial purpose does not come under the purview of Sec-2(d)(ii) of C.P. Act and hence not maintainable.

The Opposite Party contend that, after getting information from the complainant, deputed Er. Makunda Sahu an independent surveyor to process the claim who went to the garage at Bargarh and inspected the damaged vehicle. On Dt.05/10/2007 the surveyor wrote a letter to the complainant seeking some clarification but denied to have received the clarification letter along with the original bill and voucher, money receipts and station diary entry sent by the Complainant. The damage vehicle had already been dismantled and repaired the denting portion before his arrival and the accident was not reported to police. Due to above reasons the surveyor found difficulties to assessing the loss. But the surveyor on physical verification of the vehicle assessed the loss at Rs.13,800/-(Rupees thirteen thousand eight hundred) only and communicated to the Opposite Party. After getting the report from the surveyor the Opposite Party also vide its letter Dt.19/01/2008 requested the Complainant to send his response to the earlier letter of surveyor within seven days from the date of that letter. But the Complainant remain silent in spite of receiving the letter. So the Opposite Party repudiated the claim of the Complainant and intimated the Complainant vide its letter Dt.28/01/2008. The Opposite Party tried its level best to settle the claim but due to non co-operation of the Complainant it could not be materialized. Hence there is no any deficiency in service on the part of the Opposite Party towards the complainant.

The Opposite Party prays for dismissal of the complaint with cost.

We have gone through the complaint petition, Opposite Party's version as well as the copies of documents filed by the Parties and find as follows:-

It is not disputed that the Complainant is the registered owner of Tata Indica Car bearing Regd No. OR-17-D-0034 which was insured with the Opposite Party vide policy No. OG-07-2403-1803-00002213 for a period from Dt.30/12/2006 to Dt.29/12/2007 under a comprehensive policy insurance. It is also not disputed that during the validity of the insurance period on Dt.10/09/2007 the vehicle met with an accident and was damaged, and intimation of the accident was sent to the Opposite Party. The Opposite Party deputed Er. Makunda Sahu, Surveyor to the sport to assess the loss. As the vehicle has already been dismantled and repaired the denting portion before arrival of the surveyor, he on physical verification and after taking into all parameters assessed the loss at Rs.13,800/-(Rupees thirteen thousand eight hundred) only and submitted his report to the Opposite Party. The copy of surveyor report is filed by the Opposite Party. After getting the surveyor report the Opposite Party again asked the complainant vide its letter Dt.19/01/2008 to send his response to earlier letter of the surveyor with in seven days and for non response of the earlier letter, the Opposite Party repudiated the claim of the complainant, which is illegal and against the principle of natural justice. The Opposite Party insurance company has committed deficiency in service, in not paying any amount even after receiving report of the surveyor deputed by it.

In the result, complaint allowed and ordered as follows:-

The Opposite Party is directed to pay Rs.13,800/-(Rupees thirteen thousand eight hundred) only as compensation towards loss, Rs.7,000/-(Rupees seven thousand) only for mental agony and harassment and Rs.1,000/-(Rupees one thousand) only for litigation cost to the Complainant within thirty thirty days from the date of this Order failing which the total amount shall carry 18%(eighteen percent) interest per annum till the date of payment.

C.C. No.17of 2008
Smt.Abantee Kumari Sahu,

W/o Sri Debendra Sahu,

At/po Paramandapur(Near Gudakhu Factory)

P.S. Bhawanipatna,Dist.Kalahandi.

…..Complainant

Versus

1. The Bajaj Allianz Life Insurance aCompany Latd.,

4th and 5th Floor,Ashoka Plaza,Corporate Software Park,

Serve No.32/3,Nagar Road,Viman Nagar,Pune-411014,.

2. Area Manager,

The Bajaj Allianz Life Insurance Company Ltd.,

Opposite Andhra Bank, New Colony,Po/Ps /Dist.Rayagada-765001(Orissa)

3. The Branch Manager,

The Bajaj Allianz Life Insurance Company Ltd.,16&B,

Forest Park,Shishu Bhawan Square,Bhubaneswar-751009(Orissa)

…..Opp.Parties

ORDER

Shri A.K.Purohit,President: The case of the complainant is that she had taken a “Unit Gain” policy bearing No.0004555992 from the O.Ps. As per the terms and conditions of the policy a yearly premium @ Rs.15,000/- to be paid for a period of three years and accordingly the complainant had paid the premium in advance, i.e Rs.40,000/- on dt.16.4.04 and Rs.5,000/- on dt.12.7.05. The complainant received an account statement from the O.P wherein she had allocated 60008.8811 amounting to Rs.1,22,965.74 as on 31.5.07. Accordingly the complainant surrender her policy on dt.5.10.07. Again the complainant received a statement showing an amount of Rs.1,47,974.71 for the aforesaid allocated units. But an amount of Rs.88,404/- only was paid to the complainant. To this the complainant represented the authorities for payment of the differential amount but the same was not responded by the O.Ps . The complainant alleges that although she is entitled to an amount of Rs.1,47,974.71p, she was paid with a lesser amount which amounts to deficiency in service on the part of the O.Ps. Hence, the complaint.



2. The O.Ps have contested the case by way of filing their written version jointly. According to the O.Ps the complainant has not paid the regular premium plus two top up premium for which her policy was lapsed. By the time her claim was settled proportionate numbers of units had been deducted under a lapsed policy, as per the policy conditions. The O.Ps have admitted the premium paid by the complainant as described in the complaint petition. The O.Ps have claimed no deficiency in service on their part.



3. Heard both the parties. The learned advocate for the complainant submitted that since the complainant had paid the entire premium amount of Rs.45,000/- she is entitled to the amount as shown in the statement as on dt.6.10.07 and hence the stand taken by the O.Ps regarding the lapsed of policy can not be sustained. On the other hand the learned advocate for the O.Ps submitted that instead of making the payment as per the regular premium of Rs.15,000/- and 2 top up premiums of Rs,.30,000/- the complainant had paid 15,000/- 25,000/- hence the premium had not been paid as per policy conditions and hence the complainant is not entitled to any differential amount.



4. Perused the documentary evidence available on record. This is a case based on the terms and conditions of the Unit Gain policy which are binding on the parties. Therefore the policy conditions has to be seen strictly.



Perused the policy schedule. The complainant is the policy hold and the date of commencement of the policy is 28.4.2004. The frequency of payment is annual and the premium amount is Rs.15,000/- and the due date of premium is 28th April of every year. It is an admitted fact that, the complainant has paid the premium of Rs.40,000/- on dt.16.4.04 and Rs.5,000/- on dt.12.7.05. The complainant had neither paid the premium on annual due date nor paid the entire 3 years premium at a time. Perused; the policy document para-6 of the policy document provides the mode of payment of premiums which reads as follows :-6.1(a) Regular Premiums are payable in full on the dates and at the rate mentioned in the Policy Schedule. However a grace period of not more than 30 days where the mode of payment of premium is other than monthly, and not more than 15 days in the case of monthly mode is allowed. If a premium is not paid during the days of grace in the first three years, the policy shall lapse and no benefit shall be payable. Provided however, if the regular premium plus top up premiums paid at any time within the first three years exceeds the regular premium payable for three years, the policy will not lapse and the benefits payable under the policy shall be as indicated in (d)below. If a premium is not paid during the days of grace after three full years’ premiums have been paid and the policy has been in force for the full sum assured for those three policy years, the benefits payable under the policy shall be as indicated in (d) below.



According to this conditions premiums are payable in full as per the rate mentioned in the policy schedule,. A grace period of 30 days is allowed for payment of premium. If the regular premiums paid at any time within the first three years, then the policy will not lapsed ;and the same shall be kept in force by effecting a premium holiday. Premium Holiday has been defined in the policy document as , “Premium Holiday is a temporary period during which the policy holder can keep his policy in force without payment of regular premiums. This holiday can be availed by the policy holde4 after payment of three years full regular premiums”. The complainant had not paid the premium on the due date as per the policy schedule, but paid the full regular premiums of three years. Therefore the complainant’s policy has not been lapsed and she has availed premium Holiday. Accordingly the policy has been kept for utilization of the funds for payment of cost of insurance. The value of the units has been calculated as per the funds available in the premium Holiday and an amount of Rs.88,404/- has already been paid to the complainant. The complainant has not produced any other calculation relating to premium Holiday. The complainant is not entitled to any amount for the period which she has not paid the premium amount. Hence there is no deficiency in service on the part of the O.Ps.

5. It is argued on behalf of the complainant that by applying the principle of estoppels the O.Ps can not deny to pay the amount as per the statement send by them on dt.6.10.07. According to the O.Ps the statement has been sent by mistake as there was computer complication. The policy conditions are binding on the parties and payments has been made as per the said conditions, the case is not coming under the principle of estoppels. Sending the statement dt.6.10.07 by the O.Ps is a mistake which was essential to the agreement as provided U/s 20 of the Indian Contract Act.


6. Under the aforesaid facts, in our considered opinion, there is no deficiency in service on the part of the O.Ps.

Hence the case is dismissed.

Pronounced in open forum today on this 11th day of November,2009 under the seal and signature of this forum.

Consumer Case No.: 15/2009.

Date of filing : 26.02.2009.

Date of final order : 09.11.2009.

Present:
A) Sri Saurish Chakraborty President.

B) Smt.Swapna Kar Member.

C) Sri Swaraj Kumar Biswas Member.

Smt. Dipti Roy,

Wife of Late Jogeswar Roy,

Village – Paran Pukur (Balir par)

Post Office – Vitihar, Police Station – Raiganj,

District – Uttar Dinajpur. Complainant.

versus

1. Bajaj Allianz General Insurance Company Limited,

Represented by the Assistant Manager (Claims),

Poddar Court (7th Floor),

18, Rabindra Sarani, Kolkata: 700 001.

2. The Golden Trust Financial Limited,

Represented by the Manager,

Golden Trust Financial Limited,

N.S. Road, Mohanbati,

Post Office and Police Station – Raiganj,

District – Uttar Dinajpur. Opposite Parties.

Judgment

Date: 09.11.2009.

The Complainant’s husband Jogeswar Roy took an insurance policy with the O.P. No. 1 under the Personal Accidental Benefit Scheme. Jogeswar Roy was murdered on 16.01.2007 and a Police Case vide Raiganj PS Case No. 17/2007 dated 14.01.2007 was initiated. The Complainant submitted her claim against the policy with O.P. No. 2, which was duly forwarded to the O.P. No. 1. But after all correspondence, the claim of the Complainant was not discharged, so this complaint filed praying for an order of award of Rs.50,000.00 (rupees fifty thousand only, the insured sum) against the O.P./ Insurer. And Rs.5,000.00 further as compensation and Rs.2,000.00 as litigation cost.

O.P. No. 1 entered into this case by filing one Written Version. The main contention of the O.P./ Insurer is that as because the identity of the deceased was doubtful, so the claim was not discharged.

Decisions with reasons:

Upon perusal of the Written Version of the O.P./ Insurer we do find that the Complainant has submitted Attested copies of Insurance Policy, Voter’s ID Card, Death Certificate, Post Mortem Report and Charge-sheet. From it’s very case, we find it admitted that O.P. had received all the papers require for discharging the claim. It has not been clarified or explained by the O.P./ Insurer why those were not sufficient for identification of the deceased. So, such plea being not tenable is to be disbelieved.


There is no challenge to the fact that the deceased took an insurance during his life time under Personal Accidental Death Scheme from the O.P./ Insurer. There is also no denial that the deceased had faced an unnatural death (murder). In course of argument it is submitted from the side of the O.P./ Insurer that his company is ready to pay Rs.45,000.00 to the Complainant. Ld. Lawyer for the Complainant did not opposed to the offer given by Ld. Lawyer for the O.P. on behalf of the Insurance Company, he does represent. Being this position of this case this Forum does opine, the present complaint may be disposed off by awarding a sum of Rs.45,000.00 – an amount agreed by both sides.

Fees paid are correct.

So, it is ordered,

That the present complaint is allowed on compromise. The Complainant do get an award of Rs.45,000.00 (rupees forty five thousand only) against the O.P.No.1 Bajaj Allianz General Insurance Company Limited.

The O.P./ Insurer is directed to pay the awarded amount within one month from the date of this order failing which the O.P./ Insurer No. 1 will be liable to pay an interest at the rate of 6.5 percent from the date of this order till realization.

The other reliefs not being pressed are rejected.

The case against the O.P. No. 2 is dismissed on contest.
Furnish the true photocopies of this Final Order to the parties free of cost.

Consumer Case No.: 39/2009.

Date of filing : 10.07.2009.

Date of final order : 09.11.2009.

Present:

A) Sri Saurish Chakraborty President.
B) Smt.Swapna Kar Member.

C) Sri Swaraj Kumar Biswas Member.

Sabera Khatun @ Shabra Khatun,

Wife of Late Md. Hasebul Rahaman,

Village: Uttar Hatkhola Bazar,

P.O. & P. S.- Islampur, Dist.- Uttar Dinajpur. Complainant.
versus

1. The Manager,

Bajaj Allianz General Insurance Company Limited,

Regd. & Head Office – GE Plaza, Airport Road,

Yerwada, Pune – 411 006.

2. The Manager,

Bajaj Allianz General Insurance Company Limited,

Poddar Court, Gate No. – 3, 7th Floor,

18, Rabindra Sarani, Kolkata: 700 001.

3. The Manager,

Golden Multi Services Club Limited,

GTFS, 16, R.N. Mukherjee Road,

Kolkata: 700 001.



4. The Manager,

Golden Multi Services Club Limited,

Raiganj Branch, Mohanbati,

Raiganj, Uttar Dinajpur. Opposite Parties.

Judgment

Date: 09.11.2009.

The Complainant’s son Abdul Sattar took an insurance policy with the Bajaj Allianz General Insurance Company Limited under Group Personal Accidental Insurance policy for insured amount of the policy of Rs.5,00,000.00.

Said Abdul Sattar died on 12th day of August, 2006 at North Bengal Medical College and Hospital, Siliguri due to a road accident on 07.08.2006 at 05:30 p.m. under Islampur P.S. and a Police Case was initiated vide Matigara UD Case No. 383/06, dated 12.08.2006. Therefore, the Complainant, mother of the deceased claims with attaching all the necessary documents for discharging the claim amount of Rs.5,00,000.00, which was received by the office of the Opposite Party in the month of October, 2006. The agency deployed by the Opposite Party to investigate the claim not received some documents from North Bengal Medical College and Hospital, which prompted the Insurance Company not to settle the claim earlier, hence the complaint filed.


However, the Opposite Party at last agreed the case amicably and they will pay Rs.5,00,000.00 (rupees five lacs, the insured sum). Accordingly, Bajaj Allianz General Insurance Company vide their letter dated 03.11.2009 of Senior Legal Executive, authorized company’s appointed Ld. Advocate Mr. Rintu Das to settle the case amicably. Ld. Advocate of the Opposite Party filed application to that effect. The Ld. Advocate on behalf of the Complainant made verbal submission that they have agreed to the proposition by propounded the Opposite Party and amicably settled the claim for Rs.5,00,000.00 (rupees five lacs only). Being this position of this case this Forum does opine, the present complaint may be disposed off by awarding a sum of Rs.5,00,000.00 – an amount agreed by both sides.

Fees paid are correct.

So, it is ordered,

That the present complaint is allowed on compromise. The Complainant do get an award of Rs.5,00,000.00 (rupees five lacs only) against the Bajaj Allianz General Insurance Company Limited.

The Insurance Company is directed to pay the awarded amount within one month from the date of this order failing which the Insurance Company will be liable to pay an interest at the rate of 6.5 percent from the date of this order till realization.
The other reliefs not being pressed are rejected.

The case against the O.P. No. 3 and 4 is dismissed on contest.

Furnish the true photocopies of this Final Order to the parties free of cost.

D.F.Case No.33/2009

Complainant:Sabya Sachi Sil,

No.10, Goods Shed Road, Burdwan,

Town, P.S., P.O. & Dist.-Burdwan.

VERSUS

Opposite Party:1. Branch Manager,

Bajaj Allianz General Insurance Co. Ltd.,

Poddar Court, Gate No.3, 7th floor,

18th, Rabindra Sarani, Kolkata-700 001.

2. General Manager, Bajaj Allianz General Insurance

Company ltd. Regd. & Head office-G.E. Plaza,

Airport Road, Yerwada, Pune-411 006.

3. Mrs.Paromita Basu,

C/o.Bajaj Allianz General Insurance Company Ltd.,

Poddar Court, Gate No.3, 7th floor,

18th, Rabindra Sarani, Kolkata-700 001.
4. Branch Manager, Bajaj Auto Finance Ltd.,

Lakxmipur, G.T.Road, Burdwan Town,

P.S. & Dist.-Burdwan.

5. Saluja Auto mobile,

Authorised Dealer of Bajaj Auto ltd.,

Laxmipur, G.T.Road, Burdwan Town,

P.S. & Dist.-Burdwan

Present : Hon’ble President: Sri Tushar Kanti Paladhi

Hon’ble Member : Smt. Jharna Majumdar

Hon’ble Member : Sri Ajit Kr. Basu

Appeared for the Complainant: Ld. Advocate, Partha Pratim Sil. Appeared for the Opposite Party No.1 & 2: Ld. Advocate, Subhajit Mondal

Appeared for the Opposite Party No.3: Ld. Advocate,

Appeared for the Opposite PartyNo.4: Ld. Advocate,

Appeared for the Opposite Party No.5: Ld. Advocate,



Date of delivery: 26.11.2009

JUDGEMENT

This is a case U/s 12 of C.P. act, alleging unfair trade practice against the O.P., and praying for direction to the O.P. to pay compensation and relief to the complainant.

The complainant had purchased a Motor Cycle from the show room of O.P. No.5 at a value of Rs.53,659/- on 4.12.2006 outs of which the complainant made down payment of Rs.18,659/- and the rest amount of Rs.35,008/- was financed by O.P. No.4 at a monthly installment of Rs.2188/- and accordingly this complainant issued 16 cheques amounting to Rs.2188/- for each cheque and O.P. No.4 took another one blank cheque for second year insurance charges to the tune of Rs.930/-.

Unfortunately the said motor cycle was lost by theft on 9.5.2007 at 8.30 p.m. n front of the house of Sri Kausick Samanta, Advocate S/o. Dr.Bimalendu Samanta, No.174 East Kalibazar, Burdwan Town, P.S. & Dist.-Burdwan. After searching for 2 and 3 hours for the recovery of said vehicle the complainant went to Burdwan P.S. fo lodging FIR about the theft of the said vehicle and Burdwan P.S.Case No.225 dated 10.5.2007 was started U/S 379 IPC.

After taking information from Burdwan P.S. about non-recovery of the said vehicle the complainant lodge Motor Insurance Claim before O.P. No.1 through O.P. No.5 on 12.5.2007 and O.P. No.5 assured the complainant that the claim will be settled within three months without charging any depreciation value as the theft cause within 6 months from the date of purchase.

After lodging of Insurance claim the complainant also gave intimation to R.T.O., Burdwan on 22.5.2007 regarding theft of said vehicle and also intimated to O.P. No.4, the fact of theft on 30.6.2007 along with Xerox copy of F.I.R. of Burdwan P.s. Case No.225/2007 U/S 379 IPC.

But even after submitting insurance claim, the complainant did not get the claim value of the insurance. Hence, this case.

O.P. contests this case by filing written objection, denying all the material allegation as in the complaint and the O.P. wanted to settle the claim for a Rs.25,000/- against the lost vehicle. But the O.P. did not submit any reason or documents for the claim they agreed to offer.

Points for consideration in this case are:-

1. Whether there is unfair trade practice on the part of the O.P.?

2. Whether the complainant is entitled to get relief as prayed for?
FINDING WITH REASON

Documents produced before the Forum, it appears that the vehicle was lost on 9.5.2007 and the cost of the vehicle was Rs.53,659/-. The vehicle was lost within six months from the date of purchase. As per terms and conditions of the Insurance Company, the complainant is entitled to get the full value of the vehicle without any depreciation. Thus the complaint case disposed of. C.F. paid is sufficient. Hence,

ORDERED

that the complaint case disposed of with direction to O.P. No.1 to pay the full value of the lost motor cycle as claimed by the complainant within 45 days from this date of order.

Complaint Case No :1105 of 2009

Date of Institution : 05.08.2009

Date of Decision : 24.11.2009

Jagdish Lal Sethi, Prop. of M/s J Sons, Shop No.40, Sector 11-D, Chandigarh.

….…Complainant

V E R S U S
1] The Bajaj Allianz General Insurance Company Ltd., through its Manager, SCO No. 329, 1st Floor, Sector 9, Panchkula.

2] Manager, The Bajaj Allianz General Insurance Company Ltd., SCO No.329, 1st Floor, Sector 9, Panchkula.

.…..Opposite Parties
CORAM: SH.JAGROOP SINGH MAHAL PRESIDENT

SH.SIDDHESHWAR SHARMA MEMBER

DR.(MRS) MADHU BEHL MEMBER


Argued by:Sh.S.L.Chander Shekhar, Adv. for Complainant.

Sh.Rajneesh Malhotra, Adv. for OPs.

PER SH.JAGROOP SINGH MAHAL, PRESIDENT

Concisely put, the Complainant who is running a Tailor Shop in the name & style of M/s J Sons, Shop No. 40, Sector 11-D, Chandigarh, obtained an insurance Policy to cover the risk of stock of clothes, tailoring shop, furniture and fitting, building etc. from the OP vide Policy Annexure C-1, which was valid from 22.12.2007 to 21.12.2008. It was averred that during the intervening night of 29/30.6.2008 it had rained heavily and when he opened the Shop in the morning of 30.6.2008, he found that water had entered into Shop upto the level of 2”, due to which the clothes, dress materials and other stocks were damaged and he suffered a loss of approximately Rs.3,83,220/- as detailed in Para No.6 of the complaint. OPs were immediately informed about the loss suffered, along with all the requisite documents as demanded by them from time to time. But to his utter dismay, OPs vide letter dated 17.11.2008 (Annexure C-2), repudiated his claim on the ground that water had leaked inside the Shop through ceiling/walls, electric conduit pipes which was purely due to improper maintenance of building. A complaint was filed before the Insurance Ombudsman on 16.12.2008, who also dismissed the complaint vide order dated 12.2.2009, on erroneous facts. However, the Insurance Ombudsman ordered that 50% of the assessed amount be paid to the Complainant. In compliance whereof, OPs paid Rs.51,000/- to the Complainant, which was received under protest by him, as he was entitled to full amount of Rs.3,83,200/-. Hence this complaint alleging that the aforesaid acts of the OP amount to deficiency in service and unfair trade practice.
2] Notice of the complaint was sent to OPs seeking their version of the case.


3] OPs filed their joint reply admitting the factual matrix of the case. It was pleaded that on receipt of the information, they deputed one Sh. Sanjay Gupta, Surveyor & Loss Assessor, who in his report dated 9.9.2008 stated that there was leakage of water from the shop due to which the stocks of clothes had been affected and the water also affected the clothes of the Shop. He also found that the roof was flooded with rain water as the drain was choked due to garbage/leaves, which resulted into seepage of water inside the Shop through crevices in the RCC and electrical conduit pipes. The Surveyor assessed the net liability of the OPs to the tune of Rs.1,04,250/- and the salvage value of the damage stocks was Rs.25,648/-, which the Complainant agreed to retain. As the claim of the Complainant was not covered under the terms & conditions of the Policy, it was rightly repudiated vide letter dated 17.11.2008, copy of which is at Annexure R-4. It was pleaded that the complaint filed by the Complainant with the Insurance Ombudsman was decided vide order dated 12.2.2009 (Annexure R-5) and giving him benefit of doubt, the Insurance Ombudsman directed to settle the claim on non-standard basis by paying the 50% of the assessed amount. The Complainant duly accepted the award passed by the Insurance Ombudsman and gave his unconditional acceptance for the award passed by the Insurance Ombudsman in full and final settlement of the claim and also signed a consent letter dated 12.2.2009. All other material contentions of the complaint were controverted. Pleading that there was no deficiency in service on their part, a prayer has been made for dismissal of the complaint.


4] Parties led evidence in support of their contentions.

5] We have heard the learned counsel for the parties and have also perused the record.

6] The OPs have produced Annexure R-1, which is the copy of the Insurance Policy showing that the premises of the complainant was insured. As per the terms & conditions of the Policy, the complainant was not entitled to any compensation if the damage was caused due to the negligence of the complainant. In the present case, the report of the Surveyor shows that the water accumulated on the roof of the building due to the closure of the roof water pipe, which was the responsibility of the complainant to maintain it in perfect working order. The water accumulated on the roof and the seepage started causing damage to the clothes. It was due to this reason that the OPs had repudiated the claim.



7] When the complainant approached the Insurance Ombudsman, the OP Insurance Company was asked to pay 50% of the assessed amount on non-standard basis as per order Annexure C-3. The complainant accordingly moved an application, copy of which is Annexure R-6, unconditionally accepting the award in full & final settlement in respect of his complaint. It is admitted that the complainant received the amount of Rs.51,000/- as mentioned in Para No.10 of the complaint. The complainant, however, concealed the correct facts from this Forum. He did not mention if he had consented unconditionally to accept the award given by the Insurance Ombudsman and the payment was to be in full & final settlement of his complaint. Rather, the complainant in Para No.10 of the complaint wrongly mentioned that he took the amount under protest. He, however, did not produce any document to suggest when the protest was lodged by him. The amount was received without any protest, which fact was concealed by the complainant in order to succeed in this case.



8] If the complainant has received the amount of Rs.51,000/- in full & final settlement of his claim, he is not entitled to any further amount as compensation. It is not his case if the consent letter Annexure R-6 was obtained by mis-representation or fraud. He has not denied having sent the said request Ann.R-6. We are, therefore, of the opinion that this false & frivolous complaint has been filed by the complainant intentionally to harass the OPs and to extract further amount from them, which otherwise was not due because this amount was paid to him only in view of the orders Annexure R-3 of the Insurance Ombudsman to which he agreed unconditionally.



9] In view of the above discussion, we are of the opinion that there is no merit in this complaint. The same is accordingly dismissed. The complainant is directed to pay Rs.10,000/- as cost to the OP Insurance Company as per Section 26 of the Consumer Protection Act, 1986 for filing this false & frivolous complaint against the OPs.



Certified copies of this order be sent to the parties free of charge. The file be consigned.

Smt. Kavita wd/o Suresh Kumar r/o House No. 127, Ward No. 3, Near Ghaa Mandi, Dasuya, District Hoshiarpur.


.......... Complainant

versus


Bajaj Alliance Life Insurance Company Limited, Branch Office: Hoshiarpur, Bhal Complex, Ist Floor, Railway Road, Hoshiarpur, through its Manager.


........... Opposite Party


Complaint u/S 12 of the Consumer Protection Act, 1986.


Quorum: Sh. P.D. Goel, President,

Sh. A.S. Jauhar, Member.


Present: Sh. Manu Kauhal, Counsel for the complainant.

Sh. Salil Chopra, Counsel for the opposite party.


PER P.D. GOEL, PRESIDENT:


1.

The complainant namely Smt. Kavita has filed the present complaint, under Section 12 of the Consumer Protection Act, 1986 (as amended upto date) “hereinafter referred as the Act”. Stated briefly, the facts of the case are that the husband of the complainant namely Suresh Kumar purchased “Invest Gain-Platinum” insurance policy from the opposite party for Rs. 1,50,000/-. The policy commenced from 27.9.2006 and was valid for 30 years. The said policy was issued after proper verification of the health of Sh. Suresh Kumar. The complainant was the nominee under the said policy.
2.

It is the case of the complainant that the husband of the complainant could not deposit second instalment due on 27.9.2007 amounting to Rs. 6,649/-, however, the husband of the complainant deposited the said amount of Rs. 6,649/- on 31.5.2008 alongwith interest and in toto Rs. 7,145/-, as such the policy was revived.
3.

It is further the case of the complainant that unfortunately, her husband died on 5.8.2008. The complainant filed the claim with the opposite party for settlement of the insurance claim alongwith all benefits and also fulfilled the necessary requirements.
4.

It is the allegation of the complainant that she was shocked to receive letter dated 9.1.2009 from the opposite party that the claim was not payable as the policy lapsed on 27.9.2007. The opposite party returned the cheque qua which the insurance policy of Suresh Kumar was renewed. The grounds of repudiation mentioned in the letter dated 9.1.2009 are baseless, as the policy was renewed by the opposite party and the premium was also accepted from the husband of the complainant. The opposite party failed to settle the claim, hence this complaint.
5.

The opposite party filed the reply. The preliminary objections vis-a-vis cause of action, maintainability, the complainant is not a consumer and jurisdiction were raised. On merits, the claim put forth by the complainant has been denied. It is replied that deceased Suresh Kumar had not complied with the terms and conditions of the insurance policy at the time of reinstatement of the insurance policy, which had lapsed on account of non-payment of the insurance premium. That as per terms and conditions of the insurance policy, a policy which had lapsed due to non-payment of insurance premium after the expiry of the grace period, can be reinstated only, if satisfactory evidence of health of Life Assured is furnished. Thereafter the reinstatement will take effect only on it being specifically communicated by the insurance company to the Proposer/Life Assured.

6.

It is further replied that the policy of deceased Suresh Kumar lapsed due to non-payment of premium due on 27.9.2007. The premium was deposited on 31.5.2008 i.e., after the grace period of 30 days. Since the premium was not accompanied with a declaration of good health, the amount deposited by the policyholder was kept in suspense account and was not adjusted in the policy account. That no communication regarding reinstatement of policy was sent to the policy holder as the policy holder had failed to submit a declaration of good health.
7.

It is further replied that the contract of insurance is a contract of utmost good faith. The policy holder and the insurance company are bound by the terms and conditions of the policy. Said Suresh Kumar had failed to submit the declaration regarding his good health at the time of applying for the reinstatement of his life insurance policy, which as per the terms and conditions of the policy was mandatory for the reinstatement of a lapsed life insurance policy. It is further replied that in case, where the policy of life insurance lapses on account of non-payment of premium, at the time of reinstatement, the insurance company has the right to re-assess the assumption of risk on the life of the policy holder and is also entitled to alter the terms and conditions of the policy. The status of the policy remained as lapsed on the date of death of the policy holder and the death claim was rejected as non admissible, which was communicated to the complainant in terms of the letter dated 9.1.2009. The cheque of Rs. 7,160/- drawn on Axis Bank bearing No. 28141 dated 6.1.2009 as refund of the amount lying in suspense account, which was paid by deceased Suresh Kumar for reinstatement of the lapsed policy, was sent to the complainant through post. The said cheque has been received by the complainant.
8.

In order to prove the case, the complainant tendered in evidence her affidavit – Ex. C-1, supplementary affidavit – Ex. C-2, letter dated 6.10.2006 – Mark C-3, copy of the policy – Mark C-4, letter dated 30.6.2006 – Mark C-5, terms and conditions- Mark C-6, receipt dated 31.5.2008 – Mark C-7, letter dated 9.1.2009 – Mark C-8, copy of cheque dated 6.1.2009 – Mark C-9, letter dated 7.1.2009 – Mark C-10 and closed the evidence.
9.

In rebuttal, the opposite party tendered in evidence affidavit of Balraj Singh – Ex. OP-1, medical attendance certificate – Ex. OP-2 (4 sheets), certificate of hospital – Ex. OP-3 (3 sheets), policy schedule – Ex. OP-4 (2 sheets), letter dated 30.9.2006 – Ex. OP-5, renewal premium receipt – Ex. OP-6, terms and conditions of policy – Ex. OP-7 (8 sheets), letter dated 9.1.2009 – Ex. OP-8, letter dated 7.1.2009 – Ex. OP-9, preliminary report – Ex. OP-10, cheque dated 6.1.2009 – Ex. OP-11, postal receipt – Ex. OP-12, letter dated 21.8.2009 – Ex. OP-13 and closed the evidence on behalf of the opposite party.
10.

The learned counsel for the parties have filed written arguments. We have gone through the written submissions and record of the file minutely.
11.

Admittedly, the husband of the complainant namely Suresh Kumar purchased “Invest Gain-Platimum” insurance policy - Mark C-4, from the opposite party for Rs. 1,50,000/-, which commenced from 27.9.2006 and was valid for 30 years. It is the case of the complainant that her husband could not deposit second instalment of Rs. 6,649/- due on 27.9.2007. However, the husband of the complainant deposited the amount of Rs. 6,649/- on 31.5.2008 alongwith interest and in toto Rs. 7,145/-, with the opposite party. That the husband of the complainant died on 5.8.2008.
12.

It is the allegation of the complainant that she was shocked to receive letter dated 9.1.2009 – Mark C-8 from the opposite party that the claim was not payable as the policy lapsed on 27.9.2007. The grounds of repudiation mentioned in the said letter are stated to be illegal and baseless, as the opposite party accepted the premium through cheque alongwith interest on 31.5.2008.
13.

The opposite party has raised the defence that deceased, Suresh Kumar had not complied with the terms and conditions of the insurance policy at the time of reinstatement of the insurance policy, which had lapsed on account of non-payment of insurance premium. That the policy of deceased, Suresh Kumar lapsed on 27.9.2007. The premium was deposited on 31.5.2008 i.e., after the grace period of 30 days. Since the premium was not accompanied with a declaration of good health, the amount deposited by the policyholder was kept in suspense account and was not adjusted in the policy account. That no communication regarding reinstatement of policy was sent to the policyholder. Sh. Suresh Kumar had failed to submit the declaration regarding his good health at the time of applying for the reinstatement of life insurance policy, which as per the terms and conditions of the policy was mandatory for the reinstatement of a lapsed life insurance policy. The status of the policy remained as lapsed on the date of death of the policy holder and the death claim was rejected as non admissible.
14.

Now, the only point which calls consideration from this Court is whether the insurance policy in question was in lapsed condition at the time of death of Suresh Kumar – policy holder. The answer to this is in the negative.
15.

The coverage of insurance commenced from the time, the premium amount is paid to the insurance company. The complainant deposited the premium amount alongwith interest on 31.5.2008 and the said fact has also been admitted by the opposite party in the reply.
16.

Now, the point for determination is whether the policy in question was in lapsed condition at the time of death of the policyholder or it stood revived on payment of the premium amount alongwith interest on 31.5.2008.
17.

In the instant case, the offer to pay the premium through cheque was made on 31.5.2008 to the opposite party – insurance policy. Admittedly, the said cheque was received by the opposite party – insurance company without any protest, therefore, it amounts to unconditional acceptance of the premium on the part of the opposite party, therefore, in view of the provisions of Section 64 VB of the Insurance Act, 1938, the contract is complete, thus the insurance company – OP is not at liberty to say that the policy was in lapsed condition on the date of death of the policyholder on 5.8.2008. Once the premium has been accepted by the opposite party, the opposite party-insurance company cannot escape from the liability.
18.

Sh. Suresh Kumar (now deceased) took the insurance policy – Mark C-4 on 27.9.2006. The premium was paid on 31.5.2008 through cheque, which was accepted by the opposite party without any objection, therefore, it can legitimately be concluded that the opposite party-insurance company had renewed the policy in question by accepting the premium. Since, the opposite party has accepted the premium for renewal on 31.5.2008, the original policy stood renewed, with effect from the date it fell due for renewal. A renewal of an insurance policy means repetition of the original policy. When renewed, the policy is extended and the renewed policy in the identical terms from a different date of is expiration comes into force, which means by renewal, the old policy is revived and it is sort of a substitution of obligations under the old policy. Since the insurance company had accepted the unpaid premium on 31.5.2008 with interest for renewal of policy without raising any objection and had not asked for medical certificate from the insured, the status of the policy will not remain lapsed, rather it will amount to revival of the insurance policy.
19.

The opposite party has accepted the offer of the complainant to pay the premium amount through cheque on 31.5.2008, therefore, subsequently the insurance company is estopped from raising the plea that since the proof with regard to the good health of deceased Suresh Kumar has not been submitted, so the policy remained lapsed. In fact, the unconditional acceptance of the premium i.e., without resistance or objection by the insurance company gives the impression that the opposite party had the intention to revive the policy in question without certificate of good health of the insured.
20.

As a result of the above discussion, it is held that the insurance policy was not in lapsed condition at the time of death of Suresh Kumar-insured. The opposite party has failed to pay the claim, which amounts to deficiency in service.
21.

As a result of the above discussion, the complaint of the complainant is accepted and the opposite party is directed to pay Rs. 1,50,000/- (insured amount) to the complainant. Litigation expenses are assessed at Rs. 1,000/- to be paid by the opposite party to the complainant. Compliance of the order be made within one month from the date of receipt of copy of the order. Copy of the order be sent to the parties free of cost. File be consigned to the record room.

Complaint No. 833/28.11.2008.

Date of order: 18.11.2009.

Rajesh Kumar son of Sh. Kharaiti Lal Makkar, resident of H. No.3067, Sector 31-A, urban Estate, Chandigarh Road, Ludhiana.

(complainant)

Vs.

1. M/s Bajaj Allianz Life Insurance Co. Ltd. 4th Floor, Shangai Tower, Feroze Gandhi Market, Ludhiana through its Manager.

2. M/s Bajaj Allianz Life Insurance Co. Ltd. GE Plaza, Airport Road, Yerawada, Pune 411 006 through its Manager.

3. M/s Bajaj Allianz Life Insurance Company Limited, Akshaya Commercial Complex, No.26, 2nd Floor, Victoria Road, Bangalore 560047 through its Manager.

4. Harinder Pal Singh alias Happy Makkar, authorised agent M/s Bajaj Allianz Life Insurance Co. Ltd,. 4th Floor, Shangai Tower, Feroze Gandhi Market, Ludhiana.
(Opposite parties)

COMPLAINT UNDER SECTION 12 OF THE CONSUMER PROTECTION ACT, 1986.

Quorum:

Sh. Rajesh Kumar, Member.

Smt. Priti Malhotra, Member.
Present:

Sh. Sachin Arora Advocate for the complainant.

Sh. Vishal Gupta Advocate for opposite parties no.1 to 3.

Op no.4 is ex-parte.
O R D E R

RAJESH KUMER, MEMBER:

1. Sh. Rajesh Kumar, above noted complainant has filed the present complaint under section 12 of the Consumer Protection Act, 1986 against M/s Bajaj Allianz Life Insurance Co. Ltd. & others.

2. Briefly stated, facts of the present complaint are that opposite party no.4 for and on behalf of OPs No.1 to 3 approached the complainant and induced that in case he invests in their plans, would get huge profits, on which complainant agreed to invest Rs.1,00,000/- every year upto six years as represented by him and purchased two policies having product name Bajaj Allianz New Unit Gain Non Participating and paid Rs.1,00,000/- by way of a demand draft no.047803 dated 27.12.2006 of State Bank of Patiala, Jamalpur, Ludhiana and also paid another sum of Rs.1,00,000/- by way of demand draft of State Bank of Patiala, Jamalpur, Ludhiana, Punjab, both in favour of M/s Bajaj Allianz Life Insurance Co. Ltd. payable at Bangalore vide SBP Bangalore 50197 and also handed over other relevant documents. Thereafter, opposite party for about four months did not issue the policies inspite of receipt of the amount. On his repeated requests policy no.0039851267 of Rs.10,000/- instead of Rs.1,00,000/- in the name of complainant commenced from 28.3.2007 after a gap of about four months. When the complainant protested for the same that no policy has been issued for the insured amount, but lateron informed the complainant that he had paid only Rs.10,000/-. Then he approached his bankers i.e. State Bank of Patiala, Jamalpur Branch, Ludhiana and obtained a certificate wherein it is clearly mentioned that opposite party had since been received the entire amount of Rs.1,00,000/- on 23.2.2007. This amounts to clear cut case of deficiency in service and unfair trade practice and due to negligence of opposite parties, complainant suffered mental pain, agony in addition to loss of premium which has been paid for the purchase of the insurance policy, as such, the opposite parties are liable to compensate the complainant for mental pain and agony for Rs.8,00,000/- in addition to pay interest @24% from the date of deposit till the date of issuance of the policy. When confirmation letter of the bank was given to opposite parties on 15.3.2008 but till date, they have not given the policy of Rs.1,00,000/- inspite of various requests and reminders. The complainant also shown the said amount in his income tax return as he had already given to the respondents Rs.1,00,000/-. He also got prepared a demand draft no.630173 of State Bank of Patiala, Industrial Area-A branch, Ludhiana of Rs.1,00,000/- for the next instalment which was due on 31.3.2008 and handed over the same to opposite party no.4. But after retaining the same for about 35 days, returned it to complainant on the pretext that they will issue fresh policy from current date and the previous policy stands nowhere. All the opposite parties purposely had retained the amount of the complainant and till date not issued any policy. Opposite party no.4 is working on behalf of opposite parties no.1 to 3 and they are fully liable for their act under vicarious liabilities of their agent. Due to negligence and deficiency in service on their part, complainant has suffered huge pain, agony, harassment and humiliation for which he is entitled to compensation of Rs.8,00,000/- besides litigation costs. He also got served legal notice dated 7.7.2008 which was replied on 22.7.2008. It has been prayed that complaint be allowed and opposite parties be directed to issue afresh policy commencing from the date when the opposite parties received the payment of Rs.1,00,000/- and also to accept subsequent instalment of Rs.1,00,000/- and pay Rs.8,00,000/- as compensation for deficiency in service and negligence on their part.

3. Opposite parities no.1 to 3 contested the complaint on the ground that complaint is not maintainable in the present form and is liable to be dismissed. The complainant has not come to the court with clean hands and suppressed the material facts. The complainant has concealed the material facts and has not disclosed true facts. In fact, the complainant has purchased the policy, but inadvertently policy of Rs.90,000/- was not issued at relevant time and when later on the complainant approached the respondent, after negotiation between the parties and as per the proposal of the complainant, the respondent has compensated the complainant and after adjusting the difference of value of unit at that time and after satisfaction of the complainant, the policy of Unit gain Plus Gold was issued in place of new Unit Gain. The first policy of Rs.10,000/- is Bajaj Allianz New Unit gain. As per statement of account, the unit of Rs.18,108.47 @Rs.13,412/- and total number of units 1350.1689 was issued after the adjustment of time gap between the receipt of the amount as well as for issuance of the policy and complainant can not take the benefits of his own wrongs by filing the present complaint. The complainant wants to pressurize the respondent in order to extort money. When the complainant had accepted the policy after his satisfaction after adjustment of difference of value of units, in that case the question of deficiency in service does not arise at all. If it is presumed that policy of Rs.1,00,000/- was issued, then the allocation of units will be 28.5%, but the respondent has issued the second policy of Rs.90,000/- i.e. Bajaj Allianz Unitgain Plus Gold and the allocation was @76% i.e. Rs.68,400/-. It shows that benefit of Rs.42,750/- was given to the complainant and the complainant has separated the same and handed over the relevant documents before issuing the said policy. In case the life assured was not satisfied with the policy, as issued he could have made an application for return of the policy within 15 days of the date of receipt of the policy documents. Since the complainant has never availed such an option, it signifies that he was satisfied with the policy as issued. Moreover, the loss of units was also compensated . In such circumstances, claim raised is belated and can not be entertained at this stage. This Fora has no jurisdiction to try the present complaint. Pleaded that respondent no.4 is not their representative. It is admitted that draft no.047803 of Rs.1,00,000/- was received by the respondent no.1 to 3. It is denied that respondent for about four months did not issue the policy to the complainant, inspite of receipt of money. When they had issued the policy after compensating the complainant, then the question of not issuing the policy does not arise at all. It is denied that respondent has only issued policy no.0039851267 of Rs.10,000/-. Averred that another policy no.0099028214 for Rs.90,000/- was issued after compensating the units and amount with the satisfaction and proposal of the complainant. Rest all the assertions made in the complaint have been denied. In view of the facts, detailed above, it is pleaded that there is no deficiency in service n the part of respondent. Prayer has been made that the complaint be dismissed with costs.

4. Opposite party no.4 did not contest the complaint and is being proceeded against ex-parte.

5. Parties led their evidence by way of affidavits and documents in support of their respective contentions.

6. We have heard the arguments addressed by the ld. counsel for the parties, gone through file, scanned the documents and other material on record.

7. Complainant argued that he paid to opposite party a bank draft of Rs.1,00,000/- bearing no. 047803 dated 27.12.2006 of State Bank of Patiala, Jamalpur, Ludhiana and also paid another sum of Rs.1,00,000/- by way of demand draft of State Bank of Patiala, Jamalpur, Ludhiana in favour of M/s Bajaj Allianz Life Insurance Company Limited, payable at Bangalore vide SBP Banglore, 50179 and also handed over other relevant documents. The complainant had argued that he received a policy bearing no. 0039851267 of Rs.10,000/- instead of Rs. 1,00,000/- in the name of the complainant Sh. Rajesh Kumar and the policy commenced from 28.3.2007 after a gap of about four months. The complainant argued that the policy was not issued for the insured amount and when the complainant approached them, it was informed that he had paid only Rs.10,000/-. Complainant argued that when he approached State Bank of Patiala, Jamalpur branch, Ludhiana and enquired about the draft then the bank has issued a certificate clearing that opposite party has received entire amount of R1,00,000/- on 23.2.2007 (Ex.C2) The complainant argued that then confirmation letter of the bank was given to the opposite party on 15.3.08 but till date opposite party has not issued the policy of Rs.1,00,000/- to the complainant. Therefore, complainant argued that they are deficient in service and may be directed to pay Rs.8,00,000/- as compensation for their negligent act on their part.

8. Opposite party argued that policy for Rs.1,00,000/- could not be issued inadvertently but later on when the complainant approached them, they after negotiation between the parties as per proposal form Ex. R.1, complainant was compensated and after adjusting difference of value of units at that time and to the satisfaction of the complainant, policy of Unitgain Plus Gold was issued in place of New Unit Gain and his policy of Rs.10,000/- is Bajaj Allianz New Unit gain. As per the statement of account dated 21.4.2009,(Annexure-A) units of Rs.18,108.47@Rs.13,412, and total number of units 1350.1689 was issued after adjustment of time gap between receipt of amount as well as in issuance of the policy. Opposite party argued that policy was issued for Rs.90,000/- i.e. Bajaj Allianz Unitgain Plus Gold . Allocation was 76% i.e. Rs.68,400/-. It means that benefit of Rs. 42,750/- was given to the complainant and handed over relevant documents before issuance of the said policy Annexure A to E. Opposite party issued letter dated 22.7.2008 to the complainant in which they have mentioned reference to the letter dated 7.7.2008 for the policy no.0039851267 for Rs, 10,000/- and policy no.0099028214 for Rs.90,000/- has been issued on 22.5.08 and this policy is Unit Gain Plus Gold size having two main benefits. In this letter, they have clearly mentioned that they have compensated loss of units incurred to him annexure E. Opposite party argued that the complainant was issued policy no. 0039851267 for Rs.10,000/- and policy no.0099028214 for Rs.90,000/- and this was issued after compensating units and to the satisfaction of the complainant. It is wrong to say that complainant has suffered any mental pain and agony and loss to the tune of Rs.8,00,000/-. It is also to mention here that the opposite party has not received any draft no.630173 of Rs.1,00,000/- for the next instalment.

9. Opposite party also argued that the complainant was given free look period (Ex.R.1) in which he could get policy back within for 15 days. Therefore, opposite party argued that the policy was not issued for Rs.90,000/- inadvertently and when it come to the notice of the opposite party, they have released the policy.

10. Fora reaches at the conclusion that the policy for Rs.10,000/- bearing no.0039851267 was issued to the complainant and when the complainant approached the opposite party that why policy was not issued for Rs. 1,00,000/- and when it came to the notice of opposite party they issued another policy no.0099028214 for Rs.90,000/- after compensating unit and amount with satisfaction of the complainant and in this way total unit of 1350.1689 was issued after adjustment of the time gap between receipt of the amount as well as issuance of the policy (Ex.R.2). Policy bearing no. 0099028214 was issue for Rs.90,000./- dated 20.5.2008 after filling proposal form Ex.R.1, which the complainant had signed. In this way Bajaj Allianz Unitgain plus Gold policy was issued and allocation was 76% i.e. Rs. 68,400/-. It shows benefit of Rs. 42,750/- was given to the complainant and the complainant was also given free look period of 15 days in which he could have get back the policy, which he did not do it(Ex.R.1).

11. Fora reaches at the conclusion that the complainant has filled the proposal form Ex.R.1 by his own will and also policy Bajaj Allianz Unitgain Plus Gold was issued giving benefit of Rs.42,750/-. It means that complainant had agreed to accept the policy for Rs.90,000/- and he has signed the proposal form. Therefore, total policy of Rs. I,00,000/- i.e. Rs.10,000/- (policy no.0039851267 plus Rs.90,000/- (policy no.0099028214) was issued. The complainant was also compensated for the loss. Therefore, this complaint finds no merit. Hence, the same is dismissed leaving the parties to bear their own costs. Copy of the order be made available to the parties free of costs. File be completed and consigned to record.

Consumer Complaint No: 459/2008
Between:
Yarava Manmada Rao, S/o Ramulu (late), Hindu Aged 28 years, R/o D.No: 12-149, Gundala Street, Thummapala Village, Anakapalli Mandal, Visakhapatnam-531032
… Complainant
A n d :

1. Road Safety Club(P) Ltd, Rep., by its Divisional Manager, 2A Prakasam Road, T.Nagar, Chennai, 600017.

2. Reliance General Insurance Co.Ltd., rep., by its General Manager, 3rd Floor, Maker Chambers IV, 222, Nariman Point, Mumbai-400021.

3. Bajaj Allianz Life Insurance Co.Ltd., Rep., by its Branch Manager, 2nd Floor, Dwaraka Plaza, Dwaraka Nagar, Visakhapatnam - 16
… Opposite Parties

This case is coming on for final hearing on 9-11-2009 in the presence of Sri Adari Appa Rao, Advocate for the complainant and of Sri.P.V.Narayana Rao, Advocate for the 1st opposite party, D.Siva Prasad Advocate for the 2nd Opposite party and T.H.Ramanath Advocate for the 3rd opposite party and having stood over till this date, the Forum delivered the following.



: O R D E R :

(As per the Honourable President on behalf of the Bench)



1. The complainant’s case is that his father, Ramulu, during his life time had taken Insurance policies for an amount of Rs.1,00,000/- (Rupees one lakh only) for (General Insurance policy) and Rs.50,000/- (Rupees fifty thousand only) for (Life Insurance Policy) from 2nd and 3rd opposite parties respectively through first opposite party. The policy issued by 2nd opposite party was in force from 29-5-2007 to 28-5-2008. The policy issued by 3rd opposite party, Group Insurance Policy was in force from 12-8-2007 to 11-08-2008. While so, the complainant’s father accidentally fell when slipped in his bathroom, while taking bath and he was immediately shifted to Area Hospital, Anakapalle and later on treated at Sri Shirdi Sai Hospital Anakapalle and he died on 7-08-2007 due to the injuries sustained by him, in the said accident. The death was intimated to the first opposite party by letter dated 8-8-2007. The opposite parties 2 and 3 had sent claim forms and the complainant submitted the original documents along with claiming form on 6-11-2007 for claiming the insurance amounts from opposite parties 2 and 3. However, the 1st opposite party informed the complainant that the claims were repudiated.Because of this unjust repudiation, the complainant sustained loss. Hence the complaint against the opposite parties for payment of Rs.1,50,000/- (Rupees one lakh fifty thousand only) together with interest at 24% and also compensation amount of Rs.50,000/- (Rupees fifty thousand only) as damages towards mental agony, pain and suffering, besides costs.

2. The first opposite party filed a counter admitting the issuance of policies to the complainant’s father through it, but denied any liability on its part contending that the disease obtained membership in club of the opposite party to get insurance benefits and as such, there is no privity of contract between complainant and this opposite party and hence the complaint against it, has to be dismissed.

3. The second opposite party filed a counter admitting issuance of Insurance policy to the complainant’s father, but denied its liability on the ground of violation of policy conditions, namely, failure to inform event of accidental death of policy holder within 30 days and also failure to produce or furnish PM report, MNC registration and copies of FIR and inquest report etc. In addition to it, it also took up a plea that a surveyor appointed by it, gave a report as per which the diseased was not at all admitted in hospitals as alleged and the documents filed by him are fabricated. In the light of these circumstances, the opposite party rightly repudiated the claim and there is no deficiency in service. Hence the complaint has to be dismissed against it.

4. The third opposite party filed a counter admitting issue of Group Insurance Policy to the complainant’s father, but asserted that it was in force from 12-8-2007 to 11-8-2008 and thus by the date of death of policy holder, there is no insurance cover by this opposite party and hence the question of liability by this opposite party. It also took up a stand that the complainant has to prove that the nature of death of his father and other documentary evidence. Thus it pleaded that there is no deficiency in service on its part and the complaint has to be dismissed being frivolous and vexatious with the cost of Rs.10,000/- (Rupees ten thousand only).

5. The third opposite party also filed an additional counter reiterating the pleas taken by it earlier and further pleaded that the father of the complainant, Ramulu

was enrolled as a new member in the scheme on 10-5-2007 and as per the conditions of the policy and the scheme, it becomes effective only from 90 days after his entry into service i.e from 12-8-2007 but by that date he had already expired on 7-8-2007.

6. At the time of enquiry, both parties filed affidavits in respect of their contentions. Ex.A1 to Ex.A11 documents were marked for complainant and Ex.B1 to Ex.B9 documents were marked for opposite parties. Both the counsels were heard.

In view of the pleadings of either side and the contentions raised at the time of enquiry, the following two points were raised for determination.

1. Whether there is any privity of contract between the complainant’s father and the first opposite party and it is liable for the claims made against it.
2. Whether the repudiation of claim by 2nd and 3rd opposite parties is not justified and the complainant is entitled for the policy amount as well as the compensation, as claimed.

7. The fact that the complainant’s father Ramulu during his life time obtained two Insurance policies, one for Rs.1,00,000/- (Rupees one lakh only) for second opposite party and another policy under Group Insurance scheme from 3rd opposite party for Rs.50,000/- (Rupees fifty thousand only) is not in dispute. Similarly Ex.A2 and Ex.A11 policies issued by the opposite parties 2 and 3 respectively would show that they were in force from 29-5-2007 to 11-08-2008 and 12-08-2007 to 11-08-2008, respectively, and these policies were obtained through first opposite party is not in dispute. The death of insurer was on 7-08-2007 as per Ex.A6 which is not in dispute. The death was claimed to be due to the injuries sustained by the diseased by a fall in the bath room, evidently prior to 27-07-2007, as the complainant is silent as to when he fell in the bath room. The Insurance claims were repudiated by both the Insurance companies, opposite parties 2 and 3, the validity of which could be considered in answering the next point.

8. However in the light of the repudiation of the claim by 3rd opposite party on the ground that the death was on date much prior to the date when policy came into force, the learned counsel of complainant vehemently urged that the premium has been paid on 10-05-2007 itself to the first opposite party, which has got a duty to forward the same to the insurance companies and by its failure to do so, the third opposite party has taken up a stand that the policy came into force only on 12-8-2007 i.e subsequent to the date of death and this resulted in the diseased having no insurance cover by the date of his death, inspite of the fact that he has already paid the premium to the first opposite party. Hence the first opposite party is to be made liable to pay the policy amount for its negligence in forwarding the premium amount to the third opposite party .

9. However, as rightly contended by the counsel for first opposite party, as can be seen from Ex.A1 membership certificate issued by it, it is only a facilitator in obtaining insurance cover to its members from different insurance companies by collecting the premium amount from them and forwarding the claims if any on a later point of time to the respective insurance companies. Such being the role of the first opposite party, in our view, the first opposite party cannot be fastned with any liability for non-insurance policy by 3rd opposite party immediately. Moreover the pleadings of 3rd opposite party would show admission of receipt of the premium amount from first opposite party within the stipulated time and it took up a stand that the complainant’s father being a new member joining the Group Insurance Policy in the middle, it will come into force only after 90 days as per terms of the scheme of policy. However the ultimate liability of 3rd opposite party will be considered it answering the second point. Thus in our view the first opposite party being only facilitator in obtaining policy does not have any liability towards the claims under such insurance policy. Accordingly this point is answered against the complainant.

10. The complaint regarding repudiation of claims under two policies issued by 2nd opposite party and 3rd opposite party, respectively, for convenience sake the claim under Ex.A11 policy issued by 3rd opposite party for Rs.50,000/- (Rupees fifty thousand only) is being considered in the first instance. It would show that it has come into effect only from 12-08-2007 and will be in force for one year. The death was on 7-08-2007 and naturally there was no policy cover by the date of death on 7-08-2007. However the vehement contention of the counsel for complainant is that since the premium amount was undisputedly paid on 10-5-2007, the issue of policy only with effect from 12-8-2007 itself is bad and 3rd opposite party cannot be allowed to repudiate claim on that ground of non issue of policy by the date of death for the delay caused by itself. However, as rightly pointed out by counsel for 3rd opposite party, Ex.B9 rules for “Group Term Life Scheme”, Rule 1-(5) would show that entry date shall mean in relation to original members the effective date, and in relation to new members i.e three months from date of membership, of the grantee’ forum. Rule 7 would show that ‘grantee’ means agency or financial institution which advances credit and which proposes or has proposed to subscribe to this Group Insurance scheme. From these rules, it is quite evident that the 3rd opposite party issued the policy which had come into force after 90 days from the date of joining as member with 1st opposite party and in accordance with rules there on. Such being the case, the validity of such rules of this scheme cannot be decided by this Forum. Thus the policy issued to the disease by 3rd opposite party effective from 12-08-2007 is in accordance with its rules and as there is no policy as on the date of death of the complainant’s father. No liability to answer the claim for insurance amount and it rightly repudiated the claim. Even otherwise also, the claim cannot be upheld for the reasons be given in the following paras. Accordingly this point is answered.

11. With regard to liability of 2nd opposite party to pay the insurance amount of Rs.1,00,000/- (Rupees one lakh only), as undisputedly the death of the complainant’s father was during the policy period only, the repudiation was made on the ground that the death was not proved to be due to any accident and the very occurrence of accident itself was disputed. As per the complainant’s case his father fell in the bath room while taking bath and sustained head injury and injuries in other parts of the body and ultimately died on 7-08-2007, said to be due to these injuries. In the absence of an FIR, the complainant is relying upon Ex.A3 Op Ticket, Ex.A4 the treatment obtained from Sri Shirdi Sai Hospital and bill for purchase of medicines. It is to be noted that the opposite party contends that these documents are false documents not supported by any other material in the light of the investigators report in Ex.B6. Though Ex.A3 shows that the patient went there with multiple injuries and X-ray of chest and skull were advised and he was ultimately referred to KGH, it was not complied with

12. Ex.A4 shows he was given the treatment at Sri Shirdi Sai Hospital, Anakapalle, which mentions that the injuries on the head and shoulder and chest were due to fall from height in bath room. It also shows that the patient was advised to KGH. There is no whisper as to whether any investigation as advised were done and the patient was taken to KGH at all.

13. Ex.B6 investigators report would show that his enquiry is revealed that these documents were false and fabricated one. The investigation relied upon the endorsement made on copy of Op Ticket, Ex.B7 by the RMO of Area Hospital, Anakapalle to the effect that. Though, Ex.B7 Op Ticket was issued by their Hospital, the notes made there in with regard to the nature of injuries and treatment and advice given were not written by any of their doctors. Similarly Ex.A8.

14. The copy of Sri Shirdi Sai Hospital treatment would show an endorsement that the hospital was not having equipment or even beds and there is no record regarding the treatment given to insurer. Thus these endorsements by authorities concerned on Ex.B7 would amply show that the prescription mentioned there in was not given by any member in that hospital and Ex.A8 treatment in the private hospital was not supported by any record of that hospital.

15. The complaint itself is silent as to whether what was to subsequent treatment obtained and where the death occurred. Thus in the first instance there is no evidence to show that it was an accidental fall in the bath room and ultimately there is absolutely no evidence that due to the injuries said to have been sustained in such an accidental fall, the death occurred ten days thereafter. Thus there is no wonder that the second opposite party repudiated the claim for want of proof. Thus in our view, both the opposite parties 2 and 3 repudiated the claims for want of proper proof and in accordance with the terms and conditions of the policy itself and such being the case, it cannot be held to be deficiency in service. Accordingly this point is answered against the complainant.

16. In the result the complaint is dismissed, but in these circumstances of the case, each party to bear their respective costs. Advocate fee is fixed at Rs.1,000/- (Rupees one thousand only).

Dictated to the Shorthand writer, transcribed by him, corrected and pronounced by us in the open Forum on this the 24th Day of November, 2009.