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UTTARAKHAND STATE CONSUMER DISPUTES REDRESSAL COMMISSION
D.K. Tyagi and Veena Sharma, Members
BAJAJ ALLIANZ LIFE INSURANCE CO. LTD. - Appellant
Versus
BANSH ALIAS EKLAVYA - Respondent
First Appeal No. 157 of 2015
Decided on : 10-10-2017

Advocates Appeared:
Sh. Vijay Pal Tiwari and Sh. Rajesh Devliyal, Learned Counsel, for the Appellants; Sh. Pradeep Bartwal and Sh. K.C. Pant, Learned Counsel, for the Respondent

Headnote:

Consumer Protection Act - Insurance Claim - 1986 - [FRAUDULENT INSURANCE CLAIM] - [Consumer Protection Act, 1986, Section 15] - The court discussed the discrepancies in the documents and evidence presented by the complainant and the insurance company, highlighting the importance of utmost good faith in insurance contracts and the duty of the insured to provide correct information. The court emphasized that the insurance policy is a contract regulated by the Insurance Regulatory and Development Authority, and any violation of the terms and conditions, such as concealing material facts, can lead to the repudiation of the claim. The court also noted the jurisdictional aspect of the case, emphasizing the place of filling the proposal form and the lack of branch offices of the insurance company in the relevant locations.

Fact of the Case:

The complainant purchased an insurance policy for his daughter, but the claim was repudiated by the insurance company due to discrepancies in the documents and evidence presented.

Finding of the Court:

The court found that there were significant discrepancies in the documents and evidence presented by the complainant, including inconsistencies in the name, address, and date of death of the insured. The court emphasized the duty of the insured to provide correct information and the consequences of violating the terms and conditions of the insurance policy.

Issues: The main issues revolved around the discrepancies in the documents and evidence presented, the duty of the insured to provide correct information, and the jurisdictional aspect of the case.

Ratio Decidendi: The court emphasized the importance of utmost good faith in insurance contracts, the duty of the insured to provide correct information, and the consequences of violating the terms and conditions of the insurance policy. The court also highlighted the jurisdictional aspect of the case, emphasizing the place of filling the proposal form and the lack of branch offices of the insurance company in the relevant locations.

Final Decision: The appeal was allowed, and the impugned judgment and order were set aside. The consumer complaint was dismissed, and no costs were awarded to either party.

ORDER

D.K. Tyagi, Member. - This appeal, under section 15 of the Consumer Protection Act, 1986, has been preferred by the appellants-Insurance Company against the order dated 12.05.2015 passed by the District Forum, Nainital in consumer complaint No. 55 of 2013, whereby the District Forum has partly allowed the consumer complaint and directed the opposite parties-Insurance Company to pay the complainant a claim amount of Rs. 3,71,000/- together with interest @ 6% per annum on the said amount, from the date of filing the consumer complaint till the date of actual payment, within one month from the date of order and it is also directed to pay Rs. 5,000/- to the complainant towards litigation expenses. The complainant is directed to make FDR of the claim amount and submit this FDR with the District Forum and will receive the said FDR only after being mature the minor.

2. Briefly stated the facts of the case, as mentioned in the consumer complaint are that the complainant-Sh. Videshi Lal had purchased a policy No. 066083703 receipt No. 6060924 after a payment of Rs. 10,000/- as annual premium and the maturity amount was Rs. 1,00,000/- in the name of his daughter Smt. Ramawati w/o Sh. Jitendra Devnatak on 22.09.2007 from the opposite party No. 1-Bajaj Allianz Life Insurance Co. Ltd. After few years, officials of the opposite party No. 1 apprised the complainant about a new plan policy, which was better than the existing policy and the existing policy was closed and after obtaining Rs. 31,928.72ps. a new policy No. 0202045621 dated 11.01.2011 was prepared and Rs. 25,712/- were charged from the complainant, but without charging Rs. 712/- only Rs. 25,000/- were charged. It was told to the complainant by the office of opposite party No. 1 that the maturity value of the new policy will be of Rs. 3,71,000/-. Officials of the Insurance Company had obtained signatures of the daughter of complainant on different papers. In the documents, the son of Smt. Ramawati named Vansh alias Eklavya date of birth 04.08.2003 was made nomine through guardian - complainant (Nana). The office of the opposite party No. 1 had apprised the complainant that insurance bond shall be provided to the complainant, when it shall come from the office of the opposite party No. 2 after one month and complainant was advised to collect the same. Unfortunately, Smt. Ramawati, daughter of the complainant, died a natural death on 22.01.2011. The complainant sent required documents such as death certificate of the insured along with claim form supported with an affidavit for settlement of claim and the complainant-Nana of the minor also sent his account No. 11178474910 of SBI, Branch Haldwani in the office of opposite party No. 1. It was told by the office of the opposite party No. 1 after obtaining certain signatures on the documents that claim amount shall be deposited in the account of complainant in SBI, after sanction of the same from the office of opposite party No. 2. The complainant time and again visited the office of the opposite party No. 1 to obtain the information regarding insurance claim amount, for which office of opposite party No. 1 assured him, but on 25.07.2012, suddenly a letter of repudiation of claim was received from the office of opposite party No. 2. The opposite party No. 1 advised the complainant to file review application before the opposite party No. 2. In this way, the opposite parties have repudiated the claim of the complainant on account of death of daughter of the complainant without mentioning any reason and thereby committed deficiency in service. By repudiating the claim without mentioning valid reason, the complainant as well as nominee Master Vansh alias Eklavya suffered mental agony and physical and financial loss. The opposite parties did not provide valid bond so far and caused harassment to the complainant to visit the office of the opposite party No. 1 time and again. After repudiating the claim, the complainant had sent a legal no

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