DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SUBARNAPUR
C.D. Case No. 5 of 2014
Aditya Kumar Satpathy, S/o. Akshya Kumar Satpathy, R/o. Ghatkaintara, P.S. Tarbha, District – Subarnapur.
………… Complainant
Vrs.
1. The Branch Manager, S.B.I. Life Insurance Co. Ltd., 2nd Floor Siva Complex, Opposite SBI Budharaja, District – Sambalpur.
2. The Regional Director, S.B.I. Life Insurance Co. Ltd., Ground Floor, Door No.5-9-588, Parisharam Bhawan, Bashir Baug, Hyderabad – 500 029.
…… Opp. Parties
Advocate for the Complainant …………. Sri R. Agrawal
Advocate for the O.Ps. …………. Sri G.S.Panda
Present
1. Sri S.C.Nayak, President
2. Smt. S.Mishra Lady Member
Date of Judgment Dt.14.03.2016
J U D G M E N T
By Sri S.C.Nayak, P.
This is complainant’s case alleging deficiency of service on the part of the B.M. and Regional Director of S.B.I., Life Insurance Co. Ltd.
The case of the complainant is that his deceased grand mother had taken S.B.I. Life Flexi Smart Insurance policy on dt.10.9.2011 with sum assured of Rs.3,00,000/- through the company agent namely Ekadasia Putel of Jhartarbha who filled up the proposal form. At that time the insured supplied all documents including voter I.D. Card.
According to the complainant his deceased grand mother was 60 years on the date of policy and her date of birth is 3.12.1950. It is alleged that the information supplied by the deceased policy holder was verified by O.P. No.1 who was satisfied that the deceased had no moral hazard health risk at the time of taking the policy. It is the averment of the complainant that the S.B.I. Life Insurance company has accepted the proposal of the deceased after verifying the genuineness and veracity of the information supplied by the policy holder and as such premium amount of Rs.15000/- was accepted from the policy holder.
-: 2 :-
The policy period was for 10 years and the policy holder has to pay Rs.15000/- per annum. As per the term of the policy the Insurance Company has to pay the sum assured i.e. Rs.3,00,000/- to the nominee in case of death of policy holder. The deceased policy holder had regularly paid the premium till her death on 3.12.2012. After the death of the policy holder the complainant being the legal heir applied before the O.Ps. for payment of death benefit claim as per the terms of the policy.
The O.Ps. illegally and arbitrarily rejected the claim on 12.3.2013 on the ground that the policy holder has misled the O.Ps. regarding her age, as she was much older at the time of taking the policy.
The complainant allege that the deceased policy holder was 60 years old on the date of policy as per her voter I.D. Card. It is further averred by the complainant that the O.Ps. have verified the genuineness of the age of the policy holder at the time of taking the policy. But now, the O.Ps. illegally rejected the claim.
Hence the complainant has prayed that the death claim amount of Rs.3,00,000/- be paid by the O.Ps. alongwith Rs.1,50,000/- as compensation and Rs.2000/- towards cost of litigation.
The O.Ps. have filed written version. According to them, the forum does not have territorial jurisdiction to decide the lis. According to them the complainant filed complaint before Hon’ble Ombudsman, Bhubaneswar, the Hon’ble Ombudsman has not heard the case. This complaint can not be entertained.
According to the O.Ps. during investigation it was revealed that the school certificate produced by the D.L.A. in proof of her age was fake and forged. According to the O.Ps. the D.L.A. was more than 65 years as per the voter list of 2013, Angan Wadi Worker statement and certificate of Gram Panchayat. As per the plan opted by the deceased the maximum age at entry is 60 years. The O.Ps. avers that she would have been found ineligible for the plan opted by her, if she would have mentioned the correct age.
It is further averred by the O.Ps. that in view of the nature of complaint and evidence on record this case cannot be effectively dealt in summary proceedings.
The O.Ps. allege that the claim has been rightly repudiated as per Section 45 of Insurance Act on the ground of suppression of material facts. The O.Ps. allege that they have transferred an amount of Rs.13,275/- to complainant’s Saving Account towards deposit amount balance, refund of excess premium and bonus.
The O.Ps. aver that the D.L.A. was more than 60 years of age at the time of proposal and availed the insurance cover fraudulently. Hence the repudiation of the claim by the Insurance company was justified. So the O.Ps. pray that the complaint case be dismissed with cost.
-: 3 :-
We have heard the learned counsel for the parties. We have also perused the material on record . From the pleadings of the parties, submissions of learned counsel during hearing the following points fall for determination by the Forum :-
i). Does the forum has jurisdiction to decide the lis ?
ii). Is the repudiation of the claim by the O.Ps. Justified ?
iii). To what relief the complainant is entitled ?
The learned counsel for the O.Ps. Vehemently contended that the addresses of the O.P. No.1 and 2 are at Sambalpur and Hyderabad respectively. But the complaint is filed before the Hon’ble Forum at Sonepur, hence learned counsel submits that this Forum does not have jurisdiction to decide the lis. On this learned counsel for the complainant submitted that the O.Ps. are carrying on their business in the districts of Subarnapur through their agent Ekadasia Putel. Learned counsel for the O.Ps. submitted that there is no evidence on record that Ekadasia Putel is the agent of the O.Ps. We are unable to accept this submission in as much as the O.Ps. in their written version have admitted that Ekadasia Putel is their agent. In their parawise comments in para 3 they have stated “The said proposal of the D.L.A. was sourced by Insurance Agent Ekadasia Putel.” So the fact that the O.Ps. are carrying on their business in the district of Subarnapur is admitted. Admissions are good pieces of evidence against the makers of it. So we are of the considered opinion that this Forum has jurisdiction to decide this complaint case as per the provisions of Sec.11 of Consumer Protection Act. 1986. ”
Now it is to be seen whether the repudiation of the claim by the O.Ps. is justified or not. The D.L.A. had submitted School Certificate of Sareal U.G.U.P. School. She had also submitted voter I.D. Card bearing No.OR/15/112/056139 in support of her proof of age. The D.L.A. died on 3.12.2012 i.e. within 1 year 2 months and 11 days from the commencement of the policy. So the O.Ps. conducted an investigation to the death claim.
The School certificate was verified at the Gram Panchayat. The concerned office of the Gram Panchayat states “ there is no any School named Sareal U.G.U.P. in our Gram Panchayat area.” On 23.9.2015 the learned counsel for the complainant filed the xerox copy of School leaving certificate of Govt. U.P. School Khari which was seen with objection by the learned counsel for the O.Ps. But no explanation is coming from the side of the complainant as to why this certificate was not submitted at the time of policy proposal. A copy of the school certificate of Sarel U.G.U.P. verified with the Gram Panchayat has been filed by the O.Ps. under Annexure –E
The O.Ps. have also filed the voter list of 2013 under Annexure F-I from this it is ascertained that the D.L.A. was 67 years as on 01.01.2013.
The Angan Wadi Worker statement has been filed by the O.Ps. under Annexure F-2, from which it is ascertained that the D.L.A. was aged 75 years as on 15.1.2013.
-: 4 :-
A copy of the Gram Panchayat Register has been filed by the O.Ps. under Annexure F-4. As per the said certificate the D.L.A. was aged 75 years as on 15.1.2013.
So from all these documents we came to the conclusion that the deceased had not revealed her correct age in the proposal form.
Contract of Insurance is based on the principle of Uberima Fides i.e. utmost good faith. Suppression of material facts is violation of the policy conditions. Hence we are of the considered opinion that the repudiation of the insurance claim by the O.Ps. is justified.
Now it is to be seen to what relief the complainant is entitled. We would have directed the O.Ps. to refund the Insurance premium of Rs.15,000/- on the ground of equity. But we find that the O.Ps. had transferred an amount of Rs.13,275/- to complainant’s saving account No.32145137057 on 11.03.2013 towards the deposit balance, refund of excess premium and bonus as per the terms and conditions. So no further direction is required to be given in this case and the complainant is not entitled to any relief.
For the reasons stated above we have no other option than to dismiss the complaint. In the result this complaint case is dismissed leaving the parties to bear their own cost.
Dated the 14th day of March 2016
Typed to my dictation
I agree. and corrected by me.
Smt. S.Mishra Sri S.C. Nayak
Lady Member President
Dt.14.03.2016 Dt.14.03.2016
