Jharkhand

Bokaro

CC/32/2021

Manju Devi - Complainant(s)

Versus

Branch Manager, SBI Life Insurance Co. Ltd. - Opp.Party(s)

Swarn Singh

31 Jul 2023

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-23-08-2021

Date of final hearing-31-07-2023

 Date of Order-31-07-2023

Case No. 32/2021

Manju Devi W/o Late Yogendra Vishwakarma,

 R/o WM 158, Near RKV School, New Mines,

 Vill and P.O Swang, P.S. Gomia, Bokaro, Jharkhand 829128

                                      Vrs.

          Manager SBI Life Insurance Co. Ltd.,

1^st Floor, Plot No. F-09, City Centre, Sector-4,

Bokaro Steel City, Bokaro

Present:-

                             Shri Jai Prakash Narayan Pandey, President

Shri Bhawani Prasad Lal Das, Sr.Member

                  Smt. Baby Kumari, Member

PER- J.P.N Pandey, President

-:Order:-

1. Complainant’s case in  brief is that her husband late Nageshwar Vishwakarma purchased SBI Life Smart Money Planner Plan 1 Money Back Policy No. 1R391267010 commencing from 20.07.2020 for Rs. 5,00,000/- sum assured in which complainant was appointed as nominee of the Policy. Further case is that on 16.01.2021 husband of the complainant became ill who was hospitalized at CCL Hospital where he died on 09.02.2021 thereafter complainant made claim of the insured amount accordingly on 08.06.2021 Shambhu Nath Prasad visited her home who obtained statement in writing of the complainant that her husband was suffering from fetal disease since long and taking treatment regularly and said statement was obtained under undue pressure and allurement. Further case is that later on her claim has been repudiated on the ground of suppression of material fact and on 22.06.2021 only Rs. 1,02,140/- has been paid to the complainant,  thereafter legal notice was served, hence this case has been filed with prayer to direct the O.P. to pay Rs. 3,97,860/- as insurance claim and to pay Rs. 50,000/- compensation and Rs. 10,000/- as litigation cost.
2. O.P. appeared and has filed W.S. mentioning therein that at the time of proposal of the policy insured was suffering from chronic lever disease, hyper tension and diabetes mellitus and was under treatment for the same who has suppressed material facts related to said illness, hence his claim has been repudiated, however the premium paid has been returned to the complainant. Further reply is that on specific questions pertaining to health insured has given negative reply for getting benefit under the policy accordingly policy has been issued. Further reply is that complainant herself has admitted the fact that her husband was suffering with chronic disease. Therefore, it is prayed to dismisse  the case of the complainant.
3. Point for determination is whether complainant is entitled to get relief as prayed ?
4. On perusal of the paper annexed with complaint petition annexure -1 is photo copy of premium  payment receipt, Annexure-2 is photo copy of death certificate, Annexure-3 is photo copy legal notice dt. 08.07.2021, Annexure- 4 is  reply of legal notice. These documents are not in dispute. Annexure-4/1 is envelop send by the O.Ps. Annexure-5 is photo copy of the medical card of the husband of the O.P. which shows that insured was taking medicines of hyper tension and diabetes much before from taking insurance policy. Annexure-6 is photo copy of death claim, annexure-7 is photo copy  of Adhar Card of the complainant, Annexure-8 is photo copy of claim repudiation letter dt. 16.07.2021. Annexure-9 is Envelop received from the office of the O.P. Annexure-10 is track report. Annexre-11 is medical certificate related to cause of death of the husband of the complainant, accordingly cause of death is “Hapato-renal Syndrom due to D M (Diabetes Mellitus and Ascitis these are the primary cause of death and secondary cause is Cardio Respiratory failure”. Annxure-12 is photo copy of the death report.
5. On behalf of O.Ps. photo copy of proposal form Annexure-A and A/1, photo copy of receipt Annexure-B, photo copy of acknowledgment Annexure-C, photo copy of claim investigation report Annexure-D, photo copy of medical card of deceased Annexure-E & F, photo copy of medical certificate disclosing cause of death of the deceased Annexure-G, photo copy of employer’s certificate Annexure-H, photo copy of claim repudiation letter Annexure-I, photo copy of legal notice and reply of legal notice Annexure-G & K and photo copy of written application dt. 08.06.2021 filed by the complainant along with her photograph Annexure-L have been filed.
6. On perusal of annexure-L it appears that complainant has admitted the fact that since one year her husband was suffering with illness who was getting treatment at C.C.L. Hospital Kathara to which he was not disclosing and later on when he became ill then on contact with C.C.L. Hospital Swang he was referred to C.C.L. hospital Gandhi Nagar where his condition was not improved rather he died and doctor disclosed that he was suffering with jaundice.
7. On careful perusal of Annexure-E,F, L along with Annexure- 4, 5,11 and 8 it appears that deceased was taking medicines of hyper tension and diabetes mellitus much before from taking the insurance policy to which he has suppressed from the O.P. at the time of taking policy for his wrongful gain. So far, Annexure-L is concerned, about it assertion has been made that said paper was obtained by use of undue pressure and allurement but there is no any evidence on this aspect by the complainant.
8. In light of above discussion we are of the view that O.P. has rightly repudiated the claim of the complainant and there is no any deficiency in service by the O.P. Accordingly this case is being dismissed with cost.

S/d

(J.P.N. Pandey)

                                                                                      President

 

S/d

(B.P.L Das)

   Sr. Member

                                                                            

                   S/d

                                                                               (Baby Kumari)

                                                                                       Member