BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, JALANDHAR.
Complaint No.124 of 2018
Date of Instt. 26.03.2018
Date of Decision:10.05.2022
Navkiranjeet Kaur aged 40 years wife of late Sukhwant Singh resident of Village & Post Office Adraman Tehil Nakodar District Jalandhar-144001.
..........Complainant
Versus
1. SBI Life Insurance Company Limited, backside PIMS Hospital, Chotti Bara Dari-1, Garha Road, Jalandhar City through its Branch Manager.
2. SBI Life Insurance Company Limited, Processing Central Level D Wing 8th Level Sea Woods, Grand Central Tower-II, Plot No.R1, Sector 40, Sea Woods, Narul Node, Navi Mumbai, 400706 through its Head Claims.
3. State Bank of India, Branch Office, Focal Point Jalandhar, through its Branch Manager.
4. Jaswinder Singh, Claim Investigator, C/o SBI Life Insurance Company Limited backside PIMS Hospital, Chotti Bara Dhari-1, Garha Road, Jalandhar City.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Dr. Harveen Bhardwaj (President)
Smt. Jyotsna (Member)
Sh. Jaswant Singh Dhillon (Member)
Present: Smt. Harleen Kaur, Adv. Counsel for the Complainant.
Sh. Vikas Sharma, Adv. Counsel for OPs No.1 and 2.
Sh. Sanjeev Sharma, Adv. Counsel for OP No.3.
OP No.4 exparte.
Order
Dr. Harveen Bhardwaj (President)
1. The instant complaint has been filed by the complainant, wherein it is alleged that she is the unfortunate wife of Sukhwant Singh since deceased, who whilst alive induced by tempting lucrative benefits and misled to opt for Life Insurance Policy risk coverage to get his life insured to cover peril of Vehicle loan advanced to the husband of the complainant against purchase of vehicle Nuvo Sportz by OP No.3.The authorized agent/representative and also by OP No.1 canvassed that this life insurance policy is suitable advantageous to the need and saving and income tax rebate benefits on the premium payment of Group Life insurance under Master Policy Holders State Bank of India. Sukhwant singh, husband of the complainant was taken in sweet word of authorized representative/agent made agreeable and paid premium as consideration against proposal for life insurance policy. The prescribed printed proposal form was got filled in and the signatures of DLA were obtained on dotted lines and other allied forms relevant for under writing and acceptance of the proposal for life insurance. The OPs No.1 and 2 after scrutiny and verifying the particulars of proposal and respective reports of the agent and fully satisfying as to the health profile and habits, physical condition and insurability of life to be insured and without raising any kind of objection as to the details given in proposal form and personal statement filled in by authorized agent/representative of OPs No.1 and 2 accepted as standard life at ordinary rate of premium. All the reports and the proposal form are with the OPs No.1 and 2 would reveal that there was no adverse feature found in the health profile of the DLA. The DLA was hale and hearty kept good health and led simple normal active health life by participating in day to day activities and duties.
2. To the misfortune and ill luck, DLA expired on 03.11.2016, due to natural death. The group life insurance policy under master plan policy bearing No.70000003903 was enforced and valid on the date of death for the full sum insured covering the entire loan liability of Nuvo Sportz. Subsequent to death of DLA, the complainant made a claim for payment of death benefit payable in case of death of DLA during the term of the policy alongwith benefits accruing there from. OP nO.1 is under supervisory and administrative control of OP No.2. The claim so made has been repudiated by OP No.2 vide letter 04.04.2017 on the pretext as per the medical treatment paper dated June and August, 2016 available with them late Sukhwant Singh was suffering from kidney disease and diabetes mellitus prior to the date of commencement of the policy and that material fact pertaining to the deceased was not disclosed at the time of signing a contract of insurance and further the amount of Rs.8871/- has been credited to nominee Saving Account 3647340444 to held in SBI on 23.03.2017 to refund of premium as per policy terms and conditions. The letter dated 04.04.2017 repudiating the liability of insurance policy was sent by post to the complainant but did not accompany any relevant and necessary documents and incriminating material on the basis of which the claim was repudiated erroneously and illegal and unlawful manner. The reasons for repudiation are wrong and are vehemently denied and disputed based on frail facts and legally infirm. The complainant has made request to OPs No.1 and 2 to furnish copy of the proposal form and policy documents alongwith the reports obtained at the time of proposing for insurance and documents submitted and obtained on the lodgment of the claim by OP No.4 at the time of the investigation of the claim, but the same were not supplied to the complainant for the reasons best known to OPs No.1 and 2, but protected follow-up. Non supply of documents under reference tantamount to deficiency in service and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to adjust and credit the entire outstanding vehicle loan liability in a loan account under State Bank of India RIN Raksha New Auto Loan Scheme under RIN Raksha LAN/PF No.35953146764, UNI No.111 No.78V02 of DLA with OP No.3 from the claim money of Life Insurance Policy No.70000003903 by death claim of Sukhwant singh, DLA payable by OPs No.1 and 2 and refund/return the claim money, if any due and payable to the complainant after adjustment and liquidating entire loan outstanding in loan account since the complainant had paid installments coerced by OP No.3 after demise of DLA which would be revealed from the Bank Statement of account maintained by OP No.3. Further, to set aside repudiation of claim by death vide letter dated 04.04.2017 and reiterated vide letter dated 16.10.2017 as fully described. Further OPs No.1 and 2 be directed to supply legible authenticated copy of proposal form i.e. Membership Form No.7007585898 dated 26.10.2016 obtained from DLA Sukhwant Singh towards the SBI Life Rinrasha Group Insurance Policy sourced through Master Policy Holder, State Bank of India under the master Policy No.70000003903 complete in all respects alongwith allied forms integral part of life insurance policy for risk coverage at the time of proposal for insurance. Further OPs be directed to pay a compensation of Rs.50,000/- and Rs.10,000/- as litigation expenses.
3. Notice of the complaint was given to the OPs, but despite service OP No.4 failed to appear and ultimately, OP No.4 was proceeded against exparte, whereas OPs No.1 & 2 appeared through its counsel and filed its joint written reply and contested the complaint by taking preliminary objections that the address of the OP No.2 is at Navi Mumbai while the complaint is filed at Jalandhar. Hence the Commission may dismiss the complaint against the OP No.2 for want of territorial jurisdiction. It is further averred that the OP No.4 is not having any office at the address given in the array of OP No.4. The same may be misleading and result into the delivery of order and notices at the wrong address. Hence, the name and address of SBI Life may be deleted from the array of OP No.4 and complainant may be directed to provide the correct address of OP No.4. The life insurance contract is a contract of Utmost Good Faith wherein the proponent is duty bound to disclose everything concerning his/her health, habits and other related matters which are within his knowledge at the time of making the proposal for insurance cover and even before the date of commencement of the policy, failing which the insurer has every right to repudiate the claim. In the instant case, the DLA Sukhwant Singh committed a breach of the principle of Utmost Good faith by suppressing the material fact that he was suffering from and was underwent for Chronic Kidney Disease and Diabetes Mellitus prior to the date of enrollment into the insurance cover. It is further averred that there is no negligence, carelessness or deficiency in service on the part of the answering OPs as defined in Section 2(1) (g) as laid down under the Act, as the DLA himself is guilty of suppressing and concealing the material and true fact that he was suffering from and was under treatment for Chronic Kidney Disease and Diabetes Mellitus prior to the date of acceptance of risk. Hence the complaint is liable to be dismissed in limine. On merits, the factum with regard to availing a loan from SBI and had applied for RiNn Raksha Group Insurance Scheme under Master Policy by the complainant is admitted, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
4. OP No.3 filed its separate written reply and contested the complaint by taking preliminary objections that the present complaint is not maintainable against the OP No.3 as the OP No.3 had advanced the vehicle loan to Sukhwant Singh deceased for the purchase of vehicle NUVO Sportz and rest of the formalities were completed by OP No.1. However, the complainant is not paying the regular installments for the said loan to the OP No.3 in spite of demands and the present complaint is filed to unnecessary harass the OP No.3. It is further averred that there is no deficiency in service on the part of the OP No.3. The present complainant is not a consumer as per the Consumer Protection Act. On merits, it is admitted that the OP No.3 had advanced the vehicle loan to Sukhwant Singh deceased for the purchase of vehicle, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
5. In order to prove the case of the complainant, the counsel for the complainant tendered into evidence affidavits of the complainant Ex.CA, Ex.CB and Ex.CC alongwith documents Ex.C-1 to Ex.C-7 and closed the evidence.
6. In order to rebut the evidence of the complainant, the counsel for the OPs No.1 & 2 tendered into evidence affidavit as Ex.OP1&2/A alongwith some documents Ex.OP1&2/1 to Ex.OP1&2/14 and closed the evidence. Similarly, OP No.3 tendered into evidence affidavit of Poonam Meenu, Branch Manager, SBI Jalandhar as Ex.OP3/1 and closed the evidence.
7. We have heard the learned counsel for the respective parties and have also gone through the case file as well as written arguments submitted by counsel for the complainant, very minutely.
8. The husband of the complainant purchased life insurance policy risk coverage to get his life insured to cover peril of vehicle loan advanced to the husband of the complainant against purchase of vehicle Nuv Sportz by OP No.3. The complainant is a nominee. The husband of the complainant died on 03.11.2016 due to natural death. After the death of the complainant, the claim for payment of death benefit was made by the complainant, which was repudiated by the OP No.2, vide letter dated 04.04.2017 Ex.C-1. The reason for repudiating the claim was mentioned by the OPs that as per the medical treatment papers dated June and August, 2016 late Sukhwant Singh was suffering from kidney disease and diabetes mellitus prior to the date of commencement of the policy and this fact was not disclosed by the complainant.
9. The contention of the Ld. Counsel for the complainant is that the OPs No.1 and 2 have rendered deficient and negligent service and has adopted unfair trade practice. The investigation report was intentionally not filed by the OPs No.1 and 2. The details were not explained by the OPs to the complainant. She has relied upon “Bajaj Allianz Life Insurance Co. Ltd. Vs. Major Singh and Other 2017 (3) CLT 383”, “Bhanwarlal Vishnoi Vs. Oriental Insurance Co. Ltd. 2017 (1) CLT 401” and “J. R. Banik Vs. National Insurance Co. Ltd. 2017 (2) CLT 376.”. It has further been alleged by the Ld. Counsel for the complainant that it was the duty of the insurer to put the insured through medical examination and the claim cannot be rejected on account of non-disclosure. She has relied upon a pronouncement, titled as“SBI General Insurance Co. Ltd. Vs. Balwinder Singh Jolly and another 2016 (4) CLT 372 (CHD), wherein it is held that Hypertension-pre-existing disease-age of insured when mediclaim insurance policy was issued was more than 45 years-held-in that event, as per instructions issued by IRDAI it was duty of the insurer to put insured through medical examination-claim raised after issuance of insurance of policy cannot be rejected on account of non-disclosure and an other pronouncement, titled as “Neelum Chopra Vs. LIC (NC) revision petition no.4416 of 2012 decided on 08.10.2018 CLT 2019 (2) 270, wherein it is held that non-disclosure of information in respect of life style disease of diabetes, will not totally disentitled the complainant for indemnification of the claim. She further submitted that mere on the ground of non-disclosure of earlier disease, the claim cannot be repudiated. Whereas the contention of the OPs is that the record obtained by their team show that he was suffering from the kidney disease prior to the inception of the policy and merely on the non disclosure of his previous disease, he is not entitled to any compensation.
10. As per Ex.OP1&2/2, the SBI Life Raksha Membership Form is dated 28.10.2016 and on the 2nd page of this document, the insured has denied the fact that he has ever suffered from any genitourinary or kidney disorder, Hepatitis B/C or any other liver disease, which has been mentioned in column 3 (f) of the policy. This form was filled on 26.10.2016. Ex.OP1&2/4 is the Discharge Slip of the deceased Sukhwant Singh dated 24.06.2016 from PIMS Hospital, Jalandhar. Ex.OP1&2/5 is the receipt showing the purchase of medicines for dialysis on 01.08.2016. Ex.OP1&2/9 is the Certificate given by the employer, which shows that the deceased Sukhwant Singh remained on earned leave from 26.07.2014 till 14.09.2016 in different spells and as per Ex.OP1&2/9, he last attended office on 02.11.2016 and died on 03.11.2016. His CT scan was done from Sacred Heart Hospital on 08.07.2015 as per Ex.OP1&2/10 and his impressions are no evidence of Renal/Ureteric Calculus, Mild B/L Prominent of PCS with Bulky Extra Renal Pelvis. Possibility of Mild Narrowing at PUJ cannot be ruled out. The receipt of the medicines is Ex.OP2/12 from Sacred Heart Hospital Pharmacy. The deceased Sukhwant Singh died on 03.11.2016 and as per the repudiation letter, the policy commenced on 05.11.2016 and the documents were signed on 28.10.2016, meaning thereby that he signed the documents just eight days prior to his death and the policy commenced after his death. The record produced by the OPs show that he was suffering from kidney problem and remained on dialysis and remained on leave for sufficient time also. It has been held by the Hon'ble National Commission in Revision Petition No.852 of 2013, case titled as “Col. T. S. Bakshi Retd. Vs. Star Health and Allied Insurance Co. Ltd. Through the Branch Manager”, wherein it is stated as under:-
“Where insured contracts a disease within first 30 days of commencement of insurance policy, insurance company shall not be liable to indemnify insured for expenses – Provided it is established that insured had a continuous health insurance policy with some Indian Insurance Company just prior to taking of insurance cover – Held, no materials produced on record to suggest that insured had a previous health insurance cover for a continuous period of 12 months – Forum below justified in dismissing claim of petitioner under insurance contract in view of Exclusion Clause.”
It has been held by Hon;ble Supreme Court in Civil Appeal No.2776 of 2002, date of decision 10.07.2009, titled as “Satwant Kaur Sandhu Vs. New India Assurance Company Ltd.”, wherein it is stated as under:-
“At the time of taking policy he was suffering from Diabetic Nephropathy/Chronic Renal Failure-Deceased did not disclose the fact of ailment while taking the policy which was within his knowledge and he was required to disclose it under the terms of policy-Death of deceased after 7 months of taking the policy-Wife claiming compensation which was repudiated by the insurance company- Held, fact suppressed was a material fact- There is no deficiency in service- Insurance company justified in repudiating the claim – Material fact means any fact which would influence the judgment of a prudent insurer in fixing insurer the premium or determining whether to accept the risk or not.”
It has further been held by the Hon'ble National Commission in Revision Petition No.1548 of 2000, date of decision 21.05.2003, case titled as “Panni Devi Vs. LIC & Ors.”, wherein it is stated as under:-
Insurance-Suppression of material fact – Information of prior surgery concealed – Contention, deceased examined by LIC Medical officer before issuing the policy, nothing adverse noticed- Contention not acceptable – Person if withholds information, doctor would not know it, unless it is visible – Cardiological problem not visible – Deceased himself told the Anaesthetist before surgery that he was operated 15 years back – Suppression of material fact at time of taking policy proved- Repudiation justified – Revision dismissed.”
11. So, as per the law laid down by the Hon’ble Supreme Court and Hon'ble National Commission, the deceased did not give the correct information regarding his previous disease of kidney problem and got the policy just 8 days prior to his death, when he was undergoing the dialysis. So, the claim of the complainant has rightly been repudiated by the OPs and there is no illegality on the part of the OPs and accordingly, the complaint of the complainant is dismissed with no order of cost. Parties will bear their own costs. This complaint could not be decided within stipulated time frame due to rush of work.
12. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jaswant Singh Dhillon Jyotsna Dr. Harveen Bhardwaj
10.05.2022 Member Member President
