PER SHRI. S.S. PATIL – HON’BLE MEMBER
1) This is the complaint regarding deficiency in service and unfair trade practice on the part of Opposite Parties as they did not settle the insurance claim of the Complainant.
2) The facts of the complaint are that the Complainant is a widow of one Shri. Nitin R. Rao, who died in a fatal accident. Before that he had been a credit card holder, bearing No.4006 6610 19461 7757 issued by Opposite Party No.3.
3) The Complainant has further stated that as per the brochure issued by the SBI Card (Opposite Party No.3), every SBI Card Holder is entitled for free insurance protection. The Brochure reads as under “As a valued SBI Mumbai card holder you get a complementary personal accident insurance coverage for loss of life of Rs.6 lacks in the event of the air accident and Rs.2 lacks in case of other accidents. The Complainant has farther stated that the Opposite Parties did not give full details of the insurance cover; terms and conditions of the policy.
4) It is also stated by the Complainant that her husband, the card holder was using the above said credit till his death (till 05.02.06).
5) It is further stated by the Complainant that her husband Nitin Rao died on 05.02.06 in an accident. The Complainant informed Opposite Party No. 3 (Customer Services SBI Cards) about death by latter dtd.17.02.06 and lodged her claim. The Opposite Party No.3 vide its letter dtd.11.03.06 directed the Complainant to contact Opposite Party No.1 directly. The Complainant accordingly requested Opposite Party No.1 to process her claim vide her letter dtd.22.03.06. Thereafter the Complainant received a letter dtd.17.04.06 from Opposite Party No.2 enclosing therewith a claim form for death benefit requesting the Complainant to provide various documents Opposite Party No.2 has mentioned in this letter number of the policy is 83001000105 under which the claim was covered. Thereafter as per the above instructions Complainant submitted her claim to Opposite Party No.2 in prescribed form along with all documents along with her letter dtd.29.04.06. Thereafter there was no response from the Opposite Parties.
6) Thereafter as per the instruction of one official from office of Opposite Party No.2, the Complainant again sent one set of claim and required documents to Opposite Party No.2 vide her letter dtd.10.08.06.
7) Inspite of sending the claim and required documents twice to the Opposite Party No.2, there was no response from the Opposite Parties. Therefore, Complainant sent a legal notice and called upon the Opposite Parties to pay the claim of Rs.2 Lacs alongwith interest vide letter dtd.21.04.07. Thereafter Opposite Party No.1 replied to the said notice by its letter dtd.23.05.07 stating that Mr. Nitin Rao was not covered under the protection plus policy as he had never opted for insurance & no premium debited in his account. The claim of Mr. Nitin Rao was under SBI Card Group Insurance Scheme and by virtue of being SBI Card Holder, he was entitled to free insurance protection and therefore, there was no question of opting or payment of premium. The Opposite Party No.1 & 2 again were called upon to pay the claim amount but there was no response.
8) It is also alleged by the Complainant that Opposite Party No.2 purposefully sent a wrong claim form applicable for SBI Card Protection plus Scheme.
9) Finally the Complainant has prayed that the Opposite Parties be declared to be guilty of deficiency in service and adopting unfair trade practice and be directed to pay a sum of Rs.2 Lacs to the Complainant against the insurance claim alongwith interest, compensation and cost of the complaint etc.
10) The Complainant has attached the xerox copies of the following documents.
a) Monthly statements of accounts in respect of Credit Card No.4006661019467757.
b) Brochure issued by op3.
c) Letter dtd.17.02.06.
d)Letter dtd.22.03.06.
e)Letter dtd.11.03.06.
f)Letter dtd.17.04.06.
g)Letter dtd.29.04.06.
h)Letter dtd.10.08.06 along with other documents as required by the Opposite Party No.2 eg FIR, Death Certificate, etc.
i)Letter dtd.23.05.07 of Opposite Party No1.
j)Letter dtd.29.05.07.
11) The complaint was admitted and notices were served on the Opposite Parties. Opposite Party No.1 & 2 have directly filed affidavit in evidence referring therein their written statement but actually there is no written statements of these two Opposite Parties on record of this complaint. Opposite Party No.3 was duly served with the notice but it did not appear before this Forum hence, an ex-parte order was passed against Opposite Party No.3 vide roznama of this Forum dtd.03.03.09.
12) One Mr.V. Shrinivas S/o late Somayajulu has filed an affidavit in evidence on the behalf of Opposite Party No.1 & 2. He has stated in his affidavit that he is well conversant with the facts and circumstances of the case and further stated that the SBI life offers individual assurance and Group life insurance coverage. In Group insurance, a group of individual is assessed to risk as group. The individual member is issued a Certificate of Insurance (called as COI) as evidence of his master policy holder i.e. the Credit Card Company in this case. However, the COI specifically mentions that the insurance coverage is granted subject to terms and conditions in master policy issued to the master policy holder who is the policy holder and who has entered in to the contract of insurance with SBI life.
13) SBI life has a scheme of group insurance for holders of credit cards issued by SBI Cards & Payment Services Ltd. known as “SBI Card Protection Plus” which offers insurance coverage to credit card holder of SBI Cards.
14) The Opposite Party No.1 & 2 have clarified that SBI life does not provide any free insurance to the members of policies issued to the SBI Cards. Granting free insurance cover is strictly prohibited terms of Sec 64VB of Insurance Act 1938.
15) In the policy issued to the master policy holder i.e. SBI Cards, it is clearly mentioned in master policy condition that “This group insurance policy is issued by SBI Life Insurance Company Ltd. on the basis of the proposal for insurance on the lives of members of SBI Cards & Payment Services Pvt. Ltd. and in consideration of premium as set out in this policy. In the instant case the Protection Plus Insurance (PPI) cover was not activated on the Card No.4006 6610 1676 6797 of Shri. Nitin Rao. As confirmed by SBI Card (Opposite Party No.2). Shri. Nitin Rao has never opted for insurance cover. Mere enrollment as a card holder, does not automatically allow the person to take advantage of the insurance cover. The Opposite Party No.1 & 2 have submitted that shri. Nitin Rao was not a member of the Group covered by SBI Life Insurance i.e. Opposite Party No.1 under Master policy 83001000105 issued to SBI Card. There was no insurance contract between Nitin Rao and SBI Life (Opposite Party No.1). So there is no question of settling the death claim of Nitin Rao.
16) In para 11 of affidavit of Opposite Party No.1 & 2 stated that “the letter provided by the SBI Cards clearly states that the D L A (Nitin Rao) was not the member of the group covered by SBI Life hence, no cause of action had arisen and finally the Opposite Party No.1 & 2 have prayed for the dismissal of the complaint with cost.
17) Both parties have filed their written arguments wherein they reiterated the facts mentioned in the complaint and affidavit in evidence respectively (The Complainant and the Opposite Parties).
18) We heard the Ld. Advocate for the Complainant and the Law Officer for the Opposite Party No.1 & 2. Opposite Party No.3 is ex-parte. We also perused the documents produced by both the parties and our findings are as follows.
19) The husband of the Complainant Shri. Nitin Rao has obtained the credit card No.4006 6610 1946 17757 from Opposite Party No.3. However, the Complainant has not produced the said credit card or any copy of this credit card. Only the copies of monthly statements of accounts of these credit cards have been filed by the Complainant alongwith the complaint. These statements contain transactions dtd.17.02.2006, 17.06.2005, 17.04.2004, 17.02.2003, 17.06.2002, 17.09.2001.
20) The Complainant has attached a xerox copy of a brochure. It has been issued by SBI Card i.e. Opposite Party No.3. It bears a signature of one Sanjay Chaturvedi, Head Marketing. It is for the SBI Mumbai Card holder. The relevant benefit offer is as below –
“Free Insurance Protection.”
“As a valued SBI Mumbai Card Holder you get a complementary personal accident insurance coverage for loss of life of Rs.6 Lacs in the event of an air accident and Rs.2 Lacs in case of other accidents. SBI Card FILL it UP”.
The above document is only a xerox copy. No original document has been filed by the Complainant and the Complainant had not filed any affidavit of evidence in this respect. Therefore, this document cannot be relied upon.
21) The insurance claim of the insured person is mainly based on the important document known as insurance policy and its terms and conditions but the Complainant has failed to produce any such document before this Forum. The deceased husband of the Complainant has obtained the credit card in the year 2001. Therefore, the necessary documents should have been obtained by him during the period from 2001 to 2006.
22) The Opposite Party No.1 & 2 have also admitted in their affidavit of evidence that “this group insurance policy is issued by SBI life Insurance Company Ltd. (Opposite Party No.1) on the basis of proposal for insurance on the lives of members of SBI Cards & Payment Services Pvt. Ltd. and in consideration of premium as set out in this policy. These Opposite Parties have further clarified that they have not obtained any premium against the policy hence, as per sec 64VB of Insurance Act, 1938, they are not liable under the Insurance Act. The Complainant has not substantiated that the required premium was paid to the insurer. If it is presumed that Opposite Party No.3 has offered free insurance, and as per the pleading of the Opposite Party No.1 & 2 that the Master Insurance Policy was given to the Opposite Party No.3 (SBI Card), there is also no evidence on record to establish that Opposite Party No.3 had paid the premium to Opposite Party No.1 & 2. There is also no evidence on record to establish that the complainant has been covered under the insurance policy. Even Opposite Party No.3 SBI Cards vide its letter dtd.28.11.07 has communicated to Opposite Party No.1 that “We hereby confirm that the protection plus insurance was not activated on SBI Card No.40066610 19467757 of Mr. Nitin S. Rao’s card account. It has further clarified that Nitin Roa’s card is not eligible for Protection Plus Insurance.
23) Hon’ble State Commission, Maharashtra State in SBI Life Insurance Co. V/s. Shri Prakash Vasant Angane, First Appeal No.A/10/440 has held that “as policy is concerned payment of premium is its pre-condition and on the date of death of insured Agne he was not insured. Accordingly the Forum’s order allowing the complaint of insurance claim of insured Agne was set asided and complaint of Mr. Agne was quashed. In the instant case the Complainant has not proved that any premium has been paid for the insurance cover.
24) In view of the above observations we pass the following order -
O R D E R
i)Complaint No.281/2007 is hereby dismissed for want of merits.
ii)No order as to cost.
iii)Copy of this order be furnished to both the parties.
