Meghalaya

StateCommission

A/3/2022

Smti Krolaris Myrthong - Complainant(s)

Versus

SBI Life Insurance - Opp.Party(s)

Mr B. K. Das

19 Jun 2023

ORDER

MEGHALAYA STATE CONSUMER DISPUTES REDRESSAL COMMISSION SHILLONG
F.A No.3 of 2022
BEFORE
Hon’ble Mr.Justice(Retd) S.Pandey PRESIDENT
Hon’ble Member : Shri W.Khyllep
Hon’ble Member : Shri C.P.Marak
Hon’ble Member : Shri W.Synrem
Hon’ble Member : Dr. G.B.M Mihsill
Smti. Krolaris Myrthong	...Appellant
-versus-
State Bank of India, Life Insurance	...Respondent
For the Appellant     :   Shri.B.K. Das, Advocate For the Respondent    :   Smti.T.Yangi, Advocate
Date of Judgment & Order  :   24.07.2023
Whether to be reported    :

          The present Appeal has been filed against the judgement/order dated 04.04.2022 passed in Consumer Complaint Case No 52/2012 whereby and whereunder the District Consumer Dispute Redressal Commission, East Khasi Hills, Meghalaya, Shillong (hereinafter mentioned ‘the District Forum’), did not find the merit in the application as the District Forum did not find any deficiency of service from the side of the S.B.I. Life Insurance, but by way of grace, directed to make payment of Rs.60000/- (Sixty Thousand) only to the claimant within 45 days from the date of receipt of the aforesaid order.

          Short facts that arise in this case is that the husband of the Complainant purchased the policy no.14000985208 dated 09.11.2004 for a sum/assured amount of Rs.2,00,000 (Two Lakh Only). As per the policy, the assured amount is of Rs.2,00,000 (Two lakh only) and the survival benefit is at rate of 10% of the sum assured. The present Appellant has been shown as a nominee of her husband. In terms of the policy, the premium is to be paid every quarter. The insured deposited the premium on 09.02.2007, but failed to deposit the next premium on and from 09.05.2007 on-wards, as a result, the policy lapsed. In pursuance thereof, on 9.11.2007, the SBI Life Insurance informed the insured (Policy Holder) that the policy was in lapsed status. Despite several reminders, premium was not paid. It was also informed that if policy needs to be revived, it is on payment of premium due and complying the revival formalities. The policy was for quarterly payment. The first premium was deposited on 09.11.2004. Next premium was due on 09.02.2005, 09.05.2005, 9.08.2005, 9.11.2005 and so on, but admittedly, the last payment was made on 09.02.2007. After that, the premium remained unpaid which had resulted in lapse of policy.

          From the records, it appears that on three occasions, the declaration of good health form was submitted. First declaration form was submitted on 09.05.2008 in presence of Mr. Ganesh Kumar Sarkar in Shillong office of the SBI Life, which was forwarded to Mumbai office headquarters. On insistence of the officer of S.B.I. Life, another declaration of good health was submitted on 20.06.2008 witnessed by S Kumar Burman, who was the agent where through him the insured (Policy Holder) had purchased the SBI Life Insurance Policy. But when the Company was not satisfied, vide letter  dated 11.05.2008, instructed the policy holder to submit the full medical report examined by Dr. Indu Ghosh along with fresh declaration of good health though the same was submitted twice earlier. In pursuance of the instruction, the insured (husband of the appellant) got himself examined by Dr. I Ghosh, and put his signature in his presence at the appropriate places, inasmuch as a new declaration of good health witnessed by the present Appellant along with a demand draft of Rs. 22,289/- (Twenty Two Thousand Two Hundred Eighty Nine only) dated 29.08.2008 bearing no.754299 drawn on SBI Life Company duly submitted on the 29.08.2008 at Shillong office. The declaration of good health witnessed by the Appellant and the medical examination form issued by Dr. Indu Ghosh are dated 29.08.2008.

          The SBI Life Insurance vide letter dated  08.10.2008 informed that the signature appearing in the declaration of good health and the medical examination form varies to each other and for that they have to submit fresh specimen signature for fresh process. Later on vide letter dated 13.12.2010 returned the amount of Rs. 22,289/- (Twenty Two Thousand Two Hundred Eighty Nine only) vide cheque no. 394473 date 08.12.2010 drawn on SBI towards refund of excess payment of premium under the policy. Ultimately, the policy was not revived. In the meantime, the insured-husband of appellant died on 06.01.2009 whereafter, the Appellant applied for the settlement of claim vide application dated 23.02.2009 attached with the original death certificate. But on 06.03.2009, the Company rejected her claim application vide letter dated 06.03.2009. The claim application was rejected on the ground that on the date of death, the policy was in lapsed condition and, as such, nothing is payable to her under the policy.

     With a view to pursue the matter before the authority of S.B.I. Life, the appellant submitted two representations vide letters dated 04.03.2010 and 04.01.2011, but of no consequences from the SBI Life. Later on, the SBI Life vide letter dated 19.01.2011 intimated their stand of repudiation on the ground mentioned above.

     Later on, the Appellant approached the office of Insurance Ombudsman by filing an application at Guwahati Centre which by order dated 19.12.2011 rejected the claim, but by way of ex-gratia directed to make payment of Rs.30,000/- (Thirty Thousand Only).

     The Respondent SBI Life Insurance appeared and filed written statement taken the plea that the policy lapsed on account of non-deposit of premium amount which was due on 09.05.2007. In terms of the policy, the due amount was to be deposited within 30 days failing which automatically, the policy will lapse. In the event of a prayer of revival of the policy was/is to be within 5 years, formalities need to be followed which the insured failed to comply as the signature appearing in the medical examination form varies with the declaration of good health submitted by the insured policy holders, inasmuch as the signatures on records, such as, signatures at three declaration of good health forms/ medical examination form along with proposal of SBI Life were sent to the centre for Forensic Detective Investigation, Chandigarh. In turn, they found that the signature in the medical examination form varies with the specimen signature as well as the declaration of good health. Hence, the prayer for revival of the lapsed policy was refused.

     In support of her claim, the Appellant appeared and examined herself as witness no.1 and has proved a number of documents. Exhibit P1 is the proposal of the SBI Life. Exhibit P2 is the Complainant letter dated 26.08.2006 and 29.08.2008 addressed to the Manager, SBI Life Insurance, Guwahati. Exhibit P3 is  a copy of SBI LIFE letter dated 9.11.2007 and a statement of Account Premium paid furnished by SBI LIFE Insurance reflecting payment dated 21.02.2008 and letter dated 31.07.2008 are Exhibits 4,5,6. Declaration of good health duly signed on 05.02.2008 in presence of Mr. Ganesh Kumar Sarkar is Exhibit P7. Signature on declaration of good health of insured is Exhibit P7/1 and signature of Mr. Ganesh Kumar Sarkar is Exhibit P7/2. Acknowledgment of SBI is Exhibit P7/3. Declaration of good health dated 26.02.2008 bearing the signature of the insured and witnessed by Mr. S. Kumar Burman is Exhibit P8 and signature of insured is Exhibit P8/1 and signature of witness Sri S. Kumar Burman is Exhibit P8/2 and Acknowledgment is Exhibit P8/3. The letter of SBI Life dated 11.05.2008 giving direction to full medical report from Dr. Indu Ghosh and declaration of good health is Exhibit P9. Medical examination form is Exhibit P10. Signature of Doctor is Exhibit-10/1 and signature of insured (policy holder) is Exhibit-10/2. Declaration of good health dated 29.9.2008 is Exhibit P11. Signature of insured on declaration of good health is Exhibit P11/1 and the signature of the present Appellant as a witness is Exhibit P11/2. Letter of the SBI Life Insurance dated 08.10.2008 informing the insured that the signature appearing in the declaration of good health varies with the medical examination form is Exhibit-12. Submission of specimen signature of insured is Exhibit P13 and identity proof is Exhibit-13 and 14. Death Certificate of the insured dated 23.01.2009 showing that death occurred on 06.01.2009 is Exhibit P15. Application for death claim filed by the Appellant is Exhibit P16. Letter of SBI Life Insurance dated 06.03.2009 informing that she is not entitled to any compensation is Exhibit-17. Representation dated 24.12.2010 to SBI Life Exhibit is Exhibit P18 and further representation dated 14.01.2011 is Exhibit P19. Letter of SBI Life to the Appellant dated 19.01.2011 refusing to settle the claim is Exhibit P20. The order of Ombudsman, Guwahati is Exhibit P21. Letter dated 17.01.2011 bearing signature of Gopal Burachat is Exhibit 22 and his signature is Exhibit-22/1.

The same documents filed by the Respondent are not required to be dealt with.  The Report of Forensic Centre, Chandigarh dated 02.07.2009 has been attached as Annexure-B of the written statement. The signature appearing in the declaration of good health and medical examination form in the specimen signature appearing in the proposal for SBI Life varies to each other.

 During argument, the counsel for the Appellant has submitted that SBI has wrongly refused the Appellant the benefit arising on account of death of her husband on the flimsy ground that the signature appearing in the declaration of good health and the medical examination form does not tally. It has been submitted that after the receipt of letter dated 09.11.2007 from the SBI Life regarding the non-payment of premium, husband of the Appellant i.e, policy holder paid an amount of Rs.9675/- through demand draft which was accepted and credited to the SBI Life account, but for reasons best known to them, after five months vide letter dated 31.07.2008 through cheque no.709359 dated 28.07.2008 drawn from SBI Life returned the amount on ground of lapse status of policy.

          In view of the clause in the policy, for revival  of the policy is within five years, the policy holder, i.e, husband of the Appellant contacted the SBI Life and on their advice presented the declaration of good health dated 05.02.2008 witnessed by Shri. Ganesh Kumar Sarkar and on further instruction of the office of the SBI Life, submitted another declaration of good health dated 20.06.2008 witnessed by Shri. S. Kumar Barman, agent through which the husband of the appellant had purchased the policy. It does not stand to reason, the S.B.I. Life vide letter dated 11.05.2008 again in the name of internal norms asked the husband of the Appellant/ policy holder for submission of fresh declaration of good health and full medical report in terms of enclosed format, it was directed to present himself (assessed, husband of appellant) to Dr. Indu Ghosh who would furnish the Medical examination report. Accordingly, her husband appeared before Dr.I.Ghosh, who put his signature as well as the husband had put his signature in Exhibit P10/2. Further, another declaration of good health was submitted bearing the signature of the husband in Exhibit P11. His signature is Exhibit P11/1 and witnessed by Appellant (Exhibit P11/2). But they have wrongly rejected thereby neutralized all efforts taken by the Policy Holder and wrongly refused to revive the lapsed policy. They have acted arbitrarily in the manner as mentioned above. The Appellant further submitted that later on she filed the specimen signature of the husband of the Appellant which is Exhibit P14, but this record does not bear the signature of receipt of the office of the SBI Life. This document is doubtful and as such it cannot be taken into consideration.

          The counsel of the respondent submitted that the SBI Life has rightly refused. However, as the Policy Holder (husband of the appellant) was to pay in the installment in time or within 30 days from the due date, but policy holder failed to comply as he was to deposit the policy on 09.05.2007 and extended by 30 days. When it was not done, the SBI Life informed the status on 09.11.2007 so the SBI Life rightly returned the cheque No. 9677 as the policy was in a lapsed condition. It has been submitted that the signature appearing in the declaration of good health does not tally with the signature appearing in the medical examination form, which can be deciphered by the naked eye. It has been submitted that the status of the signature on the different documents, especially in the policy form where the policy holder put his signature has to be verified. All signatures were sent to the Forensic Laboratory, Chandigarh from where report has been received reflecting signatures varies to each other. This is the reason for refusing to settle the death claim of the husband of the Appellant.

       In reply, the counsel for the Appellant has submitted that there was no need for any verification from the forensic examination when the policy holders had submitted his declaration of good health witnessed by different persons. So there was no further need of any report required from any other source. He placed reliance on the judgment of The Hon’ble Supreme Court reported in AIR 1973 Supreme Court 2200, Ram Narayan versus the State of Uttar Pradesh wherein it has been held that such opinion of handwriting expert is to be received with care and circumspection by the Court as like other expert opinion. So, he has submitted that the Report of the Expert by way of Forensic report is not the end of the matter especially when his signature was certified by different persons, should be accepted as a valid signature.

       In order to decide the present appeal, it will be proper to examine the two clauses mentioned in the policy documents, which are as follows:-

“Clause 2. Premium payments:- A grace period of 30 days will be allowed for payment of quarterly/half-yearly/yearly premiums and a grace period of 15 days will be allowed where premium are paid monthly. Where premium are paid monthly, three months’ premium will be payable as a lumpsum, in advance, at inception of the policy. If the premium is not paid before the expiry of the days of grace, the policy will automatically lapse. If death occurs during the grace period and the claim is admitted, the death benefit (as stated in schedule II) will be paid after deduction of the premiums then due and all premiums falling due during that policy year.

Clause 3. Revival of the policy: - A Lapse policy may be revived on request during the term of the policy and within 5 years from the due date of the first unpaid premium on submission of required evidence of health satisfactory to the company, and on payment of arrears of premium with interest at the rate referred to in clause 1 (b)(ii). The company however reserves the right to accept (on such terms and conditions stipulated by the company) or reject the revival of a lapse policy. The revival of a policy wills effective only after the same is communicated in writing by the company to the policy holder. The cause of any medical examination, including special reports, if any, require at the time of revival shall be borne by the policy holders”.    

          Before examining the merit of the case, it is relevant to examine the provision of different clauses of money back policy. It appears from the clause 2, if the policy holder fails to deposit money within the date fixed, grace period of 30 days is allowed for payment of quarterly, half yearly and yearly premiums and a grace period of 15 days is allowed where premiums are paid monthly. In the present case, admittedly the policy holders failed to deposit the premium on due date,i.e., on 09.05.2007 or within the grace period. The clause 2 itself says that in event of non-compliance, the policy would automatically lapse. In that event, Clause 3 comes into play, i.e., the revival policy wherein it has been provided for compliance of certain formalities. In the present case, declaration of good health was filed on three occasions and also on instruction of SBI Life, he presented himself before Dr I. Ghosh who examined him and submitted the medical examination report. That Report shows that the signature of Dr. I. Ghosh is appearing and on the opposite side, the signature of the policy holder is standing. On perusal by the naked eyes, it shows that the signature of the policy holder does not tally with the signature appearing in the declaration form. Though report of Forensic examination is not final, but it carries weight in the event the report remained unchallenged. It is like the opinion of any other expert, but in the present case, Appellant has not challenged the Forensic Report inasmuch as the signature appearing in the different document does not tally to each other which is clear from the naked eye. In such view of the matter, this State Forum does not find that the District Forum has acted wrongly in refusing to grant the relief to the Appellant.

       Accordingly, the appeal is dismissed, but at the same time, it is directed that the SBI Life would make payment of Rs.60000/- as directed by the District Commission as well as last premium paid to Life Insurance, if already not paid, within the period of 45 days failing which it will carry interest at the rate of 18% compound interest.