BEFORE THE DIST. CONSUMERS DISPUTES REDRESSAL FORUM; DHARWAD.
DATE: 12th August 2015
PRESENT:
1) Shri B.H.Shreeharsha : President
2) Smt.M.Vijayalaxmi : Member
Complaint No.: 80/2015
Complainant/s:
Smt.Saroja w/o.Hanumanthagouda Patil, Age: 52 years, Occ: Household work, R/o.Chikkoppa.S.K, Tq; Ramadurga, Dist.Belgaum
(By Sri.S.L.Matti, Adv.)
v/s
Respondent/s:
- SBI Life Insurance Co. Ltd., Group Claims Department, II Floor, Kapas Bhavan, Plot No.3A, Sector 10, CBD Belapur, Navi Mumbai 400614.
- Manager, SBI Life Insurance Co. Ltd., Kalyani Classic First Flore Zonal Office, State Bank of India, Kusugal Road, Keshwapur, Hubli
(By Sri.S.V.Yazi, Adv.)
- The Branch Manager, State Bank of India, Kulageri Cross, Kulageri, Tq. Badami.
(By Sri.A.V.Kerur, Adv.)
O R D E R
By: Shri. B.H.Shreeharsha : President.
1. The complainant has filed this complaint claiming for a direction to the respondents.1 and 2 to pay the entire dues in respect of tractor loan availed at respondent.3 and in due, to pay Rs.1 lakh compensation, to pay cost of the proceedings and to grant such other reliefs.
Brief facts of the case are as under:
2. The case of the complainant is that, complainant’s husband during his lifetime had joined SBI Life Dhanraksha + LPPT Tractor loan scheme with the respondents under the master policy 93000001708 under the membership form no.931335174 of State Bank of Mysore covering the risk of loan amount availed at respondent.3 commencing from 09.12.2009 till repayment to an extent of Rs.6,81,151/- & paid premium of Rs.41,151/- towards the loan of tractor. During the period of policy the husband of complainant died on 08.10.2012. Thereafter the complainant being a legal heir filed claim application to the respondents with all records for the settlement of death claim. The respondents through letter dt.28.02.2013 repudiate the claim assigning the reason, the assured while applying for enrollment to SBI Life Dhanraksha+LPPT Tractor loan scheme had suppressed the material facts. Once again on 18.06.2013 the complainant submitted claim. The said claim was also rejected on the ground that death claim has been repudiated on the basis of indisputable evidence which proves that late.Hanumantgouda Bapugouda Patil was suffering from heart disease had underwent coronary artery bypass surgery, prior to the date of enrollment of the policy. The repudiation on the said ground is an unjust, without application of mind in order to disown the liability. Repudiation is utterly false and baseless. The assured was in good health while enrolling to the SBI Life Dhanraksha+LPPT Tractor loan scheme. There was no occasion to the insured to suspect the existence of ailment as because deceased insured underwent cardiac operation about 12 years back & operation was successful & thereafter that he had never been to regular check up. At the time of enrolling none of SBI Life insurance officers never asked the insured about his previous ailments. Without disclosing any materials regarding terms and conditions of the policy and also procedure for taking the policy, without intimating to assured deduct the premium amount, the respondents have forwarded the premium amount to the master policy & suemoto master policy was issued to the complainant’s husband. Only after receipt of the policy bond her husband came to know about the policy. On perusal of the account statement of the husband maintained at SBM for 5 times premium has been debited from his account to the SBI life insurance. Hence, without considering these material irregularities the respondents have repudiated the claim. At the time of availing tractor loan her husband was not informed anything with regard to submission of proposal form. The bank authorities suemoto fill up the form along with the loan transaction form & get the signature of the husband on some unfilled printed forms. Hence, there was no occasion to disclose previous ailments by the deceased husband. Moreover there were no any symptom of heart disease while enrolling to the master policy. After bypass for more than 12 years the deceased had led healthy life. Even not considering all these aspects the respondents have repudiated the claim, which amounts to deficiency in service. As per the terms and conditions of the policy the respondent.1 and 2 liable to pay entire outstanding due of tractor loan amount in the name of the deceased with respondent.3 bank. Due to untimely death of the deceased assured the entire family members have put to hardship. Hence, the complainant filed the instant complaint praying for the relief as sought.
3. In response to the notice issued from this Forum the respondents.1 to 3 appeared and filed the written version in detail denying and disputing the complaint averments.
4. Respondent.1 and 2 join together filed written version in detail narrating and revealing nature, scheme, terms and conditions with the definition of master policy with the reference of several case laws decided by different hierarchy courts. Further among such other admissions and denials the answering respondents also reveals in detail with regard to nature of the contract of insurance, liabilities of parties to the contract, particularly narrating contract of insurance is based on good faith i.e. uberimmafiede, detrimental to Act in accordance with the terms and conditions of the policy leads the insurance contract not only void, void in abinitio. Further the respondents taken contention with regard to maintainability of the complaint on limitation point, considering the cause of action arosed & to the date of filing of the complaint in accordance with the CP Act and suppression of material facts while & at the time of enrolling to the membership of master policy and relied upon n numbers of case laws decided by the apex courts. Further the answering respondents also reveals with regard to the enrollment of the policy by the deceased assured and admits the same was in force to the date of policy and taken contention that liability to the extent of and as per terms and conditions scheme and also admits the loan availed is tractor loan and also reveals the nature of the death benefits covering the liability to an extent of outstanding loan. While taken contention that at the time of enrolling to the scheme, master policy the complainant’s husband knowingly well aware of the fact that he had been underwent cardiac surgery 12 years prior to the proposal date he suppressed & withhold those facts intentionally & obtained the policy inspite of underwent surgery and he had ailments while answering to the question no.8 of the policy he answered, no, no, to the question though he was under the treatment and he had underwent cardiac operation. Since this being earlier claim i.e. within 2 years 9 months 29 days the respondents have took up it for investigation as per the provisos during that time it is traced that according to the medical records of SDM medical college, Dharwad & Spandana hospital Dharwad reveals the complainant’s husband had underwent operation for coronary artery disease. In the proposal form the insured had also undertaken that in the event of any information furnished by him found false he is not entitled for any claim under the policy. Under those circumstances only the respondents repudiated the claim on the ground of suppression of facts and asserted justification in the repudiation of the claim on the valid grounds by referring to several relevancies. Further asserted the claim was repudiated at the instance of the assured himself on the ground of suppression of material facts as such respondent have not committed any deficiency in service as alleged and prays for dismissal of the complaint.
5. The respondent.3 also filed detailed written version in the same line as the respondent.1 and 2 admits the written version. While the respondent admits enrollment of the deceased to the membership of master policy and the answering respondent is the master policy holder & also admits the death of the policyholder and also availment of loan from the respondent.3 bank. While it is denied the deceased was not aware of the scheme & proposal and material facts entered in the proposal form & asserted the deceased borrower voluntarily enrolled to the master policy scheme being a loanee and had availed loan under tractor and trailer loan scheme for Rs.6.40 lakhs & accordingly after enrollment to the membership single premium amount of Rs.41,151/- was debited to his account and transferred to the account of SBI Life Dhanraksha +LPPT Tractor loan scheme of the respondent.1 and 2. The deceased insured has not repaid the amount as agreed by him and he is in due of the loan amount to the date 31.03.2015 an amount of Rs.1093914/- is due from the complainant to the answering respondent bank. In terms of the policy the respondent 1 and 2 have to remit the amount to the respondent.3 with all interest and the remaining balance shall be paid by the complainant who is the legal heir of the deceased. The answering respondent has not repudiated any claim as alleged & also answering respondent is not liable to make good of the loss much less the amount claimed and also the answering respondent has not committed any deficiency in service as alleged & prays for dismissal of the complaint against the answering respondent with cost.
6. On the said pleadings the following points have arisen for consideration:
- Whether complainant has proved that there was deficiency in service on the part of respondents ?
- Whether complainant is entitled to the relief as claimed ?
- To what relief the complainant is entitled ?
Both have admits sworn to evidence affidavit, relied on documents. Apart from argument both have relied on citations. Heard. Perused the records.
Finding on points is as under.
- Affirmatively
- Accordingly
- As per order
Reasons
Points 1 and 2
7. On going through the pleadings & evidence coupled with documents of both the parties it is evident that there is no dispute with regard to the fact, the complainant’s husband had availed tractor loan from the respondent.3 bank by voluntarily enrolling & becoming member to master policy, SBI Life Dhanraksha+LPPT Tractor loan scheme.
8. Now the question to be determined is, whether the deceased assured had suppressed the material facts at the time of enrolling to the membership to the master policy under respondent.1&2 justified in repudiating the claim, if so, for what relief the complainant is entitled.
9. On going through the Ex.C1 repudiation letter dt.28.02.2013 & filing of the present complaint before this Forum on 23.02.2015 the present complaint is within time and the complaint is maintainable.
10. On perusal of Ex.C1 and the grounds made out for repudiation of the claim & compared the same with Ex.R1 -4 SBI Life claim investigation report supported with Ex.R1 (5) discharge summary of SDM College and Ex.R1 (6) Indoor case sheet of Spandana hospital Dharwad it is evident that the assured had underwent coronary artery bypass surgery prior to the date of enrollment of the policy. The deceased enrolled to the master policy as per Ex.R1 (1) on 04.12.2009, this fact is rectified by perusal of proposal/ membership form Ex.R1(2) whereas to the questionnaire .8 sub clause.I, II, III, IV, V, VI, VII, VII, & IX the member/ insured answered , NO, Inviting the information furnished by the insured while enrolling to the membership of the master policy the LC for respondent take this Forum to the Ex.R1 (5) & (6) & submits the respondent 1 and 2 are justified in repudiating the claim as per Ex.C1 for the grounds mentioned in it. Pro contra the LC for complainant addressing his argument on the contention that the deceased assured did not concealed any material facts as per Sec.45 of the Insurance Act and whatever the answer he has given to the proposal form are true & correct and he has not concealed any facts which were known to him at the time of furnishing material facts to the proposal form. Thereby there does not arise question of suppression of material facts. Further argued since this policy being rund for more than 2 years 9 months 29 days as per Sec.45 of the Insurance Act at this juncture the material facts furnished cannot be called in question by insurer on the ground of statement made in the proposal. Further the LC for complainant also drawn the attention of this Forum to the membership form Ex.R1(2) to the item Sl. no.7 good health declaration at page.3 according to the conditions of good health declaration is only restricted to the period of 3 years prior to the proposal, whereas the insured as per Ex.R1(5 & 6 ) he had been underwent CABGS prior to 12 years. Under those circumstances the proposer was not supposed to mention the facts which are happened prior to 12 years and also no authorities of respondents at the time of enrolling to the membership & fillupping the membership form did not explained & narrated the facts and made clear to the proposer what are the information to be furnished. Under those circumstances only the deceased proposer did not mention the same and as per their own form at item no.7 good health declaration the information is restricted to the 3 years, during that time proposer was in hale and healthy and he was not suffering from any ailments and he was not taking treatment for any ailments. Hence, allegation of suppression does not arise further also submits his continued argument that the questionnaire .8 are not clear and are vague and contradictory to the items mentioned in the Sl.no.7 items & submits the assured has not committed any wrongs nor concealed the material facts. Further also argued the assured at the time of enrolling to the membership of the master policy had no intention to deceive the respondent 1 and 2 and also he had no intention to enroll to the membership of the master policy at the instance of the R3 only he had been enrolled and become member to the master policy & remittance of premium was also not known to the deceased husband & was known at later stage after referring to the account statement of R3 at Ex.C5. Also submits the deceased was not supposed to have the policy but as he had availed tractor loan from respondent.3 at the instance of R3 voluntarily he had been enrolled to the master policy. Further submits if the deceased had any intention to deceive R1 and R2 he would have subscribe to the other policies of different schemes of the SBI rather than purchasing tractor by availing loan.
11. In reply to this the LC for respondent.1 &2 vehemently argued and contended justification in repudiating the claim strictly based on the nature of the contract of insurance on good faith i.e. uberrimafiede. Further submits the deceased is not an ordinary layman, he was literate, he was well known of all the facts, though he was well aware of the facts he had underwent CABGS he intentionally did not disclosed the same while answering to the sub clause of the question 8 of the proposal. Since this being earlier claim while investing the same it came to know that the deceased had underwent CABGS prior to 12 years of proposal even then it was not mentioned. If it was mentioned at the time of proposal the respondents would have not issued the policy otherwise would have fix higher premium covering grave risk & further asserted repudiation is not improper. In the event of suppression of material facts and earlier claim U/s.33 of insurance Act the insurer had got every right to investigate the matter and to repudiate the claim added to it in the proposal form itself the deceased had undertaken if in the event any facts found false to disclaim the benefits under the policy & relied on the citation in support of this contention and argument. LIC of India & Anr. Vs. S.Sindhu 2006 (5) Supreme Court Cases 258 wherein it is held, the courts and tribunals cannot rewrite contracts & direct payment contrary to the terms of contract that too the defaulting party & submits wherein the instant case as per Ex.R1 (5&6) it is a latent case of suppression of facts knowingly well aware by the insured at the time of proposal even then he did not disclosed as the contract of insurance is based on good faith. Any forbearance to abide the terms and conditions the contract will become void and not only void, void in abinitio and prays for dismissal of his earlier complaint. Pro contra the LC for complainant in furtherance to the argument submitted further argued that the assured has not suppressed any material facts which required to be existing contract & had acted in accordance with the terms and conditions, no material facts were concealed which amounts to vitiate the contract and to disclaim the benefitsand repudiate. In support of this argument the LC for complainant relied on citation Civil Appeal 4186 – 87/88- LIC of India & Ors vs. Smt.Asha Goyal & ors., AIR 2001 Supreme Court 549. It is held- in order to repudiate the claim insurer shall prove 3 facts (a) the statement must be on a material matter or must suppress the facts which it was material to disclose (b) the suppression must be fraudulently made by the policyholder; and (c) the policy holder must have known at the time of making the statement that it was false or that it suppressed the facts which was material to disclose. Mere inaccuracy of falsety in respect of some recitals or items in the proposal is not sufficient. The burden of proof is on insurer to establish these circumstances and unless insurer is able to do so there is no question of the policy being avoided on grounds of misstatement of facts. Based on the observation of the apex courts in the relied case the LC for complainant submits the insured at the time proposal he has no any intention to deceive the respondents as such he has not committed any fault on his part and he has not suppressed any material facts and his claim to be allowed. By winding up the evidence and argument brought on the deceased assured had no any intention and intentionally he has not suppressed any material facts. Under those circumstances. The repudiation of the claim by the respondent.1 and 2 is not proper. The complainant with cogent and appulsive evidence established her case of deficiency in service by respondent 1 and 2 interalia the respondent 1 and 2 failed to justify the repudiation. Hence, the complainant is entitled for relief.
12. In view of the above discussions we have arrived and proceed to held issue.1 and 2 in affirmatively & accordingly.
13. Point.3: In view of the finding on points 1 and 2 proceeded to pass the following
Order
The complaint is allowed in part and dismissed against respondent.3. The respondent 1 and 2 jointly and severally to settle the claim in accordance with the terms and conditions of the policy and to clear the dues of the deceased loanee maintained with the respondent.3 to the extent as per the policy terms and conditions along with Rs.2,000/- compensation and Rs.1,000/- towards cost of the proceedings within 60 days from the date of receipt of copy of this order. Failing to comply the same, the said amount shall carry interest @9% P.A. from thereon till realization.
(Dictated to steno, transcribed by him and edited by us and pronounced in the open Forum on this day on 12th day of August 2015)
(Smt.M.Vijayalaxmi) (Sri.B.H.Shreeharsha)
Member President
Dist.Consumer Forum Dist.Consumer Forum
MSR
