Per Shri P.N. Kashalkar – Hon’ble Presiding Judicial Member:
(1) This appeal has been filed by the original Complainant against the order passed in Consumer Complaint No.281/2007 dated 12.10.2011 by South Mumbai Consumer District Consumer Disputes Redressal Forum, Parel, Mumbai.
(2) Facts to the extent material may be stated as under:
The Appellant who was the Complainant in District Forum had filed consumer complaint alleging deficiency in service on the part of SBI Life Insurance Co. Ltd. and S.B.I. Cards & Payments Services Pvt. Ltd. She pleaded that she is widow of Nitin Rao, who died in fatal accident on 05.02.2006. Before his death, during his life time he had taken credit card from Opponent No.3 bearing No.4006 6610 19461 7757. As per brochure issued by SBI Card & Payments Services Pvt. Ltd. (Opponent No.3), SBI Card holder was entitled for free insurance protection. It is stated in the brochure that “As a valued SBI Mumbai card holder you get a complementary personal accident insurance coverage for loss of life of `6 lacks in the event of the air accident and `2 lacks in case of other accidents”. The Complainant submitted that the Opponents did not give full details of the insurance cover, terms and conditions of the policy. She pleaded that her husband was SBI Card holder and he was using his credit card till his death i.e. till 05.02.2006. After her death she lodged claim with the Opponent No.3. Opponent No.3 directed her to contact Opponent No.1 – SBI Life Insurance Co.Ltd. She then wrote to Opponent Nos.1 and 2 and sent various documents in prescribed form but there was no response from the Opponents. In spite of sending claim form and required documents twice, Opponent No.2 did not give any response and therefore, she sent legal notice and claimed `2 lac as per brochure along with interest by letter dated 21.04.2007. Opponent No.1 replied the said notice by its letter dated 23.05.2007 stating that Mr.Nitin Rao was not covered under the protection plus policy as he had never opted for insurance and no premium was 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 there was no question of opting for payment of premium. The Complainant pleaded that the Opponents were guilty of deficiency in service by way of adopting unfair trade practice and therefore, she filed consumer complaint claiming amount of `2 lac against instance claim for the accidental death of her husband who was SBI Card holder. She also prayed for compensation, cost and interest on the amount.
(3) In the District Forum all the Opponents were served with the notice. The Opponent Nos.1 and 2 filed affidavit in evidence referring therein their written version. Opponent No.3 was duly served but it remained absent. It was proceeded ex-parte.
(4) Mr.V.Shrinivas S/o late Somayajulu filed affidavit in evidence on behalf of Opponent Nos.1 and 2. In Affidavit in evidence it is stated that SBI Life offers individual assurance and Group life insurance coverage. In group life insurance 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. However, the COI specifically mentioned that the insurance coverage is granted subject to terms and conditions mentioned in the master policy issued to the master policy holder and who has entered into the contract of insurance with SBI life. It further pleaded that SBI life is a scheme of group insurance for holders of credit cards issued by SBI card & Payment Services Ltd., which is known as “SBI Card Protection Plus” which offers insurance coverage to credit card holder of SBI Cards. They pleaded that SBI Life does not provide any free insurance cover to the members of policies issued to the SBI Cards. Granting free insurance cover is strictly prohibited in terms of Section 64VB of Insurance Act 1938. They pleaded that in the policy issued to the master policy holder i.e. SBI Cards, it is clearly mentioned that 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. Opponent Nos. 1 and 2 therefore pleaded that deceased was not covered by SBI Card Protection Plus Policy or he was not holder of Group Life Insurance coverage which is issued to master policy holder by issuing certificate of insurance.
(5) The District Forum, therefore, on considering the rival contentions held that in the instant case Protection Plus Insurance cover was not activated by Mr.Nitin Rao, and so the deceased Nitin Rao had never opted for insurance cover. The District Forum further held that the deceased Mr.Nitin Rao was not a member of Group Insurance Policy of S.B.I. Life Insurance under SBI Card No.40066610 19767757 issued to SBI Card Holder and there is no insurance cover issued to Mr.Nitin Rao and therefore, Mr.Nitin Rao was not covered by any of the Policies floated by Opponent Nos.1 and 2 for the benefit of SBI Card holders, as such the District Forum held that the widow of the deceased i.e. Complainant was not entitled to get any insurance claim, consequent to the death of Shri Nitin Rao. The District Forum was therefore pleased to dismiss the complaint. Aggrieved by this dismissal the original Complainant has filed this appeal.
(6) We heard submissions of Ld.Advocate Mr.U.B. Wavikar, Advocate for the Appellant. Mr.Rahul Mehta, Advocate for the Respondent Nos.1 and 2 and Mr.Andnd Patwardhan, Advocate for the Respondent No.3.
(7) We are finding that the order under challenge passed by the District Forum, South Mumbai is just and proper. It is well reasoned and it is sustainable in law. The District Forum rightly observed that insurance claim of the insured is based on important document like Insurance Policy. The Complainant failed to produce any such document before the District Forum to show that deceased Mr.Nitin Rao had paid required premium to the Insurance Company to for the insurance cover. Only thing is that he had obtained credit card in 2001 and necessary policy document should have been obtained by him during the period 2001 to 2006. The group insurance policy floated by S.B.I Life Insurance Company was meant for members of S.B.I. Card holders but that is given in consideration of the premium as stated in the policy. The stand of the Opponent nos.1 and 2 (Respondent Nos.1 and 2 in this appeal) was that they had not obtained any premium against the policy as per Section 64VB of Insurance Act and therefore, they were not liable to pay claim under the Insurance Act and it was rightly contended by Opponent Nos.1 and 2 that if Opponent No.3 had offered free insurance then Master Insurance Policy would have been given by Opponent No.3 but there was no evidence on record to prove that Appellant had paid premium to Respondent No.3 – SBI Cards Company or paid any premium to Opponent Nos.1 and 2 to insure the life of deceased husband of the Appellant. So, there was no evidence on record to establish that Complainant’s husband was covered under the Insurance Policy. Opponent No.3 - SBI Cards, clearly told Complainant and also to Opponent No.1 that Protection Plus Policy was not activated on SBI Card No.400066610 19467757 of Mr.Nitin Rao. As such Nitin Rao’s credit card was not eligible for Protection Plus Insurance. In the circumstances, we are finding that the District Forum rightly dismissed the complaint and we are finding no substance in the appeal preferred by the original Complainant. The card purchased by the Appellant’s husband was not activated for the Protection Plus Policy, normally given to the Credit Card holders of Respondent No.3. Moreover, the premium must be paid even by that card holder who wants to be insured under Protection Plus Policy. This was not done by the husband of the Appellant during his life time and therefore, the claim preferred by the widow of the deceased, the Appellant herein, for claiming `2 lac was rightly repudiated by the Opponents and complaint was rightly dismissed by the District Forum in the circumstances obtainable. In the result, we find no merit in the complaint. Hence, we pass the following order:
O R D E R
(i) Appeal stands dismissed.
(ii) No order as to costs.
(iii) Inform the parties accordingly.
Pronounced on 31st August, 2012.
