Punjab

Ludhiana

CC/21/355

Surinder Kaur - Complainant(s)

Versus

SBI Life Insurance Co Ltd - Opp.Party(s)

Vishal Khanna

07 Oct 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                             Consumer Complaint No:  355 dated 29.07.2021.                                       Date of decision: 07.10.2024. 

 

Surinder Kaur aged 65 Years W/o. Sh. Jarnail Singh, R/o. St. No.10, Near GND School, Krishna Nagar, Khanna, Distt. Ludhiana.                                                                                                                                    ..…Complainant

                                                Versus

1. Regional Director, SBI Life Insurance Co. Ltd., 3^rd & 4^th Floor, Plot No.144, Industrial Area-PH 2, Chandigarh-160002;
2. SBI Life Insurance co. Ltd., Central Processing Central, 7^th level (D Wing) & 8^th Level, Seawood Grand Central Tower 2, Plot No.R-1, Sector-40, Sewawood Nerul Node, Distt. Thane, Navi Mumbai-400706.                                                                    …..Opposite parties 

Complaint Under Section 35 of The Consumer Protection Act.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

MS. MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. Vishal Kumar Dua, Advocate

For OPs                          :         Sh. Nipun Gupta, Advocate.

ORDER

PER SANJEEV BATRA, PRESIDENT

1.                Briefly stated, the facts of the case are that in the month of August 2019, Sh. Sukhwinder Singh (Now deceased) son of the complainant took insurance policy No.1K738389908 namely ‘SBI life Smart Wealth Builder’ from the OPs for a sum insured of Rs.10,00,000/- by paying one time premium of Rs.1,00,000/-. The complainant was a nominee in the said policy. The complainant stated that her son Sukhvinder Singh died on 18.05.2020 and as such, she is entitled to get the insurance claim under the said policy being nominee. The complainant submitted claim with the OPs but the OPs paid only Rs.82,660/- to the complainant whereas the sum insured was of Rs.10,00,000/-. The complainant many times requested the OPs to pay total sum insured but they denied to pay the sum insured to her. Even the complainant served a legal notice dated 23.04.2021 upon the OPs but to no effect. Hence this complaint, whereby the complainant has prayed for issuing direction to the OPs to pay total sum insured of Rs.10,00,000/- along with compensation of Rs.1,00,000/-.

2.                Upon notice, the OPs appeared and filed written statement assailed by complaint by taking preliminary objections on the grounds of maintainability; lack of jurisdiction; the complainant being not a consumer of the OPs etc. The OPs stated that deceased Sh. Sukhvinder Singh was holding SBI Life policy No.1K738389908 with the date of commencement as 05.08.2019 and he is reported to have committed suicide on 18.05.2020 i.e. within one year from the date of commencement of the policy. Therefore, the death claim is not payable as Sh. Sukhvinder Singh committed suicide within one year from the date of commencement of the policy i.e. 05.08.2019. As per the terms and conditions of the policy, if the life assured commits suicide within 1 year of date of commencement, the sum assured is not payable. Hence the claim was repudiated and fund value as on the date of intimation was refunded as per the terms and conditions of the policy. As the claim has been repudiated strictly as per the terms and condition of the policy only.

                   In the column Brief Facts of the Case, the OPs stated that the Deceased Life Assured Sh. Sukhvinder Singh submitted proposal bearing No.1KNB249120 dated 02.08.2019 under Smart  Wealth Builder Plan along with initial premium deposit of Rs.1,00,000/-, on the basis of which a policy in question was issued being commenced from 05.08.2019 having basic sum assured as Rs.10,00,000/-. Said Sukhvinder Singh reported to have died on 18.05.2020 regarding which the OPs received claim intimation dated 18.06.2020 from the complainant in which the cause of death was stated as “Suicide”. The policy resulted into claim in just 9 months 13 days. The OPs further stated that the clause 17.2 Suicide Exclusion, of the terms and conditions of the policy, is reproduced as under:-

“17.2.1 If the Life Assured, sane or insane, commits suicide, within one year, we will not pay the death benefit.

17.2.2 We will calculate one year from the Date of Commencement of Risk or Date of Revival of the policy, whichever is later.

17.2.3 We will pay your Fund Value as on the date of intimation of death and the contract would cease.

17.2.4 Any charges recovered subsequent to the date of death shall be paid back to the nominee along with the fund value.”

 

                   The OPs further stated that Late Sukhvinder Singh committed suicide on 18.05.2020. The date of commencement of the risk cover was 05.08.2019 and the duration of insurance cover under the policy is only 9 months 13 days i.e. within one year from date of commencement. As per General Dairy Details report of policy, the DLA committee suicide by hanging himself and reason for committing suicide that DLA was jobless due to which he was mental depression stage. Further as per most mortem report, it was noted that as per the policy information DLA’s death is due to hanging. The opinion of Dr. Amita Arora who conducted PMR that cause of death of DLA is ASPHYXIA    due to hanging which is ordinary course of nature is sufficient to cause death. According to the Ops, as the DLA committed suicide within one year of date of commencement of the policy, the claim is not payable as per the suicide exclusion clause of the policy. As such, the claim was repudiated and an amount of rs.82,660.49 towards fund value refund was credited to the bank account of the complainant on 02.07.2020. Further after receiving the legal notice dated 23.04.2021 from the complainant, the case was examined and repudiation decision was found to be in order.

                   On merits, the OPs reiterated the crux of averments made in the preliminary objections and brief facts of the case. The OPs have denied that there is any deficiency of service and have also prayed for dismissal of the complaint.

3.                In evidence, the complainant tendered her affidavit as Ex. CA and reiterated the averments of the complaint. The complainant also placed on record documents i.e. Ex. C1 is the copy of letter  written by the complainant to the OPs, Ex. C2 is the copy of General Diary Details No.18 dated 18.05.2020, Ex. C3 is the copy of insurance policy, Ex. C4 is the copy of legal notice dated 23.04.2021, Ex. C5 and Ex. C6 are the postal receipts, Ex. C7 is the copy of death certificate of Sukhvinder Singh, Ex. C8 is the copy of Aadhar Card of the complainant and closed the evidence.

4.                 On the other hand, the counsel for the OPs tendered affidavit Ex. RA of Ms. Dhanya K P, authorized representative of the OPs along with documents i.e. Ex. R1 is the copy of proposal form, Ex. R2 is the copy of welcome letter and policy documents, Ex. R3 is the copy of claim form, Ex. R4 is the copy of General Diary Details no.18 dated 18.05.2020, Ex. R5 is the copy of post mortem report, Ex. R6 is the copy of repudiation letter dated 03.07.2020, Ex. R7 is the copy of legal notice dated 23.04.2021, Ex. R8 is the copy of reply dated 10.05.2021 to legal notice dated 23.04.2021 and closed the evidence.

5.                We have heard the arguments of the counsel for the parties and also gone through the complaint, affidavit and annexed documents as well as written statement, affidavit and documents produced on record by the parties.

 

 

6.                The present complaint has been filed by complainant Smt. Surinder Kaur being the mother and nominee of her deceased son Sukhvinder Singh, who on the basis of proposal form Ex. R1, availed a SBI Life Smart Wealth Builder policy Ex. C3=Ex. R2 for a sum of Rs.10,00,000/-  having risk commencing date 05.08.2019 for a period of 10 years on annual premium of Rs.1,00,000/- each. Unfortunately, said Sukhvinder Singh died on 18.05.2020 as he committed suicide by hanging himself. In this regard a General Dairy Details No.18 dated 18.05.2020 Ex. C2 = Ex. R4 was registered by the police of Police Station Khanna City-2 on the statement of Jarnail Singh father of Sukhvinder Singh. Further post mortem of Sukhvinder Singh was got conducted at Civil Hospital, Khanna on 18.05.2020 vide Post Mortem Report Ex. R5. As per the Post Mortem Report, the cause of death in this case is asphyxia due to hanging which is ordinary cause of nature is sufficient to cause death. The complainant lodged a claim with the OPs vide claim form Ex. R3, which was repudiated by the OPs vide repudiation letter dated 03.07.2020 Ex. R6 by invoking clause 17.2 of the policy terms and conditions. However, the OPs credited a sum of Rs.82,660.49 in the account of the complainant on 02.07.2020 being fund value of the policy. The operative part of the repudiation letter Ex. R6 is reproduced as under:-

“This is with reference to your claim under the Policy Number 1K738389909 on the life of Late Sukhvinder Singh. We are sad to note the unfortunate demise of Late Sukhvinder Singh.

As per the records available with us, Late Sukhvinder Singh committed suicide on 18/05/2020. The policy commenced on 05/08/2019 and Late Sukhvinder Singh committed suicide within one policy year from date of commencement, hence Sum Assured is not payable under the policy.

In this connection, you are requested to refer Clause 17.2 of Policy Document which reads:

17.2.1 If the Life Assured, sane or insane, commits suicide, within one year, we will not pay the death benefit.

17.2.2 We will calculate one year from the Date of Commencement of Risk or Date of Revival of the policy, whichever is later.

17.2.3 We will pay your Fund Value as on the date of intimation of death and the contract would cease.

17.2.4 Any charges recovered subsequent to the date of death shall be paid back to the nominee along with the fund value.

Please note that an amount of Rs.82660.49 (Eighty Two Thousand Six Hundred and Paise Forty Nine Only) has been transferred to your savings account no.******8758 held in State Bank of India, Khanna Branch, on 02/07/2020, as per terms and conditions of the policy.”

 

7.                In pursuance of settlement of the claim, the OPs have paid the fund value of premium paid. From the aforesaid facts and circumstances, it is crystal clear that death of the insured Sukhvinder Singh occurred due to suicide on 18.05.2020 and duration of insurance cover was only 9 months 13 days i.e. within one year from the date of commencement of risk cover. As such, the OPs are justified in repudiating the claim of the complainant by invoking 17.2 Suicide Exclusion Clause. Moreover, the complainant in her complaint has concealed the factum of committing suicide by her son and in para No.2 of the complaint has only written that the policy holder Sukhvinder Singh died on 18.05.2020. In these circumstances, the OPs were justified in revoking the basic claim of the complainant and there is no deficiency in service on their part.

8.                As a result of above discussion, the complaint fails and the same is hereby dismissed. However, there shall be no order as to costs. Copies of the order be supplied to the parties free of costs as per rules. File be indexed and consigned to record room.  

9.                Due to huge pendency of cases, the complaint could not be decided within statutory period.

 

 

(Monika Bhagat)                              (Sanjeev Batra)               Member                                         President  

 

Announced in Open Commission.

Dated:07.10.2024.

Gobind Ram.