Chandigarh

DF-II

CC/343/2020

Mr. Sunita Sharma - Complainant(s)

Versus

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

Sanjeev Trikha & Rishab Goel

09 Dec 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II

U.T. CHANDIGARH

 

Consumer Complaint No.	:	CC/343/2020
Date of Institution	:	10/08/2020
Date of Decision	:	09/12/2024

 

Mrs. Sunita Sharma wife of Late Pardeep Kumar Sharma, aged 63 years, resident of Flat No.B-310, Ragalia Tower, Vasant Vihar, Dhakoli, Zirakpur.

                                ...  Complainant

V E R S U S

SBI Life Insurance Company Limited through its Branch Manager, SCO No.127-128, First Floor, Sector 17-C, Chandigarh.

…. Opposite Party

 

BEFORE:
	SHRI AMRINDER SINGH SIDHU	PRESIDENT
	SHRI BRIJ MOHAN SHARMA	MEMBER

 

ARGUED BY:
	Sh.Gaurav Bhardwaj, Adv. proxy for Sh.Sanjeev Trikha, Counsel for complainant
	Sh.Rajneesh Malhotra, Counsel for OP (through VC)

       

ORDER BY AMRINDER SINGH SIDHU, M.A.(Eng.),LLM,PRESIDENT

1.        The complainant has filed the present consumer complaint alleging that her husband, Shri Pardeep Kumar Sharma i.e. the life assured had taken life insurance policy namely “SBI Life-Smart Elite Plan Gold Cover” from the OP.  The policy/plan opted by him was for five years and annual premium of ₹1,50,000/- was also to be paid for five years.  The sum insured was ₹15,00,000/- and he had paid two premiums of ₹1,50,000/- each for the year 2016 and 2017.  At the time of taking the policy, the life assured had submitted all the medical record and also clarified about his ailments and other medical documents to the representatives of the OP.   Unfortunately, the life assured died on 1.8.2018 and the complainant lodged her claim but the same was repudiated by the OP vide letter dated 3.12.2018 (Annexure C-4) on the ground of concealment of information and the OP also transferred the amount of two premiums paid i.e. ₹3,00,000/-  in the account of the complainant of 19.11.2018 without her consent or approval. Even the representation of the complainant was also rejected by the OP vide its letter dated 27.3.2019. Alleging that the aforesaid acts amount to deficiency in service and unfair trade practice on the part of OP, complainant has filed the instant consumer complaint seeking the sum assured alongwith interest, compensation and litigation expenses.
2.        In its written version OP admitted the factual matrix including that it had issued the policy in question and further that it had rejected the claim of the complainant and transferred the amount of two premiums in her account.  It is averred that prior to signing the proposal form, the life assured was suffering and was under treatment for chronic renal failure and acute pancreatitis but he did not disclose the same in the proposal form and, therefore, the claim was rightly repudiated.  The remaining allegations have been denied being false. Pleading that there is no deficiency in service or unfair trade practice on its part, OP prayed for dismissal of the consumer complaint.
3.        The complainant chose not to file replication.
4.        Parties led evidence in support of their case.
5.        We have heard the learned Counsel for the parties and have gone through the documents on record, including written arguments.
6.        Admittedly, OP had issued the policy in question to the deceased husband of the complainant i.e. the life assured having sum assured of ₹15,00,000/- and the annual premium of ₹1,50,000/- was to be paid for five years.  It is also admitted case of the parties that the life assured died on 1.8.2018 after paying two premiums of ₹1,50,000/- each i.e. total ₹3,00,000/- which was refunded by the OP while repudiating the claim of the complainant vide its letter dated 3.12.2018 (Annexure C-4).
7.        It is observed from the record that the claim of the complainant was repudiated by the OP vide its letter dated 3.12.2018 on the ground of non disclosure of material facts as the life assured was suffering from chronic renal failure and acute pancreatitis and was taking treatment for the same prior to the commencement of the policy i.e. 14.10.2016. 
8.        However, indisputably the life assured, at the time of inception/proposal i.e. 4.10.2016 was aged about 59 years. That being so, OP/insurer was bound to have conducted thorough medical examination of the insured before issuing the policy in his favour and if the OP failed to do so, complainant should not be made to suffer the consequences for the same.  It is not the first time that insurers like the OP in the present case by turning totally blind eye to the facts before them just concentrate on issuing/selling their policies but when the time comes to honour the claim they, with a view to repudiate/reject the same, resort to one or the other technicalities by totally ignoring that the purpose of taking insurance is not for any luxury but to cover up for some unforeseen eventuality.    In M/s Max Bupa Health Insurance Co. Ltd. Vs. Rakesh Walia, Appeal No.191 of 2016 decided on 18.8.2016 by Hon’ble State Consumer Commission, Chandigarh, it has been held that if contrary to the instructions issued by IRDAI, an insured above the age of 45 years, was not put to thorough medical examination, claim raised after issuance of insurance of policy cannot be rejected on account of non-disclosure of the fact of pre-existing disease when policy was obtained.
9.        Further, in SBI General Insurance Company Limited Vs. Balwinder Singh Jolly, 2016(4) CLT 372 it has been held by Hon’ble State Consumer Commission, Chandigarh that if Insurance company failed to conduct thorough check up of the policy holder then it has no right to decline the insurance claim on non-disclosure of facts of pre-existing disease when the policy was taken.
10.        Moreover, it is usual with the insurance companies to show all types of green pastures to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sorts of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted wherein it was held that Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation.  This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.  It is generally seen that the insurance companies are only interested in earning premiums and find ways and means to decline claims.
11.        In similar set of facts the Hon’ble Punjab & Haryana High Court, Chandigarh in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others, 2008(3) RCR (Civil) 111 went on to hold as under:-

       “It seems that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.  The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.”

12.        In view of the ratio of law laid down in the aforecited cases, it is safe to hold that the act of OP/ insurer in repudiating the claim of complainant certainly amounts to deficiency in service and the present consumer complaint deserves to succeed and the OP is liable to pay the sum assured alongwith interest and compensation etc.
13.        Resultantly, present consumer complaint succeeds and the same is partly allowed.  OP is directed as under :-
    1. to pay to the complainant sum assured of ₹15,00,000/- after deducting already refunded amount of ₹3,00,000/- i.e. ₹15,00,000/- – ₹3,00,000/- = ₹12,00,000/- alongwith interest @ 6% per annum from the date of this order till the date of its actual realization by the complainant. 
    2. to also pay lump sum compensation of ₹10,000/- to the complainant towards the harassment caused to her as well as litigation expenses.
14.        This order be complied with by the OP within 60 days from the date of receipt of its certified copy.
15.        The pending application(s) if any, stands disposed of accordingly.
16.        Certified copy of this order be sent to the parties, as per rules. After compliance file be consigned to record room.

ANNOUNCED 09/12/2024 hg	[AMRINDER SINGH SIDHU] PRESIDENT
	[BRIJ MOHAN SHARMA] MEMBER