Chandigarh

DF-I

CC/303/2020

Smt. Amarpreet kaur - Complainant(s)

Versus

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

Danishwar Ali

01 Sep 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

 

                    

Consumer Complaint No.	:	CC/303/2020
Date of Institution	:	27.8.2020
Date of Decision	:	1/9/2023

 

1.   Smt. Amarpreet Kaur Widow of late Sh. Tejinder Singh R/o House No.2293-A, Sector 20-C, Chandigarh.

2.   Sh. Mohinder Singh S/o Piara Singh father of late Sh. Tejinder Singh R/o House No.2293-A, Sector, 20-C, Chandigarh through SPA Smt. Amarpreet Kaur Widow of Late Sh. Tejinder Singh.

3.   Smt. Amarjit Kaur W/o Mohinder Singh mother of late Sh. Tejinder Singh R/o House No.2293-A, Sector, 20-C, Chandigarh through SPA Smt. Amarpreet Kaur Widow of Late Sh. Tejinder Singh.

4.   Ms. Avneet Kaur D/o late Sh. Tejinder Singh R/o House No.2293-A, Sector, 20-C, Chandigarh through SPA Smt. Amarpreet Kaur Widow of Late Sh. Tejinder Singh.

5.   Sarvjot Singh S/o Late Sh. Tejinder Singh R/o House No.2293-A, Sector 20-C, Chandigarh through mother being minor who is natural guardian through SPA Smt. Amarpreet Kaur Widow of late Sh. Tejinder Singh.  

… Complainants

V E R S U S

1. SBI Life Insurance Co. Ltd. Natraj through its Manager Principal office M.V. Road & Western Express Highway Junction, Andheri (East), Mumbai 400069.
2. State Bank of India through its Branch Manager, Sector 34, Chandigarh 1650022.

.  … Opposite Parties

 

CORAM :	PAWANJIT SINGH	PRESIDENT
	SURJEET KAUR SURESH KUMAR SARDANA	MEMBER MEMBER

                       

ARGUED BY		Sh. Danishwar Ali, Advocate for complainants
		Sh. Rajneesh Malhotra, Advocate for OP No.1
		Sh. Swapan Garg, Advocate for OP No.2 (Defence of OP No.2 struck off)

Per SURJEET KAUR, Member

     Briefly stated the the husband of the complainant late Sh. Tejinder Singh availed personal loan of Rs.8.00 lakh from the OP No.1. The said loan was duly covered through insurance with insurance cover valid from 7.3.2019 to 7.3.2025  and premium amount of Rs.14038/- including Rs.2142/- on account of tax paid to OP No.2. Unfortunately the husband of the complainant expired on 28.9.2019 and accordingly the LRs of the complainant filed claim but the same was declined by the OPs on the ground of disclosure of question 5(i) and question 5(iii) though the cause of death of the husband of the complainant was Refractory septic shock.  It is alleged that the OPs had only refunded Rs.11896/- towards refund of premium as per terms and conditions of the policy instead of paying the insured amount. Alleging the aforesaid act of Opposite Parties deficiency in service and unfair trade practice on their part, this complaint has been filed.

2. The Opposite Party No.1 in its reply while admitting the factual matrix of the case stated that  life insurance contract is a contract of utmost good faith and the proponent is duty bound to disclose everything concerning his/her health, habits and other related matters at the time of making the proposal of insurance cover failing which the  insurer has every right to repudiate the claim. In  It is alleged that in the instant case the deceased life assured Sh. Tejinder Singh committed a breach of principle of utmost good faith by suppressing the material fact that he was suffering from Alcoholic liver disease, chronic liver disease, portal hypertension, ascites and cirrhosis of liver and was under treatment for the same prior to the commandment of the insurance cover. Thus any breach of principle of utmost good faith is a nullity and void ab-initio and such the complaint is not maintainable and liable to dismissed.  All other allegations made in the complaint has been  denied being wrong.
3. Defence of OP No.2 struck of vide order dated 13.10.2022 as it failed to file the written version within the stipulated time despite ample opportunities granted.
4. Rejoinder was filed and averments made in the consumer complaint were reiterated
5. Contesting parties led evidence by way of affidavits and documents.
6. We have heard the learned counsel for the contesting parties and gone through the record of the case.
7. The sole grouse of the complainants is that the Ops repudiated their genuine claim after death of husband of complainant No.1. As per repudiation letter Annexure A-1 the claim has been repudiated by the OP insurance company on the ground that life insurance contract is a contract of utmost good faith  and the policy in question was issued on the basis of the information disclosed in the proposal form believing  the information to be true. However as per medical treatment paper  of the year 2018  the husband of the complainant was suffering from  Alcoholic Liver Disease, chronic liver disease, portal hypertension, ascites and cirrhosis of liver  and was under the treatment for the same prior to commencement of policy i.e. on 7.3.2019.
8. After going through the medical record and Annexure A-1, which pertains to the year 2018 it is abundantly clear that there is mention of the diseases which the late Tejinder Singh husband of complainant No.1 was  suffering in the year 2018  but the said very fact was not disclosed by the late husband of the complainant No.1 to the insurance  company and as such obtained the policy on the false declaration. As per medical certificate Annexure A-3  the cause of death of the deceased is refractory septic shock, acute on chronic liver failure, decompensated  cirrhosis (ethanol relate), spontaneous bacterial peritonitis, hepatic encephalopathy, and acute kidney injury. As per Annexure E medical attendant of the life assured shows under the columns of ‘Nature of habit’ that the deceased was consuming alcohol for last 15 years.  Even as per Annexure F the immediate cause of death was refractory septic shock, acute chronic liver failure cirrhosis (ethanol relate).  Further as per PGI record the complainant husband was suffering from alcoholic liver disease and therefore, he was hospitalized for the treatment which was not disclosed by the insured in the proposal form. In our opinion life insurance contract is a contract of utmost good faith  and the policy in question was issued on the basis of the information disclosed in the proposal form believing  the information to be true. However as per medical treatment paper  of the year 2018  the husband of the complainant was suffering from  Alcoholic Liver Disease, chronic liver disease, portal hypertension, ascites and cirrhosis of liver  and was under the treatment for the same prior to commencement of policy i.e. on 7.3.2019. Hence, as the insured has concealed the material facts  in respect of his health  from the insurance company while obtaining the insurance cover, thus,  the OP insurance company has rightly  repudiated the claim of the complainant as per terms and conditions of the policy.  
9. As far the question of refunding the premium amount is concerned, as per Section 45 sub clause 7 of Annexure-II of terms and conditions of the policy the complainants are entitled for premium amount and admittedly the premium amount has already been refunded to the complainants. Hence, no case is made out against the OPs.
10. In view of the aforesaid discussion, the present consumer complaint, being devoid of any merit, is hereby dismissed leaving the parties to bear their own costs.
11.     Certified copies of this order be sent to the parties free of charge. The file be consigned
12. Pending miscellaneous application(s), if any, also stands disposed off
13.      Certified copies of this order be sent to the parties free of charge. The file be consigned

			sd/- [Pawanjit Singh]
			President
			sd/-
			[Surjeet Kaur] Member sd/-
1/9/2023			[Suresh Kumar Sardana]
mp			Member