Punjab

Ludhiana

CC/18/712

Resham Kaur - Complainant(s)

Versus

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

RK Chand adv

04 May 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No:712 dated 04.12.2018.                                                         Date of decision: 04.05.2022. 

 

Resham Kaur widow of Sh. Kashmir Lal, R/o. House No.1524, Street No.2, Arjun Nagar, Ludhiana.                                                                                                                                                                       ..…Complainant

                                                Versus

1. SBI Life Insurance Company Limited, having its office at 2^nd Floor-223/1, B-XIX, 223/2, Rani Jhansi Road, Civil Lines, Ludhiana-141001 through its Branch Manager.
2. SBI Life Insurance Company Limited, Processing Centre, 2^nd Floor, B-XIX, 1121/A/2, Near DMC & Hospital, Hambran Road, Tagore Nagar, Ludhiana through its Manager.                                                                                                                                          …..Opposite parties 

          Complaint Under Section 12 of the Consumer Protection Act.

QUORUM:

SH. K.K. KAREER, PRESIDENT

SH. JASWINDER SINGH, MEMBER

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. R.K. Chand, Advocate.

For OPs                          :         Sh. Nipun Gupta, Advocate.

 

ORDER

PER K.K. KAREER, PRESIDENT

1.                Shorn of unnecessary details, the case of the complainant is that the agent/employee of OP1 approached the husband of the complainant namely Kashmir Lal to obtain an insurance policy on payment of one time premium. Accordingly, OP1 issued the policy and copy of certificate of insurance whereby Kashmir Lal was insured for Rs.7,50,000/-. The complainant was made nominee in the said policy. As per the policy, in case of death of Kashmir Lal, the complainant being his wife and nominee would be entitled for Rs.7,50,000/-. Unfortunately, Kashmir Lal died on 01.10.2017. After his death, the complainant lodged a claim with OP1. Thereafter, the complainant visited the office of Ops many times but they did not settle the claim. Eventually, the complainant received a letter dated 13.04.2018 from the OPs whereby it was mentioned that Kashmir Lal was not covered under the scheme as per their record. As a matter of fact, the repudiation letter dated 13.04.2018 is legally not binding upon the complainant. In the end, it has been requested that the OPs be directed to pay the claim of Rs.7,50,000/- along with interest @ 12% per annum and compensation of Rs.1,00,000/- and litigation expenses of Rs.33,000/-.

2.                The complaint has been resisted by the OPs. In the written statement filed on behalf of the OPs, it has been, inter alia, pleaded that in the case of group insurance, the privity of the contract is between the master policy holder and the insurer. The contract of insurance is entered into between the group policy holder and SBI Life where under the individual members are covered. A master policy containing all terms and conditions of the insurance coverage is issued to master policy holder and all terms and conditions are binding upon the insured members as well. The individual members of the master policy are issued certificate of insurance as evidence of their membership of the group scheme if they fulfill the eligibility criteria and duly pay the premium. It is specifically mentioned in the certificate of insurance that the insurance coverage is subject to terms and conditions of the master policy. The master policy No.83001001610 was issued to GE Country wide consumer Financial Services Limited. Later on, the master policy was taken over by SBI Life to Magma Housing Finance. Thereafter, master policyNo.83001001610 was amended and an endorsement was issued by SBI Life to Magma Housing Finance. According to the OPs, Kashmir Lal died on 01.10.2017. However, as on the date of his death, Kashmir Lal was not covered under the SBI Life-Home Equity Loan insurance scheme. The company has not received any premium under SBI Life Home Equity Loan. Therefore, the claim was rejected as nothing was payable. The decision was communicated to the complainant vide letter dated 13.04.2018. It is further pleaded that the OPs received email communication from Magma Housing finance Ltd. wherein it was confirmed that the deceased Kashmir Lal was not part of GE Sale. Thus, there was no insurance cover of the life of DLA as on the date of his death. The certificate of insurance issued to the deceased states that the holder was insured for a maximum amount of Rs.20,00,000/- under the personal accident cover as per the age band under the credit shield cover and for Rs.7,50,000/- under the personal accident cover subject to the terms and conditions contained in the Master policy issued to GE Countrywide Financial Services Limited. As per clause 4.2, the premium for each coverage shall be payable in advance and shall form part of the EMI payable by a member of GE Countrywide Financial Services Limited.  As per bank statement of the deceased, no insurance premium was debited for SBI Life Insurance from loan account No.HLHE-1334. Thus, the complainant failed to provide any evidence of premium paid by Kashmir Lal for his insurance cover. Moreover, the deceased is stated to have died in accident. However, to prove  the accidental death, it was necessary to provide the copy of FIR, panchnama, ,post mortem report. It is further mandatory to provide an accidental claim by way of an FIR, panchnama, final inquest report and post mortem report. These mandatory documents were also not  submitted. Besides any unnatural death is required to be reported to the police and post mortem was to be conducted. The complainant has not submitted any evidence in support of her statement that the DLA died in an accident. The rest of the averments made in the complaint have been denied as wrong and in the end, a prayer for dismissal of the complaint has been made.

3.                In evidence, the complainant submitted her affidavit as Ex. CA along with documents Ex. C1 to Ex. C13 and closed the evidence.

4                 On the other hand, the counsel for the OPs tendered affidavit Ex. RA of Ms. Neelam Singh, authorized representative of the OPs along with documents Ex. R1 to Ex. R6 and closed the evidence.

5.                We have heard the counsel for the parties and have gone through the record carefully. 

6.                In order to prove her case, the complainant has placed on record death certificate of her late husband Kashmir Lal as Ex. C1 and the insurance certificate Ex. C2 wherein it is mentioned that the holder of the certificate is insured for a maximum amount of up to Rs.20,00,000/- as per age band under credit shield and Rs.7,50,000/- under personal accident coverage subject to terms and conditions contained in the master policy issued to GE Countrywide Financial Services Limited.

7.                By way of this complaint, the complainant has claimed that her husband Kashmir Lal was insured for a um of Rs.7,50,000/-. Kashmir Lal died on 01.10.2017 and after his death, the complainant is entitled to the insured amount of Rs.7,50,000/- being the nominee and wife of the deceased. The complainant has relied upon Ex. C2 which shows that Kashmir Lal was covered under the personal accident scheme to the extent of Rs.7,50,000/-. However, the stand taken by the OPs in the written statement is that Kashmir Lal was not covered under the policy as it is not proved that the complainant paid any insurance premium to the OPs and as per the bank statement of the deceased, no insurance premium was debited in the account of SBI Life Insurance Company Limited. It has also been claimed by the OPs that the complainant has further failed to provide documents that Kashmir Lal died due to accident. In this regard, it is noteworthy that the complainant has placed on record only death certificate Ex. C1 and apart from that no other document has been placed on record to show that the complainant died due to accident. No FIR or any such document has been placed on record to prove the factum of accident resulting into death of deceased Kashmir Lal nor any post mortem report has been placed on record.

8.                Secondly, the complainant has not placed on record any document regarding payment of insurance premium to the OPs. On the contrary, the OPs have placed on record the statement of account Ex. R5 wherein no amount of premium is shown to have been debited in the account of the complainant or credited in the account of the complainant. Thus, it is not proved that the deceased had paid the premium in respect of the policy. It is well settled that the payment of insurance premium is a condition precedent for the initiation of the life cover. Even if the certificate Ex. C2 was issued by the OPs, in the light of the fact that no insurance premium is shown to have been paid, even the certificate Ex. C2 cannot be any help to the complainant. Moreover, by way of the complaint, the complainant has claimed only the personal accident claim but the complainant has failed to prove that Kashmir Lal died in an accident.

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

10.              Due to rush of work and spread of COVID-19, the case could not be decided within statutory period.

 

                             (Jaswinder Singh)                            (K.K. Kareer)

                    Member                                           President

 

Announced in Open Commission.

Dated:04.05.2022.

Gobind Ram.

Resham Kaur Vs SBI Life Insurance Company Ltd.                  CC/18/712

Present:       Sh. R.K. Chand, Advocate for the complainant.

                   Sh. Nipun Gupta, Advocate for the OPs.

                  

                   Arguments heard. Vide separate detailed order of today, the complaint fails and the same is hereby dismissed. However, there shall be no order as to costs. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

 

                             (Jaswinder Singh)                            (K.K. Kareer)

                    Member                                           President

 

Announced in Open Commission.

Dated:04.05.2022.

Gobind Ram.