Orissa

Sambalpur

CC/1/2017

Puspanjali Sarangi - Complainant(s)

Versus

SBI Life Insurance Company Limited. - Opp.Party(s)

Sri D.K. Thakur

23 Aug 2022

ORDER

PRESIDENT, DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SAMBALPUR

Consumer Case No- 1/2017

Present-Dr. Ramakanta Satapathy, President,

  Sri. Sadananda Tripathy, Member,

Puspanjali Sarangi,

W/O- Late Pramod Kumar Sarangi,

R/O-Qtr. No. D-2, Sambalpur University Campus,

Po-Jyoti Vihar, Ps-Burla,

Dist-Sambalpur, Odisha.                  .                                     ………..…..Complainant

Vrs.

1. SBI Life Insurance Company Limited,

Sambalpur Branch Office-2^nd Floor,

Siba Complex, Opp. SBI Budharaja Branch,

PO-Budharaja, Ps-Ainthapali,

•  

2. SBI Life Insurance Company Limited,

Registered Office- ‘Natraj’, M.V. Road & Western Express Highway Junction, Andheri(East), Mumbai-400069.

3. Branch Manager, State Bank of India,

Jyoti Vihar, Po-Jyoti Vihar, Burla,

Ps-Burla, Dist-Sambalpur.. ………..Opp. Parties

Counsels:-

1. For the Complainant                   :-Sri. D.K.Thakur, Advocate & Associates
2. For the O.P.No.1 & 2                   :- Sri. N.C. Behera & Associates
3. For the O.P. No.3                                    :-None

 

DATE OF HEARING :05.07.2022, DATE OF JUDGEMENT : 23.08.2022

           Presented by Dr. Ramakanta Satapathy, PRESIDENT,

1. The case of the Complainant is that she is the nominee in SBI Rin Rakhshya Home Loan Scheme, secured by her husband Pramod Kumar Sarangi, availed a personal loan of Rs. 3,75,000/- from O.P. No.3 having loan A/C No. 33610548868. The O.P. No.3 is the Master Policy holder and insurance covers to its members including borrower, Co-borrower or an a/c holder. For the insurance scheme for the sum assured Rs. 3,75,000/- a single premium was paid for Rs. 10,876/- against Master Policy No. 70000003903, membership form No. 7003250024 and Member ID No. 34896880 in the name of Pramod Kumar Sarangi commencing from 27.01.2014 to 27.01.2019 for 60 months.

Deceased Pramod Kumar Sarangi was making the monthly loan repayment as per the schedule and died on 29.08.2015 during treatment in AMRI Hospital Bhubaneswar. The Complainant being the wife and nominee applied for death claim through O.P. No.3 but the O.Ps repudiated the claim through their letter dated 15.03.2016 and 24.05.2016 with plea that the life assured had given false statement with regard to his health at the time of entry in to insurance scheme. The O.Ps alleged that the L.A. was suffering from ‘diabetes mellitus’ and signed the ‘Declaration of Good Health.’

The L.A. was admitted in AMRI Hospital on 24.08.2015 and died under treatment on 29.08.2015. The Medical certificate discloses the cause of death as “SEPSIS WITH MODS as consequence of G.I.Bleed.”

2. The case of the O.P. No.1 & 2 is that the present Forum/Commission has no territorial jurisdiction. The Deceased life Assured (D.L.A.) Pramod Kumar Sarangi committed breach of Principle of ‘Utmost Good faith’ suppressing material facts i.e. the suffering of Diabetes mellitus prior to the date of submission of proposal form. There is no deficiency on the part of the O.Ps. On the date of death i.e. on 29.08.2015 the sum Assured is Rs. 2,88,329/-. The O.Ps have rightly repudiated the claim.
3. Perused the documents filed by the Complainant and the O.Ps. The following issues are framed.
103606587.  

1. Whether this Forum/Commission has territorial jurisdiction to entertain the complaint?
2. Whether the repudiation of the claim by the O.P. No.1 & 2 is proper and justified?
3. What relief the Complainant is entitled to get?

Issue No.1 Whether this Forum/Commission has territorial jurisdiction to entertain the complaint?

          In the present case the master policy holder is the SBI Jyoti Vihar Burla, the sourcing Bank from whom the premium has been remitted for Rs. 10,876/- throughout the country. As per the O.P. No.1 &2 accepted the premium from Burla and also Branch offices in the district of Sambalpur, this Forum/Commission has territorial jurisdiction to entertain the complaint.

          The issue is answered accordingly.

Issue No.2 Whether the repudiation of the claim by the O.P. No1 & 2 is proper and justified?

          The O.P. No.1 & 2 submitted that the DLA has suppressed material facts, not given correct information, deposited the premium of Rs. 10,876/- and with utmost good faith the O.P. No.1 & 2 accepted the proposal. After the death of life assured conducted investigation through Total Transparency Investigation Pvt. Ltd., collected the related documents regarding the cause of death of deceased and came to a conclusion that Pramod Kumar Sarangi was suffering Diabetics Millitus prior to the date of commencement of policy. Refunded Rs. 9679/- vide cheque No. 995733 dated 11.03.2016 to-wards refund of policy premium, repudiated the claim. The review committee of the O.Ps also confirmed the repudiation.

          Insurance business is a contract between the insurer and insured. The O.Ps submitted their statement keeping in view one side of the coin. The other side of the coin is that before receiving premium and granting the policy bond it was the duty of the O.Ps to examine the policy proposal statement made by the life assured, the investigation made should have been conducted before accepting the proposal. In the instant case the O.Ps failed to perform their part of duty to ascertain the facts.

           To get business not only the banking organizations but also insurance companies take the signatures of the insured, receive the premiums and with procedural complexies linger a claim and ultimately repudiate it. It takes time to the beneficiary to get the relief. This fact is also within the knowledge of the banking and insurance companies.

          As the O.Ps accepted the premium, issued the bond, not performed their part of contract properly, the procedure adopted by the O.Ps for repudiation of the claim is not proper and justified. Accordingly the letter of repudiation dated 24.05.2016 and 15.03.2016 are set aside.

          The O.P. No.1 & 2 are deficient in their service, not properly appreciated the case of death of the deceased i.e. “SEPSIS WITH MODS as a consequence of G.I. Bleed”.

          The issue is answered in favour of the Complainant

Issue No.3 What relief the Complainant is entitled to get?

          The Complainant is the wife and nominee of the deceased Pramod Kumar Sarangi. The benefit of the policy should go to the dependants of the D.L.A. Accordingly, it is ordered:

ORDER

The Complaint is allowed on contest against O.P. No.1 & 2 and ex-parte against O.P. no.3, the master policy holder. The O.P. No.1 & 2 are directed to pay Rs. 2,88,329/- along with interest @7% P.A. w.e. from the date repudiation of the claim, within one month. Failing which the amount will carry 12% interest P.A. till realisation.

          The O.P. No.1 & 2 are further directed to pay compensation of Rs. 1.00lakh and litigation expenses of Rs. 8,000/- within one month, failing which the amount will carry 12% P.A. till realisation from the date of order.

          The O.P. No.3 is directed not to take nay coercive step, against the heirs of deceased Pramod Kumar Sarangi till the closure of the dispute.

Order pronounced in open court on this 23^rd day of August 2022.

          Supply free copies to the parties.