Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 471.
Instituted on : 26.09.2018.
Decided on : 29.08.2019.
Surinder son of Kabir Singh, resident of 1173/4, Mahabir Colony, Gohana Road, Rohtak-124001.
……….Complainant.
Vs.
S.B.I. Life Insurance Company Limited, 944/28, Ist Floor, Bharat colony, Delhi Bye pass, Rohtak(Haryana) through its Manager/Principal officer.
……….Opposite party.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
SH. VED PAL, MEMBER.
DR. RENU CHAUDHARY, MEMBER.
Present: Sh.Pankaj Sharma, Advocate for the complainant.
Sh. Gulshan Chawla, Advocate for opposite party.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that the complainant had availed one life insurance policy bearing no.35087061910 which was issued by SBI Life Insurance Co. with the date of commencement as 31.03.2015. That opposite party after fully satisfied with the information and health status given in the proposal form and panel doctor of opposite party also duly provided certificate regarding fitness of complainant and complainant was found fit person having no disease and issued the said policy to the complainant. That the sum insured under the policy was Rs.400000/- alongwith all other accrued benefits. That complainant deposited three installments of Rs.36920/- each. But now after a lapse of more than 3 years, opposite party has issued letter dated 03.03.2018 mentioning therein that they had cancelled the aforesaid policy and forfeited the amount of Rs.110760/-. That complainant contacted the opposite party and requested either to withdraw the said letter and to continue the said policy or to return the amount of Rs.110760/-, as he is ready to surrender the policy. But opposite party refused to accede the request of complainant. Complainant served a legal notice dated 27.08.2018 to the opposite party, which was not replied by the opposite party. That the act of opposite party is illegal and there is deficiency in service on the part of opposite party. As such, it is prayed that opposite party may kindly be directed to pay amount Rs. 110760/- alongwith interest thereon @ 18% per annum and Rs.50,000/- as harassment and Rs.11,000/- as litigation expenses to the complainant as explained in relief clause.
2. After registration of complaint, notice was issued to the opposite party. Opposite party in its reply has submitted that the Mr. Surinder had applied for SBI Life policy on dated 29.03.2015 and on the basis of information furnished in the proposal form, the policy was issued for a basic sum assured of Rs.400000/- and equivalent sum assured under accidental death benefit and Accidental Total & Permanent disability benefit rider. The proposal was accepted without conducting any medical examination because the Life assured did not disclose any adverse personal history at the time of proposal as well as at the time of revival. In the present case, the complainant did not pay the renewal premiums due on 31.03.2016 within grace period and hence the policy was lapsed. Subsequently, in May 2017 the complainant revived the policy by paying arrears of premiums and submitted the declaration of good health dated 09.05.2017. Based on the declaration of good health, the OP has revived the policy. That revival of a policy is akin to a de novo contract. That as per amended Insurance Act 2015, under section 45(1) it is stated that “No policy of the life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of the policy i.e. from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later”. That in the instant case, the date of commencement of policy is 31.03.2015 and policy was revived on 10.05.2017 and the policy has been cancelled vide a letter dated 03.03.2018 i.e. within three years from the date of commencement of policy and date of revival. Further, the documentary evidence produced on records amply proves that the complainant was suffering from brain tumor since 2014 and had also taken treatment for tuberculosis for 1 and ½ year as per medical record dated 02.06.2017 and the said facts were not disclosed by the complainant in the proposal form dated 29.03.2015 as well as at the time of revival of the policy on dated 09.05.2017. That complainant is making false allegations of harassment, deficiency in service on the part of opposite party. That the reply to the legal notice was also sent through speed post which was delivered to the complainant on 03.10.2018. All the other contents of the complaint were stated to be wrong and denied and dismissal of complaint has been sought.
3. Ld. counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C8 and has closed his evidence on dated 30.05.2019. Ld. counsel for the opposite party has tendered affidavit Ex.RW1/A and documents Ex.RA to Ex.RJ and closed his evidence on 16.08.2019.
4. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
5. In the present complaint, the contention of the opposite party is that the proposal form of the complainant/life assured was accepted in utmost good faith and accordingly the policy was issued. The first premium paid by the complainant on 29.03.2015. Second premium was not paid by the complainant and the complainant paid collectively two installments for the year 2016 and 2017 on dated 09.05.2017. It has not been disclosed in the written statement that who disclosed before the respondent insurance company that complainant is having tuberculosis and brain tumor at the time of purchase of the insurance policy. As per the report placed on record by the respondent the complainant was operated for brain tumor in the year 2014. In our opinion, the insurance company should investigate the matter prior to receiving the collective 2nd and 3rd installments and they should refuse to accept the premium amount on the ground that the complainant had not disclosed the true and correct facts about his health at the time of filling up of proposal form. It is the prime duty of the opposite party to conduct the medical examination of the life insured after receiving the first premium, when the complainant himself declared his health as good. But the same was not done at that time. The insurance company not written any letter to the complainant that the declaration made by the complainant regarding his health is false and fabricated. This information should have been sent by the insurance company to the complainant, when they receive the investigation report on 24.01.2018 but the same was only informed vide letter dated 03.03.2018 placed on record as Ex.RI
6. In view of the facts and circumstances of the case, it is observed that there is deficiency in service on the part of opposite party and the opposite party is liable to refund the amount of premium deposited by the complainant with the opposite party till date. As such, complaint is allowed and we hereby direct the opposite party to refund the amount of premium i.e. Rs.110760/-(Rupees one lac ten thousand seven hundred sixty only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 26.09.2018 till its realization and Rs.5000/-(Rupees five thousand only) on account of deficiency in service and litigation expenses to the complainant within one month from the date of decision.
7. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
28.08.2019.
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Nagender Singh Kadian, President
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Ved Pal Hooda, Member.
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Renu Chaudhary, Member.
