Haryana

Fatehabad

CC/233/2019

Amit Garhwal - Complainant(s)

Versus

SBI Life Insurance - Opp.Party(s)

Pardeep Baniwal

28 Nov 2023

ORDER

BEFORE THE  DISTRICT CONSUMER DISPTUES REDRESSAL COMMISSION, FATEHABAD.

Complaint No.233 of 2019.

Date of instt.11.06.2019. 

                                                          Date of Decision: 28.11.2023.

 

Amit Garhwal son of Shri Bharat Singh son of Shri Amar Singh resident of village Daulatpur Post Office Hijrawan Kalan Tehsil & District Fatehabad.

 

                                                                             ..Complainant.

                                      Versus

 

1. Branch Sales Manager, SBI Life Insurance Company, First Floor, Malhotra Bhawan, Hisar Road, Fatehabad Tehsil & District Fatehabad.
2. SBI Life Insurance Company Limited, Registered & Corporate Office: Natraj, M.V.Road & Western Express Highway Junction, Andheri (East), Mumbai 400069, through its Chairman-cum-Managing Director.
3. SBI Bank of India, Branch Fatehabad District Fatehabad through its Manager.

..Opposite parties.

     

      Complaint under Section 12 of Consumer Protection Act, 1986.          

 

Before              Sh.Rajbir Singh, President.

                        Smt.Harisha Mehta, Member.

     Dr.K.S.Nirania, Member.

Present :          Sh.Pardeep Beniwal, Advocate for complainant.

                       Sh.Rohtash Bishnoi, Advocate for Ops No.1 & 2.            Sh.Sanjeev Mehta, Advocate for Op No.3.      

 

ORDER

SH.RAJBIR SINGH, PRESIDENT

 

                         The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant against the Opposite Parties with the averments that he had purchased an insurance policy bearing No.53684481910 dated 08.06.2017 for a sum assured of Rs.15 lac, insuring the life of his father Bharat Singh, from Ops No.1 & 2 on the recommendation of Op No.3 by making the premium thereof; that the life assured was also medico legally checked up by the authorized doctor before obtaining the policy in question; that life assured (Bharat Singh) expired on 30.05.2018 and regarding this the complainant intimated the Ops besides submitting all the requisite documents with them; that instead of making the claim amount, the Ops repudiated  the claim of the complainant wrongly and illegally.  The repudiation of insurance claim of the complainant by the OPs amounts to deficiency in rendering service to the OPs.  Hence, this complaint.

2.                          On being served, OPs appeared through counsel and resisted the complaint by filing their separate written statements. Ops No.1 & 2 in their joint written statement have submitted that the life assured had committed breach of principle of utmost good faith by suppression and material fact that he was chronic alcoholic and was suffering from chronic liver disease prior to the date of signing of proposal form and he intentionally did not disclose this fact before obtaining the policy in question; that in the proposal form the life assured answered negatively to all the questions in the medical questionnaire. The relevant questions are as under:

13.              (iv) During the last 10 years, have you undergone or advised to undergo hospitalization or any operation or any investigation or tests or medical treatment:

                   (xv)Are you suffering from or did you suffer or undergo investigation in the past from or have you been advised to undergo investigation or treatment for Liver disease (Jaundice/Hepatitis etc.)

                   (xviii)Do you consumer or have ever consumed alcohol in any form or have you suffered from complications due to alcohol consumption.

 

that the available records prove that the  DLA was chronic alcoholic and was suffering from chronic liver disease. It is further submitted that the repudiation of the insurance claim of the complainant by the OPs is perfectly in accordance with the terms and conditions of the insurance policy and the same is sustainable in the eyes of law.  The OPs No.1 & 2 have further prayed for dismissal of the present complaint being devoid of merits.

3.                          OP No.3 in its separate reply has taken preliminary objections such as cause of action, locus standi, concealment of material facts and maintainability etc. It has been further submitted that an amount of Rs.1,50,000/- was debited from the account of the father of the complainant on 12.05.2017 and the same was transferred to the account of SBI Life Insurance as an installment against the insurance SBI Life Smart Elite Scheme Policy and thereafter, the complainant has ever approached to the replying OP after the death of Bharat Singh. The complainant is not the consumer of the replying Op. Other contentions have been controverted and prayer for dismissal of the complaint.

4.                          The learned counsel for the complainant tendered in evidence affidavit of the complainant as Annexure C1 along-with documents Annexure C2 to Annexure C11.  On the other hand, the learned counsel for the OPs tendered in evidence affidavits Annexure RW1/A, Annexure RH alongwith documents Annexure RA to Annexure RG.

5.                          In the present matter the insurance company has repudiated the claim of the complainant on the ground that the DLA had concealed the material and vital information about his health and did not disclose each and every aspect qua his health position in the proposal form before obtaining the policy in question. Before proceeding further, let us  have a look on the role of proposal form, the definition is a under:

When applying for insurance, a proposer has to fill out the proposal form of the life insurance company. The Insurance Proposal is an important document which provides the details of the proposer and the life assured and which is used as a basis to ascertain the insurability of an individual. The proposal form helps insurers evaluate the potential risks and determine the premium amount accordingly.

 

As per Ops No.1 & 2 the DLA had concealed the fact about chronic liver disease (Annexure C2) from them before inception of the policy in question as he has replied the relevant questions, which are as under, in negative:

13.              (iv) During the last 10 years, have you undergone or advised to undergo hospitalization or any operation or any investigation or tests or medical treatment NO:

                   (v) During last 5 years, whether you were under any medical treatment or regular monitoring for more than 14 consecutive days?

                   (xv)Are you suffering from or did you suffer

Are you suffering from or did you suffer or undergo investigation in the past from or have you been advised to undergo investigation or treatment for Digestive disorder (Ulcer, Gastric Bleeding etc.). NO

 

The fact regarding purchasing of policy (Annexure C3) as well as death of DLA on 30.05.2018 (Annexure C11) during the subsistence of the policy is not disputed.  The Ops No.1 & 2 in order to prove the repudiation in order has placed on record Death summary of the DLA (Annexure RE). Perusal of this document reveals that the reason for admission in the OP Jindal Institute of Cancer & Cardic Research Hospital is A/H/O of Sudden Loss of consciousness on 14.05.2018 at 2 P.M. with K/C/O Chronic Alcoholic Liver Disease.  If we read this death summary together with the proposal form Annexure RA wherein DLA has replied the medical and other details about his health in Column No.13 as negative, one thing becomes crystal clear that before obtaining the policy in question the fact which were disclosed before the treating doctor on 14.05.2018 qua K/C/O Chronic Alcoholic Liver Disease were concealed intentionally because in Annexure RC, issued by the same hospital i.e. NCJIM, Hospital, Hisar it has been clearly mentioned that the patient was known case of Liver Cirrhosis for the last past two years with bleeding (2016) and EVL (Endoscopic variceal ligation) was done. The fact regarding the health condition of the DLA was very much in the knowledge of the complainant as well as in the knowledge of DLA. Moreso, the complainant has not placed any record/document to counter the pleadings put-forth by the Ops No.1 & 2. It is worthwhile to mention here that the preamble of Consumer Protection Act is benevolent in nature but it does not give liberty to misuse the same by concealing the relevant information from the service provider, which has happened in the case in hand.  Therefore, we are of the considered opinion that the DLA had concealed the material fact regarding his state of health and the previous disease intentionally for obtaining the insurance policy. It is a well settled principle of law that the contract of insurance is a contract of aberrima fides and there must be complete good faith on the part of the assured and thus the assured is under a solemn obligation to make full disclosure of material fact, which may be relevant for the insurer to take into account while deciding whether the proposal should be accepted or not. The declaration in the proposal form and the statement given by the life assured were the basis of contract of mutual trust between the insurer and the assured and any false statement given with respect to state of health or disclosing the false information would make the contract vitiate as has been done in the present  case. Reliance is placed on the case law titled Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. reported in IV(2009)8 SCC Page 316 and P.C.Chacko and anr. Vs. Chairman L.I.C. India 2008 (1) SCC 321.

6.                          On the basis of above mentioned discussion, we are of the considered opinion that there was no deficiency in service at all or any unfair trade practice, on the part of any of the Ops, as alleged, so as to make any of them liable to any extent in this matter. Hence, the complaint is dismissed in view of the facts and circumstances stated above.  All the parties are left to bear their own costs. A copy of this order be supplied to both the parties free of cost as per rules.  This order be uploaded, forthwith, on the website of this Commission as per rules for the perusal of the parties. File be consigned to record room, as per rules, after due compliance.

Announced in open Commission.                                                            Dated: 28.11.2023

 

 

                                                                                                        

(K.S.Nirania)                       (Harisha Mehta)                (Rajbir Singh)                         Member                                     Member                                     President