Haryana

Fatehabad

CC/162/2018

Birmati Devi - Complainant(s)

Versus

SBI Life Insurance - Opp.Party(s)

Jitender Thakar

16 Mar 2021

ORDER

BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL COMMISSION, FATEHABAD.

Complaint no. 162/2018.                               Date of Instt. 29.05.2018                         Date of Decision:16.03.2021.

Smt. Birmati wife of Bhoop Singh, resident of village Jandwala Bagar, Sub Tehsil Bhattu Kalan, Tehsil and District Fatehabad.

                                                                             ..Complainant.

                                          Versus

1. SBI General Insurance Company Limited, Natraj, 101, 201 & 301, Junction of Western Express Highway and Andhri-Kurla Road, Andheri (East), Mumbai through its Chairman-cum-Managing Director/Managing Director.
2. State Bank of India, Bhattu Kalan, Branch Tehsil and District Fatehabad through its Branch Manager.

                                                                     ..Respondent/OPs.      

              Complaint under Section 12 of Consumer Protection Act, 1986.

 

Before:             Sh. Raghbir Singh, President.                                                                              Smt.Sukhdeep Kaur, Member.

 

Argued by:  Sh. Jitender Thakkar, Advocate for complainant.                              

Sh. UK Gera, Advocate for OP no. 1.

                    Sh. Sanjeev Mehta, Advocate for OP no. 2.

 

ORDER:-

          The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant against the OPs with the averments that son of the complainant Satish Kumar was having a saving bank account bearing no.32711032846 with OP no. 2 and he was insured with OP no. 1 for a sum of    Rs.2 lakh vide insurance policy bearing no.143820-0000-01 valid from 9.12.2016 to 8.12.2017 and the complainant has been appointed as nominee.

2.                It is further submitted that the life assured Satish Kumar died in a train accident on 23.5.2017 and after his death the complainant being nominee of the life assured submitted insurance claim with the OPs and also submitted all the requisite documents for settlement of the insurance claim.  However, the OPs instead of settling the insurance claim vide letter dated 22.3.2028 repudiated the claim of the complainant on the ground that the life assured was suffering from psychiatric, illness which led to his death.  It is further submitted that the life assured was not suffering from any disease and as such the repudiation of genuine insurance claim of the complainant by the Ops is illegal and against facts.   The act and conduct of the Ops clearly amounts to deficiency in service on their part.  Hence, the present complaint. In evidence, the complainant has tendered affidavit Annexure C1 and documents Annexure C2 to Annexure C8.

3.                 On being served, OPs appeared and filed their separate replies. OP No.1 in its reply has submitted that the present complaint has been filed just to harass the answering OP as there is no deficiency in service on its part. It is further submitted that the act of the answering Op in closing the claim file of the insured as No Claim is legal and justified and based upon the terms and conditions of the insurance policy. It has been further submitted that the complainant has no cause of action to file the present complaint as the complainant does not fall within the ambit of consumer and further the present complaint has been filed just concealing the material facts from this Commission.  It has been further submitted that from the perusal of claim documents and as per statement recorded during police investigation and the investigation conducted by answering OP the life assured was suffering from psychiatric illness which was led to his death.  It is further submitted that as per terms and conditions of the insurance policy death on account of suicide or self inflected injury or illness or mental or nervous disorder etc. is not covered under the policy.  Therefore, the answering OP is not liable to make payment to the complainant regarding the present claim.  Other contents of the complaint have been controverted and prayer for dismissal of the complaint has been made.

4.                          OP no. 2 in its reply has resisted various preliminary objections with regard to cause of action, locus standi, maintainability and suppression of true and correct facts etc. It has been  submitted that saving bank account in question was maintained by the Satish Kumar with OP no. 2 and an amount of Rs. 100/- was deducted from the account of the complainant on account of insurance which was done on his request.  It is further submitted that the answering OP is not aware  about the death of the life assured Satish Kumar and the answering OP has not been apprised regarding the occurrence by the complainant and no copy of post mortem has been submitted by the complainant regarding death of the life assured.  It is also submitted that the copy of FIR regarding the occurrence has also not been submitted with the answering OP.  There is no deficiency in service on the part of answering Op. Lastly, prayer for dismissal of the complaint has been made.  In evidence, the OP no. 1 has tendered in evidence affidavit of Jitendra Dhabhai Authorized Signatory on behalf of OP no. 1 as Annexure R-1 and documents Annexure R-2 to Annexure R-6.  OP no. 2 Sh. Vikas Kumar Jangra, Deputy Manager tendered in evidence his affidavit as Annexure RW1/A on behalf of the OP no. 2 besides document Annexure R-1.

5.                          We have heard learned counsel for the parties and have gone through the material available on the record.

6.                          Undisputedly, the life assured was having bank account with the Op No.2 and was insured with Op no.1 for a sum of Rs.2 lakh under policy Number 143820000001 having validity from 09.12.2016 to 08.12.2017 as is evident through Annexure C5. It is also not disputed that the life assured died on 23.05.2017 during the subsistence of the policy.

7.                          The insurance claim in the present case has been repudiated by the insurance company on the ground that the life assured was suffering from psychiatric illness and as such he has committed suicide and the death on account of suicide is not covered under the policy. In support of the above said contentions, the insurance company has relied upon the police investigations placed on the case file.  However, from perusal of the inquest report and other documents of police investigations placed on file, it is revealed that the police in its investigation has nowhere given the findings or observation that the life assured has committed suicide. Whereas from the perusal of inquest report and other document of investigation, it is revealed that it is a case of railway crossing accident. The insurance company has also failed to place on case file any medical record/medical history of the deceased life assured that he was patient of psychiatric problem.  The insurance company has miserably failed to prove on the case file that the life assured has committed suicide, therefore, the complaint deserves acceptance against OP No.1 only. The complaint against Op No.2 is hereby dismissed.

8.                Thus, as a sequel to our above discussion, we allow the present complaint and the repudiation of the claim of the complainant is set aside and the opposite party No.1 is directed to make payment of claim/insured amount of Rs.2,00,000/- to the complainant alongwith interest @ 9% per annum from the date of filing of present complaint till actual realization within a period of one month, failing which the complainant will be at liberty to initiate legal proceedings against the opposite part No.1. A copy of this order be supplied to both the parties free of costs.  File be consigned after due compliance.

Announced in open Commission.                                                                  Dated:16.03.2021

        (Raghbir Singh)                                                                                                                    President                                                    (Sukhdeep Kaur)              District Consumer Dispute                                                 Member                            Redressal Commission, Fatehabad.