Haryana

Ambala

CC/35/2021

Neelam - Complainant(s)

Versus

SBI Life Insurance - Opp.Party(s)

S.S. Walia

01 Jun 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	35 of 2021
Date of Institution	:	12.01.2021
Date of decision	:	01.06.2023

 

 Neelam W/O Brijesh Kumar R/o H.No.18 Hari Nagar, Behind B.D. floor Mill, Ambala Cantt.

  ……. Complainant

                                                Versus

1. SBI Life Insurance, (Jaishree Hinduja) F Wing, 8th floor, Seawood grand central, Plot No.R-1, Sector 740 Seawoods,  Nerul,  Navi Mumbai-400706 through its GM.
2. State Bank of India, Sadar Bazar, Ambala Cantt through its Manager.

                                                                                   ….…. Opposite Parties.

Before:        Smt. Neena Sandhu, President.

                             Smt. Ruby Sharma, Member,

          Shri Vinod Kumar Sharma, Member.           

 

Present:       Shri Surjit Singh Walia, Advocate, counsel for the complainant.

                     Shri Udai Singh Chauhan, Advocate, counsel for OP No.1.                      Shri Satinder Garg, Advocate, counsel for OP No.2.

Order:        Smt. Neena Sandhu, President.

1.                Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’) and prayed that OP No.1 be directed to settle the amount of two limits of OP No.2 as per the policy and OP No.2 be directed to refund the amount of Rs.80,000/- alongwith interest and to pay Rs.20,000/- as compensation.

2.             Brief facts of the case are the husband of the complainant namely Brijesh Kumar started limit account with OP No.2 in the year 2004 for Rs.1,00,000/- having account No.10333722752 and also limit of Rs.40,000/- with the account No.10333722763. House was pledged with OP No.2 and sale deed of the house is still with the OP. No. 2. Brijesh Kumar also took the insurance of O.P. No. 1 with regard to said limits for any mishappening with him. Brijesh Kumar was missing since 2006 and there was no whereabouts of Brijesh Kumar till date, which fact was informed to the police. O.P. No. 2 put pressure on the complainant to deposit the limit amounts. She informed OP No.2 about her missing husband but she was forced to deposit an amount of Rs.80,000/- in the Bank account of Brijesh Kumar. After taking the legal opinion, the complainant filed suit for declaration for declaring Brijesh Kumar as dead after 7 year of missing, in the year 2016 which was decided on 14-02-2019 by the Court of Ms. Kiranpreet Kaur Saggu, Civil Judge (Junior Division) Ambala. After receiving the order of the Court the complainant filed claim before the O.P. No. 1 for the insurance taken by Brijesh Kumar under the said limits. However, the OPs raised objection that the date of death mentioned in the death certificate of Brijesh Kumar is 10-02-2016 (which is actually the date of filling the case before the Court) and Registering authority considered the filling date of the case, as date of death and that date of death should be 14-02-2019. However, there is no other objection in the order received by the complainant from OP No.2.  OP No. 2 has raised the frivolous objection which does not affect the status of the claim whereas the insurance cover and death of insured is an admitted fact.  OP No.2 was aware of the insurance policy and later on missing of Brijesh Kumar but still pressurized the complainant to deposit the amount of limit which now the OP No. 2 is required to refund the same. The amount deposited by the complainant after missing of her husband should be refunded by the Bank as per the policy, as the law says that the person is to be presumed to be dead after 7 year from the date of missing. OP No.2 filed the case against Brijesh Kumar in the Court for depositing the amount which was decreed ex parte due to non appearance of the Brijesh Kumar and in the execution; the complainant appeared and submitted an application which was allowed.  OP No.2 demanded the amount of limit which was insured with OP No.1 and OP No.1 is duty bound as per the policy to meet the limit amount of OP No.2 of Brijesh Kumar after the death certificate has been issued after Court orders but to no avail. Hence this complaint.
3.           Upon notice, OP No.1 appeared and filed written version raising preliminary objections to the effect that  this Commission is not having territorial jurisdiction;  there is no cause of action; the complainant is disputing the terms and conditions of the insurance cover granted in September 2004 on the life of her husband-Mr. Brijesh Kumar but Mr. Brijesh Kumar had never complained about the terms and conditions of the Insurance cover which means he had agreed to the same and as such,  this complaint is barred by limitation; the complaint is not maintainable etc. On merits, it has been stated that O.P.No.1 has issued one Master policy vide no. 83001000203 in favour of State Bank of India which covered the new or existing loan account holders.  In the insurance documents, it was clearly written that "I am availing a housing loan of Rs.15,00, 000/- from your branch" Further it was declared that"I opt to join for the Scheme for life insurance cover for the duration of the housing loan as per the EMI schedule agreed and I agree to abide by the terms and conditions of the Scheme". It was also clearly stated that the outstanding loan amount is Rs.15,00,000/- and the remaining duration of the loan is 10 years. The Sum Assured is of diminishing nature in the sense that the risk cover tapers down with the EMIs paid. Hence, at any point of time during the term of the policy, the Sum Assured will be the outstanding loan amount as on the date of death as per the Original EMI Schedule. In the Annexure- X submitted by the Master policy holder, it is clearly written that Loan term is 10 years and the premium was paid vide DD no. 1015084102 dated 17.09.2004 of Rs.1911 and DD No. 084708 dated 28.09.2004 dated 28.09.2004 for Rs. 137/-. Sh. Brijesh was not covered under the Home loan group Insurance as on the date of his death, as per the order of the Hon'ble Civil Court. The liability of the insurer arises only when any event happened to the insured, during the term of the insurance cover. If the death happens after the term of the insurance cover, there is no liability on the part of the Insurer to settle the claim. O.P.no.1 do not cover any excess amount or extra term due to default in EMIS or change in the rate of interest. Hence nothing is payable under the policy as the court order declaring the DLA as dead, is after the date of end of the insurance cover. As per Schedule IV, Point no. 8, No benefit is payable under the Scheme to any surviving members after the expiry of the loan period as per the agreed Original EMI repayment Schedule. Under Section 64VB of the Insurance Act, no insurer shall assume any risk in India in respect of any insurance business unless and until the premium payable is received by him in advance or is guaranteed to be paid to the insurer in the manner prescribed by the rules framed under the Insurance Act. The liability of the insurer arises only when the insurance cover is active.  To claim the death claim insurance benefit, the claimant is required to prove the death of the insured member. In this case, as stated above, as the DLA is alleged to have been missing, the complainant filed a suit on 10.02.2016 for declaring the DLA as dead. The Hon'ble Civil Court Ambala presumed the civil death of the DLA vide order dated 14.02.2019 whereas insurance cover ended on 28.09.2014, hence, as on the date of death, the insurance cover was not in existence, as such, nothing is payable as per the terms and conditions of the policy. Rest of the averments of the complainants were denied by the OPs and prayed for dismissal of the present complaint with exemplary costs.
4.           Upon notice, OP No.2 appeared and filed written version raising preliminary objections to the effect that the matter involved in the complaint is a complicated one which requires recording of voluminous evidence and decision on intricate questions of law and facts, which are beyond the purview of this Commission; the complaint is not maintainable as it is vexatious and misconceived; the present complaint is baseless and a flagrant abuse of the process of law to harass and extract money from the OPs; the complaint has been filed with an ulterior motive to injure the reputation of OP No.2; the complainant has concealed material facts from this Commission; this complaint is not maintainable; the complaint is hopelessly time barred etc. On merits, it has been stated that Sh. Brijesh Kumar started a limit of Rs.1,00,000/- and Rs. 40,000/- with the OP No.2, in the year 2004 and also deposited the sale deed of his house as collateral security. Sh. Brijesh Kumar has also availed Insurance from the OP No. 1 with regard to the said limits. Sh. Brijesh Kumar is missing since 2006 and thereafter, the complainant got a decree of declaration for declaring Sh. Brijesh Kumar as dead vide judgment and decree dated 14-02-2019 passed by the Hon'ble Court of Ms. Kiranpreet Kaur Saggu, the then CJ (JD), Ambala vide which the date of death of Sh. Brijesh Kumar  has been declared as 10-02-2016. The tenure of policy has ended in the year 2014. The date of death declared by the court and as per the death certificate issued by the concerned authority is 10-02-2016. Therefore, the OP's are not liable to set off the claim of the complainant. The complainant is liable to pay all the outstanding of Sh. Brijesh Kumar being his legal heir. The above said loan accounts of Sh. Brijesh Kumar were declared as NPA and thereafter a recovery suit was filed against him and guarantor namely Ms. Sushma in the year 2008. The said civil suit was decreed vide judgment and decree dated 03-08-2012 passed by the Hon'ble Court of Ms. Shikha Yadav, the then CJ (JD), Ambala. Thereafter, the bank filed execution petition of the said decree dated 03-08-2012 which was adjourned sine die vide order dated 13-07-2016 passed by the Hon'ble court of Sh. Harsh Kumar, the then CJ (JD), Ambala. Moreover the payment by the insurance company is a discretion which is to be exercised by the OP no.1 and not within the competence of OP no.2. The OPs No.1 & 2 are totally different and distinct entities with no control over each other. The tenure of policy has ended in the year 2014. Rest of the averments of the complainants were denied by OP No.2 and prayed for dismissal of the present complaint with exemplary costs.
5.           Learned counsel for the complainant tendered affidavit of complainant, as Annexure CA alongwith documents as Annexure C-1 to C-12 and closed the evidence on behalf of complainant. On the other hand, learned counsel for OP No.1 tendered affidavit of Manjeet Singh son of Lt. Surjeet Singh having office SBI Life Insurance Company Limited, 1^st Floor, Triloki Chamber, Above Canara Bank, Opp. Municipal Corpn, Building, Ambala Cantt. as Annexure RX  alongwith documents as Annexure OP-1/1 to OP-1/7 and closed the evidence on behalf of the OP No.1. Learned counsel for OP No.2 tendered affidavit of Pawan Kumar Goel, Deputy Manager of OP No.2-State Bank of India, Sadar Bazar, Ambala Cantt. as Annexure OP-2/A closed the evidence on behalf of OP No.2.
6.           We have heard the learned counsel for the parties and have also carefully gone through the case file.
7.           Learned counsel for the complainant submitted that by not paying the claim amount, under the insurance policy in question, despite the fact that the husband of the complainant was found missing since 2006 i.e. during the currency of the said insurance policy and has finally been declared dead by the Civil Court, as such, the OPs are deficient in providing service.
8.           On the other hand, Counsels for OPs No.1 and 2, while reiterating their objections, submitted that since as per the Civil Court order, the date of death of the insured is 10.02.2016, whereas, the insurance policy stood expired in the year 2014, as such, the complainant is not entitled to any benefit out of the said insurance policy and on the other hand is liable to clear all the dues of Brijesh Kumar against the limits aforesaid, being his legal heir.
9.           First coming to the question as to whether this complaint is time barred, it may be stated here that because admittedly the claim of the complainant was rejected for the first time by the OPs vide email dated 24.09.2020, Annexure C-1,  as such, this complaint having been filed on 12.01.2021 is well within limitation.
10.           As far as objection taken by the OPs regarding territorial jurisdiction is concerned, it may be stated here that because the complainant is resident of Ambala, as is evident from the Headnote of this complaint, therefore this Commission has territorial jurisdiction to decide this complaint in view of Section 34 (d) of the Consumer Protection Act, 2019.
11.           Now coming to the merits of this case,  the moot question which falls for consideration is, as to whether, the complainant is entitled to get any relief, under the policy in question, which had been purchased by her husband and declared dead by the Civil Court on 10.02.2016 or not. It may be stated here that admittedly, the policy in question, under home loan group, had been obtained by the husband of the complainant on 20.09.2004 for a period of ten years i.e. till 28.09.2014. It is also an admitted fact that though the insured/husband of the complainant went missing since 2006, yet, when the complainant filed suit no.RBT-CS-29 before the Civil Court, Ambala, for declaring Sh.Brijesh as dead, vide order dated 14.02.2019, Annexure G,  the civil death date of Sh.Brijesh has been presumed by the said Court as 10.02.2016.  It is very significant to mention here that this Commission has no discretion/power to presume the date of death of the insured-Brijesh and this power was vested only with the Civil Court, as has been done in the present case also. When we go through the terms and conditions of the insurance policy, Annexure C-4, it has been clearly mentioned against the clauses 4 and 5 that the insurance cover is  available to the housing loan borrower from the date of enrollment and will be current during the tenure of the loan and that in  the event of death of the insured housing loan borrower due to any cause, the sum assured will become payable to the Group Administrator, which will be equivalent to the outstanding loan amount including interest as per the original EMI schedule.
12.           In the present case, as stated above, the insurance policy against the loan in question was for a tenure of 10 years i.e. till 28.09.2014 meaning thereby that claim  was payable to the beneficiaries of the insured after his death,  during the currency of the policy only i.e. till 28.09.2014. However, in the present case, though the insured was found missing in the year 2006, yet, his civil date of death has been declared as 10.02.2016 by the Learned Civil Court, as referred to above, i.e. after about more than 1½ years, from the date of expiry of the said insurance policy.   It may be stated here that the insurance policy between the insurer and the insured represents a contract between the parties and the insured cannot claim anything more than what is covered by the insurance policy. Our this view is supported by the ratio of law laid down by the Hon’ble Supreme Court of India in Oriental Insurance Co. Ltd Vs Sony Cherian (II 1999 CPJ 13 SC) wherein it was held that- ― “..The insurance policy between the insurer and the insured represents a contract between the parties. Since the insurer undertakes to compensate the loss suffered by the insured on account of risks covered by the insurance policy, the terms of the agreement have to be strictly construed to determine the extent of liability of the insurer. The insured cannot claim anything more than what is covered by the insurance policy. That being so, the insured has also to act strictly in accordance with the statutory limitations or terms of the policy expressly set out therein…”. Under these circumstances, the OP No.1 cannot be said to be wrong in refusing to pay the claim amount to the complainant.
13.           In view of peculiar facts and circumstances of this case, it is held that because the complainant has failed to prove her case, therefore, no relief can be given to her. Resultantly, this complaint stands dismissed with no order as to cost. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

Announced:- 01.06.2023.

 

(Vinod Kumar Sharma)	(Ruby Sharma)	(Neena Sandhu)
Member	Member	President