Punjab

StateCommission

A/11/1208

Sanjay Kapoor - Complainant(s)

Versus

SBI Life Insurance - Opp.Party(s)

Rakesh Bhatia

13 Jul 2015

ORDER

                                                               FIRST ADDITIONAL BENCH

 

STATE  CONSUMER  DISPUTES  REDRESSAL COMMISSION,  PUNJAB

          SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.

                                     

                   First Appeal No.1208 of 2011

 

                                                          Date of Institution: 10.08.2011                        

                                                          Date of Decision : 13.07.2015

 

 

Sanjay Kapoor S/o Kali Charan Kapoor, R/o H.No.1227/9, Gali No.7, Gali Hatimtal, Opposite Ravi Dass Mandir, I/S Gate, Khazana, Amritsar.                                                                                                                                                                                                                                                                                                                                                                                                   …..Appellant/Complainant

         

                                      Versus

 

1.       S.B.I Life Insurance Company Ltd., Central Processing Centre, 2nd     Floor, Kapas Bhavan, Plot No.3-A, Sector 10, CBD Belapur, Navi   Mumbai.

2.       SBI Life Insurance Company Ltd., SCO No.28, IIIrd Floor, District        Shopping Complex, Ranjit Avenue, Amritsar through its Branch   Manager.

3.       G.E. Countrywide R.S Towers Hall Bazar, Amritsar through its   Branch Manager.

 

                                                                                                        … Respondents/Opposite Parties

 

First Appeal against order dated 01.07.2011 passed by the District Consumer Disputes Redressal Forum, Amritsar

Quorum:-

 

          Shri J. S. Klar, Presiding Judicial Member.

          Shri. Harcharan Singh Guram, Member

 

Present:-

 

          For the appellant                        : Sh.Rakesh Bhatia, Advocate  

          For the respondent no.1 & 2      : Sh.Rajneesh Malhotra, Advocate

          For the respondent no.3            : Ex-parte.

 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

J.S KLAR, PRESIDING JUDICIAL MEMBER :-

         

          The appellant Sanjay Kapoor of this appeal (the complainant in the complaint) has directed this appeal against the respondents of this appeal (the opposite parties in the complaint), challenging order dated 01.07.2011 of District Consumer Disputes Redressal Forum Amritsar, dismissing the complaint of the complainant. The instant appeal has been preferred against the same by the complainant now appellant in this appeal.

2.      The complainant Sanjay Kapoor has filed  the complaint U/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the OPs on the averments that his mother Mrs. Rani Kapoor was policyholder of SBI Life Plan Swadha, vide insurance policy no. 09001246005 dated 13.09.2004 through their corporate agent GE Countrywide, vide SBI Life Plan Swadha for assured sum of Rs. 5 lac for the period of five years. Last installment was paid by above mother of the complainant on 16.03.2007 and next installment was due on 06.06.2007. This fact came to knoweldge of the complainant after demise of his mother. Mother of the complainant Rani Kapoor, who was assured, fell ill and was admitted at Muni Lal Chopra Hospital Amritsar and remained under the treatment of Dr. J.S. Sidhu. She was suffering from gastro and after the biopsy, the treating doctor diagnosed that she was suffering from Lymphoma (high grade) on 03.06.2007. She was admitted in the hospital for a long period and eventually she died on 4.12.2007. She could not make the payment of next installment, which was due on 06.06.2007 to OPs of the above policy. Due to above-referred reasons, the complainant found insurance papers of his mother and, thus, lodged the insurance claim with the OPs duly supported with documents. The OPs rejected the insurance claim of the complainant pertaining to his mother Rani Kapoor, vide letter dated 17.07.2008 on the ground that policy of the holder stood lapsed due to non-payment of last installment on 6.6.2007. The complainant approached the insurance Ombudsman Chandigarh on 7.1.2009 and it rejected the petition of the complainant on 27.04.2009 by means of non-speaking order. The complainant has, thus, filed the complaint directing the OPs to pay the amount of Rs.5  of the insurance policy along with interest, besides compensation of Rs.1 lac for mental harassment against OPs.

3.      Upon notice, OP No.1 and 2 filed their separate written reply and contested the complaint of the complainant by raising preliminary objections that policy of the life assured was in a lapsed condition on the date of death of deceased life assured. The repudiation of the claim is justified and being in order due to lapsed condition of the policy. The insurance Ombudsman Chandigarh, thus, rightly dismissed the complaint of the complainant. It was further pleaded that the policy no. 09001246005  was in lapsed condition with effect from 6.6.2007. The OPs further averred that under Section 51 to 55 of the Indian Contract Act, the promise was reciprocal and complainant filed the complaint on infirm footing without making payment of the due installment amount of the premium of the insurance policy. The complaint was contested even on merits on the above-referred grounds and the above OPs prayed for dismissal of the complaint.

4.      OP No.3 filed its separate written reply and contested the complaint of the complainant by raising preliminary objections that no cause of action accrued to complainant to file the present complaint. The present complaint is not maintainable since the complainant has already availed the remedy before Ombudsman about this matter. OP No.3 pleaded that it is only corporate agent of OP No.1 and 2 and all the rights and liabilities of OP No.3 are defined in the contract, entered into between the parties and, thus, prayed for dismissal of the present complaint.

5.      The complainant tendered in evidence the affidavit of Sanjay Kumar Complainant Ex.C-1, copy of renewal premium intimation Ex.C-2, copy of insurance policy Ex.C-3 and Ex.C-4, copy of schedule of terms and conditions Ex.C-5, copy of policy document Ex.C-6, copy of declaration of hearth form Ex.C-7, copy of demand draft dated 15.03.2007, copy of courier receipt Ex.C-9,  copy of report of Histopathology of patient Rani Kapoor Ex.C-10, copy of certificate Ex.C-11, copy of letter addressed from complainant to Manager SBI Life Insurance Company Ex.C-12, copy of courier receipt Ex.C-13, copy of claimants statement Ex.C-14, copy of death claim Ex.C-15, copy of death claim discharge form Ex.C-16, copy of certificate of Hospital Treatment Ex.C-17, copy of medical attendants certificate Ex.C-18, copy of death claim Ex.C-19, copy of policy document Ex.C-20, copy of letter addressed from complainant to OPs/insurance company Ex.C-21, copy of letter dated 17.7.2008 addressed to complainant from Head Claims, Authorized Signatory/SBI Life Insurance Company Ex.C-22, copy of letter addressed from complainant to Insurance Ombudsman Ex.C-23, copy of letter dated 31.03.2009 addressed to complainant from office of Insurance Ombudsman Chandigarh Ex.C-24, copy of letter addressed to Sanjay Kapoor complainant from SBI Life Insurance Company Ex.C-25, copy of letter addressed to complainant from Insurance Ombudsman Ex.C-26, copy of order of Insurance Ombudsman  Ex.C-27, copy of renewal premium intimation form Ex.C-28, copy of letter dated 6.3.2007 addressed to Mrs. Rani Kapoor from SBI Life Insurance Ex.C-29, copies of order of Insurance Ombudsman Ex.C-30 to Ex.C-31. As against it, OPs tendered in evidence affidavit of Sh. V.Srinivas, Legal Head of OP N.1 and 2 Ex.RW-1/A, copy of insurance ombudsman order Chandigarh Ex.R-1, copy of policy Ex.R-2, copy of repudiation letter Ex.R-3. On conclusion of evidence and arguments, the District Forum, Amritsar, dismissed the complaint of the complainant by virtue of order dated 01.07.201. Dissatisfied with the order of the District Forum Amritsar dated 01.07.2011, the complainant now appellant has preferred this appeal against the same.   

6.      We have heard learned counsel for the appellant and counsel for respondent no.1 and 2, as none appeared on behalf of OP No.3 at the time of arguments in this appeal and we have also examined the record of the case.

7.      The controversy in this case is whether the insurance policy stood lapsed and if so, what is its effect or whether the non-payment of the installments on the due date and was valid ground  in rejecting the insurance claim. The counsel for the complainant now appellant submitted that first installment was deposited by his mother on  16.03.2007 and second installment of the policy was due on 6.6.2007. Due to ill health of his mother, it could not be deposited on time on 6.6.07. It was further argued that complainant changed her address and no intimation was given by OPs  on the new address  reminding the assured to deposit the installment amount on the due date on 6.6.07.  We have examined the evidence on the record minutely in this case. Ex.C-1 is affidavit of Sanjay Kumar , complainant, which has been examined by us. Ex.C-2 is premium dated 20.01.2007, Ex.C-3 is the policy showing that amount was to be paid in quarterly installments. The policy document is also on the record, vide Ex.C-4 to Ex.C-6 in this case. Other documents regarding illness of the life assured are also on the record, which are Ex.C-7 to Ex.C-31, which have been examined by us.

8.      We have found that the only dispute in this case is as to what is the effect of lapsed insurance policy in this case. The counsel for the appellant referred to law laid down in Smt Sipra Chatterjee..versus.. Union of India and others, reported in AIR 2002 DELHI 485, we have examined this authority, wherein Single Bench of Delhi High Court has observed that insured met with an accident and immediately went to coma, permanent disability was suffered by the insured till his death. It was held that liability to pay future premium stood waived of in terms of clause in insurance policy during continuance of disability. The cited authority is not applicable in this case, because in the cited authority, there was  definite clause in the contract of insurance to that effect. Herein, there is no such clause in the contract of insurance. Admittedly installment on the due date was not paid by the life assured Mrs. Rani Kapoor on 6.6.2007 her death took place on 04.12.2007. The policy was in lapsed condition, when the insurance claim was lodged by the complainant. The matter is not res nova as the Apex Court has held in Life Insurance Company of India …versus…. Mani Ram, reported in III (2005) CPJ 31 (SC) that payment of premium to be made within grace period of one month. Policy would lapse in case of non-compliance. Premium not paid within grace period, insurance company wholly justified in rejecting the claim of the complainant. No exception can be taken to the legal proposition laid down by the Apex Court in the above referred authority. It was further held in this authority that the Forum below committed no error of law in allowing claim of respondent and order liable to be set aside. It is, thus, evident from perusal of the cited judgment of the Apex Court, which is directly applicable to this case, that where no premium has been paid by due date by the insured, the policy stands lapsed and insurance company is wholly justified in repudiating the claim of the complainant.

9.      In view of our above discussion, we are of this view that the District Forum rightly appreciated the controversy in this case and dismissed the complaint of the complainant. There is nothing on the record to constrain us to take a different view from the view of the District Forum in this case. The order of the District Forum Amritsar dated 01.07.2011 under challenge in this appeal is hereby affirmed. Finding no merits in the appeal, the same is hereby dismissed.

10.    Arguments in this appeal were heard on 09.07.2015                  and the order was reserved. Now the order be communicated to the parties.

11.    The appeal could not be decided within the statutory period due to heavy pendency of court cases.

 

                                                                          (J. S. KLAR)

                                                             PRESIDING JUDICIAL MEMBER

                       

                                                         

                                                            (HARCHARAN SINGH GURAM)

                                                                             MEMBER

 

July 13      2015.                                                            

(ravi)