Haryana

Bhiwani

CC/772/2019

Kailash Chander - Complainant(s)

Versus

SBI Life - Opp.Party(s)

Anil Kumar

30 Nov 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BHIWANI

 

                                      Complaint Case No. 772 of 2019

                                      Date of Institution:   09.09.2019

                                      Date of Decision:     30.11.2023

 

Kailash Chander Son of Sh. Ram Kumar, resident of GMS Govt. School, Shiv Mandir, Village Mundhal Khurd, Tehsil & District Bhiwani.

                                                       ….Complainant.

Versus

SBI Life Insurance Company Limited, having its Registered and Corporate Office at Natraj, MV Road & Western Express Highway Junction, Andheri (E) Mumbai-400069 and one of its Branch Office at Bhiwani through its authorized signatory.

(Insurer of Radhey Shyam under SBI Life-Smart Money Back Gold Option-1, Series 2, Policy No. IN63902310 UIN111N096V02)                                                         

....Opposite Party. 

                      

COMPLAINT UNDER SECTION 12 & 13 OF

                              THE CONSUMER PROTECTION ACT, 1986

Before: -   Mrs.Saroj Bala Bohra, Presiding Member.

               Ms. Shashi Kiran Panwar, Member.

              

Present:    Sh. Anil Jangra, Advocate for complainant.

OP exparte.

       

ORDER

 

Mrs.Saroj Bala Bohra, Presiding Member.

 

1.             Brief facts of this case, as per complainant are that his brother Radhey Shyam had taken insurance policy vide proposal No.INQQ046592 Policy No. IN639023010 sequence No.16901 Channel Code 990650924, channel name Mrs. Sonia, received  dated 08.03.2017 under the product/plan SBI Life Smart Money Back Gold Option-1 for a sum assured of Rs. 10.00 Lacs commencing  from March 09, 2017.   First premium of Rs. 57,088/- was paid on 09.03.2017 and the next premium was due on  September 09, 2017.  It is alleged that on 18.09.2017, Radhey Shyam life assured was admitted in Medanta- The Medicity Hospital, Gurgaon vide UHID No. MM01094046, IPD No. 14404150 and he died on 26.09.2017 at Medanta-The Medicity Hospital, Gurgaon. The complainant being nominee of the policy holder  as well as his legal heir, lodged death claim for getting benefits of the policy. The OP did not release the claim rather repudiated the same in a arbitrarines manner vide letter dated 29.01.2018 on the ground that material facts were not disclosed intentionally and fraudulently by the life assured at the time of signing the proposal for insurance policy and this active concealment of material facts viz. concelment of kidney disease by late Radhey Shyam prior to propsal tantamount to fraud.  Complainant has alleged that at the time of submitting proposal form thogough medical examination of the deceased life assured done and he was found hale and healthy.  At the time of submitting the  proposal form, medical examination of deceased life assured was got done and he was found hale and healthy and he was not suffering from any chronic kidney disease nor got any treatment for this purpose.  Complainant has urged that the OP got procured false  particulars in respect of the alleged disease of the life assured from the hopsital to repudiate the claim. Hence, the presnet complaint has been preferred by complainant alleging gross negligence as well as deficinecy in service on the part of OPs  and prayed that OP may kindly be directed to pay the insurance amount of Rs.10,00,000/- (Ten Lakh) alongwith interest @ 18% p.a. from the date of death till actual realization and also to pay Rs.50,000/-as compensation on account of mental agony and  harassment.  Any other relief, to which this Hon’ble Commission deems fit has also been sought.
2.             Notice was issued to the opposite party but no one appeared on behalf of opposite party, therefore, the opposite party was proceeded against exparte vide order dated 26.11.2021.

3.                 To prove its complaint, counsel for the complainant has tendered in evidence affidavit of complainant as Annexure CW1/A documents Annexure C-1 to Annexure C-6 and closed the evidence vide his separate statement dated 12.09.2022.

4.                 We have heard learned counsel for complainant and with his able assistance have gone through the case file minutely.

5.                 The counsel for complainant has argued that the OP insurance company has arbitrarily and illegally repudiated the genuine claim of complainant on the ground of suppression of previous ailment by life assured while taking the insurance policy. The counsel has vehemently argued that in fact, the life assured was not suffering from any disease as medical examination of the complainant was done prior to issuing of the policy.  The counsel, to support of his case, has placed reliance on a case law delivered by the Hon’ble Supreme Court of India in Civil Appeal No.8386 of 2015 Manmohan Nanda Vs. United India Assurance Co. Ltd. & Anr. decided on 06.12.2021 reported in 2022 (1) Apex Court Judgment (SC)-685.  Further, the counsel has also placed reliance on a case law delivered by Hon’ble Punjab & Haryana High Court in CWP No.26178 of 2016 titled as National Insurance Co.Ltd. Vs. Sandeep & others reported in 2017 (1) RCR (Civil) Page 621 wherein it has been  held that “Insurance companies give lucrative offers to attract customers-However, the moment any insured puts even the most genuine claim, seldom said claim would be accepted by any insurance company.”

6.                 After hearing learned counsel for the parties and going through the record put-forth by both the parties, it is clear from policy document (Annexure C-1) that the policy was for a basic sum assured of Rs.10,00,000/- (Ten lacs) and that the life assured died during the subsistence of the policy.  As per repudiation letter (Annexure C-5), there is also not a dispute qua nominee of complainant in the said policy. As per this letter, the only dispute in this case is that at the time of taking the policy, life assured suppressed the treatment taken by him prior to issuance of the policy. Learned counsel for complainant has averred in his pleadings that before issuing the policy, thorough medical examination of life assured was  done and he was found hale and healthy and during the course of arguments he has submitted that the said document is lying with the OP insurance company. However, complainant to substantiate the version of complaint has placed on record his affidavit Annexure CW1/A,  which  corroborates the facts of complaint.  OP insurance company did not defend their case despite notice to it and remained exparte from the proceedings of this case.  In such a situation, we have no option except to believe the version of complainant.  Therefore, it cannot be said that Insured/Life assured had concealed the fact of his previous ailment or breached the terms & conditions of the insurance policy.  In this regard, case laws submitted by counsel for complainant is fully applicable to the facts of present case.  Accordingly, we hold that the OP has illegally & arbitrarily repudiated the claim of complainant which caused monetary loss as well as mental and physical harassment to complainant. As such, present complaint is allowed and complainant being nominee in the policy is entitled to benefits of the policy in question. Therefore, OP is directed to comply with the following directions within 40 days from the date of passing of this order:-

(i)       To pay Rs.10,00,000/- (Rs. Ten  lacs) to the complainant alongwith simple interest @ 9% per annum from the date of filing of this complaint till actual realization.

(ii)      To pay a sum of Rs.20,000/- (Twenty thousand) to the complainant as compensation for harassment.

(iii)     Also to pay a sum of Rs.55,00/- (Rs.Five thousand five hundred) as litigation expenses.

                                                           

                    In case of default, the OP shall liable to pay simple interest @ 12% per annum on all the aforesaid awarded amounts for the period of default. Certified copies of this order be sent to parties concerned, free of costs, as per rules. File be consigned to the record room, after due compliance.  

Announced.

Dated:30.11.2023.

 

                              (Shashi Kiran Panwar)              (Saroj Bala Bohra)

                                                   Member                 Presiding Member

District Consumer

Disputes Redressal

Commission,Bhiwani