DISTRICT CONSUMER DISPUTES REDRESSAL FORUM PALAKKAD Dated this the 30th Day of December 2011 Present : Smt.Seena H, President : Smt. Preetha.G. Nair, Member : Smt. Bhanumathi.A.K, Member Date of filing: 03/12/2009 (C.C.No.164/2009) K.S.Viswanathan, S/o.Subarama Iyer, Adithya, 2nd Street, Venketeswara Colony, Ambikapuram (PO), Kalpathy, Palakkad. (Adv.Saju Abraham) - Complainant V/s 1.State Bank of India Life Insurance Co.Ltd., Rep.by its Manager, Central Processing Centre, Kabas Bhavan, Plot No.3A, Sector – 10, CBD Belabur Navi, Mumbai – 400 614. (By Adv.P.Prasad) 2.The Assistant Manager (Claims), State Bank of India Life Insurance Co.Ltd., Central Processing Centre, Kabas Bhavan, Plot No.3A, Sector – 10, CBD Belabur Navi, Mumbai – 400 614. (By Adv.P.Prasad) 3. SBI Credit Cards Payment Services Pvt.Ltd. Rep.by its Manager, P.B.No.28, GPO, New Delhi – 110 001. 4. State Bank of India Life Insurance Co.Ltd. Rep.by its Manager, Palakkad. (By Adv.P.Prasad) 5. Head Claims Rep.by its Manager, Authorised Signatory For SBI Life Insurance, Kapas Bhavan, Plot No.3A, Sector – 10, CBD Belabur Navi, Mumbai – 400 614. (By Adv.P.Prasad) 6. Manager Customer Services SBI Cards & Payments Services Pvt.Ltd. P.B.Bag No.28, GPO, New Delhi – 110 001. - Opposite parties O R D E R By Smt.SEENA.H. PRESIDENT Brief fact of the complaint. 3rd opposite party has canvassed the complainant to avail a credit card for which the complainant was assured to get the benefit of a personal accident coverage policy for a sum of Rs.6 lakhs. At the time of canvass it was stated that in the event of death or accident petitioner will be entitled for the amount. At the time of issuance of credit card it was again informed that he will have a personal accident insurance cover. At the time of taking the credit card, neither the conditions of the insurance policy by way of proposal form nor the policy certificate was furnished to the complainant. 3rd opposite party has never informed about any restriction in the policy coverage. Accordingly credit card was issued by 1st opposite party and premium towards the personal accident insurance and insurance administration charges was credited from the credit card. On 21/4/2007 complainant and his family met with an accident while coming from Calicut to Palakkad in a car and the petitioner had to undergo major surgeries. When contacted the 2nd opposite party, they served a copy of the certificate of Insurance on 25/6/2007 which neither contained the name of the policy holder nor any other particulars. Complainant on intimating the incident to 1st opposite party received a letter expressing condolence on the death of the insured. Again a letter was sent narrating all the facts for which 2nd opposite party requested for the production of the documents. Accordingly all the requisite documents were sent. 1st opposite party on 4/3/2009 issued a letter repudiating the claim stating that disability of the complainant does not fall within the definition of the total and permanent disability as per the condition in the policy. Hence complaint was filed for realizing the insurance claim. 3rd and 6th opposite parties representing SBI Credit Card System were set exparte. 1st, 2nd, 4th & 5th opposite parties representing SBI Life Insurance Company filed version. It is admitted that SBI Life Insurance Company has issued a master policy in favour of SBI Cards vide Policy No.83001000105 where in the complainant is also a member of the group. As per the terms and conditions of the policy in order to avail the benefit of personal accident coverage the person should be totally and permanently disabled as a result of the accident. Further explains that the accident shall result in bodily injury or injuries to the life assured and such injuries shall independently of any other means and within 120 days of the occurrence of the accident result in i) Total & irrecoverable loss of sight of both eyes ii) Loss or severance of 2 or more limbs at or above wrist or ankles iii) Total & irrecoverable loss of sight of one eye and loss by severance of limb at or above wrist or ankle or iv) Life assured being in coma for a continuous period of at least 60 days. Complainant here in has assessed to have a permanent disability of 14% only. The reported 14% does not come under any of the above clauses also. Since the claim is not admissible and there cannot be any deficiency in service on the part of the opposite parties. Further SBI cards and SBI Life Insurance are separate and different legal entities and SBI Life Insurance Company is not responsible for action of any other opposite parties. The evidence led by the complainant consists of the chief affidavit and Ext.A1 to A16. 4th Opposite party filed chief affidavit on behalf of 1st, 2nd, 4th and 5th opposite parties. Ext.B1 to B4 marked on their side. Issues for consideration are - Whether there is any deficiency in service on the part of opposite parties ?
- If so, what is the relief and cost complainant is entitled to ?
Issue No.1 Complainant being an SBI Card Holder is the member of the group insurance for which SBI Card Systems is the master policy holder and SBI Life Insurance is the insured is an admitted fact. Fact of accident and 14% disability is also an admitted fact. Complainant himself at the time of cross examination has admitted that 14% disability is not a criteria for claiming insurance amount as per the terms and conditions of the policy. On going through Ext.B1 Policy terms and conditions we are also on the same stand. But the actual question is whether the complainant herein is bound by the terms and conditions which were not made known to him at the time of availing the policy. Admittedly SBI Cards System is the master policy holder of the group insurance policy of which complainant is a member. Complainant has repeatedly saying that he was not served with any of the terms and conditions of the policy at the time of availing the policy. He was not made known of any restriction in the policy. Opposite parties 1, 2, 4 & 5 has no case that complainant was informed of the terms and conditions before issuance of the policy and copy of Ext.B1 which contains the terms and conditions has handed over to the complainant. Instead the SBI Life Insurance Company is shifting the responsibility upon SBI Cards Systems viz. opposite parties No. 3 & 6. Opposite parties 3 & 6 is exparte. Whether opposite parties 3 & 6 has handed over the same to the complainant, there is no evidence. As per Ext.A3 the complainant has received the copy of the policy itself only on written request after the accident i.e. on 21/4/07. Opposite parties are bound to provide information regarding the policy at the time of acceptance of premium itself. Whether it be a group insurance or individual insurance, premium is levied on individual basis. Opposite parties 1,2,4 & 5 cannot absolve liability stating that in the case of group insurance policy the whole liability lies upon the master policy holder. Copy of certificate of insurance marked as Ext.A3 is an unfilled certificate of insurance, where in the name of the card holder as well as column for signature of card holder is left blank. Overleaf of the page contains the terms and conditions of the policy. In Ext.A3 it is noted as follows: “This certificate is issued only for the information of the card holder being admitted to the scheme”. Important Pls.fill the columns overleaf, sign this certificate and retain this certificate in safe custody. By this statement we understand that opposite parties are bound to issue certificate of insurance to the individual member even if it is a group insurance policy. Evidence on record shows that it is not done by any of the opposite parties. Hence we find that there is deficiency in service on the part of all opposite parties and complainant is entitled for relief. But we find that as per the policy conditions, complainant is not entitled for the claim amount. Hence we are not in a position to award insurance claim amount as per the policy. There is also no evidence on record to show what actually is the treatment expenses incurred by the complainant. But for the reason that opposite parties failed to issue certificate of insurance within time and complainant was not made known the restrictions in the policy, complainant is entitled for a reasonable amount as compensation. In the result complaint partly allowed. Opposite parties are jointly and severally held liable. Both opposite parties are directed to pay complainant an amount of Rs.1,00,000/-(Rupees One lakh only) as compensation and Rs. 1,000/- (Rupees One thousand only) as cost of the proceedings. Order shall be complied within one month from the date of receipt of order, failing which the complainant is entitled for 9% interest per annum for the whole amount from the date of order, till realization. Pronounced in the open court on this the 30th day of December 2011 Sd/- Seena.H President Sd/- Preetha G Nair Member Sd/- Bhanumathi.A.K. Member APPENDIX Exhibits marked on the side of the complainant Ext.A1 – Statement issued by 1st opposite party dtd.2/8/05 Ext.A2 – Copy of Discharge card issued to complainant by Moulana Hospital, Perinthalmanna Ext.A3 – Copy of Certificate of Insurance issued by opposite parties Ext.A4 – Copy of letter sent to 1st opposite party dated 29/6/07 by the complainant Ext.A5 – Copy of letter dated 14/7/07 sent to complainant by opposite party Ext.A6 – Copy of letter dated 21/11/07 sent by complainant to opposite party Ext.A7 – Copy of letter dated 22/12/07 sent to complainant by opposite party Ext.A8 – Copy of letter dated 13/12/07 sent by complainant to opposite party Ext.A9 – Copy of letter dated 3/12/07 sent to complainant by opposite party Ext.A10 – Copy of letter sent by complainant to opposite party Ext.A11 – Copy of letter dated 4/3/09 sent to complainant by opposite party Ext.A12 – Copy of letter dated 31/10/08 sent to complainant by opposite party Ext.A13 series – SBI Card Monthly statements Ext.A14 – Copy of certificate in the name of complainant issued by Sr.Divisional Manager, United India Insurance, Palakkad Ext.A15 – Copy of salary certificate in the name of complainant issued by Sr.Divisional Manager, United India Insurance, Palakkad Ext.A16 – Copy of Standing Disability Certificate issued in the name of complainant by Senior Superintendent District Hospital Palakkad. Exhibits marked on the side of the Opposite parties Ext.B1 – Copy of Master Policy Ext.B2 – Copy of the Disability Certificate Ext.B3 – Copy of the report filed before Judicial Magistrate Ext.B4 – Copy of the covering letter received from complainant on 17/2/09 Complainant examined PW1 – Viswanathan Opposite party examined DW1 – Rajkumar.V Cost Allowed Rs.1,000/- allowed as cost of the proceedings. | 
