Punjab

Ludhiana

CC/21/343

Gurmukh Singh - Complainant(s)

Versus

State Bank of India - Opp.Party(s)

Suresh Kumar

08 Nov 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No:343 dated 19.07.2021.                                                         Date of decision: 08.11.2023.

 

Gurmukh Singh age 39 years son of Late Sh. Mehar Singh, resident of Village Kaddon, Tehsil Payal, District Ludhiana.                                                                                                                                       ..…Complainant

                                                Versus

1. State Bank of India, Branch Office Kaddon, Tehsil Payal, District Ludhiana through its Branch Manager.
2. State Bank of India, Main Branch, Civil Lines, Ludhiana through its Manager.
3. The SBI General Insurance Company Ltd., IInd Floor, Takkar Tower, B-XIX-121/1, Mall Road, Adjoining Golden Plaza, Fountain Chowk, Civil Lines, Ludhiana, Punjab-141001 through its Branch Manager.
4. The SBI General Insurance Company Ltd., Regd., Office Natraj 101, 201 & 301, Junction of Western Express Highway Andheri, Kurla Road, Andheri East Mumbai 400069 through its Senior Manager.

…..Opposite parties 

Complaint Under section 35 of the Consumer Protection Act, 2019.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

SH. JASWINDER SINGH, MEMBER

MS. MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. Suresh Kumar, Advocate.

For OP1 and OP2          :         Exparte.

For OP3 and OP4          :         Sh. Vyom Bansal, Advocate.

 

ORDER

PER SANJEEV BATRA, PRESIDENT

1.                Briefly stated, the facts of the case are that Late Sh. Mehar Singh, father of the complainant had savings bank account No.65122933707 in State Bank of India, branch Kaddon, Tehsil Payal, District Ludhiana in which the complainant was nominee of Mehar Singh. On the asking of the officials of OP1, Mehar Singh got insurance cover of Rs.4,00,000/- on premium of Rs.100/- per year from his savings account and OP1 issued insurance policy from OP3 and OP4. The premium amount for insurance policy had been regularly deducted from the said savings account by OP1 every year. However, OP3 and OP4 insured Late Mehar Singh but did not issue the policy No.11994384. The complainant further stated that Sh. Mehar Singh was insured vide journal No.000658622 for Rs.4,00,000/- and an acknowledgement slip was issued by OP1 on 14.03.2019 which shows deduction of Rs.100/- from savings account of Sh. Mehar Singh. Unfortunately, Sh. Mehar Singh son of Late Sh. Pala Singh died on 11.09.2019 in a road side accident with an unknown vehicle, regarding which a DDR No.21 dated 12.09.2019 was registered at Police Station Sadar, Nabha. Post mortem of Mehar Singh was conducted from Civil Hospital, Nabha and police conducted proceedings under Section 174 Cr.P.C. Senior Superintendent of Police, Patiala issued a certificate of approval of proceedings under Section 174 Cr.P.C. to the complainant.

                   The complainant further stated that lastly his father availed health insurance master policy from the OPs bearing No.11994384 w.e.f. 15.02.2019 to 14.02.2020. However, OP3 and OP4 wrongly mentioned the sum assured to the tune of Rs.2,00,000/- only but they acknowledged the insured sum to the tune of Rs.4,00,000/-. Even the cover note of master policy had not been received by father of the complainant during his life time and till date by the complainant. The complainant paid premium of this policy to the OPs till death of his father up to date i.e. 15.02.2019 to the tune of Rs.100/- deducted from his savings account by OP1. The complainant submitted claim No.798439 along with all the relevant papers with the OPs but they dilly dallied the matter on one pretext or the other and rejected the claim vide text message dated 18.08.2020 without assigning any reason for rejection of the claim. The complainant followed up the matter with OP3 and OP4 but in vein. According to the complainant, the rejection of the claim is illegal, arbitrary and against the canons of natural justice and fair play. The complainant further stated that he approached the officials of OP3 and OP4 with request to disburse the claim amount but they have failed to do the needful. Even the complainant served a legal notice dated 27.12.2020 through registered post on 28.12.2020 upon OP1 to OP3 through his counsel but to no effect. Hence this complaint, whereby the complainant has prayed for issuing directions to the OPs to disburse the claim amount of Rs.4,00,000/- along with compensation of Rs.2,00,000/- + Rs.1,00,000/- and litigation expenses of Rs.50,000/-.

2.                Upon notice, none turned up on behalf of OP1 and OP2 despite service of notice and as such, OP1 and OP2 were proceeded against exparte vide order dated 18.10.2021.

3.                Upon notice, OP3 and OP4 filed joint written statement and assailed the complaint by taking preliminary objections on the ground of maintainability of complaint; lack of jurisdiction; lack of cause of action; suppression and concealment of material facts etc.  OP3 and OP4 stated that they processed the claim of the complainant only after due perusal of all documents received and within the precincts of terms and conditions of the policy. OP3 and OP4 denied any deficiency in service and unfair trade practice on their part.

                   On merits, OP3 and OP4 reiterated the crux of averments made in the preliminary objections and facts of the case. However, OP3 and OP4 admitted issuance of insurance policy to Mehar Singh under SBI General’s Personal Accident Insurance Policy subject to terms and conditions of Master Policy No.11994384 for the period of 15.02.2019 to 14.02.2020 for a maximum sum of Rs.2,00,000/- vie individual certificate No.81570318. OP3 and OP4 further admitted submission of claim by the complainant with them, which was registered vide claim No.798439 and a claim deficiency letter dated 13.12.2019 was issued to the complainant. The complainant subtitled claim form with insurance company but the insurance company did not receive the documents from the complainant despite issuance of reminder letters dated 02.01.2020, 22.01.2020 and 15.02.2020. The insurance company appointed a detective agency namely M/s. Detective Centre (India) to verify the cause and veracity of death of Mehar Singh, who visited the complainant, Police Station etc. and collected their statements, documents and submitted his report dated 05.02.2020. Upon reading the documents and application of mind, the officials of insurance company found the claim not payable and intimated the complainant vide repudiation letter dated 18.08.2020. According to OP3 and OP4, the master policy is issued to State Bank of India and the maximum amount insured under the said policy was restricted to the maximum of Rs.2,00,000/-. OP3 and OP4 have denied that there is any deficiency of service and have also prayed for dismissal of the complaint.

4.                The complainant filed replication to the written statement reiterated the facts mentioned in the complaint and controverted those mentioned in the written statement.

5.                In support of his claim, the complainant tendered his affidavit Ex. CA in which he reiterated the allegations and the claim of compensation as stated in the complaint. The complainant also tendered documents Ex. C1 is the copy of passbook of savings account of Mehar Singh, Ex. C2 is the copy of acknowledgement slip, Ex. C3 is the copy of death certificate of Mehar Singh, Ex. C4 is the copy of DDR, Ex. C5 is the copy of post mortem report of Mehar Singh, Ex. C6 is the copy of police certificate, Ex. C7 is the copy of master policy, Ex. C8 is the copy of text message, Ex. C9 copy of legal notice, Ex. C10 and Ex. C11 are the postal receipts, Ex. C12 is the copy of Aadhar card of the complainant and closed the evidence.

6.                On the other hand, counsel for OP3 and OP4 tendered affidavit Ex. RA of Sh. Jitendera Dhabhai, Deputy Manager – Consumer Litigation of SBI General Insurance Co. Ltd. New Delhi office along with documents Ex.  R1 is the copy of policy schedule, Ex. R2 is the copy of letter dated 13.12.2019, Ex. R3 is the copy of claim form, Ex. R4 to Ex. R6 are the copies of letters dated 02.01.2020, 22.01.2020 and 15.02.2020 respectively, Ex. R7 is the copy of report dated 05.02.2020, Ex. R8 is the copy of repudiation letter dated 18.08.2020 and closed the evidence.

7.                We have heard the arguments of the counsel for the parties and also gone through the complaint, replication, affidavit and annexed documents and written reply along with documents produced on record by both the parties.

8.                The complainant is the son and nominee of Mehar Singh deceased who was subscribed to SBI General’s Personal Accident Insurance Policy (exclusively meant for State Bank of India account holders) by OP1 bank being the master policy holder of the policy. The policy was linked to bank account Np.65122933707 of the deceased having a policy period 15.02.2019 to 14.02.2020 for a sum insured of Rs.2,00,000/-. Ex. R1 is the PA Insurance Cover Confirmation  dated 18.08.2021 which contains terms and conditions and exclusion clauses. The relevant clauses are reproduced as under:-

                   Terms and Conditions:-

• This policy can be bought by any permanent Indian resident having a Saving Bank/Individual Current Account with SBI/SBH/SBM/SBBJ/SBT/SBOP/RRBs or SBI & its Associate Banks and aged between 18 years to 65 years…”

Exclusions:-.

• Suicide, attempted suicide (whether sane or insane) or intentionally self-inflicted injury or illness, or sexually transmitted conditions, mental or nervous disorder, anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS), Human Immune deficiency Virus (HIV), infection….”.   

 

9.                It is the specific case of the complainant that the terms and conditions of the policy schedule was never sent to his father but premium was being deducted by OP1 bank which was further transferred to OP3 and OP4. The opening lines of Ex. R1 dated 18.08.2021 corroborates the contentions of the complainant whereby OP2 has expressed regret for not getting the certificate under insurance policy. This fact was acknowledged by OP2 and OP3 after lapse of 2½ years from the date of inception of the policy and even after the death of insured Mehar Singh. This has caused prejudice to the rights of the insured as well as the complainant. 

10.              Unfortunately, insured Mehar Singh met with a roadside accident on 11.09.2019 in the area of Police Station Sadar, Nabha and the local police conducted inquest proceedings under Section 174 Cr.P.C. vide DDR No.21 dated 12.09.2019 Ex. C4. Upon the submission of the claim Ex. R3, investigator M/s. Detective Centre (India) was appointed by OP insurance company, who submitted his report Ex. R7 and opined that the deceased was mentally upset. The investigator gave the insured details as under:-

                   Insured Details               

Name, Age & Sex of the Deceased Person	Mehar Singh
Fathers Name	Pala Singh
Date of Birth/Age	01.01.1948 as per PAN card
Permanent address	Village/PO Kaddon, Tehsil Payal, District Ludhiana
Address at the time of accident	Accident took place in the area of Nabha, District Ludhiana
Occupation & Income pm (Only Deceased)	Was old man aged 71 years, mentally disturbed as per statements with Police.
Mental/Physical Status of the Deceased before the incident	Not so good

 

Taking cognizance of the contents of report and other conditions of the policy, the claim was repudiated letter dated 18.08.2020 vide Ex. R8, the operative part of which reads as under:-

“This is with reference to claim lodged by you on 13.12.2019. We acknowledge the receipt of documents.

We have carefully pursued the claim documents and it is observed that insured found dead on road. Exact incidence leading to death of insured is not established from received documents. However, our investigations established that insured was mentally imbalanced. Final police report received to us also confirms the fact of mental status of insured. As per Terms and conditions of the Policy death due to 'suicide, attempted suicide (whether sane or insane) or intentionally self inflected injury or illness, or sexually transmitted conditions, mental or nervous disorder, anxiety, stress or depression, acquired Immune Deficiency Syndrome (AIDS), Human Immune deficiency Virus (HIV)' is not covered under this policy. Further we also noted from Aadhar card of insured that age of insured is 71 year old as on issuance of policy (birth years 1948 as per Aadhar card). Policy covers insured aged between 18 years to 65 years. Hence basis of above mentioned clauses, claim is repudiated.

The foregoing repudiation by us on liability is issued based on the facts as at present. We reserve the right to extend or modify this repudiation in the event of new/additional facts or circumstances brought to our knowledge.

We regret, consequently, that we are unable to consider this claim. Should you believe that we have overlooked any material fact or circumstance, or should you wish to present an alternative interpretation of any relevant policy provision, please draw the same to our attention for our further consideration by contacting SBI GIC GRIEVANCE REDRESSAL COMMITTEE, address of which is given hereunder, with details for resolution.”

 

11.              The first ground pertains to invoking of exclusion clause by OP2 and OP3 is based on conjectures and surmises. The investigator did not collect any medical record which could establish that the deceased was suffering from mental or nervous disorder to such an extent which entitles the OP insurance company to deny the claim. The statement of general nature recorded by the complainant cannot be made basis to press the exclusion clause in service.  The other ground that the policy covers insured between 18 years to 65 years and at the time of death, the deceased insured was of 71 years, is also without any substance or merit. OP1 bank being a corporate agent of OP3 and OP4, filled the proposal form and transmitted the same to OP3 and OP4 along with other requisite documents including the proof of age. OP1 bank obtained an ECS mandate from the deceased and continued to deduct premium annually till the death of the insured. OP3 and OP4 were also accepting the same and by necessary implication, the insurance cover was extended to the deceased insured. As per extract of passbook Ex. C1 issued by OP1 bank, the account was opened on 02.09.2011 on the basis of PAN card. The age of the deceased in the bank records has been mentioned as 01.01.1948. As per Ex. C2 which was also duly issued by the OP bank, the first premium of Rs.100/- was deducted on 14.03.2013 meaning thereby that at that time the deceased was of 65 years of age. It is apposite to mention that PAN card is considered as one of the requirements for KYC compliant. Particulars along with documents were appeared to have been forwarded to the insurance company and accordingly, deceased was enrolled as a member. Although the complainant claims that initially insurance cover was extended for a sum of Rs.4,00,000/- as evident from Ex. C2 but the document which has been produced by the OPs on record shows that the extent of coverage was Rs.2,00,000/-. Therefore, it is evident that the Ops were fully aware of the age and terms and conditions but these were not supplied to the insured even during his life time and he was kept in dark. Now the OPs cannot be allowed to raise eligibility issue of age as a ground to decline the claim. The officials of the OPs were not only negligent but it also amounts to adoption of unfair trade practice in deducting the premium. In this regard, reference can be made to  2022 LiveLaw (SC) 937 in M/s. Texco Marketing Pvt. Ltd. Vs TATA AIG GIC Ltd. and others passed by the Hon’ble Supreme Court of India, appellant secured a Standard Fire & Special Perils policy which was meant to cover a shop situated in the basement of the building. However, exclusion clause of the contract specifies that it does not cover the basement. The appellant continued to pay the premium promptly. The shop met with fire accident for which the appellant raised a claim. The claim was repudiated by respondent No.1 taking the umbrage under the exclusion clause. The Hon’ble Supreme Court partly allowed the appeal and observed in para No.37 of the judgment:-

•  “37.Once it is proved that there is a deficiency in service and that respondent No. 1 knowingly entered into a contract, notwithstanding the exclusion clause, the consequence would flow out of it. We have already discussed the scope and ambit of the provisions under the Indian Contract Act, 1872. Even as per the common law principle of acquiescence and estoppel, respondent No. 1 cannot be allowed to take advantage of its own wrong, if any. It is a conscious waiver of the exclusion clause by respondent No. 1.”

So in the given circumstances, the repudiation of the claim of the complainant is not justified and it would be just and appropriate, if the OPs are directed to reimburse Rs.2,00,000/- to the complainant within 30 days from the date of receipt of copy of order along with composite costs of Rs.10,000/-.

12.              As a result of above discussion, the complaint is partly allowed with direction to the OPs to reimburse Rs.2,00,000/- to the complainant within 30 days from the date of receipt of copy of order  failing which the opposite parties shall pay interest @8% per annum on the settled amount to the complainant from the date of order till its actual payment. The opposite parties shall further pay a composite cost of Rs.10,000/- (Rupees Ten Thousand only) to the complainant. Payment of costs shall be made within a period of 30 days from the date of the receipt of the copy of this order. The liability of the OPs shall be joint and several. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.            

13.              Due to huge pendency of cases, the complaint could not be decided within statutory period.

 

(Monika Bhagat)          (Jaswinder Singh)             (Sanjeev Batra)

Member                         Member                              President        

 

Announced in Open Commission.

Dated:08.11.2023.

Gobind Ram.