BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM, JALANDHAR.

Complaint No.49 of 2014

Date of Instt. 06.02.2014

Date of Decision :26.02.2015

Maninderjit Kaur aged about 47 years wife of Late Sh.Mukesh Kumar, R/o 78-C, Gobind Nagar, Basti Guzan, Jalandhar.

..........Complainant

Versus

1. State Bank of Patiala, Zonal Office, RASMECC Branch, Ambedkar Chowk, Jalandhar through its Branch Manager.

2. State Bank of Patiala, The Mall, Patiala, through its General Manager/Mg.Director.

3. SBI Life Insurance Co.Ltd, through its Branch Manager, Ist Floor, SCO 5-6, Crystal Plaza Market, Near Punjab Institute of Medical Science, Chhoti Baradari, Phase-I, Jalandhar.

4. SBI Life Insurance Co.Ltd, through its Mg.Director, Ground Floor, Turner Morrising Bedg.GN Vaidya Marg Fort, Mumbai.

.........Opposite parties

Complaint Under Section 12 of the Consumer Protection Act.

Before: S. Jaspal Singh Bhatia (President)

Ms. Jyotsna Thatai (Member)

Sh.Parminder Sharma (Member)

Present: Sh.Pritpal Singh Adv., counsel for complainant.

Sh.JS Aneja Adv., counsel for OPs No.1 & 2.

Sh.Vikas Sharma Adv., counsel for OPs No.3 & 4.

Order

J.S Bhatia (President)

1. The complainant has filed the present complaint under section 12 of the Consumer Protection Act, against the opposite parties on the averments that opposite party No.1 is Zonal office of State Bank of Patiala and opposite party No.2 is head office of State Bank of Patiala, who are responsible for the act and conduct of State Bank of Patiala. The opposite party No.3 is branch office of SBI Life Insurance Co.Ltd and opposite party No.4 is head office of the SBI Life Insurance Co.Ltd, who are responsible for the act and conduct of SBI Life Insurance Co.Ltd. Husband of the complainant namely Mukesh Kumar has taken a home loan amounting to Rs.8,90,000/- from the opposite party No.1 under SBP Rinn Raksha Plan Scheme having A/c No.65159410297. At the time of taking the above said loan, employee of opposite party No.1 told the husband of the complainant that under this scheme he has to pay a one time premium to take the benefit of insurance equal to the loan amount from SBI Life Insurance Co.Ltd i.e opposite party No.3. The employee of opposite party No.1 also told the husband of the complainant that getting insurance policy is mandatory for every loanee who wants to take home loan from the bank. The employee of the opposite party No.1 also apprised regarding the fact that if under this scheme any loanee die in that case, the insurance company i.e opposite parties No.3 and 4 shall be fully liable to pay the outstanding dues of the loan to the bank. As husband of the complainant was in need of home loan as such he agreed to take the benefit of said scheme. The employees of the opposite party No.1 completed all the formalities and filled up the form required for loan as well as insurance policy and at that time, the husband of the complainant provided each and every information regarding his income, health and about his family, which is required for the loan and policy. Moreover, at that time husband of the complainant was having good and sound health. After getting complete formalities, the husband of the complainant also paid premium for the above said insurance policy which was duly accepted by opposite party No.3 after getting complete inquiry about his health and have also issued the insurance policy bearing No.70000000702 to him. On 30.3.2013, husband of the complainant suffered a heart attack and he was firstly admitted in Tagore Hospital, Jalandhar and then he was again shifted to BBC Heart Care Centre, Jalandhar for treatment but unfortunately husband of the complainant died on 3.4.2013. The complainant incurred medical expenses amounting to Rs.94,650/- for the treatment of her husband. After the death of her husband, the complainant many times visited the office of opposite party No.1 and requested the opposite party No.1 to settle their claim with regard to the home loan taken by her husband with opposite parties No.3 and 4 and to issue no due certificate to her but opposite parties did not hear the genuine request of the complainant and kept lingering on the matter on one pretext or other. The complainant also visited the office of opposite parties No.3 and 4 and requested them to make the payment of the medical expenses i.e amounting to Rs.94,650/- which was incurred by her for the treatment of her husband and also requested opposite party No.3 to settle the account with opposite parties No.1 & 2 but opposite party No.3 did not hear the genuine request of the complainant and linger on the matter on one pretext or other. On such like averments, the complainant has prayed for directing the opposite parties No.1 and 2 to settle outstanding loan amount with regard to the home loan taken by her husband under SBP Rinn Raksha Scheme with opposite parties No.3 and 4 and to issue no due certificate to her. She has also claimed Rs.94650/- as medical expenses and further Rs.50,000/- as damages and Rs.20,000/- as litigation expenses.

2. Upon notice, opposite parties appeared and filed their written replies. In their separate written reply, opposite parties No.1 and 2 took preliminary objections regarding maintainability, want of cause of action etc. They further pleaded that Mukesh Kumar husband of the complainant had taken home loan having account No.65159410297 amounting to Rs.8,90,000/- from opposite party No.1. The loan amount has not been liquidated and is still outstanding against the loanee, husband of the complainant. During the subsistence of the loan Mukesh Kumar expired on 3.4.2013 and opposite party No.4 has repudiated the claim of policy No.70000000702 vide letter dated 2.9.2013. The intimation of repudiation has been sent to opposite party No.1 which in turn informed the complainant on 1.11.2013. The complainant instead of liquidating and repaying the amount of loan outstanding has filed the present false and frivolous complaint and dragged the answering opposite parties without any cause of action, malafidely and arbitrarily to harass the answering opposite parties by making false imputation against the answering opposite parties. They denied other material averments of the complainant.

3. In its separate written reply, the contesting opposite parties No.3 and 4 pleaded that SBI Life Insurance Co.Ltd has a Group Insurance Scheme, for the borrower of loans of different categories like Housing Loan, Personal Loan, Vehicle Loan, Tractor loan etc from State Bank of India, where under the borrower member is offered insurance subject to the terms and conditions incorporated in the Master Policy which is issued in favour of the State Bank of Patiala bearing No.70000000702 as an evidence of the insurance contract. The terms and conditions of the master policy are binding on all the insured members. The DLA, Mukesh Kumar Dhari (hereinafter referred to as DLA) had also submitted a member ship form (Declaration of Good Health hereinafter referred to as DGH) for grant of insurance cover under master policy No.70000000702 and on acceptance of his membership form, a certificate of insurance (COI) was issued to the DLA. In case of group schemes, each individual member whoever wishes to be covered under the policy, must submit a Good Health Declaration, which becomes the sole basis for granting the insurance cover. Hence any misstatement/concealment in the declaration amount to the breach of the doctrine of Utmost Good Faith. The declaration should be signed only by the healthy lives who are not suffering from any of the diseases mentioned therein and those who suffer from any of the listed ailments are not eligible to be covered under the group insurance scheme. The insurer is well within its rights to repudiate the claim arising under the insurance cover if it is found that there was suppression of material facts. The life insurance contract is a contract of Utmost Good Faith wherein the proponent is duty bound to disclose correct facts concerning his/her age, health and other related matters which are within his/her knowledge at the time of making the proposal, failing which the insurer has every right to repudiate the claim. In the instant case the deceased life assured committed a breach of the principle of Utmost Good Faith by suppressing material facts of his pre-existing illness and committed a breach of the doctrine of Utmost Good Faith by deliberately and intentionally suppressing the material fact. It is clear from the documentary evidence that the DLA Mukesh Kumar Dhari was suffering from heart disease and had underwent Angioplasty in 2008 i.e prior to the date of commencement of risk. Had the deceased life assured disclosed that he was suffering from heart disease and underwent Angioplasty, the risk cover would not have been accepted by the answering opposite parties and the answering opposite parties would have rejected the proposal for insurance cover itself. Thus the claim repudiation action by the answering opposite parties is just and legal. The DLA has specifically declared in the membership form that he is of sound mental and physical health and that he was not suffering from any disease. He has not been hospitalized in that last 3 years for any diseases and he has not been advised or be taking treatment for any critical illness. Further, he has replied in negative to the specific questions in the membership form. But documents placed on record amply prove that he was suffering from heart disease and underwent Angioplasty prior to the date of enrollment into scheme of insurance and thus he suppressed the material facts deliberately. The DLA committed a fraud with an intention to obtain the insurance cover by suppressing the history of pre-existing disease which was very well within his knowledge, as he had taken the treatment for the same. Thus in terms of section 17 of India Contract Act, 1872 the contract is void and there can not be any enforcement of any right under a contract which is void ab-initio. They denied other material averments of the complainant.

4. In support of his complaint, learned counsel for the complainant has tendered affidavit Ex.CA alongwith copies of documents Ex.C1 and Ex.C16 and closed evidence.

5. On the other hand, learned counsel for opposite parties No.1 and 2 has tendered affidavits Ex.OP1/A Ex.OP1/B alongwith copies of documents Ex.OP1/1 to Ex.OP1/7 and closed evidence. Further learned counsel for the opposite parties No.3 and 4 has tendered affidavit Ex.OP3/A alongwith with copies of documents Ex.OP3/1 to Ex.OP3/12 and closed evidence.

6. We have carefully gone through the record and also heard the learned counsels for the parties and further gone through the written arguments submitted on behalf of complainant.

7. It is not disputed that husband of the complainant namely Mukesh Kumar had taken home loan amounting to Rs.8,90,000/- from opposite party No.1 and at the time of taking loan he also took insurance policy from opposite party No.3 and under the policy the benefit of insurance equal to the outstanding loan amount was covered. Unfortunately the husband of the complainant suffered heart attack and died on 3.4.2013. The complainant preferred the claim but opposite party insurance company repudiated her claim on the ground of concealment of pre-existing disease i.e heart problem at the time of taking insurance policy. According to the complainant, the opposite party insurance company has repudiated the claim on false and frivolous ground. Further according to the complainant, at the time of execution of loan document Mukesh Kumar since deceased provided all necessary information pertaining to health to the loan officer. Further according to the complainant the proposal form has also been singed by the deceased and it was later on filled by loan officer of opposite parties No.3 and 4 and as such the deceased did not conceal any facts regarding his health from the opposite parties. We have carefully considered the above contentions of the complainant. Ex.OP3/2 is proposal form. It is signed by Mukesh Kumar deceased. Where any person signs any document, the presumption is that he has signed the same after fully understanding its contents. In M/s. Grasim Industries Ltd & Anr. Versus M/s. Aggarwal Steel 2010 (1) SC 33, it has been held by the Hon'ble Supreme Court as under:-

"In our opinion, when a person signs a document, there is a presumption, unless there is proof of force or fraud, that he has read the document properly and understood it and only then he has affixed his signatures thereon, otherwise, no signature on a document can ever be accepted."

8. Clause No.7 of the proposal form relates to medical questionnaire and the deceased has given answers in negative to all the questions regarding his health. Question No.III and No.VIII are as under:-

"Q.No.III. Have you ever been treated for or told that you have diabetes or raised blood sugar, high blood pressure, heart attack, chest pain or any heart disease, stroke/paralysis or any other disorder of the circulatory system, HIV infection or a positive test to HIV?

Q.No.VIII. Have you had or have been advised to undergo any of the following tests or investigations?

1. Ultra Sonography 2.CT Scan/MRI

3. Biopsy 4. Coronary Angiography".

9. To both these questions, the deceased life assured gave answers in negative. However from the documentary evidence on record, it stand proved that Mukesh Kumar had gone Angioplasty before taking the policy. So he was having heart problem before inception of the policy. Ex.OP3/6 is Angioplasty report of Mukesh Kumar since deceased issued by Mediciti Hospital. Ex.OP3/7 is discharge card issued by above hospital wherein date of admission is mentioned as 28.4.2008 and date of discharge is mentioned as 6.5.2008. From the discharge card it is evident that the deceased has undergone Angiography on 29.4.2008 which revealed CAD:Single Vessal Disease(RCA). Ex.OP3/8 is certificate issued by the above said hospital wherein it is mentioned as under:-

" This is to certify that Mr.Mukesh Kumar son of S.Shadi Ram aged 43 years, R/o H.No.284, Partap Nagar, Jalandhar City was admitted in our hospital on 28.4.2008 with the diagnosis of CAD:Unstable Angina with normal sinus Rhythm with No LVF. Coronary Angiography was done on 29.4.2008 which revealed CAD:Single vessal disease (RCA). PTCA to RCA was done on 3.5.2008. He was discharged on 6.5.2008 and advised rest for one week till 13.5.2008. He has been examined today again and is advised further rest for two weeks w.e.f today".

10. So from this certificate, it is also evident that the deceased was suffering from CAD:Unstable Angina and has undergone Angioplasty. While taking the policy in question the deceased has suppressed these material facts regarding his health. The deceased was suffering from heart problem before taking the policy in question and according to the own version of the complainant the deceased suffering heart attack and ultimately died on 3.4.2013. So ailment which deceased life assured i.e Mukesh Kumar suppressed has directed nexus with his death. So in the above circumstances, the opposite parities No.3 and 4 insurance company was justified in repudiating the claim of the complainant on the ground of suppression of material facts by DLA at the time of taking policy.

11. In view of above discussion, we hold that there is no merit in the present complaint and same is hereby dismissed with no order as to cost. Copies of the order be sent to the parties free of costs under rules. File be consigned to the record room.

Dated Parminder Sharma Jyotsna Thatai Jaspal Singh Bhatia

26.02.2015 Member Member President