Punjab

StateCommission

FA/12/560

SBI Life Insurance Company Ltd. - Complainant(s)

Versus

Sukhpreet Kaur - Opp.Party(s)

Rajneesh Malhotra

06 Aug 2015

ORDER

                                                               FIRST ADDITIONAL BENCH

 

STATE  CONSUMER  DISPUTES  REDRESSAL COMMISSION,   PUNJAB

          SECTOR 37-A, DAKSHIN MARG, CHANDIGARH

                                     

                   First Appeal No.560 of 2012

 

 

                                                          Date of Institution: 08.05.2012          

                                                          Date of Decision : 06.08.2015

 

1.       SBI Life Insurance Company Limited, through its Authorized  Signatory, Registered Office at State Bank Bhawan, Madame         Cama  Road, Nariman Point, Mumbai 400021.

 

2.       SBI Life Insurance Company Limited, through its Authorized    Signatory, Central Processing Centre, Kapas Bhawan, Plot No.3-A,    Sector 10, CBD Belapur, Navi Mumbai 400614.

 

          (Through Shri. V.Srinivas S/o Late V.M Somayajulu, having office   at, SBI Life Insurance Company, Ist Floor, Kapas Bhawan, Central Processing Unit (CPC) CBD, Belapur, Navi Mumbai 400614

                                                                                                                                                                                                                                                                                                                                                                                     …..Appellants/Opposite Party no.2 and 3

                                               

                                      Versus

 

1.       Sukhpreet Kaur wife of Late Sh. Jaspal Singh Randhawa son of late     Sh.Jung Singh, resident of K.No.3, Near Puri Service Station, Puri Colony, Faridkot.

2.       Gupreet Kaur minor daughter of late Jaspal Singh Randhawa son of     late Sh. Jung Singh through her mother Smt. Sukhpreet Kaur as her      natural guardian resident of K.No.3, Near Puri Service Station, Puri        Colony, Faridkot.

                                                                                                                                                …..Respondents/Complainant no.1 and 2

 

3.       State Bank of Patiala, Main Branch, Faridkot through its Manager.

 

                                                                                                                                         … Performa Respondent/Opposite Party no.1

 

 

First Appeal against order dated 30.03.2012 passed by the District Consumer Disputes Redressal Forum, Sri Faridkot

Quorum:-

 

          Shri J. S. Klar, Presiding Judicial Member.

          Shri. Harcharan Singh Guram, Member

 

 

Present:-

 

          For the appellant                      : Sh.Rajneesh Malhotra, Advocate  

          For the respondent no.1 & 2   :  Sh.Vivek Goyal, Advocate

          For the respondent no.3         :  Sh.D.K.Singal, Advocate.

 

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

 

J.S KLAR, PRESIDING JUDICIAL MEMBER :-

         

          The appellants of this appeal (the opposite parties no.2 and 3 in the complaint) have directed this appeal against the respondents no.1 and 2 of this appeal (the complainants no.1 and 2 in the complaint) and respondent no.3 (the opposite party no.1 in the complaint), challenging order dated 30.03.2012 of District Consumer Disputes Redressal Forum Faridkot, accepting the complaint of the complainant and directing the OP No.2 and 3 to pay the outstanding amount of Rs.3,03,657/- on 13.09.2010 along with interest up to date and other charges, if any, as per the statement of account  maintained by OP No.1, besides Rs.25,000/- as  compensation for mental harassment and litigation expenses. OP No.2 and 3 have been further directed to pay the above said amount within a period of one month from date of receipt of copy of this order, failing which OP No.2 and 3 shall pay interest @ 9% per annum from the date of order till its realization. The instant appeal has been preferred against the same by the OP No.2 and 3 now appellants in this appeal.

2.      The complainants have filed  the complaint U/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the OPs, on the averments that Jaspal Singh Randhawa was the husband of the complainant no.1/Sukhpreet Kaur  and father of complainant no.2 minor Gupreet Kaur and he was employed  as Assistant Excise & Taxation Commissioner Faridkot and he died on 13.09.2010 due to heart failure. The above-said Jaspal Singh Randhawa availed car loan from OP No.1 amounting to Rs.3,80,000/- and he was sanctioned the loan on 11.6.09, vide account no.65056789201 and said car was duly registered with the DTO Office Faridkot. The hypothecation clause in favour of OP No.1 was duly entered in the registration cover. Jaspal Singh Randhawa (since deceased) also purchased one SBP Dhanaraksha Plus LPPT Group Insurance Scheme launched by SBI Life Insurance Company Limited Nariman Point Mumbai through SBI Life Insurance Company Limited/OP No.1. The membership of insurance policy bore no.9320844  having Master Policy No.93000000203 and an amount of Rs.3,83,000/- was the sum assured under the said policy on 08.09.2009 and the premium of Rs.3000/- was duly paid by the Jaspal Singh Randhawa (since deceased) to OPs . The mother of the life assured Jaspal Singh Randhawa, namely Smt. Charanjit Kaur predeceased him on 15.7.2005 and life assured Jaspal Singh Randhawa died on 13.09.2010. The complainant  no.1 lodged the insurance claim with the OPs after death of life assured Jaspal Singh Randhawa being his legal representative on 2.11.2010, which was referred to OP No.2 and 3  by OP No.1. OP No.2 and 3 repudiated the insurance claim on flimsy grounds that Jaspal Singh Randhawa was suffering from pre-existing disease of Diabetes Mellitus, which was totally against the facts. The insurance claim was repudiated by OP No.2 and 3 on 10.2.2011 without any valid reasons. The complainant contacted OPs, but to no effect. The complainants have, thus, filed the present complaint against the OPs directing them to pay the policy amount to the complainants, taken against car loan availed by the deceased Jaspal Singh and to issue No Due Certificate for releasing hypothecation clause in the registered cover of the car bearing No.PB-04-N-2710 and to pay Rs.50,000/-, as compensation for mental harassment to complainant and Rs.11,000/-, as costs of the litigation.

3.      Upon notice, OP No.1 filed its separate written reply raising preliminary objections that complainants have no locus standi to file the present complainant and complaint is not maintainable. It was further pleaded that Jaspal Singh Randhawa suppressed the material facts regarding his health, when he took the insurance policy from OPs. He submitted the declaration of his good health when he took the insurance policy and had not disclosed that he was already suffering from Diabetes Mellitus and Hypertension prior to taking insurance policy in this case. On merits, OP No.2 further pleaded that during the investigation of the claim, it came to light that Jaspal Singh Randhawa was suffering from Diabetes Mellitus and Hypertension since 2008. It was further pleaded that the insured submitted wrong declaration regarding his health by suppressing material facts in the declaration and OP No.1 prayed for dismissal of the present complaint on the above-referred grounds.

4.      OP No.2 and 3 filed their separate written reply raising preliminary objections that complainant admitted this fact in the complaint that she also complained to Insurance Ombudsman Chandigarh and hence the jurisdiction of the Consumer Forum is excluded. The Contract of Insurance is based on utmost good faith and life assured Japal Singh Randhawa was already suffering from pre-existing diseases of  Diabetes Mellitus and Hypertension and he intentionally concealed the material information from OP No.2 and 3 deliberately, when he took the insurance policy. On merits, it was admitted that Jaspal Singh Randhawa availed housing loan from State Bank of Patiala and applied for Dhanraksha Plus LPPT Group Insurance Scheme under Master Policy No.93000000203 through Membership Form No.9320844 dated 11.06.2009, which was received on 07.09.2009. The life assured had not disclosed that he was already suffering from Diabetes Mellitus and Hypertension and, thus, concealed this material fact with regard his previous ailment from insurer. OP No.2 and 3 contested the complaint of the complainant primarily on the ground that under Section 45 of the Insurance Act, when life assured concealed any material fact regarding his health deliberately and fraudulently, then Contract of Insurance stands nullified. It was further pleaded that Contract of Insurance is based on the principle of utmost good faith. The Consumer Forum has no jurisdiction, as Insurance Ombudsman Chandigarh has already taken cognizance of the matter. OP No.2 and 3 prayed for dismissal of the present complaint.

5.      The complainant tendered in evidence, the affidavit of the complainant Ex.C-1 along with copies of the documents Ex.C-2 to Ex.C-8. As against it, OPs tendered in evidence the affidavit of V. Srinivas Central Processing Center (CPC) Ex.R-1 and affidavit of Vijay Kumar Sharma Chief Manager SBOP Faridkot Ex.R-19 along with copies of documents Ex.R-2 to Ex.R-18. On conclusion of evidence and arguments, the District Forum, Faridkot, accepted the complaint of the complainant directing OP No.2 and 3 to pay the outstanding amount of Rs.3,03,657/- on 13.09.2010 along with interest up to date and other charges, if any, as per the statement of account  maintained by OP No.1, besides Rs.25,000/- as compensation for mental harassment and litigation expenses. The OP No.2 and 3 now appellants carried this appeal against the same.

6.      We have heard learned counsel for the parties and have also examined the record of the case with able assistance of counsel for the parties.

7.      The only contention raised by Sh.Rajneesh Malhotra, counsel for appellants in this appeal is that life assured Jaspal Singh Randhawa was already suffering from pre-existing diseases of Diabetes Mellitus and Hypertension and he had fraudulently suppressed the fact of his above pre-existing diseases i.e. Diabetes Mellitus and Hypertension from OPs and thereby the Contract of Insurance stood nullified, which is founded on the utmost good faith principle. In fact, the sole point raised for consideration in this appeal before us is whether there is any deliberate material concealment of his pre-existing diseases i.e. Diabetes Mellitus and Hypertension by the life assured Jaspal Singh Randhawa or not?

8.      The evidence is required to be examined by us on the record to decide the controversy in this case. Pleadings of both the parties contained in their respective affidavits as well have been duly considered by us carefully. The fact of Jaspal Singh Randhawa having taken the insurance coverage from OP No.2 and 3 through OP No.1 is not disputed one in this case. Similarly, it is not disputed fact that he had paid premium for this insurance policy. The affidavit of Sukhpreet Kaur complainant is Ex.C-1 on the record to the effect that her husband availed of a car loan from the OP No.1 of Rs.3,80,000/- and he was sanctioned loan on 11.6.2009. The said car was registered with the Registering Authority Faridkot and hypothecation clause was additionally entered therein. She further stated that her husband purchased one SBP Dhanraksha Plus LPPT Group Insurance Scheme launched by SBI Life Insurance Company Limited, Mumbai. The said policy was purchased from OP No.1 by her husband. She further stated that premium of Rs.3000/- was duly paid by her husband to the insurer. The Contract of Insurance taken by her husband Jaspal Singh Randhawa was repudiated by the OPs without any valid grounds against the instructions of the Insurance Regulatory Development Authority (IRDA). Ex.C-1 is copy of the insurance on the record. Ex.C-4 is certificate of Insurance (COI). Ex.C-5 is Premium Certificate. Ex.C-6       is the Voter Card of Sukhpreet Kaur complainant. Ex.C-7 is the registration certificate of the vehicle in question.

9.      To counter this evidence, the OPs relied upon the affidavit of Sh. V.Srinivas , Central Processing Center (CPC), Belapur Navi Mumbai Ex.OP-1 on the record. He stated in this affidavit that Contract of Insurance is based on the utmost good faith. The declaration was required to be signed by healthy person, who was not suffering from any diseases before taking the insurance policy. He further stated that Jaspal Singh Randhawa had not intentionally disclosed the fact that he was already suffering from Diabetes Mellitus and Hypertension prior to taking the insurance policy in question in this case. He gave wrong answers in the proposal form, when he took the insurance policy. Ex.R-2 is copy of the policy on the record. Ex.R-3 is proposal form of SBI Life Insurance Company. Ex.R-4 is Certificate of Insurance. Ex.R-5 is letter from M.L. Bhatia who sent investigation report to OP No.2 and 3. OPs also relied upon Ex.R-6 the prescription slip issued by Punjab Health System Corporation Limited to Jaspal Singh S/o Jung Singh on 06.06.08. The diagnosis of Diabetes Mellitus and Hypertension is recorded in Ex.R-6, vide registration no. 27375 dated 6.6.2008. Ex.R-7 is report of the laboratory dated 14.6.2008 by Har Gobind Clinical Laboratory. The glycemic index was found positive in the urine report of the insured. Ex.R-8 is report of Chandigarh Clinical Laboratory Faridkot regarding glycemic index (fasting) as 344 and Uric Acid as 6.2, this report is dated 30.10.2010. Ex.R-9 is prescription slip of Punjab Health Systems Corporation of Jaspal Singh Randhawa, in which  it was observed that Japal Singh Randhawa was a patient of Diabetes Mellitus and Hypertension and CAD and this slip is dated 14.07.2010. Ex.R-10   is death claim lodged by the complainant. Ex.R-11 is Medical Attendant's Certificate regarding his death on 13.09.2010 and it recorded that he was a patient of Diabetes Mellitus and Hypertension CAD. Ex.R-12 is Certificate of Hospital Treatment. Ex.R-13 is letter addressed to OP No.1 by OP No.2 and 3 that life assured gave false good health declaration in this case in the insurer. Order of Insurance Ombudsman Chandigarh Ex..R-18 for sending the documents to complainant. Ex.R-19 is affidavit of Vijay Kumar Sharma Chief Manager Principal Officer of State Bank of Patiala in support of allegations of the OPs.

10.    From evaluation of the above-referred evidence on the record, we are of this conclusion that complainant was sanctioned loan on 11.6.09, vide account no.65056789201 of the car. Jaspal Singh Randhawa (since deceased) also purchased one SBP Dhanaraksha Plus LPPT Group Insurance Scheme launched by OP No.2 and 3 through OP No.1 at that time. The assured amount was of Rs. 3,83,000/-  and Rs.3,000/-, as premium and policy was dated 08.09.09. From Ex.R-6 is prescription slip of Punjab Health System Corporation, it is evident that on 6.6.08 life assured Jaspal Singh Randhawa was suffering from Diabetes Mellitus and Hypertension. Ex.R-6 could not be a fabricated document, it has proved this fact that Jaspal Singh Randhawa was a patient of Diabetes Mellitus and Hypertension on 6.6.08. Even from analysis of his sugar level, it was found  positive, vide laboratory report Ex.R-7 dated 14.6.08, which is in corroboration to prescription slip Ex.R-6. Ex.R-9 is the prescription slip dated 14.7.2010 recording him to be a patient of Diabetes Mellitus and Hypertension CAD. We find that the document Ex.R-6 issued by Punjab Health System Corporation (Government Hospital) cannot be a false document and it carries authenticity to it. It has, thus, clearly proved on the record that Jaspal Singh Randhawa was suffering from Diabetes Mellitus and Hypertension on 6.6.08. Jaspal Singh Randhawa was an educated person and it cannot be presumed that he was not aware of his health status, when medicines were given to him by means of prescription slip/OPD Slip vide, Ex.R-6, vide registration no. 27375 dated 06.06.2008. This important aspect of the matter has been overlooked by the District Forum in this case in the order under challenge in this case. District Forum has overlooked this important aspect of the matter that it is the responsibility of the life assured to declare correctly that he was suffering from any pre-existing disease; life assured gave wrong answer by not declaring this fact to OPs and took the insurance policy by keeping the OPs in darkness about it. OPs might have refused to insure the life assured Jaspal Singh Randhawa, had they come to know that he was already suffering from Diabetes Mellitus and Hypertension much earlier to taking the policy in question. The Contract of Insurance is based on principle of Uberrima Fides, which is of utmost good faith and any suppression of material information intentionally by the life assured renders it as invalid contract.  

11.    In view of law laid down by Apex Court in "P.C Chacko and another versus.  Chairman Life Insurance Corporation of India and others" (2008) 1 SCC 321  and "Satwant Kaur Sandhu versus LIC" , reported in 2009 CTJ 956 (Supreme Court) (CP), we are of this view that repudiation of the Contract of Insurance is liable to be upheld on the ground of non-disclosure and mis-statement in the proposal form to various questions by the life assured/Jaspal Singh Randhawa in a false manner. It has also been held in "Mithoolal Nayak versus LIC of India" reported in AIR 1962 (SC) 814  that even if life assured is examined by a doctor of the insurer, the insured is not absolved from his responsibility of disclosure of material facts in a Contract of Insurance. The mere fact that he was examined by doctor of the insurer would not absolve him from giving correct answers regarding his health status to OPs, when he took the insurance policy.

12.    In the light of our above discussion, we hold that Contract of Insurance has been rightly repudiated by OPs in this case. The order of the District Forum under challenge in this case is unsustainable in this appeal and by setting aside the order of the District Forum Fardikot dated  30.03.2012, we accept the appeal of the appellant and hereby dismiss the complaint of the complainant.

13.    The appellant has deposited an amount of Rs.25,000/- with this Commission at the time of filing the appeal. This amount with interest, if any, accrued thereon, be refunded by the registry to the appellant by way of crossed cheque/demand draft after 45 days from receipt of copy of this order.

14.    Arguments in this appeal were heard on 30.07.2015 and the order was reserved. Copies of the order be communicated to the parties as per rules.

15.    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

 

August 6,  2015.                                                            

(ravi)