Karnataka

Gadag

CC/115/2019

Smt Manjula W/o Late Basavaraju Hugar - Complainant(s)

Versus

The Branch Manager, SBI Life Insurance Co Ltd., and another - Opp.Party(s)

M.V.Mudagal

28 Feb 2020

ORDER

 

-::O R D E R::-

 

BY: SMT.C.H.SAMIUNNISA ABRAR, PRESIDENT.

 

1.       The complainant has filed this complaint claiming direction to the OPs to pay policy amount of Rs.10,00,000/-, Rs.50,000/- towards mental and physical pain, Rs.50,000/- towards deficiency of service and cost of Rs.10,000/-, in all a sum of Rs.11,10,000/- with interest at the rate of 18% p.a and such other relief.

-::Brief facts of the case are as under::-

2.      The case of the complainant is that, the husband of complainant late Basavaraju S/o Narayanappa Hugar has obtained insurance policy from the OP bearing Policy No.35750463610 under Plan SBI life – Shubh Nivesh Endowment Option on 03.08.2017 for a sum of Rs.10,00,000/-.  The policy was half yearly premium of Rs.19,965/-.  The complainant made a nominee under the policy who is the wife of life insured.  It is further submitted that, the husband of complainant died unexpectedly on 29.11.2017 due to heart attack at Koppal.  Thereafter, the complainant approached the OP and claimed the policy amount by producing all the necessary documents.  For that, the OP has issued letter dated 19.03.2018 refusing the claim by stating that, her husband had taken another policy informing the wrong occupation and income, which is not reasonable.  The proposal form was filled by the agent of OP in English language, which is a deficiency of service and unfair trade practice, which caused physical and mental stress to the complainant.  The cause of action arose to file this complaint on 19.03.2019 when the OP failed to fulfill the demands of complainant.  Hence, the OPs are liable to pay an amount of Rs.10,00,000/-, Rs.50,000/- towards mental and physical pain, Rs.50,000/- towards deficiency of service and cost of Rs.10,000/-, in all a sum of Rs.11,10,000/- with interest at the rate of 18% p.a.

3.      Registered the complaint and notice was ordered, as such OPs present before the Forum and filed written version, the contents are as follows.

Written Version of the OPs

The OPs contended that, the life assured Basavaraj had submitted proposal form bearing No.35QW625914 on 29.07.2017 for SBI Life Shubh Nivesh Plan and obtained the policy bearing No.35750463610 with date of commencement of risk as 03.08.2017 for a sum assured amount of Rs.10,00,000/- with half yearly premium of Rs.19,965/-.  As per the investigation report, the husband of complainant died in the month of June 2017 and not on 29.11.2017 and there is a suspicion of death prior to date of signing of proposal form.  It is true that, the complainant approached the OPs claiming insurance amount.  The claim of the complainant was not payable as (1) deceased life assured availed the insurance cover fraudulently by (a) suppression of previous insurance policy applied with Reliance life (b) suppression of preexisting illness of liver disease (c) declared income in the proposal was Rs.3,00,000/- and the actual income was Rs.1,50,000/-, (2) suspected pre-DOC death.  It is specifically denied that grounds of repudiation are incorrect.  A person who signs a document is responsible for the contents of the document signed by him/her, he/she cannot plead ignorance of the documents signed by her/him. It is further specifically denied that life assured had no knowledge signed by him/her.  If the proposer/DLA disowns the information given in the proposal and thereby disowns the proposal form itself, the proposal itself becomes a nullity and when the proposal form is invalid, the contract of insurance issued based on such proposal form, also by default becomes null and void.  Hence, all the allegations in this regard are denied.  There is no deficiency of service on the part of the OPs and the complainant not suffered any physical and mental agony due to the action of these OPs.  The address of OP No.2 is at Mumbai, but the complaint is filed before this Forum, hence, the complaint is not maintainable for want of territorial jurisdiction of this Forum and hence, this complaint is liable to be dismissed against OP No.2.  It is well decided principle of law that a person is responsible for the contents of document signed by him/her.  He/she cannot plead ignorance of the document signed by him.  The DLA never raised any such issues during his life time, hence the complainant has no locus to raise any such issues.  If the proposer/DLA disowns the information given in the proposal and thereby disowns the proposal form itself, the proposal itself becomes a nullity and when the proposal form is invalid, the contract of insurance issued based on such proposal form, also by default becomes null and void.  Hence, all the allegations in this regard are denied.  Therefore, the complainant is not entitled to get Rs.10,00,000/- towards the policy amount, Rs.50,000/- towards physical and mental torture, Rs.50,000/- towards deficiency in service, Rs.10,000/- towards fee/charges in total Rs.11,10,000/- with interest or any amount of whatsoever in nature as prayed.  It is further submitted that, the DLA and the complainant had committed a fraud as is evident from the facts and documents as stated supra.  It is further submitted that, as per the amendment to Section 45 of the Insurance Act, 1938, it is clearly stated that, “ ……. In case of fraud, the onus of disproving lies upon the beneficiaries in case the policyholder is not alive.”  Therefore, the present complaint is frivolous and the complainant is trying to harass OPs by making issue out of no issue.  Hence, the present complaint is liable to be dismissed by imposing pecuniary damages on the complainant for filing this frivolous complaint and wasting the precious time of this Forum as the complainant failed to prove any carelessness, negligence, deficiency in service or unfair trade practice on the part of these OPs.  As there is a lack of basic ingredients required for Consumer Dispute, the present complaint does not fall under the Consumer Protection Act, 1986 and hence, the present complaint is to be dismissed in limine.        

4.      The complainant has filed her affidavit evidence and filed 02 documents.  The Authorized Representative of OPs filed his affidavit evidence and 05 documents have been produced.

COMPLAINANT FILED DOCUMENTS AS follows

	Particulars of Documents	Date of Document
C-1	Customer acknowledgement slip
C-2	Letter of refusing the claim

OP FILED DOCUMENTS AS follows

	Particulars of Documents	Date of Document
OP-1	Proposal Form
OP-2	Letter of acceptance by OP
OP-3	Claimant’s statement-Death Claim
OP-4	Online message
OP-5	Letter of refusing the claim

 

5.     On the basis of above said pleading, oral and documentary evidence, the following points arises for adjudication which are as follows:

1.       Whether the Complainant proves that, the OPs have committed deficiency of service and unfair trade practice?

2.       Whether the Complainant proves that, he is entitled for the relief?  

            3.       What order?

6.      Our Answer to the above points are:-

​            1.Affirmative

             2.Partly Affirmative

             3. As per final order

 

REASONS

7.      Point No-1 & 2:- Since both the points are identical and interlinked with each other and hence, we proceed both together.   

8.      The complainant has filed this complaint against the OPs stating that, the OP had not settled the death claim of deceased Basavaraj Hugar on the ground that, non-disclosure of material information and non-disclosure of other insurance policy.  The said deceased insured his life with OP under the name and fame of policy SBI life Shubh Nivesh endowment option on 03.08.2017 for Rs.10,00,000/- and further complainant submits that, he had paid six installments.  On 29.11.2017, husband of the complainant died due to heart attack.  Complainant approached the OP, OP repudiated the same as supra. 

9.  On the other hand, OP submits that, the complainant’s husband suppressed the material information, the insurance is a fatal to the contract which is based on the principle of utmost good faith.   Complainant failed to prevail pre-existing disease and existing life insurance details with other insurance Company. 

10.     On going through the complaint and written version and documents placed before the Forum, it is an undisputed fact that, husband of the complainant insured his life with OP.  The important point has to be discussed and clarified is that, whether husband of the complainant had suppressed the information which has prevailed during the purchase of the policy.  OP produced the document pertaining to the policy i.e., Ex.OP-4, the investigation report filed by the OPs Company.  That the visitor visited on 01.03.2018 and he had collected some information about the deceased.  As per the investigation report, in page No.11, Point No.5, it has been mentioned that, there is an ambiguity to the date of death is different from the date of death certificate produced before the OP. While investigating about the deceased, he had died in the month of June 2017, but the Death Certificate speaks that, he died on 29.11.2017.  If so, the OP had not filed any single document to substantiate the same.  If the deceased died in the month of June 2017, how can the OP issued/insured the life of a deceased as per Ex.OP-1.  Ex.OP-1 speaks that, complainant insured his life on 29.07.2017, if so, how the agent of OP insured the life of a deceased. Anyhow, to this extent also, the OP is vicariously liable for the act of his agent.  But, complainant produced the Death Certificate issued by the competent authority, which has been produced by the complainant before the Forum, it says that, the husband of the complainant had died on 29.11.2017.  Anyhow, as stated supra in page No.11, the reporter of OP, report that, one Dr. Chandrakanth stated that, he was admitted as an inpatient in his Hospital before two days of complainant’s husband death and he was suffering from Hepatitis.  Such being the fact, how the OP came to the conclusion that, he had a pre-existing disease abdominal related illness and chronic alcohol and smoker.  Without filing proper document to prove their case and without any evidence of a Doctor OP cannot say that, he had a chronic disease before purchase of the said policy.

11.     Prior to the another contention taken by the OP is that, the husband of the complainant was insured his life with the other insurance Company also, if so, why OP had not filed the document pertaining to the other policy as per their defence.   Hence, we cannot rely upon the report filed the OPs agent himself since the policy has been issued by OP through the agent of his own, but they denied the date of death that means when they denied the same which has been mediated by his agent only, how can we accept the report of his agent without proper document.  Hence, Forum comes to the conclusion that, OP is liable to pay the claim amount.  Hence, we answer point No.1 is in Affirmative and Point No.2 in partly Affirmative.

12.    Point No.3:-        For the reasons and discussion made above we proceed to pass the following:-

6698606.  

1.       The complaint filed by the complainant is partly allowed.

2.       OP is directed to pay the sum assured amount of Rs.10,00,000/- along with interest @ 6% from the date of filing this complaint within one month.  Further Op is directed to pay an amount of Rs.5,000/- towards mental agony and harassment, deficiency of service and Rs.1,000/- towards litigation charges.

3.       Further OP is directed to comply this order within one month, failing which OP is liable to pay interest @ 12% on the sum assured from the date of repudiation till realization.    

4.       Send a copy of this order to both parties free of cost.  

(Dictated to the Stenographer, transcribed by him, corrected and then pronounced by me in the Open Court 28^th day of February-2020)

 

 

 (Shri B.S.Keri)                                        (Smt.C.H.Samiunnisa Abrar)

       MEMBER                                                      PRESIDENT