The complainant Sri Devendra Singh has filed this complaint petition against Branch Manager, S.B.I. Life Insurance Company Ltd. Sinha Complex, near Jubba Sahani Park, Club Road Muzaffarpur and one another for realization of Rs. 5,00,000/- as sum assured, Rs. 51, 000/- for compensation for mental, agony and physical harassment, and Rs. 25,000/- as litigation cost with 18 % p.a interest on total sought amount from the date of death of life insured person till date of final payment/ realization.
The brief, facts, of the case is that the father of the complainant namely Chandradeo Singh purchased a policy bearing No. 35048777607 for sum assured amount Rs. 5,00,000/- along with other monetary benefits from o.p company after paying premium of Rs. 14,800/- by way of D.D. No. 296562 on 31-12-2013. The further case of the complainant is that the entire proposal form was filledup by companie’s agent and the complainant ‘s father only put his signature wherever agent told him to do so, in good faith trusting upon agent knowledge and techanility about life insurance policy. After accepting the premium amount the aforesaid company issued premium receipt and bond in the name of L.A. person namely Chandradeo Singh and risk was started from 10-01-2014, The further case is that on 08-02-2014 all of a sudden the aforesaid policy holder namely Chandradeo Singh complaint about chest pain followed by cold/diahrrea to the family member who in return consulted with family Dr. A.K.Sharma but he could not save his life and the L.A. expired on the same day. The further case is that the complainant filed death claim against policy with all the relevant documents but the insurance company repudiated the claim on the ground that yearly income of L.A. was less than he had stated in the proposal form that is less than Rs. 1,80,000/-
The complainant has filed the following documents with the complaint petition - photocopy of first premium receipt annexure-1, photocopy of death certificate annexure-2, photocopy of land and possession certificate annexure-3, photocopy of repudiation letter annexure-4
On issuance of summon, o.ps. appeared and filed their w.s. on 22-05-2018 with prayer to dismiss the complaint with exemplary cost. It has been further mentioned in the w.s. that the Managing Director ( o.p no.2) is not involved in the operational activities and as such the complaint is not tenable against him. Issuance of policy bearing No.- 35048777607 by o.p company, commencement from 10-01-2014 for terms of 20 years with sum assured Rs. 5 lacs has been admitted in the w.s. The o.ps have annexed the proposal form and policy document as annexure- A and B, filing of claim before o.p company on 26-09-2014 is also an admitted fact and the same has been marked as annexure-C. It has been also mentioned in the w.s. that L.A. had given wrong answer in the proposal form regarding his annual income and occupation and as such he suppress the material facts. It has been further mentioned that on the above ground the complaint is not maintainable. It has been further mentioned that L.A has committed fraud by suppressing material facts. It has been further mentioned that as the policy result in an early claim within 29 days from the date of its commencement, investigation was started. It has been further mentioned that from the investigation it was revealed that the D.L.A was not having any Kirana Store at the time of proposal for insurance coverage. As per the investigation report, the D.L.A was a land less farm labour with no verifiable income. He had neither shop nor any agricultural land in the village. It has been further mentioned that was DLA with poor health and he had no means to get treatment due to fund shortage. O.ps have annexed the Investigation report as annexure-D. It has been further mentioned that during investigation, it also came that at the time of investigating complainant provided a copy of D.L.A passbook having account No.- 512355 in the post office. On enquiry it was revealed that D.L.A was not having said amount in the post office. The same was also confirmed from superintendent of Post of Dharbhanaga and it was found that account no.512355 was in the name of Dharmantri Kumar of Village-Tekta and the said account was closed on 21-05-2195. Copies of the passbook, letter from the superintendent, copy of ledger of account no. 512355 have been annexed as annexure E1, E2, E,3. It has been further mentioned that o.ps checked the financial status of the D.L.A online and it was revealed that the name of the L.A appeared in the B.P.L list of Government of Bihar. Copy of the B.P.L. list has also been annexed as annexure-F. It has been further mentioned that the premium paid by the D.L.A was refunded to the complainant in his company account No.-112710026809 in the Dena Bank. A copy of repudiation letter has been annexed as annexure-G. It has been further mentioned that o.ps had received a letter for reconsideration from the complainant with a plea that D.L.A was holding some land. The same was submitted before review committee, who decided to uphold the repudiation letter’s decision. O.ps have marked the copy of representation received along with land documents and receipt, acknowledgment letter and C.R.C. decision letter as annexure- H, I & J.
On behalf of complainant, Devendra Singh has examined himself on affidavit as AW-1. In his deposition, he has marked the annexure already filed as exhibit 1 to 5.
On behalf of o.ps, OPw-1 Nilam Singh has been examined on affidavit.
The o.ps company have repudiated the claim of the complainant on the ground that Late Chandradeo Singh had answered the question no.-6 in proposal form as follows- ‘The question relating to occupation – Kirana store and annual Rs. 1,80,000/-. It has been further mentioned that Late Chandradeo Singh had grossly overstated his income in the proposal form and had not disclosed correct information regarding his occupation and income in the proposal form.” The complainant has stated in the complaint petition that the entire proposal form was filled by company’s agent and complainant ‘s father only put his signature wherever the agent told him to do so in good- faith trusting upon agent’s knowledge and techanility about life insurance policy.
On perusal of proposal form annexure-A, it transpires that the proposal form has been filled in English and the D.L.A has put his signature in Hindi on the proposal form. In para 18 of the proposal form, agent Sushil Kr has declared in the following language- “ I, here by declare that I have explained contents of the form to the proposal in Hindi language, that I have truly and correctly recorded the answers given by the proposer and that the proposes has affixed his/her thumb impression on the proposal form in my presence after fully understanding the contents their of”.
The agent Sushil Kr.has not been examined on behalf of o.ps. No explanation has been offered on his behalf to show as to why he was not examined. So, it is not proved that the contents of the proposal form has been read over to the proposer and the same has been truely recorded by the agent. On behalf of o.p, op- W1 Neelam Singh has been examined who is only authorized representative of SBI Life Insurance company and she is only hearsay witness in this regard.
Complainant Devendra Singh has denied in his deposition filed on affidavit that L.A. has not suppressed about his income and occupation.
Learned Lawyer for the complainant relied on two rulings one of National Consumer Dispute Redressal Commission new Delhi, and other of Hon’ble Delhi High court.
In the case of Life Insurance Corporation of India V/s Smt. Chanagori Upendra, revision petition No.-519/2007, Hon’ble National Commission Dispute Redressal Commission, new Delhi has observed vide order dated 10-01-2012 in the following manners –“ Having accepted the premiums and issued the policies the insurance company cannot absolve their liability without adducing in any evidence to substantiate their contention that the insured had will fully and fraudulently suppressed the material facts which he ought to have disclosed. “Lastly on the above ground Hon’ble Commission reached at the conclusion that at this Juncture the insurance companies is not justified in repudiating the claim.
In another Case of Manoher Lal / Vs Life Insurance Corporation, The Hon’ble Delhi High Court has considered on 11-09-1980 that the question is whether an accurate description of occupation in the proposal form for insurance “avoids the policy’. In para-47 of the order Hon’ble High Court has observed as follow- (47). The Policy in the present case was repudiated after more than 2 years. It was done by letter dated 20/21st November 1959. The burden u/s -45 is on the insurer to show that the suppression of the fact that the plaintiff was a mill worker was a circumstances which it was material to disclose and its suppression was fraudulent and that the policy holder know at the time of making it that his statement about occupation was false and that it suppressed facts which it was material disclose. Nothing short of deliberate fraud has to be proved by the insurance if the policy is called in question after 2 years. I have come to conclusion that the corporation has utterly failed to discharge the onus”.
As we have already discussed that the insurance company has not discharged his duty by adducing proper evidence and repudiated the claim of the complainant on the ground of income and occupation. In the circumstances we find that there is deficiency on the part of the company.
Accordingly, complaint petition is allowed and the o.ps are directed to pay Rs. 5,00,000/- as sum assured with7 % interest p.a from the date of filing of complaint petition, i.e 10-03-2016, Rs. 20,000/- as compensation for physical and mental harassment and Rs. 10,000/- as litigation cost within two months from the date of order, on failure to pay the aforesaid amount the o.ps shall be liable to pay the same with 9 % p.a. interest till realization. Let a copy of this order be furnished to both the parties as per rule.
