DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KALAHANDI AT BHAWANIPATNA

CC 69 OF 2018

Date of order 18^th February, 2019

Present:-

Sri. Aswini Kumar Sahoo, M.A, LL.B OSPS(I) Sr. Retd.                             President.

Smt. Bhawani Pattnaik, M.A, LL.B, PGDCLP,                                            Member.

Gouri Rout, aged about 50 years,  W/O. Late Bibhisan Rout,

At- Kanyashram Pada, P.O./P.S.- Junagarh, District Kalahandi,

 Odisha. Pin-766014.                                                                                                                                                                                                      ……Complainant.

                                     VRS.

1. The Branch Manager, State Bank of India, Junagarh ADB Branch,

At- Main Road, P.O. Junagarh, District Kalahandi, Odisha. Pin-766014.

2. The Regional Manager, SBI, Regional Business Office, Region – IV,

At/P.O./P.S.- Bhawanipatna, District Kalahandi, Odisha. Pin-76001

3. The Branch Manager, SBI Life Insurance Company Limited,

At- Nuapada, Near BSNL Office, P.O./P.S.- Bhawanipatna (Town),

District Kalahandi, Odisha. Pin-766001.

Central Processing Center, Kapas Bhawan, Sector – 10,

CBD Belapur, Navi Mumbai- 400614……Opposite parties.

            Counsel :

For the Complainant :  Sri Satyen Choudhury &  Associates Advocate,  Bhawanipatna.

For the O.P. 1 & :        Sri S. K.Agrawal Advocate, Bhawanipatna

For the O.P.3, 4 & 5:   Sri Nabin Pradhan & Associates Advocate, Bhawanipatna

                                                 JUDGEMENT

   The facts of the Complaint in brief is that the deceased husband (Bibhisan Rout) of Complainant has availed a loan of Rs.5,00,000/- (Rupees Five Lakh) only from O.P. NO.1. The O.P. No.1 insist the husband of the Complainant to insured his life under SBI Life Insurance Co. Ltd. “Rin Raksha” group insurance scheme. The life of Complainant’s husband was insured by the O.P. No.3 on dt.2^nd February 2012 under SBI Life-RiNn Raksha scheme and a certificate of insurance is issued vide policy No.70000000310 covering period from 27.01.2012 to 27.01.2022. The scheme of the policy is in the event of death of the life assured during the term of the policy, provided the policy is in full force, the sum assured applicable for the month and year of death, as per the sum assured schedule is payable to the Master Policy holder.   During the valid period of insurance, on dt.15.05.2013 the husband of the Complainant is died. A Death Certificate has been the issued by the Registrar of Birth & Death, Bhawanipatna. The Complainant is the wife and legal representative of Bibhisan Rout claim to Opposite Parties for settle the home loan with assured amount. But the Opposite Party insurance Company repudiated the claim of the Complainant Arbitrarily and due to non-settlement of claim of the assured amount, the Complainant took shelter of this Forum and to pray to direct the O.P’s to pay the assured amount on the death of the Complainant husband as well as the interest claim by the O.P. No.1 &2 till date of realization along with 15% interest. Further direct to pay Rs.1,00,000/- as compensation and Rs.50,000/-  as litigation cost.

Being notice the Opposite Party No. 1 & 2 and Opposite Party No.3,4 & 5 appeared through their respective Advocate and filed their separate written versions. It is submitted by the O.P. No. 1 & 2 that the Complainant’s husband availed a home loan from O.P. No.1 and his life is insured with the SBI Life Insurance Co. Ltd. A master policy no.70000000310 in favour of State Bank of India. Bibhisan Rout died on dt.15.05.2013, after his death the claim is not settle by the O.P. No.3, 4 & 5 and the loan amount is mounted to Rs7,78,319 as on 18.03.2018 along with interest. The O.P. No. 3,4 & 5 submitted that “SBI Life” is a insurance company carrying on life insurance business coverage to individuals through individual assurances and to groups of individuals borrowers of loan a financial institution, account-holders of a bank. A master policy bearing No.70000000310 is issued in favour of State Bank of India and Bibhisan Rout is a member to the said policy. It is also submitted that the deceased Bibhisan Rout committed a breach of the principle of Utmost good faith by suppressing the material fact that he was suffering from and was under gone treatment for diabetes, Mellitus, Hypertension and Asthma prior to the enrolment into the insurance cover.  Further it is submitted that, the complaint is time barred as per section 24-A of the Consumer Protection Act, 1986. There is no deficiency of service from the side of O.P. No.3,4 & 5 and the reliefs claimed by the complainant are not genuine as per law and complainant is not entitled to get any relief and this case may be dismissed.

                                               FINDING

We perused the complaint petition written versions and documents filed by the parties to this case are available on record and hear argument of parties to this case. Considering the submission of the Advocate for the parties it is to be determined that whether the repudiation of claim of the Complainant on the ground suppressing the material fact is justified?

             It is admitted fact that the deceased husband of the Complainant has avails a home loan from O.P. No.1 and his life is insured by the O.P. NO3 under “RiNn- Raksha” group insurance scheme. The O.P’s has received the premium of Rs.3,220/- along with service taxRs.332/- in shape of demand draft. A master policy bearing No.70000000310 is issued in favour of State Bank of India covering period from 27.01.2012 to 27.01.2022 and Bibhisan Rout is a member to the said policy. It is also admitted that Bibhisan Rout died on dt.15.05.2013, which is well within the insurance cover period. It is clear that there was presumption of acceptance of the proposal in favour of the deceased as the proposal form along with good health declaration form along with insurance premium in shape of demand draft was accepted by the bank and sent to the insurance company. The deceased did not receive any intimation form the Opposite Party insurance company even though he continued to remain alive for more than one year and three months. Perused the condition of the insurance policy which is in question, the finance value Rs.5,00,000/- (Rupees Five lakh) is the maximum sum assured Benefit  and medical examination is not a condition precedent as per the terms and condition of the Insurance policy. From above it is clear that there was presumption of acceptance of the proposal in favour of the deceased. Bibhisan Rout is died on dt.15.05.2013 and the sum assured benefits is on the date of death is Rs.4,91,943/- as per the Sum Assured Benefits schedule. The Opposite Party insurance company repudiate the claim of the Complainant on dt.23.11.2013 on the ground that the Life Insurance Contract is a contract of “Utmost Good Faith” and the insurer suppress the material facts and he was suffering from and under treatment for diabetes Mellitus, Hypertension and Asthma. The insurance contract being a contract of utmost good faith, is a two-way door. The standards of conduct as expected under the utmost good faith obligation should be met by either party to such contract. The Opposite Party insurance company never asks for medical examination of the Complainant moreover, in present case medical examination is not necessary condition of the insurance contract. The Complainant serve a legal notice in this context to the Opposite Parties on dt.29.06.2018 and the Opposite Party insurance Company reply the legal notice of the Complainant on dt.02.08.2018 give a fresh cause of action in this case. Therefore, the complaint is in time. The loan amount is mounted to Rs7,78,319 as on 18.03.2018 along with interest.

            The Learned Advocate for the Opp.Party No.3 & 4 relied on the order of Permanent Lok Adalat in PLA No.505/2014 dt.23.04.2018 in their  support. But on perusal of the order it is found that PLA 505/2014 was not decided on merit but has been dropped on the strength of memo filed  by the appellant  for withdrawal of the same. So the same  will no way affect the proceeding  of the  case in the Forum. Further the complainant also raised  an objection on the ground that the complaint petition is barred by Section 11 of CPC on the principle of Resjudicate as the complainant had filed a W.P©  No.7287/2016 before the Hon’ble High Court of Odisha. It is admitted by the Ops No.3 & 4 on their written version that the W.P was withdrawal by the complainant. When the WP was withdrawal and no order has been passed  on merit and no  issues between the parties had been decided by Hon’ble High Court, in our opinion the complaint case  before this forum is not barred by the principle of Resjudicate . So far limitation in filing the case the Ops had not challenged the same at any point of time nor filed any revision before the higher forum after receiving the notice along with copy of  complaint petition. Further the only ground of repudiation of claim by the OP 3 to 5 is suppressing material particular by the complainant. Again the policy is  for a period of  ten years and also to cover the loan amount  against the husband of the complainant and OP Bank(1 & 2) are charging interest on the loan amount till filing   of the case.

The Advocate of the Complainant relied on a decision of Apex Court in the matter of D.Srinivas Vs. SBI Life Insurance Co. Ltd. decide on16.02.2018. The aforesaid decision is applicable in the present case. There is no reason to believe that there was no complete contract. There is clear presumption of the acceptance of the proposal in favour of the proposer.

In the view of aforesaid discussion, we found deficiency on the Part of the opposite party and hence the complaint petition is allowed in part against the Opposite Party No.3,4 & 5 and we do not found any fault on the part of Opposite Party No. 1 & 2. Hence, it is ordered.

ORDER

              In view of the above discussion, finding and documents available on record, the OP No.3 to 5 are directed to deposit the insured amount of Rs.4,91,943/- in the loan account of the husband of the complainant within 45 days of receiving the order , failing which the OP No.3 to 5  will be liable to pay interest @9% from the date of death of the complainant till reimbursement of the loan in the loan account .

            Pronounced in open forum today on this 18^th day of February,2019 .

                  Member                                                                   President

Documents relied upon:

1. Copy of SBI Life Rin Raksha Plan Policy details
2. Copy of First Premium Receipt
3. Copy of Rin Raksha Certificate of  Insurance
4. Copy of Key features of the policy
5. Copy of Table of Sum Assured Benefits
6. Copy of Death Certificate
7. Copy of Legal Heir Certificate
8. Copy of Letter Dt.12.06.2015 of Insurance Ombudsman
9. Copy of Pleader Notice
10. Copy of reply of pleader notice dt.02.08.2018
11. Copy of demand notice  dt.12.06.2014
12. Copy of Demand Notice dt.05.10.2018

By the OP No.1 & 2:

1. Copy of letter dt.13.02.2014 of SBI life
2. Copy of  letter dt.06.02.2014 of  OP No.1
3. Copy of letter dt.18.01.2014
4. Copy of application of the complainant
5. Copy of letter dt.23.11.2013 of SBI Life

By the Opp.Party No.3,4 & 5:

1. Copy of Order of Insurance Ombudsman
2. Copy of the Master Policy
3. Copy of the membership form
4. Copy of the Certificate of Insurance
5. Copy of the Investigation report
6. Copies of the medical records
7. Copy of Medical papers of Dr.Umakanta Panda
8. Copy of Medical Papers of Dr.Prasad Lal
9. Copy of the repudiation letter
10. Copy of CRC decision letter dt.13.02.2014
11. Copy of the claim form
12. Copy of legal notice and reply