Date of filling : 09.07.2010
Date of order : 22.09.2022
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, VELLORE
PRESENT: THIRU. A. MEENAKSHI SUNDARAM, B.A., B.L. PRESIDENT
THIRU. R. ASGHAR KHAN, B.Sc., B.L. MEMBER – I
SELVI. I. MARIAN RAJAM ANUGRAHA, M.B.A., MEMBER-II
THURSDAY THE 22nd DAY OF SEPTEMBER 2022
CONSUMER COMPLAINT NO. 22/2010
1. J. Jayalakshmi,
W/o. A. Jayakumar,
2. Minor Prabhu,
S/o. A. Jayakumar,
3. Minor Kamala,
D/o. A. Jayakumar,
4. A. Shantha,
W/o. Appasamy,
All are residing at,
No. 128/3, Jain Koil Street,
Uppuvellore, Vanoor Taluk,
Villupuram District – 606 154. …Complainants
-Vs-
1. The Manager,
SBI Life Insurance Company Limited,
Central Processing Centre,
Kapas Bhavan,
Plot No. 3A, Sector 10,
CBD Belapur,
Navi Mumbai 400 614.
2. The Manager,
G.E. Money Financial Services Ltd.,
401 & 402, 4th Floor,
Aggarwal Millenium Tower,
E-1,2,3, Nethaji Subash Place,
Pitampura, New Delhi.
3. The Agent,
S.B.I Life Insurance Company Limited,
1st Floor, Kushi Complex,
No.16, Arani Road,
Vellore – 632 001.
4. The Agent,
G.E. Money Financial Service Ltd.,
73 Ground Floor, Thiyagarajapuram,
Officer’s Line, Krishna Nagar,
Vellore – 632 001. …Opposite Parties
Counsel for complainants : Thiru. T. Saikrishnan
Counsel for first opposite party : Thiru. G. Ravi
Second and third opposite parties : Set exparte on 15.09.2010 & 11.08.2010
Fourth opposite party : Dismissed
ORDER
THIRU. A. MEENAKSHI SUNDARAM, B.A.,B.L.PRESIDENT
This complaint has been filed Under Section 12 of consumer Protection Act 1986. The complainants have prayed this Hon’ble Commission to direct the opposite parties to pay to the complainants a sum of Rs.12,40,000/- being the sum assured and compensation due, together with interest at the rate of 24% per annum from 04.08.2009 till date of realization and award cost.
1.The case of the complaint is briefly as follows:
The complainants are the legal heirs of the deceased A. Jayakumar also died on 04.08.2009. The first complainant is the widow of the deceased Jayakumar, second complainant is the minor of the deceased A. Jayakumar, third complainant is the daughter of the deceased A. Jayakumar and the fourth complainant is the mother of the deceased A. Jayakumar. The complainants are the only legal heirs of the deceased Jayakumar. The deceased Jayakumar was working as a Marketing Agent of the Oil Company Castrol India Limited and he was doing marketing for the said company under the name and style Magaram agencies at Vellore. While so, the said A.Jayakumar had availed personal loan with the second opposite party herein under loan account No. RSVE: 00001655 during the year 2006 and the monthly EMI payable was Rs.1679/- and also post dated cheques were issued by the deceased A.Jayakumar towards repayment on the same. At the time of availing the said loan transaction, he had taken an insurance policy from the first opposite party, by which in case of death of the insured, loan amount to an extent of Rs.2,00,000/- and personal accident coverage upto an extent of Rs.5,00,000/- would be provided by the first opposite party and one time premium was also paid by the deceased A. Jayakumar certificate of Insurance was granted by the first opposite party under Master Policy No.83001000909. The complainants state that the deceased A. Jayakumar had several transactions with the second opposite party and was continuously paying the personal loan instalments and on some occasions the deceased A. Jayakumar would not be able to honour the cheques, but however he would pay the monthly instalment in cash. From the records available with the complainants, it is seen that the monthly instalment for the month of May 2009 was paid by the deceased A. Jayakumar on 29.05.2009. The complainants are unable to ascertain as to the payments made for the month of June and July 2009, since, the second opposite party would not divulge any details and no statement of accounts is provided to the complainants herein. Unfortunately the said Jayakumar met with a road accident on 03.08.2009 at about 11 P.M near Chinna Ayyampalayam Koot Road, while travelling in a Toyota Quali Car bearing Registration No. TN20 T 3616, met with an accident sustained grievous injuries and was admitted at Christian Medical College Hospital Vellore. He died at about 6.15P.M. on 04.08.2009 and the post mortem was conducted on 05.08.2009 at the Government Hospital Vellore. The accident was reported to the Inspector of Police at Kannamangalam Police Station, Tiruvannamalai District and a case has been registered under Crime No.614 of 2009, originally registered under sections 279 and 337 of the IPC and later on altered to sections 279, 337, and 304 -A of the IPC. As per the policy of insurance granted by the first opposite party, the first opposite party is liable to pay a sum Rs.5 lakhs to the complainants herein and the same has to be paid to the first complainant herein who is the nominee in respect of the policy. As such the complainants herein approached the second opposite party through their Vellore Branch and submitted the death claim due under the said policy. The second opposite party provided a claim from which was duly filled up and submitted by the complainants. The complainants state that initially the claim was processed and as a matter of fact several particulars were repeatedly required by the first opposite party insurance Company which were periodically furnished by the claimants, including the First Information Report, Death Certificate and Legal Heirship Certificate etc., While the claimants were expecting the sum assured bonafidely due to them, they were shocked to receive the repudiation letter dated 21.01.2010, whereby the opposite, party has repudiated the claim stating that as per the master policy given to them by the second opposite party, there is an exclusion clause that “if the borrowers account remains delinquent for a period of 3 billing cycles prior to the date of death, the coverage shall stand automatically cancelled” and that the second opposite party has informed that as on date of death the loan account was delinquent for 3 billing cycles as such the same falls under the exclusion clause as per the policy. The repudiation by the opposite party is totally not bonafide and ex-facie and amounts to deficiency in service. Even admittedly no such master policy was ever given to or made available for even reading or Inspection to the deceased Jayakumar and as such, such exclusion clause is not connected to the insured and the insured is not party thereof to the documents. Secondly even otherwise the opposite parties are playing fraud since there is no billing cycle in respect of personal loan which will be the case in respect of a Credit card. As such a simple personal loan is repayable as debit on a promissory note and the entire amount is due at all times, after the amount is granted till the total amount is repaid. As such there is no concept of a billing cycle in respect of a personal loan and the alleged exclusionary clause does not apply to the instant transaction. Further he was no delinquency as alleged in respect of the account of the deceased Jayakumar and he has been repaying the loan from the year 2009. As such the account had never been classified as a delinquent account by the second opposite party till date of death of the said Jayakumar. As a matter of fact, even in the month of May 2009, the EMI was paid by the deceased Jayakumar for which the complainant gave particulars about the receipt thereof. For the foregoing reason, the repudiation letter are Ex-facie false and it is generally done by the Insurance companies by luring every person at the time of issue of policy by promising all benefits and by repudiating all claims in one pretext or the other whenever claim is made. The first opposite party has done the same in the case of the complainants also. In the process, in the name of exclusionary clause, the first opposite party has failed to understand that.
a) the family of the complainants is in dire straits and are in a extremely critical financial situation on account of the sudden death of the sole breadwinner of the family.
b) It is difficult for the first plaintiff widow even to provide for the barest
requirement of food, education and clothing for the family.
c) the minor children of the deceased are in serious hamper of discontinuing their education.
d) the family is in extreme poverty.
The first and second opposite parties had only worked over time to find out a flimsy untenable reason to repudiate the claim and in any even such repudiation if firstly wilful and wantonly and not in consonance with the contract of food faith which is an essential part in every insurance contract. The repudiation is made on erroneous and false facts and that too without even giving the copy of the communication of the second opposite party to the first opposite party, as to how and when the loan account became delinquent and without supplying a copy of the Master Policy which is supposed to be supplied only by the second opposite party. The complaints do not know what exactly are the conditions of the alleged exclusionary clause or whether such exist at all, it may be seen that the entire manner of the issuance of policy and getting the terms of the policy in contract from the insurer by itself is illegal and not in consonance with the principles of good faith. Therefore, the first and second opposite party have efficiently and effectively blocked the deceased from getting the policy within the coverage terms, if at all there is some exclusionary clause and now repudiating the insurance claim on the strength of their own default. As per the claim is concerned, the certificate itself enumerates the requirements such as claim form, post mortem report, fir police inquest, panchanama, and death certificate, which are duly produced by the complainants. The opposite parties are due and liable to pay the sum assured being a sum of Rs.5,00,000/- as on 04.08.2009. The opposite parties somehow took time for repudiation and are wilfully denying the claim. Hence this complaint.
2. Written version of the first opposite party is as follows:
It is clearly shown in the records that Late A. Jayakumar had made default in several consecutive EMI’s before his of death. As per the loan account statement maintained and provided by second opposite party, it is observed that the deceased A. Jayakumar had defaulted in payment of EMI since 07.11.2007 and as the EMI is inclusive of the insurance premium, it is crystal clear that the deceased A. Jayakumar did not pay the insurance premium since 07.11.2007 i.e. for approximate 22 months prior to his date of death i.e. 04.08.2009. Hence, as per the terms of the Master Policy, when any loan account is in three EMI defaults, the cover will be treated as terminated and hence on the date of the death, the deceased A. Jayakumar was not covered under the Group Insurance Scheme. The copy of statement of account is appended as “Annexure-E”. Hence the complaint deserves to be dismissed and it be dismissed accordingly with costs.
3. On receipt of this notice from this Hon’ble Commission. Second and third opposite parties did not appear, several opportunities given, the opposite parties called absent set exparte.
4 Proof affidavit of complainant filed. Ex.A1 to Ex.A10 were marked. Written argument of complainant filed. Proof affidavit of first opposite party filed. Ex.B1 to Ex.B7 were marked. Written argument of first opposite party filed. Oral arguments of complainant side heard.
5 The Points that arises for consideration are:
1. Whether there is any deficiency in service on the part of the opposite
parties?
2. Whether the complainant is entitled for relief as claimed in the complaint?
3. To what relief, the complainant is entitled to?
6. POINT NOS.1&2: The complainant one Mr. A. Jayakumar died on 04.08.2009 the complainants are his legal heirs of the said A. Jayakumar. The said A. Jayakumar availed a personal loan from the second opposite party. While availing the personal loan there is an add on policy which covers the life insurance of the Jayakumar for a value of Rs.5,00,000/-. As well as, in case there is an default with regard to the non payment of the personal loan of Rs.2,00,000/-. The said add on policy was marked as Ex.A2. The allegation of the complainant is that after times of the said A.Jayakumar, the complainants have prepared a claim with the first opposite party. The first opposite party has repudiated the claim of the complainants, on the ground that the said A. Jayakumar had defaulted in repayment of the aforesaid personal loan for three consecutive EMI and hence, they are not entitled for the insurance policy claimed by them. For which the counsel for the complainants has replied that the A. Jayakumar has not defaulted in repayment of the said loan, but he has made delayed payment subsequently. There is no default alleged by the opposite party before death of the complainant. The complainant has produced only one receipt that too with regard to the delayed payment made by the complainants by way of cash. The opposite party has filed the statement of account wherein, we find that the deceased A. Jayakumar has defaulted more than three EMI. For which when we are raising the issue with the complainants’ counsel. The complainants’ counsel informed that the deceased A. Jayakumar has kept the pass book, where about of the pass book not known A. Jayakumar. We could not find out. Therefore we are not in a position to produce before Hon’ble Commission for inspection. On the other hand we feel that they can very well obtained the copy of the statement from the concerned bank, that also they have not produced. Therefore, we are not in a position to contravene the contention of the opposite party for each reference we reproduced hereunder:-
Further, in view of the “Master Policy clause No. 6.2 N, which make it clear that in any loan account is in 3 EMI cover will be treated as terminated with effect from the date of three months”.
Therefore we could not rewrite the contractual terms of insurance. Therefore, complainant not proved this case. Hence, this case is dismissed. No Costs. Hence, these Point Nos 1 and 2 are answered accordingly.
7. In Point Nos.1 and 2, we have decided that the complainant has not proved any deficiency in service on the part of the opposite parties. Hence, the complainant is not entitled for any relief. This Point No.3 is also answered accordingly.
8. In the result, this complaint is dismissed. No costs.
Dictated to the steno-typist transcribed and typed by her corrected and pronounced by us in the open Commission on this the 22nd September 2022.
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MEMBER-I MEMBER – II PRESIDENT
LIST OF COMPLAIANNT SIDE DOCUMENTS:
Ex.A1-30.07.2007 - Copy of loan sanction letter issued by the second opposite party
Ex.A2 - Copy of Certificate of insurance issued by the first opposite
Party
Ex.A3 - Copy of Statement issued by the second opposite party
Ex.A4-29.05.2009 - Copy of Receipt for payment issued by the second opposite
Party
Ex.A5-04.08.2009 - Copy of FIR in Cr. No.614 of 2009
Ex.A6-05.08.2009 - Copy of Death report of Jayakumar
Ex.A7-05.08.2009 - Copy of Post mortem certificate of deceased Jayakumar
Ex.A8-17.08.2009 - Copy of Death certificate of Jayakumar
Ex.A9-18.09.2009 - Copy of Legal heir ship certificate issued to complainants
Ex.A10-27.01.2010 – Copy of Letter of repudiation issued by the first opposite party
LIST OF FIRST OPPOSITE PARTIES SIDES DOCUMENTS:
Ex.B1 - Copy of Master Policy
Ex.B2 - Copy of Certificate of Insurance
Ex.B3-19.01.2010 - Copy of letter from second opposite party
Ex.B4-21.12.2009 - Copy of e-mail from the second opposite party
Ex.B5 - Copy of the statement of accounts
Ex.B6-27.01.2010 - Copy of the claim repudiation letter
Ex.B7-02.02.2010 - Copy of the order Revision petition No. 211 of 2009
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MEMBER-I MEMBER – II PRESIDENT
