Order by:

Sh.Amrinder Singh Sidhu, President

1.       The complainant  has filed the instant complaint under section 12 of  the Consumer Protection Act, 1986 (as amended upto date) on the allegations that the Complainant is daughter of Sarabjeet Kaur and in the month of September 2017 one agent of the Opposite Parties namely Vijinder Kumar Code 990704666 came to Sarabjeet Kaur and told regarding the insurance policy i.e. SBI Life-Shubh Nivesh and on the allurement of the agent of the Opposite Parties, Sarabjeet Kaur purchased the policy bearing No.35609505202 from the Opposite Parties against the payment of premium of Rs.32,000/- as first installment and further installments to be paid half yearly for 18 years and the sum assured was Rs.10 lakhs. The Complainant further alleges that Sarabjeet Kaur insured mother of the Complainant expired on 30.09.2017 and the Complainant is the nominee in the said policy as the father of the Complainant is also pre-deceased. Thereafter, the Complainant sent all the filled forms and original copy to the Opposite Parties on 05.01.2018, vide receipt No.RL A RP7201529281N for the purpose of claim compensation being the nominee of the deceased insured, but the Opposite Parties repudiated the claim of the Complainant on the false and frivolous ground.    As such, there is deficiency in service on the part of the Opposite Parties. Vide instant complaint, the complainant has sought the following reliefs.

a)       To pay  the insurance claim of Rs.10 lakhs alongwith interest @ 9% per annum and Rs.50,000/-  on account of deficiency in service and Rs.11,000/- for the litigation expenses and also to pay any additional or alternative relief for which the c may be found entitled to.

2.       Opposite Parties  appeared through counsel and contested the complaint by filing  the written version taking preliminary objections therein inter alia that the proceedings before this Commission being summary in nature, the complaint s not maintainable. There is suspicion on the claim and these issues require a thorough investigation and examination and cross examination of witnesses which are beyond the purview of this District Commission. Further alleges that  while issuing the policy, the Opposite Parties rely on the information furnished in the proposal form and grants insurance cover on the principle of utmost good faith. Any suppression of the material facts in the proposal form will render the insurance cover invalid in respect  of the insured. Details of existing life insurance policies and the proposals submitted by the proposer helps the insurance company to determine whether the sum assured proposed is commensurate with his/ her standard of living and earning capacity. If the proposer misstates his/ her existing insurance details and obtains the insurance cover fraudulently, any subsequent revelation of mis-statement or suppression of existing insurance details  would render the insurance cover void ab initio. In such circumstances, the insurer is well within its contractual  rights to repudiate the death claim.  Further alleges that in the instant  case while applying for SBI Life policy No. 35609505202 through proposal No.35QP220441 dated 06.10.2015 for sum assured of Rs.10 lakhs, the DLA Sarabjeet Kaur suppressed the fact regarding the previous insurance policies held by her and also regarding the proposals submitted by her to other insurance companies. The quantum of insurance cover is determined on a host of factors which inter alia include the need for insurance and its affordability so that the principle of insurable interest is not  violated. Any contract of insurance without adequate insurable interest is a wager and thus is void ab-initio. On merits, it alleges that it was found that DLA applied for/ was holding  insurance policies with other insurance companies which she has not disclosed in her proposal form, the detail of which as follows:-

Hence, the DLA has concealed the aforesaid policies while purchasing the the policy from the answering Opposite Parties and   hence the claim is not maintainable and the claim of the Complainant was repudiated vide letter dated 24.03.2018.  On merits, the Opposite Parties took almost same and similar objections  as taken up by them in the preliminary objections.           

3.       In order to  prove  her  case, the complainant has placed on record her affidavit Ex.C1 alongwith copies of documents Ex.C2 to Ex.C11.

4.       On the other hand,  to rebut the evidence of the complainant,  Opposite Parties  placed on record affidavit of Ms.Dhanyua K P Ex.Ops1/A,  alongwith copies of documents Ex.Ops1 to Ops7.

5.       We have heard the ld.counsel for the parties, perused the written arguments submitted by the Complainant  and also  gone through the documents placed  on record. Not only this, ld.counsel for the Opposite Parties made separate statement before this District Commission on 20.08.2021 that the written reply filed by the Opposite Parties may please be treated as part and parcel of the written  as well as oral submissions. 

6.       Perused the  written arguments submitted on behalf of the complainant which are on the lines of averments made in the complaint and during the course of arguments, ld.counsel for the Complainant has  mainly reiterated the facts as narrated in the complaint and contended Sarabjeet Kaur mother of the Complainant expire don 30.09.2017 and father was predeceased and Complainant is the nominee in said policy and that the Complainant completed all the formalities for the claim and after checking the documents, the Opposite Parties repudiated the claim of the Complainant on the ground that  the policy holder is holding more six polices which are not disclosed by her at the time of purchasing the instant policy and hence, on the ground of concealment of previous polices, the claim of the Complainant is repudiated vide letter dated 24.3.2018 which is not legal and valid.  However, the deceased assured has definitely filled the proposal form for the purchase of some more policies, but after verification by the concerned insurance companies, same was rejected and not issued any policies against these proposal forms and hence, the repudiation by the Complainant of her claim is without application of mind. To prove her case, the Complainant has cited the order of this District Consumer Commission, Moga titled as    Nachhatar Kaur Vs. SBI Life Insurance  decided on 24.05.2016, and  judgement of Chhatisgarh State Commission, titled as: Branch Manger Life Insurance Corporation Vs. Heera Bai of Chhattisgarh State Consumer Disputes Redressal Commission, Raipur Appeal No. 182 of 2014 decided on 17.12.2014.

7.       On the other hand, ld.counsel for the Opposite Parties has repelled the aforesaid contention of the ld.counsel for the Complainant on the ground that    while issuing the policy, the Opposite Parties rely on the information furnished in the proposal form and grants insurance cover on the principle of utmost good faith. Any suppression of the material facts in the proposal form will render the insurance cover invalid in respect  of the insured. Details of existing life insurance policies and the proposals submitted by the proposer helps the insurance company to determine whether the sum assured proposed is commensurate with his/ her standard of living and earning capacity. If the proposer misstates his/ her existing insurance details and obtains the insurance cover fraudulently, any subsequent revelation of mis-statement or suppression of existing insurance details  would render the insurance cover void ab initio. In such circumstances, the insurer is well within its contractual  rights to repudiate the death claim.  Further alleges that in the instant  case while applying for SBI Life policy No. 35609505202 through proposal No.35QP220441 dated 06.10.2015 for sum assured of Rs.10 lakhs, the DLA Sarabjeet Kaur suppressed the fact regarding the previous insurance policies held by her and also regarding the proposals submitted by her to other insurance companies. The quantum of insurance cover is determined on a host of factors which inter alia include the need for insurance and its affordability so that the principle of insurable interest is not  violated. Any contract of insurance without adequate insurable interest is a wager and thus is void ab-initio. On merits, it alleges that it was found that DLA applied for/ was holding  insurance policies with other insurance companies which she has not disclosed in her proposal form, the detail of which as follows:-

Contended that the DLA has concealed the aforesaid policies while purchasing the policy from the Opposite Parties and   hence the claim is not maintainable and the claim of the Complainant was repudiated vide letter dated 24.03.2018. To prove the aforesaid contention regarding suppression of material facts, the Opposite Parties has relied upon the judgement of Hon’ble Supreme Court of India in case (1) Chachochan Vs. LIC (2007 X AD (SC) 429 Civil Appeal No. 5322 of 2007 and further jugement of Hon’ble Supreme Court of India titled as (2) Sealark Vs. united India Insurance Company Limited, (3) Hon’ble National Commission in case HDFC Stanadard Life Insurance Company Ltd. Vs. Smt.Vijayalakshmi (RP No. 336 of 2007) decided on 04.02.2011 (4)  Hon’ble National Commission in case LIC Vs. Mansa Devi-II 2003 CPJ 135 (NC) and (5) Neelam Gupta Vs. Reliance Life Insurance & Another in RP No. 4486 of 2010 decided on 09.02.2011 in these supra judgements, it has clearly been  held that the insurer is justified in repudiating a claim wherever there is a suppression of material fact. In the instant case, the DLA/policy holder did not disclose even in the proposal form at the time of purchasing the policy regarding the other proposal for purchasing some other policies from different companies and hence suppressed/ concealed the material facts from the Opposite Parties. On the other hand, the judgements cited by the Complainant are not applicable to the facts of the present dispute and the same are quite distinguishable.    In this way, this District Consumer Commission  finds no deficiency in service on the part of the Opposite Parties while repudiating the claim of the Complainant.  

8.       In view of the aforesaid facts and circumstances of the case, the instant complaint is dismissed. However, keeping in view the peculiar circumstances of the case, the parties are left to bear their own costs. Copies of the order be furnished to the parties free of cost. File be consigned to record room after compliance.

Reason for delay in deciding the complaint.

This complaint could not be decided within the prescribed period because the government has not appointed any of the Whole Time Members in this Commission for about 3 years i.e. w.e.f. 15.09.2018 till 27.08.2021. Moreover, the President of this Commission is doing additional duties at District Consumer Commission, Faridkot and furthermore due to non-sitting of this District Commission virtually for a long period due to pandemic of COVID-19.

Announced in Open Commission.

Dated: 14.09.2021.