Haryana

Karnal

CC/630/2021

Smt. Santosh - Complainant(s)

Versus

The Manager, SBI Life Insurance Company Limited - Opp.Party(s)

M.C. Bhardwaj

08 Jun 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                        Complaint No. 630 of 2021

                                                        Date of instt.15.11.2021

                                                        Date of Decision:08.06.2023

 

Smt. Santosh wife of Amar Singh, resident of VPO, Khera tehsil Indri, District Karnal, Haryana, age 50 years.

                                               …….Complainant.

                                              Versus

 

1.     The Manager, SBI Insurance Co. Ltd. SCO 144, 2^nd floor, near OPS Vidya Mandir, Sector-13, Karnal.

 

2.     The Manager, SBI Life Insurance Co. Ltd. “Natraj” MV Road and Western Express highway Junction, Andheri (East) Mumbai-400069.

 

                                                                      …..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary……Member

          

 Argued by: Shri Hardyal Singh, counsel for the complainant.

                    Shri N.K. Zak, counsel for the OPs.

       

                    (Jaswant Singh President)

ORDER:   

                

                 The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that husband of complainant had got insured from OPs, vide policy no.IM426620410 and paid regular premium against the policy. At the time of taking the policy the husband of complainant was healthy. Complainant is the nominee in the said policy. Husband of complainant died on 02.11.2020. Thereafter, complainant requested the OPs so many time to pay the claim and also deposited all the relevant documents to settle the claim but OPs did not pay any heed to the request of complainant and lingered the matter on one pretext or the other. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version, raising preliminary objections with regard to maintainability; territorial jurisdiction and concealment of true and material facts. On merits, it is pleaded that deceased life assured,  Mr. Amar Singh had applied for SBI Life Insurance Policy vide proposal form no.IMYA436187 dated 04.10.2018. In the proposal form of Mr. Amar Singh, under point no.6, details of proposer/life to be assured/HUF Karta, declared his annual income as Rs.5,40,000/- and Occupation as service. On the basis of the information furnished in the proposal form given by the proponent and relying on the information to be true and accurate, the proposal form was accepted and a policy was issued, vide policy no.IM426620410 with date of commencement 29.10.2018 for a Basic Sum Assured of Rs.9,99,000/-. It is further pleaded that proposal form whether he/she considers it as material or not. The proposal form is the sole basis to decide the eligibility as to whether a proposer can be granted insurance cover. The proposal form thus is a very important document wherein the life assured is enquired to submit full and correct information. Any suppression of material fact in the proposal form will constitute a breach of Doctrine of Utmost Good Faith. Thus, if the life assured does not reveal correct information and subsequently the insurer comes to know about the suppression of any material fact, the insurer comes to know about the suppression of any material fact, the insurer is well within his right to repudiate the claim under any insurance cover so granted on the basis of such proposal. It is further pleaded that life assured reported to have died on 02.11.2020. The OPs received a claim intimation on 22.02.2020 from the complainant. During assessment of claim, the OPs conducted an investigation into the claim and it was found that deceased life assured was daily wages labourer and come under the BPL category, thus he had misstated his occupation and income in the proposal form and availed the insurance cover fraudulently. As per Mahatma Gandhi Rastriya Gramin Rojgar Guarante Yojna (MANREGA) card of Karnal, Haryana, the deceased life assured was enrolled into MANREGA. The deceased life assured was holding a BPL card, had this fact been disclosed in the proposal form, the OPs would not have granted any insurance cover to the deceased life assured and hence the repudiation of claim for suppression of material facts is quite just and legal. There is no deficiency in service and unfair trade practice on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of bank passbook Ex.C1, copy of statement of account Ex.C2, copies of payment acknowledgement slips Ex.C3 to Ex.C5, copy of Aadhar card of complainant Ex.C6, copy of death certificate of Amar Sigh Ex.C7, postal receipt Ex.C8, copy of legal notice Ex.C9 and closed the evidence on 21.09.2022 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Neelam Singh Ex.OP1/A, copy of proposal form Ex.O1, copy of insurance policy Ex.O2, copy of claim form Ex.O3, copy of claim investigation report Ex.O4, copy of MANREGA card Ex.O5 and Ex.O6, copy of ration card Ex.O7, copy of repudiation letter dated 01.06.2021 Ex.O8, copy of reply to legal notice Ex.O9 and closed the evidence on 01.12.2022 by suffering separate statement.

6.             We have heard learned counsel for the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that Amar Singh (since deceased) purchased the insurance policy during his life time for a sum of Rs.9,99,000/- from OPs. Complainant is nominee in the said policy. Amar Singh had expired on 02.11.2020 and thereafter death claim under abovesaid policy was submitted to the OPs, but they did not pay the entitled claim amount and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel of OPs while, reiterating the contents of written version, has vehemently argued that on receipt of claim intimation on 22.02.2020 from the complainant,  OPs conducted an investigation for assessment of the claim and it was found that deceased life assured was daily wages labourer and come under the BPL category, thus he had misstated his occupation and income in the proposal form and availed the insurance cover fraudulently. As per MANREGA card, the deceased life assured was enrolled into MANREGA. The said facts have not been disclosed by the life assured at the time of filling the proposal form hence the repudiation of claim for suppression of material facts is quite just and legal and lastly prayed for dismissal of the complaint.

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, 04.10.2018 life assured had purchased the insurance  policy from the OPs and the sum assured of the policy was Rs.9,99,000/- and deceased life assured had paid premium amount of Rs.99900/- yearly.  It is also admitted that complainant is the nominee in the said policy. It is also admitted that on 31.05.2021 OP has paid the amount of Rs. Rs.304010.75 to the complainant.

11.           The claim of the complainant has been denied by the OPs, vide repudiation letter Ex.O8 dated 01.06.2021 on the ground, which is reproduced as under:-

Question no.                   Question                                                      Answer

Q.6                       Details of proposer/life to be assured/                   =Service

                             HUF Karta Occupation:

                             Name and address of the Employer/

                             Business Organization/Work place:

                             Specify the exact nature of your duties:

                             Annual Income:                                           =Rs.5,40,000

                  

12.           As per version of the OPs, in the proposal form, life assured had shown his occupation as service and annual income of Rs.5,40,000/- annually.

13.           Life assured had purchased the policy in question on 29.10.2018  for the basic sum  insured of  Rs.9,99,000/-. Life assured had expired on 02.11.2020 and amount of Rs.304010.75 has already been paid by the OPs on 31.05.2021 to the complainant being nominee and remaining amount of Rs.6,94,990/- (Rs.999000-Rs.304010) has not been paid by the OPs on the ground mentioned in the repudiation letter Ex.O8 dated 01.06.2021.

14.           The onus to prove its version was relied upon the OPs but OPs have miserably failed to prove the same by leading any cogent and convincing evidence. OPs have failed to prove on record as to why remaining amount has not been paid to the complainant. The ground on which the OP has declined the remaining amount is not  tenable to deny the claim. The policy in question purchased in the year 2018 and life assured expired in the year 2020. It is not the case of the OPs that deceased life assured was defaulting for paying the installment of the policy. The premium of the policy was to be paid in the month of October of every year. It is not the case of the OPs that life assured has not paid the premium amount on due date before his death. It was up to the life assured to decide from where he had to make arrangements for paying the premium of the policy. The life assured vide receipts Ex.C3 to Ex.C5 has paid the premium amount of Rs.99900/-each on 29.10.2020, 04.10.2018 and 29.10.2019 respectively. Prior to death, life assured has paid three installments of Rs.99900/-without any delay. It was the duty of the OPs to verify the income of the life assured at the time of issuing the policy. On receipt of huge amount of premium amounts, OPs cannot take the such type of excuse mentioned in the repudiation letter ExO8 dated 01.06.2021.

15.           Further,  Hon’ble Punjab and Haryana High Court in case titled as New India Assurance Company Ltd. Versus Smt. Usha Yadav & others 2008 (3) RCR (Civil) 111, has held as under:-

“It seems that the Insurance Companies are only interested in earning the premiums which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance companies make the effected people to fight for getting their genuine claims. The Insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy”.

 

 16.          Keeping in view the ratio of the law laid down in the abovesaid judgment, facts and circumstances of the complaint, we are of the considered view that act of the OPs withholding the remaining assured amount amounts to deficiency in service and unfair trade practice.

17.           As per insurance policy Ex.O2, the basic sum assured is Rs.9,99,000/- and an amount of Rs.304010.75 has already been refunded  by the OPs to the complainant. Thus, complainant is entitled for the  remaining amount of Rs.6,94,990/- (Rs.999000-Rs.304010)) alongwith interest, compensation for mental agony and towards litigation expenses.

18.           Thus, as a sequel to abovesaid discussion, we allow the present complaint and direct the OPs to pay Rs.6,94,990/- (Rs. six lakhs ninety four thousand nine hundred ninety only) to the complainant alongwith interest @ 9% per annum from the date of repudiation of claim till its realization. We further direct the OPs to pay Rs.25,000/- to the complainant on account of mental agony and harassment suffered by her and Rs.11,000/- towards the litigation expenses. This order shall be complied with within 45 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:08.06.2023   

                                                        President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.

 

                (Vineet Kaushik)        (Dr. Rekha Chaudhary)      

                      Member                        Member