State Consumer Disputes Redressal Commission
Shiv Prasad Gupta vs B.M, Sbi Life Insurance Co. Ltd. & Anr. on 10 July, 2017
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION,
PANDRI, RAIPUR (C.G.)
Complaint Case No.CC/2017/12
Instituted on : 23.03.2017
Shivprasad Gupta, S/o Late Tulsi Sao, Aged 51 years,
Profession : Service,
R/o : Village - Kunkuri Kala,
Police Station & Tehsil Batauli, District Surguja (C.G.). ..Complainant.
Vs.
1. Branch Manager,
S.B.I. Life Insurance Company Limited,
Branch Office - Basantlal Marg, Branch Ambikapur,
Police Station & Tahsil Ambikapur, Dist. Surguja (C.G.)
2. Chief Claims Manager,
S.B.I. Life Insurance Company Limited,
Central Processing Centre, Kapas Bhawan,
Plot No.3 A, Sector No.10, C.B.D., Belapur,
Navi Mumbai (Maharashtra) Pin 400614 .... Opposite Parties
PRESENT: -
HON'BLE SHRI JUSTICE R.S. SHARMA, PRESIDENT
HON'BLE SHRI D.K. PODDAR, MEMBER
HON'BLE SHRI NARENDRA GUPTA, MEMBER
COUNSEL FOR THE PARTIES:
Shri Amit Soni, Advocate for the complainant.
Shri Narendra Kumar Mishra, Advocate for the opposite parties.
ORDER
Dated : 10/07/2017 PER :- HON'BLE SHRI JUSTICE R.S. SHARMA, PRESIDENT. The complainant filed this consumer complaint against the OPs seeking following reliefs :-
// 2 //
(a) To direct the OPs to pay a sum of Rs.50,00,000/--
(Rupees Fifty Lakhs), which is insured amount along with interest @ 9% p.a.
(b) To direct the OPs to pay a sum of Rs.50,000/- (Rupees Fifty Thousand) towards cost of litigation to the complainant.
(c) To direct the OPs to pay a sum of Rs.5,000/- (Rupees Five Thousand) towards Advocate Fees to the complainant.
2. Briefly stated the facts of the complaint of the complainant are that the younger brother of the complainant, Late Shyam Bihari Gupta, who was working as an Agent of Life Insurance Corporation of India, Branch Ambikapur, District Surguja (C.G.) and was unmarried. The deceased Shyam Bihari Gupta obtained Smart Shield Insurance Policy No.45001788602 from the O.P. No.1 on 19.05.2011. The premium amounting to Rs.7,762/- every year was required for 10 years. The premium was to be paid till 19.05.2020. If natural death of the policy holder is occurred during above period, then Rs.25,00,000/- and if accidental death is occurred then Rs.25,00,000/-, total Rs.50,00,000/- would be received by the nominee Shivprasad Gupta/ complainant from the OPs, because at the time of obtaining insurance policy, the deceased Shyam Bihari Gupta, made nominee to his elder brother Shivprasad // 3 // Gupta/complainant. On 15.02.2014, Shyam Bihari Gupta was going to Village Durgapara from Batauli in the motor cycle. The vehicle dashed with ralling of the pool due to which he died and his post-mortem was conducted at Community Health Centre, Batauli. The first information report was lodged at Police Station Batauli, District Surguja (C.G.) where Offence No.18/14 under Section 304A IPC was registered. The complainant gave intimation regarding death of deceased Shyam Bihari Gupta, to the O.P. No.1 within 90 days on 13.05.2014 and the O.P. No.1 provided claim form to the complainant on 13.05.2014. The complainant filled up the claim form and submitted the same in the office of the O.P. No.1 within 15 days. Thereafter, the documents demanded were submitted by the complainant in the office of the O.P. No.1 on 23.07.2014. The O.P. No.1 sent all the documents to the O.P. No.2. All documents were submitted by the complainant to the O.P. No.1, but even then the claim amount was not paid, therefore, the complainant sent a letter on 07.05.2015 through courier in the office of the O.P. No.2 for making payment of the claim amount at the earliest. The claim of the complainant was repudiated on the ground that in the proposal form signature of Late Shyambihari Gupta is not present and complete and correct information has not been given, whereas the policy bond is not issued without signature of the policyholder and all information. Thus after completion of all information only, the policy bond is issued. The O.P. No.1 sent a letter to the complainant regarding the claim amount in // 4 // which it is mention that you are not satisfied with their decision, then you can file appeal before General Manager, Claim Review Committee, Navi Mumbai. The complainant made complainant before the O.P. No.2 on 07.05.2015 and 14.09.2015 along with documents. The application submitted on 07.05.2015 was dismissed on 07.07.2015 and no reply was given in respect of application dated 14.09.2015. Following the instructions of the O.P. No.1, the complainant again sent application to the office of Insurance Ombudsman, Bhopal on 14.01.2016. The Insurance Ombudsman passed order on 21.03.2016 to the effect that in their office, handwriting expert is not available, therefore, the signature put by the deceased in the policy bond and the cheque through which payment was made, could not be matched, therefore, decision cannot be given, whereas in the terms and conditions of the policy there is no mention regarding the same and the policy bond was issued in favour of the deceased after completion of all formalities by him and insurance was done. The OPs passed erroneous order. The claim of the complainant, was repudiated by the OPs violating the terms and conditions of the policy and the orders. Thus, by not paying the claim amount, the OPs committed deficiency in service. Due to the act of the OPs, the complainant suffered financial loss. Hence the instant complaint.
3. The OPs have filed their written statement and averred that the address of the O.P. No.2 is at Mumbai, but the complaint is filed before // 5 // the Hon'ble Commission, at Bilaspur. Hence the complaint is not maintainable for want of territorial jurisdiction of the Hon'ble Commission. Hence on this ground alone, the complaint is liable to be dismissed. As the Ombudsman, Bhopal is a quasi judicial body established by Central Government notification under Redressal of Public Grievance Rules, 1998, has already heard the case and given his award, hence the complaint is hit by Section 11 of Civil Procedure Cod under the principle of Res Judicata. The Ombudsman has dismissed the complaint on merits after going through the documents and evidence produced on record by the complainant as well as S.B.I. Life. The Ombudsman has been pleased to dismiss the complaint vide order dated 21.03.2016 and has observed and concluded that '' from perusal of record it is apparent that the DLA has also taken two policies bearing No.207006359 and 207007909 of LIC of India having date of commencement as 21.08.2010 and 06.09.2010 respectively prior to applying for SBI Life Policy. It is further observed that the DLA had not disclosed about previous policies taken from LIC of India. Thus, it is established that the deceased has suppressed the material fact, which is crucial to the contract of insurance. Further since there is dispute of signature of DLA on the proposal forms, which require production of evidence (oral and documentary) by both the parties particularly handwriting expert witness for providing the above disputed facts. N the catena of decisions, it has been clearly observed that for allegation of // 6 // fraud and forgery, the complainant should seek remedy in Civil Court. Thus the complaint is beyond the scope of this Forum. The Life Insurance Contract is a contract of "Utmost Good Faith" wherein the proponent is duty bound to disclose everything concerning his / her health, habits, income, occupation, details of previous life insurance policies, age etc. and other related matter, which are within his / her knowledge at the time of making the proposal for insurance cover and even before the date of commencement of the policy, failing which the insurer has every right to repudiate the claim. In the instant case, the Deceased Life Assured Shri Shyam Bihari Gupta committed a breach of the principle of Utmost Good Faith by suppressing the material fact that the DL was having previous life insurance policies of LIC of India prior to the date of submission of the proposal form for issuance of the SBI Life Policy. In the proposal form, the DLA replied in negative to the specific questions No.6 under the proposal No.45QB300209 dated 25.04.2011, but from the documents produced on record, it is evident that the DLA had taken two policies bearing No.207006359 and 207007909 of LIC of India having date of commencement as 21.08.2010 and 06.09.2010 respectively prior to applying for SBI Life Policy, which deceased had not informed to SBI Life and fraudulently procured the policy. In the insurance contract, there is positive duty on the proposer to disclose all facts material to the risk being proposed, accurately and fully. Every fact is material which would influence the judgment/assessment of risk by // 7 // an insurer in fixing the premium or determining whether he / she will undertake the risk or not. Concealment is failure of the assured to reveal a material fact to the insurer. The suppression of material information is fatal to the contract of insurance, which is based on the principle of "Utmost Good Faith". Thus, any contract of insurance procured by breach of the principle of "Utmost Good Faith" is a nullity and void ab- initio. Therefore, the complaint is not maintainable and hence deserves to be dismissed. The allegations of fraud and forgery made in the complaint require a thorough investigation and examination and cross- examination of witnesses which are beyond the purview of the Hon'ble State Commission. Only Civil Courts are competent to handle such cases because the proceedings before a State Consumer Disputes Redressal Commission are summary in nature. Hence this complaint is not tenable. There is no negligence, carelessness or deficiency in service on the part of the SBI Life as defined in Section 2(1)(g) as laid down under the Act, as the DLA (deceased/assured) himself is guilty of suppressing and concealing the material and true fact that he was having LIC policies prior to the date of submission of the proposal form. As SBI Life has duly discharged all the obligations, no deficiency can be alleged on the part of the SBI Life. Thus, the complaint did not fall within the definition of Section 2(1)(c) and 2(1)(g) respectively of the Consumer Protection Act. Further there was no locus for the complainant and hence the complainant could not fall within the definition of Section 2(b) of the // 8 // Consumer Protection Act. The complaint has not been filed for real cause of justice, but has been filed with the malafide intention to harass SBI Life as well as to pressurize SBI Life to sanction the claim filed by the complainant knowing fully well that the DLA had fully well that the DLA had concealed and suppressed the material fact at the time of proposing for insurance cover from SBI Life. The complaint is frivolous and malicious and hence is liable to be dismissed. The deceased Life Assured Mr. Shyam Bihari Gupta, had applied for SBI Life Smart Shield Plan vide proposal bearing No.45QB3000209 dated 25.04.2011. In the proposal form, the DLA had also gave declaration. On the basis of the basis of the information furnished in the proposal form and relying on the information to be true and accurate, the proposal form was accepted and SBI Life Smart Shield Policy bearing No.45001788602 was issued with date of commencement 19.05.2011 for the Basic Sum Assured of Rs.25,00,000/- and the same sum assured for accidental benefit rider and with a term of 10 years. The mode of premium was yearly and the premium amount payable was Rs.7,672/-. In the preamble of the policy, it was stated that "The information you have given in your proposal form, personal statement together with any other reports or other documents and declarations form a part of this contract of insurance with us. Your policy document, comprising this policy schedule along with the policy booklet and endorsement is evidence of the contract." The Deceased Life Assured, Mr. Shyam Bihari Gupta, had also applied // 9 // SBI Life Smart Performer vide Proposal bearing No.442272739 dated 29.03.2011. In the proposal form he gave declaration. On the basis of the information furnished in the proposal form and relying on the information to be true and accurate, the proposal form was accepted and SB Life Smart Performer Policy bearing No.44021401407 was issued with date of commencement 31.03.2011 for a sum assured of Rs.5,00,000/- with a term of 10 years. The mode of premium was yearly and the premium amount payable was Rs.50,672/-. Mr. Shyam Bihari Gupta is reported to have died on 15.02.2014. In reply to question No.11 under the proposal form No.45QB300209 and question No.6 under the proposal No.442272739 which states that 'Do you have any other individual life insurance policies or have you applied for one ? the DLA replied in negative. However, the DLA was holding a policy with LIC prior to applying for SBI Life Policy. As per the LIC Policy receipts, the DLA was insured with them under Policy Number 207006359 and 207007909 having date of commencement as 21.08.2010 and 06.09.2010. During investigation, it was revealed that the proposal forms were not signed by the DLA. The Company had got verified the signatures of the policy holder on the proposal form with the signatures on the premium payment cheque. In the instant case the income profile of the deceased life assured does not justify such a huge insurance cover and thus the DLA committed a fraud . The DLA had committed a breach of doctrine of Utmost Good Faith by committing a forgery of signature and not // 10 // disclosing policies held earlier. The amount of insurance cover to be granted depends on the human life value of the individual to be insured. Any disproportionate insurance will increase the moral hazard and a question arises with regard to the insurable interest. Any disproportionate insurance cover will affect the insurer adversely. In the instant case, the deceased Mr. Shyam Bihar Gupta had given false information relating to his previous life insurance policies and acquired SBI Life Policy fraudulently by forgery of signature on the proposal form. Thus, there is a suppression of material fact, which is crucial to the contract of insurance. Hence, the repudiation of the claim is valid, just and legal. The proposal form is the fundamental basis for assessment of risk and answer to each and every question asked for therein is vital for the underwriter to decide whether the proposed life is to be insured or not. Thus, any incorrect information stated in the proposal form certainly vitiates the interests of the insurer and hence the insurer is well within their rights to repudiate the claim wherever material facts are suppressed by the life assured. Thus, it is confirmed that there is a deliberate suppression of material fact with a fraudulent intention to obtain insurance. Thus, the contract is void ab initio in terms of Section 17 of Indian Contract Act, 1872 because any contract entered into by fraud is Void-ab-initio. There is no cause of action for the complainant to file the present complaint. The complaint is not maintainable because the repudiation action of SBI Life Insurance Co. Ltd. is valid, legal and // 11 // justified. Thus, the claim has been repudiated strictly within the terms and conditions of the policy. The action of SBI Life Insurance Co. Ltd. is just & legal and the complainant has no locus to file the present complaint. A request for reconsideration was received from the complainant vide letter dated 08.05.2015. The case was put up before the Claims Review Committee headed by a Retired High Court Judge. However, after examining the records put before the Committee, it upheld the decision to repudiate the claim. The Decision of the Claim Review Committee was communicated to the complainant vide letter dated 07.07.2015. SBI Life rely on the information furnished in the proposal form and other documents attached with the proposal and grants insurance policy on the principle of "Utmost Good Faith". Any suppression of material facts in the proposal form will render the insurance cover invalid in respect of the insured. The DLA had misstated life insurance details and made a deliberate misrepresentation with the meaning on Section 18 of the Indian Contract Act, 1872. Thus, the contract of evidence is void in terms of Section 10 read with Section 14(4) and Section 18 of the Indian Contract Act. Hence, the repudiation action is valid and present complaint is not maintainable and should be dismissed. The complaint involves larger issues like fraud and hence the complaint should be thoroughly investigated and tried before a Court of competent jurisdiction. The DLA had appointed Shiv Prasad Gupta under this policy. The benefits under the policy are payable to the // 12 // nominee as per the terms and conditions of the policy and prevailing laws of India. While processing the claim, it was observed that as per the LIC policy receipts, the DLA was insured with them under policy Number 207006359 and 207007909 having date of commencement as 21.08.2010 and 06.09.2010 much prior to the submission of SBI life proposals, but the DLA did not disclose these facts in the SBI life proposal forms, also he replied in negative to specific question in the SBI Life proposal form. Thus, the DLA suppressed the facts abou his previous Life Insurance Policies intentionally. Also it was observed that the proposal forms were not signed by the DLA. The OPs had got verified the signatures of the policy holder on the proposal form with the signatures on the premium payment cheque of the DLA. Hence the death claim was repudiated. The same was intimated to Shiv Prasad Gupta vide letter dated 05.03.2015. The OPs had received a letter for reconsideration vide letter dated 08.05.2015. The case was put up before the Claims Review Committee headed by a Retired High Court Judge. However after examining the records put before the Committee, it upheld the decision to repudiate the claim. The decision of CRC was communicated vide letter dated 07.07.2015. The complaint filed before learned Ombudsman was dismissed as the DLA had suppressed the facts about his previous life insurance policies and thus suppressed the material facts intentionally. It was also observed that as per the hand writing expert opinion, the SBI Life proposal form were not signed by // 13 // the DLA, hence it is a matter of fraud and the Forum has no jurisdiction to entertain the complaint for forgery. The Ombudsman has passed the award dated 21.03.2016 after considering the submissions made by both the parties. Thus, no cause of action has arisen to file this complaint, as the Ombudsman did not take any decision, as alleged by the complainant. The complainant is not entitled to get Rs.50,00,000/- along with interest @ 9% p.a., Rs.50,000/- towards cost of litigation, Rs.5,000/- towards advocate fees, as prayed or otherwise. The DLA had suppressed the facts about his previous life insurance policies while applying for SBI Life policies. He replied in negative to specific question in the proposal form, in this regard. Thus, the DLA intentionally suppressed the material facts and obtained the insurance policies fraudulently. The signatures on the proposal form were also not matching with his signature on the proposal cheque. Thus the policies issued to the DLA were void-ab-initio. The action of SBI Life is as per the terms and conditions of the policy and the same cannot be treated as carelessness, negligence or deficiency in service. Hence, no cause of action has arisen for the complainant to file instant complaint. The complaint be dismissed with costs to the SBI Life.
4. The complainant has filed documents. The documents are Suchna Panji Register year 2014-15,, letter dated 23.07.2014 sent by the complainant to Branch Manager, S.B.I. Life, Ambikapur, death certificate of Shyam Bihari Gupta issued by Deputy Registrar, Birth-Death, letter // 14 // dated 05.03.2015 sent by the OPs to the complainant, letter dated 07.05.2015 sent by the complainant to Manager (Head Claim) SBI Life, Mumbai, Uphold Repudiation Letter dated 07.07.2015 sent by Head Claims, SBI Life Insurance Company Ltd., letter dated 14.012016 sent by the complainant to Manager, Insurance Ombudsman Office, Bhopal (M.P.), copy of award dated 21.03.2016 passed by Insurance Ombudsman (M.P. & C.G.), Bhopal, letter dated 20.05.2011 sent by the OPs to Shyam Bihar Gupta, policy schedule, proposal form, First Information Report, Final Report, merg intimation, inquest report, application for post mortem, post mortem examination report, legal notice dated 16.01.2017 sent by Shri Anwarul Haque, Advocate to the OPs, postal receipts, adhar card of the complainant.
5. The OPs have filed documents. Annexure A is Proposal Form, Annexure B is letter dated 20.05.2011 sent by the OPs to Shyam Bihari Gupta, first premium receipt, policy document etc. Annexure C is Proposal Form - SBI Life Smart Performer, Annexure E is LIC policies, Annexure F is Forensic Expert Report dated 23.01.2015, cheque issued on 18.04.2011 by Shyam Bihari Gupta, Annexure G are letters dated 05.03.2015 sent by the OPs to the complainant, Annexure H is letter dated 11.05.2015 sent by the complainant to the Manger (Head Claim,) S.B.I. Life Insurance Company Limited, Mumbai, Reconsideration Acknowledgement dated 03.06.2015, Annexure I is letter dated 07.07.2015 sent by the Head Claims, SBI Life Insurance Co. Ltd. to the // 15 // complainant, Annexure J is legal notice dated 16.01.2017 sent by Shri Anwarul Haque, Advocate to the OPs, letter dated 13.02.2017 sent by the OPs to the complaiant, Award dated 21.03.2016 passed by the Insurance Ombudsman (M.P. & C.G.), Bhopal.
6. Shri Amit Soni, learned counsel appearing for the complainant has argued that the younger brother of the complainant, Late Shyam Bihari Gupta, who was working as an Agent of Life Insurance Corporation of India, Branch Ambikapur, District Surguja (C.G.) and was unmarried. The deceased Shyam Bihari Gupta obtained Smart Shield Insurance Policy No.45001788602 from the O.P. No.1 on 19.05.2011. The premium amounting to Rs.7,762/- every year was required for 10 years. The premium was to be paid till 19.05.2020. If natural death of the policy holder is occurred during above period, then Rs.25,00,000/- and if accidental death is occurred then Rs.25,00,000/-, total Rs.50,00,000/- would be received by the nominee Shivprasad Gupta/ complainant, because at the time of obtaining insurance policy, the deceased Shyam Bihari Gupta, made nominee to his elder brother Shivprasad Gupta/complainant. On 15.02.2014, Shyam Bihari Gupta was going to Village Durgapara from Batauli in the motor cycle. The vehicle dashed with ralling of the pool due to which he died and his post-mortem was conducted at Community Health Centre, Batauli. The first information report was lodged at Police Station Batauli, District Surguja (C.G.) where Offence No.18/14 under Section 304A IPC was // 16 // registered. The complainant gave intimation regarding death of deceased Shyam Bihari Gupta, to the O.P. No.1 within 90 days on 13.05.2014 and the O.P. No.1 provided claim form to the complainant on 13.05.2014. The complainant filled up the claim form and submitted the same in the office of the O.P. No.1 within 15 days. Thereafter, the documents demanded were submitted by the complainant in the office of the O.P. No.1 on 2307.2014. The O.P. No.1 sent all the documents to the O.P. No.2. All documents were submitted by the complainant to the O.P. No.1, but even then the claim amount was not paid, therefore, the complainant sent a letter on 07.05.2015 through courier in the office of the O.P. No.2 for making payment of the claim amount at the earliest. The claim of the complainant was repudiated on the ground that in the proposal form signature of Late Shyambihari Gupta is not present and complete and correct information has not been given, whereas the policy bond is not issued without signature of the policyholder and all information. Thus after completion of all information only, the policy bond is issued. The O.P. No.1 sent a letter to the complainant regarding the claim amount in which it is mention that you are not satisfied with their decision, then you can file appeal before General Manager, Claim Review Committee, Navi Mumbai. The complainant made complainant before the O.P. No.2 on 07.05.2015 and 14.09.2015 along with documents. The application submitted on 07.05.2015 was dismissed on 07.07.2015 and no reply was given in respect of application dated // 17 // 14.09.2015. Following the instructions of the O.P. No.1, the complainant again sent application to the office of Insurance Ombudsman, Bhopal on 14.01.2016. The Insurance Ombudsman passed order on 21.03.2016 to the effect that in their office, handwriting expert is not available, therefore, the signature put by the deceased in the policy bond and the cheque through which payment was made, could not be matched, therefore, decision cannot be given, whereas in the terms and conditions of the policy there is no mention regarding the same and the policy bond was issued in favour of the deceased after completion of all formalities by him and insurance was done. The OPs passed erroneous order. The claim of the complainant, was repudiated by the OPs violating the terms and conditions of the policy and the orders. Thus, by not paying the claim amount, the OPs committed deficiency in service. Due to the act of the OPs, the complainant suffered financial loss. The complaint is entitled to get reliefs as mentioned in the relief clause of the complaint. The complaint may be allowed.
7. Shri Narendra Kumar Mishra, learned counsel appearing for the OPs has argued that the address of the O.P. No.2 is at Mumbai, but the complaint is filed before the Hon'ble Commission at Bilaspur. This Commission has no territorial jurisdiction to take cognizance in the matter. He further argued that the Insurance Ombudsman, Bhopal is a quasi judicial body, who rejected the claim of the complainant and the claim has already been decided by Insurance Ombudsman, therefore, the // 18 // complaint is not maintainable. The reconsideration application made by the complainant, was sent to Claim Review Committee, which is headed by a Retired Judge of Higher Court and the Claim Review Committee upheld the decision of repudiation of claim, done by the OPs. Therefore, the final decision has already been passed by the Insurance Ombudsman and Claim Review Committe, hence the instant complaint is not maintainable. The deceased life assured earlier obtained two insurance policies, but the same were not disclosed in the proposal form. In the proposal form and other documents, the signatures of the deceased life assured are not similar. The allegations of fraud and allegations made out for which detailed inquiry is necessary and elaborate evidence is required, therefore, only the Civil Court can decide the matter and in summary proceedings before the Consumer Fora, it cannot be decided. The Deceased Life Assured suppressed material facts, therefore, the complaint is liable to be dismissed.
8. We have heard learned counsel appearing for both the parties and have also perused the documents filed by them in the complaint case.
9. The first objection of the OPs is that this Commission has no jurisdiction to take cognizance in the matter. The above contention of the OPs is not sustainable.
10. Sub section 2 of Section 11 of the Consumer Protection Act, 1986 runs as follows :-
// 19 // "(2) A complaint shall be instituted in District Forum within the local limits of whose jurisdiction -
(a) the opposite party or each of the opposite parties, where there are more than one, at the time of the institution of the complaint, actually and voluntarily resides or carries on business or has a branch office or personally works for gain, or
(b) any of the opposite parties, where there are more than one, at the time of institution of the complaint, actually and voluntarily resides or, carries on business or has a branch office, or personally works for gain, provided that in such case either the permission of the District Forum is given, or the opposite parties who do not reside, or carry or business or have a branch office, or personally work for gain, as the case may be, acquiesce in such institution; or
(c) the cause of action, wholly or in part, arises."
11. From perusal Sub Section 2 of Section 11 of the Consumer Protection Act, it is clear that the complaint may be filed at any place where the opposite parties voluntarily resides or, carries on business or has a branch office. The head office of the OPs is situated at Mumbai (M.H.) and branch office of the OPs is situated at Basantlal Marg, Ambikapur, District Surguja (C.G..). The details of the policy holder has been given in the Policy Schedule. In the Policy Schedule, it is mentioned that "if you require further information, please contact us or your servicing Agent / Facilitator Mr. Praveen Kumar Jaiswal (IA Code 13658796). The proposal form was filled at office of SBi Life, Bilaspur and SBI Life, Raipur, therefore, cause of action accrued at Raipur & Bilaspur. The accident took place at Village Batauli, District Surguja, therefore, the cause of action has also accrued at Ambikapur, District // 20 // Surguja (C.G.), therefore, this Commission has territorial jurisdiction to take cognizance in the matter.
12. Now we shall consider whether the complainant is consumer ? The Deceased Life Assured obtained the insurance policy from the OPs for safety of life assured and not for earning income. The complainant Shiv Prasad Gupta, is nominee of the Deceased Life Assured in the insurance policy, therefore he is beneficiary. Being beneficiary, he is consumer of the OPs. Therefore, the complainant is a "consumer" and dispute between the parties comes within purview of "consumer dispute".
13. Now we shall consider whether this Commission has territorial jurisdiction to take cognizance in the matter after passing order by the Insurance Ombudsman ?
14. Section 3 of the Consumer Protection Act, 1986 makes the position clear. It reads thus :-
"3. Act not in derogation of any other law.- The provisions of this Act shall be in addition to and not in derogation of the provisions of any other law for the time being in force."
15. Merely, the orders have been passed by the Insurance Ombudsman and Claim Review Committee, the jurisdiction of this Commission is not barred and the complaint is maintainable before this Commission.
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16. The main objection of the OPs is that the Deceased Life Assured purchased two other insurance policies prior to obtaining the instant policy but the same was not disclosed him in the proposal form.
17. In ICICI Prudential Life Insurance Co. Ltd. Vs. Lalita Jain, II (2015)CPJ 246 (NC), Hon'ble National Commission has observed that "Deceased insured had withheld material information from petitioner company and had misrepresented by writing NA (Not Applicable while replying to clause requiring disclosure of other insurance policies taken and applied by him. Information with respect to other life insurance policy and / or applied by proposer cannot be said to be inconsequential or trivial information. Repudiation justified."
18. In Pushpa Chauhan Vs. Life Insurance Corporation of India, II (2011) CPJ 44 (NC), Hon'ble National Commission has observed that "When an information on a specific aspect is asked for in proposal form, insured is under a solemn obligation to make a true and full disclosure of information on subject which is within his knowledge."
19. The life insurance Contract is a contract of "Utmost Good Faith", therefore, the life assured, who submitted proposal form, is duty bound to disclose everything regarding information sought in the proposal form.
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20. In Export Credit Guarantee Corpn. of India Ltd. vs. M/s Garg Sons International, II (2013) CPJ 1 (SC), Hon'ble Supreme Court, has observed thus :-
"9. The insured cannot claim anything more than what is covered by the insurance policy..... the terms of the contract have to be construed strictly, without altering the nature of the contract as the same may affect the interests of the parties adversely."
21. In United India Insurance Company Ltd. vs. M/s Harchand Rai Chandan Lal, 2005 (1) CPR 64 (SC); Hon'ble Supreme Court has observed thus :-
"6. The terms of the policy have to be construed as it is and we cannot add or subtract something. Howsoever liberally we may construe the policy but we cannot take liberalism to the extent of substituting the words which are not intended. It is true that in common parlance the term 'burglary' would mean theft but it has to be proceeded with force of violence. If the element of force and violence is not preset then the insured cannot claim compensation against theft from the insurance company. (Para 6).
It is not open to interpret the expression appearing in policy in terms of common law; but it has to give meaning to the expression reproduced the terms of the policy as also the definition of burglary and / or housebreaking as defined in the policy."
22. In Deokar Exports Pvt. Ltd. vs. New India Assurance Company Ltd. , I (2009) CPJ 6 (SC), Hon'ble Supreme Court has observed thus :-
// 23 // "11. A policy of insurance is a contract based on an offer (proposal) and an acceptance. The appellant made a proposal.
The respondent accepted the proposal with a modification. Therefore, it was a counter proposal, in which event three would have been no contract. The second was to accept either expressly or impliedly, the counter proposal of the respondent (that is respondent's acceptance with modification) which would result in a concluded contract in terms of the counter proposal. The third was to make a counter proposal to the counter proposal of the respondent in which event there would have been no concluded contract unless the respondent agreed to such counter proposal. But the appellant definitely did not have the fourth choice of propounding a concluded contract with a modification neither proposed nor agreed to by either party."
23. In M/s Vijay Concerns vs. State Bank of India, Through Branch Manager & Anr., 2013 (4) CPR 165 (NC), has observed thus :-
"8. From the material on record, it is very clear that the place where the loss has occurred was not within the knowledge of the Insurance Company. Moreover, the Bank can also not be held liable for any deficiency in service, because it was the primary duty of the complainant/petitioner to obtain the Insurance Policy and to have knowledge about its terms and conditions.
9. The State Commission while passing the impugned order have rightly placed reliance on the orders passed by the Hon'ble Supreme Court in the case United India Insurance Co. Ltd. v. M/s Harchand Rai Chandan Lal and in the case Deokar Exports Pvt. Ltd. v. New India Assurance Co. Ltd. according to which the rights and obligations of the parties are strictly governed by the policy of Insurance and no exception or relaxation can be made on // 24 // the grounds of equity. Further, a similar view has been expressed by the Hon'ble Supreme Court in the case of Suraj Mal Ram Niwas Oil Mills Private Ltd. v. United India Insurance Co. Ltd. & Anr. In which it has been observed by the Hon'ble Supreme Court as follows :-
"The Courts should always try to interpret the "words" in the insurance contract as they have been expressed by the parties. It is not open for the Court to add, delete or substitute any words. The words used in the Insurance Contract must be given paramount importance."
24. In Narsingh Ispat Ltd. Vs. Oriental Insurance Co. Ltd. and Anr. 2017 (2) CPR 856 (NC), Hon'ble National Commission has observed that "Insurance Contract is a species of commercial transaction and it must be construed strictly like any other contract to its own terms and by itself. Insurance contract like any other contract is binding on parties and endeavour of Court must always be to construe contract in context of terms and conditions in insurance policy."
25. In A.V. Cottex Limited Vs. The Oriental Insurance Company Limited, 2017 (2) CPR 696 (NC), Hon'ble National Commission has observed that "Insurance policy is a contract between insured and insurer and its terms and conditions are to be considered as such in same spirit in which they are written and agreed upon by parties."
26. The complainant has filed Common Proposal Form - Traditional Plans in which it is mentioned thus :-
// 25 // "9.5. For SBI Life Saral Life Only.
(i) Have you taken or applied for SBI Life Policy apart from this current proposal.
(ii) If yes, then please state Total Cover under SBI Life Saral Life
(iii) Has any proposal for life cover and / or Critical Illness on the life to be Assured Been declined / deferred/withdrawn or accepted with extra premium or any other restrictive clause ?
In reply to the above question the Life Assured gave answered in negative i.e. "No".
27. According to the Clause 9.5 of the Proposal Form, it is mandatory for the life assured to disclose regarding previous insurance policies obtained by him, but in the instant case, the proposal form, the deceased life assured did not disclose regarding the previous insurance police and in reply to questions asked in Clause 9.5, he gave answer in respect of previous policy in negative form.
28. The OPs have repudiated the claim of complainant, then the complainant filed appeal before Insurance Ombudsman, Bhopal.
29. The complainant and the OPs both have filed Award No.IO/BHP/A/LI/0202/2015-16 dated 21.03.2016 passed by Insurance Ombudsman (M.P. & C.G.), Bhopal, in which it is mentioned thus :-
"21. Result of hearing with both parties (Observations & Conclusion) // 26 // A. From perusal of the record, it is apparent that the DLA had also taken two policies bearing no.2070006359 and 207007909 of L.I.C. of India having date of commencement as 21.08.2010 and 06.09.2010 respectively prior to applying for SBI Life Policy.
B. From perusal of proposal forms, it is clear that DLA had not disclosed about previous policies taken from LIC of India. Thus, it is established that the DLA has suppressed material fact which is crucial to the contract of the insurance. The insurance contract is based on the principles of utmost good faith and the DLA had violated the same as the proposer / DLA had to answer every question put to him with complete honesty.
C. It is alleged by the respondent that the proposal forms were not signed by the DLA as the signature of the policy holder on the proposal form and signature on the premium payment cheque does not tally as per forensic report of signature verification and has filed the forensic report.
D. Since, there is dispute of signature of DLA on proposal forms which requires production of evidence (oral and documentary) by both the parties particularly hand writing expert witness for providing the above disputed facts but the complainant could not get any opportunity to rebut the forensic report to prove that signature is not forged. In the catena of decisions, it has been clearly observed that for allegations of fraud and forgery, the complainant should seek remedy in Civil Court.
E. This Forum has got limited authorities under RPG Rules, 1998. It can only hear the parties at dispute without calling fresh witnesses, summon them for deposition, asked for various evidence including cross examining outside parties which is beyond the scope of this forum. In order to resolve the subject matter of dispute, calling other witness may help in arriving at a just decision.
// 27 // AWARD Under the aforesaid circumstances, the complaint stands dismissed with a liberty to the complainant to approach some other appropriate forum / court to resolve the subject matter of dispute.
Both parties shall bear their own cost of proceeding in this forum."
30. According to the OPs, the complainant submitted a reconsideration application, which was sent by them to the Claim Review Committee, which is headed by Retired Judge of High Court and Claim Review Committee upheld the repudiation order passed by the OPs. The Insurance Ombudsman and Claim Review Committee held that the Deceased Life Assured had not disclosed in the proposal form regarding previous policies obtained by him, which is fundamental breach of terms and conditions of the insurance policy.
31. In the instant case the Deceased Life Assured had not disclosed regarding the previous insurance policies obtained by him and suppressed the facts, which is fundamental breach of terms and conditions of the insurance policy, therefore, the OPs have rightly repudiated the claim of the complainant. The complainant is not entitled to get any compensation from the OPs.
// 28 //
32. Therefore, the complaint filed by the complainant against the OPs, is liable to be dismissed, hence the same is dismissed. Parties shall bear their own costs.
(Justice R.S. Sharma) (D.K. Poddar) (Narendra Gupta)
President Member Member
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