State Consumer Disputes Redressal Commission
Sbi Life Insurace Co Ltd. & Anr. vs Smt. Sumna Devi & Ors. on 26 February, 2020
H. P. STATE CONSUMER DISPUTES REDRESSAL
COMMISSION SHIMLA
First Appeal No. : 28/2018
Date of Presentation: 07.02.2018
Order Reserved on : 08.08.2019
Date of Order : 26.02.2020
......
1. SBI Life Insurance Co. Ltd. Central Processing Centre Kapas
Bhavan Plot No.3A Sector No.10 CBD Belapur Navi
Mumbai-400 614 now shifted to new address Seawoods
Grand Central F Wing 8th Floor Plot No.R-1 Sector-40
Seawoods Nerul Navi Mumbai-400706.
2. SBI Life Insurance Co. Ltd. State Bank of India Nadaun
District Hamirpur (H.P).
...... Appellants/Opposite Parties No.2 & 3
Versus
1. Ms. Sumna Devi wife of late Shri Rajinder Kumar.
2. Mr. Ajay Kumar S/o late Shri Rajinder Kumar.
Both residents of Kumwkar Village P.O. Ghallour Tehsil
Jawalamukhi District Kangra-H.P Pin Code-176031.
......Respondents No.1 &2/Complainants
3. Branch Manager State Bank of India Nadaun District
Hamirpur (H.P).
......Respondent No.3/opposite party No.1
Coram
Hon'ble Justice P.S. Rana (R) President
Hon'ble Ms. Sunita Sharma Member
Whether approved for reporting?1 Yes.
For Appellants : Ms. Anita Jalota vice Mr. Manohar Lal
Sharma Advocate.
For Respondents No.1&2: Mr. Shashi Bhushan Advocate.
For Respondent No.3 : Mr. Rakesh Thakur Advocate.
1
Whether reporters of the local papers may be allowed to see the order? Yes.
SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors.
F.A. No.28/2018
JUSTICE P.S. RANA (R) PRESIDENT:
O R D E R :-
1. Present appeal is filed against order dated 08.12.2017 passed by Learned District Consumer Forum/Commission in consumer complaint No.44/2015 titled Suma Devi & Anr. Versus State Bank of India & Ors. Brief facts of consumer complaint:
2. Complainants Smt. Sumna Devi & Anr. filed consumer complaint under Consumer Protection Act pleaded therein that Sh. Rajinder Kumar deceased was husband of Smt. Sumna and was father of Sh. Ajay Kumar. It is pleaded that deceased Sh. Rajinder Kumar obtained house loan from State Bank of India Nadaun Branch for a sum of Rs.800000/-
(Eight lac). It is pleaded that loan was to be repaid within five years and mode of premium was monthly. It is pleaded that deceased Sh. Rajinder Kumar was employee in office of BSNL at Nadaun (H.P) and was regularly paying loan installments. It is further pleaded that Sh. Rajinder Kumar died on dated 27.09.2013 at Village Kumwkar P.O. Ghallour Tehsil Jawalamukhi District Kangra (H.P). It is pleaded that complainants being legal heirs of deceased insured filed insurance claim before opposite parties No.2 & 3 but opposite parties No.2 & 3 repudiated the claim in illegal manner and 2 SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors. F.A. No.28/2018 committed deficiency in service and also committed unfair trade practice. Prayer for acceptance of consumer complaint sought.
3. Per contra version filed on behalf of opposite party No.1 pleaded therein that deceased insured has concealed pre-ailment disease from insurance company. It is pleaded that deceased insured was suffering from (1) Coronary Artery Disease (2) Hypertension (3) Single Vessel Disease. It is further pleaded that deceased insured concealed material facts from insurance company at the time of obtaining insurance policy. It is pleaded that insurance company is not under legal obligation to pay insurance amount. Prayer for dismissal of consumer complaint sought.
4. Per contra separate version filed on behalf of opposite parties No. 2 & 3 pleaded therein that deceased insured has concealed prior ailment in declaration form. It is pleaded that Life Insurance contract is contract of almost good faith and deceased insured was suffering from (1) Coronary Artery Disease (2) Hypertension (3) Single Vessel Disease prior to date of commencement of policy. It is further pleaded that deceased insured deliberately suppressed material facts from insurance company and insurance company is not under legal obligation to pay insurance claim. It is further pleaded that insurance company has repudiated 3 SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors. F.A. No.28/2018 insurance claim strictly in accordance with laws and proved facts. It is pleaded that opposite parties No.2 & 3 did not commit any deficiency in service and did not commit any unfair trade practice. Prayer for dismissal of consumer complaint against opposite parties No.2 & 3 sought.
5. Complainant filed rejoinder and reasserted allegations mentioned in consumer complaint. Learned District Consumer Forum/Commission ordered opposite parties No.2 & 3 to pay insurance claim to the tune of Rs.800000/-(Eight lac) to complainants alongwith interest @ 9% per annum from the date of filing of complaint i.e. w.e.f. 11.02.2015 within 30 days from date of receipt of copy of order. Learned DCF/DCC further ordered that opposite parties No.1 would be legally entitled to recover loan amount from amount granted to complainants. In addition learned DCF/DCC ordered that opposite parties No.2 & 3 would pay punitive compensation to complainant to the tune of Rs.5000/-(Five thousand). In addition learned DCF/DCC ordered opposite parties No.2 & 3 to pay litigation costs to complainant to the tune of Rs.5000/-(Five thousand).
6. Feeling aggrieved against order passed by learned DCF/DCC opposite parties No.2&3 filed present appeal before State Commission.
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SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors. F.A. No.28/2018
7. We have heard learned Advocates appearing on behalf of parties and we have also perused entire record carefully.
8. Following points arise for determination in present appeal.
1. Whether appeal filed by appellants is liable to be accepted as mentioned in memorandum of grounds of appeal and whether insurance company is liable to pay insurance claim when exclusion clauses of insurance policy were not communicated to insured in view of ruling reported in 2000(2) Supreme Court Cases 734 Modern Insulators Ltd. Versus Oriental Insurance Company Ltd.?
2. Final order.
Findings upon point No.1 with reasons:
9. Complainants filed affidavit of Smt. Sumna Devi Anenxure-C1 in evidence. There is recital in affidavit that husband of deponent obtained loan from opposite party No.1 amounting to Rs.800000/-(Eight lac). There is recital in affidavit that opposite party No.1 sanctioned house loan.
There is recital in affidavit that opposite party No.1 pressurized husband of deponent to insure loan amount from opposite parties No.2 & 3. There is recital in affidavit that thereafter loan amount was insured with opposite parties No.2 & 3 for an amount of Rs.800000/-(Eight lac). There is recital in affidavit that deceased insured had paid all 5 SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors. F.A. No.28/2018 installments regularly. There is recital in affidavit that deceased insured died on 27.09.2013. There is recital in affidavit that thereafter insurance claim was submitted before opposite parties but opposite parties repudiated the claim in an illegal manner and committed deficiency in service and committed unfair trade practice. State Commission has carefully perused all annexures filed by complainant.
10. Opposite party No.1 filed affidavit of Shri R.K Dhiman Branch Manager SBI Nadaun Branch. There is recital in affidavit that predecessor-in-interest of complainants obtained loan for construction of house from opposite party No.1. There is recital in affidavit that loan was to be repaid by insured Sh. Rajinder Kumar in 180 monthly installments. There is recital in affidavit that each installment was to the tune of Rs.8618/-(Eight thousand six hundred eighteen) per month. There is recital in affidavit that deceased Sh. Rajinder Kumar was working in office of BSNL Nadaun and he has paid all installments regularly. There is recital in affidavit that deceased insured died on dated 27.09.2013 and suddenly loan payment was stopped. There is recital in affidavit that deceased insured Sh. Rajinder Kumar became NPA on dated 02.10.2013. There is recital in affidavit that opposite party No.1 has no knowledge whether 6 SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors. F.A. No.28/2018 deceased Sh. Rajinder Kumar was suffering from any prior pre-existing disease.
11. Opposite party No.1 also filed affidavit of Sh. Manish Goyal Investigator SA Associates in evidence. There is recital in affidavit that deponent is working as investigator with SA Associates and duly authorized to swear affidavit on behalf of SBI Life Insurance Co. Ltd. There is recital in affidavit that SA Associates conducted investigation and submitted factual report to SBI Life Insurance Co. Ltd. on dated 11.12.2013.
12. Opposite parties No.2 & 3 filed affidavit of Ms. Neelam Singh in evidence. There is recital in affidavit that deponent is authorized representative of SBI Life Insurance Co. Ltd. and is working as Manager Legal in SBI Life Insurance Co. Ltd. There is recital in affidavit that deceased insured has concealed his preexisting disease in declaration form. There is recital in affidavit that deceased insured was suffering from (1) Coronary Artery Disease (2) Hypertension (3) Single Vessel Disease. There is recital in affidavit that deceased insured has suppressed material facts from insurance company. There is recital in affidavit that insurance company is not under legal obligation to pay insurance amount on the concept of exclusion clause 7 SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors. F.A. No.28/2018 mentioned in insurance policy. State Commission has carefully perused all annexures filed by opposite parties.
13. Submission of learned Advocate appearing on behalf of appellants that deceased insured was suffering from pre-existing disease i.e. (1) Coronary Artery Disease (2) Hypertension (3) Single Vessel Disease and deceased insured has suppressed material facts from insurance company at the time of obtaining insurance policy and order of learned DCF/DCC that appellants would pay insurance amount to the tune of Rs.800000/-(Eight lac) alongwith interest @ 9% per annum from the date of complaint is contrary to laws and proved facts is decided accordingly. As per certificate of insurance policy placed on record date of birth of deceased insured Sh. Rajinder Kumar was 30.03.1958. As per certificate of insurance placed on record insurance policy became effective on 07.02.2013. At the time of obtaining insurance policy age of insured was more than 45 years. As per instruction issued by IRDA if age of insured is more than 45 (Forty five) years at the time of obtaining insurance policy in that eventuality insurance company is under legal obligation to conduct prior premedical examination of insured prior to issuance of Insurance policy. In the present matter there is no evidence on record that insurance company conducted premedical examination of deceased insured prior 8 SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors. F.A. No.28/2018 to issuance of Insurance policy despite the fact that age of deceased insured was more than 45 years when deceased insured obtained insurance policy in question. It is well settled law that insurance company could not be allowed to take benefit of its own laxity and non action. See 2018(2) CLT 205 SCDRC U.T Chandigarh titled Manish Goyal Versus Max Bupa Health Insurance Co. Ltd. & others.
14. There is no evidence on record in order to prove that exclusion clauses of insurance policy were communicated to deceased insured by insurance company. It is well settled law that when exclusion clauses of insurance policy were not communicated to insured in that eventuality insurance company could not escape from liability of payment of insurance claim. See 2000(2) Supreme Court Cases 734 Modern Insulators Ltd. Versus Oriental Insurance Company Ltd. See 2007(III) CPJ 34 NC National Insurance Company Ltd. Versus D.P. Jain. See 2019(2) SC 820 Himachal Law Reporter (H.P High Court) titled Bharat Watch Versus National Insurance Co. Ltd.
15. Even insurance company did not file affidavit of Medical Officer in order to prove contents of prescription slip issued by Nanda Hospital Hamirpur Road Una (H.P). It is well settled law that proceedings under Consumer Protection Act are quasi judicial proceedings. It is well settled law that 9 SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors. F.A. No.28/2018 contents of controversial documents should be proved by way of affidavit of a person who has signed controversial document. See 2019 (III) CPJ 1 NC titled ICICI Prudential Life Insurance Co. Ltd. Versus Dattatrey Bhivsan Gujar.
16. Even as per Nomination Rules 2005 (1) Spouse (2) Children (3) Parents falls within beneficial nominee. It is well settled law that compensation rights survives to LRs in insurance policy if insured died interstate. There is no evidence on record that deceased insured has executed any testamentary document. Admittedly complainant No.1 is widow of deceased insured and complainant No.2 is son of deceased insured and both falls within class-I legal heirs mentioned under Hindu Succession Act 1956. See 2006(2) CPC 667 Apex Court titled Mukesh Kumari Versus M. Lal Oswal Cancer Treatment and Research Foundation & Anr.
17. Submission of learned Advocate appearing on behalf of appellants that learned DCF/DCC has imposed excessive punitive compensation upon appellants to the tune of Rs.5000/-(Five thousand) and on this ground appeal filed by appellants be allowed is decided accordingly. State Commission is of the opinion that learned DCF/DCC has imposed reasonable punitive compensation upon appellants and it is not expedient in the ends of justice and on the 10 SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors. F.A. No.28/2018 principles of natural justice to interfere in punitive compensation order passed by learned DCF/DCC.
18. Submission of learned Advocate appearing on behalf of appellants that learned DCF/DCC has imposed excessive litigation costs upon appellants to the tune of Rs.5000/-(Five thousand) and on this ground appeal filed by appellants be allowed is decided accordingly. State Commission is of the opinion that complainant No.1 is widow of deceased and complainant No.2 is son of deceased insured and they have engaged Advocate before learned DCF/DCC and they have also paid litigation costs before learned DCF/DCC. It is held that learned DCF/DCC has imposed equitable litigation costs upon appellants and it is not expedient in the ends of justice and on the principles of natural justice to interfere in litigation costs order of learned DCF/DCC.
19. Facts of case laws cited by learned Advocate appearing on behalf of appellants i.e. (1) R.P. No.3864/2017 NC, R.P No.3865/2017 NC & R.P. No.3866/2017 NC titled Allaudin @ Ajauddin Versus Kotak Mahindra Old Life Insurance Ltd. (2) 2003(III) CPJ 15 NC titled Panni Devi Versus LIC (3) 1997(2) CPC 234 NC titled Ajay Parkash Mittal Versus LIC (4) Smt. Devamma Versus Branch Manager LIC of India decided on 30.01.2014 by Hon'ble National Consumer 11 SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors. F.A. No.28/2018 Commission (5) Appeal No.11/300 SCDRC Maharashtra titled LIC of India Versus Ashish Aggarwal (6) Civil Appeal Nos.5994/2004, 7477/2004 and 1733/2005 Apex Court titled Grasim Industries Ltd. Versus Agarwal Steel (7) R.P. No.469/2006 NC titled United India Insurance Company Ltd. Versus Subhash Chandra decided on 19.05.2010 (7-A) F.A. No.428 of 2008 NC titled New India Assurance Company Ltd. Versus Gopal Gupta & others (8) R.P. No.947/1997 NC titled LIC of India Versus Raksha Goyal (9) R.P. No.2091/2007 Apex Court titled Mithoolal Nayak Versus LIC of India and Mayadevi Versus LIC of India decided on 31.05.2011 (10) 1966(3) SCR 500 Apex Court titled General Assurance Society Ltd. Versus Chandumall Jain & Anr. (11) R.P. No.211/2009 NC titled Reliance Life Insurance Co. Ltd. Versus Madhavacharya (12) F.A. No.157/2006 NC titled IND Swift Ltd. Versus New India Assurance Company Ltd. (13) R.P. No.469/2006 NC titled United India Insurance Company Ltd. Versus Subhash Chandra (14) LIC of India Versus Kamlesh decided by Hon'ble National Consumer Commission on 09.01.2014 (15) 2004(8) SCC 644 Apex Court titled United India Insurance Company Ltd. Versus Harchan Rai Chandan Lal (16) Col. T.S. Bakshi Retd. Versus Star Health & Allied Insurance Co. Ltd. decided on 06.05.2014 NC (17) P.J. Chacko Versus LIC of India 2007 S.C 429 Civil Appeal No.5322/2007 (18) R.P. No.336/2007 NC titled HDFC 12 SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors. F.A. No.28/2018 Standard Life Insurance Co. Ltd. Versus Smt. Vijayalakshmi (19) 2003 CPJ 135 NC titled LIC Versus Mansa Devi-II (20) R.P. No.4486/2010 NC titled Neelam Gupta Versus Reliance Life Insurance & Anr. (21) R.P. No.3114/2014 NC titled Amzad Khan Versus The Manger Aviva Life Insurance Co. Ltd. (22) R.P. No.2130/2007 NC titled LIC of India Versus Surekha Shankar Jadhav (23) LIC of India Versus Smt. Shahida Khatoon & others NC decided on 10.09.2013 (24) Civil Appeal No.2776/2002 decided on 10.07.2009 SC titled Satwant Sandhu Versus New India Assurance Company Ltd. (25) F.A. No.242/2006 NC titled Dineshbhai Chandarana & others Versus LIC of India decided on 27.07.2010 (26) R.P. No.2830/2012 NC titled K.D. Mandappa & Anr. Versus Metlife India Insurance Co. Ltd. & Anr. (27) Krushna Sureshkumar Taruna Versus LIC of India & Anr. NC decided on 26.07.2016 and facts of present case are entirely different. It is held that ruling cited supra are distinguishable in present matter due to distinguishable facts.
20. Submission of learned Advocate appearing on behalf of complainant that order of learned DCF/DCC is in accordance with laws and in accordance with proved facts and does not warrant any interference by State Commission is decided accordingly. State Commission is of the opinion that it is not expedient in the ends of justice and on the 13 SBI Life Insurance Co. Ltd. & Anr. Versus Sumna Devi & Ors. F.A. No.28/2018 principles of natural justice to interfere in order of learned DCF/DCC and it is held that order of learned DCF/DCC is strictly in accordance with laws and in accordance with proved facts. Point No.1 is decided accordingly. Point No.2: Final Order
21. In view of findings upon point No.1 above appeal filed by appellants is dismissed. Order of learned DCF/DCC is affirmed. Parties are left to bear their own litigation costs before State Commission. File of learned DCF/DCC alongwith certified copy of order be sent back forthwith and file of State Commission be consigned to record room after due completion forthwith. Certified copy of order be transmitted to parties forthwith free of costs strictly as per rules. Appeal is disposed of. Pending application(s) if any also disposed of.
Justice P.S. Rana (R) President Sunita Sharma Member 26.02.2020 K.D 14