State Consumer Disputes Redressal Commission
Head Group Operations (Pmjjby) Sbi Life ... vs Smt. Hima Devi. & Ors. on 7 December, 2022
H. P. STATE CONSUMER DISPUTES REDRESSAL
COMMISSION SHIMLA.
First Appeal No.: 86/2021
Date of Presentation: 08.12.2021
Order Reserved on : 28.11.2022
Date of Order : 07.12.2022
___
...
1. Head Group Operations, (PMJJBY) SBI Life Insurance
Company Limited, Central Processing Center, 8th Floor,
Seawoods Grand Central, Tower-2, Plot No.R 1, Sector 40,
Seawoods, Nehru Node, Navi Mumbai, Maharashtra-
400706
2. Manager Group Operations, (PMJJBY) SBI Life Insurance
Company Limited, Central Processing Center, 8th Floor,
Seawoods Grand Central, Tower-2, Plot No.R 1, Sector 40,
Seawoods, Nehru Node, Navi Mumbai, Maharashtra-
400706
3. SBI Life Insurance Company Limited, 2nd Floor, Sahib
Complex, 118/9, Serti Bazar, District Mandi, H.P. through its
General Manager/Regional Manager.
...... Appellants/Opposite parties No.2 to 4
Versus
1. Smt.Hima Devi W/o Sh. Diwakar R/o Village Kuther, P.O.
Chail Chowk, Tehsil Chachyot, District Mandi, H.P.
2. Sh.Diwakar S/o Late Sh. Devi Ram R/o Village Kuther, P.O.
Chail Chowk, Tehsil Chachyot, District Mandi, H.P.
....Respondents No.1& 2/Complainants.
3. State Bank of India, Branch Chail Chowk, Tehsil Chachyot,
District Mandi, H.P. through its Branch Manager/Authorized
Officer.
...Respondent No.3/Opposite party No.1
Head Group Operations (PMJJBY) SBI Life Ins. Co.& Ors Vs.HIma Devi & Ors
(F.A. No.86/2021)
Coram
Hon'ble Justice Inder Singh Mehta, President
Hon'ble Ms.Sunita Sharma, Member
Hon'ble Mr.R.K. Verma, Member
Whether approved for reporting?1 Yes
For the Appellants: Mr.Himanshu Kapila, Advocate vice
Mr.Manohar Lal Sharma, Advocate.
For Respondents No.1&2: Mr. Chetan Viraj Sharma, Advocate.
For the Respondent No.3: Ms.Kiran Sharma, Advocate
vice Mr.Arvind Sharma, Advocate.
Justice Inder Singh Mehta, President
ORDER
Instant appeal is arising out of the order dated 10.11.2021 passed by Learned District Consumer Commission, Mandi in Consumer Complaint No.65/2021 titled Smt.Hima Devi & Anr. Versus State Bank of India & Others. Brief facts of Case:
2. Briefly, the case of the complainants is that son of the complainants Shri Chaman Lal Sharma (since deceased) was the holder of savings bank account No.20259606461 with State Bank of India, Chail-Chowk Branch (opposite party No.1).
Sh.Chaman Lal Sharma enrolled himself under Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY) through State Bank of India and insured himself for a sum of Rs.2,00,000/-. Insurance premium of Rs.330/- was paid through his account on 1 Whether reporters of the local papers may be allowed to see the order? 2 Head Group Operations (PMJJBY) SBI Life Ins. Co.& Ors Vs.HIma Devi & Ors (F.A. No.86/2021) 12.07.2019. Shri Diwakar (father of deceased life assured) was appointed as a nominee in the said policy. On 22nd August, 2019, Shri Chaman Lal Sharma (life assured) died due to cardic arrest. The claim was lodged by the complainant No.2 (Diwakar) with the opposite parties on 12.09.2019, but the claim was wrongly and illegally rejected by the opposite parties vide letter dated 02.01.2020.
3. The opposite parties No.2 to 4/Insurance company filed reply and submitted that the date of commencement of risk in the case of Chaman Lal Sharma (deceased life assured) was 12.07.2019 and he expired on 22.08.2019. Death occurred within a period of 45 days from the date of commencement of risk. The complainants disclosed the cause of death as cardic arrest, which is a natural death. As per directions issued by the Ministry of Finance, Government of India, dated 02.05.2016, the Insurance company is not liable to pay the sum assured, if the life assured dies within first 45 days, from the date of commencement of insurance cover. The claim has been rightly rejected.
4. The opposite party No.1 (bank) has adopted the reply filed by the opposite parties No.2 to 4.
5. In rejoinder, the complainants have reiterated the contents of complaint and refuted the objections put forth by 3 Head Group Operations (PMJJBY) SBI Life Ins. Co.& Ors Vs.HIma Devi & Ors (F.A. No.86/2021) the opposite parties.
6. Thereafter, the complainants and the opposite parties No.2 to 4 led their evidence in support of their respective pleadings. Opposite party No.1(Bank) adopts the evidence filed by the opposite parties No.2 to 4/Insurance company.
7. After hearing the parties, learned District Commission allowed the complaint of the complainants.
8. Feeling aggrieved by the order of the Ld. District Commission, the Appellant/Insurance company has preferred the instant appeal before this Commission.
9. We have heard learned counsel appearing on behalf of the parties and have also gone through the record carefully.
10. Learned counsel of the appellants/Insurance company has submitted that Sh.Chaman Lal Sharma (since deceased) enrolled himself under Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY) through State Bank of India and insured himself for a sum of Rs.2,00,000/-. The said policy was commencing w.e.f. 12.07.2019. The life assured Chaman Lal, died natural death on 22.08.2019. As per the policy, if the life assured dies natural death within 45 days from the date of commencement of the risk, the policy will not be applicable in view of the exclusion clause.
4Head Group Operations (PMJJBY) SBI Life Ins. Co.& Ors Vs.HIma Devi & Ors (F.A. No.86/2021)
11. The learned counsel of the respondents No.1 and 2 has submitted that the exclusion clause was never informed to the deceased/life assured. He has relied upon the Judgments passed by the Hon'ble Supreme Court of India in case titled M/s Texco Marketing Pvt. Ltd. Vs Tata AIG General Insurance Company Ltd. and Ors., order passed by National Consumer Disputes Redressal Commission, New Delhi in case titled National Insurance Co. Ltd. vs D.P. Jain, case titled as United India Insurance Co. Ltd. & Anr. Vs S.M.S. Tele Communications & Anr., and order passed by Uttaranchal State Consumer Disputes Redressal Commission, Dehradun in case titled Oriental Insurance Co. Ltd. vs Neeraja Rani Sharma, and order passed by Orissa State Consumer Disputes Redressal Commission, Cuttack in a case titled as New India Assurance Co. Ltd. & Anr. vs Patitapaban Karan, and order passed by Himachal Pradesh State Consumer Disputes Redressal Commission, Shimla in case titled Life Insurance Corporation of India & Anr. Vs Puran Chand.
12. The learned counsel of the respondent No.3/bank has submitted that the policy was executed in favour of the deceased life assured Chaman Lal Sharma.
5 Head Group Operations (PMJJBY) SBI Life Ins. Co.& Ors Vs.HIma Devi & Ors (F.A. No.86/2021) FINDING
13. The admitted fact emerging on record is that son of the complainants namely Shri Chaman Lal Sharma (since deceased) was the holder of savings bank account No.20259606461 with State Bank of India, Chail-Chowk Branch. Sh.Chaman Lal Sharma enrolled himself under Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY) through State Bank of India and insured himself for a sum of Rs.2,00,000/-. Insurance premium of Rs.330/- was paid through his account on 12.07.2019.
14. On 22nd August, 2019, Shri Chaman Lal Sharma (life assured) died due to cardic arrest. The claim was lodged by the complainant No.2 (Diwakar) with the opposite parties on 12.09.2019. The claim was repudiated by the Insurance company on account of exclusion clause i.e. terms and condition No.2 in the insurance policy. The said exclusion, i.e. terms and condition No.2 is reproduced as under:-
"Exclusion (Lien Period): For new members enrolling into the scheme the risk will not be covered during the first 45 days from the date of enrolment into the scheme (lien period) and in case of death (other than due to accident) during lien period, no claim would be admissible".6
Head Group Operations (PMJJBY) SBI Life Ins. Co.& Ors Vs.HIma Devi & Ors (F.A. No.86/2021)
15. It is also admitted fact emerging on record that deceased life assured Chaman Lal Sharma died natural death on 22.08.2016 within 45 days from the date of taking policy in question.
16. Since deceased life assured Chaman Lal Sharma died natural death on 22.08.2016 within 45 days from the date of taking policy in question, the aforementioned exclusion clause in the policy disentitles the complainants from claiming any amount from the Insurance company.
17. Moreover, after taking the policy and paying the premium, nothing was to be done either by the life assured or the respondents till the next payment of premium or renewal of the policy.
18. Since there is exclusion clause in the policy, which disentitles the complainants from claiming any amount from the Insurance company, the finding given by the District Commission below on this account is bad in law and facts.
19. As far as the judgments relied upon by the respondents No.1 and 2 are concerned, the same are of no help to their case.
20. Therefore, the appeal of the appellants/Insurance company is allowed and the impugned order dated 10.11.2021 passed by learned District Commission, Mandi, is set aside. 7 Head Group Operations (PMJJBY) SBI Life Ins. Co.& Ors Vs.HIma Devi & Ors (F.A. No.86/2021)
21. Parties are left to bear own litigation costs.
22. Certified copy of order be sent to the parties and their counsel(s) strictly as per rules. Certified copy of this order alongwith file of District Commission be sent back and file of State Commission be consigned to record room after due completion. Appeal is disposed of. Pending applications, if any, also disposed of.
Justice Inder Singh Mehta President Sunita Sharma Member R.K. Verma Member 07.12.2022 Manoj 8