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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Ajit Bharihoke, Presiding Member, Rekha Gupta, Member
SBI Life Insurance Co. Ltd. - Petitioner
Versus
Swapna Das & Anr. - Respondents
Revision Petition No. 1720 of 2012
Decided On : 13-11-2014
Advocate Appeared:
For the Petitioner:Mr. Rakesh Malhotra, Advocate.
For the Respondent:Mr. Suman Tripathi, Advocate.
The main legal point established in the judgment is the interpretation of the insurance policy's terms and conditions, specifically focusing on Section 1(a) of Schedule-I, to determine the sum assured and the liability of the insurance company based on the outstanding loan amount of the insured.
Headnote:
Insurance Claim - Group Insurance Scheme - Schedule-I - [Section 1(a) of Schedule-I] - The court discussed the terms and conditions of the insurance policy, specifically focusing on Section 1(a) of Schedule-I, which outlined the sum assured for the Premium Payable Insurance Cover (PPI). The court emphasized that the liability of the insurance company is either the amount outstanding in the loan account of the insured or Rs. 7,50,000, whichever is less. The court also highlighted the lack of evidence to establish that the insured died due to an accident, leading to the conclusion that the sum assured under the insurance policy should be determined based on the outstanding loan amount, which had been liquidated by the petitioner. The court set aside the impugned orders as violative of the terms and conditions of the contract.
Fact of the Case:
The respondent/complainant filed an insurance claim under a Group Insurance Scheme after her husband's death, but the claim was repudiated by the insurance company. The District Forum allowed the complaint, directing the opposite parties to pay the insured sum, compensation, and litigation costs. The petitioner, JD No. 2, claimed to have complied with the order by liquidating the outstanding loan amount of the deceased insured, but the plea was rejected by the Executing Court.
Finding of the Court:
The court found that the petitioner had complied with the order by liquidating the outstanding loan amount of the deceased insured, and the impugned orders were set aside as violative of the terms and conditions of the contract.
Issues: The issues revolved around the compliance with the insurance claim order, the interpretation of the insurance policy's terms and conditions, and the determination of the sum assured under the policy.
Ratio Decidendi: The court's decision was based on the interpretation of Section 1(a) of Schedule-I of the insurance policy, which outlined the sum assured for the Premium Payable Insurance Cover (PPI) and emphasized the liability of the insurance company based on the outstanding loan amount of the insured.
Final Decision: The court allowed the revision petition and set aside the impugned orders as violative of the terms and conditions of the contract.
ORDER :
Ajit Bharihoke, Presiding Member
This revision is directed against the order of the State Commission dated 29.3.2012 whereby the State Commission West Bengal dismissed the revisional application No. SC Case No. RC/97/2011.
2. Briefly stated the facts relevant for the disposal of this revision petition are that late Alok Kumar Dass, husband of the respondent/complainant, obtained Home Equity Loan of Rs. 5,22,135 from M/s. GE Money Financial Services which was to be paid in monthly instalments of Rs. 9383 w.e.f. July, 2005. The said loan was covered by SBI Life Insurance Policy obtained by MS GE Money Financial Services under Group Insurance Scheme. Husband of the complainant unfortunately died before he could discharge the aforesaid loan. The respondent/complainant being nominee under the insurance policy filed the insurance claim which was repudiated by the petitioner/insurance company on the ground that late husband of the complainant was not covered under the Group Insurance Scheme as per the confirmation received from GE Money Financial Services. Being aggrieved of repudiation of the insurance claim, the respondent/complainant filed consumer complaint in District Forum 24 Pgs, Barasat. The complaint was resisted by the Opposite Parties. The District Forum on consideration of the pleadings of the parties and the evidence allowed the complaint and directed thus:
“The Opposite Parties are jointly and severally directed to pay the insured sum with interest at the rate of 9% p.a. w.e.f. the date of filing P.O.C. till realization after making an adjustment with the outstanding amount there from within 2 months from the date of this order. O.Ps are further directed to pay sum of Rs. 10,000 towards compensation to the complainant. OPs are further directed to pay the sum of Rs. 5,000 towards the cost of litigation within two months from the date of this order.”
3. The above order of the District Forum was not challenged in appeal and it has become final. As the order was not complied with, the respondent/complainant filed an Execution Petition being Execution Case No. 66/2011 in the District Forum concerned. The petitioner JD No. 2 in response to the notice of the Execution Petition appeared before the Executing Court and took the plea that he has complied with the order by liquidating the house building loan of late husband of the complainant by paying Rs. 6,59,980 to JD No. 1 Finance Company and has also paid Rs. 12,000 by cheque to the respondent/decree holder towards compensation and cost of litigation.
4. The aforesaid plea of the petitioner / JD No. 2 was rejected by the District Forum by observing that JD No. 2 has not fully satisfied the order because he has failed to pay the balance insurance amount after adjusting the loan account of late insured.
5. Being aggrieved of the order of the Executing Court, the petitioner approached the State Commission and the State Commission vide the impugned order dismissed the revision application preferred by the petitioner with following observations:
“We have carefully gone through the impugned order and find that the learned District Forum has rightly observed that SBI Life Insurance Co. Ltd. issued the insurance certificate in favour of the deceased insured and as such, question of exonerating the OP/Revisionist does not arise at all at the very initial stage of the execution proceeding without going into the merit of the same. In this connection, we find much merit in the submissions so put forward on behalf of the OP/Complainant, according to whom, only a part pecuniary liability has been discharged at the instance of the OP/Revisionist and the real controversy between the parties can only be property adjudicated at the time of hearing of the execution case. Having considered the present Revisional Application in the light of above discussion we are of the considered opinion that the application for exonerating the Revisional Petitioner appears to have been made prematurely and the
