Order-28.

Date-30/09/2015.

This is an application u/s.12 of the C.P. Act, 1986.

          Complainant by filing this complaint has submitted that complainant is the wife of the deceased Rajendra Kumar Agarwal.

          OP1 is engaged in the banking service as well as provides financial assistance to intending citizens and the OP2 is an insurance company who provides various schemes of policies to various interested people and is ruled by the guidelines of the Insurance Regulatory Authority (IRDA). 

          OP1 in collaboration with the OP2 provided Accidental Death Coverage Schemes to its’ customers.  Deceased husband of the complainant being one of the esteemed customers of OP1 was provided with an Accidental Death Coverage Schemes by OP1 sometimes in 2003 for the coverage to the extent of Rs.1 lakh against the SB A/c. No.073110025302267 wherein the complainant was introduced as the nominee of the account holder.

          Accordingly, every year from 2004 till 2012 the OP1 deducted the premium for the said policy from the Savings Account of the deceased husband of the complainant but peculiar factor is that OP1 did not issue any policy certificate to the insured person at any point of time.

          Unfortunately, on September 5, 2012 the husband of the complainant, the insured person accidentally fell into the Hooghly River, drowned and died.

          Complainant was mentally unstable due to sudden death of her husband and had no knowledge about the said policy.  Subsequently, complainant came to know from the Savings Pass book of the deceased husband that her deceased husband had an accident coverage policy of Rs.1 lakh provided by the OP1.

          After gathering knowledge regarding the existence of the said policy on 18-01-2013 complainant lodged claim with the OP2 in their prescribed form along with all relevant documents and waited for their reply but vide letter Ref. No.DO-I:KOL:TECH:0637:2012 dated March 28, 2013 the OP2 intimated the complainant stating as follows “please be informed that on our seeing record it reveals that no such policy in the name of above has so far been issued by this office and hence we are returning entire documents to you…..”.  So, on receipt of the letter from the OP2 complainant was surprised and on several occasions talked with the officials of the OP2.  OP2 verbally assured the complainant that they will look into her matter with special care and also they will ensure that the complainant will get the claim, but nothing was happened and the complainant after waiting for a couple of months by a letter dated 26-10-2013 requested the OP2 to settle the claim at an earliest possibility and the copy was also sent to the OP1.

          In the meantime OP1 sent the following documents duly attested by them to the complainant and their Head Office Marketing Department covered by a forwarding letter being Lr. No.0731/51/ABG dated November 22, 2013, 1) Police Report No.27187/RPT of 07/12/2012, 2) Inquest Report 711 of 2012 and 3) Post Mortem Report 868/06-09-2012.

          In fact, OP2 failed to keep their verbal assurance and at the same time OP1 has not hand over the policy for which the complainant has suffered and in the above circumstances, complainant has prayed for relief and for directing the OP1 to pay the compensation for causing harassment, mental agony and also for deducting the said premium from the account of the complainant.

          On the other hand OP2 by filing written statement submitted that complainant has failed to produce any document to show that any policy was issued in the name of the complainant’s husband at any point of time.  Not even any premium receipt was produced by the complainant to prove the policy number or the name of the insurance company or about its validity or anything and OP2 further submitted that no individual policy was issued in the name of the bank account holder but the account holder became a member under the Master Policy and in case of lodging claim, the claimant had to submit the number and other particulars of the Master Policy for processing the claim by the insurer but the complainant failed to provide it.

          Most interesting factor is that in the complaint no policy particulars and details are mentioned and already OP2 reported to the complainant that there was no policy issued in the name of Rajendra Kumar Agarwal.

          OP2 submitted specifically that complainant must have to furnish the policy number otherwise insurer is helpless and no step can be taken.  So, complainant shall have to prove it and there was no negligence and deficiency on the part of the OP2.  So, the complaint should be dismissed.

          OP1 even after service of notice did not appear to contest the case.  Accordingly the case is taken up for final decision on the basis of the material so far collected on completion of the entire proceeding of the complaint.

Decision with Reasons

On comparative study of the complaint and the written version and also considering the vital fact related to alleged insurance coverage we have gathered that, in fact, complainant has failed to give any detail of the insurance policy and also about premium receipt and no doubt OP insurance company has specifically submitted before this Forum as and when the details of the policy shall be submitted.  They shall have to enquire but on the basis of the complainant’s prayer they searched out their entire document but the did not find any policy issued by the OP2 in favour of Rajendra Kumkar Agarwal, since deceased the husband of the complainant.

          Then question is on the basis of which complainant is claiming such accidental benefit of the insurance and in this regard we have gathered that the complaint and written version and also pass book of Andhra Bank of the SB account of Rajendra Kumar Agarwal being No. 073110025302267 issued Burrabazar Branch, Kolkata and from the said pass book’s first page it is found it is noted Abhaya Gold Savings Bank offers Rs.1 lakh Accidental Insurance Coverage and from the statement of account since 03-08-2004 it is found that an amount of Rs.42.75 or Rs.45 were deducted from the account as insurance premium since 03-08-2004 to 31-10-2012 and considering that account book it is clear that from 30-10-2004 to 31-10-2012 insurance premium was collected by the bank and it was deducted from the account of the complainant but bank is very much silent about such deduction of insurance premium from the account of Rajendra Kumar Agarwal.  No doubt bank has deducted that insurance premium amount suo moto from the account of the complainant time to time and it was deducted for about 8 years.  Then it is the duty of the Andhra Bank, Burrabazar Branch to disclose against which policy number that amount has been deducted by the Andhra Bank and invariably there is an insurance policy for which the bank deducted it.  But name of the insurance company is not noted in the said account statement and probably Andhra Bank committed some illegality for which they are not appearing before this Forum.  Further from the head of the first page of said Pass Book of Andhra Bank, Burrabazar Branch it is found Abhaya Gold Savings Bank offer Rs.1 lakh accidental insurance coverage and no doubt that complainant’s husband Rajendra Kumar Agarwal was covered by Abhaya Gold Accident Insurance coverage and it was opened by the Andhra Bank, Burrabazar Branch and this bank has been deducting that amount for long period till the death of the complainant’s husband.  But that OP1 as service provider did not give any details about that policy for which this complainant has suffered and is being suffered continuously till now.  Practically bank has deducted such premium then invariably bank issued such insurance policy that is Abhaya Gold Accident Insurance Coverage then it is the duty of the bank to supply the details of insurance policy to the wife of Rajendra Kumar Agarwal i.e. the present complainant but that has not been done.  Truth is that OP1 was given chance to explain for such deduction but that has not been explained.  They got chance to defend the complainant in this case but that has not been done then it is clear everything was done by the OP1 as corporate agent and they did it for long period.  Truth is that premium has been deducted but details of deduction against which policy has not been issued then it is clear that for the laches of the OP1 the complainant has failed to get her benefit.  When that is the fact then OP1 is liable for such loss of accidental benefit of the complainant on the death of Rajendra Kumar Agarwal when OP1 has deducted such premium against Abhaya Gold Accidental Insurance Coverage and if OP1 fails to give any details then it is the liability of the OP1 to pay Rs.1 lakh what the complainant is entitled to get from Abhaya Gold Accident Insurance Coverage.

          No doubt OP2 is not liable to pay at this stage because Andhra Bank OP1 or the complainant have failed to give the details of the policy and OP1 and complainant have also failed to give details actually which insurance company issued that policy and OP1 is liable to compel and to give details of the policy what OP1 had been selling as corporate agent against Abhaya Gold Accidental Insurance Coverage. When that is the fact then at this stage we did not find any liability of the OP2.  OP’s liability only would arise if complainant is found able to supply the details of the policy and name of the company who issued the same.  but anyhow in the present case the negligent and deficient manner of act on the part of the OP1 is proved beyond any manner of doubt when OP1 time to time deducted premium from the account of the complainant, but OP1 failed to give details, then OP1 has to pay them for deduction of the premium by the OP1 from the account of Rajendra Kumar Agarwal.  OP1 shall have to pay Rs.1 lakh to the complainant.

In the result, the complaint succeeds against OP1 but fails against OP2.  In this case after giving anxious thought to entire conduct of the OP1 we find that the OP1 acted illegally and arbitrarily and also harassed the complainant in so many manner including her deceased husband and for the laches, negligence and deficient act on the part of the OP1 complainant has suffered financial loss against Abhaya Gold Accident Coverage which had been run by the OP1 at the relevant time and no doubt complainant’s husband was covered by the said accidental insurance coverage and truth is that complainant’s husband due to sudden fall into the Hooghly River died accidental death no doubt.

Further after proper evaluation of the conduct of the OP1 we find that OP1 adopted an unfair trade practice for which the present compliant succeeds against the OP1 in ex parte form.

Hence,

Ordered

That the case be and the same is allowed ex parte against the OP1 with a cost of Rs.Rs.5,000/- and dismissed on contest against OP2 without any cost.

          OP1 is hereby directed to pay a sum of Rs.1 lakh to the complainant within one month from the date of this order along with banking interest  at the rate of6 percent p.a. to the complainant with effect from 06-09-2012 and till its full payment by the OP1.

          OP1 is directed to pay the entire decretal amount with interest to the complainant within one month from the date of this order failing which for non-compliance of the Forum’s order and also for disobeyance of the Forum’s order OP1 shall have to pay penal damages of Rs.100/- per day till full satisfaction of the decree and if it is collected it shall be deposited to this Forum.

OP1 is directed to comply the order very strictly failing which for repeated disobeyance of the Forum’s order OP1 shall be prosecuted u/s.25 read with Section 27 of the C.P. Act for which they shall be further penalized and fine shall be imposed.