Order-17.
Date-16/11/2015.
In this complaint Complainant Santosh Kumar Kunduby filing this complaint has submitted that complainantlost his only son DebasisKundu in a car accident which took place on 30.10.2011 in the said accident the wife of the said DebasisKundu, Smt. Ruby Kundu also lost her life and their two minor daughters were seriously injured and after the demise of his said son and daughter-in-law the present complainant is the custodian of the said two minor female child as the wife of the complainant has died long ago.
During his lifetime of DebasisKundu he had been enjoying an accidental claim policy under the New India Assurance Co. Ltd., being policy No.11270046111300000001 having risk coverage of Rs. 5 lakhs only and he was also a provity Platinum Debit Card holder of the Axis Bank Ltd. vide Debit Card No. 4062289001746516 and by virtue of holding such Debit Card and in accordance with the provision of benefit the said accidental policy was payable.
That the incident of the accident and the factum of death of the said DebasisKundu was duly informed to the op no.2 by the complainant by a letter dated 10.12.2011 with a request to issue a claim form so that complainant can claim insurance from the New India Assurance Co. Ltd.But after sometime passed and debit card documents without the Insurance Policy of the said DebasisKundu.Thereafter on 30.10.2012 the claim form along with all relevant papers and documents were submitted to the New India Assurance Co. Ltd. for settlement of the claim.After that New India Assurance Co. Ltd. wanted to some further query from complainant and the same was duly complied with.
In fact op no.2 Bank gave him only a claim form but they did not give any policy copy and then complainant submitted the claim form to the New India Assurance Co. Ltd. and after some considerable period of time when the complainant went to the New India Assurance Co. Ltd. at Kolkata Regional Office to know the status of his claim, the Insurance Company informed that some papers again needed from the op no.2 Bank and complainant personally visited to the bank and collected all the papers and forwarded the same to the Insurance Co..
Finally on 08.04.2013 under File No. 46/000264 the New India Assurance Co. Ltd. intimated the complainant that the claim is not payable because it is beyond the purview of the policy period and after receipt of the said letter, complainant submitted an application to Insurance Company requesting them to review his claim but the Insurance Company did not give any reply and accordingly complainant submitted his appeal letter addressing to the Chairman of the op no.3 for reviewing and condoning the repudiation of the said claim.
Thereafter a letter was issued on 24.07.2013 from the Mumbai Regional Office of the New India Assurance Co. Ltd. where the Insurance Company clearly expressed their inability in the matter of further reviewing of the complainant’s claim.Fact remains that the deceased son of the complainant DebasisKundu during his life time did not receive any papers relating to the Insurance policy from the op no.2 bank and he was also unaware about the terms and conditions of the concerned Insurance policy and the said matter of ignorance of DebasisKundu was duly communicated to the Insurance Company Ltd.Complainant received all the documents relating to the said policy after the demise of his son and on several times complainant contacted with the bank officials as well as the officials of the New India Assurance Co. Ltd. for getting the said claim, but ops did not pay any heed and in the above circumstances, complainant has prayed for redressal, compensation, refund of claim amount etc. against the ops.
On the other hand op nos. 1 & 2 Axis Bank by filing written statement submitted that the benefit which was attached with the Debit Card was given free of cost to the deceased son of the complainant, without any additional charge.Free Accidental Death Insurance associated with the ATM International Debit Card was provided to the deceased son of the complainant without charging any consideration from the complainant or his deceased wife and the same is being associated with the said ATM International Debit Card does not fall under the purview of the C.P. Act, 1986 as well as in law is not considering that service does not include the rendering of any service free of charge and as such the question of gross negligence or gross deficiency or unfair trade practice does not arise at all.
Another factor is that op nos. 1 & 2 wrongfully made parties because it is the liability of the Insurance Company op nos. 3 to 5 and op nos. 1 & 2 are not in the business of Insurance and it cannot carry on Insurance Business as per Banking Regulation Act, 1949.Moreover the entire complaint against the op nos. 1 & 2 is misconceived.
On the other hand op nos. 3, 4 & 5 jointly by filing written statement submitted that claim is not payable because it is beyond the purview of policy conditions and op Insurance Company submitted that son of the complainant i.e. Late DebasisKundu had a savings account with Axis Bank being No. 910010048739945 and had a Priority Platinum Debit Card being No. 4062289001746516 and the Axis Bank took an insurance policy from the New India Assurance Co. Ltd. For a period from 15.04.2011 to 14.04.2012 insured their account holders under various heads and out of such insurance policies, the son of the complainant as Platinum Debit Card holder got a Personal Accidental Policy benefit from the New India Assurance Co. Ltd. with certain terms and conditions and one of the condition was that the platinum debit card holder for getting the accidental benefit should make 1 PIS (Point of Sale) transaction in preceding 180 days of incident.
Ops further submitted that company after receiving the claim from the complainant scrutinized the records including the bank statement supplied by the Axis Bank and finally concluded and communicated to the complainant on 08.04.2013 and that claim is not payable since DebasisKundu, since deceased did not make any POS transaction preceding 180 days from the date of accident i.e. 30.10.2011.So, the said fact clearly revealed through the bank statement of DebasisKundu which was also being filed by the Ld. Lawyer to this Forum by the complainant.Therefore complainant is not entitled to get any compensation from the op Insurance Co. as there was a breach of terms and conditions of the policy and in the above circumstances, the present complaint is not maintainable in the eye of law for which the present complaint should be dismissed as there was no deficiency or negligence on the part of the ops.
Decision with reasons
On comparative study of the complaint and written version and also considering the terms and conditions of the policy including the general conditions for getting benefit of the said Accidental Insurance Policy, it is found that DebasisKundu the deceased son of the complainant did not use even once for making any Point of Sale (POS) transaction.Though the said debit card which carried the accidental death insurance coverage was not used for the purchase of any goods or service without cash within 180 days prior to the death of the deceased son of the complainant and that condition being one of the two conditions for availing of the benefit of the accidental death so insurance coverage was not invoked and thus the insurance company repudiated the claim of the complainant.
Considering the entire conditions and insurance contract, it is clear that the insurance company repudiated the claim of the complainant considering non-compliance of the monetary provision and clause of the policy and as per policy account holder under various heads of the Axis Bank were covered under the Personal Accident Insurance Policy benefit from the New India Assurance Co. Ltd. but with certain terms and conditions and out of that one of the two conditions shall be fulfilled for getting the accidental benefit for one point of sale transaction preceding within 180 days of the incident.But as per bank statement it is found that DebasisKundu did not avail of the said benefit by making any POS transaction for preceding 180 days of the incident.So, as per policy conditions there is breach of terms and conditions of the policy and no doubt for the said breach of terms and conditions, the claim of the complainant was repudiated and considering the legal aspect and also the binding principle, we are of view that parties of a contract must be guided by the terms and conditions of the policy and Forum has no legal capacity to condone any such sort of condition by any meanswhatsoever and there is no question of giving any relaxation for any ground to the parties and in this regard National Commission already decided that Forum shall be guided by the terms and conditions of the policy and considering that settled principle of law we are of the view that terms and conditions of the policy was not followed by DebasisKundu for which this claim was repudiated and considering all the aspect and position, we are of view that the repudiation is justified and legal and there is no deficiency and negligence on the part of the ops for which the present complaint bears no merit.
In the result the present complainant is not entitled to get any relief.Thus the complaint fails.
Hence, it is
Ordered,
That the complaint be and the same is dismissed against all the ops.
