Haryana

Bhiwani

CC/92/2019

Smt.Neelam - Complainant(s)

Versus

Axix Bank - Opp.Party(s)

Ashok Nehra

16 May 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BHIWANI.

 

  CONSUMER COMPLAINT NO.       92 of 2019

                                DATE OF INSTITUTION:                02.04.2019

                                          DATE OF ORDER:                          16.05.2024                           

 

Smt. Neelam wife of Late Sh. Pardeep R/o Kharak Jattan, Tehsil Meham, District Rohtak.

 

          ……Complainant.

 

Versus

 

1. Axis Bank Limited, Loharu Road, Bhiwani, Branch Code-548308, Haryana through Branch Manager.

 

2. Axis Bank Limited, Axis House C-2, Wadal International Centre, PG Marg,  Worli Mumbai, through Chairman/MD & CEO.

 

3. The New India Assurance Co. Limited, Mumbai, LCBO-III, New India Centre Ground Floor, 17 Cooperage Road, Mumbai, through its Branch Manager at Bhiwani.

….. Opposite Parties.

 

COMPLAINT U/S 12 OF CONSUMER PROECTION ACT, 1986.

 

BEFORE:     Mrs. Saroj Bala Bohra, Presiding Member

Ms. Shashi Kiran Panwar, Member

 

Present:-        Sh. Ashok Nehra, Advocate for complainant.

                    Sh. Sunil Sharma, Advocate for OPs No.1 & 2.

Sh. Balbir Sharma, Advocate for OP No.3.

 

ORDER:

 

Saroj Bala  Bohra, Presiding Member:

 

1.                 Brief facts of this case are that husband of complainant late Sh. Pardeep had a bank account No.915010010594030 with OP No.1 from 2015 and was issued ATM Card having benefits of Personal Accident Insurance Cover of Rs.5.00 lac. It is submitted that husband of complainant was a farmer, who while spraying mustard crop and in furtherance accidentally inhaled pesticide and died on 24.11.2016. So, complainant approached OP No.1 for providing benefit under the scheme and submitted all relevant documents but the claim was repudiated by the OPs. Hence, the present complaint has been preferred by complainant alleging deficiency in service against the OPs. In the end, prayer has been made to direct the Ops to pay Rs.5.00 lac to the complainant.

2.                 Upon notice, OPs appeared.  Ops No.1 & 2 filed their written statement raising preliminary objections qua jurisdiction, locus standi, maintainability of complaint and mis-joinder and non-joinder of necessary parties. On merits, it is submitted that husband of complainant was having bank account and ATM was issued by their bank in his favour.  It is submitted that role of answering OPs is only of the facilitator and it had no relevance qua insurance related services. Further it is submitted that complainant not submitted the claim within 90 days as per policy conditions and thus violated the terms and conditions of policy. In the end, prayed for dismissal of complaint with costs.

3.                 OP No.3 filed its written statement raising preliminary objections that the complaint is not maintainable in terms of insurance policy. On merits, it is submitted that husband of complainant died due to inhale of pesticide as alleged in the complaint which is not covered under the insurance policy. However, OP company is liable to pay the sum insured in the event of accidental bodily injury causing the death of card holder within 12 months of  such injury.  Moreover, complainant did not submit the required documents to the company for processing the claim. It is stated that the claim of complainant is time barred as death of her husband occurred on 24.11.2016 and complaint was filed in the year 2019.  It is stated that as per general conditions of the policy a point of sale (POS) transaction is also required to be done by the card holder while using the debit card within 180 days from the date of incidence. As such, claim of complainant was rightly closed as No Claim. In the end, denied for any deficiency in service and prayed for  dismissal of complaint with special costs.

4.                 Ld. counsel for complainant tendered in evidence, affidavit of complainant as Annexure PW1/A alongwith documents Annexure C-1 to Annexure C-8 and closed the evidence.

5.                 On the other side, learned counsel for OPs No.1 & 2 tendered in evidence documents Ex. R-1 to Ex. R-5 and closed the evidence.

6.                 Ld. counsel for OP No.3 tendered in evidence affidavit of Anjana Mistry as Ex. RW6 alongwith documents Ex. R-7 & Ex. R-8 and closed the evidence.

7.                 We have heave heard learned counsel for the parties and gone through the record carefully. Written arguments on behalf of OP No.3 filed.

8.                 Learned counsel for complainant has argued that OP insurance company wrongly denied claim to complainant whereas she is fully entitled for the same under the terms of the insurance policy. In support of his case, the counsel has drawn our attention towards post mortem report (Annexure C-6) pertaining to insured Pardeep Kumar wherein information furnished by police  was ‘inhale of spray while spraying the fields’.

9.                 Perusal of claim rejection letter (Annexure C-5) reveals that OP insurance company has denied the claim to complainant on ground of non-submission of claim documents as per the SLA. Case file reveals that complainant has moved application (Annexure C-2) to the OP insurance company qua death claim of her husband followed by legal notice (Annexure C-3).  It is admitted case of OP Bank that Pardeep Kumar was having a bank account with it and was insured under the scheme, thus the OP insurance company can easily get the documents from OP bank with regard to process of the claim. Perusal of Insurance Policy (Ex. R-8) general conditions reveals that there should POS Transaction in preceding 180 days of incident and reporting of claim to be done 90 days for personal accident. In the present case, as per Annexure C-1, transaction through the ATM was done prior to the incident and that complainant had moved application dated 03.03.2017 (Annexure C-1) with regard to claim in the policy but it is somehow delayed by 7 days.  It is pertinent to mention here that that the higher Courts have given their verdict in many judgments that on the ground of delay in intimation of loss to the police or insurance company, claim cannot be denied to the insured.

10.               From the documents produced on file, it is proved on record that life assured Pardeep Kumar died due to inhale of spray while spraying his fields and thus  the death of life assured comes under the purview of personal accident. As such, the complainant is entitled to get claim from the OP insurance company. From claim rejection letter (Annexure C-5) and document (Ex. R-4) it is cleared that Pardeep Kumar was insured for Rs.5.00 lac under the policy.  It is not a dispute of any of the OPs that complainant is not entitled to the claim amount being nominee in the bank account of Pardeep Kumar. From copy of Aadhar card (Annexure C-7) it is clear on record that complainant was wife of Pardeep Kumar.

11.               After having heard learned counsel for the parties and going through the record, we are of the view that complainant has not placed on record any document which could show that the claim by complainant was properly submitted that too within the prescribed period under terms & conditions of the policy. But on the other side, it is also true that OPs have not suggested the complainant to make certain formalities to get benefit under the policy, after receiving death intimation from complainant. The Ops, even after issuing of the legal notice or during pendency of complaint before this Commission, never showed any promptness to settle the claim by obtaining required documents rather they were trying to absolve their liability. Accordingly, we are of considered opinion that the OP No.3 has wrongly and illegally repudiated the claim of complainant which amounts to deficiency in service.  As such, the complaint is allowed and OP No.3 is held liable to pay compensation to the complainant within 40 days from the date of receipt of certified copy of this order:-

(i)       To pay a sum of Rs.5,00,000/- (Rs. Five Lac) to the complainant alongwith interest @ 9% per annum from the date of filing of this complaint till actual realization.

(ii)      To pay a sum of Rs.10,000/- (Rs. Ten thousand) as compensation on account of mental and physical harassment.

(iii)     Also to pay a sum of Rs.11,000/- (Rs.Eleven thousand) as litigation expenses.

                     In case of default, the OP No.3 shall liable to pay simple interest @ 12% per annum on all the aforesaid awarded amounts for the period of default. If this order is not complied with, then the complainant shall be entitled to the execution petition under section 71 of Consumer Protection Act, 2019 and in that eventuality, the opposite party may also be liable for prosecution under Section 72 of the said Act which envisages punishment of imprisonment, which may extend to three years or fine upto rupees one lac or with both.  Certified copies of this order be sent to parties concerned, free of costs, as per rules. File be consigned to the record room, after due compliance. 

Announced.

Dated: 16.05.2024