J U D G M E N T.
In the matter of complaint petition filed by the complainant alleging deficiency in service by the opposite parties.
The factual matrix of the case is that :-
The complainant is the husband of insured deceased Gouri Mahanand. The deceased Gouri Mahanand has obtained a House Loan bearing Account No. 1739300500020 from United Bank of India, Nuapada Branch (O.P. No. 2) for an amount of Rs. 6,00,000/- (Rupees six lakhs) for construction of residential home on 31.08.2012. The complainant being the husband of the loanee stood as one of the guarantor of the said loan. The deceased Gouri Mahanand was the insured member under Group Credit Protection Plus Policy called as Master policy vide Policy Holder No. 0219268217 of her United Bank of India on payment of adequate premium of Rs. 12,748.37 Ps for a Sum Assured of Rs. 6,00,000/- (Rupees six lakhs) the total loan amount and got membership bearing No. 0295212022 and commencement of the said policy was on 15.02.2013 and date of Risk Covered was on 24.02.2013. Thereafter the insured Gouri Mahanand unfortunately died on 24.04.2013 and on the very day the said policy was in force and the complainant is the legal heir (husband) of the insured and beneficiary under the said policy is entitled for all the benefits under the said insurance policy. The matter of death of Gouri Mahanand has been intimated to O.P. No. 2 for needful action and for release of insurance benefit and the same is also intimated to O.P. No. 1 which is acknowledged by the insurer (O.P. No.1) on 06.11.2013 with an allotment of Claim Notification No. 71314020879 vide Quarry No. 45828171 dated 06.11.2013. As per the said letter of O.P. No. 1 all the required documents
have been submitted before the O.P. No. 1 through O.P. No. 2 with a request to early release of the said death claim. Thereafter O.P. No. 1 (Insurer) has rejected the claim under the said Policy No. 295212022 on 12.02.2014 and intimated the O.P. No. 2. The complainant further stated that during the date of sanction of loan the complainant alongwith his wife Gouri Mahanand (Loanee) had been to the office of O.P. No. 2 and on the very day the Branch Manager United Bank of India, Nuapada had taken signature of Gouri Mahanand (Insured) on a blank proposal form for insurance of the aforesaid loan and with a great hope and trust upon her Bank, she put her signature in the said proposal form of group insurance in presence of complainant on 09.01.2013. Thereafter O.P. No. 2 asked some relevant questions from the proposal form to the wife of complainant and write down the answer in a separate sheet and taken the signature of the wife of complainant thereon with a promised to fill-up the proposal form through an agent of the Insurance Company and verified himself for him and for the insured loanee when the proposal form submitted to the insurer. The complainant stated that no opportunities for verification of the proposal form has been given to the insured Gouri Mahanand when it was submitted to the insurer. There is no question of concealment of any material facts as alleged by insurer for insurance of late Gouri Mahanand under the said Group Credit Protection Plus Policy as she has replied all the questions put to her by O.P. No. 2 in his Bank in presence of complainant. Further the complainant has stated that O.P. No. 2 (United Bank of India, Nuapada Branch) has debited the premium of Rs. 12,748.37 Paise in the loan account of deceased Gouri Mahanand and remitted the said premium to O.P. No. 1 (Bajaj Allianz Life Insurance Company Ltd.) and charging interest therein
till date by O.P. No.2. Further he has stated that the demand for repayment of loan charging high interest is arbitrary and illegal and the complainant is no way liable to repay the said loan and the claim of EMI by the O.P. No. 2 with interest since the death of insured loanee is illegal. Further he has stated that the repayment of the said loan of Rs. 30,000/- (Rupees thirty thousand) as demanded by the O.P. No. 2 after the death of insured loanee Gouri Mahanand is need to be refunded to the complainant with interest.
The cause of action in this complaint arose on 24.04.2013 on the death of the insured and when the O.P. No. 1 rejected the death claim of complainant under the said policy on account of the death of his insured wife and as such the complainant claimed relief’s as prayed for.
Further he has stated that O.P. No. 1 is performing its insurance business in the district of Nuapada and the O.P. No. 2 has its banking activities at Nuapada having its branch office at Nuapada and as such the complaint is well within the jurisdiction of this Forum.
The complainant has filed the documents in support of their claim as under :-
1) Attested xerox copy of Certificate of Insurance of Gouri Mahanand (Annexure-1).
2) Attested xerox copy of Death Certificate of Gouri Mahanand (Annexure-2).
3) Attested xerox copy of Legal Heir Certificate of late Gouri Mahanand (Annexure-3).
4) Attested xerox copy of Service Request Acknowledgment Letter dated 06.11.2013 issued by O.P. No. 1 (Annexure-4).
5) Attested xerox copy of Letter vide claim Notification No. 71314020879 dated 06.11.2013 issued by O.P. No. 1 (Annexure-5).
6) Attested xerox copy of Letter vide claim No. 71314020879 dated 12.02.2014 issued by O.P. No. 1 (Annexure-6).
7) Customer Account Ledger Statement from 01.01.2013 to 04.06.2014 issued by OP No.2 ( Annexure-7).
8) Pass Book of deceased Gouri Mahanand vide SB A/c No.1739010006781 issued by OP No.2 (Annexure-8).
Being noticed, O.P. No. 1 appeared on 26.05.2015 through their Counsel and filed written version alongwith xerox copy of Investigation Report of Gouri Mahanand on 10.09.2015 and on the very day the District Forum has passed an order and accepted the same. But the complainant had challenged the said order and basing on that the Hon’ble State Commission has set aside the above order in Revision Case No. 07/2016 dated 31.10.2016. So the written version alongwith documents of O.P. No. 1 are not treated in this case.
The O.P. No. 2 has appeared through their Advocate and filed a written version without any documents in this case. In Paragraph No. 2 of written version, O.P. No. 2 has partly admitted that the deceased Gouri Mahanand was the insured member under Group Credit Protection Plus Policy Holder No. 0219268217 for a sum assured of Rs. 6,00,000/- (Rupees six lakh) valid from 15.02.2013 to 24.02.2014.
O.P. No. 2 has challenged and denied the allegations of complaint petition of complainant except complaint petition Paragraph No. 1,3,4,6 & 13 in this case.
In the above pleadings, the following issues are framed and considered :-
I) Whether the complainant is a consumer or not ?
II) Whether the complaint is maintainable in the eye of law ?
III) Whether the Forum has jurisdiction to adjudicate upon and there is any cause of action ?
IV) Whether there is any negligence and deficiency in service on the part of the Opposite Parties ?
V) To what relief, if any, the complainant is entitled to ?
ISSUE No. I to IV:-
Since, the issues are very much linked with each other, those are taken up for jointly discussion and findings.
On perusal of case record as well as the documents of the complainant, it is found that the complainant is the husband of Gouri Mahanand. During the life time of Gouri Mahanand, she has obtained a House Loan from United Bank of India, Nuapada Branch (O.P. No. 2) for an amount of Rs. 6,00,000/- (Rupees six lakhs) for construction of residential home and she was the insured member under Group Credit Protection Plus called as Master Policy vide No. 0219268217 on payment of premium of Rs.12,748.37 Paise for a Sum Assured of Rs. 6,00,000/- (Rupees six lakh) the total loan amount and got membership bearing No. 0295212022 and commenced from 15.02.2013 and date of Risk was Covered on 24.02.2013 and the complainant stood as one of the guarantor of the said loan. Unfortunately Gouri Mahanand died on 24.04.2013 and at that time the said policy was in force and the complainant is the legal heir (Husband) of the insured and beneficiary under the said policy is entitled for all the benefits of the said policy.
As per the Consumer Protection Act, 1986, Section 2 (d)(ii) explain Consumer means any person “ who hires or avails of any service for a consideration which has been paid or promised or partly promised or any system of deferred payment and includes any beneficiary of such services other than commercial purpose. ” So the status of consumer cannot be deniable and thereby the maintainability.
Further it is seen that opposite parties are doing their business in this locality and earned benefits from their customer and as such this Forum has wide jurisdiction to adjudicate the matter and there is a cause of action in this case.
Further it is seen that, the matter of death of Gouri Mahanand has been intimated to O.P. No. 2 by the complainant and for release of insurance benefit and the same is also intimated to O.P. No. 1 which is acknowledged by the insurer (O.P. No.1) on 06.11.2013 with an allotment of Claim Notification No. 71314020879 vide Quarry No. 45828171, dated 06.11.2013.
As per the said letter of O.P. No. 1, the complainant has submitted all the required documents before the O.P. No. 1 through O.P. No. 2 to early release the said death claim. But O.P. No. 1 (Insurer) has rejected the claim under said Policy No. 295212022 on 12.02.2014 and intimated the O.P. No. 2.
In such an uncongenial situation and without any option, the complainant knocked the door of this Forum.
In another point is that during the date of sanction of loan, the petitioner alongwith his wife named Gouri Mahanand (Loanee) were present before the office of O.P. No. 2 and on the very day O.P. No. 2 has taken signature of Gouri Mahanand (Insured) on a blank Proposal Form for insurance of the aforesaid loan in presence of complainant on 09.01.2013 and thereafter O.P. No. 2 asked some relevant questions as per the proposal form to the wife of complainant and recorded the answer in a separate sheet and taken signature of the wife of complainant thereon.
In another factual aspect is that, no oppertunities for verification of the proposal form has been given to the insured Gouri Mahanand when it was submitted to the insurer. In facts, there is no question of concealment of any material facts as alleged by insurer for insurance of late Gouri Mahanand under the said policy as she has replied all the questions put to her by O.P. No. 2 in his bank in presence of complainant.
Further it is asserted that, O.P. No. 2 has debited the premium of Rs. 12,748.37 Paise from the loan account of deceased Gouri Mahanand and remitted the same to O.P. No. 1. But after the death of Gouri Mahanand OP No.2 demanded the EMI with interest since the death of insured loanee as yet which is squarely absurd by him.
In another factual aspect is that, O.P. No. 2 has admitted that the policy, premium, death of insured as well as the policy of Gouri Mahanand was in force at the time of her death and also it is admitted that the complainant is the legal heir of the insured and the beneficiary under the said policy is entitled for all benefits under the said insurance policy. It is also admitted that O.P. No. 1 has rejected the claim of the said policy and basing on that he intimated the same to the complainant.
In another vital point is that, at the time of opening the policy of insured, the Opposite parties should demand a medical certificate from Gouri Mahanand on the point of her pregnancy and it is their duty to do the same but they have not done on it and after the death of Gouri Mahanand and when the matter of claim raised by the complainant, the opposite parties after thought created a new story to repudiate the claim of complainant and finally they rejected the claim of complainant which is squarely arbitrary and illegal.
Further, in another vital point is that, there is no such any documents from the side of opposite parties to the effect that the insured Gouri Mahanand was in pregnancy at the time of commencement of the said policy and it is the duty of opposite parties and burden lies on them to prove the same on the strength of relevant documents but they failed to do the same.
So here, on the above discussion, we are of considered opinion that, the plea taken above by the opposite parties is evasive, unjustified and not tenable in the eye of law.
In fact, the complainant has proved their case as per Annexure – 1 to 8 in this case.
Further it is asserted that, the complainant is not liable to pay the loan money of deceased Gouri Mahanand to O.P. No. 2 as the policy bearing No. 0219268217 of insured was in force at the time of her death.
In another factual aspect is that, the insurance is contract of utmost good faith and the insured person takes the insurance policy by keeping faith on the company. But, his hopes and dreams shattered by the attitude of insurer when the issue of claim arises. The Insurance Company find several ways how to repudiate the claim even it is genuine one and harass the claimant and make him to run from pillar to post. It is just unfair and unacceptable.
Here, the Consumer Protection Act is social legislation and there is need to strike down such practices and need to give proper redressal to the consumers.
In fact, the insurance company should be magnanimous enough generous to award the claim at single window, without any hassle and with full co-operation.
So, from the perusal of the provision of Consumer Protection Act, 1986, applied to all type of goods, and all type of services availed by the consumer against consideration paid, or promised.
Section 1 (iv) of the Consumer Protection Act, 1986, is of wide connotation.
Supporting to the all above findings, we quote a decision of Hon’ble Supreme Court of India in the case of Rubi (Chandra) Dutta V/s. M/s United India Insurance Co. Ltd. in Civil Appeal No. 2588 of 2011.
Supporting to the all above findings, we again quote a decision of Hon’ble Supreme Court of India in the case of D. SRINIVAS V/s. SBI LIFE INSURANCE CO. LTD. AND OTHERS in CIVIL APPEAL No. 2216 of 2018. Decided on 16.02.2018.
Here, the Advocate for complainant has filed a decision of Hon’ble National Consumer Disputes Redressal Commission, New Delhi in Revision Petition No. 3165-3166 of 2013, Decided on 01.04.2014 in the case of the Oriental Insurance Company Ltd. V/s. Satpal Singh & Anothers (2014 (2) CLT – 305 NC).
In the above case, the Advocate for complainant as well as Advocates for Opposite parties have argued on the point of their claim.
Perused the documents of complainant, we found that the claim of complainant is justified and relevant and as such taken in consideration.
Hence, it is apparent from the above issues that there is a deficiency in service by the opposite parties as not attending properly to the grievance of the complainant for which the complainant is suffering financial loss and mental agony due to negligence and deficiency in service by the opposite parties.
So, we are of considered opinion that there is a deficiency in service by the opposite parties. Thus, opposite parties are liable for deficiency in service.
So, accordingly, the issue answered and goes in favour of the complainant.
ISSUE No. V.
It is clear crystal that, the complainant has proved his case and he is entitled to get relief in this case. Hence, order.
O R D E R.
In the aforesaid matrix of facts and circumstances, the complaint is allowed and we direct U/s 14 (i)(d) of the Consumer Protection Act, 1986 as below :-
1) We direct the Opposite Party No. 2 ( The Branch Manager, United Bank of India,Nuapada) to waive the outstanding loan amount of Account No. 1739300500020 of insured Gouri Mahanand within 45 (forty five) days from the date of order.
2) We further direct the O.P. No. 1(Bajaj Allianz Life Insurance Co.Ltd,Sambalpur) to pay the outstanding loan amount of Account No. 1739300500020 of insured Gouri Mahanand to O.P. No. 2 within 45 (forty five) days from the date of order,failing which the OP No.2 is at liberty to realise the same from OP No.1 as per process of Law.
3) Failing which, the above order, the parties are at liberty to take steps as per process of law.
Judgment pronounced in the Open Court of the District Consumer Disputes Redressal Forum, Nuapada, this the 4th day of September 2018.
