Complainant Baljit Singh has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 (for short, ‘the Act’) has sought issuance of necessary directions to the opposite parties to pay Rs.2,00,000/- insured amount alongwith interest and compensation of Rs.5,00,000/- for causing mental agony and harassment and Rs.3,00,000/- as litigation expenses, in the interest of justice.

2.           The case of the complainant in brief is that his mother purchased a policy of Pradhan Mantri Suraksha Bima Yojna by paying Rs.12/- as premium which was debited from her saving account no.60048727568 by opposite party no.1 and he was the nominee of the said policy. His mother suffered cardiac arrest and died on 1.12.2015 and she was insured with opposite party for a sum of Rs.2,00,000/-. He is the nominee of the accidental insurance policy and after her mother’s death, he informed the opposite party no.1 and claim form alongwith death certificate, doctor certificate, case history, copy of ration card, adhaar card and copy of account were furnished to the opposite party no.1 for deciding their claim being the nominee and legal heir of deceased Kashmir Kaur but the opposite party no.1 kept on procrastinating his genuine claim and till date he has not been given insurance amount by opposite parties which is unfair trade practice and deficiency in service by the opposite parties. Hence this complaint.

3.          Upon notice, the opposite party no.1 appeared and filed its written reply through its counsel by taking the preliminary objections that the complaint is not maintainable against opposite party and complaint is bad for non joinder of necessary party as the complainant has not impleaded the United India Insurance Company Limited as party in the said complaint, which is necessary party. On merits, it was submitted that actually the mother of the complainant has not insured with the opposite party Bank rather she was insured with United India Insurance Company Limited having its office located at Gurdaspur. The Bank had debited the amount of Rs.12/- from the Account of the deceased and the said amount was later on credited in the account of the Insurance Company namely United India Insurance Co. Ltd. Gurdaspur as such the opposite party is not liable to pay any compensation to the complainant. The opposite party is just conduit between the complainant and Insurance Company. Moreover as per the terms and conditions of the said Insurance Policy, the person who has died in road accident, the legal heirs of that person are entitled for getting Insurance Claim alongwith copy of Post Mortem Report. In the matter in hand, the complainant is claiming Insurance of his mother who had died due to Cardiac arrest, which is fully implicit from the Medical Certificate in which clearly shows that the cause of death is due to Heart attack. As such the instant complaint is not maintainable and is liable to be dismissed on this score alone. It was further submitted that the  complainant has approached to the opposite party no.1 on 15.12.2015 and lodged his claim under the Pardhan Mantri Suraksha Beema Yozna and his case was sent to the Insurance Company. The complainant without waiting the result of Insurance Company has filed the instant false and frivolous complaint. All other averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.

4.   Complainant has tendered into evidence his own affidavit Ex.C1, alongwith other documents Ex.C2 to Ex.C9 and closed the evidence.

5.       Sh.Rajwinder Singh Deputy Manager of opposite party no.1 tendered into evidence his own affidavit Ex.OP-1, alongwith other document Ex.OP2 and closed the evidence.  

6.        We have carefully examined and thoroughly considered the evidence along with its supporting documents (and statutory merits etc) as available on records of the proceedings in the backdrop of the arguments as put forth by the learned counsels for the participating litigants and also the scope of ‘adverse inference’ that may be discretionarily drawn on account of the non-production of some vital documents ignored to be produced during the proceedings. We find that the complainant has successfully proved through production of the DLA’s (Deceased Life Assured) Bank Pass-Book (Ex.C5) duly issued by the OP Bank with duly debited entry of Rs.12/- (on 03.06.2015) as annual premium for the purchase/ joining (by the then SB A/c Holder) of the ‘membership’ of PMSBY Master Policy with the engaged Public Sector insurers of OP Bank’s choice. Incidentally, the premium of Rs.12/- has been apparently deducted as premium for PMSBY (Pardhan Mantri Suraksha Bima Yojna) but the related entry of 03.06.2015 in the Pass Book (Ex.C5) has been ‘narrative-marked’ as PMJJAY-768528 (i.e., an abbreviation ‘fitter’ for Pardhan Mantri Jeeven Jyoti Bima Yojna) though inadvertently, by the OP Bank in its ‘negligence’. The related paper-ad (Ex.C2) supports the above observation/proposition. Further, the death certificate (Ex.C3) proves the ‘demise’ of the DLA on 01.12.2015; whereas, Claim Form (Ex.C4) proves its (in order) filing with the OP Bank (admittedly) for onward submission to its own-engaged Insurers for settlement of the same. The documents exhibited here as: Ex.C6, C7 & Ex.C8 establish the identity and inter-se relationship besides ‘succession’ of the complainant to the DLA estate etc. We, also find that the complainant has produced one undated Ayurvedic Physician’s Certificate of DLA’s medical ailment, its treatment (Ex.C9) and also stating the ‘cause’ of subsequent death as: ‘Cardiac Arrest’ duly corroborating with that given in the claim form (Ex.C4) as: ‘Heart Attack’. It does provide the then patient’s registration no. 48073/ 31.10.2015 under which the DLA Kashmir Kaur was treated for ‘left-hemiplegic’ medical-situation & cured within a month. As is, construed from certificate (Ex.C4) itself, it was issued post-death (date not specified but evidently post 01.12.2015) in lieu of ‘cause of death’ evidence (PMR etc) but not as interpreted to be non-feasibly dated ‘death-certificate’ by the OP Bank. The marked date: 31.10.2015 has not been ‘date of issuance’ of document but the then date of registration for treatment under the given registration no. as 48073.

7.       We find that the OP Bank has admittedly (written statement & its affidavit Ex.OP1) collected PMSBY premium of Rs.12/- from the DLA’s inoperative SB A/c (Ex.C5) but have failed to produce the DLA’s written consent/debit authorization and enrollment etc (on the prescribed formats) into the scheme in terms of the Rules as exhibited vide Ex.OP2. Further, the OP Bank does admit having received the claim form (Ex.C4) on 15.12.2015 and also having forwarded it to its engaged insurers for settlement of the ensuing claim but somehow have again failed to produce any cogent evidence proving the same. The OP Bank has been noticeably silent as to what transpired to the ‘settlement’ of the present claim at the insurers’ end. The OP Bank has neither produced any evidence of follow-up efforts towards settlement of the impugned claim nor rejection/repudiation of the same at the insurer’s end. Surprisingly, on one hand the OP Bank (paragraph ‘4’ of affidavit Ex.OP1) has deposed that it has been just a ‘conduit’ between the complainant and the insurers and on the other hand it has been evaluating the impugned ‘claim’ on merits. The OP Bank has been suo-moto but un-necessarily expressing unasked for opinions on ‘death by accident’ to mean as: ‘dying in road accident’ and claim-entitlement of legal-heirs with copy of PMR etc. It shall be pertinent to mention here that claim settlement merits or otherwise are to be determined by the insurers’ claim settlement authorities and not by the self pro-claimed ‘conduits’. It has been more than ‘9’ months since the ‘death’ of the DLA (and subsequent filing of claim) & the OP Bank has failed to convey/ conduit ‘fate’ of the impugned claim to the complainant & that speaks volumes of infringement of his consumer rights & OP’s deficiency in service.       

8.       We find that the OP Bank has failed to prove having forwarded the complainant’s insurance claim to the engaged insurers whereas the complainant has also no knowledge or notice of the insurers directly or through the ‘conduit’ Bank etc there shall be reasonable apprehensions that the requisite claim was never forwarded to ‘insurers’ for ‘settlement’ by the OP Bank and that rakes it up against an adverse award under the applicable ‘statute’. However, the engaged insurers (if any) shall be at liberty to settle the present claim as per its ‘inter-se’ arrangement/agreement with the OP Bank.              

9.       In the light of the all above, we find that the OP no.1 Bank has indeed bruised the consumer rights of the present complainant and that lines them up for an adverse award under the applicable statute. We, therefore, partly allow the present complaint and thus ORDER the OP Bank to procure and convey the insurers’ settlement/repudiation decision to the complainant besides to pay him Rs.10,000/- as cost and compensation within 30 days of the receipt of the copy of these orders. However, if the OP Bank fails to convey/conduit the insurers’ decision within the stipulated time to the complainant on account of its own-default at any stage of the insurance transaction in its totality, it shall be liable to pay the full insurance claim amount with full policy benefits etc along with the accrued interest @ 9% PA from the date of the present orders till actual payment.

10.     Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.  

                                                              (Naveen Puri)

                                                                     President.                                                                                                    

ANNOUNCED:                                (Jagdeep Kaur)

September 15, 2016                                    Member.                                             

*MK*