PER:

Charanjit Singh, President;

1        The present complaint has been received from the District Consumer Disputes Redressal Commission Amritsar by the order of the Hon’ble State Consumer Disputes Redressal Commission Punjab, Chandigarh for its disposal.

2        The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section  11, 12 and 13 against the opposite parties on the allegations that the complainant is legal heir (mother) of deceased Balwidner Kumar son of Sh. Lal Chand opted for the Group Insurance with opposite party No. 1 through opposite party No. 2 and paid the requisite premium of Rs. 12.50 Paise on 2.5.2016 and Rs. 42/- on 2.6.2016 as per the scheme and policy. The complainant is legal heir and beneficiary of Balwinder Kumar. Thus, complainant is entitled to file present complaint against the opposite parties. As per information of the complainant the policy number is 11630035 but no policy has ever been issued by the opposite parties to the complainant.  On the fateful day on 10.5.2016, Balwinder Kumar met with an accident and died. The proceedings under Section 174 of Cr.P.C. were conducted vide No. 10 dated 7.5.2016 by police station Majitha, District Amritsar (Rural) Punjab. The post mortem of Balwinder Kumar was also conducted at J.B.M.M. civil Hospital, Amritsar. Thereafter, the complainant approached the opposite parties for the settlement of claim out of the aforesaid policy. The complainant approached the opposite party No. 2 and asked for the settlement of claim arising out of the death of Balwinder Kumar. The opposite party No. 2 assured the complainant that the claim of complainant shall be settled soon. The complainant handed over the copy of DDR as well as copy of postmortem to opposite party No.2. The representative of opposite party No. 2 at that time assured the complainant that all the documents will be furnished with the opposite party No. 1 as the deceased Balwinder Kumar availed the policy of opposite party No. 1 through opposite party No. 2 and all the other documents regarding the policy are lying with the opposite party No.2. The complainant with his relatives requested the opposite party No. 2 to supply the copy of insurance policy but they did not supply the same. The opposite party No. 2 may kindly be directed to produce all the relevant documents pertaining to the insurance policy as well as scheme relating to Balwinder Kumar. After waiting for few days, the complainant approached the opposite parties for the settlement of the claim but they have not given justice to the genuine request of the complainant. After visiting number of times to the office of opposite parties, the complainant received one letter dated 30.1.2017 through which the opposite party No. 1 admitted the insurance money received by them through opposite party No. 2 but they refused to settle the claim and closed the file without settling the genuine claim of the complainant on the lame excuse. The complainant has prayed that the following reliefs may kindly be granted in favour of complainant and against the opposite parties.

(a)     The opposite parties may kindly be directed to settle the claim of the complainant in respect of aforesaid insurance policy alongwith interest @12% p.a. from the day when Balwinder Kumar died till its actual realization.

(b)     The opposite parties may kindly be directed to award appropriate damages and compensation to the tune of Rs. 50,000/- to the complainant for causing mental harassment.

(c)      The opposite party No. 2 may kindly be directed to produce all the relevant documents pertaining to the insurance policy as well as scheme relating to Balwinder Kumar.

(d)     The opposite parties may also be directed to pay litigation expenses of Rs. 11,000/-.    

3        After formal admission of the complaint, notice was issued to Opposite Parties and opposite party No. 1 appeared through counsel and filed written version and contested the complaint by taking preliminary objections that the complaint is legally not maintainable and is liable to be dismissed. The opposite party No. 2 i.e. Amritsar Central Coop Bank is the insured who insured periodically all members of the Bank through PA (Personal Accident) Policy once the premium is deducted from the member’s bank account, all the accounts holders are collectively insured as a group. In the present case PA claim was filed with the replying opposite party by the insured bank as the premium for the deceased member was deducted after commencement of the policy, therefore, he was not insured in the policy issued to the Amritsar Central Coop Bank nor the premium as paid to the opposite party No. 1, therefore, policy has not issued to the deceased in a group insurance.  After receiving partial claim documents of deceased Balwinder Kumar, the opposite party no. 1 investigated the matter and after scrutinization of the documents it revealed that as per the ledger account details submitted by the insured, it is confirmed that premium was deducted on 2.5.2016 and 2.6.2016 i.e. Rs. 12.50 Paise and Rs. 42/- after issuance of the subjected policy. As per the issued policy and held by the insured i.e. opposite party No. 2 having policy period is 1.6.2015 to 31.5.2016, therefore, as per the Section 64 VB of Insurance Act of 1938 “No Risk is to be assumed unless premium is received in advance”. The complainant is estopped by her own act and conduct from filing the present complaint. The complainant has filed the present complaint without any cause of action against the opposite party No.1, therefore, liable to be dismissed. The complainant has no locus standi to file the present complaint. On merits, it was pleaded that so far as the policy bearing No. 11630035 is concerned that is issued on 1.6.2015 to 31.5.2016 whereas as admitted in the present Para the premium was deducted on 2.5.2016 and 2.6.2016 Rs. 12.50 Paise and Rs. 42/- respectively whereas the above said policy issued much prior to deduction of the premium from 1.6.2015 to 31.5.2016, from which it is quite clear that the opposite party No. 1 did not receive the premium, therefore, not liable to pay any claim.  The claim was rejected and due intimation was given to the complainant vide letter dated 30.1.2017.  The opposite party No. 1 has denied the other contents of the complaint and prayed for dismissal of the same.

4        The opposite party No. 2 appeared through counsel and filed written version and contested the complaint interalia pleadings that the complainant is mother of the deceased Balwinder Kumar. The deceased had opened a saving bank account under Saving Bank Bima Yojna (SBBY) with the opposite party No. 2 on 22.4.2016, which gives cover to the depositor for an accidental insurance of Rs. 1.00 Lac to be provided by the opposite party No.1. The opposite party No. 2 had deducted a sum of Rs. 12.50 Paise on 2.5.2016 for the remaining period of insurance scheme up to 30.5.2016 and a sum of Rs. 42/- as deducted on 2.6.2017 for insurance cover of the next year w.e.f. 1.6.2016 to 31.5.2017 and the amount was duly remitted to the opposite party No. 1 for group insurance of the depositors of bank. No individual policy is issued to the depositors by the opposite party No. 1 being a group personal accident insurance scheme under policy No. 11630035.  The complainant had intimated the opposite party No. 2 about the death of Balwinder Kumar. The claim papers were duly forwarded to the opposite party No. 1 alongwith documents. The opposite party No. 1 had declared the insurance as ‘No Claim’ vide their letter dated 30.1.2017.  All the documents furnished by the complainant were forwarded to the opposite party No. 1 for settlement of the death claim, which are in the custody of the opposite party No.1. The opposite party No. 1 had repudiated the death claim vide letter dated 30.1.2017. The complaint is not maintainable against the opposite party No. 2 and the complainant is not entitled to any relief from the opposite party No. 2 and the insurance claim is to be provided by the opposite party No.1. The opposite party No. 2 has denied the other contents of the complaint and prayed for dismissal of the same.

5        To prove the case, Ld. counsel for the complainant has placed on record affidavit of complainant Ex. CW1/A alongwith documents i.e. copy of DDR dated 10.5.2016 Ex. C-1, copy of postmortem report Ex. C-2, copy of the insurance policy Ex. C-3, copy of statement of account Ex. C-4, Copy of death certificate Ex. C-5 and closed the evidence. On the other hands, Ld. counsel for the opposite party No. 1 tendered in evidence affidavit of Sh. Pardeep Kumar Ex. OP1/1, copy of pass book of Balwinder Kumar Ex. OP1/2, copy of account statement of Balwinder Kumar Ex. OP1/3, copy of repudiation letter Ex. OP1/4, copy of postal receipt Ex. OP1/5 and closed the evidence.  Ld. counsel for the opposite party No. 2 tendered in evidence affidavit of Manohar Singh Branch Manager Ex. OP2/1 and closed the  evidence.

6        We have heard the Ld. counsel for the complainant and opposite parties and have gone through the record on the file.

7        Ld. counsel for the complainant contended that she is legal heir (mother) of deceased Balwidner Kumar son of Sh. Lal Chand and Balwinder Kumar opted for the Group Insurance with opposite party No. 1 through opposite party No. 2 and paid the requisite premium of Rs. 12.50 Paise on 2.5.2016 and Rs. 42/- on 2.6.2016 as per the scheme and policy. As per information of the complainant, the policy number is 11630035 but no policy has ever been issued by the opposite parties to the complainant.  On the fateful day on 10.5.2016, Balwinder Kumar met with an accident and died. The proceedings under Section 174 of Cr.P.C. were conducted vide No. 10 dated 7.5.2016 by police station Majitha, District Amritsar (Rural) Punjab Ex. C-1. The post mortem of Balwinder Kumar was also conducted at J.B.M.M. Civil Hospital, Amritsar and post mortem report is Ex. C-2. Thereafter, the complainant approached the opposite parties for the settlement of claim out of the aforesaid policy. The complainant approached the opposite party No. 2 and asked for the settlement of claim arising out of the death of Balwinder Kumar. The opposite party No. 2 assured the complainant that the claim of complainant shall be settled soon. The complainant handed over the copy of DDR as well as copy of postmortem to opposite party No.2. The representative of opposite party No. 2 at that time assured the complainant that all the documents will be furnished with the opposite party No. 1 as the deceased Balwinder Kumar availed the policy of opposite party No. 1 through opposite party No. 2 and all the other documents regarding the policy are lying with the opposite party No.2. The complainant with his relatives requested the opposite party No. 2 to supply the copy of insurance policy but they did not supply the same. After waiting for few days, the complainant approached the opposite parties for the settlement of the claim but they have not given justice to the genuine request of the complainant. After visiting number of times to the office of opposite parties, the complainant received one letter dated 30.1.2017 through which the opposite party No. 1 admitted the insurance money received by them through opposite party No. 2 but they refused to settle the claim and closed the file without settling the genuine claim of the complainant on the lame excuse and prayed that the present complaint may be allowed.

8        Ld. counsel for the opposite party No. 1 contended that the opposite party No. 2 i.e. Amritsar Central Coop Bank is the insured who insured periodically all members of the Bank through PA (Personal Accident) Policy once the premium is deducted from the member’s bank account, all the accounts holders are collectively insured as a group. He further contended that PA claim was filed with the opposite party No. 1 by the insured bank as the premium for the deceased member was deducted after commencement of the policy, therefore, he was not insured in the policy issued to the Amritsar Central Coop Bank nor the premium as paid to the opposite party No. 1, therefore, policy has not issued to the deceased in a group insurance. After receiving partial claim documents of deceased Balwinder Kumar, the opposite party No. 1 investigated the matter and after scrutinization of the documents it revealed that as per the ledger account details submitted by the insured, it is confirmed that premium was deducted on 2.5.2016 and 2.6.2016 i.e. Rs. 12.50 Paise and Rs. 42/- after issuance of the subjected policy. As per the issued policy and held by the insured i.e. opposite party No. 2 having policy period is 1.6.2015 to 31.5.2016, therefore, as per the Section 64 VB of Insurance Act of 1938 “No Risk is to be assumed unless premium is received in advance”. The complainant is estopped by her own act and conduct from filing the present complaint. The complainant has filed the present complaint without any cause of action against the opposite party No.1, therefore, liable to be dismissed. It is further contended that the policy bearing No. 11630035 is concerned that is issued from 1.6.2015 to 31.5.2016 whereas as admitted the premium was deducted on 2.5.2016 and 2.6.2016 of Rs. 12.50 Paise and Rs. 42/- respectively whereas the above said policy issued much prior to deduction of the premium from 1.6.2015 to 31.5.2016, from which it is quite clear that the opposite party No. 1 did not receive the premium, therefore, not liable to pay any claim.  He further contended that the claim was rejected and due intimation was given to the complainant vide letter dated 30.1.2017. 

9        Ld. counsel for the opposite party No. 2 contended that the complainant is mother of the deceased Balwinder Kumar. The deceased had opened a saving bank account under Saving Bank Bima Yojna (SBBY) with the opposite party No. 2 on 22.4.2016, which gives cover to the depositor for an accidental insurance of Rs. 1.00 Lac to be provided by the opposite party No.1. The opposite party No. 2 had deducted a sum of Rs. 12.50 Paise on 2.5.2016 for the remaining period of insurance scheme up to 30.5.2016 and a sum of Rs. 42/- as deducted on 2.6.2017 for insurance cover of the next year w.e.f. 1.6.2016 to 31.5.2017 and the amount was duly remitted to the opposite party No. 1 for group insurance of the depositors of bank. No individual policy is issued to the depositors by the opposite party No. 1 being a group personal accident insurance scheme under policy No. 11630035.  The complainant had intimated the opposite party No. 2 about the death of Balwinder Kumar. The claim papers were duly forwarded to the opposite party No. 1 alongwith documents. The opposite party No. 1 had declared the insurance as ‘No Claim’ vide their letter dated 30.1.2017.  All the documents furnished by the complainant were forwarded to the opposite party No. 1 for settlement of the death claim, which are in the custody of the opposite party No.1. The opposite party No. 1 had repudiated the death claim vide letter dated 30.1.2017. The complaint is not maintainable against the opposite party No. 2 and the complainant is not entitled to any relief from the opposite party No. 2 and the insurance claim is to be provided by the opposite party No.1 and prayed that the present complaint may be dismissed.

10      In the present complaint it is not disputed that the son of the complainant namely Balwinder Kumar was the account holder of the opposite party No. 2. Now dispute in the present case is that according to opposite party No. 1 after scrutinization of the documents it was revealed that as per the ledger account details submitted by the insured, it is confirmed that premium was deducted on 2.5.2016 and 2.6.2016 i.e. Rs. 12.50 Paise and Rs. 42/- after issuance of the subjected policy. But as per version of the complainant an amount of Rs. 12.50 Paise was deducted on 2.5.2016 for the remaining period of the policy in question. As per opposite party No. 2, the opposite party No. 2 had deducted a sum of Rs. 12.50 Paise on 2.5.2016 for the remaining period of insurance scheme up to 30.5.2016 and a sum of Rs. 42/- as deducted on 2.6.2017 for insurance cover of the next year w.e.f. 1.6.2016 to 31.5.2017 and the amount was duly remitted to the opposite party No. 1 for group insurance of the depositors of bank. The complainant has also placed on record statement of account of Balwinder Kumar Ex.C-4 in which it is clear that an amount of Rs. 12.50 Paise has been deducted on 2.5.2016 and an amount of Rs. 42.50 Paise has been deducted on 2.6.2016. It is also clear from the statement that the said amount has been deducted as Bima Premium, this fact has also not been denied by the opposite party No.1. The opposite party No. 2 has clearly mentioned in its written version that an amount of premium of Rs. 12.50 paise has been deducted and same for the remaining period of insurance scheme up to 30.5.2016. As such, premium amount of Rs. 12.50 Paise has been deducted on 2.5.2016 from the account of Balwinder Kumar and same is remitted to the opposite party No. 1 by opposite party No. 1. It is pertinent to mention here that the opposite party No. 2 has deducted the premium to continue the policy and said policy was also renewed from time to time. The opposite party No. 1 has taken the stand that premium by the opposite party No. 2 was deducted on 2.6.2015 which is after the commencement of policy but we are not agree with the plea taken by the opposite party No. 2 as every policy is renewed after a year. There is a grace period of every policy after the lapse of one year in this matter the policy was commenced on 1.6.2015 and the premium was deducted on 2.6.2015. Hence, it is very much clear that the death of DLA was occurred during the currency of the said policy. Meaning thereby that Balwinder Kumar was insured on 2.5.2016 up to 30.5.2016. Balwinder Kumar died during the currency of policy period on 7.5.2016 as per death certificate of Balwinder Kumar Ex. C-5. It is also stated by the opposite party No. 2 in its written version that whole of the documents have been sent to the opposite party No. 1 for settlement of claim. But the claim has not been settled by the opposite party No. 1 for a long time.

11      Furthermore, It is usual with the insurance company to show all types of green pastures to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation.  This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.  It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.UshaYadav& Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-

“It seams that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.        The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.

12      In light of the above discussion, the complaint succeeds and the same is hereby allowed with costs in favour of the complainant and against the opposite party No. 1. The complaint against the opposite party No. 2 is dismissed. The complainant has been harassed by the opposite party No. 1 unnecessarily for a long time. The complainant is also entitled to Rs.5,000/- ( Rs. Five Thousand only) as compensation on account of harassment and mental agony and Rs. 4,000/- ( Rs Four Thousand only) as litigation expenses. Opposite Party No. 1 is directed to comply with the order within one month from the date of receipt of copy of the order, failing which the complainant is entitled to interest @ 9% per annum, on the awarded amount, from the date of complaint till its realisation.  Copy of order will be supplied by District Consumer Disputes Redressal Commission, Amritsar to the parties as per rules. File be sent back to the District consumer Disputes Redressal Commission, Amritsar.

Announced in Open Commission

14.07.2022