Presented by Miss R. Pattnayak, President .
The present complaint is filed against the Opposite Parties (In short OP's) alleging deficiency in service regarding non-settlement of insurance claim of the deceased Rikhiram Sharma. The facts of the case in brief is that, the Father of the Complainant namely Rikhiram Sharma had opened a pass book under the Opposite Party No.1(one) (here-in the Branch Manager, Andhra Bank, Bargarh) bearing it's Account No. ABJ-185, which is an insurance linked saving account, covering insurance of Rs.1,00,000/-(Rupees one lakh)only. In that account Rs.372/-(Rupees three hundred seventy two)only has been debited towards the Life Insurance Premium. The Account holder died on Dt.28/08/2008 and his wife Santosh Sharma being the nominee of the deceased account holder intimated the Opposite Party No.1(one) bank about the death information of her husband and requested to release the insurance coverage amount and the balance amount lying in the pass book through two letters Dt.20/10/2008 and Dt.16/09/2008 posted under certificate of posting. Subsequently, the bank has directed the nominee to deposit Rs.1,000/-(Rupees one thousand)only to the account of Late Rikhiram Sharma, so that they will release the insurance coverage amount and the balance amount lying in the pass book in favour of nominee. On dated 03/12/2008, the nominee had deposited Rs. 1,000/-(Rupees one thousand)only in the said account on a hope that they will release the insurance coverage amount and the balance amount of the pass book in favour of her, but in vain. Lastly, the nominee had sent pleader Notice on Dt.03/08/2009 and Dt.03/09/2009 to the Opposite party No.1(one) demanding the release of insured amount and the balance amount but the Opposite Party No.1(one) rejected the claim under the ground that the claim was not lodged within the stipulated time of ninety days from the death of the account holder. According to the Complainant, there was no delay in the submission of the claim, rejection of the genuine claim on such flimsy ground amounts to deficiency in service on the part of Opposite Party No.1(one) and No.2(two). Hence the nominee filed this case with a prayer.
To direct the Opposite Party No.1(one) to release the insurance coverage amount and the balance amount lying in the pass book in favour of the Complainant.
To direct the Opposite Party No.1(one) to release the above mentioned amount with an interest of 12%(twelve percent) per annum from the date of death of her husband.
To direct the Opposite Parties to pay Rs. 50,000/-(Rupees fifty thousand)only towards compensation for causing mental agony and harassment and another Rs.6,000/-(Rupees six thousand)only towards litigation expenses.
During the pendency of the case, the nominee died and after substitution, the present Complainant namely Jitendra Sharma, S/o Santosh Sharma and Rikhiram Sharam has proceeded with this case.
In support of his case, the Complainant has filed the following documents along with written argument and citation reported in 2002 Cr.L.J. 2731/2005(1) Crimes 146.
Xerox copy of Pass book bearing Account No.ABJ-185.
Xerox copy of Pleader Notice Dt.03/08/2009/ Dt.03/09/2009.
Original receipt of Under certificate of posting sent by the Complainant on Dt.16/09/2008 and Dt.20/10/2008.
A.D. Card in Original showing recovered of Pleader Notice Dt.03/09/2009.
Copy of reply Dt.05/08/2009 of Andra Bank to Pleader Notice Dt.03/08/2009.
Copy of death certificate of Santosh Sharma.
Xerox copy of Pass Book of Rikhiram Sharma bearing its Account No. ABJ-185.
Xerox copy of death certificate of Rikhiram Sharma issued by Municipality, Bargarh.
Xerox copy of letter Dt.16/09/2008 and Dt.20/08/2008 issued by Santosh Sharma to B.M. Andhra Bank, Bargarh.
Original Affidavit of Jitindra Sharma,
Notices were duly served upon the Opposite Parties. Opposite Party No.1(one), No2(two) and No.3(three) appeared and filed their written version on Dt.04/08/2011 and Dt.06/01/2014 respectively. Proforma Opposite Party No.4(four) and No.5(five) did not appeared and become set-exparte on Dt.21/04/2014.
The Opposite Party No.1(one) and No.2(two) appeared through their Advocate and filed written version admitting the fact that the deceased Rikhiram Sharma had opned the A.B.J. Saving account vide Account No. 185 having insurance facility and accordingly they have issued a pass book containing all the terms and conditions, mode of operation and the procedure of a death claim which is in the possession of the Complainant. The Opposite Party No.1(one) and No.2(two) being a banking institution provides different types of banking and financial facilities to the public has introduce A.B.J. Saving Account Scheme in collaboration with the L.I.C. of India providing insurance facility to the nominees of account holder in case of death of the account holder subject to the terms and conditions of this scheme. To attract the benefit of this scheme and insurance link A.B.J. Account holder is required to maintain the minimum balance of Rs.1,000/-(Rupees one thousand)only plus the amount of two annul premium regularly. It is submitted by the Opposite Party No.1(one) and No.2(two) that the scheme had certain conditions and limitations, that in case of death of account holder, the nominee is required to inform the bank about the death within 90 (ninety) days and to prefer the claim by sending the required documents through the bank within 180 (one hundred eighty) days positively. Further on receipt of the claim documents , the bank is obliged to sent it to the insurance company for settlement of the claim and the L.I.C. of India settle the claim with in their sale discretion as per the norms and guideline in that regards. Opposite Party No.1(one), in this scheme, he is acting only as a facilitator and all the settlement of the claim absolutely lies with in discretion of the Insurance Company.
Further As per the norms, the said Rikhiram Sharma failed to maintain the minimum balance in his account. On the date of death the balance in his account was much less then the required amount. However to patch up the deficiency, he made a deposit of Rs. 1,000/-(Rupees one thousand)only on Dt.03/12/2008 to make out a case for preferring a claim. However immediately after getting the information, they acted upon it by sending information to the office of D.M., L.I.C. Of India and send the claim form duly filled in by the Complainant on Dt.03/10/2009.
But it is also submitted that in the present case neither the Complainant informed the bank about the death with in 90(ninety) days nor preferred any claim within 180(one hundred eighty) days. As such the claim of the Complainant was repudiated by the Divisional Manager (P & GS) on Dt.123/12/2009 on the ground that the claim papers were not submitted within the stiuplated period of 180(one hundred eighty) days and the same was intimated to the Complainant. Accordingly to the Opposite parties, they have not committed any deficiency in service and have righly rejected the claim. Since the claim was not submitted within the stipulated time as per the terms and conditions of the scheme. Hence the case is liable to dismissed.
The Opposite Party No.1(one) and No.2(two) has submitted the following documents in supports of his case. They have also filed written arguments/ Additional written Argument, memo of citations which are attached to the case record.
Later send by B.M. Andhra Bank, Bargarh to the D.M., P & G's unit L.I.C. of India vide No. 038/11/2088 Dt.05/08/2009.
Letter with claim of ABJ Account No. 185 send by B.M., Andhra Bank, Bargarh to the D.M., P & G's Unit, L.I.C. of India for settlement vide No.038/11/400 Dt.03/10/2009.
Letter send by D.M.
Copy of Hand Book of Insurance Linked Saving Schemes.
Original Affidavit of Branch Manager, Andhra Bank.
The Opposite Party No.3(three) while filed version through his Advocate has submitted that since the Complainant has no where mentioned about his (Opposite Party No.3(three) involvement in the aforementioned case, and since there is no claim against him (Opposite Party No.3(three) by the Complainant and also the Complainant has not mentioned the reason why and how this Opposite Party No.3(three) is liable to pay the claim amount to the claimant so this case is not maintainable in the eye of law and liable to be dismissed with cost.
In support his case, the Opposite Party No.3(three) filed written argument along with following citations.
AIR 1993 Orissa 48.
Criminal Appeal No. 228/2008, Supreme Court.
2011 STPL(LE) 45123 SC.
Heard the parties and perused the documents available on record. It is not dispute that the deceased Rikhiram Sharma had opened a pass book bearing Account No. ABJ-185 in the bank of the Opposite Party No.1(one). It is also an admitted fact that the account is a insurance linked saving deposit account in which insurance coverage is Rs.1,00,000/-(Rupees one hundred)only. It is also an admitted fact that Rs. 372/-(Rupees three hundred seventy two)only was debited each year, from the pass book towards the Life Insurance Premium which is further proved from the copy of statement of account of Rikhiram Sharma field by the Opposite Party No.1(one). It is also an admitted fact that the Complainant has deposited Rs.1,000/-(Rupees one thousand)only in the pass book on Dt.03/12/2008 which is further proved from the copy of statement of account of Rikhiram Sharma. The Opposite Parties have also not disputed about that the Complainant is a consumer.
It is the case of the Complainant that after the death of the insured on Dt.28/08/2008, the Complainant applied to the Opposite Party No.1(one) to get the insured amount along with the outstanding balance amount but the Opposite Party No.1(one) failed to do so with a reply that the claim is to be lodged within 90(ninety) days from the date of death of the insured.
On the other hand, the Opposite Party No.1(one) and No.2(two) contended that the claim has to be settled only by the insurance company as the Account holder was insured with Life Insurance Corporation of India and their duty is to facilitate the arrangement of insurance cover and otherwise there is no role and responsibility except to forward the claim application. So they have not committed any deficiency of service as they have duty forwarded the claim to the authority of the company to settle the claim but the authority of the insurance company repudiated the claim as it has not been intimated within 90(ninety) days and the claim has not been submitted within 180(one hundred eighty) days.
The learned counsel for the Opposite Party No.3(three) urged that since the Opposite Party No.1(one) and No.2(two) failed to produce any documents regarding the contract between Opposite Party No.1(one) with Opposite Party No.3(three) (LIC) and also not produced any documents regarding the submission of premium amount to L.I.C. And not disclosed the policy number if any issued by Opposite Party No.3(three), So the Opposite Party No.3(three) is not liable to settle the claim. It is further submitted by the Opposite Party No.3(three) that since the Complainant has not claim any thing against this Opposite Party No.3(three), so no relief can be granted against this Opposite Party No.3(three).
In the instant case. Gone through the para-II of the written version of the Opposite Party No.1(one) and No.2(two) (Bank) where they mentioned that they have issued the pass book to the Complainant and on that pass book all the term and conditions and the mode of operation were mentioned. We perused the copy of pass book issued to the deceased where we found that the Opposite Party No.1(one) and No.2(two)(Bank) has not mentioned/disclosed any terms and conditions, mode of operation and the procedure of death claim in the said pass book.
They have also not filed any documents regarding the contract of agreement with the L.I.C.. They have also filed any document regarding the onward submission of premium amount to L.I.C. We perused the “Hand book of insurance liked saving schemes” of Andhra Bank bearing circular No. 399, Ref No.51/18 date 12/12/2003 clearly shows that this is simply a guideline of Andhra Bank but not a contract document which is a hand book of year 2003. The Opposite Party No.1(one) and No.2(two)(bank) has not filed the guideline status book of the year 2007 when the Complaint raised the issue for settlement of the claim. Regarding the page No.5(five) of the book, the Complainant has deposited Rs.1,000/-(Rupees one thousand)only. Regarding the page No.12(twelve) (last para), Page No.14(fourteen), Para-9(nine), it is a general terms and condition mentioned there where there is no disclose of the name of the insurance company to which this Opposite Party No.1(one) and No.2(two) had tie-up. At page 21(twenty one), at serial No.5(five), it is mentioned that the Nodal branch address for A.B.Jeevan Abhaya Scheme is L.I.C. Extention counter branch, code No.533 base office, Saitabad, Hyderabad-500004. If at all we believe the point No.5(five) but why the concerned bank has not field any document regarding statutory agreement with this company. On perusal of the page-22(twenty two) of the book, we found that Opposite Party No.1(one) and No.2(two) bank has tie-up with different company in different scheme i.e. with Oriental Insurance Company, National Insurance company, IFFO-TOKIO General Insurance Company, The New India Assurance Company, United India Insurance Co. Ltd, Birla Sunlife insurance Co. Ltd and with the Life Insurance Company. So without the filing of copy of document of contract of agreement the contention can not be accepted that the bank i.e. Opposite Party No.1(one) and No.2(two) have tie-up with the Opposite Party No.3(three) (L.I.C.). Another thing is that this book has been filed by the Opposite Party No.1(one) and No.2(two) before the Forum on Dt.12/08/2014 after the hearing was concluded on Dt.07/07/2014 and the case was already posted for order. It is created a doubt that why the book was not filed earlier before the Forum, so that opportunity could not been availed to the Complainant to adduce any evidence against this book. After the hearing except the death certificate and original pass book which was directed by the Forum for submission the Complainant and the Opposite Party No.1(one) and No.2(two) filed certain documents and Affidavits which is taken into consideration only to ascertained the real truth and for proper adjudication of the case. Further the Opposite Party No.1(one) and No.2(two) neither filed any insurance policy bond nor disclose the policy No. and the branch office to the Complainant. The bank should provide insurance particulars to the Complainant. It is their duty to disclose all material facts in their knowledge because utmost good faith must be observed by the contracting Parties. The suppression of material facts by the Opposite Party No.1(one) and No.2(two) is unjustified.
Regarding late intimation of death claim, the Opposite Party has submitted that Complainant did not inform the Opposite Party No.1(one) and No.2(two) about the death within 90(ninety) days nor preferred any claim within 180(one hundred eighty) days. So claim was rightly repudiated by insurance company. In answer to this the Complainant has contended that, he intimated the death information of account holder twice to the bank within 90(ninety) days i.e. on Dt.16/09/2008 and Dt.20/10/2008. UCP (Under Certificate of Posting ) for release of amount. We perused the original certificate (U.C.P.) issued by the post office and followed the two decision relating to this issue which proved and support the submission of complainant. Further without hanging to the technical defects, the bank ought to have settled the insurance claim immediately without resorting to the plea of limitation to defeat the just claim of the deceased person. As for the various decision of Apex Court in case of minor violation, the claim can not be completely rejected.
Regarding the submission of Opposite Party No.1(one) and No.2(two), the death certificate of Rikhiram Sharma filed by the Complainant seems to be not genuine. We verified the Original death certificate produced by the Complainant. This is a document which was issued by the Registrar of Birth of Death & Health Officer, Bargarh Municipality while discharging the public duty. So it is admissible under Sec-35 of Indian evidence Act. Further the Opposite Party No.1(one) and No.2(two) neither adduce any cogent and convincing evidence to proved that it is a forged document, because burden lies on them. So the contention of Opposite Party No.1(one) and No.2(two) regarding this issue is not acceptable. Admittedly, the decease had paid premium in the policy and as such the Opposite Party No.1(one) and No.2(two) are bound to pay the insured amount. Refujal to make payment amounts to deficiency in service. Since the Opposite Party No.1(one) and No.2(two) without any valid ground refused the claim and as such they are also liable to pay the compensation for casing mental agony to the Complainant.
Hence Order.
- O R D E R -
In the result, the complaint is allowed. The Opposite Party No.1(one) and No.2(two) are directed to pay insurance amount Rs.1,00,000/-(Rupees one lakh)only in respect of insurance linked saving account and the outstanding balance lying amount along with compensation of Rs.5,000/-(Rupees five thousand)only for causing mental agony, harassment and litigation expenses within one month from the date of Order, failing which the awarded amount shall carry 12%(twelve percent) interest per annum till the realization for actual amount.
Further if there is any agreement between the Opposite Party No.1(one) and No.2(two) with any insurance company including the Opposite Party No.3(three), the bank may realise the insurance amount before paid to the Complainant as per the provision of law.
The case is disposed off accordingly.
Copy of order be furnished to the Parties free of cost.
Typed to my dictation
and corrected by me.
I agree, I agree, I agree ( Miss Rajlaxmi Pattnayak) ( Smt. Anjali Behera) (Sri Pradeep Kumar Dash)
P r e s i d e n t. M e m b e r. M e m b e r.
