SRI BIJOY KUMAR DAS,PRESIDENT:-
Deficiency in service in respect of illegal repudiation of death claim are the allegations arrayed against the Opp. Parties.
2. Complaint, in brief reveals that, Complainant’s deceased son namely Abhisek Lenka opened a S/B Account on ODISHA GRAMYA Bank, Garapur, Kendrapara with its No. 418934006000246. It is revealed that at the time of opening of the S/B Account, on the instruction of the Op-Bank, Complainant obtained a Life Insurance Policy under Pradhan Mantri Surakhya Bima Yojana and an amount of Rs. 12/- was deducted from the S/B Account on dt. 25.05.2016 towards premium amount of the policy and the sum assured of policy was for Rs. 2 Lakhs. The Policy covers for the period of one year. The policy holder Abhisek Lenka died on 06.04.2017 on a road accident, after completion of all the legal formalities, Complainant intimated the facts and filed claim before Op No.1 Bank on dt. 02.05.2017 by courier service. It is also alleged that, till 02.05.2017 no information was given about the details of the policy to the Policy holder. Subsequently, the mother of the complainant, who was the nominee of the S/B Account, filed necessary documents, i.e, copy of the F.I.R., Post-mortem report, and charge sheet of the GR Case No. 99/2017 etc. before Op-Bank for settlement of the claim. But on 17.11.2018, OpNo.2 universal SOMPO General Insurance Co. Ltd. sent an e-mail rejecting the claim of the complainant as a delayed lodging of claim. It is further alleged that, the rejection of claim by OP-2 Insurance Company is illegal and arbitrary, which gives financial loss and mental agony to the complainant and such action of Ops are treated as deficiency in service. The cause of action of the instant case arose on 06.04.2017, when the Policy-holder died and on 17.11.2018 when the OpNo.2 illegally repudiated the claim, In the complaint, it is prayed that a direction may be given to OpNo.2 Insurance Company to settle the claim on sum assured with 10% interest P.A. from 2.5.2017 to till its realization and cost of proceeding be awarded in the favour of the complainant.
3. Regional Manager and Branch Manager, ODISHA Gramya Bank, Garapur, Kendrapara OpNo.1 & 2 of this proceeding on receipt of the Notice appeared through their Ld. Counsel and filed joint written version into the dispute, admitting the facts of opening of S/B Account and taking of Life Insurance Policy as averred in the complaint. It is averred in the written version that as per the Policy under Pradhan Mantri Surakhya Bima Yojana, which is a Govt. sponsored scheme with a sum assured of Rs. 2 Lakh in the event of the death of the Account-Policy holder. In the instant proceeding Minati Lenka mother of the deceased Account-Policy holder is the nominee who lodged the claim before the Op-Bank on dt. 04.12.2017 with all the documents and same sent to the Op-Insurance Company on 06.12.2017 by Op No.3. It is categorically averred that, Complainant has lodged the claim before the Op No.1-Bank on 04.12.2017 and not on 02.05.2017 as stated by the Complainant. It is also averred that, it is the duty of the Op-Insurance Company to settle the claim on receipt of the documents, accordingly, OpNo.1 & 2 has not committed any deficiency in service rather has acted promptly, when the claim and intimation is received, for its early settlement by Op No.2 Insurance Company.
UNIVERSAL SOMPO GENERAL INSURANCE Company Ltd. Op-2 on receipt of the Notice appeared through their Ld. Counsel Mr. Md. Nayeem at later stage of the proceeding and was allowed to take part in the proceeding U/S 13(2)(b)(ii) of C.P.Act-1986 on being ex-parte.
4. Heard the arguments advanced by Authorized Representative of Complainant and Ld. Counsels Mr. R.P.Lenka appearing for Op-Bank and Ld. Counsel Mr. Md. Nayeem appearing for Op-Insurance Company. Complainant to substantiate her case filed attested Xerox copy of F.I.R. dt. 6.4.2017,attested Xerox copy of letter addressed to Op-1 dt. 2.5.2017 along photocopy of courier receipt, attested photocopy of Inquest and P.M. report and attested photocopy of e-mail dt. 17.11.2018 addressed to complainant by Op-2 Insurance Company. Equally the contesting Op-Bank filed documents as per the list. The list of documents presented by Op-Bank on dt. 1.7.2019 is duely acknowledgment by the parties.
Considering the submissions of the parties and on perusal of complaint/written version, and documents filed by the parties, the admitted facts of the case are that, Complainant’s deceased son namely Abhisek Lenka was a S/B Account holder of ODISHA Gramya Bank, Garapur, Kendrapara branch, bearing S/B Account No. 418934006000246, where mother, Minati Lenka-Complainant was a nominee. It is also admitted that the deceased Abhisek Lenka obtained a Life Insurance Policy under Pradhan Mantri Bima Yojana by paying a premium amount of Rs.12/- and the sum assured of the Policy is Rs. 2 Lakhs on the death of the Policy-holder. It is a fact that Policy holder died on 06.04.2017 on a road accident, F.I.R, was lodged, inquest and P.M. report was conducted and Police registered a GR Case bearing No. 99/17 and charge sheet has been submitted before the Ld. J.M.F.C., Pattamundai U/S279/304-A of I.P.C. It is also a fact that the death claim has been lodged before the Op-Bank for settlement of the claim by Op-Insurance Company. The claim of the complainant is rejected by OP- insurance Company vide their e-mail letter dt. 17.11.2018.
The only ground of rejection of claim revealed from the e-mail copy dt. 17.11.2018 of Op_insurance Company that, due to huge delay of 333 days of submission of claim from the date of death of the Policyholder, the claim can’t be considered and is rejected. Considering the ground of rejection, we are of the opinion that deceased Policy holder died on 06.04.2017 on a road accident, and it is a fact that to lodge a claim different documents like Death certificate, legal heir certificate, copy of the F.I.R. alongwith police & P.M report and charge sheet etc. are required for settlement of the claim. It is also a fact that to collect/procure such documents certainly needs few days/months. There is dispute between complainant and Op-Bank regarding submission of the claim. It is the case of the complainant that intimation/claim of death was given to Op-Bank on 02.05.2017 by Courier service, which is vehmently opposed by the Op-Bank. The Op-Bank’s version is that, Complainant submitted all the documents alongwith claim form on 04.12.2017. In this dispute, we are of the opinion that, simple giving an intimation to the Op-Bank can’t be held that the claim has been lodged on 02.05.2017. So, it is abudently clear that the claim has been lodged on 04.12.2017 by the complainant before the OP-Bank. Hence, the ground of delay of lodging the claim of 333 days is not sustainable as according to e-mail information of the Op- Insurance Company claim documents were submitted on 05.03.2018. The documents presented before us revels that on receipt of the claim by the complainant on 04.12.2017 and on the same date the claim was forwarded to the Regional Office of the Op-Bank vide letter No. Bo/197/17-18 and submission of claim on 05.03.2018 as per the Op-Insurance Company is an internal matter between Op-Bank and Op-Insurance Company for which the complainant cannot be blamed. It is also clear from the e-mail letter dtd. 17.11.2018 of Op-Insurance Company that the Policy issued to the deceased Policy holder bears the Policy No. 3336/56196021/00/228.
We carefully gone though the guide lines applicable for the settlement of the death claim under Pradhan Mantri Bima Surakhya Yojana. In column 3 of the said guidelines ensure that the claim has to be lodged by the claimant preferably within 30days of the occurrence of the accident. In addition to the same the guidelines directed the claimant to submit vital documents like original F.I.R,/ Panchanama /P.M. report etc for settlement of the claim. As we have observed earlier to collect/procure those documents some days/month is required and in the instant case, we observe that, certain documents are procured after 2/3 months of the death of the Policy holder and if any delay is caused, it is not intentional on part of the complainant-claimant. We give utmost importance to column-7 of the said guidelines, where it is specifically mentioned that within 30days of receipt of the claim form, the Insurance Company shall processed the claim. We rely on the e-mail dt. 17.11.2018 where Op-Insurance Company has admitted that the claim documents were submitted on 05.03.2018,but even after lapse of 8months, the Op-Insurance Company has not taken any action on the claim of the complainant-claimant, which is nothing but a clear case of the deficiency in service of the Op-Insurance Company. We, see no fault with the Op-Bank, accordingly Op-Bank, (OPNo.1& 3) is freed from allegation of deficiency in service. Accordingly, the rejection of claim of the complainant by the Op-insurance Company is illegal and non-application of guidelines under Pradhan Mantri Bima Surkhya Yojana. It is a fact that under Pradhan Mantri Bima Yojana, the Insurance Company has to take liberal and flexible approach for settlement of the claim as the Insurance of life under the scheme is meant to financial assistance to the family of deceased Policy holder.
Having observations reflected above, it is clear that Op No.2, Universal SOMPO General Insurance Company shall release the sum assumed of Rs. 2 Lakhs(Rs. Two Lakhs only) to the complainant-Claimant alongwith 6% S.I. calculating from 4.12.2017 to its date of realization. The order is to be carried out within one month of receipt of this order, failing which 9 % S.I. interest will charged for the delayed period alongwith other penal provisions under the C.P.Act-1986.
According the Complaint is allowed inpart without cost on contest.
Pronounced in the open Court, this 12th day of July-2019.
I, agree.
Sd/- Sd/-
MEMBER PRESIDENT
