IN THE CONSUMER DISPUTES REDRESSAL FORUM, KOLLAM

DATED THIS THE DAY OF 20^thAUGUST 2020

Present: -      Sri.E.M.Muhammed Ibrahim, B.A, LLM. President

                      Smt.S.Sandhya   Rani. Bsc, LLB ,Member

                     Sri.Stanly Harold, B.A.LLB, Member

CC.No.32/2016

Smt.Sreekumari,

W/o Late Anil G., aged 43 years

AnithaBhavan ,Naduvilakkara,

Umayanalloor P.O., Kollam.                                          :         Complainant

(By Adv.UmayanallorK.Ramachandran Nair,

Adv.KalladaP.Kunjumon& Adv.K.Jayan)

V/s

1. Canara Bank,

        Thattamala, Kollam Rep.by its Branch Manager:Opposite parties

         (By Adv.K.C.Ushadevi,)

2. L.I.C. of India,

        Divisional Manager,Divisional Office,

       Pattom 695004.Thiruvananthapuram.

       (By Adv.K.Radhamani)

3. The General Manager,

        Canara Bank, Circle Office,

       Spencer Junction, Thiruvananthapuram

      Rep.by its Manager, CanaraBank,Thattamala Branch, Kollam.

        (By Adv.K.C.Ushadevi)

ORDER

Smt.Sandhya Rani, B.SC, LLB, Member

1.       This is acase based on a consumer complaint filed under section 12 of the Consumer Protection Act 1986.

2.       The averments in the complaint in short are as follows.

          The complainant is the widow of Late Sri.Anil G., who died on 06.07.2015 due to heart attack and he was a long standing customer of the 1^st opposite party Canara Bank Thattamala Branch by operating Saving Bank Account No.1786101003946.  Being a customer he had approached the 1^st opposite party for taking policies under JeevanJyothiBeemaYojana of Life Insurance Corporation of India covered by its mater policy No.900100006 and PradhanamantriBeemaSurakshaYojana of United India Insurance Company Ltd, covered by its Master policy No.0726004215 P 99999005.  The said policies were available to persons those who have kept sufficient amount with their Savings Bank assigned by the Govt.of India.  The said policies were introduced with a noval idea to extend financial assistance to the victims, who died during the existence of policies due to ailments or accidents, with small amount of yearly premiums deducted from the Savings Bank Account.  Accordingly the complainant’s husband had submitted applications for the above schemes on 10.06.2015 and the 1^st opposite party had issued acknowledgements and Insurance policies to him with respect to the above said schemes.  After his demise on 06.07.2015, when those things were came to the notice of the complainant she sent written requests to the opposite parties 1 and 2 on 28.07.2015 claiming Rs.2,00,000/- promised in the policy.  But she has received a very strange reply from the 1^st opposite party stating that the date of birth of the deceased Sri.Anil C. in the application form was different from the date of birth enshrined in the savings bank account details with them.  As a Higher Secondary Teacher with sufficient knowledge and intelligence there is no possibility of having such a defect.  If the 1^st opposite party had found out such a discrepancy in the application submitted by the deceased they would have issued an intimation to the deceased.  As the opposite parties defeated the intention of the Government to support the victims family they have committed deficiency in service. Apart from a lame and flimsy reason regarding the difference in Date of Birth alleged by the 1^st opposite party it is not a sufficient reason notto process the application for insurance.  The acknowledgement would only be given after the due deductions from the Savings Bank Account bearing No.1786101003946 maintained by the deceased husband of the complainant.  The 1^st opposite party had convinced and satisfied the contents of the applications and issued the acknowledgments and those documents would prove the acceptance and the payment of the premium together with the insurance coverage of the 2^nd opposite party’s policy.  The denial of the benefits under the above scheme caused huge financial loss besides mental agony and hardships.  Hence the complaint.

3.       Opposite parties 1 and 3 admits that late Sr.Anil was an account holder of 1^st opposite party Canara Bank, Thattathumala Branch and he had submitted an application on 10.06.2015 for availing the benefits under the policy scheme viz, Prime Ministers JeevanJyothiBeemaYojana Scheme formulated by the LIC.  At the time of submitting the application he was given acknowledgement and a format which specifically stipulating that the application shall be forwarded to the LIC only on the fulfilment of the terms and conditions by the applicant as a pre-condition for forwarding  the application to the LIC to issue policy.  But he could not submit the necessary details and requisites to forward the application to LIC because he died due to heart attack on 06.07.2015.  The opposite parties have received notice sent by the complainant and they had served reply notice in detail stating that the deceased Anil had not produced any proof regarding the age and date of birth along with health condition which were necessary for the final approval and acceptance of the policy hence they are not bound to give the policy amount Rs.2,00,000/- as claimed by the complainant.

4.       2^nd opposite party would contend that they are not competent to comment on the contents of para 1 of the complaint because 2^nd opposite party was not aware that the complainant had obtained a policy of PradhanamanthriJeevanJyothiBeemaYojana through the 1^st opposite party before receiving the written request send by the complainant claiming policy amount Rs.2,00,000/-.  After receiving the written request send by the complainant 2^nd opposite party received copy of the death certificate of the complainant’s husband and they have forwarded the same to the 1^st opposite party requesting them to forward requirements to their P&GS unit, Bangalore and they have also forwarded the requisite claim form and Discharge form to the complainant so that she may duly fill up the same and submit to the 2^nd opposite party for onward transfer to P&GS Bangalore.  2^nd opposite party is not aware whether the 1^st opposite party had collected the necessary requirements from the complainant and forwarded the same to their Bangalore P&GS unit that they have not received any claim request from the claimant nor any claim papers from the 1^st opposite party.  The Canara Bank Head Office email dated 15.02.2016 confirms that the claim file pertaining to the deceased Sri.Anil G. was not received by them from the 1^st opposite party.  Since the claim papers are not received by the 2^nd opposite party, 2^nd opposite party is not aware of the facts of the case.  The 2^nd opposite party furnishes the scheme offers one year Renewable Term Insurance Cover to the eligible Savings Bank Account holders, life insurance cover for death due to any reason etc. The master policy holder (MPH) is responsible for enrolment of members as per rules.LIC reserves the right to call for any evidence of age of the Member satisfactory to the corporation before any benefits in respect of him are paid under the policy.

5.       The 2^nd opposite party is also having right to terminate the assurance upon the performance of the required conditions.  On the happening of death of the insured savings bank account holder the claimant/nominee should approach the bank branch where the life insured was having the account with completed claim form and Discharge Receipt duly completed by the nominee and counter signed by the Bank along with the death certificate and nominee bank account details will be forwarded by the Bank through their designated office to the designated P&GS unit which is servicing the Master Policy.  The Canara Bank Head office at Bangalore is collecting the death claim cases received by their Branches and after satisfying the eligibility, they would prefer the claim papers to P&GS unit LIC of India Bangalore.  But in this case the papers pertaining to the complainant are not received from the Canara Bank Head office at Bangalore till 15.02.2016.  Hence the facts of the claim are not known to the 2^nd opposite party.

6.       Moreover as per records available with the office of the 2^nd opposite party’s Bangalore unit, Late Sti.Anil G. is not insured under the policy No.900100006 under the PradhanMantriJeevanJyotiBeemaYojana with the 1^st opposite party .  No claim papers whatsoever pertaining to the said deceased Anil G. have reached the office of the Bangalore P&GS unit.  Hence the question of deficiency of service does not arise in the matter of uninsured person.

7.       In the light of the above pleadings the points that arise for consideration are:-

1. Whether there is any deficiency in service on the part of 1^st and 3^rd opposite parties being the Master policy holders in not enrolling the deceased Anil.G as a member of PMJJBY Scheme of the 2^ndopposite party LIC?
2. Whether the complainant is entitled to get Rs.2,00,000/- as compensation in lieu of the insurance claim?
3. Reliefs and costs
8.  

9.       Evidence on the side of opposite parties consists of oral evidence of DW1.  Both sides have filed notes of argument.  Heard both sides.

Point No.1&2

10.     For avoiding repetition of discussion of materials these two points are considered together.  The following are the admitted facts  in this case.  The complainant is the wife of Late.Anil.G who died on 06.07.2015 due to heart attack.  The said Anil.G is a long standing customer of the 1^st opposite party Canara Bank, Thattamala Branch and he has been operating SB A/c bearing No.1786101003946.  Being a customer the deceased Anil.G approached the 1^st opposite party for taking policy under JeevanJyothiBeemaYojana  of LIC covered by its Master policy No. 900100006  and PradhanmantriBeemaSurakshaYojana of  United India Insurance Company Ltd. Covered by its Master policy No.0726004215 P 99999005.  The said policies were available to persons who used to keep sufficient amount with their saving bank account assigned by the Government of India.  The 1^st opposite party Bank is the Master policy holder and hence responsible for the enrolment of members as per rules and as per the policy conditions life of the insured will be covered for death due to any reason. The late Anil.G submitted application for the  above schemes on 10.06.15 and the 1^st opposite party bank had issued acknowledgment cum insurance policy to him with respect to the above said schemes.  After the death of Sri.Anil.G the complainant who is none other than his widow sent written request to the opposite party No.1&2 on 28.07.2015 claiming the policy amount of Rs.2,00,000/-.  But she has received a reply stating that the date of birth of the deceased Anil.G in the application form was different from the date of birth shown in the saving bank account details with them.  The complainant has caused to send Ext.P3 notice to the 1^st opposite party requesting to disburse death claim of her husband covered by policy by name PradhanmanthriJeevanJyothiBeemaYojana under Master policy No.900100006.  She had also send Ext.P4 request to the 2^nd opposite party.  The 1^st opposite party  on receipt of the said notice issued Ext.P5 reply notice  stating that though the bank has received the application for insurance under PMJJBY from Sri.Anil on 10.06.2005,  it could not process the same due to difference in the date of birth declared by the applicant in the insurance application form. 

11.     The major contention of the opposite party bank is that there is difference in the date of birth declared by the applicant in the insurance application form and  the details furnished to the bank at the time of opening the SB A/c with the Bank.  It is further contented that though the matter was immediately brought the notice of the deceased Anil he has neither turned up nor filed necessary document to show the correct date of birth and therefore he was not enrolled in  the insurance scheme and hence he is not eligible for the benefit  of the insurance claim.  Ext.P1 Acknowledgment cum insurance certificate would indicate the following 4 aspects.Firstly the deceased Anil.G has filed a duly filled up application expressing his intention to join PMJJBY scheme of LIC. Secondly the deceased Anil.G was maintaining SB A/c No.1786101003946 with 1^st opposite party bank thirdly he has agreed to deduct the policy premium amount from his SB A/c maintained with 1^st opposite party.  Fourthly the deceased has  also given a declaration to the effect that the information furnished by him are correct.  The 1^st opposite party bank admitted to have received the application,the consent letter and declaration from the deceased Anil G.  In the circumstances it is the duty of the 1^st opposite party bank to forward the said application along with connected documents to the 3^rd opposite party insurance company.  But the 1^st opposite party bank has failed to forward the same to the insurance company through the 3^rdopposite party. 

12.     The definite contention of the opposite parties 1 and 3 is that there is no deficiency in service on the part of the opposite party bank in forwarding the application form would insurance company and it was due to the fault of the deceased Anil to furnished necessary documents the bank has not forwarded the application and therefore it happened due to the fault of the deceased Anil and not due to the part of the opposite party bank.  The above contention of opposite parties 1 and 3 appears to be incorrect in view of admission of DW1 himself.  DW1 to the admitted that the husband of the complainant deceased Anil G. was a Savings Bank account holder and for the benefit of the Savings Bank account holderPradhanmantriJeevnJyotiBeemaYojana has been formulated and as per the scheme the deceased Anil has also filed an application.  Along with the application he is also given a consent letter in the 1^st opposite party bank to deduct the premium amount from the Saving Bank account.  He has also filed a declaration along with the application and on getting application along with consent letter and declaration and 1^st opposite party bank has issued.  Ext.P1 acknowledgment date 10.06.2015.  DW1 further admit that as per the byelaws the date of paying premium is date of entry into the scheme.  It is also clear from Ext.P6 statement of SB A/c of the said Anil G. there was sufficient funds to deduct the required premium. But according to DW1 deceased Anil has not produced documentary evidence to prove his date of birth, the bank has not deducted the premium from the Savings Bank account and therefore there is no latches on the part of the bank.

13.     According to the learned counsel appearing for the 1^st and 3^rd opposite party Bank the date of birth shown in the policy application would not tally with the date of birth furnished to the bank while opening SB A/c.  But it is to be pointed that the said reason is not find a place in Ext.P1 acknowledgment cum policy certificate.  There is no mention in P1 that the applicant has to furnish documentary evidence to prove date of birth.  The 1^st opposite party bank has also not produced the account opening form filled by deceased Anil G. while opening the bank and duly filled up insurance application form filed before the bank to convince the Forum that the said Anil G. has differently stated the date of birth in the above 2 documents.

14.     According to the learned counsel for the complainant the above contention has been raised by the bank to wriggle out from the liability of not sending the insurance application to the 2^nd opposite party insurance company.  We find force in the above contention.  There is nothing on material apart from the ipsy-dixit of the 1^st opposite party bank that the date of birth shown in the policy  application would  not  tally with the date of birth already furnished to the bank while opening the bank account.  The 1^st opposite party bank has not produced the above 2 documents before the Forum for the reasons best known to them.  The learned counsel for the complainant has also filed an IA No.15/2019 seeking to issue direction to the opposite party bank to cause production  of the above two documents.  The petition was allowed and the 1^st opposite party was directed to produce the document.  But the bank has not complied with the order.  In view of the suppression of the above two material documents which is in the custody of the 1^st opposite party bank the Forum is entitled to draw adverse inference u/s 114 (g) of the Indian Evidence Act that if those documents were produced, the same would be unfavourable to the 1^st opposite party Bank who withholds its.

15.     The 2^nd contention of the 1^st and 3^rd opposite parties that Late Sri.Anil.G has died within one month from the date of application as he was affected with heart disease prior to the date of filing the application and by concealing the material fact  he filed  the application to join PMJJBY.  Therefore he is not entitled to get admitted in the insurance scheme.  In para 3 of the proof affidavit DW1 would swear that aspect.  Apart from the above bald allegations the 1^st opposite party has not produced any documentary evidence to prove that Sri.Anil.G was a chronic heart patient even prior to the date of filing the application.    Simply because  of person died due to heart attack the Forum is not entitled to presume that he was a chronic heart patient prior to the date of death.  The medical literature would indicate that there are instances of death on the 1^st heart attack itself.  It is pertinent to point out the oral evidence of PW1 in this regard.  PW1 has answered to thespecific question to the effect that her husband was chronic heart patient and by concealing that fact he has filed application to enrol in the insurance schemethat it was the 1^st attack and prior to that day her husband has not affected any heart disease and after her marriage with deceased Anil she was not aware that her husband is a person having any heart disease.  In view of the above evidence of PW1 it is clear that the deceased Anil G. died due to the first heart attack itself and he was not a chronic heart patient when he filed application to enrol in the insurance scheme.

16.     The learned counsel for the 1^st and 3^rd opposite parties would point out clause No.5 of the policy conditions where in it is stated at the time of getting enrolled as a policy holder,  the applicant has produce the certificate showing that his health condition as satisfactory .  But the above rule requires that ]²-Xn-bn tNcm-\p-ff k½X ]{X-¯nepw {]J-ym-]-\-¯nepw ]dª {]ImcwAwK-Xz Ah-[n-¡p- tijw ]²-Xn-X-bn {]th-in-¡p¶ ka-b¯vHmtcmAwKhpwcorporation \nÀtZ-in¨ C]-ImcwXsâBtcm-K-y- kw-_-Ô-ambXr]vXn-I-c-ambsXfnhvlmP-cm-t¡-­-Xm-Wv.  What is the ‘AwK-Xz Ah-[n-’ is stated in the above condition is not clear.  Any how the rule 4 and 5 would not indicate that along with the application form the applicant has to produce certificate showing date of birth and certificate regarding the health condition of the applicant.  It is brought out during the re-examination of DW1 that claim  hcp-t¼mÄ am{Xwcondition – ]d-bp¶ tcJ-IÄ lmP-cm-¡n-s¡m-­mÂaXnF¶vLIC ]d-ªn-«p-­v.  The above admission of DW1 would indicate that even if any certificate stated in the terms and condition No.4 & 5 are not produced the bank is not justified in not forwarding the application to the insurance company.

17.     The learned counsel for the complainant has vehemently argued that even if 3 weeks have elapsed after receiving the application and there was sufficient amount in the SB A/c of the deceased Anil G. the 1^st opposite party bank was sitting over on the application without forwarding it nor sent any intimation to the applicant directing him to furnish any document or cure the defect and hence there is culpable negligence on the part of 1^st and 3^rd opposite party.  In view of the materials available on record we find force in the above argument.  On evaluating the entire materials available on record we come to a conclusion that there is culpable negligence and derelictions of duty on the party of the 1^st opposite party bank in not forwarding the application to the insurance company which ultimatelyhas prevented the complainant who is the wife, the legal heir and nominee of the deceased G.Anil in getting the claim even though her husband had died. 

18.     As the insurance application admittedly filed by the deceased Anil G. during his life time was not been forwarded to the insurance company the said company cannot be asked to pay insurance claim to the legal heir of the disease and the 2^nd opposite party insurance company is only to be exonerated.  It is clear from the available materials that the latches and negligence on the part of the 1^st opposite party bank in not forwarded the application filed by the deceased Anil G. has caused much mental agony apart from financial loss to the complainant who is none other than his wife. Therefore we have no hesitation to hold that the 1^st opposite party has committed deficiency in service and if the 1^st opposite party bank has duly forwarded the application through the 3^rd opposite partyto the 2^nd opposite party insurance company, the wife of the deceased would have received the policy amount of Rs.2,00,000/- from the LIC.  Having regard to the facts and circumstances of the case, we are of the view that compensation to the tune of Rs.2,00,000/- is reasonable and sufficient to meet the ends of justice.  In the circumstances complainant is entitled to get Rs.2,00,000/- as compensation from the opposite parties No. 1 & 3 to make amend the above loss.  Point answered accordingly.  Point No.3

In the result complaint stands allowed in the following terms.

1. The   1^st and 3^rd opposite parties are directed to pay Rs.2,00,000/- as compensation to the complainant with the interest @ 6 % per annum from the date of complaint till realization.
2. The 1^st and 3^rd opposite parties are further directed to pay Rs.10,000/-as costs of the proceedings. 
3. The 2^nd opposite party LIC is exonerated from liability.
4. 1^st and 3^rd opposite parties are directed to comply with the directions No. (i) and (ii) within 45 days from the date of receipt of a copy of this order failing which the complainant is entitled to recover Rs.2,00,000/- with interest at the rate of 9 % per annum along with costs from opposite parties 1 and 3and  from their assets.

Dictated to the Confidential Assistant  Smt. Minimol S. transcribed and typed by her corrected by me and pronounced in the  Open Forum on this the  20^th   day of  August 2020.

                                                                                                E.M.MuhammedIbrahim:Sd/-

           S.SandhyaRani:Sd/-

          StanlyHarold: Sd/-

                                                                                                Forwarded/by Order

                                                                                                Senior superintendent

INDEX

Witnesses Examined for the Complainant:-

PW1                :           Sreekumari

Documents marked for the  complainant

Ext.P1             :           Acknowledgment cum insurance certificate

Ext.P2             :           Acknowledgment cum insurance certificate

Ext.P3             :           Request for the Disbursement of Death claim

Ext.P4             :           Disbursement Request by virtue of Master Policy

Ext.P5             :           Reply notice

Ext.P6             :           Statement of SB A/c

Ext.P7             :           Photocopy of SSLC certificate

Ext.P8             :           Death Certificate

Ext.P9             :           Memorandum of understanding PradhanmantriJeevanJyoti

BimaYojana

Witnesses Examined for the opposite party:-

DW1               :           Nizar

Documents marked for opposite party:-Nil

           E.M.Muhammed Ibrahim:Sd/-

           S.SandhyaRani:Sd/-

         StanlyHarold:Sd/-

                                                                                              Forwarded/by Order                      

                                                                                             Senior superintendent