SRI BIJAYA KUMAR DAS,PRESIDENT:-
Deficiency in service in respect of illegal repudiation of insurance claims are the allegations arrayed against the Opp.Parties.
2. Complaint, in brief reveals that complainant’s deceased father namely Nilamani Panda obtained an insurance policy captioned as ‘Sarva Shakti Surakhya Policy’ launched by OP No.3 i.e. Bajaj Allianz Gramya Bank, Derabish Branch, Odisha(OP No.1). On 13th March,2010 with an annual premium of Rs.2000/- vide Policy No.0140000645. The policy holder Sri Nilamani Panda was expired on dtd. 13.11.2013 and complainant being the nominee of the policy applied for the insurance claim to OP No.1 on dtd.24.11.13. It is also alleged that after lapse of one year i.e. on dtd.01.12.2014 the OP No.1 instead of paying the maturity amount of Rs.50,000/- transferred an amount of Rs.5,384/- to the A/C No.40180100003122 which belongs to the complainant. It is further stated that annual premium has been deducted from the complainant-policy holder A/C No.4080100002865 on dtd.12.03.10, 26.04.11,26.04.12 and dtd.18.04.2013 amounting to Rs.2000/,Rs.1000/-,Rs.1000/- and Rs.2,000/- respectively. When complainant approached the OP No.1 to get back his maturity amount OP No.1 replied that OP No.3 the Bajaj Allianz Insurance Company to award the maturity and OP-Bank has no role to play in this regard. On contact to agent of the OP No.3 it is told that the policy was directly dealt at Corporate office,Pune and due to non- submission of premium amount in time the maturity claim was not settled. Complainant, finding no other alternative took the shelter of this forum with prayer to get back the maturity amount of Rs.50,000/- along with Rs.20,000/- for financial loss and harassment.
3. Being noticed OP-Bank appeared through their Ld. Counsel and filed written statement into the dispute challenging the maintainability of the complaint. Written version reveals that complainant’s deceased father namely Nilamani Panda was having a S/B Account with OP No.1-Bank bearing A/C No.40180100002865 and had taken an insurance policy of Bajaj Allianz Life Insurance Co.Ltd.(OP No.3) called as Swayam Shakti Surakhya(SSS) vide Policy No.0140000645 commencing from dtd.04.11.2009, Membership No.21043 with sum assured of Rs.50,000/- under Tatkal Bima Yojana. The policy holder during his life time has regularly deposited the amount in his S/B Account towards the payment of the insurance premium amount, which is debited by OP No.1-Bank for its payment to OP-Insurance Company. The written statement further reveals that a specific procedure is adopted for payment of premium dues to OP-Insurance Company. As per the list submitted by the authorized officer of the insurance company indicating the premium amount of different policy holders and OP No.1-Bank basing on the said list debited the premium amount from the concerned policy holders and granted premium payment voucher and the said amount is deposited at the Head Office of OP-Bank at Cuttack. In this regard OP-Bank has to act on the guidelines issued by the Head Office vide Circular No.HO/PDIT/222009-10. The Circular reveals that in the event of death of the member at any time during the tenure of Membership OP-Insurance Company will pay the death benefit. It is averred in the written statement that one Pradeep Kumar Sahoo working as a Sales executive of insurance company regularly collected the premium payment voucher from the OP No.1 which includes the premium amount of the policy holder Nilamani Panda. As the Sales Executive Pradeep Kumar Sahoo use to visit the OP-Bank at due time and submits the Tatkal Bima Yojana Enrollment summary-cum-payment voucher and OP No.-Bank relying on the payment voucher debit the premium amount from the individual account of the customers and grant a payment voucher favoring the insurance company. OP –Bank in the written statement further states that in the case of deceased policy holder Nilamani Panda the payment voucher has been prepared by the officials of OP-insurance company and due to erroneous preparation of Tatkal Bima Yojana enrollment summary-cum-payment voucher an amount of Rs.1000/- has been debited on dtd. 26.04.2011 and on dtd. 18.04.13 instead of the actual premium amount of Rs.2,000/-, whereas on dtd.12.03.10 and on dtd. 26.04.12 the actual premium amounts of Rs.2,000/- has been paid. It is further stated that from the year 2010 to 2013 three premium was due towards the policy of Nilamani Panda the deceased policy holder who died on dtd.13.11.2013, but a total premium amount of Rs.6,000/- has been collected by the OP-Insurance Company as three years premium dues,though due to latches of the Pradeep Kumar Sahoo Sales Executive of OP-insurance company for wrong submission of the premium payment voucher. OP-Bank elaborately describing the date and amount of premium states that on dtd.26.04.2011 an amount of Rs.1000/- was collected instead of Rs.2,000/-. Thereafter OP-Insurance company without claiming the deficity amount of Rs.1000/- collected the next premium of Rs.2,000/- , further the mistake was repeated on dtd.18.04.2013 when the authorized officer collected the premium amount of Rs.1,000/- from the deceased policy holder. It is also stated that after payment of first premium the premium for the following year can be paid on any date within one year of grace period and the policy will remain in force. The written statement reveals that after the death of policy holder Nilamani Panda on dtd. 13.11.2013 his son the present complainant lodged a claim through OP No.1 by submitting the relevant documents for settlement of the insurance claim. But, after much delay insurance company rejected the claim of the complainant intimating that due to non-submission of the installment in time the maturity claim is not settled. The written statement further reveals that as per the contract between OP-Bank and insurance company no premium amount can be directly transferred without production of the Tatkal Bima Yojana Enrollment Summary-cum-payment voucher before the OP-Bank and without production of the debit voucher granted by the OP-Bank before its Head Office by the company. It is categorically stated in the written statement that as per the letter of Op-Insurance Company dtd. 04.11.2009 the participation of OP-Bank is on “No Risk Basis”. In the written statement it is alleged that the policy holder has to be careful regarding payment of premium dues in time, and fixing the responsibility solely throwing the responsibilities on the OP-Bank. The policy holder can not sit silently. Considering the facts and circumstances, OP-Bank prays this Forum that no deficiency in service has been committed by them and the complaint is devoid of any merit and liable to be dismissed.
Notice was served to OP-Insurance Company by Regd. Post and same is acknowledged, but OP No.3 Insurance Company did not prefer to appear into the dispute, hence set ex-parte by this Forum.
4. Heard the submission of complainant and Ld. Counsel appearing for OP-Bank.,complaint petition and written statement of OP-Bank reveals the fact that complainant’s deceased father namely Nilamani Panda was a S/B account holder with OP No.1-Bank bearing S/B Account No.40180100002865 and had taken an insurance policy of Bajaj Allianz Life Insurance Co. Ltd.(OP No.3) called as Swayam Shakti Surakhya vide Policy No.0140000645 with a annual premium of Rs.2,000/-. The membership no. of policy holder was 21043 and the policy commenced from dtd.04.11.2009 with sum assured of Rs.50,000/- under Tatkal Bima Yojana. Annexure-3 filed by the OP-Bank reveals the procedure of payment of annual premium to OP-Insurance Company, clause-11 of the Annexure describes ‘xxxxxxxx’. In case the authorized person of the company visit the branch on the same day the credit voucher, summary-cum-payment voucher and enrollment form upper portion) to be handed over to him with an advise to deposit the same with the Accounts Deptt.”. It is the version of the OP-Bank that one Pradeep Kumar Sahoo authorized officer of the OP-Insurance Company usually visit the branch to collect the premium amount and OP-Bank after receipt of Tatkal Bima Yojana enrollment summary-cum-payment voucher filled in by the authorized officer and basing on the said enrollment voucher OP No.1-Bank debit the premium amount of policy holder and a payment voucher favouring the insurance company, following the procedure mentioned on the Annexure-3. It is also revealed from the written statement of the OP-Bank that Rs.2,000/- each has been de4bited on dtd.12.03.2010 and dtd. 26.04.2012 and Rs.1,000/- each has been debited on dtd.26.04.2011 and dtd.18.04.2013 towards premium dues of the policy holder to OP-Insurance Company, which according to OP-Bank is wrong calculation of the authorized officer of OP-Insurance company namely Sri Pradeep Kumar Sahoo.
Now, the question to be decided by the Forum that as per the complainant and written statement of OP-Bank, OP-Insurance Company rejected the claim of the complainant due to non-submission of maturity amount in time, whether this plea is legally sustainable or not ? It appears from the Annexures, complaint petition and written statement of OP-Bank that on dtd. 12.03.10,26.04.2011,26.04.12 and dtd.18.04.13 an amount of Rs.2,000/-Rs.1,000/-, Rs.2000/-,Rs.1000/- total Rs.6,000/- has been debited from the deceased policy holders S/B Account No.4080100002865. It is also a fact that deceased policy holder died on dtd.13.11.2013. The dispute of non submission of premium amount is the only ground for non-settlement of the insurance claim. It is clear from the Annexure-3 that the debit of premium amount and its payment to the insurance company directly, involves the role of the concerned bank where the policy holder account operates and the acceptance of the premium amount is finalized by the insurance company.The policy holder is least concerned about the debit and payment of premium amount. In the case in hand, the deceased policy holder Nilamani Panda father of the complainant takes the policy on dtd.12.03.10 and expired on dtd.13.11.2013 but during course of submission complainant submitted that the date of death of his father mentioned in the complaint petition is a typographical error and has been overlooked during the time of typing of the petition, but attested Xerox copy of death certificate and letter addressed to OP-Bank on dtd.24.12.13 reveals that the date of death of complainant’s father is dtd.07.11.2013. We, feel it that the date of death of policy holder is dtd.07.11.2013 and it is a typographical mistake on the complaint petition by mentioning that the date of death is dtd.13.11.2013. It is crystal clear that when policy holder availed the policy on 2010 and he continued to pay the premium amount through OP No.1-Bank upto the year 2013. The next date of the payment of premium is in the year 2014 as it is an annual premium paid policy. As per the condition of the policy till survival of the policy holder the legitimate premium dues are Rs.6,000/-. Whatever discrepancies in connection to payment of annual premium it is between the OP-Bank and OP-Insurance Company. Further, on plea of non-submission of instalment, the OP No.3 is more negligent than any other parties. OP No.3, inspite of receipt and acceptance of shortfall premium amount sit silently by neither informing the policy holder nor their business partner OP-Bank, rather the plea was raised when the policy holder died and claim was filed to get back the sum assured as per the condition of the policy. The complainant is least responsible in this regard. Equally we give importance to the plea of OP-Bank that as per the contract and letter of OP-Insurance company dtd. 04.11.2009 which reveals that the participation of OP-Bank was as “No Risk Basis” which is evident from the letter dtd. 04.11.2009 filed into the dispute. During course of submission complainant submits that OP-Insurance Company has refunded Rs.5384/- dtd.01.12.2014 to the complainant’s S/B account and during the pendency of the present proceeding OP-Insurance company has credited Rs.1,000/- on dtd.04.05.2016 as revealed from the Branch Manager, OP No.1-Bank. In the circumstances, it is observed that OP-Insurance Company has credited Rs.6384/- to the complainant’s account through OP No.1-Bank.
Considering the facts and documents presented before this Forum and in absence of any counter by OP-Insurance Company, it is well evident that OP No.3-Insurance company has committed deficiency in service by illegally non-settling the claim of the complainant.
Considering the facts, documents and letter of Ops dtd. 04.09.2011, we freed OP-Bank from any such liability of deficiency in service. Accordingly, complaint deserves to get the sum assured of policy amounting of Rs.50,000/-. Complainant can not let to be suffer for mishandling of the payment of premium amounts. The question of maintainability as raised by the OP-Bank in their written statement creates no significant impression as the same are formal in nature.
Having observations reflected above, it is directed that OP No.3-Insurance company will settle the claim of the complainant by awarding the sum assured of Rs.50,000/- by deducting the payments ( Rs.6384/-)made earlier along with 9 per cent interest calculating from dtd.24.12.13 to till the date of realization after completing the official formalities. It is further directed that OP No.3-insurance company will pay Rs.1,000/- to the complainant as cost of litigation. The order is to be carried out within one month of receipt of the order, failing which 12 per cent interest will be charged for the delayed period.
Complaint is allowed in part with cost.
Pronounced in the open Court, this the 12th day of September,2016.
