Haryana

Ambala

CC/339/2017

Kevala Devi - Complainant(s)

Versus

Canara Bank - Opp.Party(s)

Ashutosh Aggarwal

20 Nov 2018

ORDER

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AMBALA

 

                                                                      Complaint case no.        :  339 of 2017

                                                          Date of Institution         :  03.10.2017

                                                          Date of decision    :   20.11.2018

 

 

Kevala Devi w/o Late Sh. Ram Manorath, age 50 years, r/o H.No.5, Indira Park, Ambala Cantt.

……. Complainant.

 

 

1.       Canara Bnak, Triloki Chamber, Punjabi Mohalla, Ambala Cantt.

2.       Canara Bank, Asset Procurement & Management Group, DIT-WING, Head Office, Naveen Complex, 14, M.G.Road, Banglore-560001.

3.       L.I.C. of India, Jagadhari Road, Ambala Cantt.

4.       LIC of India, Jeevan Parkash, IV Floor  J.C.Road,  Banglore -560002

 

 ….…. Opposite Parties.

 

 

Before:        Sh. D.N.Arora, President.

                   Sh. Pushpender Kumar, Member.

Ms.Sushma Garg,  Member.              

         

 

Present:        Sh. Ashutosh Aggarwal, counsel for complainant.

                    Sh. Amit Gupta, counsel for OP Nos. 1 & 2.

Sh. G.S.Antal, counsel for OP Nos. 3 & 4.

 

 

ORDER:

                   In nutshell, brief facts of the present complaint is that the husband of the complainant Ram Manorath was Govt. employee working as ‘Head Mali’ with Municipal Corporation Ambala Cantt and salary of the husband of the complainant was credited in SB General Account No.0200101032179 maintained with the OP Nos. 1 & 2 for the last many years. One fine day, the deceased told by the OP No.1 to join ‘Pradhan Mantri Jeevan Jyoti Bima Yojna’. The OP No.1 told the husband of the complainant that :-

i         The master policy holder  shall be Canara Bank.

ii        The scheme is known as ‘Pradhan Mantri Jeevan Jyoti Bima Yojna’ for the savings bank account holders of bank.

iii       The life cover shall be restricted  to Rs. 2,00,000/- only in the event of death of the assured.

iv       The cover under ‘PMJJBY’ is for death only and hence benefit will accrue  only  to the nominee. PMJJBY is a pure term insurance policy which covers only mortality with no investment component except Rs. 330/- p.a. would be payable and deducted from  the savings bank account of the policy  holders towards the annual premium to cover up the benefits under the said policy.

After that the Op No. 1 collected all required documents from the husband of the complainant for the said policy and after verifying all the credentials of the deceased, deducted amount of Rs. 330/- from the SB General account on 26.05.2015 being the annual first premium payable under the said scheme and nominated the complainant as ‘nominee’ in the said policy of insurance. The Op Nos. 1 & 2 again deducted the second annual premium of Rs. 330/- on 26.05.2016.  During the subsistence of the above said policy of insurance under ‘PMJJBY’ the assured i.e. husband of the complainant Sh. Ram Manorath died on 18.4.2016. The complainant  being widow of the assured and also nominee under the policy, approached the OP No.1 for the payment of the death claim of Rs. 2,00,000/-.  All the required documents were duly submitted by the complainant to the Ops as and when asked. Inspite of repeated visits and requests by the complainant to the OP No.1, the said death claim was not paid to the complainant. Atlast the complainant served legal notice dated 02.05.2017 through his counsel to the OP No.1. Thus, the complainant has suffered economical loss and financial loss. Hence, the present complaint.

2.               Upon notice, OP Nos. 1 & 2 appeared through counsel and tendered written statement raising preliminary objections qua complaint is not maintainable being false & frivolous, cause of action, suppressed the true and material facts, estoppels no jurisdiction. On merits, OP Nos.1 & 2 stated that in the last week of April, 2017 one Mrs. Kevala claiming herself legally wedded wife of Sh. Ram Manorath visited the office of OP No.1 and claimed to be paid as per the insurance policy  of her deceased husband i.e. ‘PMJJBY’. At this she was advised to submit all her credentials and death certificate of her deceased husband Sh. Ram Manorath so that her insurance claim case could be forwarded to the OP No.3. They further stated that the insurance claim rejected by the OP No.4 on the ground that as per the records of Aadhar Card of Sh. Ram Manorath the age of said Sh. Ram Manorath (since deceased) on the bases of said Aadhar Card submitted by the present complainant  was calculated to be about 52 years  at the time of his enrollment of the said insurance policy.  As per  Aadhar Card, the date of birth of Sh. Ram Manorath was mentioned as 01.07.1963. Though it is matter of fact that whether the date of birth mentioned on the said Aadhar Card is inadvertently wrongly mentioned or not.  Thus, it is not the OP Nos. 1 & 2 who has rejected the insurance claim of the complainant but the same has been rejected by the OP Nos. 3 & 4.

Upon notice, OP Nos.3 & 4 appeared and tendered written statement and submitted that as per death certificate submitted by complainant the husband of complainant died on 18.04.2016. The claim file was received by OP Nos.3 & 4 from Head office Canara Bank on 05.12.2016. They further submitted that on the basis of Aadhar Card submitted by claimant herself the claim of the complainant is rejected. As per Aadhar Card of life assured the date of birth of deceased was 01.07.1963 and his age was more than 50 years on the date of enrolment i.e. 09.05.2015. Hence, the claim was rejected by the OP Nos.3 & 4 and intimated to the Master Policy Holder. The scheme is not lunched by LIC and it is the Government Scheme administered by both Bnak and LIC. Only Master Policy is issued under the scheme to the OP Nos. 1 and 2 and individual policy will not be issued to the members. Further consent –cum-declaration forms are collected forms the individual members at the time of enrolment into the scheme by the bank. As stated above bank is responsible for entrolment of members as per rules. So, there is no deficiency in service on the part of OPs and prayed for dismissal of the present complaint.

3                 To prove his version complainant tendered his affidavit as Annexure C-A along with documents as annexure C-1 and C-8 and close her evidence. On the other hand, Counsel for the OP Nos. 1 & 2 tendered affidavit as Annexure RW-1/A along with documents as Annexure R-1 & R-2 and close their evidence. Counsel for OP Nos. 3 & 4 tendered affidavit as Annexure RW-2/A along with documents as Annexure R/3 to R/8 and closed their evidence.

4.                We have heard both the counsels of the parties and carefully gone through the case file. It is admitted facts that the deceased Ramnorath was the Government employee and the salary of the husband of the complainant was credited in SB General Account No.0200101032179 maintained by OP Nos. 1 & 2 which is evident from the statement of account Annexure C-3. Undisputedly, the husband of the complainant was insured with OP No.3 under PMJJBY through OP No.1 in the above said policy which was introduced in the year 2015. As per the scheme the bank has deducted amount of Rs. 330/- yearly for the two years i.e. for the year 2015 and 2016 as per the statement of account produced by the complainant  as per the Annexure C-3 as per policy, the life of Ramnorth insured is covered  for two lakhs only in case of his death. It is also mentioned in the policy that saving bank account holder aged between 18 years completed and 50 years (age near birthday) on the date of enrolment and saving bank account holder should have Aadhar Card KYC. It is proved on the file as per the death certificate the deceased Ramnorath was died on 18.04.2016. The nominee of the deceased Kevala Devi has claimed the amount of Rs. 2 lakhs as per the scheme Annexure R-3 but the OPs have rejected the claim on the ground that at the time of the enrolment  the deceased has already crossed 52 years. On the basis of this the death claim was rejected.

The question arises before us is ‘whether the Ops are  justified in rejecting the claim on the basis of age declared by the deceased insured and whether it was a material concealment?’

5.      It is pertinent to note that the policy was taken by the deceased life insured through OP Nos. 1 & 2 with whom he was having salary account being a Government official (Mali), therefore, it is clear that he was illiterate person. Since the policy was obtained through Bank therefore, there is every possibility that the requisite forms were filled in by bank officials on the basis of documents as well as records which were lying with them for the last many years being submitted by the insured at the time of opening of bank account. The date of birth has been mentioned as 01.04.1970 at the time of opening of the bank account as per Annexure R-1. It is pertinent to submit that at that time Aadhar card was not in existence, therefore, the age proof i.e. ration card submitted by the life insured was taken a genuine document. In Annexure R-2 i.e. consent cum declaration form same date of birth has been mentioned as 01.04.1970. Had there being any doubt or query it was for the insurance company or bank to obtain other better age proof from his employer regarding before issuing the policy in question when the policy in question was in very much knowledge of the bank official as well as insurance company. There was a condition that the age of the insured shall not beyond 50 years at the time of the taking of the policy. Bank and insurance company are duty bound to take the age proof of the deceased in the shape of school leaving certificate, Aadhar Card or obtained the certificate from their employer but they failed to obtain the above said documents. Therefore, the insured  cannot be blamed that he has not filed  better age proof than the ration card submitted by him with the bank at the time of opening the bank account and obtaining the policy in question. It is strange that the insurance company has obtained the premium by treating the age mentioned in the ration card as correct on the basis of which the bank account was opened but now when the death claim has been submitted the insurance company has entangled the matter in technicalities by treating the age of the deceased on the basis of Aadhar Card which exceeding his age beyond 50 years.  Principle of estoppal strictly is applied in this case and OP cannot take the benefit of his own wrong.

Reliance on this point can also be taken from case law titled as Life Insurance Corporation of India Vs. Balbir Singh & Anr. IV (2008) CPJ 326 wherein it has been held by Hon’ble Punjab State Consumer Disputes Redressal Commission, Chandigarh has held that Life Insurance- Repudiation of claim-Contention, wrong date of birth given in proposal form, Date of birth given from ration card, with bona fide intention-Date of birth wrong not known to insured-School leaving certificate not demanded by insurer, cannot be placed reliance to justify repudiation of claim-Payment of assured amount with interest directed-Compensation and cost awarded. Hon’ble National Commission in case titled as Life Insurance Corporation of India & Anr. Vs. Gopal Singh II (2011) CPJ 7  has held that Insurance (Life)-Endowment Assurance Policy with Profits-Suppression of material facts-Dispute of Age-Claim repudiated –Forum allowed complaint-State Commission dismissed appeal-Hence, revision-Contention, assured had given his age incorrectly while filling proposal form on basis of voter’s list. Not accepted-Age given in voter’s list cannot be taken as a sure test to determine exact age of a person- It is a common knowledge that frequently small mistakes regarding residence, age, parentage do occur while preparing voter’s list –No conclusive evidence on record to show that assured had mentioned his date of birth incorrectly with malafide intention with any ulterior motive.

6.                In view of the above discussion and law laid down by the National Commission and squarely covered the case of the complainant. Hence, the rejection of the claim of the complainant is not justified and repudiation letter Annexure R-4 is hereby the quashed and complainant is entitled for relief. We hold that the Ops are deficient in service by not giving the genuine claim to the complainant.  Therefore, the present complaint is liable to be accepted and same is hereby allowed with cost which is assessed Rs. 5,000/- and complainant is entitled to Rs. 2 Lakhs as per policy scheme alongwith interest @ 9% from the date of filing of the complaint till its realization. The Ops are directed to comply with the orders, within a period of 30 days from the date of receiving of copy of this order. Copy of the order be sent to the parties concerned, free of costs, as per rules. File after due compliance be consigned to record room.

Announced on: 20.11.2018

                                               

 

 

(PUSHPENDER KUMAR)     (Dr.SUSHMA GARG)            (D.N. ARORA)

            Member                               Member                                 President