Punjab

Moga

CC/16/90

Paramjit Kaur - Complainant(s)

Versus

Chairman-cum-Managing Director Oriental Insurance Co. - Opp.Party(s)

Sh .Ajay Pal Singh Bhullar

16 Aug 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA.

 

                                                                                                                                                              CC No. 90 of 2016

                                                                                                                                                              Instituted on: 25.04.2016

                                                                                                                                                             Decided on: 16.08.2016

 

Paramjit Kaur age 44 w/o Sh. Gurdeep Singh r/o Village Lande Ke, Tehsil & District Moga.

                                                                          ……… Complainant

 

Versus

1.       Chairman-cum-Managing Director, Oriental Insurance Co. Ltd., Oriental House, A-25/27, Asaf Ali Road, New Delhi-110002.

 

2.       Manager Oriental Bank of Commerce, Branch Bughipura, Tehsil & District Moga.

 

3.       Regional Manager, Oriental Bank of Commerce, B-XV-136, Jandu Tower, Miller Ganj, G.T.Road, Ludhiana- 141003.

 

 

                                                                           ……….. Opposite Parties

 

 

Complaint U/s 12, Section 2 (1) (g), (o) and section 14(1) (c), (d)  of the Consumer Protection Act, 1986.

 

 

 

Quorum:    Sh. Ajit Aggarwal,  President,

                   Smt. Vinod Bala, Member,

                   Smt. Bhupinder Kaur, Member.

 

Present:       Sh. Ajay Pal Bhullar, Advocate Cl. for complainant.

       Sh. Pawan Kumar Sharma, Advocate Cl. for opposite party no.1.                    

       Sh. Dinesh Kumar Garg, Advocate Cl. for opposite party nos. 2 & 3.

 

 

ORDER :

(Per Ajit Aggarwal,  President)

 

1.                Complainant has filed the instant complaint under Section 12/14 of the Consumer Protection Act, 1986 ( hereinafter referred to as the "Act") against Chairman-cum-Managing Director, Oriental Insurance Co. Ltd., Oriental House, A-25/27, Asaf Ali Road, New Delhi and others (hereinafter referred to as the opposite parties) directing them to pay a sum of Rs. 2,00,000/- as a claim of insurance of her deceased son alongwith interest @ 18% p.a. from the date of rejection of claim. Further opposite parties may be directed to pay Rs. 2,00,000/- as compensation on account of mental pain and agony and to payRs.22,000/- as litigation expenses to the complainant. Further any other additional or alternative relief for which the complainant is found entitled under the law, the same may also be granted.

2.                Briefly stated the facts of the case are that on dated 01.06.2015 son of the complainant namely Avtar Singh s/o Sh. Gurdip Singh (deceased) had opened an account no.202621610033701 with Oriental Bank of Commerce, Branch Bughipura, Tehsil & District Moga. At the time of opening the said account with opposite party no.2, the deceased was given an option to get registered with the Pardhan Mantri Suraksha Bima Yojna. After due assurance given by the officials of the opposite party no.2, the complainant and his son opted for the said scheme on the same day and deposited Rs.1050/- in the said account. However, the bank had not deducted the premium on the same day, rather same was auto debited on next day i.e. on 02.06.2015, which is clearly a deficiency in service on the part of opposite party bank. The bank branch never provided the copy of insurance policy to Avtar Singh, rather they only gave a policy no. 271700482016203 of Oriental Insurance Co. Ltd. The deceased was insured for an amount of Rs.2,00,000/- and in the event of any mishap, the nominees/heirs of the deceased were entitled to get the insurance amount from the opposite parties to the tune of Rs. 2,00,000/-. The son of the complainant namely Avtar Singh was expired on dated 16.06.2015 due to electrocution. In this regard D.D.R no.16 dated 16.06.2015 was also lodged with the Police Station Sadar, Moga. The complainant duly informed the opposite party no.2 regarding the death of her son and subsequently being the nominee and legal heir of Avtar Singh, the complainant contacted opposite party no.2 for the claim/payment of the insurance amount. On 13.10.2015, the complainant got intimation from the main branch of OBC that her claim was rejected due to the reason that death of Avtar Singh occurred out of the policy period. The Public Information Officer of Oriental Bank of Commerce, Ludhiana has also informed under RTI that death occurred outside policy period. The opposite party no.3 also provided under RTI, letter dated 15.03.2016 alongwith Consent-cum-Declaration Form, Claim form and PMSBY Claims Procedure. The insurance company and bank branch is unable to explain the said reason that how the death occurred out of the policy period as insurance company had issued him policy no.271700482016203 before 14 days of his death. Moreover requisite premium amount has already been auto debited in the bank account. Actually opposite party no.2 has never forwarded the case of complainant to the concerned insurance company which is essential as per the claim procedure of scheme, rather they rejected the claim on their own level. The opposite parties have illegally and wrongfully retained the amount of Rs.2,00,000/- of the complainant for causing wrongful loss to the complainant and for making wrongful gain to themselves. Moreover, opposite party no.2 knowingly violated the PMSBY claims procedure (clasue-5) by not forwarding the case to the insurance company concerned within 30 days of the submission of the claim.  By rejecting the genuine claim of complainant is clearly deficiency of service by opposite party nos. 1 to 3. Hence this complaint.

3.                Upon notice opposite party nos.1 to 3 appeared through their counsels and filed their separate written replies.

                   Opposite party no. 1 filed written reply taking preliminary objections that the complaint is not maintainable; that the complainant is not consumer of the opposite party no.1; that the complainant has no locus-standi to file the present complaint against opposite party no.1; that the complainant has no cause of action against opposite party no.1; that the complainant has not filed any insurance claim or any other document in connection with the alleged policy to reveal any liability of the answering opposite party. Thus, the answering opposite party is not liable to pay any claim. The answering opposite party is unable to reply the facts without seeking the documents relating to them. However, the answering opposite party reserves its right to file the amended written statement on later stage as and when some new material facts comes to the light and knowledge of the answering opposite party. Opposite party no.1 neither received the claim form nor any other documents relating to the claim till today nor the complainant has filed any document relating to the answering opposite party in the Forum. The complainant may kindly be directed to file the documents relating to the claim and insurance company; that there is no deficiency in service on the part of opposite party no.1, as the complainant is not the consumer of opposite party no.1; that the answering opposite party has been impleded falsely. Thus, the name of answering opposite party may kindly be struck off/deleted; that the claim of the complainant has been rightly repudiated by the opposite party no.2, as per the policy term and condition no.5 which says "I agree that the cover shall commence from the 1^st of the month subsequent to the date of enrolment in the scheme". On merits, the all other allegations made in the complaint have been denied and a prayer for dismissal of the complaint with special costs has been made.

4.                Opposite party nos.2 & 3 filed written reply taking preliminary objections that the complaint is not maintainable; that the complainant has got no locus-standi; that no deficiency in service has been attributed to the opposite party; that the complainant has not come with clean hands before this Forum. As per rules and regulations, the said policy was to be effective w.e.f. 1.7.2015 after one month from the date of purchase of policy. The policy was purchased on 2.6.2015 and same was to be operated on 1.7.2015 and death occurred on 16.06.2015, thus the complainant is not entitled to any relief from this Forum; that the complainant has concealed the material and patent facts from this Forum, while filing the present complaint which ipso-facto disentitles the complainant to seek any relief against the opposite party; that the complaint of the complainant is false, frivolous, baseless, vague and malicious, therefore, in the event of dismissal of the complaint the opposite parties are entitled to special costs as provided under Consumer Protection Act. On merits, the all other allegations made in the complaint have been denied and a prayer for dismissal of the complaint with special costs has been made.

5.                In order to prove the case, complainant Paramjit Kaur tendered in evidence her duly sworn affidavit Ex. C-1 and copies of documents Ex.C-2 to Ex.C-17 and closed the evidence. 

6.                In rebuttal, the opposite party no.1 tendered in evidence duly sworn affidavit of Sh.Muneesh Nagpal, Branch Incharge, Oriental Insurance Co. Ltd. Ex.OP-1/1 and closed the evidence. Whereas, opposite party nos.2 & 3 tendered in evidence affidavit of Sh.Asheesh Mehta s/o Sh. Kewal Krishan, Manager, Oriental Bank of Commerce Ex.OP-2,3/1 and copies of documents  Ex. OP-2,3/2 to Ex.OP-2,3/5 and closed the evidence.

7.                We have heard the learned counsel for the parties and have very carefully gone through record placed on file.

8.                Ld Counsel for complainant vehemently argued that son of complainant opened an account with OBC Bank on 1.06.2015 and at that time, OP-2 advised his son to get registered with Pardhan Mantri Suraksha Beema Yojna and on assurance of OP-2, he opted for said scheme on same day, deposited Rs.1050/-with them, but bank deducted the amount of insurance premium on 2.06.2015. Bank gave policy no 271700482016203 of OIC to his son, but did not supply any policy or policy document. As per policy, son of complainant was insured for Rs2,00,000/-against any kind of mishap and in the event of any mis-happening, nominees/heirs of deceased are entitled for insurance amount of Rs.2,00,000/- from OPs. It is submitted that son of complainant died on 16.06.2015 due to electrocution and DDR to this fact was also got registered in Police Station Sadar, Moga. Complainant duly informed about this fact to OPs, but on 13.10.2015, OPs intimated complainant that her claim was rejected on the ground that death of her insured son occurred out of Policy period. PIO of OBC also informed under Right to Information Act that death of son of complainant occurred outside the policy period. Ld counsel for complainant contended that policy in question was issued 14 days prior to the death of son of complainant as he was insured on 2.06.2015. Insurance Policy commenced on 2.06.2016 and death of son of complainant occurred on 16.06.2016 and in this way, he was insured prior to his death, but rejection of claim by Ops on the ground that death of son of complainant occurred outside policy period amounts to deficiency in service and has caused great harassment to complainant. She has prayed for accepting the present complaint alongwith compensation and litigation expenses.

9.                To controvert the allegations of complainant counsel, ld counsel for OPs averred that complaint in hand is not maintainable and complainant has no locus standi to file the same. Complainant has not come to the Forum with clean hand. It is brought before the Forum that son of complainant purchased the policy in question on 02.06.2015 and it was to be operative w.e.f. 01.07.2015 and death occurred on 16.06.2016 and thus, complainant is not entitled to any relief as sought by her. All the other allegations have been denied being wrong and incorrect and prayer for dismissal of complaint is made. It is further reiterated that there is no deficiency in service on the part of OPs.

10.              We have heard the ld counsel for complainant as well as OPs and have carefully gone through the record available on file.

11.              The case of complainant is that on 1.06.2015, son of complainant opened an account with OP Bank and on assurance of OPs he got himself registered with Pradhan Mantri Beema Yojna. He deposited Rs.1050/-with OP bank, the insurance premium was debited by OPs on 2.06.2016. Son of complainant was insured for a sum of Rs.2,00,000/-against any kind of risk. Unfortunately, son of complainant died on 16.06.2016 due to electrocution and DDR to this fact was also registered with Police at Moga and due intimation regarding it was also given to OPs, but OPs rejected the claim of complainant on the ground that death of her son has occurred outside Policy period. Public Information Officer of OBC also informed complainant that complainant is not entitled to any relief as sought by her as death of her son has occurred outside policy period. As per OPs, policy was purchased on 2.06.2015 and it became effective on 1.07.2015 and as death occurred on 16.06.2016, thus, it has occurred outside the period of insurance policy and therefore, complainant is not entitled for any relief.

12.              It is admitted case of the parties that son of complainant namely Avtar Singh opened a bank account with OP Bank and got registered himself with Prime Minister Suraksha Beema Yojna for a sum of Rs.2,00,000/- and OP-2 Bank debited the insurance premium from the account of Avtar Singh and issued a Policy Number of Oriental Insurance Company to him. Death of said Avtar Singh on 16.06.2016 is also not disputed. As per Insurance Policy, in case of mis-hap or death of Avtar Singh the legal heir of said Avtar Singh were entitled for insurance claim of Rs.2,00,000/-. It is further admitted that complainant lodged claim regarding the death of her son Avtar Singh with OP-2 Bank, which is repudiated by the Bank on the ground that as per terms and conditions of the Policy, the Insurance Cover shall commence from the first of month subsequent to the date of enrolment in the scheme, whereas Avtar Singh died prior to first of subsequent month i.e he purchased the Insurance Cover on 2.06.2016 and died on 16.06.2016. So, as per terms and conditions of the Policy, he died out of insurance period and is therefore, not entitled for insurance claim. On it, ld counsel for complainant argued that at the time of issuance of Insurance Policy, the Ops did not disclose regarding its terms and conditions to the complainant or her son. When once they issued Insurance Policy, then, from that very time, the insured is entitled for insurance claim under the Policy. No such terms and conditions of the policy have ever been conveyed to complainant or her son. He has put reliance on citation 2000(1) CPR 93 (Supreme Court) 242 titled as M/s Modern Insulators Ltd. Vs The Oriental Insurance Company Ltd. wherein Hon’ble Apex Court held that clauses which are not explained to complainant are not binding upon the Insured and are required to be ignored. Furthermore, it is generally seen that Insurance Companies are only interested in earning the premiums and find ways and means to decline the claims. He further placed reliance on citation 2008(3)R.C.R. (Civil) Page 111 titled as New India Assurance company Ltd Vs Smt Usha Yadav & Others wherein our Hon’ble Punjab & Haryana High Court held that it seems that Insurance Companies are only interested in earning premiums and find ways and means to decline the claims. The conditions, which generally are hidden need to be simplified so that these are easily understood by a person at the time of buying any Policy. The Insurance Companies in such cases, rely upon the clauses of agreement which a person is generally made to sign on dotted lines at the time of obtaining the policy. He further put reliance upon citation 2012 (1) RCR(Civil) 901 tilted as IFFCO TOKYO General Insurance company Ltd Vs Permanent Lok Adalat (Public Utility Services), Gurgaon and others, wherein our Hon’ble Punjab and Haryana High court held that  Contract Act, 1872 – Insurance Act, 1938 – contract among unequal – Validity – Medicalim Policy – Exclusion clause – Pre existing disease – Exclusion clause is standard form of contracts – When bargaining power of the party is unequal and consumer has no real freedom to contract – Courts can strike down such unfair and unreasonable clause in a contract where parties are not equal in bargaining power.

13.              He argued that complainant is entitled for insurance claim for the death of her son. From the above discussion, we are of considered opinion that OPs have wrongly and illegally repudiated the claim of complainant on the basis of wrong terms and condition, which were never explained to complainant or her son. When the OPs once issued the insurance policy in favour of insured they cannot deny the claim on flimsy grounds.  However, in the present case, the OP no.1 insurance company submitted that they never received any claim form or the documents for settlement of the claim in question and it is only the bank OP-2 and 3, who have rejected the claim at their own. As per Prime Minister Sureksha Beema Yojna claim procedure, the claim for the same shall be submitted to the bank alongwith all required documents and the bank shall check the same and to forward the case to the Insurance Company concerned within 30 days of the submission of the claim. The insurer will verify and confirm that premium has been  remitted for insured and the claim shall be processed by the Insurance Company within 30 days from its receipt.

14.              In the present case, the plea of Insurance Company is that they never received claim form and other documents from the Bank for the processing. It is admitted by the bank that the complainant submitted claim form alongwith documents to them but instead of forwarding the same to Insurance Company, the Bank themselves at their own repudiated the claim of the complainant for which they had no right. The Bank is only a Service Provider to collect the claim form and after verifying, it should be submitted to the Insurance Company and the Bank had no authority to decide the claim. It is only the Insurance Company who has to decide the claim but in the present case, the bank at its own decided and repudiated the claim without any authority. Therefore, present complaint in hand is hereby allowed. Opposite party nos.2 and 3 are directed to pay Rs. 2,00,000/- as insurance claim of deceased son of complainant alongwith interest at the rate of 9% per annum from 13.10.2015 when they repudiated the claim of complainant till final realization. They are further directed to pay Rs.5,000/- (Five thousand only) as compensation to complainant for harassment and mental agony suffered by her besides Rs.3,000/- (Three thousand only) as litigation expenses within one month of receipt of the copy of the order failing which, complainant shall be entitled to proceed under Section 25 and 27 of the Consumer Protection Act. Copy of order be given to parties free of cost under rules. File be consigned to record room.

Announced in Open Forum

Dated : 16.08.2016

 

                        (Bupinder Kaur)                           (Vinod Bala)               (Ajit Aggarwal)

                             Member                                     Member                       President