Personal Accident Cover of up to Rs.5,00,000/- :  In the unfortunate event of loss of life in a mishap, the customer`s beneficiaries will receive the benefit of accident insurance of up to Rs.5 lac.  [ To keep your personal accident insurance cover activated, you should have made a purchase transaction in 365 days prior to the day of the unfortunate incident and maintained an average quarterly balance of Rs.5,000/-(Urban & Metropolitan Branches) or Rs.2,500/-(Rural & Semi-Urban Branches) as the case may be in the two quarters before the date of the incident. A report would also have to be made to Axis Bank within 60 days of a personal accident or 30 days of loss of card.]

          Dissatisfied with the said repudiation letter, it is stated in the complaint that even after providing gold debit card respondent never issued the copy of insurance policy to the deceased husband of the complainant.  On 6.5.2010 she issued legal notice to respondent No.1 & 2 and requested to review death claim papers.  Respondent No.1 neither replied the notice nor allowed the claim.  But one of the employees Kedar Deshpande contacted and directed her to submit the claim with the insurance company. Legal notice issued to respondent No.2 was replied by insurance company on 24.5.2010 and denied the claim . On 25.5.2010 complainant preferred the claim with the insurance company.  Her claim was lastly repudiated on 30.6.2010.  Therefore complainant was constrained to approach to the District Consumer Forum.

3.       Opponent No.1 Axis Bank though served with the notice by District Consumer Forum did not appear before the Forum. Hence Forum proceeded exparte against them by its order dated 18.2.2011. 

4.       Opponent No.2 insurance company appeared before the Forum and submitted that as per terms and conditions of the policy life assured did not keep the balance of stipulated amount in his account as quarterly average.  Therefore the claim of complainant was rightly repudiated.  In support of their contention they produced copy of policy of period 11.4.2010 to 10.4.2011 before the Forum. 

5.       After hearing all the parties District Consumer Forum partly allowed the complaint and directed opponent No.2 present appellant to pay Rs.5 lakhs within 30 days or else it will carry interest @ 9% from 7.9.2010 till realization. Forum also directed opponent No.2 to pay Rs.5000/- towards mental agony and Rs.3000/- towards cost. Forum directed opponent No.1 Axis Bank to pay Rs.5000/- for mental and physical agony.

6.       Adv.Shri.S.G.Chapalgaonkar appeared for appellant and Adv.Shri.Jayant Chitnis appeared for respondent No.1.  We heard appeal finally at the admission stage with the consent of both the counsel.  It is submitted by Adv.Chapalgaonkar that policy was obtained by bank,  therefore the terms and conditions of the policy were made aware to the bank and it is obligatory on the part of bank to inform about the same to their account holders. It is further submitted by Adv.Chapalgaonkar that though policy of next period was produced before the Forum it was one and same which was issued earlier in respect of deceased Pawan Save. As per terms and conditions of the policy account holder was under obligation to maintain average quarterly balance in his account and as it was not maintained his claim was rightly repudiated. 

7.       Adv.Chitnis submitted that gold debit card was provided by bank to its account holders. With the said gold debit card welcome kit was provided. There were number of directions issued in respect of use of said gold debit card. But nowhere in the said terms mentioned to maintain particular balance amount in the account as quarterly average. Therefore life assured was never knowing about the same. As the policy documents were not provided to the life assured he was unaware about terms and conditions of the policy.  Policy documents were given to the bank only.  As the terms and conditions of the policy were not provided to the life assured repudiation by relying on the terms and conditions of the policy is not legal and proper.

8.       We thus considered the submissions of both the counsel and perused the record. It is an admitted fact that terms and conditions of the policy were never supplied to the life assured Pawan Save. Guidelines issued about gold debit card did not contain any condition about maintaining of average quarterly account by keeping certain amount. Policy documents were with the bank only.  They never supplied to the life assured. Therefore life assured was totally unaware about the terms and conditions of the policy.  Even otherwise maintaining  account with meager amount of Rs.2500/- or Rs.5000/- is not impossible for any person to abide the terms and conditions of the policy.  But unfortunately life assured in the present case was unaware about any such terms and conditions.  Appellant insurance company even failed to produce copy of terms and conditions of the policy of relevant year before the Forum.  Not providing the terms and conditions of the policy to the life assured is itself deficiency in service . 

9.       We are relying on New India Assurance Co.Ltd. –Vs- Awadh Wood Products, it is held by Hon`ble National Commission that, "insurance company not made available to the complainant detail terms and conditions of the policy and by that committed deficiency in service.  Insurance company could not bound down complainant to provision of the policy on which he was not made aware". 

10.     We are also relying on M/s Modern Insulator Ltd. –Vs- Oriental Insurance Co. Ltd., reported in AIR (2000) SC 1014.  It is held by Apex Court that, “it is fundamental principle of insurance law that utmost good faith must be observed by the contracting parties and good faith forbids either party from non-disclosure of the facts which the parties know.  The insured has a duty to disclose and similarly it is duty of insurance company and it`s agent to disclose all material  facts in their knowledge since obligations of good faith applies to both equally”.            In the instant case, the terms and conditions of the standard policy wherein exclusion clause was included, were neither part of contract of insurance nor disclosed to insured, thus insurer cannot claim benefit of the said exclusion clause.

11.     In our view said principle is applicable to the case in hand. Condition regarding average quarterly deposit was not made aware to the policy holder.  We failed to understand that anybody can neglect to maintain the deposit of meager amount i.e. Rs.5000/- quarterly by ignoring the benefit of huge amount of Rs.5 lakhs. In our view appellant committed deficiency in service by not providing the terms and conditions of the policy to the policy holder. District Consumer Forum has rightly appreciated the facts and evidence while allowing the complaint. We are therefore upholding the order of District Consumer Forum by dismissing the appeal.

                                                 O   R    D    E     R

1.                 Appeal is dismissed.

2.                 No order as to cost.

3.                 Copies of the order be sent to both the parties.

Pronounced on dt.30.07.2013.