HON'BLE Mrs. YASHODA BHASKAR PATIL,

                                                      B.Com, L.L.B(Spl.,) M.Ed.,

                                                             WOMAN MEMBER     

Complainant:               1. Smt. Basavannevva W/o Devappa Madiwalar, Age:62 Yrs, Occ:Agriculture and Housewife R/o Kiratageri

                                     Tq:& Dist:Gadag.

                                             2. Shri. Sharanappa S/o Devappa Madiwalar, Age:39 Yrs, Occ:Agriculture

                                             R/o Kiratageri Tq:& Dist:Gadag.

                                             3. Shri. Hanamantappa S/o Devappa Madiwalar, Age:37 Yrs, Occ:Agriculture, R/o Kiratageri

                                             Tq:& Dist:Gadag.

                                             4. Shri. Bhimappa S/o Devappa Madiwalar, Age:35 Yrs, Occ:Agriculture, R/o Kiratageri
Tq:& Dist:Gadag.

                                            (Rep. by Sri.R.S.Hattikal, Advocate)

V/s

JUDGEMENT

JUDGEMENT DELIVERED BY SMT. YASHODA.B.PATIL, WOMAN MEMBER

            The complainants have filed the complaint U/Sec.35 of the C.P. Act, 2019, seeking direction against the Ops to pay Pradhan Mantri Suraksha Bhima Yojana (PMSBY) insurance claim amount of Rs.2,00,000/- with interest @ 12% and Rs.1,00,000/- towards mental agony, financial loss and cost of litigation.

2.    The brief facts of the complaint are as under:

            The complainant No.1 is wife of deceased Shri.Devappa Madiwalar, complainant No.2 to 4 are children’s of deceased
Shri. Devappa Madiwalar, who was customer of OP No.4 Bank bearing S.B account No.17043103194 and having balance of Rs.47,674/- and his account was covered with the (PMSBY) Yojana, and paying premium of Rs.12/- as annually and on renewal the same was debited on 22.05.2020.  On 02.11.2020 Sri. Devappa Madiwalar died in a road accident, the complainants within a month informed the death of Devappa to Op No.4 along with death certificate and PM report. Op No.4 obtained signature for claim application and other forms and told that, the insurance amount of Rs.2,00,000/- will be paid after receipt from insurance Company. Complainant No.1 to 3 are illiterate and during the peak  pandemic Covid-2019 they repeatedly did  inquire with OP No.4, but later again on enquiry with OP No.4 they informed that, there is an inordinate delay in filing claim and thereby insurance Company has repudiated the claim. On 11.06.2022 complainant issued a legal notice through Advocate and Op No.4 gave reply notice stating that, the policy is repudiated due to delay in filing claim. So, Ops have committed the deficiency of service. Hence, filed this complaint.

          3.   In pursuance of service of notice, OP No.1 to 4 appeared through their counsel.  Op No.1 & 4 filed their written version and OP No.3 filed memo for adopting the same written version filed by Op No.4. Op No.2 did not file written version within statutory period of 45 days from the date of service. Later filed I.A. No.1 with written version, I.A. No.1 is rejected as written version filed is after statutory period and not taken the written version on record.  

4. The brief facts of  written version filed by OP No.1 is as under:

          OP No.1 denied the various allegations and contended that, it is not disputed about the account or its continuation it is for the bank to look into the business of the complainant.  The Scheme is floated by Central Government, this Op has to forward it to public in general. Just by  paying the premium for the scheme, it is not correct to say the payment should be made to the person who has paid the premium amount. It was their duty to convince that they were the competent person to receive the compensation of the insured as he had died.  The premium is for qualification not right to claim compensation by paying. The transaction is between the complainant and with the concerned bank only, nowhere concerned to this Op No.1. No cause of action arose against the Op. So, complainant has  made this Op No.1 an unnecessary party to this proceedings. If, any dispute arises between the Bank and the insurance company relief is to be claimed against them not against the Op No.1.   It is not concerned to this Op any relief is to be taken its against the other Ops. Therefore, there is no deficiency of service committed by the OP No1. Hence, prays for dismissal of the complaint.

5. The brief facts of  written version filed by OP No. 4 is as under:

The Op No.4 denied the various allegations and contended that, the complaint is not true and correct and they are totally denied by Op No.4.  It is false to state that the complainants have submitted the death certificate and post mortem report of Devappa Madivalar to Op No.4 and it is further false to state that Op No.4 has obtained the signature on some documents. The complainant have not lodged their claims within the stipulated time to the Insurance Company.  Late Devappa S/o Nagappa Madivalar died on 02.11.2020 and complainants submitted their claim papers to the office of the United India Insurance Company on 18.08.2021 through E-mail and hard copies on 24.08.2021.  The Manager of the Op No.4 bank has immediately sent claim papers to the Insurance Company as soon as papers were submitted to the Bank by the complainants.  The Op No.2 Insurance Company has given reply to Op No.4 stating that there is an inordinate delay of 9 months in sending the claim papers.  All claim papers should be submitted to insurer within 60 days from the date of accident or loss.  There is undue and inordinate delay on the part of the claimants in sending claim papers.  Therefore, they are unable to consider the claim. The said message is orally and immediately intimated to the complainants by Op No.4. The complainants have not submitted their claim papers within stipulated time.  There is absolutely no deficiency of service on the part of OP No.4. It is the bounden duty of the complainants to submit their claim papers in time to the concerned authorities.  The complainants are not entitled for any compensation.  Therefore, there is no deficiency of service committed by the OP No.3 & 4. Hence, prays to dismiss the complaint.

        6. To prove the case, the complainant No.3 has filed his affidavit and was examined as PW-1 and got marked the documents as Ex.C-1 to Ex.C-25. Sri. Rajendra Venkatesh Mugalihal has filed affidavit for OP No.4 and got examined as RW-1 and got marked the documents as Ex.Op-1 & Ex.Op-2.   

       7. Heard, the arguments on both sides.

        8.   The points for consideration to us are as under:             

1. Whether the complainants prove the deficiency of service committed by the Ops?

2. Whether the complainants are entitled for

3. What Order?

   9.        Our findings on the above points are as under:

               Point No. 1:  In the  affirmative.

               Point No. 2:  In the partly affirmative.

               Point No. 3:  As per the final Order

R E A S O N S

            10.     Point No.1 :- The learned counsel for complainants argued that, as per evidence of PW-1 and documents Ex.C-1 to
Ex.C-25, complainants have proved the case. The learned counsel for OPs argued that, complainants have failed to prove that, deficiency of service is committed by the OPs.

          11.     On perusal of the materials placed before us, PW-1 has filed affidavit and reiterated the contents of the complaint. PW-1 has stated that, the complainant No.1 is wife of deceased complainant No.2 to 4 are children of  Shri. Devappa Madivalar, who was customer of OP No.4 Bank bearing S.B account No.17043103194 and having balance of Rs.47,674/- and his account was covered with the (PMSBY) Yojana through Op No.4 and paying premium of Rs.12/- as annually and on renewal the same was debited on 22.05.2020.  On 02.11.2020 Sri. Devappa Madivalar died in a road accident, the complainants within a month informed the death of Devappa to Op No.4 along with death certificate and PM report. Op No.4 obtained signature for claim application and other forms and told that, the insurance amount of Rs.2,00,000/- will be paid after receipt from insurance Company. Complainant No.1 to 3 are illiterate and during the pandemic Covid-2019, they repeatedly did enquire with OP No.4, but later again on  enquiry with OP No.4 they informed that, there is an inordinate delay in filing claim and thereby insurance Company has repudiated the claim. On 11.06.2022 complainant issued a legal notice through Advocate and Op No.4 gave reply notice stating that, the policy is repudiated due to delay in filing claim. So, Ops have committed the deficiency of service.

12. Per contra, RW-1 has filed affidavit and reiterated the contents of the written version filed by Op No.4. RW-1 has stated that, the Op No.4 denied the various allegations and contended that, the  complaint is not true and correct and they are totally denied by Op No.4.  It is false to state that the complainants have submitted the death certificate and post mortem report of Devappa Madivalar to Op No.4 and it is further false to state that Op No.4 has obtained the signature on some documents. The complainant have not lodged their claims within the stipulated time to the Insurance Company.  Late Devappa S/o Nagappa Madivalar died on 02.11.2020 and complainants submitted their claim papers to the office of the United India Insurance Company on 18.08.2021 through E-mail and hard copies on 24.08.2021.  The Manager of the Op No.4 bank has immediately sent claim papers to the Insurance Company as soon as papers were submitted to the Bank by the complainants.  The Op No.2 Insurance company has given reply to Op No.4 stating that  there is an inordinate delay of 9 months in sending the claim papers.  All claim papers should be submitted to insurer within 60 days from the date of accident or loss.  There is undue and inordinate delay on the part of the claimants in sending claim papers.  Therefore, they are unable to consider the claim. The said message is orally and immediately intimated to the complainants by Op No.4. The complainants have not submitted their claim papers within stipulated time.  There is absolutely no deficiency of service on the part of OP No.4. It is the bounden duty of the complainants to submit their claim papers in time to the concerned authorities.  The complainants are not entitled for any compensation.  Therefore, there is no deficiency of service committed by the OP No.3 & 4.

13. At the very outset, Ops have not disputed that the deceased Devappa Madivalar was having his account with Op No.4 and his account was covered with PMSBY scheme, death of Devappa and complainants being the legal heirs have filed claim petition. The main contention of Op No.2 to 4 are that claim papers were furnished through mail on 18.08.2021 and hard copy were furnished on 24.08.2021 and insurer repudiated the claim on ground for in ordinate delay, of more than 60 days.

14. Ex.C-1 pass book, Ex.C-2 death certificate Ex.C-3 statement of account of deceased Devapppa Madivalar is not disputed by the Ops. Ex.C-4 legal notice, Ex.C-5 to Ex.C-8 postal receipts, Ex.C-9 to  Ex.C-12 Postal acknowledgments reveal that, notice was duly served to the Ops. Ex.C-13 reply notice issued by Op No.4, Ex.C-14 direction issued by Op No.1 to Op No.4, Ex.C-15 FIR, Ex.C-16 complaint, Ex.C-17 Chargesheet, Ex.C-18 & 19 Postmortem reports, Ex.C-20 Scan report, Ex.C-21 P.M. Notes, Ex.C-22 service receipt, Ex.C-23 hospital bill, Ex.C-24 results, Ex.C-25 Laboratory report are also not in dispute. Ex.OP-1 circular dtd: 03.06.2022 issued to OP No.4 bank regarding revision of premium rates of PMSBY scheme. Ex.OP-2 Pamphlet published by OP No.4 that, in case of death of the insured claim shall be submitted to insurance company within 30 days but the insured had died 2 years back.   Ex.OP-1 a circular of P.M.S.B.Y Scheme is issued on 03.06.2022 after 2 years of the decease Devappa Madivalar’s death Ex.Op-2 is only printed copy stating that, claim shall be submitted within 30 days from the date of death which is also recent one. In written version Op  No.2 and OP No.4 state that, claim shall be submitted within 60 days. So, Ex.Op-2 is contrary to the defence taken by Op No.4. Moreover, whether the Op No.2 & OP No.4 issued in writing to the deceased or complainants regarding time limit of claim that it should be submitted within 60 days.  So, Ex.Op-1 & Ex.OP-2 are subsequent documents which are not helpful to prove their contention. Even, OP No.4 has not produced the documents to substantiate their version the  CONSENT-CUM-DECLARATION FORM submitted by deceased and complainants having submitted their claim to Op No.2 insurance company after 9 months on 18.08.2021 through e-mail and hard copy on 24.08.2021.
PW-1 has specifically stated that, immediately after death of her husband, they went to OP No.4 bank, submitted the death certificate and post mortem report. The manager of Op No.4 bank has obtained their signature on blank claim declaration and other forms. In the written version of OP No.4 have stated as under:-

“ Late Devappa S/o Nagappa Madivalar died on 02.11.2020 and complainants submitted their claim papers to the office of the United India Insurance Company on 18.08.2021 through E-mail and hard copies on 24.08.2021.  The Manager of the Opponent No.4 has immediately sent claim papers to the Insurance Company as soon as paper are submitted to the Bank by the complainants.  The opponent No.2 Insurance Company has given reply to Opponent No.4 stating that there is an inordinate delay of 9 months in sending the claim papers.

For the above, on one breath Op No.4 stated that, complainants submitted the claim after 9 months directly to insurance Company on 18.08.2021 & 24.08.2021 sent through  E-mail and hard copy, and on another breath contend that, the manager has immediately sent claim papers to the Insurance Company as soon as papers are submitted to the bank by the complainants. If, the OP No.4 had the knowledge that the claim form should be submitted within 60 days, then they should not have accepted the claim and forwarded the same to the Insurance Company. It is crystal clear that, Op admitted the claim form being submitted by complainants to the bank, but not submitted to insurance Company directly. Op No.4 has not produced any scrap of paper to show that, the complainants submitted the claim form after 9 months to the bank. The Ops have not come forward to prove that the complainants submitted the documents late by producing the documents which are in their custody before the Commission.  Therefore, it crystal clear that complainants submitted death certificate and postmortem of deceased immediately within statutory period to the bank. Ex.C-19 Postmortem report reveals that, OP No.4 bank has received the document on 08.11.2020 and acknowledged with seal signature of the bank. However, the bank neglected to submit the claim petition to insurance Company within 60 days. In consent –Cum-Declaration form also, there is no recital of time limit regarding that the claim should be submitted within 60 days. Such being the case, neither deceased nor complainants know anything regarding limitation of 60 days for submitting the claim. Therefore, Op No.3 & 4 have committed the deficiency of service.

15. Even, if we presume for a moment that, the complainants submitted claim petition beyond 60 days, during that period the whole world was suffering from pandemic Covid-2019.  The pandemic Covid-2019 commenced from 15.03.2020 and continued till 28.02.2022, deceased died on 02.11.2020 when pandemic was on peak and claim petition was received by insurance Company on 18.08.2021. As per the office order No.07 of 2022  issued by Hon’ble NCDRC, Government of India dtd:14.01.2022 reveals that as per order dtd:10.01.2022 passed by the Hon’ble Supreme Court of India in writ petition (Civil) No.3/2020 period from 15.03.2020 till 28.02.2022, in cases where the limitation would have expired during the said period is exempted. So, Hon’ble Apex Court has exempted the citizens of India for delay in filing claim or complaint during Covid-19 period. Admittedly, the date of death of deceased Devappa and submitting the claim petition all comes under the exempted Covid-19 period. So, Op No.2 insurance Company should not have repudiated the claim only on the ground of inordinate delay in filing the claim petition. Even, Op No.2 has not filed written version within statutory period of 45 days from the date of service. Op No.2 filed written version along with I.A. No.1 after statutory period, hence, Commission rejected the I.A. No.1 and did not taken the written version on record.  The oral and documentary evidence of complainant is remained unchallenged by the OP No.2 and there is no reason to disbelieve the case of the complainants against Op No.2.  At least on humanitarian ground, the Op  No.2 should have considered the claim of the complainant as the incident had taken place during peak pandemic period when the whole world was at standstill position. 

16. The learned counsel for complainant is relying on Supreme Court of India (F.B.) IN RE: Cognizance for extension of Limitation dtd:08^th March 2021, Citation : 2021 Law Suit(SC) 172. Wherein, it is held that, Commercial  Courts Act, 2015  Section 12-A – Limitation – Condonation of delay – In filing litigation due to pandemic – Held – Requisite direction issued – Petition disposed off.

The facts, circumstances and ratio of the above decision is aptly applicable to case on hand, as deceased died during the Covid-19 Pandemic period.

            As per decision, Civil appeal No.407/2022 dtd:20.05.2022, in Gurmelsingh V/s The Branch Manager National Insurance Company. Ltd., Wherein, it is held that;

          “While settling the claims, insurance company should not seek documents which are beyond the control of insured to furnish”. Further, held that, insurance company should not be too technical and ask for the documents, which, the insured is not in position to produce due to circumstances beyond is control.  It is found that the insurance companies are refusing the claim on flimsy grounds and on technical grounds”.

          The facts, circumstances and ratio of the above decision is aptly applicable to case on hand, as insurance company repudiated the claim on flimsy grounds that there is inordinate delay in filing claim, but as covid-19 pandemic was on peak during the said period and which is beyond the control of complainants.

 Further, as per reported in Daksha Legal, the Hon’ble Supreme Court of India held as under:-

“Judicial decision is as per law, administrative decision is as per policy & quasi-judicial function lying in between is an administrative function to be exercised in some respects as if it were judicial. Supreme Court explains”.

For the above, Commission has to consider the administrative and Judicial decisions in respect of aim and objectives of PMSBY Scheme. Therefore, complainants have proved that, Op No.2 has also committed the deficiency of service. Accordingly, we answer point No.1 in the affirmative.

17. Point No.2:- The reasons stated in the point No.1, the complainants have proved that, OPs have committed the deficiency of service and they are entitled for the relief.  Ex.C-3 statement of account of deceased reveals that on 22.05.2020 is debited for Rs.12/- under (PMSBY) scheme and on renewal the policy No.6002083070 is debited on 23.05.2021 for Rs.12/- under PMSBY scheme for policy No.06002083070. So, complainants are entitled for Rs.2,00,000/- as per scheme (PMSBY). Complainants are claiming interest @ 12% p.a., it is on higher side.  Therefore, it is  proper to award interest @ 9% p.a. from the date of hard copy of claim petition received by insurance Company  i.e. on 24.08.2021 till realization. Complainants being the legal heirs widow and children of deceased Devappa Madivalar have suffered mental agony due to deficiency of service committed by the Ops. Therefore, complainants are entitled for a sum of Rs.30,000/- towards mental agony and Rs.15,000/- towards cost of litigation. Accordingly, we answer point No.2 in the partly affirmative.        

          18. Point No.3:-In the result, we pass the following: 

  //O R D E R//

The complaint filed U/Sec.35 of the Consumer Protection Act, 2019 is partly allowed against OP No.2 and complaint dismissed against Op No.1, 3 & 4.

           The complainants are jointly entitled for the claim amount of Rs.2,00,000/- from OP No.2 with an interest at 9% p.a. from 24.08.2021  till realization.

Further, the complainants are entitled for a sum of Rs.30,000/- towards mental agony and  Rs.15,000/- towards cost of litigation.  

Op No.2 is directed to pay the above claim amount within two months from the date of this order.

Office is directed to send the copies of this   order to the parties free of cost.

           (Dictated to the Stenographer, directly on computer corrected and then pronounced by us in the Open Commission on this  9^th day of March-2023)

 (Shri Raju N. Metri)     Shri. D.Y. Basapur)  (Smt.Yashoda Baskar.Patil)

        MEMBER                       PRESIDENT                 WOMAN MEMBER

-: ANNEXURE :-

EVIDENCE ON BEHALF OF COMPLAINANT/S:

PW-1: Shri. Hanamantappa S/o Devappa Madiwalar,

DOCUMENTS ON BEHALF OF COMPLAINANT/S

Ex.C-1 : Original pass book of Karanataka Vikas Grameen Bank  

            saving Bank A/c of Devappa Nagappa Madiwalar.

Ex.C-2: Death certificate.  0

Ex.C-3: Computerized S.B. A/C statement of Devappa Madiwalar.

Ex.C-4: Copy of legal notice.

Ex.C-5 to 8: Postal receipts.

Ex.C-9 to 12: Postal acknowledgments.

Ex.C-13: Legal notice.

Ex.C-14: Copy of letter issued by D.C. Gadag. Dtd:29.06.2022.

Ex.C-15:Copy of FIR.

Ex.C-16: Copy of complaint.

Ex.C-17: Copy of Final report/Charge-sheet form.

Ex.C-18 & 19: Copies of Post-Mortem Report.

Ex.C-20: CSI Basel Mission Scan Centre report dtd:02.11.2020.

Ex.C-21: CSI Basel Mission Scan Centre P.M.Notes dtd:02.11.2020.

Ex.C-22 : Basel Mission (C.S.I.) Hospital Gadag-Betageri, service

               Receipt, dtd:02.11.2020.  

Ex.C-23: Basel Mission (C.S.I.) Hospital bill. Dtd:02.11.2020.

Ex.C-24: Results.

Ex.C-25: Laboratory report.

EVIDENCE ON BEHALF OF OPs:

RW-1 : Sri. Rajendra V. Mugalihal

DOCUMENTS ON BEHALF OF OPs:

Ex.Op-1 : Copy of Karnataka Vikas Grameen Bank Circular

              dtd:03.06.2022.

Ex.Op-2 :Karnataka Vikas Grameen Bank, Betageri Branch                   

              Pamphlet.   

(Shri Raju N. Metri)    (Shri. D.Y. Basapur)      (Smt.Yashoda Bhaskar. Patil)

      MEMBER                      PRESIDENT                  WOMAN MEMBER