Complainant Mrs.Kavita Kapahi through the present complaint filed U/s 12 of the Consumer Protection Act 1986 (hereinafter, called the Act) has prayed for issuance of necessary directions to the titled opposite parties to pay Rs.2,00,000/- as Insurance Claim and Rs.50,000/- as damages by way of mental agony, interest and harassment etc and Rs.10,000/- as litigation expenses alongwith future interest @ 18% per annum from the date of filing of the complaint till actual realization of the amount to her, in the interest of justice.
2. The case of the complainant in brief is that her husband Sh.Rakesh Kapahi was having Saving Account no.50100086838705 with the opposite party no.1 and a sum of Rs.5250.76 P lying credit in the said account at the time of opening of the account, the said Sh.Rakesh Kapahi appointed her as his nominee. As per the scheme formulated by the Govt. of India, her husband got himself insured under Pradhan Mantri Jeevan Jyoti Bima Yojana with HLIC for cover under Master Policy No.PM000001 and the opposite party no.1 debited a sum of Rs.330/- as premium from his abovesaid Saving account and got insured for Rs.2,00,000/- for life insurance claim for the period from 9.6.2015 to 8.6.2016 and under Pradhan Mantri Suraksha Bima Yojana with opposite party no.2 company under Master Policy No.0206004215P999990008 and opposite party no.1 debited a sum of Rs.12/- as premium from his Saving Account and got insured for Rs.2,00,000/- for Accidental Insurance claim for the period from 9.6.2015 to 8.6.2016. Unfortunately, her husband met with an accident on 20.7.2015 with the Car I 20 bearing Registration No.PB-07AZ 0108 at near Mod Khabe Rajputan Roadside Pacci Sarak, P.S.Mehta, District Amritsar Rural, Tehsil Baba Bakala with the result that he died at the spot and a F.I.R. No.77 dated 20.7.2015 under Section 304-A/279/427 IPC was duly registered with Police Station Mehta and the Post Mortem took place by the Medical Officer, Civil Hospital, Amritsar on 21.7.2015. She informed the opposite party no.1 about the accident and death of her husband and approached the opposite party no.1 for the claims against both the Insurance Policies issued by the opposite party no.1 but the opposite party no.1 has paid the claim against the life insurance policy under the Scheme Pradhan Mantri Jeevan Jyoti Bima Yojana with HLIC for cover under Master Policy No.PM000001 for Rs.2,00 lacs to her being the nominee of the deceased Rakesh Kapahi but the opposite parties have failed to pay Rs.2.00 lacs under Pradhan Mantri Suraksha Bima Yojana covered under Master Policy No.0206004215P999990008. She is entitled for the same and also entitled Rs.50,000/- as damages by way of mental agony, interest and harassment which has been caused due to non payment of the amount by the opposite parties. Thus there is deficiency in service on the part of the opposite parties. Hence this complaint.
3. Notice of the complaint was issued to the opposite parties. Opposite party no.2 appeared through its counsel and filed its written reply taking the preliminary objections that the present complaint is not maintainable against the opposite party no.2, because there is no contract of insurance between the insurance company and the complainant. As per rules and procedure laid down for PMSBY, the complainant was required to contact the bank opposite party no.1 and fill up claim form which is available with them. The claim form duly completed alongwith other documents was required to be handed over to the concerned bank, who in turn will submit to the insurance company. The complainant instead of following the procedure and filling up the form has come to the Forum. Hence the complaint is liable to be dismissed as the complaint is premature and no such claim has been lodged through opposite party no.1 or the complainant herself with the Insurance Company, hence there is no deficiency in service either on the part of the Company or any of its employees. On merits, all averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.
4. Notice issued to opposite party no.1 has not been received back. Case called several times during the day but none had come present on its behalf. Therefore, it was proceeded against exparte vide order dated 11.2.2016.
5. Complainant tendered into evidence her own affidavit Ex.CW1/A alongwith other documents Ex.C1 to Ex.C6 and closed the evidence.
6. Counsel for the opposite party no.2 tendered into evidence affidavit of Sh. Pardeep Singh Branch Manager U.I.I. Ex.OP-2/1 alongwith other document Ex.OP-2/2 and closed the evidence.
7. We have carefully examined and thoroughly considered the evidence along with its supporting documents as available on records of the proceedings in the backdrop of the arguments as put forth by the learned counsels for the participating litigants along with the scope of ‘adverse inference’ that may be discretionarily drawn on account of the intentional stay-away absence of the OP1 Bank (preferring to suffer ex-parte proceedings, instead) in spite of the successful service of the ‘summons’. We find that the complainant has successfully proved (Ex.C2) on record the purchase/joining (by OP1 Bank SB A/c Holder) of the ‘membership’ of PMSBY Master Policy # 0206004215P999990008 vide debit Ref # SBY535696 with the OP2 insurers through the OP1 Bank and the subsequent road-side accidental ‘death’ of the insured DLA (deceased life assured) through FIR # 77 (Ex.C4), PMR (Ex.C5) and Death Certificate (Ex.C6). Somehow, the complainant has been the successful recipient of ‘timely’ receipt of the other parallel JBY insurance claim but the present SBY insurance claim deluded her and thus she preferred the present complaint. Further, we find from the insured’s statement of SB A/c # 50100086838705 with the OP1 Bank that the JBY insurance premium for Rs. 330/- was duly debited on 30.06.2015 vide JBY 565334 but the debit of Rs.12/- pertaining to the SBY 535696 could not be found debited to the SB A/c but the requisite Acknowledgement cum Certificate of Insurance was duly issued (Ex.C2). We find the same (non-debit of SBY premium to the DLA’s SB A/c) to be a probable reason for the OP1 Bank having not forwarded the requisite insurance claim (for settlement) to the OP2 insurers and also preferring to go ‘ex-parte’ (stay away absence) in the present proceedings. However, it shall be the OP1 Bank’s own prerogative as to how to manage/ subside the presently ‘cropped-up’ situation but that certainly entitles the present complainant to ‘one’ favorable award under the statutory provisions of the applicable Consumer Protection Act’ 1986.
8. We find that the OP2 insurers have amply clarified its position that the requisite claim was never forwarded to it for ‘settlement’ by the OP1 Bank and that saves it against an adverse award under the applicable ‘statute’. However, the OP2 insurers shall be at liberty to settle the present claim as per its ‘inter-se’ arrangement/ agreement with the OP1 Bank.
9. In the light of the all above, we find that the OP1 Bank has indeed bruised the consumer rights of the present complainant and that lines them up for an adverse award under the applicable statute. We, therefore, partly allow the present complaint and thus ORDER the OP1 Bank to pay the SBY Claim proceeds (to its full benefits) to the complainant besides to pay her Rs.5,000/- as cost and compensation within 30 days of the receipt of the copy of these orders otherwise the aggregate awarded amount shall attract interest @ 9% PA from the date of the complaint till actual payment. The OP1 Bank shall however be at liberty to claim reimbursement or otherwise share the award-amount (so-paid in such-like situations) with the OP2 insurers as per their own inter-se arrangements etc.
10. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.
(Naveen Puri)
President
ANNOUNCED: (Jagdeep Kaur)
July, 14 2016. Member.
*MK*
