Punjab

Ludhiana

CC/18/721

Harbans Singh - Complainant(s)

Versus

New India Assurance Co. - Opp.Party(s)

Lakhvir Singh Advocate

27 Apr 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No: 721 dated 06.12.2018.                                                        Date of decision: 27.04.2022. 

 

1. Harbans Singh S/o. Bachan Singh S/o. Kishna,
2. Kamaljit Kaur W/o. Harbans Singh S/o. Bachan Singh,

Both R/o. H. No.494, St. No.5, Guru Teg Bahadur Nagar, Lalheri Road, Khanna, Distt. Ludhiana. ..…Complainants

                                                Versus

1. The New India Assurance Co. Ltd., through incharge, Corporate office, 87, M.G. Road, Fort, Mumbai-400001.
2.  Regional Office, The New India Assurance Co. Ltd. through incharge, S.C.O. 36 & 37, Sec-17A, Chandigarh. (UT)
3. Branch office, The New India Assurance Co. Ltd., through incharge, G.T. Road, Khanna, Distt. Ludhiana.
4. Axis Bank Ltd., through incharge, Axis House, C-2, Wadai International Centre, P.B. Marg,  Worli, Mumbai-400026.
5. Regional office, Axis Bank Ltd. through incharge, S.C.O. 139, 140, 141, & 142, Sec 9C, Madya Marg, Chandigarh-160009 (UT)
6. Branch Office, Axis Bank Ltd., through incharge, G.T. Road, Khanna, Distt. Ludhiana.                                                                                                                                                           …..Opposite parties 

          Complaint Under Section 12 of the Consumer Protection Act,               1986.

QUORUM:

SH. K.K. KAREER, PRESIDENT

SH. JASWINDER SINGH, MEMBER

 

 

COUNSEL FOR THE PARTIES:

For complainants            :         Sh. Lakhvir Singh, Advocate.

For OP1 to OP3             :         Sh. Rajeev Abhi, Advocate.

For OP4 to OP6             :         Exparte.

 

ORDER

PER K.K. KAREER, PRESIDENT

1.                Briefly stated, the case of the complainants is that they are permanent residents of Khanna. They had three children i.e. two sons and one daughter. Their son Parminder Singh was in service and was holder of card No.4691970000720581 of Axis Bank Ltd. with insurance value of Rs.5,00,000/- in any eventuality. Unfortunately, Parminder Singh died on 10.06.2017. He was a bachelor. The claim documents of card No. 4691970000720581 were deposited with the Axis Bank Ltd. However, the claim of Rs.5 Lac was rejected by OP1. In the end, it has been requested OPs be directed to pay the claim of Rs.5 Lac along with damages and compensation of Rs.5 Lac to the complainant.

2.                The complaint has been resisted by OPs. In the written statement filed on behalf of OP1 to OP3, it has been, inter alia, pleaded that the complaint is not maintainable. According to Op1 to OP2, on receipt of the claim, it was duly registered and processed. Axis Bank Ltd., Mumbai had obtained Group Personal Accident Policy No.990000/46/17/13/0000003 from OP2 for card holders. Parminder Singh, being debit card holder, was insured for a sum of Rs.5 Lac from 15.04.2017 to 14.04.2018 subject to the term and conditions of the policy, warranties and exclusions mentioned in the policy. It was one of the conditions of the policy that the insured or the beneficiary under the insurance policy will supply the documents, in respect of which the claim is lodged, within the period of 90 days. Parminder Singh, debit card holder of the Axis Bank became one of the beneficiaries of group personal accident insurance policy. The claim on account of death of Parminder Singh was lodged on 10.06.2017. The complainants were required to submit the following documents for processing the claim i.e. original claim form duly filled and signed, attested copy of FIR/panchnama/inquest panchnama, translated copy of FIR and post mortem report in English/Hindi, attested bank statement of 180 days before accident, attested hot listing certificate, final police report, assignee verification form, photo, original death certificate etc. OP1 to OP3 received certain documents from the Axis Bank after 101 days i.e. after the period of 90 days has elapsed. After due application of mind by the officials of OP1 to OP3, the claim was rejected as no claim on the ground of non-submission of the claim documents as per SLA (Service Level Agreement) since there was delay in submission of documents. The insured in the present case is Axis Bank and as such, the claim rejection letter was sent to Axis Bank Ltd., Mumbai and the Axis Bank had informed their customer regarding the claim status. The claim has been rightly repudiated and the grounds of rejection were legal and valid. Therefore, there has been no deficiency of service on the part of OP1 to OP3. The rest of the allegations made in the complaint have been denied as incorrect and a prayer for dismissal of the complaint has also been made.

3.                In a separate written statement filed on behalf of OP4 to OP6, it has been pleaded that the present case has arisen out of an order passed by OP1 to OP3  without date rejecting the claim of the complainant. OP1 to OP3 while conducting their business of multiple dimensions have prepared a special contingency policy for covering debit/credit card holders. The agreement OP No.4/1 has been entered into with an intent to implement and enforce the said policy which was not signed by the card holder/insured. None of the documents could be signed by the incurred card holders because his involvement vis a vis the insurance and the bank come into being only when he meets with an accident or otherwise on account of events beyond his control. OP4 to OP6 being a welfare institution envisaged the facility of personal accident insurance cover benefit on debit card which entitles every debit card holder to personal accident cover and the insurance cover would be considered as active at the time of accident if he has made a successful purchase transaction on his card within 180 days prior to the occurrence. The impugned order has not rejected the claim for an amount of Rs.5 Lac on any ground except non-submission of the claim amount as per SLA. The agreement further provides that competent authority has right of repudiation of the claim which neither contained the date when the same was issued nor the date up to which the claim should have been filed. On merits, it has been pleaded that OP4 to OP6 Axis Bank Ltd. has unnecessarily been impleaded party in this case as no claim is made against them nor any cause of action to file the claim has arisen against OP4 to OP6. OP4 to OP6 have also prayed for dismissal of the claim as against them.   

4.                In evidence, complainant No.1 has submitted his affidavit as Ex. CA along with documents Ex. C1 to Ex. C6, complainant No.2 submitted her affidavit as Ex. C3, affidavit of Sh Rajnit Singh as Ex. C4 and closed the evidence.

5.                On the other hand, learned counsel for the OP1 to OP3 tendered affidavit Ex. RA of Sh. J.S. Dhaap, Manager of the New India Assurance co. Ltd., Regional Manager, Surya Kiran Complex, Ludhiana along with documents Ex. R1 and Ex. R33 and closed the evidence. Subsequently, none turned up for OP4 to OP6 during the pendency of the case and as such, OP4 to OP6 were proceeded against exparte.

6.                We have heard the arguments advanced by the counsel for the parties and have gone through the record carefully.

7.                During the course of argument, the counsel for the complainant has argued that the claim was submitted within 89 days with OP4 to OP6 who had issued the debit card to the son of the complainants and the policy was also obtained by OP4 to OP6 from OP1 to OP3. Therefore, if the claim was not forwarded by OP4 to OP6 within time to OP1 toOP3, the complainants cannot be made to suffer on this count. The counsel for the complainant has further contended that since the claim was submitted within the stipulated period of 90 days with OP4 to OP6, the same could not be repudiated on any ground.

8.                On the other hand, the counsel for OP1 to OP3 has contended that the claim was not lodged directly with OP1 to OP3; rather the same was lodged with the bank i.e. OP4 to OP6. The claim was liable to be lodged with OP1 to OP3 within 90 days whereas it was lodged after the expiry of period of 90 days. Even OP4 to OP6 have not placed on record any document to prove as to exactly when the claim was lodged. Therefore, OP1 to OP3 are not liable to pay the claim. The counsel for OP1 to OP3 has further contended that the policy was subject to terms and conditions and the claim documents were to be submitted within 90 days from the date of death. According to counsel for OP1 to OP3, there was another condition in the policy that at least one POS (Point of sale transaction) should have been made by the debit card holder and ATM withdrawal and net banking are not considered as POS transaction and only a valid purchase transaction using the card is considered as POS active card.

9.                We have weighed the contentions raised by the counsel for the parties and have gone through the record carefully.

10.              As per the claim rejection letter Ex. R1 issued by OP1 to OP3, the claim has been rejected on the ground of non-submission of claim documents as per service level agreement (SLA). As per the policy documents Ex. R33 clause 10, the claim documents must be submitted to The India Insurance Company Ltd. within 90 days from the date of death of the card holder by way of personal accident and intimation of PA claims, to the insurer should be given within 90 days. As per the policy documents Ex. R33 and more particularly clause 2.1.1, the insurance company i.e. OP1 to OP3 are liable to pay sum assured in the event of accidental bodily injury causing the insured’s death within 12 months of the accidental bodily injury sustained. As per the death certificate Ex. R2, Parminder Singh died on 10.06.2017. It is not disputed that Parminder Singh died in a road accident. In this regard, a reference can be made to the report Ex. R20 of  Kotwali Haldwani, District Nainital wherein it is clearly mentioned that Parminder Singh son of Harbans Singh of Khanna, district Ludhiana and one Kuldeep Sharma son of son of Rajesh Sharma, resident of Chandigarh died in a road accident. The report under Section 174 I.P.C. also confirms the death of Parminder Singh in a road accident.  It is an admitted case of the OPs that Parminder Singh had a group personal accident policy cover being debit card holder of Axis Bank Ltd. as has been candidly admitted by OP1 to OP3 in para no.2 of the preliminary objection of written statement that Parminder Singh being debit card holder was insured for a sum of Rs.5,00,000/- from 15.04.2017 to 14.04.2018. The death of Parminder Singh having been taken place on 10.06.2017 is within the policy period. Primarily, the claim has been rejected due to non-submission of claim documents within 90 days. In our considered view, when the policy is admitted and death by way of accident is also admitted, the claim could not have been rejected merely on the ground that it was not submitted within 90 days. In this regard, the case of the complainants is that the claim was submitted with OP4 to OP6 on the 89^th day and the lapse, if any, is on the part of OP4 to OP6 who did not forward the claim within time. However, considering the fact that the claim was submitted with OP4 to OP6 with whom the deceased was maintaining the account and the debit card was also issued by OP4 to OP6 the reason for rejection of the claim due to non-submission of documents with OP1 to OP3 becomes even more unreasonable and unjustifiable.

11.              As regard the contentions raised by the counsel for the OPs that the card holder must have made POS transaction within 180 days  before the accidental death, the same is not tenable considering the fact that no such objection has been raised in the rejection letter Ex. R1. Secondly, as per the account statement Ex. R26, there are many POS transactions in the account of deceased Parminder Singh. In the given facts and circumstances of the case, we are of the considered view that the rejection of the claim merely on account of non-submission of the claim within 90 days is not sustainable and is hereby set aside.

12.              As a result of above discussion, the complaint is allowed with a direction to OP1 to OP3 to consider and reimburse the claim strictly as per terms and conditions of the policy within a period of 40 days from the date of receipt of copy of this order along with interest @6% per annum from the date of filing of complaint till date of actual realization. The OP1 to OP3 shall further pay a composite costs of Rs.10,000/- (Rupees Ten Thousand only) to the complainant. However, complaint as against OP4 to OP6 is hereby dismissed. Compliance of the order be made within 30 days from the date of receipt of copy of order.  Copies of the order be supplied to the parties free of costs as per rules. File be indexed and consigned to record room.

13.              Due to rush of work and spread of COVID-19, the case could not be decided within statutory period.

 

                             (Jaswinder Singh)                            (K.K. Kareer)

                    Member                                           President

 

Announced in Open Commission.

Dated:27.04.2022.

Gobind Ram.

Harbans Singh Vs New India Assurance Co. Ltd.                     CC/18/721 

Present:       Sh. Lakhvir Singh, Advocate for the complainant.

                   Sh. Rajeev Abhi, Advocate for the OP1 to OP3.

                   OP4 to OP6 exparte.

 

                   Arguments heard. Vide separate detailed order of today, the complaint is allowed with a direction to OP1 to OP3 to consider and reimburse the claim strictly as per terms and conditions of the policy within a period of 40 days from the date of receipt of copy of this order along with interest @6% per annum from the date of filing of complaint till date of actual realization. The OP1 to OP3 shall further pay a composite costs of Rs.10,000/- (Rupees Ten Thousand only) to the complainant. However, complaint as against OP4 to OP6 is hereby dismissed. Compliance of the order be made within 30 days from the date of receipt of copy of order.  Copies of the order be supplied to the parties free of costs as per rules. File be indexed and consigned to record room.

 

                             (Jaswinder Singh)                            (K.K. Kareer)

                    Member                                           President

 

Announced in Open Commission.

Dated:27.04.2022.

Gobind Ram.