Punjab

Faridkot

CC/14/106

Amarjit Kaur - Complainant(s)

Versus

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

Rahul Chaudhary

06 Aug 2015

ORDER

 DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FARIDKOT

 

Complaint No. :     106

Date of Institution: 11.08.2014

Date of Decision :   06.08.2015

 

Amarjit Kaur w/o Karam Singh s/o Inder Singh.

Karam Singh s/o Inder Singh.

Both r/o Village Kanian Wali now r/o Guru Har Sahai road, Sadiq, District Faridkot.                                                                      

                                                                                      ...Complainant

Versus

1. New India Assurance Company Ltd, Belapur DO-170200, 2^nd floor Vindhya Commercial Complex, Sector-11, CBD Belapur, Navi Mumbai-400614 through its Division Manager.

2. State Bank of India, Branch Faridkot through its Branch Manager, Circular Road, Faridkot.

3. Parjeet Kaur w/o Hardeep Singh s/o Inder Singh d/o Harwinder Singh r/o village Tehna Tehsil and District Faridkot.

                                                                         .............OPs

Complaint under Section 12 of the

Consumer Protection Act, 1986.

 

 

Quorum: Sh. Ajit Aggarwal, President,

               Smt Parampal Kaur, Member,

               Sh P L Singla, Member.

 

Present: Sh Parshotam Lal Chaudhary, Ld Counsel for Complainant,

              Sh Y P Bansal, Ld Counsel for OP-1,

              Sh  Madan Lal Bansal, Ld Counsel for OP-2,

    Sh B S Brar, Ld Counsel for OP-3.

(Ajit Aggarwal, President)

                         Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against  United India Insurance Co/OP seeking directions to OPs to make payment of Rs 3,00,000/- as insurance claim  with interest and for further directing OPs to pay Rs 50,000/- as compensation for deficiency in service and harassment and Rs 10,000/- as litigation expenses.

2                           Briefly stated, the case of the complainant is that Hardeep Singh son of both the complainants was holder of salary package DSP/Silver, Salary account 30834625783 of State Bank of India, Faridkot and said Hardeep Singh got insured himself under the Personal Accidental (Death) Cover Insurance Policy bearing no. 17020042120100000493 for Rs 3,00,000/-valid from 4.01.2013 to 3.01.2014 under unnamed group insurance scheme. It is pleaded that their son Hardeep Singh died in a road accident and rapt no. 14 dt 30.10.2013 was got recorded to this effect in Police Station Sadar Faridkot and after post-mortem cause of death was reported to be multiple injuries of antimortem nature on vital parts of body, which were sufficient to cause death. It is further contended that deceased son of complainants was married with OP-3, who left the house of deceased after his death and relinquished all her rights in the estate of deceased and therefore, complainants being only natural heirs of deceased Hardeep Singh are entitled to get the sum insured alongwith interest at the rate of 18 % per anum from the date of death till realization. It is contended that complainants were not in possession of policy and therefore, were not aware of terms and conditions of the policy. However, OP-2 got signed claim forms/documents and sent the same to OP-1 alongwith post-mortem report and police report by registered post on 9.01.2014. Complainants were surprised to receive the copy of letter dt 7.04.2014 addressed to Branch Manager, State Bank of India, Faridkot by OP-1 for submission of certain more documents to enable OP-1 to process the claim and on receipt of said letter, complainant no. 2 approached OP-2, where officials of OP-2 got his signatures on some documents and the same was sent to OP-1. Complainants received letter dt 5.05.2014 from OP-1 wherein claim of complainants for insurance was repudiated with remarks for want of required documents for the settlement of death claim within stipulated period and closed the file as ‘No Claim’. OP-1 has wrongly done so only to escape the liability to pay insurance claim. It is submitted that OP-2 was negligent in sending and submitting the claim form of complainants, nominee or the legal heirs within stipulated period. OP-3 left the house of complainants and has not joined them and therefore she is arrayed as OP. All this amounts to deficiency in service and has caused harassment and mental tension to complainants for which they have has prayed for directing the OPs to pay Rs 50,000/- as compensation and Rs 10,000/- as litigation expenses incurred by him besides the main relief. Hence, the complaint.

3                                    The counsel for complainant was heard with regard to admission of the complaint and vide order dated 12.08.2014, complaint was admitted and notice was ordered to be issued to the opposite party.

4                                 On receipt of the notice, the OP-1 filed written statement taking legal objections that complaint is without any cause of action and complainants have no locus standi to file the present complaint and therefore, complaint is liable to be dismissed.  It is averred that OP-1 issued policy bearing no. 1702004212010000493 in favour of SBI from their office situated at Belapur and even repudiation letter was also issued from Belapur and therefore, entire cause of action, if any, arises at Belapur, Navi Mumbai and therefore, present complaint should have been filed before Consumer Forum at Belapur and this Forum has no jurisdiction to hear and try the present complaint. It is further averred that preliminary inquiry and issues need to be framed to decide the point of jurisdiction and present complaint is not tenable in the eyes of law and cannot be  entertained by this Forum for want of cause of action and on other grounds under Consumer Protection Act. Moreover, complainants have concealed the material facts for the reasons best known to them and complainants have not come to this Forum with clean hands and are guilty of playing fraud and their conduct does not entitle them to seek any relief as they have made baseless and futile allegations. It is further averred that complaint involves complicated questions of law and facts, which require thorough investigation and recording of evidence at length and same cannot be conducted in this Forum with limited jurisdiction. However, on merits OP-1 has denied all the allegations levelled by complainant and submitted that there is no deficiency in service or unfair trade practice on the part of opposite party no. 1. It is averred that complainants have not pleaded the cause of death and also denied that OP-3 had left the house of deceased after his death and relinquished all her rights in the estate of deceased as alleged. It is also denied that complainants are the only legal heirs and representatives of deceased as only complainant no. 2 is the beneficiary as per the Policy. It is asserted that as per terms and conditions of the policy issued by OP-1, all the claim related documents were not submitted within 180 days, which was a mandatory period and documents were submitted later on by complainant no. 2 at a later stage after 180 days with no logical reason or explanation for delay. Thus, there is non compliance of the claim related procedure and adhering to and complying with the agreed terms and conditions of the policy by complainants and also by OP-2.   It is admitted that deceased was covered and insured as per the agreement between Op-1 and Op-2 in case of any accidental death for Rs 3,00,000/-. However, legal heirs and the beneficiary have to comply with all the terms and conditions as agreed at the time of taking of the policy and its due compliance is of utmost importance and prime requirement for taking claim, but neither complainants nor OP-2 submitted the relevant documents within time limit as per terms and conditions of the policy. Due to non compliance and non fulfilment of agreed terms and conditions as per contract entered into and policy cover issued, the answering OP is unable to entertain the claim of complainant due to delay on their part and thus, no cause of action arises in favour of complainant and therefore, answering OP was left with no other alternative and option but to close the file of complainant. There was no delay on the part of answering OP in dealing with the claim and they cannot be the necessary party to the complaint and there is no reasons for the complainants to raise any dispute regarding claim. OP-1 has gone through all the records and files relating to the present complaint and had correctly examined the claim of complainants and had properly scrutinized the file and had come to the conclusion that claim of complainant was not made in accordance with and as per terms and conditions of the Policy and due to non intimation and further due to non fulfilment of mandatory documents as required within time limit as prescribed under the agreement. Several letters dt 31.01.2014, 7.04.2014 and 20.04.2014 were written by Op-1 Company to Op-2 and complainants, but documents were not submitted to Company/Op-1 and complainants did not bother to submit requisite documents as called for in letter dt 30.01.2014. There is no deficiency in service on the part of answering OP and complaint is malafide and is filed only to harass and harm the answering OP/Insurance Company and as such, complaint is not maintainable in this Forum and is liable to be dismissed. All the other allegations with regard to relief sought too were refuted with a prayer that complaint deserves to be dismissed with costs.

5                                           OP-2 filed reply and took preliminary objections that complainants have no locus standi to file the present complaint and complainants have unnecessarily impleaded OP-2 as no cause of action arises against OP-2 and therefore, complaint is liable to be dismissed. Complainant Amarjeet Kaur is not the nominee of Hardeep Singh, so complaint is liable to be dismissed. It is averred that for death claims, claimant will submit claim with relevant documents directly to New India Assurance Company Ltd (NIACL) and National Assurance Company will settle the claims independently and Bank will not be a party to any dispute between the cardholder and National Assurance Company Ltd. It is further averred that all correspondence shall be between claimant and National India Assurance Company. It is further submitted that all the correspondence related to claim will be taken up directly between claimant/nominee and National India Assurance Company ltd without involving the Bank and Bank will not be a party to any dispute or claim, but in view of aforementioned  terms and conditions of the Policy, complainant has unnecessarily impleaded the OP-2/Bank as party in this complaint and therefore, complaint is liable to be dismissed on this ground. However, on merits, OP-2 has denied all the allegations levelled by complainant being wrong and incorrect and reiterated that there is no deficiency in service or unfair trade practice on the part of opposite party. The allegations with regard to relief sought too were refuted with a prayer that complaint deserves to be dismissed with costs.

6                                              In reply OP-3 admitted that she was married to Hardeep Singh and being natural heir of Hardeep Singh after his death, she entitled to all the benefits accruing on his death. She admitted that she is living with her parents but has denied all the allegations levelled by complainant being wrong and incorrect and asserted that she has never relinquished her rights. She has prayed that case for claim has been prepared with OP-2 by OP-3 and  she/OP-3 alone is entitled for the claim and requested for directing OP-1 and Op-2 to make payment to only OP-3.

 

7                                            Parties were given proper opportunities to prove their respective case. The complainant no. 1 /Amarjit Kaur w/o Karam Singh tendered in evidence her affidavit Ex.C-W1/A, complainant no. 2/Karam Sigh s/o Inder Singh tendered in evidence his affidavit Ex CW-2/A and documents Ex C-1 to C-37 and then, closed their evidence.

8                                       In order to rebut the evidence of the complainant, the opposite party no. 1 tendered in evidence affidavit of Deen Dyal Divisional Manager, New India Assurance Company, Divisional Office, Ferozepur City as Ex OP-1/1 and documents Ex OP-1/2 to 19 and then, closed the evidence on behalf of OP-1. Ld Counsel for opposite party no. 2 tendered in evidence, affidavit of V K Narang, Chief Manager, State Bank of India as Ex OP-2/1 and document Ex OP-2/2 and documents Ex Op-1/9 to 1/14 already exhibited by OP-1 and then, closed the evidence.  Ld Counsel for OP-3 also tendered in evidence affidavit of Parjeet Kaur w/o late Sh Hardeep Singh as Ex OP-3/A and documents Ex OP-3/1 to Op-3/4 and then evidence of OP-3 was closed by order of this Forum.

9                      The Ld Counsel for complainant argued that Hardeep Singh was the only son of complainants who was serving in Indian Army. He had salary account with OP-2. OP-2 had launched a personal accident insurance scheme for their salary account holders with a tie up with OP-1. In this scheme, Hardeep Singh was insured for a sum of Rs 3,00,000/-valid from 4.01.2013 to 3.01.2014. He died in motor accident on 29.10.2013. Rapat dt 30.10.2013 was recorded with Police Station Sadar Faridkot and post-mortem examination was also conducted. Copy of the post-mortem report is Ex C-10 and Police Report is Ex C-11. In post-mortem, cause of the death was reported  on account of multiple injuries on the vital parts of the body. Death certificate of Hardeep Singh is Ex C-13. Said Hardeep Singh was married with Op-3, who after his death left her matrimonial house and relinquished all her rights in the estate of deceased. Now, the complainants are the only legal heirs of Hardeep Singh. As complainants had no knowledge regarding the above said policy and they were not in possession of the same and were not aware of terms and conditions of the Policy. Later on, it came to the notice of complainants that complainant no. 2 is appointed as nominee in the Insurance Policy. They approached the official of OP-2 who got signatures of complainant no. 2 on various forms and documents and sent the same to OP-1 alongwith post-mortem report, police report and other required documents. The complainants received a letter dt 7.04.2014 from OP-1 addressed to OP-2 for submission of certain more documents to enable OP-1 to process the claim. On it, complainant approached OP-2, where they took signatures of complainant no. 2 on some documents and claim forms and  sent to OP-2. Complainants received a letter dt 5.05.2014 from OP-1 vide which they informed that claim of the complainant is repudiated with remarks for want of required documents of death claim within stipulated period and closed the file as “No Claim”. Copy of letter dt 7.04.2014 is Ex C-30 and letter dt 5.05.2014 is Ex C-31. OP-1 wrongly and arbitrarily closed the claim of complainant as No Claim only to escape the liability to pay the insurance claim to complainants. This act of OPs is illegal and unjust and is against legal rights of the complainants. The complainants deposited all the required documents which they demanded from them to OPs in time through OP-2 and if OP-2 was negligent in sending and submitting the claim form and other documents within stipulated period, then, OP-2 is liable for it and there is no fault on the part of complainants. There is deficiency in service on the part of OPs in not reimbursing the claim of complainant. It also amount to unfair trade practice, which caused great mental tension and harassment to complainants. They have prayed for accepting the complaint and also prayed for compensation and litigation expenses.

10                                     In reply to the arguments of complainant, counsel for OP-1 argued that complainants are not the consumers of OP-1. They have no cause of action to file the present complaint and there is no privity of contract between complainant and OP-1. The contract regarding insurance policy was only between OP-1 and OP-2. This Forum has no jurisdiction to try and decide this complaint against OP-1 as the Policy in dispute was issued by Divisional Officer, Belapur, new Mumbai and only court at Belapur is having jurisdiction to try and decide this complaint. There is no deficiency in service on the part of OP-1. The allegations against OP-1 are false and baseless. There is no delay or lapse in the duty of OP-1. OP-2 purchase the insurance policy in dispute for death benefit to cover their salary package account holders. It was agreed between OP-1 and 2 that this Insurance Company should entertain claim where intimation from the branch is received by OP-1 within 90 days of death of account holder and further it was agreed upon that period of maximum 90 days for submission of all the claim related documents required for the processing of the claim shall be given to Insurance Company by account holder or Bank for processing for sending the claim. However, it is true that Hardeep Singh deceased was covered under the Policy and complainant no. 2 was registered as his nominee but all the claim related documents were not submitted within 180 days as per terms and conditions of the Policy. Documents were submitted at later stage after 180 days and no reason or explanation is given in this regard. If there is non-compliance of the terms and conditions of the Policy, then OP-1 cannot entertain the claim of complainant and they cannot be blamed for the same. Complainant had intimated the death of Hardeep Singh on 24.12.2013 i.e about 2 months after his death that was too to United India Insurance Company which was received by OP-1 on 16.01.2014. Even all the documents pertaining to claim were not submitted to OP-1 within 180 days. The claimants or beneficiaries have not paid any premium directly to OP-1 and it is a contract between State Bank of India and OP-1 and is a beneficial policy for the ultimate consumer and not indemnified under contract of Insurance under like cases in normal insurance. The complainants or the beneficiary did not supply documents within stipulated period so, their claim cannot be entertained due to delay in intimating the death and non submission of documents. OP-1 had properly verified and dealt with the claim of the complainant as per terms and conditions of the Policy. They issued letters dt 30.01.2014, 7.04.2014 and 20.04.2014 addressed to complainant and OP-2 for giving proper clarification and detail explanation with regard to the policy, but the complainant had not submitted the duly filled claim form as per Annexure 4 within stipulated time. Neither complainant nor the OP-2 has bothered to provide the documents needed for processing the claim within mandatory period. Due to non compliance and non fulfilment of terms and conditions, the claim of complainant was repudiated as no claim and OP-1 was left with no other alternative but to close the file of complainant as to ‘No Claim’. There is no fault on the part of OP-1 in dealing with or in processing the claim. There is no deficiency in service and unfair trade practice on the part of OP-1. They have rightly repudiated the claim of complainant as per terms and conditions of the Policy and prayed for dismissal of the present complaint.

 11                                  Ld Counsel for OP-2 argued that complainants have no locus standi to file the present complaint. They are unnecessarily impleaded as party to this complaint. As per the terms and conditions of the Policy, the claim will be submitted alongwith relevant documents directly to Insurance Company/OP-1 and they will settle the claim independently and Bank is not the party to any dispute between complainants and Insurance Company. All the correspondence relating to claim will be directly taken up by the claimants with Insurance Company without involving the Bank and all the settlement of claim will be settled by Insurance Company and Bank will not be a party to such disputes. The settlement of claim is at all entire responsibility of Insurance Company and Bank will not be a party to such disputes. OP-2 never got signatures on any paper or documents from complainant for sending the same to OP-1, which is the duty of complainant to directly submit the claim form to Insurance Company and OP-2 has no liability for sending the same to OP-1. If Insurance Company demanded more documents from complainant and it was in the knowledge of complainant, then, it is between complainant and OP-1 to submit these documents. OP-2 did not know whether complainants have sent these documents to OP-1 or not. OP-2 never got signatures of complainant no. 2 and documents for further sending the same to OP-2. There is no deficiency in service on the part of OP-2. It is all between OP-1 and complainant and Bank has nothing to do with settlement of claim and prayed for dismissal of present complaint.

12                                 Counsel for OP-3 argued that Op-3 was married with Hardeep Singh and she is his legally wedded wife and after his death, she is the only natural heir of Hardeep Singh. Moreover, as per Section -8 Schedule 1 of Hindu Succession Act, only complainant no. 1 and 3 are natural heirs of Hardeep Singh being his mother and wife. Complainant no. 2 is not entitled for inheritance of Hardeep Singh in the presence of complainant no. 1 and Op-3 as they are preferential heirs then complainant no. 2 and prayed that she alone is entitled for the insurance claim.

13                             We have heard the arguments addressed by all the parties and have also gone through the file and documents led by the parties. It is admitted case that Hardeep Singh deceased had a salary account with Op-2 and as per scheme of OP-2, he was insured for Rs 3,00,000/-against accidental death with  Op-1 through Op-2.  As per OP-1, death of deceased should have been intimated to them within 90 days of death which is intimated to them on 16.01.2014 i.e within stipulated period of 90 days. The case of the Ops is that the complainants have not submitted the required documents within stipulated period of 180 days from the date of death of insured and as such, OP-1 repudiated the claim of complainants.                                       

 14                            OP-2 argued that they had nothing to do regarding settlement of insurance claim and it is between claimants and Insurance Company directly and there is no role of OP-2 in settlement of claim and they are not liable or responsible for the same. In this case, we have thoroughly gone through the evidence led by the parties. Complainants summoned the entire claim file from OP-1, from which a certificate issued from the Bank regarding the death of Hardeep Singh is Ex C-16, intimation letter is Ex C-17. These documents are sent by Op-2/Bank to OP-1 which is evident from the postal envelop Ex C-23. Letter dt 30.01.2014 requiring the documents for settlement of claim is Ex C-21 which is also sent to the Bank. Letter dt 25.03.2014 issued by Op-2 to OP-1 vide which it forwarded the English translation of Police Report and Post-mortem Report  and regarding Annexure 4 which is sought by Op-1, they have written that it is not traceable and requested to OP-1 to sent the same to them so that they may forward it to OP-1 after filling the same. Letter dt 7.04.2014 by OP-1 to OP-2 for demanding documents regarding claim of complainant is Ex C-30, copy of letter dt 20.04.14 by Op-1 to OP-2 for submitting documents regarding settlement of claim is Ex OP-1/15. These all letters show that all documents for settlement of claim are sent to Op-1 through OP-2 and in these circumstances, OP-2 cannot deny its responsibility for settlement of insurance claim. As per letter dt 5.05.2014 vide which the claim of claimants is repudiated as “No Claim” is Ex C-31. It is clearly mentioned that the claim is repudiated due to non receiving of duly filled claim form as per Annexure 4. It was the duty of OP-1 and 2 to provide the claim form Annexure 4 to the complainants to fulfil it and to submit it. Vide letter dt 25.03.2014 Ex C-29, it is clear that Bank wrote to OP-1 that Annexure 4 is not available with them and requested that it may be send to them as it was to be submitted to OP-1 after filling the same. There is no evidence that Op-1 sent Annexure 4 to Bank or complainants to fill the same and when Annexure 4 is not provided to complainant by Ins. Co. or Bank then how it can be presumed that they will submit the same to Ops within time. However, the     counsel for complainants argued that mere delay in intimation of death or submitting the documents is no ground to repudiate the claim. He placed reliance on the case law 2012 (2) Consumer Law Today 664 titled as Reliance General Insurance Co. Ltd Vs Sri Avvn Ganesh decided by Hon’ble National Consumer Disputes Redressal Commission, New Delhi. In this case, Hon’ble National Commission observed that Consumer Protection Act, 1986 Sections 2 (1) (g) and 21 (b) Life Insurance- Delayed intimation of death to the insurer – Claim was repudiated on the ground that death of insured was intimated after four months as against stipulated period of one month – Complaint of deficiency in service of OP was dismissed – State Commission allowed the appeal – All the conditions for acceptance of insurance claim except point of reporting loss within one month of its occurrence had been substantially fulfilled – Delayed intimation of death of insured due to injuries he suffered on account of accident could not be held to be destructive to insurance claim because the facts and circumstances of death were clearly established on the basis of medical on records as well as deposition of doctor who attended the insured- Like in case of theft of movable insured property, delay in intimation was not prejudicial to the insurer because in such cases, Insurance Company was not prevented, because of delay, from carrying out any investigation into the facts and circumstances as to whether the accident and consequent loss fell within the substantive condition of insurance policy and it cannot be imagined that the complainant could have cooked up the story that his father died in the manner stated and that too in active collaboration and collusion with doctor of the hospital – No infirmity found in the impugned order – Revision petition dismissed.

                                Whereas the question of liability of Bank regarding the settlement of claim , the Counsel for complainant placed reliance on the case cited as 2011 (3) Consumer Protection Judgments,(N.C) 477 titled as State Bank of India Vs Suresh Chand & Ors wherein Hon’ble National Consumer Disputes Redressal Commission, New Delhi observed that Consumer Protection Act, 1986 Sections 2 (1) (g) and 21 (b) Banking and Financial Institutions Services-Credit Card-Scheme of Personal Accident Insurance-Repudiation of claim-Complaint dismissed by Forum-  Appeal- Complaint allowed - Revision- Plea that terms of insurance scheme that death should be due to unnatural cause of accident not communicated to holder of  passbook – Accepted - Obligation for Bank to bring to notice of its customers nature and condition of relevant insurance scheme-For non-observance, customer cannot be held liable-No interference with order of State Commission.

  15                                       From the above discussion, we are fully convinced with the evidence, documents and case law produced by the complainant.  The complainants have succeeded in proving their case and OP-1 and OP-2 have utterly failed to prove their case. They have wrongly and illegally repudiated the claim of complainants on the excuse of non submission of documents within stipulated period. It amounts to deficiency in service and unfair trade practice on the part of OP-1 and Op-2. Now, the issue is that who is entitled for the claim amount. The complainants pleaded that they are entitled for the claim amount being parents of deceased Hardeep Singh. They pleaded that after the death of Hardeep Singh, Op-3 who is widow of Hardeep Singh, left her matrimonial house and relinquished all the rights in the estate of her deceased husband Hardeep Singh, whereas OP-3 claim that only she is legal heir of Hardeep Singh and she is entitled for the entire amount of claim. As per Section 8 of Schedule 1 of Hindu Succession Act, complainant no. 1 being mother and Op-3 being widow of deceased Hardeep Singh are his legal heirs and complainant no. 2 does not fall in this domain of schedule. As such, complainant no. 1 and OP-3 are entitled for the inheritance of Hardeep Singh deceased in equal shares. From the above discussion, complaint in hand is hereby allowed and OP-1 and Op-2 ordered to pay Rs 3,00,000/-i.e insurance claim alongwith interest at the rate of 9 % per anum from 5.05.2014 when  OP-1 repudiated the claim till final realization to complainant no. 1 and OP-3 in equal shares. OP-1 and 2 are also directed to pay Rs 10,000/-as compensation for harassment and mental tension and Rs 5,000/-as litigation expenses. Ops are directed to comply with the order jointly and severally within one month from the date 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 : 6.08.2015

                     Member            Member                   President

                      (P Singla)         (Parampal Kaur)      (Ajit Aggarwal)