Delhi

North

CC/271/2022

SMT. ANITA SEHGAL - Complainant(s)

Versus

NEW INDIA ASSURANCE COMPANY LTD - Opp.Party(s)

16 Feb 2024

ORDER

District Consumer Disputes Redressal Commission-I (North District)

[Govt. of NCT of Delhi]

Ground Floor, Court Annexe -2 Building, Tis Hazari Court Complex, Delhi- 110054

CC No.: 271/2022

 

IN THE MATTER OF:

 

SMT. ANITA SEHGAL

W/O LATE SH. OM PRAKASH SEHGAL,

G-1, TYPE- IInd,

NEW POLICE LINE,

KINGSWAY CAMP,

DELHI-110009                                                                  ……….        COMPLAINANT                                    

 

VERSUS

 

1. THE NEW INDIA ASSURANCE COMPANY LTD.

 THROUGH ITS GENERAL MANAGER,

MUMBAI LCBO-2-990000,

NEW INDIA CENTRE,

GROUND FLOOR,

17A, COOPERAGE ROAD,

MUMBAI-400039                                                                               …….OPPOSITE PARTY -1                     

 

2. AXIS BANK,

4/6/B, GROUND FLOOR,

ASAF ALI ROAD, NEW DELHI-110002                                          …….OPPOSITE PARTY -2    

 

ORDER

                                           16/02/24

 

Ashwani Kumar Mehta, Member:

 

I).      The present complaint has been filed under Section 35 of the Consumer Protection Act, 2019. The brief details of facts, as alleged by the Complainant in the Complaint in hand, are that the complainant is widow/Nominee of Sh. Om Prakash Sehgal (now deceased) who was working as  Assistant Sub-Inspector in the New Rajender Nagar police station, Delhi Police at the time of his accidental death.  The deceased husband of the complainant was having salary account with Axis Bank, Asaf Ali Road Branch New Delhi/ OP no.2. At the time of opening the aforesaid bank account with OP no.2, one complementary life insurance policy was also given to the husband of the complainant as per contract between employer of the deceased and the OP-2/Axis Bank. As per terms and conditions of the insurance policy,  if the employee of Delhi Police lost  life in any accident, the OP no.1 will pay a sum of Rs. 30,00000/- (Rupees Thirty Lacs Only) to the family of such employee.  On  14/10/2017,  the husband of the complainant was  found dead on railway track near railway line at Fatak no.3, Sawan Park, Ashok Vihar, Delhi and a DD No. 12A dated 14/10/2017 was registered with police station Subzi Mandi Railway Station regarding the accident. After proper investigation,   the investigation officer of the case has filed a report under section 174 CrPC.  Thereafter, the complainant filed a claim, in respect of death of her husband with OP no.2. The officials of OP no.2 asked the complainant to complete the documentation and other formalities to disburse the claim and the complainant completed all the formalities and submitted all the requisite documents with OP no.2 but the claim filed by the complainant was repudiated by OP no.2 on the pretext that the OP no.1 shall not pass the claim of the person who run over by the running train while crossing the railway track. The complainant was shocked to receive a letter of repudiation dated 08/10/2018 issued by the OP no.2. It has been alleged that the OP no.2 without any proper and cogent proof came to the conclusion that the husband of the complainant was crossing a railway track at the time of his death and on mere presumption, OP-2 had repudiated the claim of the complainant without any reasonable cause in arbitrary manner.  As per terms and condition of the policy, OP-2 has to compensate the family of the person who lost his/her life in any accident but it has been denied without any logical reason. Therefore, the complainant has filed complaint praying that the OPs be directed to make the payment of (a) amount of compensation along with interest @24% per annum from the date of death of the husband of the complainant till its realization, (b) Rs.1,00,000/- for mental, pain, shock and agony and (c) Rs.55,000/- as litigation charges. It has also been prayed to Pass further order(s) which may be deemed fit in the above facts and circumstances of the case.

 

II).      Accordingly, the notices were issued to the Opposite parties but the OP-1 could not file reply within the statutory period, therefore, the right for filing the reply by the OP-1 was closed. Thereafter, the OP-1 had filed an application of condonation of delay alongwith reply to the complaint, in the registry of commission vide diary No.809 on 26.08.2022 for taking the reply on record. On perusal of the application and documents filed by OP-1, it was found that the reply of OP-1 was signed and notarized on 26.08.2022 whereas the statutory period for filing reply was already over on 08.08.2022 and the right to file reply of the OP-1 was already closed vide our order dated 22.08.2022. Therefore, the application for condonation of delay in filing the reply filed by the OP-1 was rejected vide order dated 30-11-2022   and the reply so filed by the OP-1 alongwith the application of condonation of delay was not taken on record.

III).     The OP-2 /AXIS BANK has filed written reply, within statutory period, with   Preliminary Objections also. While perusing the reply filed by OP-2 cursorily, it was appearing weird with the stench of malice because the OP-2, instead of contesting on correctness of the reasons mentioned in the repudiation letter dated 23-05-2022, has been contesting the irrelevant issues which are not at all connected with the reasons of repudiation explained in the repudiation letter. Therefore, it was considered desirable to reproduce the preliminary objections and reply on merit for better & judicious examination of the instant complaint:-

PRELIMINARY OBJECTIONS:-

1. At the outset, the O.P No. 2/Axis Bank Ltd deny each and every allegations, contentions and statement made by the Complainant in the aforesaid complaint which are contrary to and or inconsistent with what is stated herein below and the Complainant is put to strict proof thereof.
2.  The complainant has neither pleaded the debit card number nor has submitted the copy of same in whole complaint against which the complainant is seeking indemnification from O.P.-1 & 2 and thus, the present complaint is incomplete/defective and is liable to be rejected/dismissed.
3. The present complaint has been filed after more than 2 years from the date of alleged accrual of cause of action i.e. 14.10.2017 and hence, the same is barred by limitation as envisaged in Section 24 A of the C.P Act, 1986 or Section 69 of the CP Act, 2019 and thus, liable to be dismissed on this ground as held by Hon'ble National Commission in case titled as Richard Raja Singh Vs Ford Motor Company & B.S Agricultural Industries Vs SBI.
4. The said alleged indemnification is subject to fulfilment of terms and conditions w.r.t debit card in question as well as of insurance policy.
5. The O.P No. 2-Axis Bank Ltd cannot carry on "Insurance Business" as per the provision of Banking Regulation Act, 1949 and hence does not offer insurance product.
6. Insurance policy was issued by The New India Assurance Company Ltd and hence, the complaint cannot be maintained against the O.P No. 2-Axis Bank Ltd.
7.  The O.P No. 2-Axis Bank's role is only as a facilitator/referral agent and the actual insurance is issued by the New India Assurance Company i.e. OP No.1. There exists no privity of contract between the complainant and the O.P No. 2-Axis Bank Ltd to claim the insurance from the Bank and as such the complaint is not maintainable against the O.P No. 2-Axis Bank Ltd and is liable to be dismissed on this count also.
8.  It is settled principle of law u/s 230 of Indian Contract Act that an agent can neither sue nor be sued except under the special circumstances mentioned therein. For ready reference, Section 230 of Indian Contract Act is reproduced below:-

 

“Section 230: In the absence of any contract to that effect an agent cannot personally enforce contracts entered into by him on behalf of his principal nor is he personally bound by them Such a contract shall be presumed to exist in the following cases:- (1) Where the contract is made by an agent for sale or purchase of goods for a merchant resident abroad. (2) Where the agent does not disclose the name of his principal. (3) Where the principal though disclosed cannot be sued.”

The perusal of the above provision indicates that none of the circumstances envisaged therein have been existed in the instant case. Therefore, on this sole ground alone the complaint is liable to be dismissed qua the O.P No. 2-Axis Bank Ltd.

 

1. Furthermore, the insurance benefit is an additional facility/perk given by the O.P No. 2-Axis Bank Ltd. through The New India Assurance Co. Ltd, i.e. the insurance company-OP No.1 to its customers. As the insurance is free of charge and is without any consideration, and thus, there was no privity of contract between the son (SIC) of the complainant and the O.P No. 2-Axis Bank Ltd. Hence, the present complaint is not maintainable qua the O.P No.2 -Axis Bank Ltd. and is liable to be dismissed.

 

10. Before applying the debit card, every customer has to sign the Terms and Conditions of Debit Card and as per the terms of Insurance Policy, all claims have to be intimated to the Insurance company within 60 days of the occurrence of the event in case of a lost card insurance claim, purchase protection and 90 days in case of Personal Accident Insurance claim.

IV).     In addition to the above explained preliminary objections, the OP-2 has also furnished  para wise reply on merits to the complaint which  has also been reproduced below for proper examination of the rebuttal of allegations by the OP-2/Axis Bank:-

 1.  the contents of para no. 1 need no reply being a matter of record.

2.  the contents of para no. 2 need no reply being a matter of record.

 3.  the contents of para no. 3 need no reply being a matter of record.

4. the contents of para no. 4 need no reply being a matter of record.

5. the contents of para no. 5 are wrong and denied as written.

The reason of repudiation as submitted by OP No.1-NIA to OP No2 is that the husband of complainant was run over by running train while crossing the railway track. As per Railway Act, crossing of railway track is prohibited and an offence. Hence "No Claim" and thus the insurance claim was out of scope policy as submitted by complainant in repudiation letter annexed at page 46 of complaint. The complainant after realizing the fact that her present complaint has become time barred as per S-24A/69 of The CP Act, she procured a fresh repudiation letter dated 23.05.2022 (annexed at page 47 of complaint) to fill up the lacuna of limitation period, which is liable to be ignored by this Commission. However, the Personal Accident insurance cover of Rs. 30 Lakh was given by The New India Assurance Co. Ltd-OP No.1 herein subject to fulfilment of its terms and conditions attached to it. The said alleged indemnification is subject to fulfilment of terms and conditions w.r.t debit card in question as well as of insurance policy. The policy number was 99000046171300000003 which was valid w.e.f 15.04.2017 to 14.04.2018, which was issued from the branch of OP-2 situated at New India Centre, Ground Floor, 17-A, Cooperage Road, Mumbai-400039.

There exists no privity of contract between the complainant and the O.P No. 2-Axis Bank Ltd to claim the insurance from the Bank, and, as such, the complaint cannot be filed against the O.P No. 2-Axis Bank Ltd and is liable to be dismissed on this count also. While opening the savings account all the Terms & Conditions were explained to the customer/ husband of the Complainant and he had acknowledged the same by signing the following declaration as mentioned in the account opening Application Form, which is as under:-

 DECLARATION

"I/We have read and understood the Terms and Conditions    (a copy of which I am in possession of) governing the opening of an account with Axis Bank and those relating various services including but not limited to ATMs/Debit Card/Mobile Banking/ Phone Banking/Net Banking/ Bill Pay facility. I/We accept and agree to be bound by the said Terms and Conditions including those excluding/limiting the Bank's liability. I/We understand that the Bank may, at its absolute discretion, discontinue any of the services completely or partially without any notice to me/us. I agree that the Bank may debit my account for service charges as applicable from time to time. I/We am/are residents of India. Apart from this, the current Schedule of Charges has been received by me and I agree with the same."

The above-said declaration had been signed by the deceased husband of complainant. The husband of the complainant must have read and understood the terms and conditions at the time of opening of savings bank account. The terms and conditions mentioned in the declaration given by the husband of complainant is binding on him as well on his legal heirs. Beside this, the terms and conditions are placed in Branch notice board and also on Bank's website. All these can be taken as due notice to the deceased husband of the complainant. The Bank follows all regulator/legal guidelines in this regard. The complainant has filed a premature complaint before this  Forum without following the claim procedure as mentioned in the "Debit Card' usage guide manual and terms and conditions booklet which contains complete details of activation, features and benefits, national and international usage of the card as mentioned in the letter which was sent by the O.P No.2-Axis Bank to its customers/deceased husband of complainant in the present case at the time of giving of debit card facility.

 How to activate your Debit Card: Your PIN (Personal Identification Number) has been sent in a sealed envelope separately and you will receive it shortly. Please remember to use your new Debit Card at an ATM for activating Point of Sale usage. Enclosed is the "Debit Card' usage guide manual and terms and conditions booklet which contains complete details on activation, features and benefits, national and international usage of your card.

 Furthermore, the applicants ought to have submitted the following documents required for Personal Accident insurance:-

Duly Completed Claim Form (Attested from Axis Bank) Consent Form(Attested from Axis Bank)

Assignee verification form(Attested from Axis Bank)

Attested copy of FIR(Attested from Axis Bank)

Attested copy of Panchnama (Attested from authorized notary)

Inquest Panchnama (Attested from authorized notary) Attested copy of Statement of Witnesses, if any lodged with police authorities(if any) (Attested from authorized notary) Photocopy of Debit Card (Attested from authorized notary) Attested copy of Post Mortem Report (Attested from authorized notary)

Attested copy of Viscera report if any (Attested from authorized notary)

Original Death Certificate Burial Certificate (wherever applicable) (Attested from authorized notary)

Attested copy of Drivers License (in case of a motor/vehicular accident) where the deceased was driving) (Attested from authorized notary)

 Copy of address proof (Ration Card or electricity bill copy) (Attested from authorized notary)

The above said documents should have to be submitted with "The Incharge Claims, The New India Assurance Co.Ltd., D.O 112700, 22, 2nd floor, Mittal Chambers, Nariman Point, Mumbai-400021. Admittedly, the complainant has not filed the above said requisite documents alleged to have been submitted before the O.P No. 2-Axis Bank Ltd. Even then, the incomplete documents were forwarded to the New India Assurance Co. Ltd-Op No.1, i.e. Insurance Company to settle the claim of the complainant subject to fulfilment of terms and conditions with regard to operation of said ATM card issued to the deceased husband of the complainant. Admittedly, the husband of the complainant had died "due to cranio cerebral damage consequent upon blunt force impact along with multiple injuries", as submitted in Post Mortem report & other police reports. Hence the present complaint is not maintainable qua the O.P No.2-Axis Bank Ltd. and is liable to be dismissed. The copy of policy has been annexed as  Annexure-R-1 with the reply.

6.    the contents of para no. 6 need no reply being a matter of          record. However, a detailed reply has been given in the preceding paras and is not repeated herein for the sake of brevity.

7.   the contents of para no. 7 need no reply being a matter of record. However, the complainant may be put to strict proof to prove the same.

8.  the contents of para no. 8 are absolutely wrong and hence denied. The O.P No.2- is not competent to check the veracity of claim. The said reason of repudiation had been forwarded by the O.P No.1-NIA after verifying the claim documents submitted by complainant and above said insurance policy terms and conditions to O.P No.2-Axis Bank and the O.P No.2- Axis Bank had forwarded/conveyed the same to the complainant. However, a detailed reply has been given in the preceding paras and is not repeated herein for the sake of brevity.

9.  the contents of para no. 9 are wrong and denied as written. The indemnification is subject to fulfilment of terms of conditions of debit card issued to the customer/deceased husband of complainant as well as of insurance policy as submitted above and is not repeated herein for the sake of brevity.

10. the contents of para no. 10 are absolutely wrong and hence denied. However, a detailed reply has been given in the preceding paras and is not repeated herein for the sake of brevity.

V).     The complainant has also filed rejoinder affirming the allegations levelled in the complaint and refuting the averments/reply of the OP-2 stating that the OP no.2 without any proper and cogent proof, has repudiated the claim of the complaint without any reasonable cause in arbitrary manner. It has been contended that it is an admitted fact that on 14/10/2017, the husband of the complainant namely Sh. Om Prakash Sehgal was found dead on railway track near railway line at Fatak no.3, Sawan Park, Ashok Vihar, Delhi and DD No. 12A dated 14/10/2017 Station was registered with Police Station Subzi Mandi Railway regarding the said accident. It is also admitted by the O.P. No.2 that the husband of the complainant was covered under Personal Accident Cover of Rs.30,00,000/- (Rupees Thirty Lacs Only) vide policy issued by the O.P. No.1. It is also contended by the complainant that during investigation of abovementioned accident, the investigation officer of the said case had not recorded the statement of any person deposing that the husband of the complainant was walking/running on the railway track. It has also been alleged that without any proper and cogent proof, the OPs came to the conclusion that the husband of the deponent was crossing a railway track at the time of his death and on mere presumption, have repudiated the claim without any reasonable cause in arbitrary manner. It has also been contended that even in post-mortem report attached with the report U/S 174 Cr. PC, it has been mentioned that “the incident to be "Alleged Road Traffic Accident" and despite the fact that the OPs have presumed that the deceased was running/walking on the railway track. The complainant has placed on record the proof of employment of the deceased, insurance policy and report of inquest proceedings u/s 174 Cr.PC, as such, the complainant has proved her case. The complaint of the complainant is within limitation and entitled for the relief claimed in the complaint.

VI).       The complainant and OP-2 have also filed evidence by way of affidavit and written arguments. The complainant and OP-2 have also participated in the oral arguments’ proceedings but the OP-1 did not participate in the arguments proceedings.

VII).      The allegations levelled in the complaint have been examined and scrutinized in light of the averments made by the parties and we have noticed that the OP-2 has furnished elaborate and absurd averments to mislead the commission with the intention to hide its deficiency either by getting the deficiency shifted towards OP-1 or dismissal of the complaint on technical reasons. Therefore, we consider it proper to discuss the contents of preliminary objections and reply on merit filed by the OP-2.

 

VIII).      Regarding Preliminary objections, we observe as under:-

1. The OP-2 has raised objection that the complaint is incomplete and defective and liable to be dismissed as the Complainant has neither pleaded the debit card nor submitted the copy of the same against which the Complainant is seeking indemnification from the OPs.

In this regard, it is not in dispute as to whether any debit card was issued to the deceased, it is not clear as to why the OP-2 has raised this issue.The OP-2 has also failed to explain as to how the complaint is defective in the absence of debit card number and copy which was issued to the deceased, not to complainant? It has not been explained by OP-2 as to how the absence of debit card number and its copy have made the claim unindemnified? The details explained regarding debit card and documents required for settlement of claim, in Para (IV) 5 above, also appear irrelevant to the facts of the case and appears to have been added with the intention to mislead the commission.

2. The OP-2 has raised objection that  the complaint is time barred as the complaint has been filed after more than 2 years from the date of alleged accrual of cause of action i.e. 14.10.2017 and hence, the same is barred by limitation as envisaged in Section 24 A of the C.P Act, 1986 or Section 69 of the CP Act, 2019 and thus, liable to be dismissed on this ground as held by Hon'ble National Commission in case titled as Richard Raja Singh Vs Ford Motor Company & B.S Agricultural Industries Vs SBI.

In this regard, the OP-2 has raised this objection with absurdity hiding the fact that the cause of action shall start after the final repudiation of claim of death compensation and It has not explained as to how this complaint filed on 26.05.2022 is barred by limitation whereas no records/ communication have been filed to prove that the Complainant was informed/ communicated in writing on 14.10.2017 or 08/10/2018 about rejection of the claim. Moreover, the OP-2 is also not clear as to which section or Act is to be referred in the instant case.

 

3.  The OP-2 has also stated that the repudiation letter dated 23.05.2022 is manipulated one but has not explained as to why it should be ignored by this Commission specifically when this letter has been issued by the OP-2 itself. If this was manipulated one, what action was taken by the OP-2 against the Bank officials involved in this act of manipulation?  Besides,   the OP-2 has also failed to justify the issuance of an undated repudiation letter also. So far as we understand, undated letter was issued to complainant by the OP-2 to complicate the issue and on complainant’s insistence, letter dated 23-05-2022 was issued to correct the apparent mistake. Now the OP-2 is defining this letter as manipulated one to mislead the commission.
4. To address the issue of limitation in this case, it is clarified that even if for argument sake, we take the date of 08/10/2018 as date of repudiation (as stated in the complaint though no written communication of this date has been made available by either of the parties), the limitation for filing  this complaint would prevail till 07/10/2020 but period from 15-03-2020 to 29-05-2022 stands excluded for the purpose of calculation of limitation in terms of the Hon’ble NCDRC’s Order No.7/2022 dated 14-01-2022. Therefore, the instant complaint filed on 26-05-2022 is not barred by the limitation and this aspect was also considered while admitting the complaint for issuance of notices to the OPs. However, the repudiation letter dated 23-05-2022 is sufficient to count the limitation period as no documentary evidence has been filed by the OPs to prove that the repudiation of claim was communicated to the complainant prior to 08/10/2018.
5.  The remaining preliminary objections have also been found inter- linked   with the points of reply of allegations given on merits and are being discussed hereunder with the connected points. 

 

IX).    Regarding parawise reply on merits, filed by the OP-2, (reproduced at para IV (1) to IV(10),  we observe as under:-

 

1. In Paras No.1 to 6, the reply has been given as the contents of these Paras need no reply being a matter of record whereas no such record has been referred or filed by the OP-2.

2. The policy number was 99000046171300000003 which was valid w.e.f 15.04.2017 to 14.04.2018, which was issued from the branch of OP-2 (SIC) situated at New India Centre, Ground Floor, 17-A, Cooperage Road, Mumbai-400039. On perusal, it has been found that the policy has been issued by the OP-The OP-2 has filed a copy of the policy schedule for “credit card package insurance policy” issued by the OP-1 on receipt of premium of Rs.13.80 crore but the details of risk covered states that it is for PA & Purchased Protection for Debit Card Holders of Axis Bank. It also refers some details as per annexures and attached policy wording but no such annexures have been filed to understand the OPs justification to denial of the claim.

3. In Para 5 of the reply, the OP-2 has elaborated the details of documents required for settlement of claim and has stated that the Complainant has filed incomplete documents but it has failed to place on record any written communication to the Complainant intimating the deficiencies of documents in the complaint whereas the repudiation letter dated 23.05.2022 does not indicate any deficiency of the documents in the claim filed by the Complainant.

4.  The reasons of repudiation explained in the repudiation letter, available on record, are that “the said claim is repudiated as per the FIR/Investigation report, it is a known case of deceased run over by the running train while crossing the railway track. As per railway act crossing of railway track is prohibited & an offence.”

In view of the above position, the judgment passed by the Hon’ble Supreme Court in the matter of Saurashtra Chemicals Ltd. Vs. National Insurance Co. Ltd. [(2019) 19 SCC 70] appears relevant in this case wherein it has been held that the Insurance Company cannot travel beyond the grounds mentioned in the letter of repudiation.

The OP-2 instead of confining its objections, reply and arguments within the scope of reasons of repudiation communicated to complainant, has tried to create various other irrelevant grounds for objections/arguments etc. with the intention to mislead the commission.

 

X).    We have also observed that in Para 3 of the complaint, the Complainant has mentioned that one complimentary life insurance policy was also given to the deceased as per contract between the employer of the husband of the Complainant i.e. Delhi Police and OP-2 but the OP-2, while replying to this Para, has simply replied that the contents of this Para as “need no reply being matter of record” which is being considered by us as admission of the averments made in the relevant para of the complaint. Since copy of any contract between the Delhi Police and the OP-2 has neither been filed by the Complainant nor by the OP-2 which led to suspicion in our mind as to why the OP-2 has not referred or filed the copy of said contract and we tried to find out the details of this contract to examine the conduct of the OPs for a judicious decision in the matter. Accordingly, we have come across the contents of a MoU, which is available in public domain, executed by the OP-2 on 30.10.2002 with Delhi Police (Employer of the deceased) for providing benefits and facilities i.e. life insurance cover etc., to the Delhi Police personnel.  As per this MoU, the OP-2 had managed to get salary account opened in its bank from all the Delhi Police Personnel in bank because it was made mandatory by the Delhi Police (Employer) for all the staff to open a salary account with OP-2. In this bargain, the OP-2 had agreed to provide the package of benefits/ facilities for Delhi Police staff under this MoU  and these benefits have further been enhanced vide letter dated 31.12.2020 issued by the OP-2 which provides the Life Insurance Cover to Delhi Police staff as under:

 

1. LIFE INSURANCE COVER (including COVID Death) - Rs. 28 LACS

No POS condition/any other condition is required.

The cover will be available for all "On duty" as well as "Off duty" deaths due to natural causes/any type of illness.

•  The cover will continue till the age of 65 yrs provided at least 01 salary/pension is credited into the account in the last 06 months.

 

2. SUICIDE COVER - Rs. 10 LACS

•  No POS condition/any other condition is required.

The cover will be available for all "On duty" as well as "Off duty" deaths due   to Suicide.

The cover will continue till the age of 60 yrs provided at least 01 salary/pension is credited into the account in the last 06 months.

 

    3. PERSONAL ACCIDENT INSURANCE COVER - Rs. 78 LACS

No POS condition is required.

The cover will be available for all "On duty" as well as "Off duty"

Accidental deaths.

All deaths other than "Natural death" and "Suicide" shall be covered under the definition of the word "Accidental Death" such as death due to read accidents, electrocution, drowning, snake bite, wild animal attack etc including rescue operations, riot, civil commotion, while combating naxalites/Maoists, etc, within Indian territories.

 

• The cover will continue without any upper age limit till the time salary/pension is being credited into the account (at least 01 salary/pension must be credited into the account in the last 06 months preceding to the date of the incident).

NOTE: If the death is due to a "Terrorist Attack", an additional cover of Rs. 10 Lacs will be available subject to 01 Debit card swipe in last 90 days and provided the incident is categorized as a "Terrorist Attack" by the Govt. of India. However, if the death is due to an action by/encounter with criminals OR due to an injury caused by any person by doing an act which is punishable as an offence under the Indian Penal Code, a cover of Rs. 78 Lacs shall be available as in case of "Personal Accident" mentioned at S.No. 3 above.

 

In case of multiple accounts related to a single customer, only 01 account will be taken into consideration.

Claim document must be submitted to the respective branch within 180 days from the date of death.

The cover will not be available:

If the accident has occurred under the influence of intoxicating liquor or drugs and the same is responsible for the cause of accident.

If there is any deliberate or intentional, unlawful or criminal act, error or omission on part of the insured.

in case of war (whether declared or not), civil war, invasion, act of foreign   enemies, rebellion, revolution, insurrection, mutiny, military or usurped power, seizure, capture, arrest, restraint or detainment, confiscation or nationalisation or requisition of or damage by or under the order of any government or public local authority.

 

On perusal of the above terms of MoU, it has also been found that these terms does not debar the pending /unsettled cases of death compensation to claim enhanced compensation irrespective of the date of death.

 

XI).     In our opinion, this MoU makes OP-2, solely, liable for various life insurance cover and other facilities towards the Delhi Police staff but it is very strange to observe that the OP-2 has very cleverly maintained mysterious silence over the contents of this MoU during entire proceedings before the commission  and never discussed its features and the liability of the OP-2 with the obvious intention to mislead the Commission to hide its deficiency and unfair trade practice in the instant case. The reply given on merit by the OP-2 for Para 3 of the complaint is the glaring example of misconduct on the part of the OP-2 for which a heavy cost is liable to be imposed upon OP-2.

XII).    The OP-2 has also tried to escape from its responsibility to pay the claim stating that it does not carry on “Insurance business” and does not offer insurance product whereas in the MoU signed by it with the Delhi Police, the OP-2 has owned the responsibility of various life insurance cover to be paid on the death of Delhi Police staff.

XIII). The OP-2 has contended to escape from the liability of the payment of the claim on the ground that the insurance policy was issued by the New India Assurance Co. Ltd./OP-1 whereas as per the MoU signed with the Delhi Police, the OP-2 has owned the responsibility of the payment of the life cover of Delhi Police staff though it is open for it to get this liability executed to any other entity but OP-2 cannot hold that third party responsible in compensating Delhi police staff. As per schedule of the policy (placed on record) for credit card packaged insurance policy issued by the OP-1 against coverage PA & Purchased Protection for Debit Card Holders of Axis Bank but no details of MoU signed by the OP-2 with the Delhi Police are mentioned which makes us to understand that it is an arrangement made by the OP-2 to provide risk coverage to the Delhi Police staff, therefore, the OP-2 cannot escape from its responsibility as per the MOU.

XIV).   Besides, in Para 3 of the preliminary objections filed with reply, the OP-2 has tried to take shelter under Section 230 of Indian Contract Act which deals with the issue of non-enforceability of contract by an agent on behalf of the Principal. The OP-2 has referred to this provision to state that the said OP-2, being an agent of OP-1, cannot be held responsible for repudiation/rejection of claim by OP-1. In the instant case, in view of the MoU signed between OP-2 and Delhi Police, OP-2 is not the agent of OP-1 Insurance Company. As per the MoU, OP-2 is responsible to administer the insurance policy and consider/examine/process the claim alongwith OP-1. Since the OP-2 alongwith OP-1 becomes Principal with respect to all insurance policies governed as per the said MoU, the death/accidental death insurance claim is to be considered/examined/processed by the OP-2 alongwith OP-1 as per terms & conditions of the MoU.

XV).    We also observe that the repudiation of Accidental death insurance claim in respect of a deceased Delhi Police staff by the  OPs  is unjustified as it has repudiated the claim without any cogent reason and evidence. In the PMR No.-1522/17 dated 15/10/2017, it is mentioned against brief history as “alleged road traffic accident” and under heading “OPINION”, it is also stated that “The cause of death in this case is cranio cerebral damage consequent upon blunt force impact alongwith multiple injuries”. The entry in DD no:12 A dated 14-10-2017 of  PS SMRS and report of inquest proceedings u/s 174 CrPC also mention about it and cause of death has not been defined due to  any criminal act for which the claim could have been repudiated by the OPs. Therefore, we hold OP-2 responsible for deficiency in service and unfair trade practice in this case.

 

XVI)    Since the Accidental death claim of deceased Delhi Police staff (referred in this complaint matter) has not been paid/settled and vide MoU dated 31-12-2020, the Accidental death insurance amount has been increased to 78 Lakhs, and we are of the considered opinion that the amount of instant claim should also be treated as Rs.78 lakh for payment to complainant. Therefore, while holding OP-1 and OP-2, jointly and severally, liable for deficiency in service, we direct as under:-

 

1.  OP-2 (Axis Bank Ltd) is directed to pay Rs.78,00,000/- (Rupees seventy eight Lakh only) to the Complainant within thirty (30) days from the date of receipt of this order, with interest at the rate of 9% p.a. from 26-05-2022 (date of filing the complaint) till the date of the payment to the complainant.

After making the payment to the complainant, the OP-2 shall be at liberty to recover the said amount from OP-1 on pro-rata basis in accordance with law;

2. OP-2 (Axis Bank Ltd) is also directed to pay Rs.100000/-(Rupees One Lakh only) as compensation to the Complainant, for the mental pain, agony and harassment caused by the OP-2.

 

XVIII). It is clarified that if the above said amount is not paid by the OP-2 to the Complainant within the period as directed above, the OP-2 shall be liable to pay interest @12% per annum from the date of expiry of 30 days period.

 

XVII).  We also feel appropriate to impose cost of Rs.100000/- (Rs. One Lakh only) upon the OP-2 for its attempt to misguide the commission. It further clarified that out of this amount of cost, Rs.50000/- (Rs. Fifty Thousand only) shall be paid to the complainant and remaining Rs.50000/- (Rs. Fifty Thousand only) shall be deposited in the “State Consumer Welfare Fund (L/Aid), SBI Account No.10310544717, IFSC No.SBIN0018175” within 30 days from the receipt of this order. It is clarified that if this amount is not paid to the Complainant & deposited in “State Consumer Welfare Fund (L/Aid) respectively, by the OP-2 within the period as directed , the OP-2 shall be liable to pay interest @12% per annum on this amount also from the date of expiry of 30 days period.

 

XIX).   Let a copy of this order be also sent to the Commissioner of Delhi Police, Delhi Police HQ, Jai Singh Road, New Delhi-110001 to examine the conduct of the Axis Bank in this case, in light of the terms of the MoU signed by it with Delhi Police for providing life insurance & other benefits to Delhi police staff.

XIX.    Order be given dasti to the parties in accordance with rules. Order be also uploaded on the website. Thereafter, file be consigned to the record room.

 

                          ASHWANI KUMAR MEHTA                                           HARPREET KAUR CHARYA

                                        Member                                                                                    Member      

                               DCDRC-1 (North)                                                                      DCDRC-1 (North)

 

DIVYA JYOTI JAIPURIAR

President 

DCDRC-1 (North)