DISTRICT CONSUMER DISPUTES REDRESSAL FORUM (CENTRAL)

ISBT KASHMERE GATE DELHI

CC/237/2017

Smt. Vedwati

W/o Sh. Attar Singh

R/o D-2/96, HarijanBasti,

KarawalNagar,

New Delhi-110094.                                                              …..COMPLAINANT

VERSUS

The Oriental Insurance Co. Ltd.

Having its regd. office at:

Oriental House,

A-25/27, Asaf Ali Road,

New Delhi.

The Oriental Insurance Co. Ltd.

Having its divisional office at:

4-E13, Azad Bhawan,

IInd Floor, Jhandewalan Extension,

New Delhi-110055.

Punjab National Bank

Through its Senior Manager,

Shalimar Bagh,

New Delhi-110088.                                                     …..OPPOSITE PARTIES

Quorum:     Ms. Rekha Rani, President

                   Ms. Manju Bala Sharma, Member

                   Dr. R.C. Meena, Member

ORDER

Ms. Rekha Rani, President

1. Instant complaint has been filed by Ms. Vedwati (in short the complainant) under Section 12 of the Consumer Protection Act 1986 (in short the Act) as amended up to date inter-alia pleading therein that she is the mother of Sh. Mukesh Kumar (her son) who was account holder with Punjab National Bank (in short OP3) vide bank account number 4184001700011500 in which she was a nominee. As per the Government policy, son of the complainant took an insurance cover under PMSBY scheme. In the middle of May 2015 he filed a proposal form. Insurance premium amount was deducted from the bank account of her son. Under the policy, the Oriental Insurance Co. Ltd. (in short OP1) was liable to pay Rs. 2,00,000/- to the legal heirs of the account holder in case of accidental death of the insured. Mukesh Kumar died by drowning in Yamuna River while taking bath. Complainant approached OPs for the release of the amount of Rs. 2,00,000/- under PMSBY Scheme. OPs repudiated her claim which is unlawful. Hence the instant complaint was filed seeking direction for OPs to pay her Rs. 2,00,000/- under the policy, Rs. 1,00,000/- as compensation for causing mental and physical agony and Rs. 21,000/- as litigation expenses.
2. Notice of the instant complaint was sent to OPs who appeared and contested the claim. OP1 and 2 vide their written statement pleaded that deceased Mukesh Kumar got himself insured under the PMSBY Scheme by paying the premium through auto debit system of OP3 Bank on 01/07/2015. It is further stated that as per records, the insured Mukesh Kumar died due to drowning in river on 28/06/2015 much prior to remittance of the premium to OP and as such the claim was rightly repudiated by the insurer vide its letter dated 21/10/2015. It is also stated that the deceased completed the declaration form vide which he agreed to verify declarations made therein and one such is that:

‘I agree that the cover shall commence from 1^st of the month subsequent to the date of enrolment in the scheme.’

It is submitted that although the deceased had completed the proposal form at the end of the month of June, 2015, but according to the said scheme, the cover under the policy commenced on 01/07/2015. It is also stated that claim form dated 01/09/2015 was jointly signed by OP3 and the complainant and at the end of the claim form it is written that:

‘Certified that the information relating to the nominee and the bank account is attested. The premium was debited from the bank account on 01/07/2015 and was sent to the insurer on 01/07/2015.’

          Further it is stated that according to the FSL report no. FSL/2015/ C5141 dated 21/11/2015, the deceased was found to have consumed alcohol and was intoxicated. The said report mentioned “On chemical microscope, TLC & GC-HS examination.  i). Exhibits ‘1A’, ‘1B’ & ‘1C’ were found to contain Ethyl Alcohol. ii). Exhibit ‘1C’ was found to contain Ethyl Alcohol 73.10mg/100ml. of and blood”. It is submitted that the policy excludes any injury or death under the influence of any intoxicating liquor or drug and as such the unfortunate demise of the deceased is excluded from the purview of the policy and the claim was rightly rejected by the insurer. It is also stated that in the certificate of insurance given in the scheme in question, the nominee has been mentioned as Attar Singh, who is presumably the father of the deceased and not the complainant therefore the complainant has no legal status to file the complaint against OPs. 

3. We have heard Sh. Mithilesh Singha, counsel for OP1 and 2.  Parties have adduced evidence by way of affidavits.
4. Insurer (OP1 and 2) have placed on record copy of certificate of insurance which reads as follows:

‘Nominee: Relationship ATTAR SINGH’

          It is argued on behalf of the complainant that complainant is one of the legal heirs of the deceased and is entitled to receive the claim amount. Since the nominee as per certificate of insurance is Attar Singh, the complainant is not entitled to the claim amount.

Rules for PMSBY scheme are placed on record as Anxxure-R1.  Under the head Premium, it provides: “Rs. 12/- per annum per member.  The premium will be deducted from the account holder’s savings bank account through ‘auto-debit’ facility in one instalment on or before 1^st June of each annual coverage period under the scheme.  However, in the case where auto debit takes place after 1^st June, the cover shall commence from the first day of the month following the auto debit.  In the instant case premium was paid to OP1 and 2 through auto debit system of OP3 bank on 01.07.2015 as is evident from bank statement of the deceased placed on record.

The deceased expired on 26/06/2015 i.e. before the policy commenced and became effective. Accordingly the claim of the complainant is rightly repudiated. Copy of this order be sent to the parties as statutorily required.  File be consigned to record room.

          Announced this      Day of                   2019.