BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SIRSA.
Consumer Complaint no. 25 of 2021
Date of Institution : 04.02.2021
Date of Decision : 25.07.2023.
Sukhdev, aged 35 years son of Shri Mahender Lal, resident of village Jodhkan, Tehsil and Distt. Sirsa. Mobile No. 99920-70845.
……Complainant.
Versus.
1. The Oriental Insurance Company Ltd., Divisional Office Jawahar Market, opposite ‘D’ Park, Model Town, Delhi Road, Rohtak District Rohtak through its Senior Divisional Manager.
2. Haryana Gramin Bank, branch office village Jodhkan, Tehsil and District Sirsa through its Branch Manager.
...…Opposite parties.
Complaint under Section 35 of the Consumer Protection Act, 2019.
BEFORE: SH. PADAM SINGH THAKUR……..…PRESIDENT
SMT. SUKHDEEP KAUR………. …… MEMBER.
Present: Sh. G.S. Chahal, Advocate for the complainant.
Sh. Ravinder Goyal, Advocate for opposite party no.1.
Sh. S.L. Sachdeva, Advocate for opposite party no.2.
ORDER
The complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite parties (hereinafter referred as OPs).
2. In brief the case of the complainant is that Pradhan Mantri Suraksha Bima Yojana (PMSBY) is available to the people in the age group of 18 to 70 years with a bank account who give their consent to join/ enable auto debit. That father of complainant namely Mahender Lal son of Munshi Ram was an agriculturist having his agricultural land in village Jodhkan, Tehsil and District Sirsa. He was having his KCC account bearing No. 83011700004785 with op no.2. That as per above said scheme of Central Government, the insurance cover was also extended to his father and was insured with the op no.1 and accordingly an amount of Rs.12/- was deducted on 06.06.2015, 25.05.2016, 22.05.2017, 23.05.2018 and 23.05.2019 regularly by op no.2 bank from the account of deceased Mahender Lal and was transferred to the account of op no.1 against the said insurance. It is further averred that father of complainant died on 18.04.2019 in a motor vehicle accident and an FIR No.92 dated 18.04.2019 under Sections 279 and 304-A IPC was lodged in Police Station Sadar Sirsa. The post mortem of the deceased was also got conducted. So, the complainant being nominee of the deceased is entitled to get insurance amount of his father. That complainant applied to get insurance amount but the insurance company/ ops raised the objection that at the time of his death, the age of deceased was above 70 years, so the insurance amount cannot be released to him. In this regard, as per middle standard examination certificate issued by Education Department Punjab, the date of birth of deceased Mahender Lal is 08.03.1951 which is true and correct and as per death certificate of Mahender Lal he died on 18.04.2019. In this way at the time of his death his correct and accurate age was 68 years, 1 month and 11 days i.e. below 70 years. Hence, the complainant is entitled to get the insurance amount but this fact was also not accepted by the ops and they refused to release the insurance amount in question and wanted to grab the amount of insurance claim. Hence, this complaint.
3. On notice, ops appeared. Op no.1 filed written statement raising certain preliminary objections regarding maintainability, locus standi, suppression of true and material facts and estoppal and that op has rendered the claim of complainant as No Claim vide letter dated 17.7.2019 due to overage i.e. 72 years of the insured at the time of inception of policy no. 261200/48/19/250. On merits, it is submitted that on claim lodged by complainant being nominee of the deceased insured Mahender Lal, it was observed that the insured at the time of inception of the policy was more than 71 years of age as per his date of birth appearing on his Aadhar Card i.e. 01.01.1947. So, as per terms and conditions of the insurance policy, the insured being overage i.e. 72 years, therefore, the claim lodged by the complainant was rendered as No Claim vide letter dated 17.7.2019 in a legal and lawful manner. It is further submitted that the insured at the time of obtaining the above insurance policy had furnished his aadhar card as a proof of his date of birth and the date of birth of the insured as appearing on his aadhar card was taken on record. No alleged High school certificate was provided by the insured to the answering op at the time of insurance. This is afterthought story of the complainant. Remaining contents of complaint are also denied and prayer for dismissal of complaint made.
4. Op no.2 also filed written version raising certain preliminary objections. It is submitted that answering op has not charged any penny for itself on account of any insurance of the father of complainant and whatever amount has been deducted from the account of father of complainant same has been transferred to op no.1 for the insurance of the father of complainant under Pardhan Mantri Suraksha Beema Yojna. It is further submitted that complainant had informed the answering op with regard to death of his father on 23.05.2019 and accordingly the answering op lodged the claim form alongwith relevant documents for the payment of compensation on account of death of father of complainant with op no.1 immediately. That op no.1 raised objection with regard to age of the deceased which was informed to complainant. It is further submitted that it is insurance company who has charged insurance premium and same is still lying with the op no.1 and has not refunded till today. Hence it is insurance company who has to indemnify the loss if any to the complainant. Remaining contents of complaint are also denied and prayer for dismissal of complaint qua op no.2 made.
5. The complainant in evidence has tendered his affidavit Ex. CW1/A and copies of documents i.e. aadhar card of complainant Ex.C1, FIR Ex.C2, post mortem report Ex.C3, statements of accounts Ex.C4, Ex.C5, middle examination certificate of his father Mahender Lal Ex.C6, pass book of his father Ex.C7, death certificate of his father Ex.C8, document regarding scheme of PMSBY Ex.C9 and letter dated 17.07.2019 Ex.C10.
6. On the other hand, op no.1 has tendered affidavit of Ms. Puja Incharge Legal Hub as Ex. R1/A and copies of documents i.e. letter dated 17.07.2019 Ex.R1, document regarding scheme of PMSBY Ex.R2, aadhar card of Mahender Lal Ex.R3, details of Mahender Lal regarding his account number, date of birth etc. Ex.R4, consent cum declaration form Ex.R5.
7. Op no.2 has tendered affidavit of Sh. Manish Bansal, Manager as Ex. R2/A.
8. We have heard learned counsel for the parties and have gone through the case file carefully.
9. Undisputedly the father of complainant namely Sh. Mahender Lal was having his KCC account bearing no. 83011700004785 with op no.2 and as per scheme of Central Government namely Pradhan Mantri Suraksha Bima Yojna, the insurance cover was given to the father of complainant Mahender Lal and accordingly he was insured with op no.1 through op no.2. The insurance premium amount of Rs.12/- for the insurance of father of complainant for the first time was deducted by op no.2 bank from his above said account on 06.06.2015 and then it was subsequently deducted on 25.05.2016, 22.05.2017, 23.05.2018 and 23.05.2019 by op no.2 bank from the account of Mahender Lal and was paid to op no.1 insurance company which fact is also not dispute and is also proved from the statement of account of Mahender Lal as Ex.C4 and Ex.C5. In the said statements of account Ex,C4 and Ex.C5, it is mentioned that on 06.06.2015 the premium amount of Rs.12/- was deducted on account of insurance of Mahender Lal under PMSBY and thereafter on above said dates i.e. on 25.05.2016, 22.05.2017, 23.05.2018 and on 23.05.2019 the insurance premium amounts of Rs.12/- each were deducted on account of renewal of PMSBY for 2016-2017, 2017-2018 and 2019-2020 respectively. It is also proved on record that said Mahender Lal met with an accident on 18.04.2019 and died in the said accident and an FIR for the offences under Sections 279, 304A IPC was registered on the same date in Police Station Sadar Sirsa against unknown driver of a Bus and the copy of the said FIR is also placed on file by complainant as Ex.C2. The post mortem examination on the dead body of Mahender Lal was got conducted from Civil Hospital, Sirsa and PMR is also placed on file as Ex.C3 and death certificate of Mahender Lal is also placed on file as Ex.C6. The claim lodged by complainant being son and nominee of said Mahender Lal has been rendered as No Claim by the op no.1 insurance company on the ground of overage i.e. 72 years of the insured at the time of inception of policy in question. In this regard, op no.1 in order to justify its letter dated 17.07.2019 regarding No Claim has asserted that it was observed that the insured at the time of inception of the policy was more than 71 years of age as per his date of birth appearing on his aadhar card i.e. 1.1.1947. The op no.1 has further asserted that as per the terms and conditions of the insurance policy, the insured being overage i.e. 72 years, therefore, the claim lodged by complainant was rendered as No Claim vide letter dated 17.07.2019 in a legal and lawful manner.
10. Now the question arises for consideration that whether op no.1 insurance company has rightly closed the claim of complainant being No Claim or not? The complainant as well as op no.1 has placed on file a document regarding Pradhan Mantri Suraksha Bima Yojana (PMSBY) as Ex.C9 and Ex.R2 which stipulates as under:-
“The Scheme is available to people in the age group 18 to 70 years with a bank account who give their consent to join/ enable auto-debit on or before 31st May for the coverage period 1st June to 31st May on an annual renewal basis. Aadhar would be the primary KYC for the bank account. The rist coverage under the scheme is Rs.2 lakh for accidental death and full disability and Rs.1 lakh for partial disability. The premium of Rs.12 per annum is to be deducted from the account holder’s bank account through ‘auto-debit’ facility in one installment. The scheme is being offered by Public Sector General Insurance Companies or any other General Insurance Company who are willing to offer the product on similar terms with necessary approvals and tie up with banks for this purpose.”
11. Learned counsel for op no.1 during the course of arguments contended that from the above said document itself, it is clear that the scheme was available to people in the age group 18 to 70 years and the policy in question under the said scheme was to be renewed before 31st May for the coverage period 1st June to 31st May of every year but as Mahender Lal already crossed his age of 70 years before his death on 18.04.2019, therefore, he was not entitled for the insurance benefit of the above said scheme. The op no.1 has also placed on file copy of aadhar card of Mahender Lal as Ex.R3 in which the date of birth of Mahender Lal is mentioned as 01.01.1947. Whereas according to the complainant, as per Middle Standard Examination Certificate issued by Education Department Punjab, the date of birth of deceased Mahender Lal is 08.03.1951 which is true and correct and in this way at the time of his death his correct and accurate date was 68 years one month and 11 days i.e. below 70 years. In this regard complainant has also placed on file copy of said certificate of middle standard examination as Ex.C6 in which the date of birth of his father Mahender Lal is mentioned as 08.03.1951 according to which at the time of his death he was below 70 years of age. However, op no.1 has specifically asserted that insured at the time of obtaining the above insurance policy had furnished his aadhar card as a proof of his date of birth and the date of birth of the insured i.e. 01.01.1947 appearing on his aadhar card was taken on record and even if said assertion of op no.1 is admitted to be true for the sake of arguments even then op no.1 itself has accepted the premium amount of Rs.12/- on 23.05.2018 when as per said date of birth mentioned in the adhar card said Mahender Lal was above 70 years and even on 23.05.2019 i.e. at the age of more than 71 years the op no.1 has accepted the premium and has never refunded the premium amounts of Rs.12/- each received by it on 23.05.2018 and on 23.05.2019. When the op no.1 insurance company has accepted the premium amount for insurance of said Mahender Lal on 23.05.2018 and on 23.05.2019 on the basis of his aadhar card as per own version of op no.1 insurance company, therefore, we are of the considered view that op no.1 insurance company has to pay the insurance benefits for the death of said Mahender Lal insured to the complainant being his son and nominee. Moreover, at the time of inception of policy in question i.e. on 06.06.2015 even as per said adhar card, the deceased Mahender Lal was of the age of 68 years and thereafter the said policy in question is being continuously renewed by op no.1 after receiving premium amount of Rs.12/- for the subsequent four years i.e. of 2016, 2017, 2018 and 2019. When the insurance company can receive insurance premium after the overage of the insured against the terms and conditions of the policy, then it cannot deny the insurance benefits of the insured person after his death. Since the op no.1 was receiving the premium on the basis of entry of date of birth in the aadhar card and was renewing the policy in question after taking on record his adhar card and has not refunded the premium amounts and op no.1 has not justified receiving of premium amount after overage of insured, therefore, op no.1 is liable to pay insurance claim amount to the complainant. The complainant in this case is found entitled to receive insurance benefits of his deceased father on two grounds firstly because on the date of inception of policy even as per his aadhar card which the op no.1 claims to have taken on record, the age of insured was 68 years and then as per statements of account of insured the said policy has been continuously renewed by op no.1 after taking premium amounts. Secondly even if for the sake of arguments, it is admitted that the policy in question is not renewable and the age is considered on the year to year basis and is not available to a person after the age of 70 years, then also op no.1 is liable for payment of insurance claim since it has received premium amount against the terms and conditions of the policy and has not refunded the same to the insured till his death i.e. up to 18.04.2019 and was insuring him under the above said policy. When the aadhar card was already with op no.1 and op no.1 was receiving the premium on the basis of aadhar card, so now op no.1 cannot be absolved from its liability for its wrong act or mistake, if any. So the op no.1 has wrongly and illegally closed the case of complainant as No Claim. The complainant being son and nominee of deceased Mahender Lal is entitled to insurance claim amount of Rs.2,00,000/- (Rs. Two Lacs) from the op no.1 insurance company as per scheme of the policy in question on account of accidental death of his father.
12. In view of our above discussion, we allow this complaint qua opposite party no.1 and direct the op no.1 to pay the insurance amount of Rs.2,00,000/- to the complainant within a period of 45 days from the date of receipt of copy of this order, failing which complainant will be entitled to receive the said amount of Rs.2,00,000/- alongwith interest @6% per annum from op no.1 from the date of this order till actual payment. We also direct the op no.1 to further pay a sum of Rs.5000/- as composite compensation for harassment and litigation expenses to the complainant within above said stipulated period. However, no liabity of any kind of op no.2 towards the complainant is made out and as such complaint qua op no.2 bank stands dismissed. A copy of this order be supplied to the parties as per rules. File be consigned to the record room.
Announced: Member President,
Dated: 25.07.2023. District Consumer Disputes
Redressal Commission, Sirsa.
JK
