PER:
Nidhi Verma, Member
1 The complainants have filed the present complaint by invoking the provisions of Consumer Protection Act under Section 11 and 12 against the opposite parties on the allegations that the complainant No.1 alongwith her husband Maskeen Singh are having joint bank account bearing No. 01182151012527 with the opposite party No.1 since 18.12.2008. The complainant No 1 is wife of deceased Maskeen Singh, complainant No.2 & 3 are minor children and proforma OP No. 3 is mother of the deceased Maskeen Singh. The deceased Maskeen Singh got insured himself under Pardhan Mantri Suraksha Bima Yojna scheme for Rs.2,00,000/- through opposite party No.1 as the deceased was having bank account with it and the amount of premium of Rs. 12/- was deducted from the bank account of the deceased. The policy was accidental policy and benefit of accidental death was covered under the policy. There exists relationship of consumer qua the opposite parties. The deceased was working as cleaner on Truck/Trailer bearing No. PB46-K-9213 and he used to go with the truck. On 6.4.2017 the deceased alongwith driver Kulwant Singh S/o Surain Singh after loading Potatoes on their truck were going from Nainagudi to Tinsukhia Assam and unloaded the potatoes. They loaded coal on their truck/trailer and when the deceased Maskeen Singh was putting tarpol (tarpal) over the truck/trailer, high voltage electric wires which were passing over the truck pulled the iron pole, which was hold by Maskeen Singh for putting tarpal and due to said reason the deceased Maskeen Singh electrocuted and suffered burn injuries. On same day the deceased Maskeen Singh was got admitted in the Assam Medical College & Hospital, Dibrugarh, Assam and discharged from the hospital on 14.4.2017 Thereafter, the deceased was again admitted to PGI, Chandigarh on 8.5.2017 and from where he was discharged on 11.6.2017. Thereafter, the deceased Maskeen Singh remained under treatment at home and ultimately he succumbed to injuries on 22.11.2017. As the insured was covered under the policy for accidental death, the complainant No.1 approached the opposite party No. 1 and informed regarding the death, but the opposite party No. 1 did not do anything and even it did not disclose the opposite party No 2 with whom the policy was got issued. Few days back the complainant No.1 again approached the opposite party No.1 and requested to release the payment of claim amount, but the officials of opposite party No. 1 refused to pay the same without any rhyme and reason. As per government policy under PMSBY, the opposite parties are liable to release the claim amount under the policy, but inspite of repeated request till today, the amount has not been released by the opposite parties. The complainant has prayed as under:-
- The opposite parties may kindly be directed to release Rs. 2,00,000/- the amount covered under policy alongwith other benefits accrued on the policy alongwith interest at the rate of 18% P.A. in favour of complainant.
- Compensation to the tune of Rs. 50,000/- may be awarded to the complainant.
- The cost of the complainant also be awarded to the complainant.
Alongwith the complaint, the complainant has placed on record affidavit of complainant Kulwinder Kaur Ex CW1/A, self attested copy of bank passbook Ex C-1, self attested copy of OPD slip dated 06.04.2017 is Ex C2, self attested copy of discharge certificate of Assam Medical College Hospital, Dibrugarh, Assam dated 14.04.2017 is Ex C3, self attested copy of discharge certificate of PGI Chandigarh dated 11.6.2017 Ex. C-4, Self attested copy of Adhar Card of Kulwinder Kaur Ex. C-5, Self attested copy of Adhar Card of Gurlen Khehra Ex. C-6, Self attested copy of Adhar Card of Harleenpreet Kaur Ex. C-7.
2 Notice of this complaint was sent to the opposite parties and opposite party No. 1 appeared through counsel and filed written version by taking interalia pleadings that insurance business as its business is confined to what is listed out in Banking Regulation Act, 1949. Bank’s role is only as a facilitator/referral agent and the actual insurance is issued by the insurance company, i.e. opposite party No- 2. There exists no privity of contract between the complainant and the bank to claim the insurance from the bank i.e. this opposite party No- 1 and as such, the complaint cannot be filed against the opposite party No- 1 and liable to be dismissed on this count only. 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:-
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.
The accidental policy is issued by the Oriental Insurance Co. Ltd. and not by the Life insurance Corp. of India and on this score alone the complaint merits dismissal as the complainant has arrayed a wrong party in the complaint as OP No. 2. The deceased Maskeen Singh insured himself under Central Govt. Scheme. Oriental Bank of Commerce Tarn Taran in collaboration with Oriental Insurance co. provides the personal accident insurance policy for the customers of Oriental bank. The said policy is voluntary and at the sole discretion of the customer. The opposite party No. 1 is only a corporate agent/facilitator and the actual insurance is issued by the Oriental Insurance Co. Ltd and as such the present petition against the replying party is not maintainable . The complainant never visited or approached the Opposite Party No.1 with any such request. The claim is to be settled by the insurance company after due procedure on receipt of claim and prayed that the present complaint may be dismissed. Alongwith the written version the opposite party No. 1 has placed on record affidavit of Anil Kumar Gupta Branch Manager OBC Tarn Taran Ex. OP-1.
3 The opposite party No. 2 (Oriental Insurance Company) appeared through counsel and filed written version by taking interalia pleadings that the present complaint filed against OP No.2 is not legally maintainable because no cause of action has been disclosed qua OP No.2 by the Complainant. Hence the complaint is liable to be dismissed with Cost. In fact initially the complaint was filed only against OP No 1 Oriental Bank of Commerce Branch Amritsar Road Tarn Taran & Ors. However, at the instance of OP No.1, the OP no.2 has been added only as proper party by the complainant in the light of objections raised by OP No.2 in its written version. Except filing amended title there is no reference of any correspondence between the complainant and OP No.2. Moreover, till date neither the complainant nor O.P No.1 has supplied any alleged insurance policy. In case any such policy is produced, even then the OP No 2 has no role in the matter in this regard kind attention of this Commission is drawn towards Para No 5 of on merits in which it has been clearly mentioned by the OP that 'If there is accidental death then the bank forward claims to the insurance company. But case in hand death occurred due to burn injuries and the death also occurred after seven months of the accident (accident occurred on 6.4.2017) and death of Maskeen Singh happened on account of burn injuries on 22.11. 2017 so the bank did not forward the death claim to the insurance company and rejected the claim. From this it is very clear that in fact neither any claim lodged by the complainants with OP No.1 nor the same was rejected by it at its own level and no papers have ever been forwarded to OP No.2 which clearly shows that the OP No.2 never came into picture as far as the present complaint is concerned. The present complaint qua OP No.2 is liable to be dismissed being not maintainable. There is no question of deficiency in service on the part of OP No.2. Neither the complainants nor the opposite party No.1 were ever approached to the opposite party No.2 and informed it regarding the death of Maskeen Singh. The opposite party No. 2 has denied the other contents of the complaint and prayed for dismissal of the same. Alongwith written version, the opposite party No. 2 has placed on record affidavit of Manmohan Jeet Singh Lehri Sr. Div. Manager of OP No. 2 Ex. OP2/1.
4 The opposite party No. 3 appeared through counsel and filed written version by taking interalia pleadings that the complainants and opposite party No. 3 are legal heirs of successors of deceased Maskeen Singh. During his life time he did not execute any will or letter of administration of his estate after his death, as such the complainants and opposite party No. 3 are entitled for claim in equal shares and prayed that the claim amount may kindly be awarded in favour of all three complainants and opposite party NO. 3 in equal shares in the interest of justice.
5 We have heard the Ld. counsel for the complainant and opposite parties and have carefully gone through the record placed on the file.
6 In the present complaint, deceased Maskeen Singh husband of complainant No.1 covered under the policy for accidental death as per Government policy PMSBY (Pardhan Mantri Suraksha Bima Yojna) for Rs2,00,000/- through OP No.1 as the deceased was having bank account with it and the amount of premium of Rs12/- was deducted from the bank account.
7 On dated 6 April 2017 the deceased along with driver kulwant Singh after loading potatoes on their truck were going from Nainagudi to Tinsukhia Assam and unloaded the potatoes. They loaded coal on their truck and when the deceased Maskeen Singh was putting tarpal over the truck, high voltage electric wires which were passing over the truck pulled the iron pole which was held by Maskeen Singh for putting tarpal and due to said reason the deceased Maskeen Singh electrocuted and suffered burn injuries. On same day Maskeen Singh was got admitted in the Assam Medical College and hospital Dibrugarh Assam and discharged from the hospital on 14th April 2017. Thereafter the deceased was again admitted to PGI Chandigarh on 8th May, 2017 and from where he was discharged on 11th June, 2017. Thereafter the deceased Maskeen Singh remained under treatment at home and ultimately he succumbed to injuries on 22nd Nov2017.The complainant No.1 approached the OP No.1 and informed regarding the death but the OP No.1 did not do anything and even it did not disclose the matter with the OP No.2 from whom the policy was got issued.
8 OP No.1 stated in their written version that Oriental Bank Of Commerce Tarn Taran in collaboration with Oriental Insurance Company provides the personal accident insurance policy for the customer of Oriental Bank. The said policy is voluntary and at the sole discretion of the customer. The replying party is only a corporate agent and the actual insurance is issued by the Oriental Insurance Company Ltd. and as such the present petition against the replying party is not maintainable. Further, OP NO.1 denied the fact that the complainant approached the bank for the claim.
9 OP No.2 stated in their written version that neither the complainant nor the OP No.1 have ever approached to the OP No.2 and informed the death of Maskeen Singh. It is pertinent to mention here “If there is accidental death then the bank forward claim to the insurance company but in case in hand death occurred due to burn injuries and the death also occurred after 7 months of the accident and death of Maskeen Singh happened on account of burn injury on 22nd November 2017 so the bank did not forward the death claim to the insurance company and rejected the claim”. From this it is very clear that in fact neither any claim lodged by the complainants with opposite party NO.1 nor the same was rejected by it and no papers have ever been forwarded to OP NO.2 which clearly shows that the opposite party No.2 never came into picture as far as the present complaint is concerned.
10 We have gone through the rival contentions of the parties. It is observed that the complainant has not placed any claim form to get the claim of the deceased Maskeen Singh with the O.Ps, no policy documents are placed on record by the complainant. Further, no death certificate was also placed on record by the complainant. To prove her point the complainant placed on record the bank statement (Ex.C1) where premium of Rs12/- was deducted under the renewal of PMSBY on dated 30/5/2016 , copy of OPD slip on dated 06/04/2017 Assam Medical College & Hospital, Dibrugarh (Ex.C2), discharge certificate of Assam Medical College & Hospital, Dibrugarh dated 14.04.2017 (Ex.C3), Discharge certificate of PGI dated 11.06.2017 (Ex.C4). But if we go through the written reply by O.Ps they did not denied the fact that the policy was issued, death of the deceased Maskeen Singh and treatment done after the accident. The only defence taken by the parties are:-
11 OP No.1 – The bank(OP No.1)is an agent and the insurance is issued by the Oriental Insurance Company (OP No.2 ). OP NO.2 – No claim form have ever been forwarded to insurance company by OP No.1 and the complainant. On the above basis and taking into consideration the fact that method and operation of the insurance is of collaborative constitution, neither of the parties can escape from it’s culpability to pay the insurance claim to the complainant. By denying the fact that the complainant never approached the OP NO.1 for the claim , cannot make a justification for not forwarding or processing the insurance claim of the complainant. If policy is issued and death happened it is the responsibility of the bank to process the claim form after getting complete documents from the complainant and forward the same to the Insurance Company. Rejecting the claim of the complainant or by merely replying to the complainant that bank cannot do anything in this regard without any investigation and process of claim form , clearly proves deficiency in the service and unfair trade practice on the part of the bank – OP NO.1
12 OP No.1 collected the premium amount from the complainant on the behalf of OP No.2 and cannot shift his responsibility on the OP NO.2 by merely saying that the bank is an agent and the actual insurance is issued by the Oriental Insurance Company Ltd. We may considered that due to the lack of knowledge the complainant failed to provide the complete set of documents on record or to submit the claim form to the OPs to process the insurance claim of the deceased Maskeen Singh. Further, no policy terms and conditions are placed on record by both the parties. Hence , point mentioned by the OP NO.2 has no relevant stand that , “ death occurred after 7months of the accident, so the bank did not forward the death claim to the insurance company and rejected the claim”. OP NO.2 clearly mentioned that the death of Maskeen Singh happened on account of burn injuries and not denying the fact that the same burn injuries are due to the accident happened on dated 06/04/2017 but still claim of the complainant is not processed by the O.Ps, clearly proves the deficiency in the service and unfair trade practice on the part of the insurance company OP NO.2 .
13 We cannot denied the fact that on dated 06/04/2017 deceased Maskeen Singh ,while putting tarpal over the truck electrocuted and suffered burn injuries. He survived from that accident at that time but again admitted to the hospital on dated 08.05.2017 due to same burn injuries and remained under treatment at home and ultimately succumbed to injuries which were received due to accident on dated 22.11.2017. Same fact was also admitted by the Op No.2 in their written reply that death of Maskeen Singh happened on account of burn injuries on 22.11.2017 but the only reason for not processing the insurance claim was that the death occurred after seven months of the accident . In the absence of terms and conditions of the insurance policy as not supplied by the O.Ps this point stands no justification for not processing the claim of the complainant. No where in the written reply of O.Ps mentioned that – if death happened after 7months of the accident then insurance company is not eligible to pay the claim. Moreover, Maskeen Singh insured under PMSBY scheme for Rs200,000/- and the policy was accidental policy and benefit of accident death was covered under the policy , deceased suffered burn injuries and he survived for 7months after the accident/burn injuries, it is not necessary that a person who met with an accident will die immediately after the accident. Moreover, Maskeen Singh died of burn injuries which may took long time to recover but in the instant case the Maskeen could not recovered from the burn injuries and died . Hence, it is established on the record that Maskeen Singh died after 7 months due to an accident.
14 The claim has not been decided so far and is still pending due to non providing of documents. In case Balu Waman Kadam vs. ICICI Lombard General Insurance Co. IV (2013) CPJ 16A (CN) (Mah.), the matter was similar, wherein the Insurance Company was asking the complainant to submit the documents again and again and the complainant was alleging that he had already submitted the requisite documents to the Insurance Company. In such circumstances, the Hon’ble State Consumer Disputes Redressal Commission Maharashtra disposed of the matter, by directing the Insurance Company to reconsider the claim of the complainant within one month on receipt of the required documents from the complainant. While relying upon the above said authority, the Hon’ble State Commission, Punjab, Chandigarh passed the similar orders in case M/s Trends, through its Proprietor vs The Oriental Insurance Company Limited & Anr. Consumer Complaint No.245 of 2015 decided on 04.08.2017; and M/s Gurbir Rice Mills v. United India Insurance Company Ltd. & Ors. Consumer Complaint No.404 of 2016, decided on 09.10.2017, directing the Insurance Company to reconsider the claim of the complainant after submission of requisite documents by the complainant to it.
15 In view of our above discussion as well as keeping in view the ratio of above said judgments, we are of the opinion that the ends of justice would be met, if the Insurance Company be directed to decide the claim of the complainant, after the complainant submit all the requisite documents. However, the opposite party No. 2 has not demanded the specific documents from the complainant and have not pleaded the required documents in their written version.
16 In view of the above discussion, the present complaint is disposed of with the direction to the complainant to submit the claim alongwith documents to the opposite parties No. 2-Insurance Company for deciding the claim within a period of 30 days from the date of receipt of copy of order and on approaching the complainant for supplying the requisite documents, the opposite party No. 2 will issue proper receipt acknowledging the same. The opposite parties No. 2 shall decide the claim of the complainant within a further period of two months therefrom and in case of failure on the part of the opposite party No. 2 the claim case of the complainant deemed to have been accepted. The opposite party No. 1 is also directed to co-operate the complainants in submitting the documents to the opposite party No. 2. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Commission and due to COVID-19. Copies of the order be furnished to the parties as per rules. File is ordered to be consigned to the record room.
Announced in Open Commission
25.05.2023
