Chandigarh

DF-I

CC/471/2018

Sanjay Surin - Complainant(s)

Versus

Punjab National Bank - Opp.Party(s)

Gaurav Gupta

19 Sep 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I,

U.T. CHANDIGARH

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Consumer Complaint No.	:	CC/471/2018
Date of Institution	:	26/09/2018
Date of Decision	:	19/09/2019

 

Sanjay Surin S/o Sh. Joseph Surin, R/o H.No.273, Kachi Colony, Dhanas, U.T. Chandigarh.

…..Complainant

 

V E R S U S

 

 

Punjab National Bank, Branch Office, VPO Dhanas, Chandigarh, U.T. 160014, through its Manager.

…… Opposite Party

QUORUM:	RATTAN SINGH THAKUR	PRESIDENT
	MRS.SURJEET KAUR	MEMBER
	DR.S.K. SARDANA	MEMBER

                               

PRESENT	:	Sh. Gaurav Gupta, Counsel for Complainant.
	:	Sh. Ajay Sapehia, Counsel for Opposite Party.

 

PER SURJEET KAUR, MEMBER

1.         The facts, in brief, are, Smt. Bimla Surin wife of the Complainant was insured under Pradhan Mantri Suraksha Bima Yojna [PMSBY] and Pradhan Mantri Jeevan Jyoti Bima Yojna [PMJJBY] through OP-Bank for which OP-Bank debited premium of Rs.330/- and Rs.12/- towards the above said Insurance Schemes from her Bank Account No.1542001700057884 on 17.05.2016 (Annexure C-1). The Policies provide total cover of Rs.4 Lakh (Rs.2 Lakh) each to the Insured. Unfortunately, on 03.12.2016, Smt. Bimla Surin died after the delivery of child due to severe sepsis/insufficient blood flow (Annexure C-2). The Complainant being nominee and husband of the deceased Smt. Bimla Surin preferred claim with the Opposite Party and submitted all the documents on 30.03.2017 (Annexure C-3). However, when the Opposite Party failed to pay the claim amount, the Complainant got served a legal notice dated 17.09.2018 (Annexure C-8), but neither the said legal notice was replied nor the claim amount was paid. Alleging that the aforesaid acts amount to deficiency in service and unfair trade practice on the part of the Opposite Party, the complainant has filed the instant complaint.
2.         Notice of the complaint was sent to Opposite Party seeking its version of the case. 
3.         Opposite Party contested the complaint and filed its reply, inter alia, admitting the basic facts of the case. It has been pleaded the answering Opposite Party processed the claim of the Complainant under Pradhan Mantri Jeevan Jyoti Bima Yojana [PMJJBY] and had credited the amount of Rs.2 Lakh in the account of the Complainant on 28.09.2018. It has been urged that the Complainant is trying to avail benefit of the second scheme which is not permissible as Pradhan Mantri Suraksha Bima Yojana [PMSBY] is an accident insurance scheme which offers accidental death and disability cover in case of death or disability due to an accident. Hence neither the Complainant is entitled for claim nor did he apply for the same. Since the death of the account holder was not accidental one so Complainant is not entitled for the said claim. Claim of the Complainant whatever he applied vide Annexure C-3 has already been released to him. Thus, pleading that there is no deficiency in service or unfair trade practice on its part, Opposite Party has prayed for dismissal of the complaint.
4.         Controverting the allegations contained in the reply and reiterating the pleadings in the Complaint, the Complainant filed the rejoinder.
5.         The parties led evidence in support of their contentions.
6.         We have gone through the entire record and have also heard the arguments addressed by the Learned Counsel for the Parties.
7.         The sole grouse of the Complainant in the present Complaint is that the Opposite Party illegally and arbitrarily repudiated his genuine claim on untenable grounds.
8.         It is an admitted fact that the wife of the Complainant Smt. Bimla Surin was insured under Pradhan Mantri Suraksha Bima Yojna [PMSBY] and Pradhan Mantri Jeevan Jyoti Bima Yojna [PMJJBY] through OP-Bank for which it debited premium of Rs.330/- and Rs.12/- towards the above said Insurance Schemes from her Bank Account on 17.05.2016 as per Annexure C-1.
9.         It is important to note that the present Complaint was filed by the Complainant on 26.09.2018 and during the pendency of the case, the Opposite Party credited the amount of Rs.2,00,000/- in the account of the Complainant on 28.09.2018 under the Pradhan Mantri Jeevan Jyoti Bima Yojna [PMJJBY].
10.         As far as the claim of the Complainant with regard to the second scheme i.e. Pradhan Mantri Suraksha Bima Yojna [PMSBY], the Opposite Party took a plea that the same is not permissible as the said Scheme is an accidental insurance scheme which offers accidental death and disability cover in case of death or disability due to an accident.
11.         From the foregoings, it is evident that Opposite Party has admitted that the wife of the Complainant was insured under both the Policies. Per pleadings of the parties, there is no dispute about the fact that the wife of the Complainant died due to severe sepsis/insufficient blood flow after the delivery of her child.
12.         The Opposite Party throughout held its nerve contending that the person who dies in an accident will only be covered under the Pradhan Mantri Suraksha Bima Yojna [PMSBY]. However, we are not impressed with the same. We feel that delivery of child by female (mother) is a natural process, which may be normal delivery or Cesarean delivery and after proper medication and sufficient rest, as prescribed by the attending doctor, she becomes fit and fine to take proper care for her child and family. Accident, to our mind, means some sudden or unexpected event taking place or mishappening. In the case in hand, the death of the wife of the Complainant has occurred suddenly and was totally unexpected due to severe sepsis/insufficient blood flow after the delivery of her child.
13.         Hence, the act of the Opposite Party for repudiating the genuine claim of the Complainant to be not covered under the Pradhan Mantri Suraksha Bima Yojna [PMSBY] proves deficiency in service and unfair trade practice on the part of the Opposite Party which certainly caused unprecedented harassment to the Complainant and in turn resulted in the present unnecessary litigation.    
14.         For the reasons recorded above, we are of the opinion that the present Complaint must succeed. The same is accordingly partly allowed. Opposite Party is directed as under:-

1. To pay the claim amount under the Pradhan Mantri Suraksha Bima Yojna [PMSBY] to the Complainant.
2. To pay Rs.20,000/- to the Complainant as compensation for deficiency in service, mental agony and harassment caused to him;
3. To pay to the Complainant Rs.10,000/- as costs of litigation.

                The above said order shall be complied within 30 days of its receipt by the Opposite Party; thereafter, Opposite Party shall be liable for an interest @12% per annum on the amounts mentioned in sub-para [i] & [ii] above from the date of institution of this complaint, till realization, apart from compliance of the directions as per sub-para [iii] above.  

15.         Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room.

	Sd/-	Sd/-	Sd/-
19/09/2019	[Dr.S.K.Sardana]	[Surjeet Kaur]	[Rattan Singh Thakur]
	Member	Member	President
“Dutt”