Haryana

Kaithal

290/21

Saroj Goyal - Complainant(s)

Versus

Punjab National Bank - Opp.Party(s)

Sh.H.R Wadhwa

24 May 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KAITHAL

 

                                                                    Complaint Case No. 290 of 2021.

                                                                    Date of institution:   26.11.2021.

                                                                    Date of decision:      24.05.2024.

 

Saroj Goyal widow of Shri Sajjan Kumar Goyal, r/o H.No.655, near Community Centre, Sector-210, HUDA, Kaithal.

                                                                                      …Complainant.

                                                     Versus

 

1. Punjab National Bank, Ambala Road, Kaithal branch, through its Senior Branch Manager.
2. Life Insurance Company, through its Divisional Manager (P&GS) P &GS Department, Divisional Office-1, Jeevan Parkash Building, 6^th Floor, 25, Kasturba Gandhi Marg, New Delhi-110001.

...Opposite Parties.

 

          Complaint under Section 35 of the Consumer Protection Act

 

 

CORAM:   SMT. NEELAM KASHYAP, PRESIDENT.

                   SMT. SUMAN RANA, MEMBER.

                   SHRI SUNIL MOHAN TRIKHA, MEMBER.

                  

Present:       Shri Hem Raj Wadhwa, Advocate for the complainant.   

                   Shri Karan Kalra, Advocate for Opposite Party No.1.

                   Shri Sudeep Malik, Advocate for Opposite Party No.2.

                  

ORDER  -  NEELAM KASHYAP, PRESIDENT:

          Complainant has filed this complaint under Section 35 of Consumer Protection Act, 2019, against the OPs.

2.                In the complaint, complainant alleged that her husband namely Sajjan Kumar Goyal had taken policy of Pardhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY) and Rs.330/- has been debited yearly from the saving bank account No.0248000111144570 with OP No.1 since 08.06.2015 and same was deposited with OP No.2. That said Sajjan Kumar Goyal died due to accident on 14.05.2021 and she being his nominee submitted the claim form dated 29.06.2021 with OP No.1 within time for payment of claim under PMJJBY scheme, but OP No.2 repudiated the claim as informed by OP No.1 through email. That at the time of taking the benefits of said scheme, Sajjan Kumar Goyal had given his Aadhaar Card and other documents, in which his date of birth has rightly been written as 05.06.1963, but OP No.1 has written the date of birth as 05.06.1966 and due to that reason, OP No.2 declined the claim of complainant. That the above act and conduct of OPs, of repudiating the genuine claim, amounts to gross deficiency in service, on their part, due to which, she suffered huge physical harassment, mental agony as well as financial loss, constraining her, to file the present complaint, against the OPs, before this Commission.

3.                Upon notice of complaint, OPs appeared and filed their respective written statements.

4.                OP No.1, in its written statement stated that the insurance under PMJJBY was got done by OP No.1 bank and premium in the sum of Rs.300/- p.a. was debited from SB Account of Sajjan Kumar Goyal  and same was further remitted to OP No.2 LIC, hence the liability of payment of compensation, if any, is of OP No.2 only. That the claim was rejected by OP No.2 on the ground that at the time of joining the scheme, the deceased was 52 years of age, whereas, the maximum age limit was 50 years. If the deceased was more than age limit at the time of joining i.e. 08.06.2015, the OP No.2 should not have insured him right from the beginning. That now after continuous insurance of about 6 years and taking premium, they are now avoiding their liability.

5.                OP No.2, in its written statement stated that all Saving Bank Account holders in the age group 18 years (completed) to 50 years (age nearer birthday) as on 01.06.2015 or on the subsequent date of joining the scheme are eligible to join the scheme. That in the present case, the master policy holder under PMJJBY scheme is OP No.1, who had to deduct the premium from the bank account of account holder Sajjan Kumar Goyal as per rules of scheme. That OP No.2 is the insurer chosen by the bank for the scheme. That as per rules, PMJJBY scheme was introduced by Government of India in 2015, age criteria to become member of scheme is 18 to 50 years. That at the time of enrolment of a member, the OP No.1 bank obtains consent cum declaration form and has to obtain age proof, which are retained by OP No.1 bank at its end. Only data is sent to LIC along with premium. That OP No.1 bank deducts premium of Rs.330/- per member per annum and remits Rs.289/- to OP No.2 and balance Rs.41/- is charged by OP No.1 bank as processing fee, hence, the amount retained by OP No.1 as processing fee holds them responsible for checking the eligibility criteria. That as per documents submitted by the Master Policy Holder i.e. OP No.1 bank along with claim forms, the age of deceased Sajjan Kumar Goyal at the time of becoming member of the PMJJBY scheme was more than 52 years and was not eligible for entering into scheme. That Sajjan Kumar joined the PMJJBY on 08.06.2015 and his date of birth is 05.06.1963 as per Aadhaar Card and PAN Card, so his age was 52 years 3 days on the date of entry into scheme. Hence, claim was rightly rejected and conveyed to the nominee. That OP No.1 bank should have not enrolled Sajjan Kumar Goyal at this age, rather, bank sent wrong date to LIC showing his date of birth as 05.06.1966 instead of correct age 05.06.1963. Hence, there is clear cut deficiency in service, on the part of OP No.1 bank.

6.                To prove the case, complainant tendered into evidence affidavit Ex.CW1/A alongwith documents Annexure-C1 to Annexure-C8.

7.                 On the other hand, OP No.1 tendered into evidence affidavit Ex.RW1/A and documents Annexure R21 to R24. OP No.2, in its evidence tendered affidavit Ex.RW2/A and documents Annexure R1 to Annexure R20.

8.                We have heard the learned counsel for the parties and perused the record carefully.

9.                Learned counsel for the complainant has argued that husband of complainant namely Sajjan Kumar Goyal had taken policy of Pardhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY) and Rs.300/- has been debited yearly from the saving bank account with OP No.1 since 08.06.2015 and same was deposited with OP No.2. He further argued that said Sajjan Kumar Goyal died due to accident on 14.05.2021 and the complainant, being his nominee, submitted the claim form dated 29.06.2021 with OP No.1 within time for payment of claim under PMJJBY scheme, but OP No.2 wrongly repudiated the claim as informed by OP No.1 through email. He further argued that at the time of taking the benefits of said scheme, Sajjan Kumar Goyal had given his Aadhaar Card and other documents, in which his date of birth has rightly been written as 05.06.1966, but OP No.1 has written the date of birth as 05.06.1966 and due to that reason, OP No.2 declined the claim of complainant, which amounts to gross deficiency in service, on the part of OPs.

10.              On the other hand, learned counsel for OP No.1 has argued that the insurance under PMJJBY was got done by OP No.1 bank and premium in the sum of Rs.300/- p.a. was debited from SB Account of Sajjan Kumar Goyal  and same was further remitted to OP No.2 LIC, hence the liability of payment of compensation, if any is of OP No.2 only. He further argued that the claim was rejected by OP No.2 on the ground that at the time of joining the scheme, the deceased was 52 years of age, whereas, the maximum age limit was 50 years. He further argued that if the deceased was more than age limit at the time of joining i.e. 08.06.2015, the OP No.2 should not have insured him right from the beginning. He further argued that now after continuous insurance of about 6 years and taking premium, they are now avoiding their liability. In order to support his above contentions, he placed reliance upon case laws titled Balwinder Singh Vs. The Life Insurance Corporatino of India and another, First Appeal No.1136 of 2004, DOD 11.05.2010 (Punjab State Commission); Life Insurance Corporation of India Vs. Lakhbir Kaur, First Appeal No.1696 of 2009, DOD 14.01.2014 (Punjab State Commission); Manish Goyal Vs. Max Bupa Health Insurance Company Limited, Complaint Case No.234 of 2017 DOD 22.03.2018 (Chandigarh State Commission).

11.              Learned counsel for OP No.2 has argued that as per rules, PMJJBY scheme was introduced by Government of India in 2015, age criteria to become member of scheme is 18 to 50 years. He further argued that at the time of enrolment of a member, the OP No.1 bank obtains consent cum declaration form and has to obtain age proof, which is retained by OP No.1 bank at its end. Only data is sent to LIC along with premium. He further argued that OP No.1 bank deducts premium of Rs.330/- per member per annum and remits Rs.289/- to OP No.2 and balance Rs.41/- is charged by OP No.1 bank as processing fee, hence, the amount retained by OP No.1 as processing fee holds them responsible for checking the eligibility criteria. He further argued that as per documents submitted by the Master Policy Holder i.e. OP No.1 bank along with claim forms, the age of deceased Sajjan Kumar Goyal at the time of becoming member of the PMJJBY scheme was more than 52 years and was not eligible for entering into scheme. He further argued that Sajjan Kumar joined the PMJJBY on 08.06.2015 and his date of birth is 05.06.1963 as per Aadhaar Card and PAN Card, so his age was 52 years 3 days, on the date of entry into scheme. Hence, claim was rightly rejected and conveyed to the nominee. He further argued that OP No.1 bank should have not enrolled Sajjan Kumar Goyal at this age, rather, bank sent wrong date to LIC showing his date of birth as 05.06.1966 instead of correct age 05.06.1963, hence, there is clear cut deficiency in service, on the part of OP No.1 bank.

12.              From the Statement of Account Annexure C-1, there is no dispute that Sajjan Kumar Goyal (DLA) had a saving bank account bearing No.0248000111144570 with OP No.1 and on 09.06.2015, DLA Sajjan Kumar Goyal had taken policy Pardhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY), from OP No.2, through OP No.1, and premium of Rs.330/- has been debited yearly, from the said account i.e. on 09.06.2015, 25.05.2016, 22.05.2017, 26.05.2018, 23.05.2019, 24.06.2020 and lastly on 22.05.2021. Said DLA Sajjan Kumar Goyal had expired on 14.05.2021, as is evident from his Death Certificate Annexure C-2. After his death, complainant Saroj Goyal, being his nominee, in PMJJBY scheme, lodged the claim form, with OPs for claim amount of Rs.2 lacs, vide Claim Form Annexure C-3, but OP No.2 rejected/repudiated the same and the same was communicated to the complainant by OP No.1, vide its letter dated 30.03.2022 Annexure C-7 and email Annexure C-8. However, PMJJBY scheme was introduced by Government of India in the year 2015 and in that scheme, the age criteria to become a member of scheme is 18 to 50 years, and in the case in hand, it is duty of OP No.1 bank to deduct the premium amount, under the scheme, from the saving bank account of policy holder along with declaration form, personal details and sent the same to OP No.2 insurance company.

13.              Learned counsel for OP No.2 has submitted that Sajjan Kumar joined the PMJJBY on 08.06.2015 and as per Aadhaar Card and PAN Card, his date of birth is 05.06.1963, but OP No.1 has shown his wrong date of birth as 01.09.1966 instead of correct date of birth 05.06.1963 and believing the version of OP No.1 to be correct, OP No.2 enrolled the said Sajjan Kumar Goyal under the PMJJBY scheme, but after the death of said Sajjan Kumar Goyal, when his nominee submitted the claim form along with his Aadhaar Card and PAN Card, then OP No.2 came to know that the correct date of birth of said Sajjan Kumar is 05.06.1963 instead of 01.09.1966 (which was submitted by OP No.1) vide document Annexure R-7, and since Sajjan Kumar had joined the said scheme on 08.06.2015, therefore, as per date of birth 05.06.1963, his age was 52 years 3 days, on the date of entry into scheme i.e. on 08.06.2015, which amounts to deficiency in service, on the part of OP No.1. Hence, OP No.2 has rightly repudiated the claim on this very ground.

14.              On the other hand, learned counsel for OP No.1 bank has firstly submitted that the DLA Sajjan Kumar Goyal was/is their customer from 15.05.2007 and at that time, as per documents, submitted by the complainant himself, his date of birth was 05.06.1966, as in the year 2007, Aadhaar Card was not in general use. In order to support his above contentions, learned counsel for OP No.1 has drawn attention of this Commission towards document Annexure R21 of Sajjan Kumar, wherein, the start from date is mentioned 15.05.2007 and the date of birth is 05.06.1966.

15.              Learned counsel for OP No.1 has drawn attention of this Commission towards Consent-Cum-Declaration Form as Mark-A and submitted that this form Mark-A is issued by RBI and in that form, in column “Applicant Details, as per Bank/KYC records”, there is specifically mentioned “Aadhar Number, if available”, meaning thereby, the RBI also believes that at that time every person was not having Aadhaar Card and said Sajjan Kumar has also not submitted his Aadhaar Card and what information has been provided by him, believing the same as correct, the same was forwarded to the OP No.2. Hence, there is no deficiency in service, on the part of OP No.1 bank.

16.              From the above pleadings of the parties, we found that it is admitted fact that DLA Sajjan Kumar Goyal was enrolled under the PMJJBY scheme, by the OPs, from the year 2015, and after that, every year, the OPs are deducting the premium amount of Rs.330/-, from his account and lastly deducted the same till the death of said Sajjan Kumar. Meaning thereby, after the death of said Sajjan Kumar Goyal, complainant being his nominee, was legally bound to receive the claim amount of Rs.2 lacs, under the said scheme, either from OP No.1 or from OP No.2, and when she (complainant) lodged the claim, in this regard, with the OPs, then they both (OPs) refused to pay the same and tried to shift the burden, from one to another.

17.              Learned counsel for OP No.1 has firstly contended that DLA Sajjan Kumar was opened his saving account with it in the year 2007 and at that time, the complainant had told his date of birth as 05.06.1966 and the same was entered in the record by OP No.1 bank, but it is pertinent to mention here that the Aadhaar Card was firstly launched by Government of India in the year 2010. However, after that, as per RBI guidelines, every customer/consumer has to update his KYC, in the bank concerned, where his/her account exists, by submitting his Aadhaar Card as well as PAN Card there. In the case in hand, to comply with the above guidelines of RBI, OP No.1 bank had also updated the KYC of said Sajjan Kumar Goyal (before his death), by taking his Aadhaar Card/PAN Card, and at that time, the correct date of birth has been come into the knowledge of OP No.1 bank. After coming to know the same, it was mandatory for OP No.1 bank to stop deducting the premium amount, under PMJJBY scheme, from the account of complainant, if he was not eligible for the same being aged above 50 years. But contrary to it, OP No.1 bank did not do so, rather, they kept deducting the premium amount of Rs.330/-, from the account of said Sajjan Kumar Goyal till his death and lastly deducted the premium on 22.05.2021, which amount to gross deficiency in service, on the part of OP No.1 bank.  

18.              Moreover, it was also mandatory for OP No.2 insurance company to verify all the personal details of DLA Sajjan Kumar Goyal (i.e. his date of birth, address, name etc.) from his documents, submitted by him, with OP No.1 bank, before accepting the premium amount of Rs.330/-, from OP No.1 bank under the said scheme. But contrary to it, OP No.2 insurance company did not do so, rather, they accepted all the premium amounts of DLA Sajjan Kumar Goyal, from the last seven years i.e. from 2015 till his death in the year 2021, which is still lying with OP No.2 till today, and now when DLA Sajjan Kumar Goyal has been expired and his wife, being nominee, lodged the claim with OP No.2, demanding the claim amount of Rs.2 lacs, under the said policy, they (OP No.2) at this belated stage, had wrongly repudiated the claim, on the flimsy ground that at the time of enrolment under the said scheme, the age of said DLA Sajjan Kumar Goyal was above 50 years. The above act and conduct of OP No.2 insurance company also amounts to deficiency in service, on its part.

19.              So, keeping in view the above facts & circumstances of the present case, we are of the considered opinion that OPs fell in error while repudiating the claim of the complainant, which amounts to gross deficiency in service, on the part of both the OPs. Since under the PMJJBY, the sum insured is Rs.2 lacs, therefore, both the OPs are liable to pay the said amount of Rs.2 lacs along with compensation + litigation expenses, to the complainant. The case laws, produced by OP No.1 are not applicable to the case in hand, being rested on different footings. 

20.              In view of our above discussion, we accept the present complaint and direct both the OPs to make the payment of claim amount of Rs.2,00,000/- (Rupees two lacs) along with compensation amount of Rs.5,000/- + litigation expenses of Rs.5,000/-, total Rs.2,10,000/-, jointly and severally, in equal shares of 50% each, to the complainant. Both the OPs are further directed to comply with the order of this Commission, within a period of 45 days positively, failing which, the total award amount shall carry interest @6% per annum, from the date of filing the present complaint, till its actual realization.

21.              In default of compliance of this order, proceedings shall be initiated under Section 72 of Consumer Protection Act, 2019, as non-compliance of Court order shall be punishable with imprisonment for a term which shall not be less than one month, but which may extend to three years, or with fine, which shall not be less than twenty five thousand rupees, but which may extend to one lakh rupees, or with both. A copy of this order be sent to the parties free of cost. File be consigned to the records, after due compliance.     

Announced in open Commission:

Dt.:24.05.2024.

                                                                                      (Neelam Kashyap)

                                                                                      President.

 

(Sunil Mohan Trikha).             (Suman Rana).              

Member.                                  Member.

 

Typed by: Sham Kalra, SSS.