Chandigarh

StateCommission

A/235/2019

Punjab National Bank - Complainant(s)

Versus

Sanjay Surin - Opp.Party(s)

Ajay Sapehia Adv.

24 Feb 2022

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

 

Appeal No.	:	235 of 2019
Date of Institution	:	16.10.2019
Date of Decision	:	24.02.2022

 

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

…..Appellant/Opposite Party.

Versus

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

…Respondent/Complainant.

 

 

BEFORE:    MRS. PADMA PANDEY, PRESIDING MEMBER.

                   MR. RAJESH K. ARYA, MEMBER.

 

Argued by: (Through Video Conferencing):

 

Sh. Ajay Sapehia, Advocate for the appellant.

Sh. Karan Verma, Advocate for the respondent.  

 

PER  RAJESH  K.  ARYA, MEMBER

          This appeal has been filed by the opposite party (appellant herein), namely, Punjab National Bank against order dated 19.09.2019  passed by District Consumer Disputes Redressal Forum-I, U.T., Chandigarh (now District Consumer Disputes Redressal Commission-I, U.T., Chandigarh) (in short ‘District Commission’), vide which, consumer complaint bearing No.471 of 2018 filed by the complainant (respondent herein) namely, Sh. Sanjay Surin was partly allowed and the appellant was directed to (i) pay the claim amount under the Pradhan Mantri Suraksha Bima Yogna (PMSBY) to the complainant besides payment of (ii) Rs.20,000/- as compensation and (iii) Rs.10,000/- as cost of litigation. The order was to be complied with within 30 days from the date of receipt of its certified copy, failing which, the opposite party was made liable to pay the aforesaid amounts mentioned at (i) and (ii) alongwith interest @12% p.a. from the date of institution of the complaint till realization besides paying litigation expenses of Rs.10,000/-.

2.     Briefly stated the facts before the District Commission were that Smt. Bimla Surin wife of the complainant was insured under Pradhan Mantri Jeevan Jyoti Bima Yojna [PMJJBY] and Pradhan Mantri Suraksha Bima Yojna [PMSBY] through the opposite party - Bank for which the opposite party - 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). It was further averred that 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 - Bank and submitted all the documents on 30.03.2017 (Annexure C-3). However, when the opposite party - Bank 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.

3.             On the other hand, the opposite party – Punjab National Bank, in its reply, while admitting the factual matrix of the case, stated that it processed the claim of the complainant under Pradhan Mantri Jeevan Jyoti Bima Yojana [PMJJBY] and credited the amount of Rs.2 Lakh in the account of the complainant on 28.09.2018. It was pleaded that the complainant is trying to avail benefit of the second scheme which is not permissible as Pradhan Mantri Suraksha Bima Yojana [PMSBY] was accident insurance scheme which offers accidental death and disability cover in case of death or disability due to an accident. It was further pleaded that neither the complainant was entitled for claim nor did he apply for the same. It was further the case of the opposite party – Bank that 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.

4.     The order passed by the District Commission has been assailed by the appellant/opposite party - Punjab National Bank on the ground that the District Commission has travelled beyond pleadings as it failed to consider and peruse Annexure C-2, which was Medical Certificate of cause of death, wherein it was specifically mentioned that the manner of death was natural , as such, the District Commission wrongly allowed the claim of the complainant. It has further been stated that further the District Commission failed to peruse the guidelines, procedure for accidental insurance claim under PMSBY wherein in column IV, it has been specifically mentioned that the claim form under PMSY shall be supported by the original FIR/Panchnama, Postmortem Report and death certificate and in case of permanent disability, original FIR/Panchnama and a Disability Certificate issued by a Civil Surgeon was required. It has further been stated that the District Commission failed to deliver justice by ignoring mandatory guidelines and procedure to be followed for processing the claim.

5.                On the other hand, Counsel for the respondent/complainant has submitted that the District Commission after due appreciation of facts and law has rightly passed the order and the same is liable to upheld and the appeal is liable to be dismissed.

6.                After hearing the Counsel for the parties and having gone through the material available on record and the written arguments of the both the parties very carefully, we are of the considered view that the appeal is liable to be accepted  for the reasons to be recorded   hereinafter. Perusal of the Pradhan Mantri Suraksha Bima Yogja (PMSBY) for Accidental Insurance Coverage of Rs.2,00,000/-, at Page 33 of record of District Commission, abundantly makes it crystal clear that the said Yojana (PMSBY) provides coverage of Rs.2 lacs for accidental death or full disability and Rs.1 Lac for partial disability on payment of premium of Rs.12/- per year. In the instant case, the wife of the complainant had been insured under two Yojnas i.e. Pradhan Mantri Suraksha Bima Yojna (PMSBY) and Pradhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY). The claim of the complainant was duly processed and accepted and Rs.2 Lakhs were credited in his account on 28.09.2018 under Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY) as the claim under the said coverage was payable seeing the nature of death of the wife of the complainant after the delivery of child due to severe sepsis/insufficient blood flow. However, in our considered opinion, the nature of death of the wife of the complainant was not an accidental death. Had it been an accidental death, then her death claim would have been covered under the second Yojna i.e. Pradhan Mantri Suraksha Bima Yojna (PMSBY) as only accidental death claim(s) or full/partial disability claims were covered under this Yojna. In our considered opinion, the District Forum has failed to appreciate this Pradhan Mantri Suraksha Bima Yojna (PMSBY) and stipulations provided therein. When this Pradhan Mantri Suraksha Bima Yojna (PMSBY) did not cover the nature of death of the wife of the complainant, then, how her death claim could be allowed to his husband (complainant) by the District Forum under any situation. The complainant cannot be allowed to be doubly benefited in such a manner as has been done by the District Commission while passing the impugned order. The complainant has already got the death claim of Rs.2 Lakhs of her wife under Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY). In our concerted view, the interpretation arrived at by the District Forum in its order that accident means some sudden or unexpected event taking place or mis-happening when correlating it with the nature of death of the wife of the complainant, cannot be accepted because the Pradhan Mantri Suraksha Bima Yojna (PMSBY) clearly stipulates the coverage for accidental death, which, as per our considered view, is an event that strictly occurs as a result of an accident. Thus, in view of the foregoing discussion, the appeal filed by the appellant/opposite party is liable to be accepted and the impugned order passed by the District Commission is liable to be set aside being not sustainable in the eyes of law.

7.                For the reasons recorded above, this appeal is allowed and the impugned order dated 19.09.2019 passed by the District Commission-I, U.T., Chandigarh in Consumer Complaint No.471 of 2018 is set aside. Consumer Complaint No.471 of 2018 stands dismissed with no order as to costs.

8.                Certified copy of this order be sent to the parties free of charge.

9.                File be consigned to the Record Room after completion.

Pronounced.

24.02.2022.

 (PADMA PANDEY)

       PRESIDING MEMBER

 

 

(RAJESH  K. ARYA)

MEMBER

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