BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SIRSA.
Consumer Complaint no. 279 of 2020
Date of Institution : 09.11.2020
Date of Decision : 25.07.2024.
Ms. Raj Bala aged 42 years daughter of Shiv Charan (wife of Bharat Singh) resident of village Chuli Bagrian, Tehsil Adampur District Hisar at present resident of village & post office : Chaharwala, Tehsil Nathusari Chopta, District Sirsa. Mobile No. 98965-62160, Aadhar Card No. 9696 4953 6919.
……Complainant.
Versus.
1. Sarva Haryana Gramin Bank, Branch Office,Chuli Bagrian, Tehsil Adampur District Hisar through its Branch Manager.
2. The Oriental Insurance Company Limited, Divisional Office, Jawahar Market, opposite ‘D’ Park, Model Town, Delhi Road, Rohtak (Haryana) through its Divisional Manager.
...…Opposite parties.
Complaint under Section 35 of the Consumer Protection Act, 2019.
BEFORE: SH. PADAM SINGH THAKUR……..…PRESIDENT
SMT. SUKHDEEP KAUR………. …… MEMBER.
SH. OM PARKASH TUTEJA …………..MEMBER
Present: Sh. R.S. Bhaker, Advocate for the complainant.
Sh. Amit Sharma, Advocate for opposite party no.1.
Sh. R.K. Mehta, 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 brother of complainant namely Subhash son of Shiv Charan resident of village Chuli Bagrian, Tehsil Adampur, District Hisar was having his bank account bearing no. 81261700057454 with op no.1. The complainant is nominee of Subhash. That as per scheme of PMSBY, a sum of Rs.170/- was debited to the above mentioned account of Subhash and same was credited to the account of op no.2. The parents of Subhash have expired and only brother of Subhash also expired. The complainant is only sister of deceased Subhash who was unmarried and as such complainant being the only legal heir/ representative and dependent of deceased Subhash is entitled to the benefits of PMSBY. It is further averred that on 08.03.2020 Subhash after taking motor cycle bearing engine no. NF5NK1504094, chassis No. MD625PF52L3A39354 from Jai Automobiles, Mandi Adampur for trial purposes had left village Jandwala Bagar, Tehsil and District Fatehabad for village Chaharwala. He was driving the same carefully, cautiously on correct side of the road abiding all the traffic rules and at a moderate speed and when at about 6.00 p.m., the motor cycle reached at Jandwala Daiyar road one kilometer away from village Jandwala Bagar in village Jandwala Bagar, P.S. Bhattu Kalan, then all of a sudden a Neel cow came in front of the motor cycle due to which Subhash lost balance over the motor cycle and same struck into camel cart coming from the opposite direction. That Subhash sustained multiple, grievous and serious injuries on various parts of his body and he was taken to hospital where he was declared dead. It is further averred that post mortem of deceased Subhash was conducted vide PMR No. JPS/PMR/FTB/02/2020 dated 09.03.2020 by Medical Officer, General Hospital, Fatehabad and a DDR No. 14 dated 09.03.2020 was recorded in Police Station Bhattu Kalan, Tehsil and District Fatehabad. That complainant informed the ops about the death of her brother Subhash and requested the ops to give benefits of scheme of PMSBY but to the shock of complainant, her claim has been repudiated by op no.2 vide letter dated 11.09.2020 on false and flimsy grounds that Subhash Chander at the time of accident was driving the motor cycle and he was not having driving licence and said letter of op no.2 has been received by her from op no.1 vide its letter dated 18.09.2020. It is further averred that Subhash Chander was having valid and effective driving licence to drive the motor cycle but after his death she could not trace his driving licence and she cannot be deprived of the benefits of PMSBY in case of non production of driving licence of the insured deceased as only the death of the person insured is to be confirmed and verified which is not disputed even by ops. That the repudiation of claim of complainant by op no.2 is with a view to escape its liability of indemnifying the complainant and as such the impugned letter dated 11.09.2020 is wrong, against law and facts and against the terms of master policy and is null and void and is liable to be set aside and there is deficiency in service on the part of ops. Hence, this complaint.
3. On notice, op no.1 appeared and filed written statement raising certain preliminary objections regarding maintainability, locus standi, suppression of true and material facts, estoppal and that complainant is not consumer of answering op bank and that op no.1 bank is located at Chuli Bagrian, Tehsil Adampur, District Hisar and deceased Subhash was having his account with answering op at Chuli Bagrain, therefore, this Commission at Sirsa has no territorial jurisdiction to entertain and try present complaint. On merits, it is submitted that the Govt. of India launched a scheme known as Pardhan Mantri Suraksha Bima Yojna in which an amount of Rs.12/- was to be paid as insurance premium which was to be paid from the account of an account holder with the bank. It is incorrect, baseless, wrong and incorrect hence denied that a sum of Rs.170/- was debited in the said scheme. As a matter of fact, said amount was debited as per the instructions of the account holder Shri Subhash Chand by the Head Office of the Bank for some other purpose. It is further submitted that answering op on receipt of information about the death of the account holder, the case was referred to the Regional Office of the answering op bank at Rohtak and then the same was forwarded to the Oriental Insurance Company for settlement of the claim. The Oriental Insurance Company wrote letter dated 30.06.2020 to the complainant for supplying certain documents for settlement of her claim. Even the answering op also wrote letter dated 08.07.2020 to the complainant for providing certain documents to the insurance company, but the complainant failed to supply these documents to the insurance company. Therefore, the claim of complainant has been repudiated by insurance company due to non supply of required documents. It is further submitted that claim of complainant has been repudiated by the insurance company in a legal and lawful manner due to non supply of required documents as demanded by insurance company. It is further submitted that there was no deficiency in service on the part of answering op towards the complainant as the complainant is not consumer of the answering op. Remaining contents of complaint are also denied to be wrong and prayer for dismissal of complaint made.
4. Op no.2 also appeared and filed written statement raising certain preliminary objections that present complaint is not maintainable, deceased alleged to have been died in a road side accident while driving the motor cycle, but the complainant failed to submit the copy of driving license of deceased Subhash Chander or its particulars despite the letter dated 31.08.2020 issued by answering op and due to this very reason claim was repudiated, hence complaint is liable to be dismissed for want of any cause of action against answering op. It is further submitted that according to law and policy, terms and conditions and PMSBY guidelines issued by Govt. of India, insurance benefits are available to the members subject to the conditions specified in the policy document. Master policy holder in this case is Sarv Haryana Gramin Bank and as per claim procedure, claim form should be submitted to the insurance company within 30 days of occurrence and maximum time limit for insurance company to approve claim and disburse money thereafter in 30 days, but in this case date of accident is 08.03.2020 and intimation was given and claim form was submitted on 09.06.2020, thus claim is not tenable and payable as it was mandate by guidelines, policy, terms and conditions governing the payment and entitlement for the claim of death or otherwise as the case may be under PMSBY, hence answering op otherwise has no liability even in case complainant produces driving licence of deceased. It is further submitted that claim was submitted after three months of death by complainant through bank and for the delay, laches, lapses, violation of guidelines, term and conditions of policy, it is the only op no.1 bank which can be held liable for reimbursement of any amount of claim, in case any decision is taken on merit, ignoring the violation of guidelines and term and conditions of policy, as compliance of mandate given in the guidelines issued by Govt. of India would have been done by op no.1 by submitting the claim form to insurance company within 30 days. It is further submitted that there is no deficiency in service in any manner on the part of answering op or its officials, as claim lodged by complainant has been decided by Competent Authority according to term and conditions of policy, guidelines issued by Govt. of India and that complaint is false and frivolous and same is liable to be dismissed with costs qua answering op.
5. On merits, it is submitted that claim has been repudiated rightly as per terms and conditions of policy, guidelines issued by Govt. of India. Further according to the term and conditions of policy, claim form has not been submitted with answering op within 30 days, which was mandatory, hence answering op cannot be burdened with any kind of liability, even if complainant produces the copy of driving license of deceased. The claim of complainant has been repudiated in accordance with the norms and law of insurance as deceased was driving the motor cycle on public place without holding driving license. The complainant failed to submit the copy of driving license of deceased Subhash Chander or its particulars despite the letter dated 31.08.2020 issued by answering op. If deceased was having driving license, then complainant should submit the same or its particulars, but complainant failed to do so. It is further submitted that claim has been repudiated factually and as per norms of insurance, mentioning the major ground of having no Driving License as deceased died while driving the motor cycle and law never permits any person to drive any motor vehicle without driving license at public place. The pleas of preliminary objections are also reiterated, remaining contents of complaint are denied to be wrong and prayer for dismissal of complaint qua op no.2 made.
6. The complainant in evidence has tendered her affidavit Ex. CW1/A and copies of documents Ex.C1 to Ex.C14.
7. On the other hand, op no.1 has tendered affidavit of Sh. Rakesh Kumar, Branch Manager as Ex.R1 and copies of documents Ex.R2 to Ex.R8. Op no.2 has tendered affidavit of Ms. Pooja Tapwal, Incharge Legal TP Hub Ex.R9 and copies of documents Ex.R10 to Ex.R16.
8. We have heard learned counsel for the parties and have gone through the case file.
9. It has come on record that Subhash Chander now deceased brother of complainant was account holder of op no.1 bank and from the statement of account of Subhash Chander Ex.R8, it is evident that on 04.03.2020 an amount of Rs.12/- was deducted by op no.1 bank as premium under Pradhan Mantri Suraksha Bima Yojana (PMSBY) for insurance of said Subhash Chander with op no.2 insurance company. Though according to complainant as per said scheme, a sum of Rs.170/- was debited from the account of Subhash, but however, premium amount of Rs.170/- was deducted by op no.1 bank under PMSYM scheme as is evident from copy of pass book Ex.C1 and PMSYM card Ex.C2 and not for above said PMSBY scheme because under PMSBY premium amount of Rs.12/- was to be deducted. The said PMSBY scheme was launched by the Government of India on 01.06.2015 and premium amount of Rs.12/- is deducted in a year under said PMSBY scheme and was to be renewed every year and in case of death of insured, sum insured amount of Rs. two lacs is paid to the nominee/ legal heir of deceased and in case of permanent disability, an amount of Rs. One lac is given to the insured. It has also come on record that on 08.03.2020 i.e. during the period of above said policy Subhash Chander insured while driving a motor cycle met with an accident at Jandwala Daiyar road within the jurisdiction of Police Station Bhattu Kalan, Tehsil and District Fatehabad as all of a sudden a blue cow came in front of his motor cycle and he lost balance over the motor cycle and struck into a camel cart. Said Subhash sustained multiple, grievous and serious injuries on his various parts of body and he was taken to Civil Hospital, Fatehabad where he was declared as dead. His post mortem examination was conducted in Civil Hospital and post mortem report is also placed on file as Ex.C6 which reveals that said Subhash Chander received multiple and grievous injuries and Medical Officer has also given his opinion about cause of death that cause of death is due to hemorrhage and shock due to injuries. A rapat bearing No. 14 dated 09.03.2020 was also registered by Police Station Bhattu Kalan on the statement of Krishan Kumar son of Om Parkash cousin brother of deceased Subhash and copy of the same is also placed on record as Ex.C8. According to complainant as her brother Subhash insured under the said policy expired due to accident and her parents have already expired, therefore, being only legal heir of her brother she is entitled to the claim amount of Rs. two lacs under the policy. However, the claim of complainant has been denied by op no.2 vide letter dated 11.09.2020 mainly on the ground that Subhash Chander was driving the motor cycle at the time of accident and as per letter of claimant she has not found the driving licence of the deceased, so the claim is not tenable. However, we are of the considered opinion that op no.2 has wrongly repudiated the genuine claim of complainant. The complainant in her statement Ex.R15 which was got recorded by op no.2 has categorically stated that license was in the pocket of Subhash Chander at the time of accident and his clothes were removed at the time of post mortem and were thrown there due to which his driving license was lost. So the complainant has clarified the genuine reason of non availability of driving license of the deceased to op no.2. Since brother of complainant Subhash got insured himself under PMSBY policy as well as under PMSYM scheme by paying premium amount of Rs.12/- and Rs.170/-, therefore, it can easily be said that he was very vigilant about risks of life, therefore, it cannot be said that he was not having valid driving licence or that he was driving the motor cycle without driving licence. Moreover, there is no requirement of copy of driving license of the insured as per Pradhan Mantri Suraksha Bima Yojana (PMSBY) Claims Procedure placed on file. So, the op no.2 was wrongly asking the complainant to submit copy of driving license of deceased. Further more, the plea of op no.2 insurance company regarding delay in lodging the claim by complainant has also no substance because it is settled principle of law that op no.2 cannot reject the genuine claim on mere technicalities and because in the present case a sister has lost his young brother and as such she was under mental trauma and therefore, op no.2 is not justified to plead that there is delay in lodging the claim because there is no extra ordinary delay in lodging the claim and some delay occurred due to above said major tragedy. The death of brother of complainant took place on 08.03.2020 and admittedly complainant lodged her claim with the op no.1 bank on 09.06.2020 and delay, if any was for the reason that complainant lost his young brother and their parents had already expired and such delay therefore is not fatal. In so far as objection of op no.2 regarding jurisdiction of this Commission is concerned, the complainant is residing in village Chaharwala, Tehsil Nathusari Chopta, District Sirsa and as such this Commission has jurisdiction to entertain, try and decide the present complaint and as such objection of op no.2 is hereby repelled. Since the parents of the deceased have already expired, therefore, complainant being sister and only legal heir of deceased is entitled to the death benefits of his brother Subhash insured now deceased as Government of India launched the above said scheme covering the life risk of poor families and as such withholding of claim amount of complainant by op no.2 on above said false excuses is not justified. The complainant is entitled to death benefits of her brother as he died in personal accident and as such the repudiation of claim of complainant by op no.2 is hereby set aside.
10. In view of our above discussion, we allow the present complaint against opposite party no.2 and direct the opposite party no.2 to pay claim amount of Rs. two lacs alongwith other benefits to the complainant for the death of insured Subhash her brother within a period of 45 days from the date of receipt of copy of this order, failing which complainant will be entitled to all the benefits under the scheme alongwith interest @6% per annum from the date of this order till actual payment. We also direct the op no.2 to further pay a sum of Rs.10,000/- as composite compensation for harassment and litigation expenses to the complainant within above said stipulated period. However, no liability of op no.1 is made out and therefore, complaint qua op no.1 stands dismissed. A copy of this order be supplied to the parties as per rules. File be consigned to the record room.
Announced: Member Member President,
Dated: 25.07.2024. District Consumer Disputes
Redressal Commission, Sirsa.
