BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KAITHAL.
Complaint no.64/17.
Date of instt.:02.03.2017.
Date of Decision:28.09.2018
- Sona wd/o late Shri Natha Ram Raj Kumar s/o late Shri Natha Ram;
- Rajesh Kumar s/o late Shri Natha Ram;
- Dilbagh s/o late Shri Natha Ram;
- Geeta w/o Shri Sonu;
- Anita w/o Shri Kuldeep, all residents of village Dhand, near Railway Fatak, Solu Majra, Kaithal.
……….Complainants.
Versus
- Sarv Haryana Gramin Bank, village Dhand, Distt. Kaithal through his Branch Manager.
- Oriental Insurance Company, Divisional office: Jawahar Market, Opp. D-Park, Model Town, Delshi Road, Rohtak.
- Branch Manager, Oriental Insurance Company, Ambala Road, Kaithal.
……..Opposite Parties.
COMPLAINT UNDER SEC. 12 OF CONSUMER PROTECTION ACT, 1986.
Before: Shri Rajbir Singh, Presiding Member.
Ms. Suman Rana, Member.
Present: Shri Surender Gorsi, Advocate for complainant.
Shri Sunil Kumar, B.M. for Opposite Parties No.1.
Shri Sudeep Malik, Advocate for the opposite parties No.2 & 3.
ORDER
(RAJBIR SINGH, PRESIDING MEMBER).
The complainant has filed the present complaint under Section 12 of Consumer Protection Act, 1986, with the averments that complainant No.1 is widow and complainant No.2 to 4 are sons and complainant No.5 & 6 are daughters of deceased Amarnath@ Natha Ram. It is further alleged that zs in case of accidental death. It is further alleged that unfortunately said Natha Ram died on 12.6.2015 due to injuries suffered in a roadside accident. It is further alleged that the complainants are the only legal heirs of said Natha Ram and are entitled to the insurance amount of Rs.2,00,000/- under the PMSBY scheme from the OP. It is further alleged that the complainants duly lodged the claim with the OP bank but the Manager of Dhand bank are postponing the matter on one pretext or the other and finally refused to process the claim and misbehaved and said that the complainants may go to the Court to get the insurance amount of Rs.2,00,000/-. This way, the OPs are deficient in service. Hence, this complaint.
2. Upon notice, the opposite party No.1 appeared before this forum and filed reply raising preliminary objections regarding maintainability; locus standi; cause of action; that the complainant did not come to the Court with clean hands and they are guilty of suppression of true and material facts from this Court; that the complaint of complainant is not maintainable in the eyes of law in the present form against the OPs as the OP has paid the insurance premium amount to the Oriental Insurance Company, Divisional Office Jawahar Market, Opp D Park, Model Town, Delhi Road, Rohtak and the insurance company had insured the deceased Natha Singh under PMSBY; that the claim amount would be paid by the Oriental Insurance Company to the family of the deceased Natha Singh. On merits, the rest of the contents of the complaint are denied and prayed for dismissal the same.
It is pertinent to mention here that when the case was fixed for final arguments, the OP moved an application for impleading the Oriental Insurance Company as OP being necessary party and the said application was allowed vide order dt. 24.11.17. Accordingly, amended title filed and upon notice, the new impleaded parties i.e. OPs No.2 & 3 appeared before this forum and filed reply raising preliminary objections regarding maintainability; mis-joinder and non-joinder of necessary parties; locus standi; cause of action and jurisdiction. It is further submitted that the claim under the policy has already been repudiated vide letter dt. 31.3.2017 on the ground that as per policy conditions, all new accounts holders during the month will be covered w.e.f. the succeeding month on receipt of premium and in the present case, the premium was received on 08.6.15 whereas the alleged insured expired on 12.6.15 i.e. within the same month, hence the claim under the policy was rightly repudiated. On merits, the rest of the contents of the complaint are denied and prayed for dismissal the same.
3. In support of his case, the complainant tendered in evidence affidavit Ex.CW1/A and documents Mark CA to Mark CE and closed evidence. On the other hand, the OP No.1 tendered in evidence affidavit Ex.RW1/A and document Mark R1 to Mark R4 and closed evidence. The OPs No.2 & 3 tendered in evidence affidavit Ex.RW1/A and documents EX.R1 to Ex.R4 and closed evidence.
4. We have heard ld. counsel for both the parties and perused the case file carefully and minutely and have also gone through the evidence led by the parties.
5. Ld. counsel for the complainant reiterated all the points mentioned in the complaint. He further argued that complainant No.1 is widow and complainant No.2 to 4 are sons and complainant No.5 & 6 are daughters of deceased Amarnath@ Natha Ram. He further argued that deceased Natha Ram was having a regular running account with the OP No.1 bank and said Natha Ram insured with accidental insurance scheme by the said bank under the Pradhan Mantri Suraksha Bima Yojna for Rs.2,00,000/- and charged sum of Rs.12/- on 08.6.2015. He further argued that unfortunately said Natha Ram died on 12.6.15 due to injuries suffered in a roadside accident and the complainants are the only legal heirs of said Natha Ram and are entitled to the insurance amount of Rs.2,00,000/- under the PMSBY scheme from the OP. He further argued that the complainants duly lodged the claim with the OP bank but the Manager of Dhand bank are postponing the matter on one pretext or the other, finally refused to process the claim. This way, the OPs are deficient in services.
6. Ld. counsel for the OP No.1 has argued that the complaint of complainant is not maintainable in the eyes of law in the present form against the OPs as the OP has paid the insurance premium amount to the Oriental Insurance Company, Divisional Office Jawahar Market, Opp D Park, Model Town, Delhi Road, Rohtak and the insurance company had insured the deceased Natha Singh under PMSBY. He further argued that the claim amount would be paid by the Oriental Insurance Company to the family of the deceased Natha Singh and prayed for dismissal the same.
The ld. counsel for the OPs No.2 & 3 argued that the claim under the policy has already been repudiated vide letter dt. 31.3.2017 on the ground that as per policy conditions, all new accounts holders during the month will be covered w.e.f. the succeeding month on receipt of premium and in the present case, the premium was received on 08.6.2015, whereas, the alleged insured expired on 12.6.15 i.e. within the same month, hence the claim under the policy was rightly repudiated and prayed for dismissal the same.
7. From the pleadings and evidence of the parties, it is clear that husband of complainant No.1 namely Natha Ram (since deceased) was having a bank account with the OP No.1 and said Natha Ram got insured himself under the Pradhan Mantri Suraksha Bima Yojna (PMSBY) with the OPs No.2 & 3 on 07.05.2015 w.e.f. 01.06.2015 to 31.5.2016 and charged sum of Rs.12/- on 08.06.2015 for a sum of Rs.2,00,000/-, which are payable to his L.Rs, in case of his accidental death, vide original policy Ex.R1. The said insurer Natha Ram was died on 12.06.2015 vide Death Certificate Mark CA. The complainants produced a copy of PMR of deceased Natha Ram as Mark CD on the case file and on perusal of said PMR, it is crystal clear that the death of Natha Ram was a accidental death. The LRs of deceased Natha Ram submitted the claim with the OPs, but the OPs repudiated their claim vide repudiation letter dt. 31.3.2017 Ex.R2. The ld. counsel for the OPs No.2 & 3 has contended that as per policy conditions, all new accounts holders during the month will be covered w.e.f. the succeeding month on receipt of premium. He further contended that in the present case, the premium was received on 08.6.2015, whereas, the insured Natha Ram was expired on 12.6.2015 i.e. within the same month, so, his claim under the policy was rightly repudiated by the OPs. As the OPs have repudiated the claim of the complainant, the onus to prove the grounds on which the claim was repudiated was upon the OPs. To prove the same, the OPs No.2 & 3 produced Rules for the Pradhan Mantri Suraksha Bima Yojna and its Clause “Premium” reads as under:-
Premium: Rs.12/- per annum per member. The premium will be deducted from the account holder’s saving bank through ‘auto debit’ facility in one installment on or before 1st June of each annual coverage period under the scheme. However, in case where auto debit takes place after 1st June, the cover shall commence from the first day of the month following the auto debit.
8. The OPs further produced copy of Consent-cum-Declaration Form Mark R-1 and as per that Declaration Form, the Date of Entry into the Scheme was 1st June/July/August/September, 2015, but the complainant entered into the scheme on 08.06.2015. The insurer Natha Ram also thumb marked underneath the said Declaration Form Mark R-1, wherein, it is clearly mentioned that “I agree that the cover shall commence from the 1st of the month subsequent to the date of enrolment in the scheme”.
9. In the present case, the complainants admitted in their complaint that the premium of the policy in question of Rs.12/- was charged on 08.06.2015 by the OP bank and the insured Natha Ram expired on 12.6.2015 i.e. within the same month. Meaning thereby, as per above terms & conditions of the policy in question, the policy in question shall commence from 01st July 2015, because the premium of the policy was received on 08.06.2015, not on the 1st day of the same month. So, the OPs have rightly repudiated the claim of the complainants as per terms and conditions of the policy in question. In these facts and circumstances of the case, we are of the considered view that the OPs have not committed an error while repudiating the claim of the complainants as per terms and conditions of the policy in question. Hence, we found no deficiency on the part of OPs.
10. Thus, as a sequel of above discussion, we find no merit in the complaint and accordingly, the same is hereby dismissed. No order as to costs. A copy of this order be sent to both the parties free of costs. File be consigned to the record room after due compliance. Announced.
Dt.28.09.2018.
(Suman Rana) (Rajbir Singh)
Member. Presiding Member.
Present: Shri Surender Gorsi, Advocate for complainant.
Shri Sunil Kumar, B.M. for OP No.1.
Shri Sudeep Malik, Advocate for the opposite parties No.2 & 3.
Remaining arguments heard. Order pronounced, vide our separate order in detail of even dated, the present complaint is dismissed. File be consigned to record-room after due compliance.
Dated:28.09.2018. Member. Presiding Member.
