BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KAITHAL.
Complaint No.82/17.
Date of instt.:27.3.2017.
Date of Decision: 27.10.2017.
Santosh wd/o (nominee) late Shri Rampal s/o Shri Vir Singh, r/o village Karora, Tehsil Pundri, Distt. Kaithal.
……….Complainant.
Versus
- Sarva Haryana Gramin Bank, Karora, Distt. Kaithal.
- Bajaj Allianz Life Insurance Co. Ltd., Ambala Road, Kaithal.
..……..Opposite Parties.
COMPLAINT UNDER SEC. 12 OF CONSUMER PROTECTION ACT, 1986.
Before: Sh. Rajbir Singh, Presiding Member.
Smt. Harisha Mehta, Member.
Present : Shri Vinod Bura, Advocate for complainant.
Op No.1 ex parte.
Shri C.S. Kala, Advocate for Op No.2.
ORDER
(RAJBIR SINGH, PRESIDING MEMBER).
The complainant has filed the present complaint under Section 12 of Consumer Protection Act, 1986, with the averments that her husband had an account bearing No.82710100000473 with Op No.1. It is alleged that at the time of opening of said account, Op No.1 issued a policy No.0119486435 to her husband. It is further alleged that on 11.02.2017, her husband was died and when she contacted the Op No.2, they refused to pay the amount of insurance. It is further alleged that Op No.2 admitted that they have received the premium of year 2013, 2014 and 2015, but they did not receive any premium from bank of 2016 year and the same is also clear from account statement of her husband’s account, so due to fault and negligent act of Ops, premium of year 2016 was not paid. This way, the Ops are deficient in service. Hence, this complaint is filed.
2. Upon notice, initially Op No.1 appeared through counsel, but on 01.06.2017, no one appeared on his behalf and Op No.1 was proceeded against ex parte on that date. Op No.2 appeared and filed the reply raising preliminary objections with regard to maintainability; non-joinder and mis-joinder; cause of action as death of Ram Pal was never intimated to Op and no proof of death and other mandatory claim papers/documents were ever submitted to Op and thus, Op had no opportunity to examine the admissibility of the claim as per terms & conditions of the policy; that complainant has no locus standi to file the present complaint as there is no privity of contract between complainant and Op No.2 and the contract of insurance company entered into Op No.1 and Op No.2 under Group Master Policy No.0119486435, thus complainant is not a consumer of Ops. On merits, the other contents of the complaint are denied and so, prayed for dismissal of complaint.
3. In support of his case, the complainant tendered in evidence affidavit Ex.CW1/A; documents Ex.C1 to Ex.C6, Mark C-1 and closed evidence on 18.07.2017. On the other hand, Op. No.2 tendered in evidence affidavit Ex.RW1/A; documents Mark R1 and closed evidence on 27.09.2017.
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 argued that husband of the complainant had an account with Op No.1 and at the time of opening of said account, Op No.1 issued a policy to the husband of the complainant. It is further argued that on 11.02.2017, husband of complainant was died and when complainant contacted Op No.2, they refused to pay any amount of life insurance.
6. On the other hand, ld. counsel for the Op No.2 argued that the case of complainant is pre-mature as intimation regarding death of Ram Pal was never given to Op either by the complainant or the master policy holder. It is further argued that no proof of death and other mandatory claim papers/documents were ever submitted to Op, that’s why Op had no opportunity to examine the admissibility of the claim. It is further argued that complainant has no locus standi to file the present complaint as there is no privity of contract between complainant and Op No.2 and the contract of insurance company entered into Op No.1 and Op No.2 under Group Master Policy No.0119486435, thus complainant is not a consumer of Ops.
7. From the pleadings and evidence of the case, it is clear that the husband of complainant had a bank account bearing No.82710100000473 with Op No.1 and the copy of passbook is Ex.C1. It is also clear that the husband of the complainant get himself enrolled as member of “Swayam Shakti Suraksha” Group Insurance Scheme administered by Gurgaon Gramin Bank under Master Policy No.0119486435 covered by Op No.2 vide Certificate of Insurance Ex.C2. It is pertinent to mention here that copy of said policy (with all the policy terms & conditions) was also produced by Op No.2 as Mark R-1. The husband of complainant was died on 11.02.2017 which is clear from Death Certificate Ex.C4.
8. The complainant alleges that the premium was to be paid by Auto Debit Terms and there was no need to go to the Op No.2 to deposit the premium amount and it was the mutual understanding between the Ops to pay and receive the premium amount in time. The complainant further alleges that the Op No.2 received the premium directly from Op No.1 for the year 2013, 2014 and 2015, as is clear from the copy of Account Ledger Inquiry Ex.C3, but for the year 2016, the Op No.1 has paid the premium amount on 18.3.2017 as is clear from Ex.C5 i.e. after the death of husband of the complainant. The ld. counsel for complainant contended that when the Auto Paid Facilities was adopted by the insured, then it is a fault of Op No.1 and Op No.2 did not issue any notice about the same to the deceased insured. It is pertinent to mention here that in this regard, the Op No.2 has raised no objection in his reply that the Op No.2 has not received any premium for the year 2016.
9. Ld. counsel for Op No.2 contended that as per policy terms & conditions, intimation regarding death of Ram Pal was never given to Op No.2 and due to that reason, the Op No.2 had no opportunity to examine the admissibility of the claim and so, the present complaint of the complainant is pre-mature. To prove his contention, the Op No.2 placed on the file copy of said policy with all the policy terms & conditions as Mark R-1. In the head “Claim Procedure” it is mentioned that the insurer shall be liable to pay the death benefit subject to the submission of following documents by the policy holder and to the satisfaction of the insurer:
(i) “Written notice within 180 days of the death of the Member, and the circumstances resulting in the death of the Member”.
(ii) The claimant’s proof of entitlement to receive the policy money.
(iii) Membership Certificate issued by the policy holder.
(iv) Original death certificate of the member certified by the competent authority.
(v) Medical cause of death certificate from the doctor last attending or the hospital in which the death occurred.
Any other relevant document or information as required by the insurer for the processing of the claim depending upon the cause of death.
10. Similar requirements are also mentioned in the Schedule of the policy in Clause 15 under the head “Payment of claim”. The complainant has failed to produce on the file any document from which it can be proved that the complainant had intimated the Op about death of his husband well in time as well as that the complainant has made any claim regarding the death of his husband with Op No.2. So, we found force in the contention of the Op No.2 that the complainant has neither intimated the Op No.2 as per the terms & conditions of the policy nor filed any claim before the Op No.2. Keeping in view the facts and circumstances of the case, we are of the considered view that the present complaint of the complainant is pre-mature as the complainant has not made any claim before the Op No.2.
11. Thus, as a sequel of above discussion, we dismiss the complaint being pre-mature. However, it is hereby made clear that if the complainant wants to file a claim regarding the matter in question, the complainant is at liberty to file the same before Op No.2 within 30 days from the date of receipt of copy of this order and in that eventuality, the Op No.2 is bound to settle the claim of the complainant within 30 days from its receipt and while counting any limitation, the period taken during the pendency of this complaint shall be excluded i.e. from 27.3.2017 the date of institution to 27.10.2017 the date of decision (both inclusive). 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.27.10.2017.
(Harisha Mehta), (Rajbir Singh),
Member. Presiding Member.
Present : Shri Vinod Bura, Advocate for complainant.
Op No.1 ex parte.
Shri C.S. Kala, Advocate for Op No.2.
Remaining arguments heard. Order pronounced, vide our separate order in detail of even date, the present complaint is dismissed being pre-mature. File be consigned to record-room after due compliance.
Dated:27.10.2017. Member Presiding Member.
