PER:

Charanjit Singh, President

1        The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 34, 35 and 36  of the Consumer Protection Act (herein after called   as 'the Act') against the opposite parties on the allegations that the complainant is the widow of deceased Goldy son of Ram Murti and is unemployed having two minor children to look after and maintain. The deceased Goldy had been operating a saving bank account having account No. 37041027567 with the opposite party No. 2 and had also availed life insurance policy of the opposite party No. 1 through opposite party No. 2. The opposite party No. 1 issued a personal accident insurance policy to deceased Goldy by policy No. 12733199 by receiving first yearly insurance premium of Rs. 1,000/- debited from his above said saving account on 13.3.2018 and provided personal accident insurance cover of Rs. 20 Lakh to the deceased. As per the above mentioned personal accident insurance cover the opposite party No. 1 was to receive Rs. 1,000/- as premium annually for giving the cover of Rs. 20 Lakh to Goldy and this amount was to be debited from his above mentioned saving account annually by giving written permission to the opposite party No. 2 to get it debited every year for paying to the opposite party No. 1. Unfortunately, husband of the complainant Goldy died in a road side accident on 12.5.2021 and the complainant being the nominee in above said insurance policy approached the opposite party No. 1 through opposite party No. 2 for getting the insurance claim of the deceased Goldy from opposite party No. 1 and as such, lodged the insurance claim case with the opposite party No. 1. The opposite party No. 1 did not release any insurance claim to the complainant inspite of providing all the documents as required by it nor gave any response to the claim case for a long time. The complainant again approached the opposite party No. 2 for getting the insurance claim but this party told the complainant that as the annual premium of Rs. 1,000/- was not debited to be paid for insurance premium from the saving account of the deceased Goldy and as such due to nonpayment of premium the insurance claim could not be released to the complainant. The complainant told the opposite party No. 2 that this party was not permitted to debit Rs. 1000/- from the above mentioned saving account of the deceased to be paid as premium to be paid as premium to the opposite party NO. 1 and it was the responsibility of this party to get it debited regularly/ yearly and as such this party is very much liable to pay the personal accident insurance claim to the complainant if the opposite party No. 1 is not releasing it to the complainant. The complainant also obtained documents such as proposal form of the above mentioned policy alongwith insurance confirmation of this policy from the opposite party No. 1 under RTI Act, so as to get information regarding the permission of the deceased Goldy to get the premium auto debiting from his account annually and as such, as per the documents received under RTI it was confirmed that permission to get the premium debited from the saving account of deceased Goldy was never cancelled or recalled through any written letter to the opposite party No. 2 and as such, it proves that the opposite party No. 2 did not debited amount of Rs. 1,000/- for the year 2020-21 and as such it was fault on the part of this party for nonpayment of insurance premium to the opposite party No. 1. The complainant issued a letter to the opposite party No. 2 on 7.1.2022 through registered post for requesting this party to release the insurance claim to the complainant immediately, as such the complainant is a need of finances for her day to day expenses and for expenses on her children and their studies and also annexed the requires documents with the letter but insptie for awaiting for more than 15 days no reply to this letter was sent by the opposite party No. 2 till date. The complainant has prayed the following relieves:-

1. The opposite parties may kindly be directed to release the insurance claim to the complainant to the tune of Rs. 20 Lakh.
2. The opposite parties may kindly be directed to pay compensation of Rs. 1,00,000/- for causing harassment of the complainant.
3. The opposite parties may kindly be directed to pay litigation expenses of Rs.40,000/- to the complainant.

Alongwith the complaint, the complainant has placed on record affidavit of complainant Ex. C-1, Self attested copy of RTI information dated 17.9.2021 Ex. C-2, Self attested copy of Proposal Form Ex. C-3, Self attested copy of insurance cover confirmation Ex. C-4, Self attested copy of death certificate Ex. C-5, Self attested copy of bank statement Ex. C-6, Self attested copy of letter Ex. C-7, self attested copy of Adhar Card of deceased Goldy Ex. C-8, Self attested copy of Adhar Card of complainant Ex. C9.

2        Notice of this complaint was sent to the opposite parties and opposite party No. 1 appeared through counsel and has filed written version by interalia pleadings that opposite Party has not erred in offering service to the complainant under the settled business practices of insurance industry and terms and conditions of the Policy. As there was no consumer dispute existing, hence this complaint is not tenable under the Consumer Protection Act, 2019. Keeping in view the facts, circumstances and law relating thereto the Complainant has failed to produce any evidence or specific averments worth its salt to prove its claim admissible under the terms and conditions of the Insurance Policy Therefore, the instant complaint is liable to be dismissed at the threshold. An insurance Contract has following four essential ingredients, insofar as to claim indemnification there under:-

i.        Utmost good faith,

ii        Insurable interest,

iii.      Valid consideration,

iv       Actual damages.

Unless all the above requirements are met with, insured cannot seek any indemnification from the Insurer. The complainant herein is guilty of violation of the said ingredients and does not deserve any indulgence of this Commission. The instant complaint is a gross abuse of the process of law and the complainant has approached this Commission with unclean hands and has suppressed material facts and as such, this complaint is liable to be dismissed on this very ground. The complainant is guilty of misrepresentation and concealment of material facts and has obtained the policy on the basis of such misrepresentation and concealment.  The captioned complaint is frivolous, vague and vexatious in nature and there has been no 'Unfair Trade Practice" or "deficiency of service" on the part of Opposite Party. The captioned Complaint has been made to injure the interest and reputation of the Opposite Party and therefore, the instant Complaint is liable to be dismissed in limine.  The present complaint has been filed by the widow of deceased Goldi and as admitted in para no.1 of the complaint that the deceased is having two minor children, therefore, both are also necessary party, but the same have not been made party, therefore, the present complaint is liable to be dismissed. The present complaint has been filed without any cause of action against the opposite party No. 1. As admitted by the complainant, there is no policy cover issued by the opposite party No. 1 covering the date of death, therefore, the present complaint has been filed without any cause of action and is liable to be dismissed. In the complaint, there is no deficiency in service shown by the complainant against the opposite party No. 1, therefore, the present complaint deserve dismissal. The complainant herself admits that there was no policy cover on the day of occurrence, therefore, the complainant is not entitled for any claim from the opposite party No. 1. No claim till date has been filed by the complainant with the opposite party No. 1, therefore, the claim being premature is liable to be dismissed. The complainant did not file any document to show that the deceased Goldi died in accident. The proposal form submitted with the complaint by the complainant specifically stated that "Policy shall ordinarily be renewable except on ground of fraud, Moral hazard or misrepresentation or non-cooperation by the insured Further, the SBI shall not be held liable for non-renewal of the policy for not debiting the account of the insured for whatsoever reason." . As per the proposal form there is specifically mentioned that the insurance company should not be liable for non-renewal of the policy for not debiting the account of the insured. The complainant is estopped by her own act and conduct from filing the present complaint.  The complainant has no locus standi to file the present complaint. The proposal form submitted with the complaint by the complainant specifically stated that Policy shall ordinary be renewable except on ground of fraud, Moral hazard or misrepresentation or noncooperation by the insured. Further the SBI shall not be held liable for nonrenewal of the policy for not debiting the account of the insured for whatsoever reason.  The opposite party No.1  has placed on record affidavit of Jitendra Dhabhai Legal Manager Consumer Legal Ex. OP1/1, Self attested copy of authority letter Ex. OP1/2, Self attested copy of PA cover Policy from 2018-2019 Ex. OP1/3, Self attested copy of PA cover policy from 2019-2020 Ex. OP1/4.

3        Opposite party No. 2 appeared and filed written version by interalia pleadings that the insurance business as its business is confined to what is listed out in Banking Regulation Act, 1949. Bank’s role is only as a facilitator/referral agent and the actual insurance is issued by the insurance company i.e. opposite party No- 1. There exists no privity of contract between the complainant and the bank to claim the insurance from the bank i.e. this opposite party No. 2 and as such the complaint cannot be filed against the opposite party No-2 and liable to be dismissed on this count only. It is settled principle of law U/s 230 of Indian Contract Act that an agent can neither sue nor be sued except under the special circumstances mentioned therein. For ready reference Section 230 of Indian Contract Act is reproduced below:-

230. "In the absence of any contract to that effect, an agent cannot personally enforce contracts entered into by him on behalf of his principal, nor is he personally bound by them.

The Opposite Party Bank is relying on the ratio in the judgment of Andhra Pradesh State Consumer Disputes Redressal Commission, Hyderabad on 30.7.2010 in FA No. 86/2008, in the matter of Andhra Bank, Credit Card Division, Mrs. Dinas Vervatwala and Another wherein, it was held that the bank cannot be fastened with  insurance liability. On this ground also the complaint is liable to be dismissed against the respondent. No document has been filed by the complainant to prove that deceased Goldy died in an accident. On this ground also the complaint is liable to be dismissed against the opposite party No. 2.   The deceased Goldy insured himself under personal accident insurance policy for the customers of State bank of India in collaboration with SBI General Insurance. The said policy is voluntary and at the sole discretion of the customer and renewable yearly. The opposite party No. 2 is only a corporate agent/facilitator and as such the present petition against the opposite party No. 2 is not maintainable. Amount was to be debited from the saving account annually, as stated above the said policy was voluntary at the sole discretion of the insured. The first premium was debited on 13.3.2018 and second on 30.3.2019 manually on the instructions of the account holder. The deceased was also aware of this fact from the transactions recorded in his account statement. The last insurance premium was debited on 30.3.2019 and the policy was valid upto 29.3.2020 and the deceased Goldy died on 12.5.2021. No explanation has been tendered as to how the deceased did not renew his policy whereas he could have easily paid the insurance premium by visiting the branch or through customer care no of the Insurance Co. The OP could not be held liable for acts and omissions on part of the account holder. Otherwise also it is clearly mentioned in the proposal form agreed and signed by the deceased. "SBI shall not be held liable for nonrenewal of the policy for not debiting the account of the insured for whatsoever Reason." . There was no auto debit facility active from the account of the deceased Goldy and the premium of the previous policies were paid manually on different dates and the deceased was aware of this fact verbally and through transactions recorded in his account. This information was provided by OP No. 2 under RTI dt.2.11.2021. The bank does not activate the auto debit facility by mere signing of form and without voluntary consent of the account holder Often in ignorance the account holder signs on all the spaces meant for signatures. Moreover the account holder was aware of the deductions of premium manually thereby consenting to the same and could have easily renewed his policy anytime by giving instructions to debit his account but the policy was not renewed for more than a year. The deceased himself did not get his policy renewed and remained silent over the matter for more than a year whereas he could have easily got his policy renewed by requesting the branch for the same. The OP cannot be held liable for non renewal of policy by the deceased.  As already stated the previous premiums were paid manually and no premium thereafter were paid by the deceased for more than a year neither he made any request or complaint to the OP No-2 for non renewal of his policy. The opposite party No. 2 denied the other contents of the complaint and prayed for dismissal of the same.

4        We have heard the Ld. counsel for the parties and have carefully gone through the record.

5        The case of the complainant is that her husband took namely Goldy had been operating a saving bank account having account No. 37041027567 with the opposite party No. 2 and had also availed life insurance policy of the opposite party No. 1 through opposite party No. 2 and the opposite party No. 1 issued a personal accident insurance policy to the deceased Goldy vide policy No. 12733199 and on 12.5.2021 he died but the opposite parties have not released the insurance claim to the complainant regarding the same. On the other hands, the case of the opposite party No. 1 is that the present complaint is premature. The claim of the complainant was never been lodged with the opposite party No. 1. Moreover, in their written version, the opposite party No. 1 has taken specific objection that

“That no claim till date has been filed by the complainant with the replying opposite party, therefore, the claim being pre mature is liable to be dismissed.”        

6        From the perusal of the file, neither the complainant nor the opposite parties have placed on record any document i.e. repudiation letter which reveals that the claim of the complainant has been decided. Infact the claim has not been decided so far and the same is still pending.  In case Balu Waman Kadam vs. ICICI Lombard General Insurance Co. IV (2013) CPJ 16A (CN) (Mah.), the matter was similar, wherein the Insurance Company was asking the complainant to submit the documents again and again and the complainant was alleging that he had already submitted the requisite documents to the Insurance Company. In such circumstances, the Hon’ble State Consumer Disputes Redressal Commission Maharashtra disposed of the matter, by directing the Insurance Company to reconsider the claim of the complainant within one month on receipt of the required documents from the complainant. 

7        While relying upon the above said authority, the Hon’ble State Commission, Punjab, Chandigarh passed the similar orders in case M/s Trends, through its Proprietor vs The Oriental Insurance Company Limited & Anr. Consumer Complaint No.245 of 2015 decided on 04.08.2017; and M/s Gurbir Rice Mills v. United India Insurance Company Ltd. & Ors. Consumer Complaint No.404 of 2016, decided on 09.10.2017, directing the Insurance Company to reconsider the claim of the complainant after submission of requisite documents by the complainant to it. 

8        In view of our above discussion as well as keeping in view the ratio of above said judgments, we are of the opinion that the ends of justice would be met, if the Insurance Company be directed to decide the claim of the complainant, after the complainant submit all the requisite documents.  However, the opposite party No. 1 has not mentioned in the written version that which documents are to be submitted by the complainant to the opposite party No. 1.

9        In view of the above discussion, the present complaint is disposed of with the following directions

(a)               The opposite party No. 1 will submit the list of requisite documents to the complainant within 15 days from the date of receipt of copy of this order.

(b)               The complainant will submit the claim with requisite documents to the opposite party No. 1-Insurance Company for deciding the claim within a period of further one month and on approaching the complainant for supplying the requisite documents, the opposite party No. 1 will issue proper receipt acknowledging the same.

(c)               The opposite party No. 1 shall decide the claim of the complainant within a further period of two months therefrom

The opposite party No. 2 is directed to cooperate with the complainant in providing the documents. In case of failure on the part of the opposite party No. 1 the claim case of the complainant deemed to have been accepted.  Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this commission. Copies of the order be furnished to the parties as per rules. File is ordered to be consigned to the record room.

Announced in Open Commission

30.08.2024