Order by:
Mohinder Singh Brar, Member
1. The complainant has filed the instant complaint under section 35 of the Consumer Protection Act, 2019 stating that previously he filed complaint against the Opposite Parties on the ground that her husband was insured with Opposite Party No.1 under Pardhan Mantri Suraksha Beema Yojna, but later on she came to know that her husband not insured under the PMSBY Scheme, but Opposite Party No.2 insured her husband under Personal Accident Insurance Scheme of Opposite Party No.1 and annual premium of the same is Rs. 100/-. On coming to know about the said fact, the complainant withdraws her previous complaint with a liberty to file the fresh complaint against the opposite parties and this Commission gave liberty to the complainant to file a fresh complaint. So, the present complaint is being filed. Alleged that opposite party no.2, State Bank of India, branch Kot Ise Khan, insured Sh.Tarsem, Singh (deceased) husband of the complainant under ‘Personal Accident Insurance scheme’ and debited the annual insurance premium from the account 33318771572 of deceased Tarsem Singh. Thereafter, Tarsem Singh died on 02.02.2019 in an accident and FIR No. 14 dated 03.02.2019 was also lodged at Police Station Kot Ise Khan, District Moga. Later on, the complainant came to know that her husband was duly insured under the Government Schemes of Pardhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY) and Pardhan Mantri Suraksha Beema Yojna but in fact her husband was insured with opposite party no.1 of his scheme known as Personal Accident Insurance (this covers accidental death). Accordingly, the complainant completed the formalities and lodged the claim under both the policies and the claim under PMJJBY was paid to the complainant on dated 29.06.2022, but the claim lodged with Opposite Party No.1 was repudiated for delayed submission vide their letter dated 31.10.2022 under General Claim No.1388935. Alleged further that Opposite Party No.2 under connivance with Opposite Party No.1 still debited the premium under Personal Accident Insurance on 08.03.2021 and 28.02.2022 and submitted the same to Opposite Party No.1 inspite of death of the insured on 02.02.2019. Alleged further that a legal notice dated 06.05.2023 were sent to the opposite parties, but despite that opposite party no.1 neither paid the insurance amount nor replied the legal notice. Hence, this complaint. Vide instant complaint, the complainant has sought the following reliefs:-
a) Opposite Parties may be directed to pay the amount of Rs.2,00,000/- alongwith upto date interest @ 18% p.a. from the date of claim on the basis of insurance under the personal accident insurance of the account holder Tarsem Singh (deceased).
b) To pay a sum of Rs.2,00,000/- as compensation on account of mental tension, harassment and for deficient service.
c) And any other relief which this Commission may deem fit and proper be granted to the complainant in the interest of justice and equity.
2. Opposite Party No.1 appeared through counsel and contested the complaint by filing written reply taking preliminary objections therein inter alia that there is no deficiency of service or unfair trade practice on the part of Opposite Party No.1; the complainant has failed to produce any evidence to prove its claim admissible under the terms and conditions of the insurance policy; the complainant has approached this Commission with unclean hands and has suppressed material facts; the death of the insured was on 03.02.2019 and the case was filed in March, 2024. There is a delay of more than 5 years in filing the complaint. The cause of action has arisen on 03.02.2019 only when the insured died. Hence, the complaint shall be dismissed on the ground of limitation. Averred that a certificate of insurance bearing no. 41221810 was issued under the Group Personal Accident Insurance Policy no. 175002-0000-00 covering Mr. Tarsem Singh from 08.03.2018 to 07.03.2019 for a total sum insured of Rs.2,00,000/- for accidental death. The subject policy is a personal accident policy and the coverage is subject to certain terms, conditions, and exceptions. Averred further that upon receipt of claim intimation on 16.05.2022, Opposite Party No.1 carefully perused the claim documents and rejected the claim vide rejection letter dated 31.10.2022. The claim of the Complainant was rightfully rejected according to terms and conditions of the policy. Submitted that insurance policy is a contract of indemnity and both the parties are strictly abide by the words of contract. No one is allowed to tread beyond four corners of the policy or make a fresh contract to the advantage of either of the parties. Averred further that the complaint of the complainant should be dismissed and should not be heard as complainant is unnecessarily wasting the time of court. Previously, the complainant had filed the complaint with same facts in the month of August, 2023 and withdraw the same on 31.10.2024 which shows that complainant has ulterior motive to get the compensation from Opposite Party No.1. There was no negligence or deficiency or unfairness in service on the part of Opposite Party No.1. On merits, all other allegations made in the complaint are denied and a prayer for dismissal of the complaint is made.
3. Opposite Party No.2 appeared through counsel and contested the complaint by filing written reply taking preliminary objections therein inter alia that the present complaint is not maintainable against answering Opposite Party. This policy is governed by the terms and conditions laid down in the prospectus of the said policy. The contents of said prospectus of policy are the part of proposal form and Account holder deceased Tarsem Singh had confirmed that he noted the terms and conditions of said prospectus of the said policy. The said policy was issued in accordance with IRDA (Insurance Regulatory & Development Authority). The premium of the policy in question was paid to the opposite party No.1 on behalf of Tarsem Singh on auto- debit policy basis. Thus, sole liability to settle the claim in dispute of complainant is of opposite party No.1 which are the insurer opposite party No.2 is not the insurer. Hence, present complaint is not maintainable against answering opposite party No.2. Thus present complaint against opposite party No.2 is not maintainable; present complaint against opposite party No.2 is liable to be dismissed also on the score of mis-joining opposite party No.2; there is no deficiency in service on the opposite party No.2. On merits, all other allegations made in the complaint are denied and a prayer for dismissal of the complaint is made.
4. In order to prove the case, complainant has placed on record copies of documents Ex.C1 to Ex.C9 and her affidavit as Ex.C10/A.
5. On the other hand, Opposite Party No.1 has placed on record affidavit of Sh.Jitendra Dhabhai, Chief Manager Legal, SBI General Insurance Co. Ltd. as Ex.OP1/1 alongwith copies of documents Ex.OP1/2 & Ex.OP1/3 and another affidavit of Sh.Jitendra Dhabhai, Chief Manager as Ex.OP1/4, copy of Claim Form Ex.OP1/5. Whereas, Opposite Party No.2 has placed on record affidavit of Sh.Sunny Kareer, Branch Manager & Principal Officer, State Bank of India as Ex.OP2/1.
6. We have heard the ld. counsel for both the parties, gone through the written arguments of Opposite Party No.1 and also gone through the record.
7. It is proved on record that husband of the complainant (now deceased) was insured with Opposite Party No.1 ‘Group Personal Accident Insurance Policy’ for the period 08.03.2018 to 07.03.2019 (Ex.OPs1/2). During the policy coverage, husband of the complainant expired on 02.02.2019, which is evident vide Ex.C3. After the death of her husband, the complainant lodged the claim under the policy with Opposite Party No.1, but the claim of the complainant was repudiated by Opposite Party No.1, vide letter dated 31.10.2022 (Ex.OPs1/3).
8. We have considered the rival contentions of the ld. Counsels for both the parties. The first allegation of the complainant is that her husband i.e. insured under the policy in question died in road accident, but there is no document on record showing that husband of the complainant died in a road accident. However, the complainant has placed on record copy of FIR bearing no.0014 dated 03.02.2019, but perusal of the same reveals that it is not related to deceased husband of the complainant, as in the said FIR the name of the complainant is mentioned as Jagdev Singh s/o Puran Singh and name of the Accused is mentioned as Shinderpal Singh and the person involved in the accident are Harbans Singh and his wife Karamjit Kaur on one motorcycle and Shinderpal Singh s/o Ballu Singh on other motorcycle (rehra fitted), so it clearly evident from the said FIR that it is not related to deceased husband of the complainant. Moreover, perusal of the death certificate (Ex.C3) reveals that death of the husband of the complainant occurred on 02.02.2019, but the said certificate was issued on 11.05.2022 i.e. after the gap of more than three years, which creates doubt.
9. Now, we come to the main dispute of the parties. The main dispute between the parties is regarding the repudiation of the claim. Counsel for the complainant alleged that Opposite Party No.1 wrongly repudiated the claim of the complainant. On the other hand, counsel for Opposite Party No.1 alleged that they rightly repudiated the claim of the complainant. Perusal of repudiation letter dated 31.10.2022 (Ex.OPs1/3) reveals that Opposite Party No.1 repudiated the claim of the complainant only on the ground of delay in claim intimation about the death of the insured. The relevant contents of repudiation letter are reproduced as under:-
“We have carefully perused claim documents and noted that “insured Mr.Tarsem Singh died on 2nd February, 2019. The claim intimation was received to us only on 16th May, 2022 and there is no justifiable reason observed for such a gross delay in intimation of claim.”
10. Careful perusal of the record reveals that there is delay in intimation about the death of the insured, as perusal of death certificate of the husband of the complainant i.e. insured (Ex.C3) clearly reveals that the death of the husband of the complainant occurred on 02.02.2019 and further claim form placed on record by Opposite Party No.1 (Ex.OP1/5) is evident of the fact that the claim was lodged on 06.10.2022. As such, there is delay of approximately more than three years in lodging the claim by complainant. Further there is no document on record showing that the delay was reasonable/justifiable. Moreover, perusal of the record reveals that policy in question is a ‘Group Personal Accident Insurance Policy’ and the same is issued only for one year i.e. for the period 08.03.2018 to 07.03.2019. Hence, the lodging of the claim by complainant after the elapse of the policy in not genuine. In view of the above facts and circumstances, we are of the concerted view that the complainant failed to prove any deficiency in service on the part of Opposite Party No.1 and Opposite Party No.1 rightly and legally repudiated the claim of the complainant on the ground of delay in intimation.
Although the Opposite Party No.1 repudiated the claim of the complainant on account of delay in claim intimation, however otherwise on record, there is no any post mortem report of the insured or any other document on record, which proves that death of the insured was accidental. Further there is no FIR with regard to said accident on record. Moreover, the copy of the FIR produced on record by the complainant related to someone else.
11. Sequel the above discussion, the instant complaint is hereby dismissed. Keeping in view the peculiar circumstances of the case, the parties are left to bear their own costs. The pending application(s), if any also stands disposed of. Copy of the order be supplied to the parties free of costs. File be consigned to record room.
Announced in Open Commission
