DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

PATIALA.

                                      Consumer Complaint No.141 of 7.4.2016

                                      Decided on:   8.3.2019

Robin Garg S/o Sh.Anil Garg R/o Ward No.15, Near Ramleela Mandir, Samana, District Patiala.

                                                                   …………...Complainant

                                      Versus

1.       State Bank of India, Branch Samana, District Patiala through its Branch Manager.

2.       SBI Life Insurance Pvt. Ltd., SCO 109, First Floor, Sector 17-B, Chandigarh-160017, through its Regional Manager.

                                                                   …………Opposite Parties

                                      Complaint under Section 12 of the

                                      Consumer Protection Act, 1986.

QUORUM

                                      Sh. M.P.Singh Pahwa, President

                                      Smt. Inderjeet Kaur, Member

                                      Sh.B.S.Dhaliwal, Member      

ARGUED BY

                                      Sh.Mohit Kansal, counsel for complainant.

                                      Sh.Anand Puri, counsel for OP No.1.

                                      Sh.Puneet K.Gupta, counsel for OP No.2.

 ORDER

                                    M.P.SINGH PAHWA, PRESIDENT

1. This is the complaint filed by Sh.Robin Garg (hereinafter referred to as the complainant) against State Bank of India and Anr.(hereinafter referred to as the OPs).
2. Briefly, the case of the complainant is that his mother Smt.Beena Garg W/o Anil Garg opted two life insurance policies dated 28.5.2015 bearing Master Policy No.240600/42/15/8200000061 under PARDHAN MANTRI SURAKSHA BIMA YOJNA (hereinafter referred to as PMSBY) with National Insurance Company Ltd. for Rs.12/- per annum i.e. covered under accidental policy and second policy No.76001000135 under PARDHAN MANTRI JEEVANJYOTI BIMA YOJNA (hereinafter referred to as PMJMY) with SBI Life Insurance Co. Ltd. for Rs.330/- per annum, which is covered under death policy. His mother naturally died on 17.2.2016.Complainant is nominee of his mother. Thus he is consumer of the OPs.
3. It is pleaded that after death of his mother complainant submitted claim form under PMJBY with SBI Life Insurance Co. Ltd. on account of death of his mother Smt.Beena Garg, for refund of insurance amount of Rs.2lac as per  norms of the policy.
4. Complainant also approached the bank. OP No.1 issued letter bearing Sr.No.129 dated 11.3.2016.Thereafter the complainant replied to the letter and completed all the requirements as mentioned by the OP in the letter and sent to OP No.1 vide RC dated 23.3.2016.Thereafter, the bank had issued another letter No.141 dated 29.3.2016, wherein it is mentioned that the OP No.1 has not debited Rs.330/- from the saving account of the deceased  as the said policy was not issued by the bank.
5. It is alleged that once the OP No.1 had issued the acknowledgment slip cum certificate of insurance of the policy, then it was duty of OP No.1 to auto debit the premium amount from the saving account of the deceased person Beena Garg but due to negligence of the staff of OP No.1 it has failed to do so. At the same time OP No.1 had already debited Rs.12/- of the policy with National Insurance Co. Ltd. from her saving account which is accidental policy.
6. It is further alleged that OP No.1 has committed fraud with the complainant by not issuing the insurance amount and the staff of OP No.1 has issued acknowledgement cum insurance certificate. Now with malafide intention of the staff of OP No.1 they are cleverly not issuing the insurance amount to the complainant. The complainant is entitled to the insurance amount as per norms and policy of insurance.
7. The account of deceased had sufficient amount  in her saving account from where premium of Rs.330/- was to be debited by OP No.1 at the time of issuance of the policy  on 28.5.2015 as it was done in other accidental policy on the same date.
8. It  is also alleged that no information was made by OP No.1 to the complainant or to the deceased till her death regarding the fact that no such insurance policy of Rs.330/- with SBI Life Insurance Co. Ltd. has been done.
9. On this  background of the facts, the complainant  claims to be entitled to Rs.2lac with interest @12%per annum from the date  of death of his mother  with other benefits under the policy, Rs.50,000/- as damages for mental harassment, agony and litigation expenses. Hence this complaint.
10. Upon notice, OPs appeared through their respective counsel and contested the complaint by filing separate written replies.
11. In reply OP No.1 raised preliminary objections that this Forum has no jurisdiction to try and decide the complaint; that the complaint is not maintainable; that the complainant has no cause of action to file the complaint, he has not come to the court with clean hands and has suppressed actual and material facts. Complainant has no locus standi to file the complaint against it. Hence the complaint is false, frivolous and vexatious to the knowledge of the OP. It  is liable to  be dismissed with costs.
12. On merits, the OP No.1 has denied material averments of the complainant. It is denied that mother of the complainant namely Smt.Beena Garg  opted  for two life insurance policies.
13. As per OP No.1 Smt. Beena Garg opted for one policy bearing Master Policy No.240600/42/15/820000001 under PMSBY with National Insurance Co. Ltd. for Rs.12/- per annum i.e. covered under accidental policy.
14. On 28.5.2015 Smt.Beena Garg, came to the branch and contacted Ms Pooja Goyal, official of OP No.1. She requested for insurance policy under PMSBY and PMJJBY.Ms Pooja Goyal, official of OP No.1 gave Smt. Beena Garg, forms of both the schemes for filling the same. Smt.Beena Garg, filled the forms and gave the same to Ms.Pooja Goyal and demanded acknowledgment slips of both the forms. Ms.Pooja Goyal gave her acknowledgment slips of both the forms because there was nothing wrong in giving acknowledgment slips. After taking acknowledgment slips from Ms.Pooja Goyal, Smt.Beena Garg asked Ms.Pooja Goyal the difference in both the policies i.e. PMSBY and PMJJBY and she explained the difference between the aforesaid two polices to Smt.Beena Garg. Thereafter, Smt.Beena Garg refused to get the policy under PMJBY, whose premium was Rs.330/- and requested to do the policy under PMSBY, whose premium was Rs.12/- and also requested Ms. Pooja Goyal not to debit Rs.330/-from her account and took the application from Ms.Pooja Goyal and thereafter she left the branch. On that date, there was huge rush at the counter of Ms.Pooja Goyal. She forgot to take back acknowledgment slip of the application under PMJJBY. Therefore, the bank debited only Rs.12/- and did not debit Rs.330/-from the account of Smt.Beena Garg. From this fact, it is very much clear that Smt.Beena Garg was  insured under only PMSBY and she was not insured under PMJBY from the branch of OP No.1
15. It is further stated that as per account statement, insurance premium  of Rs.12/- was debited from the account  of Smt.Beena Garg on 28.5.2015, which was the premium of PMSJY and she was not insured under PMJJBY by it. Regarding this fact, OP No.1 also issued letter No.141 dated 29.3.2016 to the complainant.
16. It is denied that mother of the complainant opted for 2^nd policy No.76001000135 under PMJBY with SBI Life Insurance Co. Ltd. for Rs.330/- per annum, which is covered under death policy .It is also alleged that the plea regarding natural death of the mother of the complainant on 17.2.2016 has been wrongly and falsely raised without any basis. It is also alleged that the complainant has lodged false claim with OP No.1 with malafide intention to extract easy money from OP No.1
17. It is admitted that letter No.141 dated 29.3.2016 was issued by OP No.1 wherein it has been rightly mentioned that OP No.1 had not debited Rs.330/- from the saving account of the deceased as she has not opted for the policy under PMJJBY.
18. It is denied that once the OP No.1 has issued acknowledgement slip cum certificate of the insurance then it is duty of  OP No.1 to auto debit the premium from the saving bank account of the deceased person namely Beena Garg.
19. It is denied that there is any negligence of the staff of OP No.1. Acknowledgment is only a receipt of the form and there was no contract of OP No.1 with regard to the policy PMJBY as the amount of Rs.330/- was not debited from the account of the complainant Beena Garg.
20. After controverting all other averments and reiterating aforesaid stand repeatedly, the OP No.1 prayed for the dismissal of the complaint.
21. OP No.2 in its separate reply also revealed that it is a Life Insurance Company and carrying on life insurance business .It grants insurance coverage to individual’s assurances and groups of individuals through Group Life Insurance Schemes. In the case of group insurance schemes, a master policy covering eligible members of the group, who applied  to the group scheme, is issued containing all the terms and conditions of the contract of insurance. One such master policy (PMJJBY) is issued to the State Bank of India vide policy No.76001000135. The insurance cover under the group insurance scheme is not automatic but is optional. The individuals who wish to enter into the scheme should necessarily submit consent cum declaration alongwith appropriate premium. There is no contract of insurance unless the proposal alongwith requisite premium of insurance is submitted and accepted by the insurer and the acceptance is communicated by the insurer. In the case of individual assurances, such communication of acceptance takes place in the form of issuance of the policy document and in the case of group schemes, the coverage of the individuals constituting the group is signified by the issuance of the certificate of Insurance. After making this clarification, the OP No.2 raised preliminary objections that the complaint is not maintainable for want of territorial jurisdiction of this Forum. It is liable to be dismissed on this ground. There is no insurance contract between deceased Beena Garg and SBI Life Insurance Company Ltd.(OP No.2).Hence there is no consumer service provider relationship between  the complainant and OP No.2.The complainant has no locus in this case because it does not fall within the definition of complainant in terms of Section 2(1)(b) of Consumer Protection Act,1986. Complainant is abusing process of law by dragging the OP into unwanted litigation. The OP No.1 and OP No.2 are different legal entities .One cannot bind another for its acts of commission or omission. There is no deficiency on its part as it has never received any proposal/membership form and requisite premium from deceased Beena Garg. That the consent cum declaration form is the basis for assessment of risk. A proposer will be admitted into the scheme based on the details in proposal form alongwith requisite premium/consideration. Beena Garg was never granted any insurance cover during her life time being holder of saving bank account as neither the consent cum declaration which is basis of any contract or premium amount was received by OP. Beena Garg was not an insured member under the master policy No.76001000135. She has never proposed OP for insurance cover. There is no contract existing between Beena Garg and the OP.There was no customer –service provider relationship between Beena Garg and the OP The complaint does not fall within the purview of Consumer Protection Act,1986. That under Section 64VB of Insurance Act, no insurer shall assume any risk in India in respect of any insurance business unless and until the premium payable is received  by it in advance or is guaranteed to be paid to the insurer in the manner prescribed by the rules  framed under Insurance Act. Advance payment of the premium under the policy is not only a contractual obligation but also a legal mandate for the continued assumption of risk under a policy of insurance.
22. It is reiterated that Smt.Beena Garg was not insured member as defined under terms and conditions of the master policy in question. The OP has also quoted some definitions under Insurance , repetition of which is not considered to be necessary for the sake of brevity. The OP also raised some other similar objections, the reference of which is not considered to be necessary for the sake of brevity.
23. On merits, the OP No.2 has reiterated its version as taken in the legal objections and controvered the averments of the complainant. In the end, OP No.2 has prayed for the dismissal of the complaint.
24. Parties were afforded opportunity to produce their evidence.
25. In support of his case, the complainant tendered into evidence his affidavit, Ex.CA, copy of acknowledgment slip, ExC1, Ex.C2, copy of death certificate of Beena Garg, Ex.C3, copy of application, Ex.C4, letter dated 11.3.2016, Ex.C5, copy of reply to the letter,Ex.C6, postal receipt,Ex.C7, copy of letter dated 29.3.2016,Ex.C8, copy of account statement of Beena Garg, Ex.C9.
26. OP No.1 tendered into evidence affidavit of Vinay Tripathi,Ex.OPB, affidavit of Pooja Goyal, Ex.OPB, letter dated 29.3.2016,Ex.OP3.
27. OP No.2 tendered into evidence affidavit of Neelam Singh, Ex.OPA, copy of policy document,Ex.OP1.
28. Complainant and OP No.1 have also submitted written arguments.
29. We have heard the ld. counsel for the parties and also gone through the record of the case file carefully.
30. The ld. counsel for the complainant has submitted that OP no.1 has issued the acknowledgment slip, Ex.C2, wherein it is acknowledged that Smt. Beena Garg has consented auto debit to join Pardhan Mantri Jiwan Jyoti Bima Yojana with SBI Life Insurance company ltd. In these circumstances, the OP was to debit the premium amount of Rs.3030/- .In case OP No.1 has failed to debit the amount, the insured is not to  suffer for the lapse on her part. The version put forth by OP No.1 is not acceptable . It is supposed that the acknowledgment slip is issued after completion of all the formalities. Had Smt.Beena Garg refused to opt for this policy, the OP No.1 was not to issue acknowledgment without getting authorization and other required documents. OP No.1 has acted as an agent of OP No.2. As such both the parties are liable to the claim of the complainant.
31. On the other hand, the ld. counsel for OP No.1 has submitted that the contract of insurance was to complete only after receipt of premium amount. Of course the complainant previously consulted for availing the insurance cover under Pradhan Mantri Jeevan Jyoti Bima Yojana but  subsequently she opted not to join this insurance policy. No amount was debited for this policy.  Smt. Beena Garg was also in the knowledge that the premium was not debited from her account. Therefore, complainant cannot claim any benefit under this scheme.
32. Ld. counsel for OP2 has submitted that there was no contract of insurance with the complainant. It was a case of master policy covering eligible member of the group and who applied to the group scheme. The policy was only available to the persons between the age of 18 years to 50 years. It is mentioned in the acknowledgment slip itself. The benefit under the scheme was also available till the age of 55. Therefore, OP No.2 was to scrutinize the declaration allegedly submitted by the complainant and she was to be admitted only in case she was eligible for the scheme. There is nothing on the record to prove that any declaration was submitted with OP No.2. There is also nothing on the record to prove that any premium was received from the complainant to allow her to join the policy. In these circumstances no deficiency in service can be attributed on the part of OP No.2. It has been unnecessarily dragged into litigation. Therefore, the complaint be dismissed with special costs.
33. We have given careful consideration to the rival submissions.
34. The complainant is legal heir of Smt. Beena Garg. It is also the case of the complainant that Smt. Beena Garg availed life insurance policy under the scheme Pardhan Mantri Jiwan Jyoti Bima Yozna. Complainant has produced acknowledgment slip-cum-certificate of insurance, Ex.C2. This document was issued by official of OP No.1. As per this document, the OP no.1 acknowledged receipt of consent-cum –declaration form from Smt. Beena Garg and the OP no.1 was authorized for auto debit regarding premium.
35. Admittedly Smt. Beena Garg was  having sufficient balance in  her account to meet out the premium amount. The OP No.1 has pleaded that this document was issued due to rush of work but Smt. Beena Garg has not availed this policy and she has only availed the policy under the scheme of Pardhan Mantri Surakshaa Bima Yozna. Of course the OP has produced on record affidavit of Pooja Garg , the dealing clerk, to show that  acknowledgment slip was issued in rush of work and it was to be taken back. It is well settled that documentary evidence has to prevail on oral evidence. Even otherwise, it was not accepted for OP No.1 to issue acknowledgment-cum-certificate of insurance before getting the formalities completed. The version of OP No.1cannot be accepted only for the reason that no premium amount was debited from the account of Smt. Beena Garg for this policy. Smt. Beena Garg has consented and authorized auto debit from the saving account. Therefore, it was OP No.1 who is under obligation to debit the same from the saving account of Smt. Beena Garg. Any lapse on the part of OP no.1 cannot be allowed to deny the benefit to the insured. Therefore, it is to be accepted that Smt. Beena Garg has availed the Pardhan Mantri Jiwan Jyoti Bima Yozna also, whereby the insured was covered up the amount of Rs.2lacs.
36. The complainant has prayed for direction to the OPs to pay this amount of Rs.2lacs with interest .Copy of the scheme is also on the file with claim form, Ex.C4. Perusal of this scheme shows that claim settlement procedure is also detailed in this policy and as per this policy, the risk cover is to be provided to the persons between 18 years till attaining age of 55 years and eligibility will cease on attaining age 55 years or on closure of the account. The death claim was to be settled by designated officer of OP No.2. Therefore, before releasing claimed amount, the claim is required to be settled and it has to be scrutinized whether the claimant was eligible for this benefit on the date of occurrence.
37. Keening in view the totality of the facts, the complaint is partly accepted with Rs.5000/- as costs of litigation against OP No.1. However, OP No.2 will examine the matter for the purpose of settlement of the claim and thereafter OP No.1 will release the payment to the complainant. Complainant  is also held entitled to compensation by way of interest @ 12% per annum on the amount if any, found payable, from the date of filing of the complaint till payment.
38. Compliance of the order be made by the OPs, within a period of 45 days from the date of the receipt of the certified copy of this order. Certified copies of this order be sent to the parties free of cost under the Rules. Thereafter, file be indexed and consigned to the Record Room.

ANNOUNCED

DATED:8.3.2019         

         B.S.Dhaliwal                   Inderjeet Kaur             M. P. Singh Pahwa

             Member                           Member                                      President