COMPLAINT FILED ON : 07/07/2015

     DISPOSED ON: 10/11/2016

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHITRADURGA

PRESENT :-     SRI. T.N. SREENIVASAIAH      PRESIDENT                                      B.A., LL.B.,

                        SRI.N. THIPPESWAMY             MEMBER

                                         B.A., LL.B.,                   

SRI. T.N. SREENIVASAIAH. PRESIDENT.

ORDER

The complainant has filed a complaint U/s 12 of C.P. Act 1986 against the OPs for a direction to the OPs to pay Rs.1,00,000/-, Rs.50,000/- compensation towards mental agony with interest at 12% p.a and such other reliefs.  

2.     The brief facts of the case of the complainant are that, complainant is the wife and the legal representative of Mr. Chetankumar who had a JanDhan A/c No.6273909656 with Indian Bank, Chitradurga Branch and the same has been insured under PMJDY Insurance with OP No.2, which covers the accidental benefit of Rs.1,00,000/-.   It is further submitted that, on 16.01.2015 at about 5-00 PM the husband of complainant deceased Chethankumar was moving in a motor cycle bearing Reg. No.KA-16 Y-8325 along with his friend Nagaraju from Vijayapura village to Chitradurga town, when they came near K-Ballekatte Gate on NH-4 road, the driver of Maruthi Alto Car bearing Reg. No.KA-16/M-6025 came in a rash and negligent manner endangering human life and dashed to the said motor cycle from back side, due to the said accident husband of the complainant sustained grievous injuries to his head and all over the body and died at the spot.  After the accident, on 25.02.2015 and 24.04.2015 complainant approached OP No.1 along with necessary documents requesting the accident claim, OP No.1 received the documents and forwarded the same to OP No.2 but, OP No.2 did not settle the claim and given a repudiation letter of OP No.2 on 25.05.2015 on the ground that, "Card Generation date, that is mentioned in card details which is provided from your end and provided bank statement there is absence of Non ATM/Non POS/Non E-Commerce Transaction During the last 45 days prior to the date of loss.  Since the above claim is not admissible as per the policy terms and conditions.  It is further submitted that, when once the PMJDY Account is opened, the duty of the bank is to give necessary Pass Book and ATM Card to the account holder but, in spite of repeated requests made by the deceased D. Chetankumar, OP No.1 did not give neither Pass Book  the OPs to settle the claim under the law.  OPs are fully knew this aspect but, they have repudiated the claim and failed to consider the same, which caused financial loss and mental agony to the complainant which is a deficiency of service and prayed for allow the complaint.

3. On service of notice, OP No.1 appeared through Sri. A.M. Rudramuni and filed version admitting about opening of JanDhan Account bearing A/c No.6273909656 with OP No.1 and the same was insured under PMJDY with OP No.2 but, denied the fact that, the same covers the accidental benefit of Rs.1,00,000/-.  It is further submitted that, it has no knowledge about the death of husband of complainant on 16.01.2015 in a motor cycle accident.  It is stated that, complainant approached OP No.1 along with documents on 25.02.2015 and 24.02.2015 and forwarded the claim form to OP No.2 and the same has been repudiated through letter on 25.05.2015 as the same is not admissible as per the terms and conditions under PMJDY Scheme.  It is further submitted that, on the date of opening of the account itself, the OP No.1 has issued Pass Book to the said Chethan Kumar and in the said Pass Book, his A/c number is mentioned as 6273909656 and the ATM Card was generated on 23.01.2015 but, the account holder on 16.01.2015 i.e., before generation of ATM Card.  As per the PMJDY Circular C.O.F.I.D/ADV/101/2014-15 dated 23.09.2014, accidental insurance cover was provided by HDFC ERGO Insurance now, NPC has entered into an agreement with New India Assurance Company Ltd. to provide the facility for the year 2015-016 came into effect from 01.04.2015 to 31.03.2016.  It is further submitted that, during the launch of PMJDY scheme on 28.08.2014 Prime Minister announced a life cover of Rs.30,000/- with Rupay Card for all those who opened Bank Account for the first time during the period from 15.08.2014 to 26.01.2015 and the benefits of insurance will be available to the card holders who performed minimum one successful financial or non-financial transaction at any channel both intra and interbank within 45 days prior to date of accident including accident date.  The husband of the complainant opened an account on 15.10.2014 and died on 16.01.2015 but, there was no transaction has been done between the said period therefore, OP No.2 rejected the claim made by the complainant.  Therefore, there is no deficiency of service on the part of OP No.1 and prayed for dismissal of the complaint. 

4.     OP No.2 appeared through Sri. K.E. Mallikarjuna and filed version denying the averments made in the complaint and the same is to be dismissed in limine as the same is not maintainable and the complainant is not a consumer under the C.P Act.  It is submitted that, an insurance contract has been entered into between the complainant and the OP and OP accepted and indemnify the insured provided that, there should not be breach of any terms and conditions of policy.  However, there is no such contract entered into between the complainant and OP No.2 and this OP No.2 has not received any premium from the complainant.  It is denied that, husband of complainant had a JanDhan account bearing No.6273909656 with OP NO.1 and the said Bank insured the same under PMJDY with OP No.2 for an accidental benefit of Rs.1,00,000/- and complainant is the legal representative of deceased Chetankumar.  It is further denied that, on 16.01.2015 at about 5-00 PM, the husband of complainant moving in a motor vehicle bearing Reg. No.KA-16/Y-8325 and at that time car bearing Reg.No.KA-16/M-6025 came in a rash and negligent manner and dashed to the said motor cycle from back side and the husband of complainant sustained grievous injuries to head and all over the body.  It is denied that, on 25.05.2015 and 24.04.2015 complainant approached OP No.1 with necessary documents to settle the accident claim and the same has been forwarded to OP No.2, OP No.2 did not settle the claim.  OP No.1 given the claim repudiation letter of OP No.2 on 25.05.2015 wherein it has been stated that, "Card Generation date, that is mentioned in card details which is provided from your end and provided bank statement there is absence of Non ATM/Non POS/Non E-Commerce Transaction During the last 45 days prior to the date of loss.  Since the above claim is not admissible as per the policy terms and conditions.  It is further denied that, when once the PMJDY Account is opened, the duty of the bank is to give necessary Pass Book and ATM Card to the account holder but, in spite of repeated requests made by the husband of complainant, OP No.1 did not give neither Pass Book  the OPs to settle the claim under the law and the duty is cast upon the OPs to settle the claim.  It is denied that, OPs are fully knew this aspect and they have repudiated the claim and failed to consider the same.  It is further submitted that, the claim has been repudiated for the reason that, One ATM transaction require for the 45 days prior to date of loss, Cardholder bank account opening date is 15.10.2015 and the date of loss was on 16.01.2015 and the Bank has issued the Card to cardholder after his death and the deceased cardholder had not operated one ATM transaction before his death and the Bank has not issued card during his life time.  It is further submitted that, the Rupay Card has been dispatched only on 23.01.2015 i.e., after the death of cardholder.  Therefore, the OP No.2 has not committed any deficiency of service and prayed for dismissal of the complaint.

        5.     Complainant himself examined as PW-1 by filing affidavit evidence and documents are marked at Ex.A-1 & Ex.A-7. 

6.     On behalf of OP No.1 one Sri.S. Subramanian, Senior Manager examined as DW-1 by filing affidavit evidence and on behalf of OP No.2 one Sri.S. Sanjay Kumar, Manager Claims, examined as DW-2 by filing affidavit evidence and Ex.B-1 to Ex.B-6 documents have been marked. 

7.     Written Arguments filed and oral arguments heard.

8.     Now the Points that arise for our consideration for the decision of the complaint are that:

Point No.1:- Whether the complainant proves that, OPs have committed deficiency of service and unfair trade practice in settling the claim made by her and she is entitled for compensation as stated in his complaint?

Point No.2:- What order?

        9.     Our findings on the above points are as follows:

        Point No.1:- Partly affirmative.

        Point No.2:- As per the final order.

                                        ::REASONS::

10. Point No. 1:- It is not in dispute that, husband of complainant Mr. Chetankumar had a JanDhan A/c No.6273909656 with Indian Bank, Chitradurga Branch and the same has been insured under PMJDY Insurance with OP No.2 for an accidental benefit of Rs.1,00,000/-.   On 16.01.2015 at about 5-00 PM the husband of complainant deceased Chethankumar was moving in a motor cycle bearing Reg. No.KA-16 Y-8325 along with his friend Nagaraju near K-Ballekatte Gate on NH-4 road, Maruthi Alto Car bearing Reg. No.KA-16/M-6025 came in a rash and negligent manner and dashed to the said motor cycle from back side and in the said accident husband of the complainant sustained grievous injuries to his head and died at the spot.  On 25.02.2015 and 24.04.2015 complainant approached OP No.1 along with necessary documents requesting the accident claim, OP No.1 forwarded the same to OP No.2 but, OP No.2 did not settle the claim on the ground that, "Card Generation date, that is mentioned in card details which is provided from your end and provided bank statement there is absence of Non ATM/Non POS/Non E-Commerce Transaction During the last 45 days prior to the date of loss.  Since the above claim is not admissible as per the policy terms and conditions.  It is argued that, when once the PMJDY Account is opened, the duty of the bank is to give necessary Pass Book and ATM Card to the account holder but, OP No.1 did not give neither Pass Book  the OPs to settle the claim under the law, which caused financial loss and mental agony to the complainant.   

 11.  In support of her contention, complainant has relied on her affidavit evidence in which she has reiterated the contents of complaint.  Complainant has also relied on documents like True copy of FIR marked as Ex.A-1, Ex.A-2 is the charge sheet, Ex.A-3 is the true copy of spot mahazar, Ex.A-4 is the true copy of IMV report, Ex.A-5 is the true copy of PM report, Ex.A-6 is the True copy of inquest mahazar and Ex.A-7 is the true copy of sketch pertains to accident spot. 

12.   On the other hand, OP No.2 argued and admitted about opening of JanDhan Account bearing A/c No.6273909656 by the complainant and the same was insured under PMJDY with OP No.2 but, denied the fact that, the same covers the accidental benefit of Rs.1,00,000/-.  It has no knowledge about the death of husband of complainant on 16.01.2015 in a motor cycle accident.  Complainant approached OP No.1 along with documents on 25.02.2015 and 24.02.2015 and forwarded the claim form to OP No.2 and the same has been repudiated through letter on 25.05.2015 as the same is not admissible as per the terms and conditions under PMJDY Scheme.  On the date of opening of the account itself, the OP No.1 has issued Pass Book to the said Chethan Kumar and in the said Pass Book, his A/c number is mentioned as 6273909656 and the ATM Card was generated on 23.01.2015 but, the account holder was died on 16.01.2015 i.e., before generation of ATM Card.  As per the PMJDY Circular C.O.F.I.D/ADV/101/2014-15 dated 23.09.2014, accidental insurance cover was provided by HDFC ERGO Insurance now, NPC has entered into an agreement with New India Assurance Company Ltd. to provide the facility for the year 2015-016 came into effect from 01.04.2015 to 31.03.2016.  During the launch of PMJDY scheme on 28.08.2014 Prime Minister announced a life cover of Rs.30,000/- with Rupay Card for all who opened Bank Account for the first time during the period from 15.08.2014 to 26.01.2015 and the benefits of insurance will be available to the card holders who performed minimum one successful financial or non-financial transaction at any channel both intra and interbank within 45 days prior to date of accident including accident date.  The husband of the complainant opened an account on 15.10.2014 and died on 16.01.2015 but, the transaction has not been done between the said period therefore, OP No.2 rejected the claim made by the complainant. 

13.   OP No.2 argued that, an insurance contract has been entered into between the complainant and the OP and OP accepted and indemnify the insured provided that, there should not be breach of any terms and conditions of policy.  However, there is no such contract entered into between the complainant and OP No.2 and this OP No.2 has not received any premium from the complainant.  Husband of complainant had a JanDhan account bearing No.6273909656 with OP NO.1 and the said Bank insured the same under PMJDY with OP No.2 for an accidental benefit of Rs.1,00,000/- and complainant is the legal representative of deceased Chetankumar and about the accident took place on 16.01.2015 and the husband of complainant sustained grievous injuries to head and all over the body is denied as false.  On 25.05.2015 and 24.04.2015 complainant approached OP No.1 with necessary documents to settle the accident claim and the same has been forwarded to OP No.2, OP No.2 did not settle the claim is denied as false.  In the claim repudiation letter of OP No.2, it has been stated that, "Card Generation date, that is mentioned in card details which is provided from your end and provided bank statement there is absence of Non ATM/Non POS/Non E-Commerce Transaction During the last 45 days prior to the date of loss.  Since the above claim is not admissible as per the policy terms and conditions.  It is argued that, the contention of complainant that, when once the PMJDY Account is opened, the duty of the bank is to give necessary Pass Book and ATM Card to the account holder but, in spite of repeated requests made by the husband of complainant, OP No.1 neither give Pass Book nor ATM Card is denied as false.  The claim has been repudiated for the reason that, One ATM transaction require for the 45 days prior to date of loss, the account opening date was 15.10.2015 and the date of loss was on 16.01.2015 and the Bank has issued the Card after his death and the same has not been operated one ATM transaction before his death.  The Rupay Card has been dispatched only on 23.01.2015 i.e., after the death of cardholder.

14.   On behalf of OPs, OPs have relied on affidavit evidence of OP No.2 in which she has reiterated the contents of complaint.  OPs have also relied on documents like Certified copy of ledger extract relating to deceased Chetakkumar marked as Ex.B-1, Ex.B-2 is the true copy of policy, Ex.B-3 is the true copy of repudiation letter,  Ex.B-4 is the true copy of card detail Form submitted by OP No.1, Ex.B-5 is the Pass Book extract pertains to deceased Chetankumar. D and Ex.B-6 is the Statement of Account.  

15.   We have carefully gone through the complaint, version filed by OPs, affidavit and the documents filed by both parties.  It is seen that, the husband of the complainant had opened a JanDhan A/c No.6273909656 with Indian Bank, Chitradurga Branch and the same has been insured under PMJDY Insurance with OP No.2 for an accidental benefit of Rs.1,00,000/-.  Complainant husband died on 16.01.2015 at about 5-00 PM in an accident took place near K-Ballekatte village on NH-4 road.  After the accident, on 25.02.2015 and 24.04.2015 complainant approached OP No.1 along with necessary documents requesting the accident claim, OP No.1 forwarded the same to OP No.2 but, OP No.2 did not settle the claim and given a repudiation letter of OP No.2 on 25.05.2015 on the ground that, there is an absence of Non ATM/Non POS/Non E-Commerce Transaction during the last 45 days prior to the date of loss and claim is not admissible as per the policy terms and conditions.  In spite of repeated requests made by the husband of complainant, OP No.1 did not give Pass Book or ATM Card to the complainant. The contention of the OPs are that, the A/c Holder has to transact/operate the account during the last 45 days prior to the loss is not acceptable because, the OPs have not issued Pass Book and ATM Card to the Account Holder i.e, the husband of the complainant.  When the OPs failed to issue the Pass Book and ATM Card to the account holder, how it is possible to operate his JanDhan Account.  OP No.2 has taken the same contention in version and written arguments filed by the OP No.1.  OP No.2 also stated in its objection that, the complainant has to activate the account within 45 days from the date of issuance of ATM Card and Pass Book.  Here the OP No.1 has committed a mistake in issuing the Pass Book and ATM Card.  OP No.2 in his version never taken a contention that, OP No.1 has committed a mistake in issuing the Pass Book and ATM Card.  Therefore, we come to the conclusion that, the non issuance of Pass Book and ATM Card by the OP No.1 is a deficiency of service on its part.  The OP No.2 is also taken a same contention that, the complainant has not operated the account within 45 days from the date of opening of account.  Both of them have taken a contention.  Hence, both of them have joint responsible in not settling the claim of the complainant. The repudiation of the claim by the complainant by the OPs is not sustainable under law. Therefore, there is a deficiency of service, for which the complainant is liable to be compensated.  Accordingly, we answer the Point No.1 held as partly affirmative.                

16.  Point No.2:- For the foregoing reasons, we pass the following:

ORDER

The complaint filed by the complainant U/s 12 of CP Act 1986 is partly allowed.

It is ordered that, the OPs are hereby directed to pay a sum of Rs.1,00,000/- to the complainant along with interest at the rate of 9% p.a from the date of filing of the complaint till realization. 

It is further ordered that, the OPs are hereby  directed to pay Rs.10,000/- towards damages/mental agony and Rs.5,000/- towards costs of this proceeding. 

It is further ordered that, the OPs are hereby directed to comply the above order within 30 days.

        (This order is made with the consent of Member after the correction of the draft on 10/11/2016 and it is pronounced in the open Court after our signatures.)

MEMBER                                         PRESIDENT

-:ANNEXURES:-

Complainant by filing affidavit evidence taken as PW-1

Witnesses examined on behalf of OPs:

 -Nil-

Documents marked on behalf of Complainant:

Documents marked on behalf of OPs:

MEMBER                                         PRESIDENT

Rhr.