The Complainant has filed this case alleging deficiency-in-service by the O.Ps, where O.P No.1 is the Branch Manager/ Official in-charge, State Bank of India, Gopalpur Branch, O.P No.2 is the Branch Manager/ Official in-charge, SBI Life Insurance Co. Ltd., Balasore and O.P No.3 is the Regional Manager, State Bank of India, Padhuanpada, Balasore.

                                 2. The case of the Complainant in brief is that the Complainant is the husband of Sukanti Khatua, who died on 30.10.2016 due to cancer. During life time of the deceased, she made an insurance policy of Rs.2.00 lacs (Rupees Two lacs) only through her S.B A/c No.33088373782 under Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY) issued by O.P No.1, where O.P No.1 debited insurance premium amount of Rs.330/- (Rupees Three hundred thirty) only from her S.B Account on 27.09.2016 and policy valid up to 31.05.2017 after submitting KYC details along with self certificate of good health by the deceased. The husband of the deceased (the Complainant) is the nominee. Thus, the Complainant submitted genuine documents to O.P No.1 for payment of claim and as per advice of O.P No.1, the Complainant submitted application before O.P No.2 on 17.12.2016 for disbursal of claim, but the O.P No.2 without any reason rejected the claim of the Complainant. Thereafter, the Complainant sent a legal notice to O.P No.1 through his Advocate on 04.03.2017 requesting to take remedial steps against his claim within one month. On 12.04.2017, the Complainant had been to O.P No.1 with a request about his insurance claim, but the O.P No.1 after telephonic conversation with O.P No.2 and 3, bluntly denied for payment of such insurance claim, which amounts to deficiency in service by the O.Ps causing mental agony to the Complainant. Cause of action to file this case arose on 27.09.2016, 04.03.2017 and on 12.04.2017. The Complainant has prayed for payment of insurance claim of Rs.2.00 lacs (Rupees Two lacs) only with interest along with compensation for mental agony and litigation cost.

                                  3. Written version filed by the O.Ps No.1 & 3 through their Advocate denying on the point of maintainability as well as its cause of action. The O.Ps No.1 & 3 have further submitted that the Complainant has totally ignored and failed to follow the strict terms of the insurance policy covered under “Pradhan Mantri Jeevan Jyoti Bima Yojana”. Admittedly, the wife of the Complainant while suffering from cancer (carcinoma left Tonsil with neck nodes) was admitted in Saroj Gupta Cancer Centre and Research Institute, Kolkata on 17.09.2016 as disclosed from Hospital discharge certificate, which was submitted with claim format, her husband-the Complainant has deliberately suppressed the above material facts and cunningly, managed to submit the insurance application and consent-cum-declaration form for “Pradhan Mantri Jeevan Jyoti Bima Yojana” on 27.09.2016 on behalf of his ailing wife and during illness, she was discharged from the said Hospital on 04.10.2016 as revealed from the discharge certificate submitted by the Complainant along with the claim form. She died on 30.10.2016 at her own residence, which revealed from the death certificate of the deceased. As per SBI Life Insurance Policy guidelines under the policy documents, the strict terms of the rules under exclusion reveals that “for new members enrolling into the scheme, the risk will not be covered during the first 45 days from the date of enrollment into the scheme (lien period) and in case of death (other than due to accident) during lien period, no claim would be admissible”. But in the instant case, the date of enrollment to the insurance scheme by the policy holder was on 27.09.2016 and her death occurred on 30.10.2016 i.e. within a period of 34 days only and as such, the claim for insurance does not cover the eligibility criteria under above insurance rules and therefore, the said claim being not admissible is repudiated and the Complainant is not entitled to claim for his deceased wife. In fact, the Complainant is the real author of the entire story of claim for insurance being well aware in advance of the consequences of his ailing wife has submitted the application along with consent-cum-declaration form for availing the claim form for his unlawful gain and benefit and has wrongly filed this case. Thus, the case against the O.Ps-Bank being frivolous and vexatious may be dismissed with cost.

                                  4. Written version filed by the O.P No.2 through his Advocate, where it is submitted that the deceased life assured (DLA) was having Bank Account No.33088373782 with State Bank of India, had applied for insurance cover under Pradhan Mantri Jeevan Jyoti Bima Yojana along with initial premium of Rs.330/- (Rupees Three hundred thirty) only. Based on the information provided by the policy holder, the O.P No.2 had granted insurance cover under the policy bearing No.76001000135 under good faith with date of commencement on 27.09.2016 for a basic sum assured of Rs.2.00 lacs (Rupees Two lacs) only. The DLA is reported to have died on 30.10.2016. Thus, she has died within 45 days from the date of commencement of insurance cover granted to her due to natural cause. As per the terms and conditions of the policy, for new members enrolling to the scheme since 01.06.2016, the risk will not be covered during the first 45 days from the date of enrollment into the scheme and in case of death (other than due to accident) during lien period, no claim would be admissible. This O.P has issued this insurance policy to the deceased life assured as she has satisfied the eligibility criteria and she has paid the requisite premium. As an evidence of contract, a policy containing all the terms and conditions of the insurance coverage was issued to the policy holder. The terms and conditions of the policy are binding on all the members of the scheme. The Government of India vide circular dtd.02.05.2016 decided to add the exclusion clause of 45 days under PMJJBY scheme. Accordingly, the amendment to the policy was communicated to the policy holder vide dtd.01.06.2016 along with the copy of circular by Government of India. As the DLA died within 45 days from the date of commencement of insurance cover granted to her, the Complainant is not entitled to get the death claim benefits. So, the claim was rejected as the date of commencement of the insurance cover is 27.09.2016 and the date of death is 30.10.2016, which is within 45 days from the date of commencement of the policy and the cause of death is not accident. The same was communicated to the Complainant vide letter dtd.30.01.2017. Thus, the Complainant is not entitled to get any benefit as claimed. Hence, the O.P No.2 prayed to dismiss the complaint with cost.

                                  5. In view of the above averments of both the Parties, the points for determination of this case are as follows:-

(i) Whether this Consumer case is maintainable as per Law ?

(ii) Whether there is any cause of action to file this case ?

(iii) To what relief the Complainant is entitled for ?

                                  6. In order to substantiate their claim, both the Parties have filed certain documents as per list. Perused the documents filed. It has been argued on behalf of the Complainant that he is the nominee of the policy holder his wife Sukanti Khatua, who had made a policy for of Rs.2.00 lacs (Rupees Two lacs) only including death claim under Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY) issued by O.P No.1 on 27.09.2016 and the policy holder died on 30.10.2016. Thereafter, when he applied for death claim, the O.Ps did not respond, for which he issued legal notice for settlement of the claim and in spite of the said notice, the O.Ps denied to settle the claim, for which he has been compelled to file this case in this Forum praying for settlement of death claim of Rs.2.00 lacs (Rupees Two lacs) only along with compensation and litigation cost. On the other hand, it has been argued on behalf of the O.Ps i.e. O.P No.1 and 3 in one set and O.P No.2 in another set that the policy was issued on 27.09.2016 and the policy holder was hospitalised on 17.09.2016 at Saroj Gupta Cancer Centre and Research Institute, Kolkata and discharged from the Hospital on 04.10.2016 and she died on 30.10.2016 at her own residence. The death certificate is available in the case record discloses the same. So, she died after 34 days of issuance of the policy. But, according to policy guidelines, “for new members enrolling into the scheme, the risk will not be covered during the first 45 days from the date of enrollment into the scheme (lien period) and in case of death (other than due to accident) during lien period, no claim would be admissible”. Such fact has been disclosed from the documents filed by the O.Ps as available in the case record. So, the O.Ps have repudiated the claim basing on this principle.

                                  7. So, now on careful consideration of all the materials available in the case record and after hearing both the sides, we are in the opinion that when the policy holder died for a disease not by accident within a period of 34 days (not after 45 days), the Complainant is not entitled to get the death claim benefit and the O.Ps have rightly repudiated the claim, for which this Consumer case is liable to be dismissed. Hence, Ordered:-

                                                     O R D E R

                                      The Consumer case is dismissed on contest against O.Ps No.1 to 3, but in the peculiar circumstances without cost.

                                      Pronounced in the open Forum on this day i.e. the 4th day of April, 2018 given under my Signature & Seal of the Forum.