DATE OF DISPOSAL: 07.08.2023
PER: SMT. SARITRI PATTANAIK, MEMBER(W):
The fact of the case in brief is that the complainant has filed this Consumer complaint under section 12 of the Consumer Protection Act, 1986 alleging deficiency in service and unfair trade practice by the Opposite Parties (in short O.Ps) and for redressal of his grievance before this Commission.
2. The complainant is the father of late Selina Majhi. The deceased selina majhi has a savings bank account in the Bank of O.P.No.1 bearing Account No. 32625532701. By virtue of sb Account No.32625532701, the daughter of the complainant was insured for an amount of Rs..4,00,000/- under personal Accident policy No. 137300-0000-00 and O.P.No.1 debited Rs.100/- on 02.11.2012. The O.P.No.2 accordingly issued the certificate of Insurance in favour of the deceased Selina Majhi wherein the present complainant was the nominee. The terms and condition of the policy is stated at the reverse side of the certificate. In the said terms and conditions of the Master policy, it is specifically stated “Coverage is limited to death on account of accident only”. The account of the policy holder i.e. Savings Bank Account No.32625532701 is available with O.P.No.1 who is required to deduct the insurance premium as is done on 02.11.2012. When the matter stood thus, the policy holder i.e. Selina Majhi died due to accidental burn injury during cooking on 22.05.2016 who was hospitalized at Sum Hospital, Bhubaneswar and declared dead at 10.07 A.M. dated 02.06.2016. On the request of Dr. Bibhudutta Mohapatra, Jr. Resident, IMS & Sum Hospital, Bhubaneswar, the police conducted inquiry and submitted its final report in U.D.G.R. case No. 263/16. The complainant as nominee submitted claim of Rs.4,00,000/- only to the O.P.No.2 as per the terms and conditions of the Master Policy. On receipt of the claim application, the O.P.No.2 requested to submit the documents. In the meantime the O.P.No.2 communicated its letter dated 21.01.2017 and stated to have receipt of Rs.200/- along with all such details. After receipt of all such documents as called for, the O.P.No.2 communicated its letter dated 04.08.2017 stating the claim is liable for repudiation. The O.P.No.2 intimated in the aforesaid letter dated 04.08.2017 that the deceased was insured under personal accident policies issued for period from 06.11.2012 to 05.11.2013 and 16.12.2016 to 15.12.2017 and the date of death of deceased falls beyond policy coverage period. It is submitted no termination of policy has been made from either side rather the policy has been given effect for the period from 16.12.2016 to 15.12.2017. The O.Ps use to debit the premium amount from the Saving Bank Accounts of the policy holder suo-moto. As such repudiation of the claim of the complainant is neither legal nor justified. The aforesaid actions of the O.P.No.2, the complainant suffered from harassment causing mental agony and such of the business is unfair trade practice so also deficiencies of services. Alleging deficiency in service on the part of the O.Ps the complainant prayed to direct the O.Ps to release of assured amount of Rs.4,00,000/- in favour of the complainant, Rs.30,000/- towards compensation and Rs.7500/- towards litigation cost in the best interests of justice.
3. After admission of the case, the notices were issued to all the opposite parties which are duly acknowledged by the Opposite Parties and appeared accordingly.
4. The O.P.No.1 filed written version and stated there in that the daughter of the complainant i.e. Selina Majhi was having an saving bank account bearing No. 32625532701 with this O.P. The allegations made in para-5 that “the O.P.No.1 who is required to deduct the insurance premium as is done on 02.11.2012” is strictly denied by the O.P. Admittedly, as instructed by Selina Majhi, the premium against the policy was deducted from her account on 02.11.2012 only. Due to absence of further instruction, no premium could be deducted from the account of Selina Manjhi towards insurance premium till 15.12.2016. So the complainant is to put to strict proof of instruction issued by the policy holder for deduction of premium from her account from 01.11.2013 to 15.12.2016 and proof of deduction from the accounts towards payment of premium. Further allegations made in para-6, 7 and 8 are not to the knowledge of this O.P. In para-9 regarding authentication by this O.P. has no relevance with the process of this claim as because the same was issued in a routine manner and there was no prior intimation regarding the date of death of Selina Majhhi. The role of this O.P. is confined to the sourcing and forwarding the proposal only. It is not a party in the contract of insurance governed under the insurance policy. This O.P. is neither responsible for settlement of the claim nor liable for payment of insured amount. This case involves complex question of facts, evidence and law. Hence this Hon’ble Forum has no jurisdiction to try the same and the matter can be properly adjudicated in the civil court. Hence the O.P.No.1 prays to dismiss the case.
4. The O.P.No.2 filed written version and denies the allegations of the complainant averred para 1-5 that the deceased had opened an SB Account with O.P.No.2 Bank bearing Account No. 32625532701. The deceased had obtained personal Accident Policy bearing Certificate No.87714301, Master policy No. 143990-0000-01with sum insured Rs.4,00,000/- and for which he had paid premium of Rs.200/- and the complainant is the nominee of the deceased. The O.P.No.2 does not admit and denies the allegations of the complainants as averred in Para no.6 that the deceased Selina Majhi died due to the accident and as such the O.P. is liable to pay the sum assured to the complainant who is the nominee to the insurance policy. In reply to statements and averments made in para-7 of the instant complaint petition this O.P.No.2 submit that, there are matters of fact which is needed to be proved by the complainant through documentary evidence. There was no such insurance policy to cover the alleged risk dated 02.06.2016. Hence the present claim is not maintainable against the O.P.No.2 and the present claim is liable to be dismissed. The complainant submitted all claim documents form to the O.P.No.2. After going through the entire documents it was found that the deceased Selina Majhi died an accidental on 02.06.2016. It is noted that deceased was insured under personal accident policy issued for period from 06.11.2012 to 05.11.2013 and 16.12.2016 to 15.12.2017. The opponent insurance Company was pleased to repudiate the claim vide letter dated 04.08.2017 of the complainant by contending that the date of death of deceased falls beyond policy coverage period. There is no deficiency in service on the part of this O.P. as such the present complaint is not maintainable and the same is liable to be dismissed on this ground alone. Hence this O.P.No.2 prays to dismiss the case.
5. On the date of hearing the Ld. Advocate for complainant as well as Ld. Counsels for O.Ps was present. We heard arguments from them. We perused the complaint petition, written version, evidence on affidavit, written argument and materials placed in the case record.
The complainant filed Xerox copy of SBI General Certificate of Insurance of Selina Majhi is insured for an amount of Rs.4,00,000/- under personal Accident Policy, subject to exclusions, provisions and other terms as specified in Master Policy No. 137300-0000-00 for a period of one year from 02.11.2012 only. The complainant had not submitted any other documentary evidence in support of his claims.
The submissions of the OP No.1 reveals that, there is no provision laid down by the State Bank of India that in absence of specific instruction from the account holder no premium can be deducted towards the insurance policy. And in the instant case also, the OP No.1 has not received any instruction from the account holder Selina Majhi till 15.12.2016. Suppressing the material information regarding the date of death of Selina Majhi to the OP No.1, an amount of Rs.200/- deposited towards the insurance premium and the same was forwarded to the concerned insurance company for the needful purpose. But in the issuance of insurance policy, the role of the OP no.1 is very limited i.e., sourcing and forwarding the proposal only as an intermediary. Further, the OP No.1 is also not a party to the contract in between the insured & the insurer. The OP No.2 adduced the materials in its submission that, the complainant has no insurance policy to cover the alleged risk dated:02.06.2016 in favour of deceased Selina Majhi at the time of accident. The date of death of deceased falls beyond policy coverage period. As such we hold there is no deficiency in service on the part of the OPs. Hence the present claim is not maintainable.
In the result we dismissed the case. No order as to cost and compensation.
The case of the complainant is disposed of accordingly.
The Judgment be uploaded on the www.confonet.nic.in for the perusal of the parties.
A certified copy of this Judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act, 2019. A copy of this order be also sent to the Secretary, State Consumer Disputes Rederssal Commission, Odisha, Cuttack for information.
The file is to be consigned to the record room along with a copy of this Judgment.
PRONOUNCED ON: 07.08.2023.
