Haryana

Karnal

CC/308/2020

Sanjay - Complainant(s)

Versus

The Branch Manager, State Bank Of Patiala - Opp.Party(s)

Sanjeev Rana

17 May 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                        Complaint No. 308 of 2020

                                                        Date of instt.21.08.2020

                                                        Date of Decision:17.05.2023

 

Sanjay son of Shri Jai Singh, resident of house no.56, village Suhana, District Karnal.

                                               …….Complainant.

                                              Versus

 

1.     The Branch Manager, State Bank of Patiala, village Ranwar, District Karnal.

 

2.     State Bank of India, Life Insurance Company Ltd. Central Processing Centre, 8^th floor, Seawoods Grand Central Tower-2, plot no.R-1, Sector-24, Seawoods, Nerul Node, Navi Mumbai, Maharashtra-400706, through its Manager, insurer of the deceased Ajit son of Jai Singh, vide policy no.7600100135 of PMJJBY.

…..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary….Member

          

 Argued by: Shri Sanjeev Rana, counsel for the complainant.

                    Shri Brijesh Sharma, counsel for the OP no.1.

                    Shri N.K. Zak, counsel for the OP no.2

 

                    (Dr. rekha chaudhary, member)

ORDER:   

                

                  The complainant has filed the present complaint under Section 35 of Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that brother of complainant, namely Shri Ajit son of Shri Jai Singh, who was unmarried, opened an account with branch of OP no.1, having account no.65232763227. The brother of complainant obtained policy as per central government policy under the Pradhan Mantri Jiwan Bima Yojna. An amount of Rs.330/- and Rs.12/- were deducted on 28.07.2015 by the OP no.1 from the account of the deceased bearing account no.65232763227 maintained by him in State Bank of Patiala, Branch village Ranwar, District Karnal for the abovesaid policy respectively. Similarly, on 30.06.2016, 28.05.2017, 27.03.2019, the abovesaid policies were again renewed by deducing the premium amount as stated above and the complainant stood nominee in the said account. Brother of complainant had expired on 05.04.2019. Thereafter, complainant being nominee of Ajit Singh, approached the OP no.1 so many times and requested to release the insured amount under the abovesaid policies. But OP did not pay any heed to the request of complainant and lingered the matter on one pretext or the other and did not release the claim amount till today. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence, this complaint.

2.             On notice, OP no.1 appeared and filed its written version raising preliminary objections with regard to maintainability; jurisdiction; cause of action and concealment of true and material facts. On merits, it is pleaded that OP has performed its/his part of contract incumbent upon him by transferring the premium amount to the OP no.2 well within the stipulated time. It is an admitted fact that renewal of the policy in the year 2016, 2017 and 2019 and after issuance of the policy, there left the privity of contract between the complainant and the OP no.2. There is no allegation on the part of the OP no.1 at the time of repudiation of the claim. Even otherwise, OP has no role to play either in acceptance of repudiation of the claim. Once the premium has been paid by the OP and has been duly remitted in the account of OP no.2 and OP no.2 has issued the policy on the force of premium amount submitted by the OP, the OP relieved from all kind of liabilities and responsibilities whatsoever. There is no deficiency in service and unfair trade practice on the part of the OP. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             OP no.2 filed its separate written version raising preliminary objection with regard to maintainability; jurisdiction and concealment of true and material facts. On merits, it is pleaded that OP no.2 has issued one such master policy under Pradhan Mantri Jeevan Jyoti Bima Yojna under group insurance scheme, vide master policy no.7600100135 issued to State Bank of India covering the account holders who have satisfied the eligibility criteria and who have paid the requisite premium. The terms and conditions of the master policy are binding on all the members of the scheme. As per the circular dated 02.05.2016 issued by the Government of India, for new members enrolling to the scheme (lien period) 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. Accordingly, the amendment to the master policy was communicated to the Master policy holder vide a letter dated 01.06.2016, alongwith the copy of circular by Government of India. It is further pleaded that in Group Insurance Scheme, the privity of contract is between the Master Policyholder and the Insurer. In the present case, the date of commencement of risk on the life of late Ajit Kumar was 27.03.2019 and the date of death was 05.04.2019 i.e. the death happened within 45 days from the date of commencement of risk due to natural cause and as per the directives issued by Ministry of Finance, Government of India, the OPs are not liable to pay any claim amount except for a claim arising out of death due to accident, during the first 45 days from the date of commencement of the cover for the insured member. Hence nothing is payable. Therefore, the claim has been repudiated. There is no deficiency in service and unfair trade practice on the part of the OP. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

4.             Parties then led their respective evidence.

5.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of death certificate Ex.C1, copy of passbook of statement of account Ex.C2, copy of Aadhar card of Ajit Ex.C3, copy of driving licence of Ajit Ex.C4, copy of Aadhar card of complainant Ex.C5 and closed the evidence on 02.02.2022 by suffering separate statement.

6.             On the other hand, learned counsel for the OP no.1 has tendered into evidence affidavit of Ashish Singal, Branch Manager Ex.OP1/A and copy of statement of account Ex.OP1/1 and closed the evidence on 11.01.2023 by suffering separate statement.

7.             Learned counsel for the OP no.2 has tendered into evidence affidavit of Dhanya K.P., authorized representative of OP no.2 Ex.OP2/A, copy of letter dated 11.08.2015 of Master policy Ex.O1, copy of letter dated 02.05.2016 regarding amendment of rules for implementation of PMJJBY Ex.O2, copy of endorsement dated 01.06.2016 Ex.O3, copy of policy particulars Ex.O4, copy of certificate of insurance Ex.O5, copy of repudiation letter dated 03.07.2019 Ex.O6, copy of claim application dated 24.05.2019 Ex.O7 and closed the evidence on 29.04.2022 by suffering separate statement.

8.             We have heard the learned counsel for the opposite parties and perused the case file carefully and have also gone through the evidence led by the parties.

9.             Learned counsel for the complainant, while reiterating the contents of written version, has vehemently argued that the brother of complainant obtained a policy as per central government policy under the Pradhan Mantri Jiwan Jyoti Bima Yojna. An amount of Rs.330/- and Rs.12/- were deducted on 28.07.2015 by the OP no.1 from the account of the deceased (Ajit)  for the abovesaid policy. Similarly, on 30.06.2016, 28.05.2017, 27.03.2019, the abovesaid policies were again renewed by deducing the premium amount. The complainant is the nominee in the said account. Brother of complainant had expired on 05.04.2019. Complainant being nominee of Ajit Singh, approached the OP no.1 and requested to release the insured amount under the abovesaid policies but OP did not release the policy amount. He further argued that insured had purchased the policy in question from the year 2015 to 2019 continuously and OP no.1 had deducted the premium for the policy continuously and prayed for allowing the complaint.

10.           Per contra, learned counsel for the OP no.1 while reiterating the contents of written version, has vehemently argued that after deduction of premium amount, under Pradhan Mantri Jeevn Jyoti Bima Yojna, OP no.1 had remitted premium in the account of insurance company, so there is no fault on the part of the bank/OP no.1 and lastly prayed for dismissal of complaint qua OP no.1

11.           Learned counsel of OP no.2, while reiterating the contents of written version, has vehemently argued that as per the circular dated 02.05.2016 issued by the Government of India, for new members enrolling to the scheme (lien period) the risk will not be covered during the first 45 days from the date of enrollment into the scheme and in case of death during lien period, no claim would be admissible. In the present case, the date of commencement of risk on the life of late Ajit Kumar was 27.03.2019 and the date of death was 05.04.2019 i.e. the death happened within 45 days from the date of commencement of risk, hence claim is not is payable and lastly prayed for dismissal of the complaint.

12.           Admittedly, the deceased life assured having an account with OP no.1 and had obtained the PMJJBY from OP no.2 through his banker i.e. OP no.1. It is also admitted that life assured had died during the subsistence of the insurance policy. It is also an admitted that the insurance premium was duly deducted from the account of deceased life assured by OP no.1 continuously from the year 2015 to 2019 and this fact is also proved from the statement of account of deceased life assured Ex.C2/Ex.OP1/1. It is also admitted that complaint is the nominee in the said policy.

13.           The claim of the complainant has been repudiated by the OP no.2, vide repudiation letter Ex.O6 dated 03.07.2019 on the ground that death of the life assured within the lien period of 45 days from the date of commencement of policy.

14.           OPs relied upon the circular dated 02.05.2016 of Government of India Ministry of Finance Department of Financial Service. The relevant portion of the said circular as under:-

i)      As per the original scheme, a declaration of good health (DGH) may be obtained from fresh enrollees from the coming enrollment cycle i.e. 1^st June, 2016 OR

ii)     A 45 days lien clause may be imposed in the PMJJBY Scheme whereby the claim cases during the first 45 days from the date of enrollment will not be paid. However, deaths due to accident would be exempted from the lien clause.

15.           Now question arises for consideration is that whether the complainant is entitled for the claim or not?      

16.           The onus to prove his case was relied upon the complainant. To prove his case complainant has placed on file copy of statement of account Ex.C2/Ex.OP1/1, on perusal of the said statement of account, the premium was deducted from the account of deceased life assured continuously from the year 2015 to 2019, for the policy in question. Meaning, thereby, the deceased life assured was not the new members and policy in question was commenced from the year 2015.  The abovesaid circular has been enforced from 02.05.2016 and the policy of complainant was not terminated. Thus, the said circular is not applicable in the present case. Moreover, it is not the case of the OP no.2 that the name of the deceased life assured does not fall in the list of new members. Hence, plea taken by the OP has no force.

17.  

“It seems that the Insurance Companies are only interested in earning the premiums which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance companies make the effected people to fight for getting their genuine claims. The Insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy”.    

18.           Keeping in view that the ratio of the law laid down in aforesaid judgment, facts and circumstances of the present complaint, we are of the considered view that act of the OP no.2 while repudiating the claim of the complainant amounts to deficiency in service and unfair trade practice, which is otherwise proved genuine one. 

19.           As per insurance policy Ex.O1, the sum insured is of Rs.2,00,000/-. Hence, the complainant is entitled for the said amount alongwith interest, compensation and litigation expenses etc.

20.           In view of the above discussion, we allow the present complaint and direct the OP no.2 to pay Rs.2,00,000/- (Rs. two lakhs only) alongwith interest @ 9% per annum from the date of repudiating of the claim till its realization. We further direct the OP no.1 to pay Rs.10,000/- to the complainant on account of mental agony and harassment suffered by him and Rs.5500/- for the litigation expense. Complaint qua OP no.1 stands dismissed. This order shall be complied within 45 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Dated:17.05.2023                                                                      

                                                                  President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Rekha Chaudhary)

                    Member                         Member