This is a case filed by the complainant under Section 35 of the Consumer Protection Act, 2019. Brief fact of the case is that the complainant is a savings bank account holder of OP No-1(bank account no-50180026196688). By the said OP No-1 the complainant purchased one Health Insurance Policy from the OP No-2&3. Policy No.150100/12587/2020/A022868/ PE02231186 valid from 04-July-2020 to 03-July-2021 under “Group Assurance Health Plan". O.P.No.1 i.e. Bandhan Bank Limited as an “intermediary” /Agent of the OP No-3. On 15.12.2020, the date on which the husband of the Policy holder, Tapan Majumder one of the beneficiaries of the Policy got seriously ill. On 15.12.2020 said Tapan Majumder got admitted at Sanjibani Neuro Centre and Multi specialty Hospital at Siliguri. On19.12.2020 said Tapan Majumder was discharged from the said hospital. On 19.01.2021 the complainant went to OP No-1and submitted necessary documents of said policy and submit the insurance claim. On 23.04.2021the complainant again submitted documents at the OP No-1 Branch, on 18.06.2021 the complainant submitted requesting letter to OP No-1, on 22.10.2021 complainant made legal correspondence with OP No-1, on 25.10.2021 the said article delivered to the OP No-1 and finally on 8.11.2021 the specific time of the said legal correspondence lapsed. OP No-4&5 are the representative or the worker of O.P.No.1 i.e., Bandhan Bank Limited. Till date the claim amount has not been disbursed in favour of the complainant and the complainant think that she is entitled to get it accordingly against the policy of her. The complainant says that due to the acts of the O.Ps the complainant sustained financial loss and put in financial crunch as well as hardship in last lockdown period. The O.P.s have neglected to resolve the matter and harassed the complainant following which she filed this case before this Commission. The complainant claimed that she had enclosed insurance claim along with all documents and that was received and acknowledged by the OP No 1 jointly working or ventured with rest office i.e. OP No 2, 3, 4 and 5. That’s why complainant seeks redressal against both the OPs for his grievances.
Complainant prays before this Ld.Commission for the reliefs as under: - a) To admit the petition. b) To direct the OP no 1, 2 and 3 jointly or severally to admit the claim and disburse the payment thereof to the extent of Rs 43921/- , the insurance claim. c) To direct the all O.Ps to pay jointly or severally of Rs 200000/-for harassment, sufferings an agony cause to the complainant by the acts of the O.Ps. d) To direct the all O.Ps to pay Rs 240000/- for practicing deficiency in service and unfair trade practice. e) Cost of Litigation of Rs 10,000/- only. e) Direction upon the Opposite parties to pay the complainant the interest accrued on awarded amount @ 12% calculated from the date of cause of action till actual realization. Any other relief or reliefs which complainant is entitled to get.
The OP No-2&3have appeared in this case and filed their Written Version as well as the Evidence on affidavit and brief notes of argument. OP No-2&3have same identity as they both are merged. OP No-2&3have stated that the complainant purchased one Health Insurance Policy from the said O.Ps through the O.P.No.1 i.e., Bandhan Bank Limited as an “intermediary” /Agent bearing Policy No.150100/12587/2020/A022868/ PE02231186 valid from 04-July-2020 to 03-July-2021 under “Group Assurance Health Plan". The complainant had been requested by the said O.Ps. to submit the essential documents (viz.:Pre numbered Final Bill with detailed break-up of the sub-sections like consultation, medicines, investigation etc.) repeatedly on several occasions and finally vide a letter dated 04 May, 2021 with a request to submit the additional documents / information necessary for processing the claim. The Complainant had never turned up to give any response to the above request and / or submitted the above mentioned additional documents information as required by the said O.Ps for processing the claim nor the said complainant had made any such communication with the Insurance Co. in this regard and the said facts are very much clear and apparent from the complaint petition itself. The OP No-2&3have could not process the instant claim due to non-submission of the required additional documents / information by the complainant. The complainant lodged the claim to the O.P. No.1 and made all subsequent communications with regard to its settlement with the other O.Ps, which are the admitted facts by the complainant herself in the complaint, whereas the complainant should have approached the insurance company with regard to her claim and make all correspondences directly with the said O.P. / Insurance Co. Moreover, OP No-2&3have stated that it is a logical question that unless the insurance co. is intimated regarding the claim under any such policy and the Insurance Company is provided with complete documentation and information related to the claim which the Company requires to establish its liability the question of settlement does not arise at all. OP No-2&3have stated to reject / dismiss the instant complaint /case as against them.
Notice upon O.P.No-1, 4&5 was duly served. The Opposite Party 1, 4&5 did not appear to contest the case in spite of service of summons hence the case was heard ex-parte against them. According to the complainant the O.P.No-4&5 is the employee of O.P.No-1,2&3.
Decision with reason
Complainant is a consumer of the O.Ps. The complainant has both the territorial and pecuniary jurisdiction for filing the case before this commission. These points are never challenged by the OPs.
We have gone through the records and other related documents of the case. From the case record it reflects that the complainant made all correspondence to the O.P.No-1. She has a savings bank account in OP No-1bank (Account No-50180026196688) i.e. Bandhan Bank Limited. In the complaint petition the complainant stated that on 24/03/2021, 08/04/2021 and 23/04/2021 the O.P.No-3 sent three reminders collectively to her with a request to submit documents and final bill for settlement of the insurance claim. But, the complainant never file any document as evidence of his correspondence with the O.P.No-2&3.One document also files by the complainant dated 03/07/2021 which reflect that she has made correspondence with OP No-1bank about the alleged matter. It is true and an admitted fact that by the said OP No-1 the complainant purchased one Health Insurance Policy from the OP No-2&3. Policy No.150100/12587/2020/A022868/ PE02231186 valid from 04-July-2020 to 03-July-2021 under “Group Assurance Health Plan". O.P.No.1 i.e. Bandhan Bank Limited as an “intermediary” /Agent of the OP No-3. According to the IRDAI guideline on 16 March 2015 regarding appointment of Insurance Agents it is clearly mentioned that an agent must render necessary assistance to the policy holder or claimants or
beneficiaries in complying with the requirements for settlements of claims by the insurer. OP-1 also never informed the O.P.No-2&3 about the claim of the complainant. Notice was duly received by the Bandhan Bank Limited (O.P.N-1) and their employee (O.P.No-4&5). So, O.P.No-1, 4&5 are totally aware about the fact and about the case.
In a very significant judgment with far reaching consequences, the THE SUPREME COURT OF INDIA in a learned, laudable, landmark and latest judgment titled Pradeep Kumar And Anr. vs Post Master General and Ors in Civil Appeal No. 8775-8776 of 2016 delivered as recently as on February 7, 2022 held that once it is established that fraud or any wrongful act was perpetrated by an employee of a post/bank office during the course of their employment, the post/bank office would be vicariously liable for the wrongful act of such employee. The Supreme Court clarified that the post office is entitled to proceed against the concerned officer, but the same would not absolve them from their liability. In Para 5 and 6 of the complaint petition the complainant stated about the involvement of O.PNo- 4&5 in this case. Considering the contentions made in the complaint and also the evidence in support of such contentions as sworn by the Complainant and also the copy of documents filed we find that the Complainant has proved her case against O.P.No-1, 4&5. There is no evidence to the contrary by the Opposite Party No-1, 4&5 and since there is no evidence contradicting the evidence of the Complainant we find that the Complainant’s case is to be believed against O.P.No-1, 4&5. The insurance company is silent about the act of their “intermediary” /Agent i.e. Bandhan Bank Limited. Opposite party number 1 Bandhan Bank has a corporate identity .Being an insurance agent of the complement they did nothing as and when complainant duly communicate with Bandhan Bank about the problem of the complainant. Being an insurance agent Bandhan Bank never feels to act according to the IRDA guideline for the insurance agents. OP number2&3 are totally silent about their appointed insurance agent/“intermediary” Bandhan Bank. The mala fide Nexus between all the opposite parties cannot be ruled out. On 18/06/2021 the complainant wrote to the O.P.No-1 to stop his premium collection regarding this insurance policy, but on dated 30/06/2021 EMI had been remitted by the OP No 1 from the bank account of the complainant. No evidence is filed by the complainant against the opposite party No- 4&5 but it is understandable that they act as directed by the Opposite Party No-1.
In their written notes of argument the OP No-2&3have stated as under………… “However in the instant case, the said O.Ps after appearing in the present case and after considering the medical documents submitted by the complainant along with the complaint, offered the complainant to settle the instant claim at the tune of Rs.32, 000/-only in view of the policy terms and conditions and the O.Ps'liability which is covered / payable under the policy, but the complainant did not agree.”
In Gurmel Singh vs Branch Manager, National ... on (CIVIL APPEAL NO. 4071 OF 2022)20 May, 2022 the hon’ble Supreme Court of India has observed as follows… “In many cases, it is found that the insurance companies are refusing the claim on flimsy grounds and/or technical grounds. While settling the claims, the insurance company should not be too technical and ask for the documents, which the insured is not in a position to produce due to circumstances beyond his control”
We have gone through the records and other related documents of the case and have come to conclusion that all the opposite parties would be liable for the contributory negligence.
In view of the aforementioned discussions, we are of the view that the complainant is entitled to get reliefs as per Consumer Protection Act 2019 and there is deficiency in service and unfair trade practice on the part of the OPs. Thus, the consumer case is allowed in part on contest against the OP- 2&3 and ex parte against OP-1with cost. The case also dismiss against Opposite Party No- 4&5 without cost.
All points are disposed of. In the result the case/ application succeeds.
Hence, it is
ORDERED
- O.P.No-2&3 is directed to pay the insurance claim amount Rs. 32000/-(Thirty two thousand only) from 20/01/2021 (the date of the insurance claim according to claim form) with 8% interest till payment date.
- OP-1 is directed pay Rs. 50,000/- (Rupees fifty thousand) only as compensation for harassment and mental agony caused to the complainant on account of deficiency in service and unfair trade practices. Out of this Rs. 50,000/- (Rupees fifty thousand) complainant will get Rs. 20.000/- (Twenty Thousand) and 30.000/- (Thirty thousand) will be deposited to the Consumer Legal Aid account of this commission.
- Above payments shall be made within 30 days from the date of this order. Failing which the amount shall carry interest @ 9 % p.a. from the date of order till its realization. Complainant is given liberty to execute the order as per law if not paid by the OPs.
Let a copy of the order be sent / supplied at free of cost to the parties concerned.
The Final Order will be available in the following website www.confonet.nic.in
