Complaint filed on: 19-01-2023
Disposed on: 30-10-2023
BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, TUMAKURU
DATED THIS THE 30th DAY OF OCTOBER 2023
PRESENT
SMT.G.T.VIJAYALAKSHMI, B.Com., LLM., PRESIDENT
SRI.KUMARA.N, B.Sc. (Agri), LL.B., MBA., MEMBER
Consumer Complaint No. 07/2023
1. Sri.Ramaiah K.T. S/o Late Thimmaiah,
Aged about 37 years, Residing at
Kathinagenahalli Village, Kasaba Hobli,
Koratagere Taluk, Tumakuru District.
2. Master. Tharun K.R. S/o Ramaiah K.T.
Aged about 15 years, Represented by his
Next friend natural guardian Father
Ramaiah K.T., the complainant No.1
R/at Kathinagenahalli Village,
Kasaba Hobli, Koratagere Taluk,
(Nominee Holder of deceased Thimmakka
In PMSBY Policy)
(By Sri.T.S.Hidayath Pasha, Advocate)
V/s
1. The Branch Manager,
United India Insurance Co. Ltd.
Divisional Office, Opposite Sony Center,
Srishankara Complex, Parvathingar,
Main Road, Bellary - 583 102.
2. The Branch Manager,
Karnataka Grameena Bank,
Akkirampur Branch,
Akkiramapura,
Holavanahalli Hobli,
Koratagere Taluk,
Tumakuru District.
(OP No.1 – By Sri. D.N.Rajendra Prasad, Adv.,)
(OP No.2 – By H.G. Prakash, Advocate)
:O R D E R:
BY SMT.G.T.VIJAYALAKSHMI - PRESIDENT
This complaint is filed by the complainants Under Section 35 of Consumer Protection Act, 2019 against the Opposite parties, to direct them to settle the insurance claim amount of Rs.2,00,000-00 along with interest from 09-08-2022 to till realization and prayed for award a sum of Rs.5,00,000-00 towards mental agony, Rs.5,000-00 as damages and the cost of legal expenditure of Rs.5,000-00 together with interest at 12% p.a from the date of complaint to till the date of payment.
2. The Opposite party No.1 is the Branch Manager, United India Insurance Co. Ltd, Divisional Office Bellary (hereinafter called as OP No.1). The Branch Manager, Karnataka Grameena Bank, Akkirampura Branch, Tumkur District is the Opposite Party No.2 (hereinafter called as OP No.2).
3. The case of the complainants’ is that, late Smt.Thimmakka W/o Gangappa who has no issues, adopted the complainant No.1. Late Smt.Timmakka mother of the complainant No.1 has took the insurance policy under Pradhana Mantri Suraksha Bima Yojana (hereinafter called as PMSBY) from OP No.1 through OP No.2. Deceased Smt.Timmakka mother of the complainant No.1 has nominated the complainant No.2 (who is the minor son of complainant No.1) to the insurance policy under PMSBY. OP No.2 has deducted Rs.20/- by auto debit facility in one installment on 09-06-2022 for insurance policy under PMSBY which covers benefit as Rs.2,00,000-00 for accidental death and full disability and Rs.1,00,000-00 for partial disability. On 05-08-2022, Smt.Timmakka fell down accidentally in the river and died. As per the terms of the policy, the complainants approached OP No.1 through OP No.2 to claim insurance policy amount of Rs.2,00,000-00. But OP No.1 has repudiated the claim of the complainants by giving reason as the deceased Smt.Timmakka has crossed the age limit of 70 years as per the terms and conditions of the policy. Hence, this complaint.
4. After receipt of notice from this Commission, OP No.1 and 2 were appeared before this Commission through their respective counsels and filed their respective versions.
5. OP No.1 has admitted that deceased Smt.Thimmakka has remitted the amount of Rs.20/- to OP No.2 and same was credited to OP No.1 on 09-06-2022. Further OP No.1 has denied the all allegations made by the complainants as false. The OP No.1 has submitted that the Central Government was introduced the PMSBY scheme offering accidental death and it would be one year coverage and every year it must be renewable and must covered from the age of 18 years to 70 years and the complainant No.1’s deceased Mother was crossed the age of 71 at the time of her death. Further, the OP No.1 submitted that as per rules governed in the PMSBY scheme clearly states that the accident cover for the scheme shall terminate on any following events and no benefit will be payable there under and it includes “on attaining the age 70 years” as that OP No.1 clearly rejected the claim of the complainants. Further, the OP No.1 submitted that they have not committed any deficiency of service, accordingly prayed for dismissal of the complaint against the OP No.1.
6. The OP No.2 has also admitted that deceased Smt.Thimmakka has approached the OP No.2 with intending to obtain benefit of PMSBY. Rs.20-00 was deducted through auto debit in one installment for PMSBY scheme in the account of deceased Smt.Thimmakka on the instruction of herself and same amount credited to OP No.1. The OP No.2 has denied all other allegations made by the complainants as false. Further, the OP No.2 has submitted that after demise of said Smt.Thimmakka, OP No.2 duly helped the nominee, complainant No.2 represented by complainant No.1, fill out the PMSBY claim cum discharge form and submitted the claim along with supporting documents vide letter to OP No.1 on 12.10.2022 and OP No.1 sent a letter dated:20.12.2022 to OP No.2 by repudiating the claim of the complainants on the basis of deceased Thimmakka has crossed the age 70 years. Further, the OP No.2 has submitted that they have done their duty and prayed for dismissal of the complaint against the OP No.2.
7. The complainant No.1 has filed his affidavit evidence on behalf him and on behalf of complainant No.2 and filed 10 documents which are marked as Ex.C1 to C10. One shri.Abhijith .R, Administrative officer of the OP No.1 has filed his affidavit evidence. One Shri. P.L. Manohar, K.G.B. Manager of OP No.2 has filed his affidavit evidence with 05 documents, which are marked as Ex.OP2(1) to Ex.OP2(5).
8. We have heard the arguments of counsel for complainants and respective counsels for OP Nos. 1 & 2.
9. The points that would arise for determination are as here under:
- Whether complainants prove the deficiency of service on the part of OPs?
- Is complainant entitled to the relief sought for?
- Our findings on the aforesaid points are as under:
Point No.1: In the Affirmative
Point No.2:Partly Affirmative as per the final order
for the following;
:REASONS:
Point Nos.(1) & (2):-
11. On perusal of pleadings, documents and evidence of the parties, it is seen that the complainant No.1 is the adopted son of deceased Thimmakka wife of late Gangappa and complainant No.2 is the minor son of complainant No.1 and also nominee of deceased Smt.Thimmakka for her insurance policy under Pradhan Mantri Suraksh Bima Yojana [PMSBY]. Ex.OP2(1)/copy of the claim cum discharge form produced by the OP No.2 has establishes that the complainant No.2 is the nominee of deceased Smt.Thimmakka for her insurance policy under PMSBY and complainant No.1 is the appointee of minor complainant No.2. Further, the deceased Smt.Thimmakka wife of late Gangappa availed the insurance policy under PMSBY from OP No.1 through OP No.2 and Rs.20-00 was auto debited by OP No.2 and credited to OP No.1 on 09.06.2022. The same was admitted by the OP Nos. 1 & 2 and Ex.C3/copy of the bank pass book of deceased Smt.Thimmakka establishes the same. On perusing the copy of bank passbook of deceased Smt.Thimmkka, it is noticed that the premium amount of Rs.20-00 was debited on 09.06.2022 for PMSBY. Further, Smt.Late Thimmakka has died accidently by drowning in the river Suvernamuki on 09.08.2022. Ex.C2/copy of the FIR reveals the same and after the death of Smt. Thimmakka, the complainants were submitted the claim form for the benefit of insurance policy and PMSBY through OP No.2 to the OP No.1. But the OP No.1 has not settled the claim amount and repudiated the claim of the complainants by writing a letter dated:20.12.2022 to the OP No.2 Ex.C1/copy of the repudiation letter wrote by the OP No.1 established that the OP No.1 has repudiated the claim of the complainants by giving reasons that the deceased at the time of her death crossed the age limit of 70 years and running 71 years.
12. Per-contra, the OP No.1 has contended that the Government was introduced PMSBY scheme and as per that accident, insurance scheme offering accidental death and disability cover for death or disability on account of an accident, it would be one year coverage and every year it must be renewable and must covered from age of 18 years to 70 years. Further, counsel for OP No.1 argued that in this case, the deceased was already age of 70 when getting the insurance policy and deceased was died at the age of 71 years. For that reason, the OP No.1 has rejected the claim of the complainants. But, the OP No.1 has not produced any documents to show that the terms and conditions of the PMSBY scheme. Further, the OP No.1 has not produced any documents to show that they have returned the premium amount to deceased Smt.Thimmakka, when she was not eligible to enter the PMSBY scheme as she has crossed the age of 70 when premium amount was deducted on 09.06.2022 and credited to the OP No.1.
13. The OP No.2 contended that deceased Smt.Thimmakka intending to obtain benefit of PMSBY scheme, had approached OP No.2 and instructed the OP No.2 to deduct Rs.20-00 from her account which is maintained with OP No.2 and to auto debit in one installment on 09.06.2022 and the same amount was credited to OP No.1. On perusing Ex.C3/copy of bank passbook of deceased Smt.Thimakka, it is noticed that the OP No.2 has deducted the premium amount of Rs.20-00 on 09.06.2022. Further, Ex.OP2(1)/copy of the claim cum discharge form reveals that OP No.2 has been collected all information about policy holder while deducting the premium amount of the insurance policy from the account of the policy holder. When having details about age proof of the policy holder, it is the duty of OP No.2 to verify whether an individual is eligible or not for availing the (PMSBY) insurance policy. Though aware the age of deceased Smt.Thimmakka, the OP No.2 has deducted premium amount of Rs.20-00 for the PMSBY insurance and credited with OP No.1 which amounts to deficiency in service on the part of OP No.2.
14. The Ex.C1/copy of repudiation letter by OP No.1, produced by complainants reveal that OP No.1 has repudiated the claim of the complainant as Smt.Thimmakka, who died in Road Accident is not covered by the PMSBY Scheme. Ex.C2/copy of FIR established that Smt.Thimmakka died due to drowning in the water. But OP No.1 has mentioned the cause of death of Smt.Thimmakka as road accident, which clearly established deficiency in service and also shows the negligence of the OP No.1. Further, being a responsible person, by knowing the age of deceased Smt.Thimmakka, the OP No.1 has not returned the premium amount to the deceased Smt.Thimmakka, which was hard earned money of Smt.Thimmakka. This act of OP No.1 amounts to deficiency in service of OP No.1. The OP No.2 has auto-debited the premium amount of Smt.Thimmakka by knowing her age and OP No.1 has not returned the premium amount to Smt.Thimmakka when she was not eligible for PMSBY scheme. This act of the OP Nos. 1 & 2 amounts to deficiency in service and unfair trade practice. Hence, OP Nos. 1 & 2 were jointly and severally liable to pay Rs.2,00,000-00 which is the benefit of PMSBY scheme to the nominee of deceased Smt. Thimmakka who is the complainant No.2 with interest @ 8% PA from 20.12.2022 i.e. the date of repudiation of the claim.
15. Further, the complainants prayed to award a sum of Rs.5,00,000-00 towards mental agony and Rs.5,000-00 as damages, but they are not produced any documents to show that they have entitled for compensation of Rs.5,00,000-00. For the act of OP Nos.1 & 2, the complainants compelled to approach this Commission. Hence, considering the mental agony caused by the OPs to the complainants, the OP Nos. 1 & 2 are jointly and severally liable to pay Rs.10,000-00 to the complainants towards compensation for mental agony and Rs.8,000-00 as litigation cost to the complainants. Accordingly, we pass the following:-
:ORDER:
The complaint filed by the complainants is allowed in part with cost.
The OP Nos. 1 & 2 are jointly and severally directed to pay Rs.2,00,000-00 [Rs.Two Lakhs only] to the complainants with interest @ 8% PA from 20.12.2022 [i.e. date of repudiation of claim] till the payment.
Further, it is directed that the OP Nos. 1 & 2 are jointly and severally shall pay compensation of Rs.10,000-00 and litigation cost of Rs.8,000-00 to the complainants.
The OP Nos. 1 & 2 are directed jointly and severally to comply the above order within 45 days from the date of receipt/knowledge of this order.
Furnish copy of this order to both parties at free of cost.
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