Harbans Lal Mehen, complainant has filed the present complaint against the titled opposite parties U/S 12 of the Consumer Protection Act, 1986 (hereinafter for short, the C.P.Act.) in which he has prayed that the opposite parties be directed to make payment of  full insured amount along with interest @18% P.A. from the  due date  till actual realization. Opposite parties be further directed to pay Rs.50,000/- as compensation for causing mental agony, physical harassment and deficiency in service on the part of the opposite parties along with Rs.5,000/- as litigation expenses, in the interest of justice.   

2.       The case of the complainant in brief is that his son namely Rahul Mehen was employed in the Indian Navy. He met with a road accident on 9.12.2015 and suffered fatal injuries and on 17.12.2015 he succumbed to injuries. The deceased Rahul Mehen had a salary account No.332647746683 at I.N.S. Chilika Naval Base Branch, Vishakha Patnam which was transferred to State Bank of India, Main Branch Dhangu Road, Pathankot and was duly maintained by the deceased during his lifetime. The deceased was insured under the Personal Accident Insurance 9 (A1) (Death) cover under Salary Package account by the opposite party no.3 vide policy no.1111342914000034 and 1111352914000038. After his death, he being nominee applied for a claim of Rs.3,00,000/- through the opposite party no.2 but the opposite party no.2 kept on delaying the processing of the claim on the one pretext of bringing various documents and kept on harassing him. Even inspite of full cooperation and fulfillment of all the formalities of the process bringing all the requisite documents, the opposite party no.1 could not process his claim. After receiving all the requisite documents from him, the opposite party no.1 due to negligence on its part, erroneously sent the claim papers to the National Insurance Co. Ltd. and the Company rejected the claim as the deceased was not insured by them and sent the claim documents back to the opposite party no.1. This fact has been revealed from letter dated 29.6.2016 of the opposite party no.1 in which he had admitted his error. The deceased was insured with the opposite party no.3 which further rejected the claim on the ground of delay. The delay, if any, the same was a result of negligence, malpractice and deficiency in service on the part of the opposite arty no.2 and this act of the opposite parties is uncalled for an any delay if cause, cannot be attributed to him as this part of the process was inter-se of the opposite parties and as such it is obligatory upon the opposite parties to pay the claim amount to him under privity of contract between him and the opposite parties. He has further pleaded that the opposite party no.3 rejected his claim no.2161007245 and intimated the same to him through its repudiation letter dated 26.7.2016. Thereafter, he communicated with the opposite party no.3 through letter dated 3.8.2016, within two week of repudiation but he has not received any response.  He also contacted the opposite party no.3 through E mail dated 25.8.2016 in reference to his claim to which the opposite party no.3 replied and intimated rejection through E mail dated 26.8.2016  due to delay of filing the claim. The delay, if any alleged by the opposite party no.3 is a result of miscommunication between the opposite parties and as such all the opposite parties are liable jointly and severally. It is a case of clear cut deficiency, gross negligence in service and unfair trade practice on the part of the opposite parties who did not pay insured amount to him on false and flimsy grounds and without any reason or rhyme. Hence this complaint.

3.         Upon notice, the opposite parties No.2 appeared and filed its written reply through its counsel submitting therein that the deceased Rahul Mahen was insured under the personal accident insurance covered under salary package account.  Actually, the deceased Rahul Mahen was                                                                                                                                               maintaining account with opposite party no.2 as such apart from other requisite documents to be submitted to the insurance company the officials of the opposite party no.2 were to authenticate the name of the nominee with the respect to the account maintained by Sh.Rahul Mahen and to verify/process the documents pertaining to the death of the account holder Sh.Rahil Mahen. When the complainant provided the relevant and necessary documents the opposite party accordingly proceeded as per the required procedure. It has further submitted that there was no negligence as alleged on the part of the opposite party no.2. The claim was lodged within stipulated period. Earlier there were contractual terms with National Insurance Co. Ltd. and same had been since ceased though the documents were sent to National Insurance Company, within the stipulated period the said company retained the documents and sent the same after the delay of 50 days to Personal Banking Business unit Mumbai. The delay was on the part of National Insurance Company as it retained the documents for quite long period. As and when the documents were received by Head Office of the opposite parties the same were forwarded to the opposite party no.3 vide letter dated 29.06.2016. The opposite party immediately sent the papers to opposite party no.3 and also had taken up the matter with the high officials of Reliance General Insurance Co. Ltd. The said information was sent to both the complainant and opposite party no.3. The liability to pay the insurance claim is of the opposite party no.3 as there is privity of contract between the complainant and the insurance company. There is no malpractice, or deficiency as alleged on the part of opposite parties. The opposite parties submitted the documents to the Insurance Company when he same were returned by the National Insurance Company.  The opposite party no.3 is liable to pay the claim which has been repudiated on flimsy grounds. All other averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.

4.       Upon notice, opposite party no.3 appeared and filed its written reply through its counsel by taking the preliminary objections that the complainant has no cause of action and locus standi to file the present complaint alongwith certain preliminary objections. On merits, it was submitted that the insurance is a contract between the two parties and both bind by the terms and conditions of the policy and no party can go outside the policy’s terms and conditions. As per terms and conditions of the policy claim is to be intimated within 90 days of the date of death and documents to be submitted within 180 days of death but in the present case the intimation has been given on 2 July, 2016 i.e. after 198 days i.e. after the date of loss. So, it is the complainant who is at fault and failed to file the complaint within the prescribed period due to which the claim has been rejected. The repudiation letter dated 26 July, 2016 has been duly sent to this regard. So, there is no deficiency ins services on the part of the opposite parties. All other averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.

5.       Notice issued to the opposite party no.1 had not been received back. Case called several times but none had come present on behalf of opposite party no.1. Therefore, it was proceeded against exparte vide order dated 13.2.2017.

6.       Counsel for the complainant tendered into evidence affidavit of complainant Ex.C1, alongwith other documents Ex.C2 to Ex.C7 and closed the evidence. 

7.       Sh.Subash  Chander Branch Manager S.B.I. opposite party no.2 tendered into evidence his own affidavit Ex.OP-2/1, alongwith other documents Ex.OP-2/2 to Ex.OP-2/4 and closed the evidence.

8.       Counsel for the opposite party no.3 tendered into evidence affidavit of Sh.Suryadeep Singh Thakur Manager Legal Ex.OP-3/1 alongwith other documents Ex.OP-3/2 to Ex.OP-3/11 and closed the evidence.

9.        We have thoroughly examined the available documents/evidence on the records so as to statutorily interpret the meaning and purpose of each document and also the scope of adverse inference on account of some documents ignored to be produced by the contesting litigants against the back-drop of the arguments as put forth by the learned counsels for their respective contestants. We find that the present dispute has arisen at the impugned ‘repudiation’ dated 26.07.2016 (Ex.OP3/2 & EX.OP3/3) of the insurance death-claim (Ex.OP3/4) as duly supported by OP2 SBI Certificate (Ex.OP3/9 of 27.04.2016) pertaining to the DLA’s Policy Cover U/Salary Package A/c (Ex.OP3/10) with a Sum Assured of Rs 3.0 Lac, on the grounds of ‘delay’ (Ex.OP3/11) in claim intimation and submission etc.

10.     We find that the titled opposite party3 insurers (hereinafter for short ‘the OP3 insurers’) have duly admitted its repudiation through written statement and accompanying affidavit (Ex.OP3/1) on the grounds of ‘delay’ in claim-submission by 198 days (from the date of loss) whereas the terms of policy desire that the same to be submitted within 180 days of the loss and that violates the terms of the applicable Policy. Further, we find that on the one hand the OP3 insurers have refused to admit (in its written statement) DLA as its own consumer/ customer stating the insurance contract had been between them and the Bank while on the other hand the OP3 vide its repudiation Ex.OP3/2 have admitted the complainant as its ‘valued customer’ and have also vehemently contested (Affidavit Ex.OP3/1) the present complaint/ impugned claim. It shall be interesting here to observe/ note that the OP2 SBI Bank has duly admitted (vide its written statement and the accompanying affidavit Ex.OP2/1) that the impugned claim was duly submitted/filed sans ‘delay’ but was somehow inadvertently dispatched to National Ins. Co. instead of the OP3 insurers and that explicitly thread-bares the matter in issue.

11.     We find that the tied-up business partners OP1/2 SBI Bank and the OP3 insurers had been jointly and co-extensively responsible for ‘amicable’ settlement and payment of the impugned claim that otherwise had been fully valid & legally enforceable and presently they both attract an adverse statutory award.

12.     In the light of the all above, we partly allow the present complaint and thus ORDER the titled opposite parties to pay the impugned claim to the complainant besides to pay him Rs.10,000/- as cost and compensation for the harassment suffered but within 30 days of the receipt of the copy of these orders otherwise the awarded amount shall attract interest @ 9% PA form the date of the orders till actual payment.

13.     Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.

                 (Naveen Puri)

                                                                                 President.

ANNOUNCED:                                                            (Jagdeep Kaur)

January 24,2018.                                                         Member               

*MK*