Shri A.K.Patra,President:

1. The captioned consumer complaint is filed by the complainant named above inter alia alleging deficiency in service & unfair trade practice on the part of the Ops for repudiation of insurance claim made on account of the accidental death of insured A/C holder .
2. The complainant seeks for the following reliefs:-

1. For a direction to the Opp.Party No.1 to disburse the insured claim amount of Rs.15, 00,000/- in favour of the complainant along with prevailing interest since the date of death of the deceased son of the complainant.
2. To  direct the Ops to pay a sum of Rs.1,00,000/- as compensation for the mental agony and harassment,
3. To direct the Ops to pay a sum of Rs.5,000/- towards the cost of the case  and advocate fees and
4. And prayed for all other relief(s) as the Hon’ble Commission may deems fit & proper in favour of the complainant.

3. The factual matrix leading to the case of the complainant as emerged from the case record is that, Padmanava Rana ,the deceased son of the complainant , was working as a  “Trainee Operator” in the YAZAKI India Private Limited and one of the account holder of the Op 2/ IDFC Bank vide A/C No. 10014007687 where in his salary was being credited. He was issued with cheque book & ATM card so also he was  insured with Op 1 /New India Assurance Company Ltd vide policy No 14160046182400000009 where in the complainant being the father was the nominee to received all the insurance benefit  in case of premature death of the deceased son/account holder .Unfortunately his son Padmanav Rana/the account holder died in a  road accident on dt.15.09.2018 at about 10.00 PM near Dulkibandh Chowk, Jaipatna matter of which is reported before the  Jaipatna Police Station vide PS Case No.236/2018 dt.16.09.2018 . In this regard, the brother and father/here the  complainant has intimated the fact to the Opp.Party No.2 and claimed accidental death benefit of  Rs.15,00,000/-  under the said insurance police .It is further contended that, the complainant being the father was the nominee  and as per the policy he  is entitle to  get the insurance benefit of  Rs.15,00,000/- but it was not responded for which  the complainant issued a  legal notice  to the OP 2 vide letter No.032/2018 on dt.21.12.2018 through registered post and in reply the Op 2 vide their e-mail letter dt.03.01.2019  denied the payment of  premium and also denied the eligibility to avail the benefit under the said policy which the3 complainant alleged as  gross negligence & deficient service on the part of the OP 2. The complainant sent the claim to the OP 1 but the claim was not lodged by the insurance company/OP 1 which caused financial loss & mental agony to the complainant. It is further stated that the cause of action arose on 03.01.2019 when the OP 2 denied the claim of the complainant and the complainant is entitled for the relief claimed but it is arbitrarily denied by the Ops . Hence this complaint
4. To substantiate his claim the complainant has filed the following documents:- (i) Copy of appointment letter of the deceased son Padmanav Rana, (ii) Original cheque book of the deceased vide SB A/C No.10014007687, (iii) Office Copy of the pleader’s notice vide letter No.32/2018 dt.21.12.2018 along with postal receipt, (iv) Copy of the e-mail dt.03.01.2019 of Op 2/Bank ,(v) Copy of claim form dt.17.01.2019 made to the OP 1 (vi) Copy of FIR, Charge Sheet, inquest & P.M report of deceased Padmanav Rana, Zimanama,  in CT No.379/2018 of the Court of the CJJD- JMFC, Jaipatna in Connection with Jaipatna PS Case No.236 dt.16.09.2018 of Ps-Jaipatna, Dist-Kalahandi .
5. Being notice, the OP 1 appeared through their Ld. Counsel Sri S.K.Patra & OP 2 appeared through Ld. Counsel Sri D.R.Bohidar. Both the Ops have   filed their written version inter alia denying the petition allegations on all its material particulars.
6. The Op 1 submits that, the deceased Padmanava Rana had neither paid any premium to the OP 1 nor the OP 1 has issued any insurance policy in favour of him and that, the alleged Insurance Policy vide No.1416004782400000009 was not issued in favour of the deceased rather it was issued in favour of IDFC First Bank Limited, Mumbai and hence there is no privity of contract between the OP 1 and the deceased Padmanava Rana. The OP 1 has never received any “Claim Form” with the relevant documents from the complaint and there is no negligence   or unfair trade practice on the part of the OP 1. The  repudiation of the claim by the OP 2  is not within the knowledge  of the OP 1 and regarding  complainant’s visit  to the OP 1 on each  date are totally false and imaginary  and  as such denied being not true. It is further submitted that, the complainant has never visited the office of the OP 1 at any point of time. The Op 1 urged that, present complaint is concocted, frivolous and vexatious and as such liable to be dismissed with cost.
7. To substantiate their claim the OP 1  has filed the true copy of subject insurance Policy Scheduled of Package Insurance Policy vide  No.14160046182400000009 issued by New India Assurance Co. Ltd. in favour of IDFC First Bank Ltd. valid from 01.04.2018 to 31.03.2019.
8. The Op 2 submitted that, the complainant had approached the Opp.Parties for a personal loan of Rs.3,08,682/-  and  after due verification & scrutiny of documents, the Opp.Parties sanctioned the above mentioned loan amount to  the complainant  & the Ops entered into a loan cum hypothecation agreement No.13396887  inter alia agreed to repay the loan in 48 installments @ Rs.9726/- from dt.05.12.2017.
9. The Op 2 further contended that, the son of the complainant was having a salary account with the OP 2/Bank and that, the deceased son of the complainant may have availed an insurance policy and the premiums were debited from his account but the  OP 2/bank  is no why connected in issuance of the insurance policy as because OP 2 is only the bank where the complainant deceased son was having salary account  and that, the OP 2 is no way responsible for payment of the insurance claim to the complainant as because the policy was issued by the OP 1 and being insurer the OP 1 is liable to release the claim amount to the complainant. The OP 2 is in no way responsible or has committed any deficiency of services or unfair trade practices as alleged by the complainant. It is further contended that, as per law this complainant does not fall within the definition of consumer and the relationship between the complainant & the Opp.Party 2  is not the borrower and lender as such no consumer dispute arises rather it is a civil dispute. Hence, this complaint is not maintainable and the complainant do not fall within the ambit & scope of the consumer protection Act, so also this Commission lacks jurisdiction and the complainant has no locus stand to file this complaint and also the complainant is not entitled to any relief as claimed .Hence this complaint is liable to be dismissed on merit with cost.
10. Both parties have led their evidence by filling affidavit as prescribed under C.P.Act 2 019 .
11.  The complainant led his evidence on affidavit and proved his contention. The facts stated in his evidence affidavit are corroborating with the averments of the complainant petition.
12. The OP 1 has filed the evidence affidavit of one Abhiram Nayak , the Senior Division Manager ,Sambalpur Division Office ,New India Assurance Co.Ltd , averment of which are corroborating with the averment of their written version .
13. The OP 2 also filed an affidavit evidence of one Peeyoosh Patnaik, the legal manager of IDFC Bank , the averment of which are corroborating with the averment of their written version .
14.  Heard. Peruse the material on record. We have our thoughtful consideration to the submission of rival parties and gone through the notes of argument & judgments cited by the learned counsel for the both parties present.
15. Here in this case ,the dispute between the parties revolves around the death claim being made by the complainant as  the nominee on account of the accidental death of the account holder /deceased son Padnava Rana  under subject bulk Package Insurance Policy vide  No.14160046182400000009  issued   in favour of IDFC First Bank Limited, Mumbai  by   New India Assurance Co. Ltd./OP1 valid from 01.04.2018 to 31.03.2019 covering the personal accident of the  Corporate Salary Account with Platinum Debit Card holder  for an amount of Rs.15,00,000/-.
16. The main question that, need to be answered in this case is that,:- whether the deceased account holder is entitle to any risk coverage or compensation under the subject Insurance Police and whether the O.Ps are deficient in service & Unfair Trade Practice causing injuries to the complainant by repudiating the insurance claim made on account of accidental death of account the holder/the son of the complainant?
17. Accidental death of the account holder and insurance policy was in force at the time of the occurrence and that the complainant being father is the nominee to received the insurance benefit under the subject insurance policy is not disputed.
18. The OP2 /Bank stated that, to cover Personal Accident Insurance benefit for the   Corporate Salary Account with Platinum Debit Card holder the minimum eligibility criteria is that, the bank account (linked with debit card) must have at least one credit transition (preferably salary) of Rs.10,000/-or above in the previous month of claim. Example is given there in the said repudiation letter  through e-mail dt 03/01/2019 of the Op 2. Example:-“if the claim is made in the month of Feb, credit above Rs 10,000/- needs to be done in the previous month i.e January”.
19. The facts remain undisputed are that ,one Padmanava Rana, the deceased son of the complainant, was an A/C holder of the OP 2/Bank where his salary was credited and that, the central authority of OP 2 i.e IDFC First Bank Ltd, Mumbai  has insured the customers of their Bank with OP 1(one)  paying proper premium under  a bulk Package Insurance Policy vide  No.14160046182400000009  issued by New India Assurance Co. Ltd./OP1  in favour of IDFC First Bank Limited, Mumbai, valid from 01.04.2018 to 31.03.2019 and that, only those customers of Op 2/Bank  who have satisfied the terms of the bank are  entitled for the insurance benefit there under said  insurance policy.
20. It is proved on affidavit of the complainant that, deceased son of the complainant was the employee of one YAZAKI India Pvt.Ltd and the undisputed letter of employment clearly shows that, deceased Salary was Rs 10,413/-per month. It is proved on admission of the OP2/Bank that, deceased Padmanava Rana was an account holder of the OP2/Bank where in his salary was being credited. It is also not disputed that, the deceased was issued with ATM/ debit card of OP 2/Bank.  It is also proved  from the copy of the pleader notice & postal receipt placed on the record that,  complainant has issued a pleader notice through registered post on 22/12/2018 to the OP 2 with a request to furnish the details of the account of the deceased account holder Padmanav Rana concerning insurance policy within one month of receipt of the notice and have requested to make process for the payment of the accidental coverage benefits in favor  of the Lrs of the deceased and that, after receiving of said pleader notice, the  OP 2/Bank has sent one e-mail dt.03/01/2019,(copy of which is placed on the record by the complainant vide Sl No .3 of his list of document  for perusal remain undisputed) stating there in that:-“ the deceased account holder does not meet the necessary criteria of salary credits in the account with required amount and hence not eligible to avail the  insurance coverage amount and the same  was informed to the insurance company who have checked the salary credits and then agreed that, the deceased account holder is not eligible to avail insurance benefit” .Thus, we are of the opinion that, onus lie there with the Op2/Bank to proved that, the deceased account holder was not fulfilled the minimum criteria for availing insurance benefit under the subject Insurance Policy. 
21. At the cost of reputation, it is further contended in the e-mail dt 03/01/2019 of the Op 2 placed on record by the complainant vide Sl No .3 of his list of document  that, no premium was taken from the deceased account holder rather the bank offer insurance coverage to their client free of cost with some terms & condition .It is further contended that, as the premium is paid by the bank authority to the insurance company & hence, bank reserved it’s  right to put terms & condition for availing insurance benefit under the said bulk   Package Insurance Policy and that,  Costumer need to meet the following eligibility criteria for claiming the personal Accident Insurance cover depending upon the type of the account held by the customer effective from 1^st May 2018:- (i)   Existing Average Monthly Balance criteria applicable on the savings account need to be met by the customer in the previous month of claim, (II) In case of Salary Accounts, credit in the account criteria need to be met by the customer  in the previous month of claim. To cover Personal Accident Insurance for the   Corporate Salary Account with Platinum Debit Card holder the minimum eligibility criteria is that, the bank account (linked with debit card) must have at least one credit transition (preferably salary) of Rs.10,000/- or above in the previous month of claim .Example is given there in the said repudiation letter through e-mail dt 03/01/2019 of the Op 2. Example:-“if the claim is made in the month of Feb, credit above Rs 10,000/- needs to be done in the previous month i.e January”. And for Corporate Salary Account with Signature Debit card holder the minimum eligibility criteria is that, the bank account (linked with debit card ) must have at least one credit transition (preferably salary) of Rs. 15,000/- or above in the previous month of claim. Example is given:-“if the claim is made in the month of Feb, credit above Rs 15,000/- (single transaction) needs to be done in the previous month i.e January”. Further it contents following terms & conditions which will be applicable :- (i). In case customer holds multiple debit card, claim will be extended on the highest eligible debit card (claim on any one debit card held by customer, subject to criteria being met), (ii). In case customer has multiple accounts with the bank link to single debit card, the eligibility criteria need to be met on one of the account held by the customer and not for a group/set of accounts.
22. It is not disputed that, the deceased son of the complainant was a Corporate Salary Account with Debit card holder and  his Salary of Rs 10,413/-per month had been crediting to the said account as such it established that, deceased account holder earned the status of “Platinum Debit card holder” in view of afore  said condition stipulated by the OP2 in the repudiation letter  e-mail dt 03/01/2019 and have insured with New India Assurance Co. Ltd./OP1 under subject bulk Package Insurance Policy vide  No.14160046182400000009  issued   in favour of IDFC First Bank Limited, Mumbai, valid from 01.04.2018 to 31.03.2019,
23. Admittedly the contract of insurance claim is based on utmost bonafied intention of the parties. Both the parties are expected to disclose each other relevant fact at the time of commencement of policy including the term & condition but not at the peril.
24.  Nothing cogent evidence is placed on record to hold that, either the Op2 /Bank or the Op 1/insurance company has ever made aware to the deceased account holder or have properly served him the terms & conditions for availing of  insurance benefit under the subject insurance policy. So all so no scrap of paper containing any terms & condition to maintain any criteria for availing insurance benefit under subject insurance policy is placed in the record for perusal.
25. Admittedly the Op 2/Bank is the custodian of the details of the subject salary account of the said deceased account holder. Nothing  material available on the record to hold that, the OP2/Bank has ever  supplied the details of the account statement of the deceased account holder Padmanav Rana concerning insurance policy as asked by the complainant in their  pleader notice of the complainant which is proved to have served through registered post dt. 22/12/2018. Hence, it clearly proved the negligence act & deficient service on the part of  the op2/bank.  
26. Furthermore, neither the Op No 2/Bank nor the Op1/Insurance Company  has filed the details of the account of the deceased account holder Padmanav Rana even during hearing of this complaint  though onus lie on the OPs to proved their contention there stated  in the letter of repudiation vide e-mail dt. e-mail dt 03/01/2019  that:-“ the deceased account holder does not meet the necessary criteria of salary credits in the account with required amount and hence not eligible to avail the  insurance coverage amount and the same  was informed to the insurance company who have checked the salary credits and then agreed that, the deceased account holder is not eligible to avail insurance benefit”. The Ops  hopelessly failed to prove those contentions.
27. The learned counsel for the complainant draws our attention over the section 14 of the Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests) Regulations, 2017 which we may  quote here below :-

        “14. CLAIMS PROCEDURE IN RESPECT OF A LIFE INSURANCE POLICY :-    A life insurer, upon receiving a death claim, shall process the claim without delay. Any queries or requirement of additional documents, shall be raised all together and not in a piece-meal manner, within a period of 15 days of the receipt of the claim.”

28. The Op 1/insurance has nothing contended or have proved that, they have ever “checked the salary credits and then agreed that, the deceased account holder is not eligible to avail insurance benefit”, so also nothing placed on the record to hold as such. Op 1 has failed to prove that he has ever conducted any investigation/ queries on the claim of the complainant earlier or even after appearing in this case. Which clearly proved the violation of the Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests) Regulations, 2017 on the part of the OP1/Insurance Company .
29. In absence of any cogent evidence it cannot be concluded that -“the deceased account holder does not meet the necessary criteria of salary credits in the account with required amount and hence not eligible to avail the insurance coverage amount and the same was informed to the insurance company who have checked the salary credits and then agreed that, the deceased account holder is not eligible to avail insurance benefit”. Rather we are of the opinion that, the repudiation of the insurance claim under the subject insurance policy is not proper and it is found arbitral.
30. It is proved from the undisputed Police Paper placed on the record such as: - Copy of FIR, Charge Sheet, inquest & P.M report of deceased Padmanav Rana, Zimanama  in CT No.379/2018 of the Court of the CJJD- JMFC, Jaipatna in Connection with Jaipatna PS Case No.236 dt.16.09.2018 of Ps-Jaipatna, Dist-Kalahandi that, account holder Padmanava Rana died accidentally on15/09/2018 while subject insurance policy was in force .
31. In view of the discussion stated above we are of the opinion that, the complainant is the consumer of the Op 2 being an account holder .The Op 2 has insured the account holders/ the deceased son of the complainant with Op1/insurance Company under the subject bulk policy only  because  the deceased was holding a  Corporate Salary Account with Debit card as such we are of the opinion that, deceased account holder is a beneficiary under subject insurance policy  issued by the OP1/insurance company  to the OP2/Bank.The Op2 to has purchased the subject insurance  policy fto support his account holder at the peril. And the complainant being legal heir/nominee of the deceased account holder is a beneficiary entitled to receive  the insurance benefit of Rs 15,00,000/- with interest  under subject insurance policy and Ops have  neglected & deficient in service to settled the claim of the complainant certainly caused financial loss & mental agony to the complainant cannot be denied.
32. We perused the case law  in the instant case where it is held and reported in  CPC- 1991, page -540 where  in  the  Hon’ble  Haryana State  Commission held that:- whenever there is any delay or dilatoriness in finalizing  the insurance claim, the same would be tantamount to a  deficiency  in service and thus comes squarely within the  purview of Consumer Forum.  Once it is held that default or negligence in the settlement of an insurance claim is a deficiency in service then an arbitrary or mischievous rejection of an insurance claim would patently be a default within its larger meaning. On principle, it would   seem somewhat manifest that, the mere repudiation of the insurance claim cannot itself operate as a jurisdiction bar for redressal forums under the C.P Act
33. The Ops have denied the insurance benefit found to be arbitrary is certainly deficient service and unfair trade practice on the part of the both OP1 /Insurer & OP 2/bank   which caused financial loss & mental agony to the complainant   cannot be denied,  as such, there is sufficient cause of action against the Ops to present this complaint. This complaint is presented on 03/02/2020 before this Commission after receiving of the letter of repudiation dt. 03/01/2019 within the jurisdiction of which  the complainant is reside as such the complaint is found to be in time,well maintainable under C.P.Act,2019 before this Commission for adjudication.  In absence of cogent evidence the preliminary objection raised by the Ops that, complaint is not maintainable before this commission under C.P Act is here by rejected.
34. It is  found that, the Ops have derailed from their  promised is clear instance of Unfair Trade Practice as defined U/S 2(47)(f) of C.P Act 2019 which runs as follow:-“makes a false or misleading representation concerning the need for ,or the usefulness of ,any goods or services;”. As such we are of our opinion that complainant is entitle for insurance benefit under the subject insurance policy but limited to sum assured amount promised in the insurance policy bond and it was wrong in repudiating the claim of complainant certainly caused financial loss & mental agony. Mental agony suffered cannot be compensated in any manner however, we think that, award of minimum monetary compensation of Rs 50,000/- against claim of Rs.1,00,000/  may heal the injuries of the complainant to some extent .
35. The Ops have  deliberately tried   to flee from their  liability is certainly an act of Unfair Trade Practice as such the interest of the consumer is to be protected in the sprite of C.P Act 2019 and the OPs should be discourage from repetition of same acts of deficient service & unfair trade practice with any other bonafied claimant for which  we think it proper to impose exemplary cost of not less than Rs.1,00,000/(one  lakh) to the each OP  payable to the Consumer Welfare Fund of the State of Odisha so that, they shall not repeat the   same act of deficient service & unfair trade practice at the peril. 
36. Based on the above discussion this complaint is allowed in part against the Ops on contest  with the following directions:-                                              

ORDER

1. The New India Assurance Company Limited /OP1 is here by  directed to release the sum of  Rs. 15,OO,000/-with interest @ 9% P.A from the date of filing of this complaint i.e from dt.03/02/2020 till its realization to the complainant  as insurance benefit under the subject insurance policy and,
2. Both the Ops are directed to pay Rs.25,000/-each to  the complainant as compensation  towards harassments  & mental agony suffered which include litigation expenses of this complaint .
3. The Ops 1&2 is further directed to pay Rs 1,00,000/- (one lakh) each as exemplary cost to the Consumer Welfare Fund of the State of Odisha.
4. It is further directed to comply the above order within 45 days of receiving of the copy of this order, failing which Ops shall liable to pay Rs 500/-each per day as delayed compensation to the complainant till its realization.
5. The consumer complaint is partly allowed in above term. Pending application if any is also stands disposed of accordingly.

Dictated and corrected by me.

          ​Sd/-

             President

                           I   agree.              Sd/-

                                                    Member

       Pronounced in open Commission today on this 15^th day of November  2023, under the seal and signature of this Commission. The pending application if any is also disposed off accordingly.

        This complaint could not be decided within the prescribed period of time due to pandemic COVID -19 situations & in want of quorum of this Commission

        Free copy of this order be supplied to the parties for their perusal or party may download the same from the Confonet be treated as copy served to the parties. Complaint is disposed of accordingly.