BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FEROZEPUR
C.C. No.370 of 2014 Date of Institution: 29.9.2014
Date of Decision: 27.1.2015
1. Sukhwinder Lal, aged 52 years, son of Angrej Lal,
2. Gaurav Kumar, aged 23 years,
3. Rajan Kumar, aged 20 years, both sons of Sukhwinder Lal, residents of Village Arniwala Sheikh Suban, Tehsil And District Fazilka.
....... Complainant
Versus
1. The Fazilka Central Co-operative Bank Limited, Branch Village Arniwala Sheikh Suban, Tehsil and District Fazilka, through its Branch Manager.
2. The Fazilka Central Co-operative Bank Limited, Head Office, Fazilka Road, Abohar, Tehsil Abohar, District Fazilka, through its District Manager.
3. United India Insurance Company Limited, Branch Office 18 Gaushala Road, Abohar, Tehsil Abohar, District Fazilka.
........ Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986.
* * * * *
PRESENT :
For the complainant : Sh. Sukhbeer Singh, Advocate
For opposite party No.1 : Sh. Raj Kumar Goklany, Advocate
For opposite party No.2 : E x-p a r t e
For opposite party No.3 : Sh. Vishal Arora, Advocate
C.C. No.370 of 2014 \\2//
QUORUM
S. Gurpartap Singh Brar, President
S. Gyan Singh, Member
ORDER
GURPARTAP SINGH BRAR, PRESIDENT:-
Brief facts of the complaint are that Raman Bala (Since deceased) was an account holder and permanent Member of society formed by opposite party No.1 for the benefits of the farmers. Raman Bala was wife of complainant No.1 and mother of complainant Nos.2 and 3 and on assurance by opposite party No.1, Raman Bala got deposited an amount of Rs.1679/- as onetime payment on 21.5.2008, which was still in existence. As per policy of opposite party No.1, in case of death of a society member i.e. account holder, opposite party No.1 was liable to pay an amount of Rs.1,00,000/- as insured amount to the legal heirs of the deceased account holder and there was also a separate insurance policy of Rs.50,000/- for society members and opposite party No.1 was also liable to pay the same to the legal heir of deceased account holder. Further it has been pleaded that Raman Bala had expired in road accident, which took place on 7.4.2013 and she was admitted in Dayanand Medical Hospital at Ludhiana and then she was referred to PGI, Chandigarh and while going to Chandigarh for treatment, she suddenly died on the way on 18.4.2013. Further it has been
C.C. No.370 of 2014 \\3//
pleaded that at the time of opening the account in question by Smt. Raman Bala (since deceased), opposite party No.1 had not delivered any booklet to Smt. Raman Bala nor explained any terms and conditions to her. The complainants, being legal heirs of deceased Raman Bala, approached and applied to opposite party No.1 for getting the insured amount in question from the opposite parties immediately after the death of Raman Bala and at that time, the complainants were accompanied by Jagdish Singh son of Ghamond Singh, resident of Village Arniwala Sheikh Suban, Tehsil and District Fazilka. The complainants also submitted all the documents and completed all the formalities before opposite party No.1, as required and demanded by the officials of opposite party No.1. The complainants approached the opposite parties many times and requested to pay them the insured amount in question, but the opposite parties did not pay any heed to the requests of the complainant and inspite of releasing the insured amount in question, opposite party No.3 gave a letter dated 18.8.2014 to the complainants and the complainants came to know that their claim file has already been closed by opposite party No.3. Pleading deficiency in service and unfair trade practice on the part of the opposite parties, the complainants have prayed that the opposite parties be directed to make the payment of insured amount of Rs.1,50,000/- on account of death of Raman Bala. Further a sum of Rs.35,000/- has been claimed as compensation for
C.C. No.370 of 2014 \\4//
harassment and Rs.11,000/- as litigation expenses.
2. Upon notice, opposite party No.1 and 3 appeared and filed their separate written replies to the complaint. In its written reply, opposite party No.1 has pleaded that deceased Raman Bala had an account No.1020 (040434028001179) with opposite party No.1 and she got insurance policy of opposite party No.3, through opposite party No.1. Further it has been pleaded that the documents supplied by the complainant to opposite party No.1 were sent to opposite party No.3. Other allegations of the complaint have been denied and dismissal of the complaint has been prayed for.
3. Opposite party No.2 did not appear before this Forum despite service of notice. Therefore, opposite party No.2 was proceeded against ex-parte vide order dated 7.11.2014.
4. In its written reply, the opposite party No. 3 has pleaded that the complainant was covered under Group Janta Personal Accident Policy being an account holder with opposite party No.1 for a sum insured of Rs.1,00,000/- bearing policy No.200100/47/12/61/00000159 for the period 1.6.2012 to 31.5.2013 and as per Condition No.1 of the policy bond, the death of Smt. Raman Bala was required to be intimated within one month of the death of the insured and the complainant in his application dated 26.6.2014 or the bank in their letter dated 27.6.2014 received by opposite party No.3 on 2.7.2014 did not even mention any reasonable cause for such
C.C. No.370 of 2014 \\5//
a considerable delay in intimation and lodging of claim as per Condition No.1 and no chance to investigate the case has been provided to the insurer. There is breach of Condition No.1 of the policy bond and the case of the complainant is squarely covered by Condition No.1 and the claim of the complainant in respect thereof has been rightly repudiated vide letter dated 18.8.2014. As regards Kishan Credit Card Scheme Policy for a sum insured of Rs.50,000/-, it has been pleaded that Policy No.200100/47/11/43/0000050 was issued to the Fazilka Central Co-operative Bank was for the period 3.10.2011 to 2.10.2012 and as per para No.3 of the complaint, the accident of deceased Raman Bal occurred on 7.4.2013 and she died on 18.4.2013, which period is not covered under the Kishan Credit Card Scheme Policy, which was for the period 3.10.2011 to 2.10.2012. The Co-operative Bank had also claimed the death claim of Raman Bala under Group Janta Personal Accident Policy and not under the Kishan Credit Card Scheme Policy because the dates on which the accident and death took place were not covered under the policy period of the Credit Card Scheme Policy. Rest of the averments of the complaint have been denied and dismissal of the complaint has been prayed for.
5. Learned counsel for the complainant tendered into evidence Ex.C-1 to Ex.C-8 and closed evidence on behalf of the complainant. On the other hand, learned counsel for opposite party No.1 tendered into evidence
C.C. No.370 of 2014 \\6//
Ex.OP-1/1 and closed evidence on behalf of opposite party No.1. Similarly, learned counsel for opposite party No.3 tendered into evidence Ex.OP-3/1 to Ex.OP-3/7 and closed evidence on behalf of opposite party No.3.
6. We have heard the learned counsel for parties and have also gone through the file.
7. It is the admitted case of the parties that deceased Smt. Raman Balal wife of complainant No.1 Sukhwinder Lal was insured under Group Janatha Personal Accident Policy Ex.OP-3/1 for the period from 1.6.2012 to 31.5.2013 for sum insured of Rs.1,00,000/- and she was also insured for sum insured of Rs.50,000/- under Kishan Credit Card Scheme Policy Ex.OP-3/5 for the period from 3.10.2011 to 2.10.2012. It is also the admitted case of the parties that insured Raman Bala died on 18.4.2013 on account of injuries suffered in a road accident on 7.4.2013. However, opposite party No.3 has refused to entertain the claim of the complainants on account of accidental death of said Raman Bala vide letter dated 18.8.2014 Ex.OP-3/4 relying upon Condition No.1 of the policy on the ground that deceased Raman Bala was injured in a road side accident on 7.4.2013 and died on 18.4.2013; the claim intimation was received by them on 2.7.2014, after a gap of more than one year and three months without giving any specific reason for delay in claim intimation. A perusal of Condition No.1 of Group Janatha Personal Accident Policy Ex.OP-3/1
C.C. No.370 of 2014 \\7//
reveals that upon the happening of any event, which may give rise to a claim under this policy, the insured shall forthwith give notice thereof to the company. Unless reasonable cause is shown, the insured should, within one calendar month after the event, which may give rise to a claim under the policy, give written notice to the Company with full particulars of the claim. In the present case, the complainants have specifically pleaded in para No.4 of the complaint that they, being legal heirs of deceased Raman Bala, approached and applied to opposite party No.1 immediately after her death for getting the insured amount in question; they also submitted all the documents and completed all the formalities before opposite party No.1 and at that time, they were accompanied by Jagdish Singh son of Ghamond Singh, resident of Village Arniwala Skheikh Suban, Tehsil and District Fazilka. In para No.4 on merits of its written, opposite party No.1 has simply pleaded that the documents supplied by the complainants to opposite party No.1 were sent to opposite party No.3. However, opposite party No.1 has not specified that as to on which date it had received intimation regarding death and claim papers on account of death of deceased insured Raman Bala from the complainants and as to on which date theses documents were forwarded to opposite party No.3. The complainants have placed on the file copy of letter dated 20.6.2014 Ex.C-6 written by opposite party No.1 to opposite party No.2, a perusal of which
C.C. No.370 of 2014 \\8//
reveals that vide the said letter, opposite party No.1 had forwarded the claim of the complainants on account of death of deceased insured Raman Bala to opposite party No.2 alongwith all the required documents, whereas, application Ex.OP-3/2 has been shown to have been received only on 26.6.2014 and opposite party No.2 had forwarded the claim of the complainants to opposite party No.3 vide letter dated 27.6.2014 Ex.OP-3/3, which was received by opposite party No.3 on 2.7.2014, as is apparent from the seal of opposite party No.3 appended on the letter dated 27.6.2014 Ex.OP-3/3 itself. Had intimation regarding death was given by the complainant to opposite party No.1 on 26.6.2014, then how it could be possible for opposite party No.1 to forward the claim of the complainants on 20.6.2014 vide letter Ex.C-6. The complainants have also placed on the file copy of duly sworn affidavit of one Jagdish Singh as Ex.C-8, vide which the said deponent has deposed that immediately after the death of Raman Bala on 18.4.2013, he alongwith Sukhwinder Lal approached opposite party No.1 for claiming insurance amount and the officials of the bank told them that the insurance amount shall be paid on completion of the required formalities. He has further deposed that they visited opposite party No.1 for the first time within a week from the death of Raman Bala and thereafter on several occasions and the officials of the bank always told that the insurance amount shall be released on receipt of the same from the
C.C. No.370 of 2014 \\9//
insurance company. There is no specific or evasive denial of opposite party No.1 regarding the alleged visit of said Jagdish Singh alongwith Sukhwinder Lal complainant No.1 at the time of giving intimation regarding death and submission of claim on account of death of deceased insured Raman Bala to opposite party No.1. This deposition of witness Jagdish Singh has not been rebutted by opposite party No.1. Even said Jagish Singh has not been subjected to cross-examination by opposite party No.1. Therefore, it is quite evident that intimation regarding death of deceased insured Raman Bala and claim thereof was submitted by the complainants well within the prescribed period, but opposite party No.1 and 2 have failed to further forward the same to opposite party No.3 in time, which resulted into refusal of opposite party No.3 to entertain the claim of the complainants vide letter dated 18.8.2014 Ex.OP-3/4. It was a Group Insurance Policy obtained by opposite party Nos.1 and 2 for their account holders/members and as such, the complainants were to lodge the claim with opposite party No.1 and it was the duty of opposite party Nos.1 and 2 to forward the same, alongwith the documents, to opposite party No.3, but having failed to forward the claim of the complainants to opposite party No.3 within the prescribed period, they have committed deficiency in service, as a result of which the complainants suffered loss of insurance claim on account death of deceased insured Raman Bala, as in
C.C. No.370 of 2014 \\10//
case of forwarding the claim of death by opposite party Nos.1 and 2 to opposite party No.3 within the prescribed period, the complainants were to receive the insurance amount of Rs.1,00,000/-. In “The Sangrur Central Cooperative Bank Versus Jasbir Kaur and another”, First Appeal No.955 of 2011, decided on 3.7.2014, husband of the complainant was having Savings Bank account in the appellant bank and by virtue of the account holder, he was covered under the scheme “Saving Bank Sehkari Bima Yojna” and as per that scheme, in case of any accidental tragedy/accidental death, a sum of Rs.1,00,000/- was payable. Husband of the complainant died of snake bite. The complainant submitted the claim regarding the death of her husband with the appellant bank and also submitted the requisite documents, but the appellant bank failed to forward the claim application to the insurance company, as a result of which the complainant was deprived of insurance amount. The Hon’ble State Commission, Punjab, Chandigarh, holding the appellant bank deficient in service, dismissed the appeal of the appellant bank and upheld the order of the District Forum directing the appellant bank/opposite party No.1 to pay Rs.1,00,000/- along with interest at the rate of 9% per annum from the date of death of the deceased insured till realization, with Rs.11,000/- as compensation for harassment and mental agony and Rs.5100/- as litigation expenses. In the present case also, the claim of the complainants has been
C.C. No.370 of 2014 \\11//
declined by opposite party No.3 on account of delayed forwarding of claim of the complainants by opposite party Nos.1 and 2. Therefore, opposite party Nos.1 and 2 are liable to make good the loss of the complainants suffered by them due to delayed forwarding of insurance claim of the complainants by opposite party Nos.1 and 2 to opposite party No.3. However, no case of deficiency in service or unfair trade practice is made out against opposite party No.3. So far as another claim of the complainants of Rs.50,000/- under Kishan Credit Card Scheme Policy is concerned, no claim under this policy has been alleged or proved to be submitted by the complainants to opposite party No.1 and further forwarded by opposite party Nos.1 and 2 to opposite party No.3. Moreover, a perusal of copy of Kishan Credit Card Scheme Policy Ex.OP-3/5 reveals that this policy was valid from 3.10.2011 to 2.10.2012, whereas, insured Raman Bala met with an accident on 7.4.2013 and died on account of accidental injuries on 18.4.2013, as is evident from copy of Death Certificate Ex.C-4 as well as copy of Certificate Ex.C-5 issued by D.M.C., Ludhiana. Therefore, before the accident and death of the deceased insured Raman Bala, Kishan Credit Card Scheme Policy Ex.OP-3/5 had already expired. Therefore, the complainants are not entitled to any claim under this policy.
C.C. No.370 of 2014 \\12//
8. In view of what has been discussed above, this complaint is accepted and opposite party Nos.1 and 2 are directed to pay to the complainants a sum of Rs.1,00,000/- on account of death claim of deceased insured Raman Bala along with interest at the rate of 9% per annum from the date of death of the deceased insured i.e. 18.4.2013 till realization. Further opposite party Nos.1 and 2 are directed to pay a sum of Rs.5000/- as compensation for harassment and mental agony and Rs.5000/- as litigation expenses to the complainant. This order is directed to be complied with by opposite party Nos.1 and 2 within a period of thirty days from the date of receipt of a copy of this order. However, complaint against opposite party No.3 stands dismissed. File be consigned to the record room.
Announced
27.1.2015
(Gurpartap Singh Brar)
President
(Gyan Singh) Member
