Haryana

Karnal

480/2012

Bala Devi W/o Ajaib Singh - Complainant(s)

Versus

The Karnal Central Coooperative Bank Ltd - Opp.Party(s)

Gulzar Singh

15 Feb 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.     

                                                                Complaint No.480 of 2012

                                                                Date of instt.: 1.10.2012

                                                                Date of decision:11 .02.2016

 

Bala Devi wife of Ajaib Singh resident of village Sadarpur tehsil and district Karnal.

                                                                  ……..Complainant.

 

                             Versus

1.The Karnal Central Cooperative Bank Limited, Karnal through its Branch Manager.

2.The Arianpura Cooperative Credit and Service Society Limited,  Arianpura tehsil Gharaunda district Karnal through its Branch Manager.

3.United India Insurance company Limited having its office at SCO No.72, Phase=9, Mohali through its Branch Manager.

 

                                                                           ……… Opposite Parties.

                     Complaint u/s 12  of the Consumer

                     Protection Act.

Before          Sh.K.C.Sharma……….President.             

                   Sh.Anil Sharma…….Member.

Present:-      Sh.GulzarSingh Advocate for the complainant.

                    Sh.Jai Parkash Sharma Advocate for Opposite party no.1 and 2.

                   Sh.Narinder Chaudhary Advocate for Opposite party No.3.

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ORDER:                     

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                   This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act, 1986, on the averments that her husband Ajaib Singh (life Assured) was having an account No.575 with the Opposite party No.2,  which was running under the control and management of Opposite party No.1.As per the scheme of the Government Opposite parties  no.1 and 2 had insured every  member of the Society with the Opposite party no.3 for an amount of Rs.50,000/-.  On 19.8.2011, her husband met with an accident, while doing agricultural work and as a result of that he died. Post Mortem was conducted at Civil Hospital, Karnal. On 1.6.2012 official of the Opposite party no.2 visited her house for recovery of the due amount from her husband and then she  told that her husband had expired. On that , the said official asked her to apply for grant of compensation as per scheme of the government. In fact, she  being an illiterate lady was not aware about the limitation for applying for any compensation. Thereafter, she applied for compensation to the office of   Opposite parties No.1 and 2 and completed all the formalities, but the Opposite party no.3 rejected her claim,  vide letter dated 9.7.20912 on the ground that the claim was not lodged within  90 days. The repudiation of her claim on such ground was not justified and amounted to deficiency in services on the part of the Opposite parties, which caused her mental pain and agony apart from financial loss.

 

2.                Notice of the complaint was given to the Opposite parties.  The Opposite parties no.1 and 2 filed joint written statement disputing the claim of the complainant. Objections have been raised that the complaint is not legally maintainable; that the complainant has not approached this Forum with clean hands and that the complainant has no locus standi to file the present complaint.

 

                   On merits, factum of death of husband of the complainant on 19.8.2011 has not been disputed. It has been submitted that Form regarding death of husband of the complainant was sent immediately to Opposite party no.3 for necessary action, but the Opposite party no.3 repudiated the claim on the ground that intimation was sent after expiry of 90 days,  There was no deficiency in service on the part of the Opposite parties no.1 and 2.

 

3.                The Opposite Party no.3 filed separate written statement controverting the claim of the complainant. It has been averred that neither any intimation regarding the accident was given to Opposite party no.3 nor any post mortem report was forwarded within ninety days of the death. As per clause 11 of the policy of insurance limitation for lodging of the claim by the nominee of the insured person is  ninety days. The complainant was required to give notice in writing to the Opposite parties no.1 and 2 within 45 days of the death and the Opposite parties no.1 and 2 were required to intimate the Opposite party no.3 within 90 days of such occurrence.  As the claim was submitted after long delay, the same was rightly repudiated. There was no deficiency in services or unfair trade practice on the part of  Opposite Party no.3. Therefore, the complaint is not legally maintainable.The other allegations made  in the complaint have been denied.

 

4.                In evidence of the complainant,  her affidavit Ex.C1 and documents Ex.C2 to Ex.C12 have been tendered.

 

5.                On the other hand, in evidence of the Opposite parties, affidavit of Sh.S.S.Vasudeva, Additional Divisional Manager Ex.OP3/A, affidavit of Sh. Sethpal Clerk of Opposite Party no.2, Ex.O1 and documents Ex.OP3/B to Ex.OP3/C and Ex.O2 to Ex.O5 have been tendered.

 

6.                We have appraised the evidence on record,  the material circumstances of the case and the arguments advanced by the learned Counsel for the parties.

 

7.                It is not in dispute that the husband of the complainant was having an account with the  Opposite Party no.2  which was under the control of Opposite party No.1 and being member of the Opposite Party no.2 , he was insured under the group insurance scheme and  died on 19.8.2011.The claim was not lodged by the complainant within  ninety days of the death of her husband. As per the case of the complainant, she came to know about the insurance from the official of the  Opposite Party No.2 on 1.06.2012 when he visited her house for recovery of the due amount in the account of her husband and thereafter she lodged claim of the insured amount, but her claim was repudiated by the Opposite Party no.3 on the ground that claim was not submitted within 90 days of the death of the life assured.

 

8.                The Learned counsel for the complainant laid emphasis on the contention that the complainant is an illiterate widow and she was not aware of the fact that her husband was insured with the Opposite Party no.3 under the group insurance scheme being the member of the society i.e. Opposite Party no.2. She came to know about the insurance from the official of the Opposite party No.2 on 1.6.2012 and thereafter she lodged the claim.   Even on the pass book of the husband of the complainant it was not mentioned that in case of his death, his nominee  was required to lodge claim within ninety days. Thus, there was no breach of any fundamental  term or condition of the  insurance policy. Therefore, insurance company cannot be absolved of its liability to make the payment.  In support of his contention  , he placed reliance upon  Jasbir Kaur Vs. Oriental Insurance  Company Ltd. and others  2011(4) PLR 296, V. Laxmikantha Vs. Branch Manager, M/s Andhra Bank Limited and another 2000(2) CPJ 70.

 

9.                To wriggle out of the aforesaid contention, the learned counsel for the Opposite Party no.3 vehemently argued that as per condition no.11.1 of the policy, the nominee of the insured person was required to give  notice in writing to the concerned branch of the bank within 45 days of the occurrence of the incident and it was responsibility of the bank to ensure that all the incidents likely to give  rise to the claim are intimated to the insurer within 90 days of such occurrence, failing which the insurer was not under any liability for such incident.  Incident  of death of insured was not intimated to Opposite party no.3 within ninety days, thus there was  violation of term of the insurance policy therefore, the claim of the complainant was rightly repudiated.

 

10.               In Jasbir Kaur’s case (Supra), claim was lodged  before the permanent Lok Adalat by the widow of the insured who was covered under the group insurance scheme. The claim was dismissed on the ground that the  fact of death had not been informed immediately and  that it had been done nearly about one and half year after the event. Under those circumstances, it was held by Hon’ble Punjab and Haryana High Court that death of a person  ought not to be taken as breach of such a fundamental condition to absolve the insurance company of its liability to  make payment to the complainant.

 

                   In para no.2 of the judgment it was observed as under:

 

                   “ In my view, it is clear misreading of the policy to contend that the time limit prescribed, constituted a legal bar for enforcement. It is only a method of preserving that fake claims are not made and that a claim form should be filed within a reasonable time. The breach that can constitute an occasion absolving the liability must be so fundamental to the term that the insurance company could plead that the  claim is not maintainable. It would be typically in a situation where there is a suppression fact, which is essential to the terms of the policy of insurance itself. It is best on the principle that all contracts of insurance being matters of utmost good faith, called as ubereima  fiedi, the party committing a breach shall not be able to enforce the claim against the insurance company. A condition requiring the claiment to inform the  contingency, in this case. After, the death of the person ought not to be taken as a  breach of such a fundamental condition to absolve the insurance company of its liability to  make the payment.   In this case, it is not denied that petitioner’s husband had died and that he was also covered by the terms of the policy and that if a notice of information had been made within the time as set forth in the policy, the insurance company would not have stated that the petitioner would not entitle for the same.”

 

                   In  V. Laxmikantha’s case (Supra), the  husband of the complainant was  account holder under  Abhaya Saving Scheme and he died in road accident on  6.1.1996.The complainant was not aware that the  account holder of such claim  was insured under group  accident insurance scheme.  On 15.4.1997, she approached   the Opposite Party no.1 for withdrawing amount of Rs.1000/-  from the account of  her husband and learnt that account  also gave  insurance coverage in case of accident of the account holder and for that Opposite Party no.2 had to be approached. On the same day, she sent claim application to the Opposite Party no.1 and again on 5.5.1997 requested it to send the claim form to the Opposite Party no.2.  The Opposite party no.2 informed the Opposite Party no.1 that claim intimation was given beyond stipulated period of ninety days, therefore, claim could not be considered for settlement and the claim was closed as “ No Claim” . On the pass book there was mention that claim had to be made within ninety days under the group personal accident insurance scheme. Under those circumstances, it was held  by the Hon’ble  Andhra Pradesh State Consumer Disputes Redressal Commission, Hyderabad that “ assuming that there was such stipulation, it was obligatory for the Opposite party no.1 and Opposite Party no.2  to see that it was printed in the pass book, since  it was the only document that was available with the appellant. When an insured person dies, the nominee or claiment under the policy has no means of knowing such conditions unless they are made known by printing in bold letters in the pass book or in the policy, if that was made available.   In the said case, it was not stated by the Opposite parties that a copy of the policy with its conditions were furnished to the insured so that the nominee or claimants under the policy could know about such conditions after the insured died.  Thus, there was clear deficiency in services on the part of the Opposite Parties.

 

11.               The propositions of law laid down in the aforediscussed authorities are fully applicable to the facts of the present case as well. The learned counsel for the Opposite parties could not cite any contrary view.  The complainant has produced the copy of the pass book Ex.C2, wherein there is no mention of the stipulation that in case of death of insured in an accident, the accident would be intimated to the Opposite Parties no.1 and 2 within 45 days and they would intimate the same to the Opposite Party no.3 within 90 days of the incident. Mere fact that  complainant did not intimate the Opposite Party no.1 and 2 within 45 days of the death of her husband and  consequently,  intimation could not be given to the Opposite Party No. 3 within 90 days of the death  cannot be termed as fundamental breach of the condition of the insurance policy because a breach that can constitute an occasion  absolving the liability must be so fundamental to the terms that the insurance company could plead that claim is not maintainable.  The death of the person ought not to be taken as a  breach of such a fundamental condition to absolve the insurance company of its liability to  make the payment. Under such circumstances, we have no hesitation in concluding that the act of the Opposite Party no.3 repudiating  the claim of the complainant merely on the ground that intimation regarding the death of the complainant in an accident was not intimated  to it within ninety  days, amounted to deficiency in services on the part of the Opposite Party no.3.

 

12.               As a sequel to the foregoing discussion, we accept the present complaint and direct the Opposite Party no.3 to make the payment of Rs.50,000/-  alongwith interest at the rate of nine per cent per annum from the date of filing of the present complain  i.e. 1.10.2012 till its actual realization. The complainant shall also be entitled for a sum of Rs.11,000/- for the mental agony and harassment suffered by him and for the litigation expenses. The Opposite party no.3 shall make the compliance of this order within a period of thirty days from the date of receipt of the copy of this order.  The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated:11.02.2016

                                                                    (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

            (Anil Sharma ) 

               Member.

 

 

                            

 

 

 

 

 

 

Present:-      Sh.GulzarSingh Advocate for the complainant.

                   Sh.Jai Parkash Sharma Advocate for Opposite party no.1 and 2.

                   Sh.Narinder Chaudhary Advocate for Opposite party No.3.

 

                   Vide our separate order of the even date, the present complaint has been accepted. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated:11.02.2016

                                                                (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

            (Anil Sharma ) 

               Member.

 

 

 

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