Haryana

Karnal

CC/687/2019

Harish Dhiman - Complainant(s)

Versus

The Manager, Punjab National Bank - Opp.Party(s)

Radhe Shyam Sharma

18 Nov 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 687 of 2019

                                                        Date of instt.04.10.2019

                                                        Date of Decision:18.11.2022

 

Harish Dhiman son of late Shri R.S. Dhiman, resident of House no.1873A, Housing Board Colony, Sector-6, Karnal.

 

                                               …….Complainant.

                                              Versus

 

1.     The Manager, Punjab National Bank, Mugal Canal, Karnal.

 

2.     The Branch Manager, Kotak Mahindra Life Insurance Co. Ltd. Sector-12, Urban Estate, Karnal.

 

3.     The Managing Director, Kotak Mahindra Life Insurance Co. Ltd. Kotak infinity 7^th floor Zone-II, Building-21, Kotak infinity Park, off Western Express Highway, General AK Vadidya Marg, Malad (East), Mumbai-400097.

 

                                                                      …..Opposite Parties.

 

Complaint under Section 12 of the Consumer Protection Act, 1986 as amended under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary……Member

          

 Argued by: Shri Radhey Shyam, counsel for the complainant.

                    Opposite Party no.1 exparte.

                    Shri Vineer Rathore, counsel for the OPs no.2 & 3.

 

                    (Jaswant Singh President)

ORDER:   

                

                The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 as after amendment under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant took admission in RPITT Engineering College in the year 2011 in B.Arch. trade and the abovesaid trade was to be completed in 10 semester of five years and the tuition fee of the each semester was Rs.36800/- approximately. The complainant was not having sufficient funds for payment of tuition fee to RPIIT college and complainant approached to OP no.1 and applied for grant of education loan and the loan was sanctioned in the year 2012. OP no.1 told to complainant and also to his father that OP no.1 has liaisoned with OPs no.2 and 3 and further assured that OPs no.2 and 3 are doing a fair business of life insurance. On believing the version of OP no.1, complainant and his father purchased a Life Group Insurance Policy from the OPs no.2 and 3 and in this regard OPs no.2 and 3 issued a policy no.cc000011/ck016698, in the name of the father of complainant, which was valid since 09.05.2012 to 08.05.2025 for a sum of Rs.5,00,000/- and installment of premium was Rs.4025/- for one year. Complainant paid the regular premium till 2017 and he was the nominee of his father in the policy in question. At the time of insurance the father of complainant was hale and hearty person and submitted a Good Health Declaration Form for PNB Education Loan Borrower and all the necessary particular were furnished in the above form and after going through the contents of the above form, OPs no.2 and 3 were fully satisfied and accepted the request of complainant and issued the abovesaid policy. On 04.08.2017, the father of complainant died due to heart failure and in this regard intimation was given to OPs and submitted the relevant documents for settlement of claim. Thereafter, complainant visited the office of OPs personally and requested to settle the claim but OPs did not pay any heed to the request of complainant and lingered the matter on one pretext or the other. OP no.1 is pressing hard upon complainant to deposit the installment of loan, otherwise the account of complainant would be declared NPA, but OPs no.2 and 3 have not listened the genuine request of complainant and as such, if insurance amount is not disbursed to complainant, in that eventuality, the account of complainant would be declared NPA and complainant would suffer irreparable loss and injury. OPs no.2 and 3 through email dated 05.08.2019, rejected the claim of the complainant without assigning any cogent reason. Complainant visited the office of the OPs several times and requested to disburse the insured amount but OPs failed to do so. Then complainant sent a legal notice dated 02.09.2019 to the OPs but it also did not yield any result. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, Shri Harish Kumar Manager appeared on behalf of OP no.1 and filed its written version stating therein that it is policy matter of the bank and as per bank guidelines “Term Loan account will be treated as NPA if interest and/or installment of principal remain Overdue for a period of more than 90 days and overdue is an amount due to the bank under any credit facility is overdue,  it is not paid on the due date fixed by the bank.”  It is submitted that account will become NPA automatically, if it is overdue for more than 90 days and all the bank guidelines are governed by Reserve Bank of India.

3.              Lateron, none has appeared on behalf of OP no.1 and opted to be proceeded against exparte, vide order dated 31.05.2022 of the Commission.

4.             OPs no.2 and 3 filed its separate written statement raising preliminary objections with regard to maintainability; cause of action and concealment of true and material facts. On merits, it is pleaded that a group policy i.e. Kotak Complete Cover Group Plan was executed between Punjab National Bank i.e. OP no.1 and answering OPs. As per the said policy contract, a group of members as specified by the policyholder availing any loan from the policyholder for specific purposes as specified in the schedule of the policy contract shall be covered by the OPs under group insurance policy for the period and amount as specified in the certificate of Insurance (COI) issued to every such specified member. OPs received a duly filled and signed membership cum declaration of good health (DOGH) from the OP no.1. The name of the member in the DOGH was mentioned as Ram Singh Dhiman i.e. father of complainant. The complainant name was mentioned as nominee. It is further pleaded that the contract of insurance executed between the OP no.1 and the answering OPs was to secure the life of the student in order to ensure the liability of the education loan obtained from the OP no.1. It is further pleaded that OPs received a duly filled and signed DOGH from the OP no.1 wherein the name of the father of complainant i.e. Mr. Ram Singh Dhiman was erroneously mentioned instead of the name of the son i.e. Harish Dhiman. Accordingly the COI was issued in the name of the complainant and his father. The complainant was mentioned as the nominee for the insurance cover. Upon receipt of the claim intimation informing about the death of the father of complainant i.e. Mr. Ram Singh Dhiman, the said error regarding incorrect entry in DOGH and COI was noted. Upon evaluation, it was discovered that the subject cover was incorrectly issued on the life of the father instead of the student, as such the claim was not payable as per the terms and conditions of the policy contract. The subject policy was designed to cover the student’s life only, however the question of payment of benefit on the death of the father does not arise at all. Moreover, as per the terms and conditions of the policy contract, the maximum entry age for granting life cover under the subject policy was 33 years, however, Mr. Ram Singh Dhiman was aged 55 years at the time of submitting the DOGH. This makes the cover provided to Mr. Ram Singh void and further makes any claim arising out of the same as invalid. Therefore, in view of the above facts, the claim of the complainant was considered invalid as the same was against the terms and conditions of the policy contract. There is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

5.             Parties then led their respective evidence.

6.             Learned counsel for complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copies of group insurance death claim intimation form Ex.C1 and Ex.C2, copy of declaration  i.e. credit policy Ex.C3, copy of death claim intimation Ex.C4, copy of authorization from member under group credit policy  Ex.C5, copy of certificate of insurance Ex.C6, copy of death certificate Ex.C7, copy of legal notice dated 02.09.2019 Ex.C8, receipt Ex.C9, reply of legal notice Ex.C10, copy of email Ex.C11, copy of Aadhar card of complainant Ex.C12 and closed the evidence on 18.11.2021 by suffering separate statement.

7.             On the other hand, learned counsel for the OPs no.2 and 3 has tendered into evidence affidavit of Shakil Ahmad Ex.OP2/A, copy of policy document Ex.OP2/1, copy of covernote Ex.OP2/2, copy of certificate of insurance Ex.OP2/3, copy of death claim Ex.OP2/4 and closed the evidence on 18.05.2022 by suffering separate statement.

8.             We have heard the learned counsel for the parties and have perused the case file carefully and have also gone through the evidence led by the parties.

9.             Learned counsel for complainant, while reiterating the contents mentioned in the complaint, has vehemently argued that complainant took admission in RPITT Engineering College in the year 2011 in B.Arch. The complainant was not having sufficient funds for payment of tuition fee and he approached to OP no.1 and applied for grant of education loan and the loan was sanctioned in the year 2012. OP no.1 told to complainant that OPs no.2 and 3 are doing a business of life insurance and on believing the version of OP no.1, complainant and his father purchased a Life Group Insurance Policy from the OPs no.2 and 3, in the name of the father of complainant, Complainant paid the regular premium till 2017 and he was the nominee of his father in the policy. On 04.08.2017, the father of complainant died due to heart failure and in this regard intimation was given to OPs and submitted the relevant documents for settlement of claim but OPs did not settle the claim. OP no.1 is pressing the complainant to deposit the installment of loan, otherwise the account of complainant would be declared NPA, but OPs no.2 and 3 have not listened the genuine request of complainant. OPs no.2 and 3 through email dated 05.08.2019 rejected the claim of the complainant without assigning any cogent reason and lastly prayed for allowing the complaint.

10.           Per contra, learned counsel for OPs no.2 and 3, while reiterating the contents of written version, has vehemently argued that OPs received a duly filled and signed membership cum declaration of good health from  OP no.1. The name of the member in the said form was mentioned as Ram Singh and name of complainant was mentioned as nominee. The OPs received a duly filled and signed DOGH from the OP no.1 wherein the name of the father of complainant i.e. Mr. Ram Singh Dhiman was erroneously mentioned instead of the name of the son i.e. Harish Dhiman. Accordingly the COI was issued in the name of the complainant and his father. Upon receipt of the claim intimation informing about the death of the father, the said error regarding incorrect entry in DOGH and COI was noted. Upon evaluation, it was discovered that the insurance policy was incorrectly issued on the life of the father instead of the student, as such the claim was not payable as per the terms and conditions of the policy contract and prayed for dismissal of the complaint.

11.           We have duly considered the rival contentions of the parties.

12.           Admittedly, complainant had obtained an Education Loan in the year of 2012 for sum of Rs.five lakhs. The loan was insured by the OPs no.2 and 3 by paying the premium of Rs.4025/- for every year.  The complainant has paid premium till 2017 without any default.

13.           As per the version of the complainant his father get himself insured with the OPs no.2 and 3 at the instance of OP no.1. On 04.08.2017, the father of complainant died due to heart failure. Complainant has submitted all the required documents with the OPs to settle his claim but OPs lingered on the matter on one pretext or the other.

14.           As per the version of the OPs no.2 and 3 that they had received duly filled and signed DOGH from the OP no.1 wherein the name of the father i.e. Ram Singh Dhiman was erroneously mentioned instead of the name of the complainant.  The COI was issued in the name of the complainant and his father. On receipt of claim intimation about the death of Ram Singh the said error regarding the incorrect entry in the DOGH and COI was noted. Upon evaluation, it was discovered that the subject cover was incorrectly issued on the life of the father instead of the student.  Hence the claim was not payable as per the terms and conditions of the policy contract.

15.           It is evident from the Group Insurance Death Claim Intimation Form (Credit Policies) Ex.C1/OP2/4, Ram Singh father of the complainant had been insured by the OPs. In the said form the date of birth of Ram Singh mentioned as 12.01.1958. The date of risk commencement is 09.05.2012. It is also evident from the Claim Discharge Form Ex.C2, Ram Singh was insured by the OPs. It is also evident from the Declaration and Authorization Letter Ex.C3, Ram Singh father of complainant was insured by the OPs. The complainant is the nominee of his father Ram Singh. It is also evident from Authorization Form Membership Under Group Credit Policy Ex.C5  dated 28.04.2012 bearing the signature of Ram Singh and same was attested by OP no.1.

16.           It is not denied that Ram Singh was insured with the OPs, but OPs have taken a plea that the name of Ram Singh was erroneously mentioned instead of name of complainant at the time of issuing the insurance policy. The education loan was sanctioned and insured in the year of 2012. Complainant has been regularly paying the installments since 2012 till the death of his father. OPs have also taken a plea that as per the detail of members of group insurance policy, minimum age at the entry of the member is 18 years and maximum 33 years. At the time of issuing the insurance policy, the father of complainant has specifically mentioned his date of birth as 12.01.1958. If he was not entitled for taking the said insurance policy as to why he was insured by the OPs ever after at that time insured  had disclosed that he was 54 years old. Since then OPs have received the premium amount without any hesitation. It is not a case of the OPs that they have received less premium considering the age of loanee as the loanee was the student. It was the duty of the OPs to verify all the documents prior to issuing of the policy. Furthermore, OPs cannot take the shelter for the wrong acts of their employee and cannot escape from their liability. Had the complainant met with an accident, the position would have remained the same and in that eventuality, OPs would have taken a plea that the complainant is not insured and Ram Singh is insured by the OPs and the claim is not payable.

17.           Furthermore, OP no.1 has not produced any evidence to rebut the version of the complainant by leading any cogent and convincing evidence and opted to be proceeded against exparte.

18. Hon’ble Punjab and Haryana High Court in case titled as New India Assurance Company Ltd. Versus Smt. Usha Yadav & others 2008 (3) RCR (Civil) 111, has held as under:-

                It seems that the Insurance Companies are only interested in earning the premiums which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance companies make the effected people to fight for getting their genuine claims. The Insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy.

19.           Keeping in view, the ratio of the law laid down in aforesaid judgments, facts and circumstances of the present complaint, we are of the considered view that act of the OPs no.2 and 3 while repudiating the claim of the complainant amounts to deficiency in service, which is otherwise proved genuine one.

20.           Thus, as a sequel to abovesaid discussion, we allow the present complaint and direct the OP no.1 not to make the account of complainant NPA. We further direct the OPs no.2 and 3 to settle the insurance claim of the complainant and to disburse the insurance amount. We further direct the OPs no.2 and 3 to pay Rs.20,000/- to the complainant on account of mental agony and harassment suffered by him and Rs.11,000/- for the litigation expense. This order shall be complied with within 45 days from the date of receipt of copy of this order till its realization. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:18.11.2022

                                                                       

                                                                  President,

                                                       District Consumer Disputes

                                                       Redressal Commission, Karnal.

 

 

 

(Vineet Kaushik)           (Dr. Rekha Chaudhary)

                     Member                        Member

                 

Sushma

Stenographer