BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SAS NAGAR, MOHALI
Consumer Complaint No.471 of 2014
Date of institution: 16.07.2014
Date of Decision: 21.09.2015
Smt. Swarn Devi wife of Mahinder Singh, resident of village Shahpur, Tehsil and District Panchkula.
……..Complainant
Versus
1. The New India Assurance Company Limited, Claims-Hub, Mumbai Regional Office-I, 12th Floor, New India Centre, 17-A, Cooperage Road, Mumbai 400039.
2. The Axis Bank Ltd., ‘Trishul’ 3rd Floor, Opp. Samartheswwar Temple, Near Law Garden, Ellisbridge, Ahmedabad 380006.
3. The Branch Manager, Axis Bank Ltd., Sadashiv Complex, Ambala Chandigarh Highway, Derabassi, SAS Nagar.
………. Opposite Parties
Complaint under Section 12 of the
Consumer Protection Act, 1986.
CORAM
Mrs. Madhu. P. Singh, President.
Mrs. R.K. Aulakh, Member.
Present: Shri Anish Garg, counsel for the complainant.
Shri Sukaam Gupta, counsel for OP No.1.
Shri Rajeev Bhardwaj, counsel for OP No.2 and 3.
(Mrs. Madhu P. Singh, President)
ORDER
The complainant has filed the present complaint seeking following directions to the OPs to:
(a) pay her Rs.2,00,000/- as per the scheme alongwith interest @ 18% per annum till actual payment.
(b) pay her Rs.1.00 lac for mental tension, agony, harassment and humiliation.
(c) pay her Rs.22,000/- as litigation expenses.
The case of the complainant is that her son Kesar Singh was having salary account No.303010100063337 with OP No.3. OP No.1 on behalf of OP No.2 and 3 issued insurance policy No.1127004613130000002 against the debit card regarding all the incidents, if happened. The complainant was the beneficiary under the scheme in the event of death of her son Kesar Singh. Kesar Singh son of the complainant died due to accident on 14.05.2013 and FIR No.131 dated 15.05.2013 under Section 279/304-A IPC was lodged at P.S. Naraingarh, District Ambala to this effect. The complainant immediately lodged the claim with OP No.3 alongwith all original documents as per demand by OP No.3. OP No.1 on 18.10.2013 rejected the claim of the complainant on the ground of delay of 138 days for submission of the complaint. The complainant contacted OP No.3 and showed letter dated 18.10.2013 but OP No.3 did not bother and asked the complainant to contact OP No.1 who only is liable to pay the claim to the complainant. The complainant served legal notice dated 27.05.2014 to the OPs for release of claimed amount. OP No.3 inn its reply shifted the liability on OP No.3 to pay the claim. Non release of the claimed amount is an act of deficiency in service and unfair trade practice on the part of the OPs. With these allegations the complainant has filed the present complaint.
2. After admission of the complaint, notice was sent to the OPs. OP No.1 in the preliminary objections of the written statement has pleaded that this Forum does not have the territorial jurisdiction to entertain the complaint as the policy was issued from Mumbai and No claim has been made by Mumbai office. As per the terms and conditions of the policy, the claim is to be reported within 90 days and in the present case death of Kesar Singh took place on 14.05.2013 and intimation for the first time was received by it on 30.09.2013 i.e. after lapse of 138 days. As per the terms and conditions of the policy the claim of the complainant was treated as No Claim and intimation to this effect was given to the complainant vide letter dated 18.10.2013. On merits, it has taken the same stand as has been taken in preliminary objections and sought dismissal of the complaint against it.
3. No separate written statement has been filed by OP No.2 and vide his statement dated 24.02.2015 counsel for OP No.2 has adopted the written statement filed by OP No.3. OP No.3 in the preliminary objections of the written statement has pleaded that the complainant has got no cause of action to file the complaint and complainant does not come under the definition of consumer. OP No.3 has not charged any insurance premium of insurance from the complainant and there is no contract between OP No.3 and complainant. The terms and conditions, issuance, cancellation, termination of any policy issued by OP No.1 is the responsibility of insurance company itself. OP No.3 works as agent to the public but does not issue any policy or charge any premium from the public for issuance of insurance policy. It has been wrongly impleaded as party in the present case. On merits also it has denied the allegations of the complainant and sought dismissal of the complaint against it.
4. To succeed in the complaint, the complainant tendered in evidence affidavit Ex.CW-1/1 and copies of the documents Ex.C-A, C-1 to C-6.
5. Evidence of OP No.1 consists of affidavit of R.N. Gupta, its Regional Manager Ex.OP-1/1 and copies of documents Ex.OP-1 to OP-3.
6. Evidence of OP No.2 consists of affidavit of Taranjit Singh, its Branch Head Ex.OP-2/1.
7. We have heard learned counsel for the parties and have also gone through the written arguments submitted by them.
8. In the present complaint the factum of currency of the insurance policy against the debit card of the account holder Shri Kesar Singh is not disputed by the OPs. The factum of accident causing death to the account holder on 14.05.2013 and FIR No.131 dated 15.05.2013 to this effect is not disputed. As per the complainant, she being the legal heir of the account holder has filed the claim documents immediately with OP No.3 alongwith original documents as per demand by OP No.3. However, the OP No.1 has rejected the claim on 18.10.2013 on the ground of delay of 138 days for submission of the claim documents. Aggrieved by the act of repudiation, the complainant has filed the present complaint.
9. Now the limited question for determination is whether the complainant has submitted her claim documents within the stipulated period as per terms of policy or not, if so to whom it has been submitted and whether OP No.1 the insurance company got the claim documents beyond the stipulated period as per terms of policy and rejected the claim as per terms of the policy or not. The onus of submissions of the claim documents within the stipulated period as per terms of policy is on the complainant. The perusal of the complaint shows that the complainant has made a mere assertion that she has submitted the claim alongwith original documents to OP No.3 immediately but there is no date of submission of documents coming in the pleadings to show the submission of documents. OP No.3 in its reply has admitted having sent the documents to OP No.1 and even No.1 has admitted having received the claim documents from OP No.3 through their Mumbai office but reply of both OP Nos.1 and 3 is also silent about the receipt of claim documents at their respective ends. OP No.1 in its reply has shifted the onus of delayed receipt of intimation regarding the death of the account insured on OP No.2 and denied any deficiency in service on its part. As per OP No.1 the claim has been repudiated in accordance with terms and conditions of the insurance policy immediately after receiving the intimation as there is breach of conditions of the insurance policy.
10. It is ample clear that complainant has averred that intimation about the factum of death of the insured was given to OP No.3 but it has not mentioned the date of said intimation. However, OP No.1 in its written statement has submitted that the intimation and the claim documents have been received by it only on 30.09.2013 from OP No.3 i.e. the Axis Bank. Thus, it transpires from the record that the claim documents have been submitted by the complainant much beyond the stipulated period of ninety days in claim of personal accident.
11. Admittedly the accident has occurred on 14.05.2013 and the insurance company has received intimation on 30.09.2013 vide Ex.OP-2 after a delay of 138 days from the stipulated period of intimation and processed the claim without delay and repudiated the same being violative of basic terms and conditions of the insurance policy. The intimation of no claim has been given to the complainant vide letter dated 18.10.2013 Ex.OP-3. Since there violations of basic terms and conditions of the policy, therefore, the OP No.1 has rightly declined the claim as No Claim of the complainant. We do not find anything amiss on the part of OPs. In support of above findings we rely on the decision of Hon’ble National Commission rendered in case titled as Branch Manager, United India Insurance Company Limited Vs. Jogendra Singh, 2014(4) CLT 259.
11. Hence the complaint being devoid of merits is hereby dismissed. Certified copies of the order be furnished to the parties forthwith free of cost and thereafter the file be consigned to the record room.
Pronounced.
September 21, 2015.
(Mrs. Madhu P. Singh)
President
(Mrs. R.K. Aulakh)
Member
