Punjab

Sangrur

CC/422/2016

Amarjit Kaur - Complainant(s)

Versus

The Sangrur Central Cooperative Bank Limited - Opp.Party(s)

Shri Swarn Singh Ratol

14 Dec 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                     

                                                Complaint No.  422

                                                Instituted on:    13.06.2016

                                                Decided on:       14.12.2016

 

Amarjit Kaur aged about 46 years wife of Late Sukhwinder Singh, resident of Kalu Patti, Village Duggan, Tehsil and District Sangrur.

                                                        …Complainant

                                Versus

1.             The Sangrur Central Cooperative Bank Limited, Patiala Gate, Sangrur through its District Manager.

2.             The Sangrur Central Cooperative Bank Limited, Branch Mastuana Sahib through its Branch Manager.

3.             Bharti AXA General Insurance Company Limited, Pearl Plaza, K-24, Plot No.ABCD & E, 2^nd Floor, Sector 18, Noida 201 301 through its Managing Director.

                                                        ..Opposite parties

 

For the complainant  :       Shri S.S.Ratol, Adv.

For OPs No.1&2       :       Shri R.S.Bhangu, Adv.

For OP No.3             :       Shri G.S.Shergill, Adv.

 

Quorum:   Sukhpal Singh Gill, President

                Sarita Garg, Member

 

Order by : Sukhpal Singh Gill, President

 

1.             Smt. Amarjit Kaur, complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the husband of the complainant, namely, Shri Sukhwinder  Singh availed the services of the OPs number 1 and 2 by opening a saving bank account number 50604 and under the said account, the husband of the complainant was insured under Cooperative Bank Personal Accident Insurance Scheme for an amount of Rs.1,00,000/- and the complainant is the nominee under the said bank account, as such the complainant being the nominee and beneficiary is said to be consumer of the OPs.

 

2.             Further case of the complainant is that unfortunately on 03.06.2014, the husband of the complainant met with a road side accident and died. It is further stated that the FIR number 43 dated 04.06.2014 was also lodged at PS Longowal and the post-mortem of the deceased was conducted at Civil Hospital, Sangrur.  It is further stated that after the death of the insured Shri Suikhwinder Singh (referred to as DLA in short), the complainant being the nominee and beneficiary gave intimation to the OPs number 1 and 2 for releasing the claim amount, who forwarded the documents to OP number 3 for release of the claim amount.  It is further averred that the complainant thereafter approached the Ops number 1 and 2 to get the claim, but of no avail. It is further averred that ultimately in the month of March, 2015, the complainant was informed by OP number 2 that the claim in question has been repudiated by OP number 3 vide letter dated 25.2.2015, which is said to be wrong and illegal.  Thus, alleging deficiency in service on the part of the OPs, the complainant has prayed that the Ops be directed to pay to the complainant the claim amount of Rs.1,00,000/- along with interest @ 18% per annum from the date of death of the insured i.e. 03.06.2014 till realisation and further claimed compensation and litigation expenses.

 

3.             In reply filed by Ops number 1 and 2, legal objections are taken up on the ground that the complainant has unnecessarily dragged the Ops into unwanted litigation and that the complainant has not come to the court with clean hands and has suppressed the material facts and that the complainant has no cause of action to file the present complaint. On merits, it is admitted that husband of the complainant was insured with the OP number 3 through OPs number 1 and 2.  It is further admitted that the complainant lodged the claim and the OPs number 1 and 2 forwarded the claim papers to OP number 3 for release of the claim amount.  Thereafter the OP number 3 repudiated the claim vide letter dated 25.2.2015 and as such the complainant was intimated accordingly.  It is further stated that the claim amount is payable by OP number 3 only and the Ops number 1 and 2 are not liable at all.

 

4.             In reply filed by OP number 3, legal objections are taken up on the grounds that the complaint is not maintainable as there is violation of the terms and conditions of the policy. As per the undertaking dated 20.1.2015 submitted by Op number 1, total number of account holders were more than the total number of account holders covered under the policy, therefore, there is a breach of condition number 9 of the policy. Under the policy 70983 account holders were insured, out of which 69433 members were insured for an amount of Rs.1,00,000/- each, 833 members for an amount of Rs.3,00,000/- and 717 members for an amount of Rs.5,00,000/- were insured, but the OP number 1 given the letter confirming the list of account holders wherein 70319 members were shown for Rs.1,00,000/-, 1241 members for Rs.3,00,000/- and 1141 members for Rs.5,00,000/-. The OP number 1 collected the premium from 72701 accounts holders and got insured only 70983 members, therefore, the liability of the OP 3 has been denied.  On merits, it is stated that the OP number 3 received the intimation regarding the death of the DLA on 10.11.2014 with a delay of 160 days and after getting the information, claim number C0676734 was allotted and the OP sent a letter dated 11.11.2014 for supply the required documents. It has been stated further that during the investigation, the OP number 1 issued the letter whereby he confirmed that 72701 account holders were insured under the policy i.e. 70319 members for Rs.1,00,000/-, 1241 members for Rs.3,00,000/- and 1141 members for Rs.5,00,000/-, whereas under the policy 70983 account holders were insured, out of which 69433 members were insured for an amount of Rs.1,00,000/- each, 833 members for an amount of Rs.3,00,000/- and 717 members for an amount of Rs.5,00,000/- were insured, therefore the OP number 1 collected the premium from 72701 accounts holders and got insured only 70983 members which is a clear cut violation of the policy clause number 9.  As such, it is stated that the claim has rightly been repudiated.

 

5.             The learned counsel for the complainant has produced Ex.C-1 copy of letter dated 25.2.2015, Ex.C-2 copy of passbook, Ex.C-3 copy of FIR, Ex.C-4 copy of PMR, Ex.C-5 affidavit, Ex.C-6 copy of letter, Ex.C-7 copy of letter dated 3.11.2014 and closed evidence. On the other hand, the learned counsel for OPs number 1 and 2 has produced Ex.OP1&2/1 copy of affidavit, Ex.OP1&2/2 copy of application, Ex.OP1&2/3 copy of letter dated 3.11.2014, Ex.OP1&2/4 account statement, Ex.OP1&2/5 copy of letter dated 25.2.2015 and Ex.OP1&2/6 copy of list of members and closed evidence. The learned counsel for OP number 3 has produced Ex.OP3/1 affidavit, Ex.Op3/2 copy of letter, Ex.OP3/3copy of policy, Ex.OP3/4 copy of terms and conditions and closed evidence.

 

6.             We have carefully perused the complaint, version of the opposite parties, evidence produced on the file and written submissions and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.

 

7.             In the present case, the DLA Shri Sukhwinder Singh was having a saving bank account with the OP number 2 as such he was insured with the OP number 3 under the personal accident policy for Rs.1,00,000/-. It is further case of the complainant that the DLA died an accidental death on 03.06.2014 of which FIR number 43 dated 4.6.2014 was recorded at PS Longowal, a copy of which on record is Ex.C-3 and the copy of post-mortem report on record is Ex.C-4. Thereafter the intimation of death was also given to the OPs number 1 and 2, who forwarded the same to OP number 3, but the grievance of the complainant is that the OP number 3 has wrongly repudiated the rightful claim of the complainant.

 

8.             After hearing the arguments of the learned counsel for the parties and on the perusal of the documents placed on record, we find that the main point of controversy in the present complaint is with regard to that whether the DLA was insured with the OP number 3 or not and whether the claim has rightly been repudiated by the OP number 3 or not.

 

9.             Admittedly, the DLA had a saving bank account with the OP number 1 and as such was insured for Rs.1,00,000/- with the OP number 3 under the personal accident policy  as is evident from the copy of ledger account produced on record as Ex.OP1&2/4 which clearly shows that an amount of Rs.40/- was debited to the account of the DLA on account of premium for the policy in question, meaning thereby the  complainant had paid the premium for the insurance policy.  Further the OP number 1 &2 has produced on record the copy of voucher Ex.OP1&2/6 along with the list of insured persons and its perusal shows that the name of the DLA Shri Sukhwinder Singh is figuring at serial number 599, meaning thereby the DLA was insured with the OP number 3 under the policy, as such, we are unable to go with the stand of the Ops that the DLA was not insured or the Ops number 1 and 2 had paid the less premium and got insured the excess persons i.e. 70983 account holders were insured, out of which 69433 members were insured for an amount of Rs.1,00,000/- each, 833 members for an amount of Rs.3,00,000/- and 717 members for an amount of Rs.5,00,000/- were insured, but the OP number 1 given the letter confirming the list of account holders wherein 70319 members were shown for Rs.1,00,000/-, 1241 members for Rs.3,00,000/- and 1141 members for Rs.5,00,000/-. Further we find that no documentary evidence has been produced by OP number 3 on record to show that the OP number 1 collected the premium from 72701 accounts holders and got insured only 70983 members from OP number 3. Under the circumstances, we feel that since it is proved on record that the DLA was insured with the OP number 3 under the accidental policy for Rs.1,00,000/-, the OP number 3 is liable to pay the insurance claim as such. We further find that the repudiation of the claim is not justified at all and by doing so the OP number 3 is deficient in service.

 

10.           In the light of above discussion, we allow the complaint and direct OP number 3 to pay to the complainant an amount of Rs.1,00,000/- along with interest @ 9% per annum from the date of filing of the present complaint i.e. 13.6.2016 till realisation.  OP number 3 is further directed to pay to the complainant an amount of Rs.5,000/- in lieu of consolidated amount of compensation and litigation expenses.

 

11.           This order of ours be complied with within a period of thirty days of its communication. A  copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                December 14, 2016.

                                                        (Sukhpal Singh Gill)

                                                           President

 

 

                                                                (Sarita Garg)

                                                                    Member