Partha Kumar Basu, Member
This complainant petition is filed by the Complainant Priyanka Naskar D/o Mr. Arabinda Naskar of Village : Raypur, PO: Dakshin Raypur, No 3, PS : Dhalahat against the United Bank of India, Dakshin Raypur Branch PIN-743349 subsequently taken over by Punjab National Bank with same branch address (OP1) and Bajaj Allianz General Insurance Co. Ltd. (OP2) with office at 6th floor, Mani Square, 164 Canal Circle Road, Kolkata 700054 under the Consumer Protection Act 2019 in a matter of alleged deficiency in service for non-settlement of Insurance claims consequent upon accidental death of three of her family members cum insured.
The gist of the case as averred by the complainant states that the OP1 bank being in Public Sector banking field had tie up for distribution of insurance products. The mother, sister and brother of the complainant respectively Late Manjuri Naskar (age 46 years), Late Pallabi Naskar (age 22 years) and Late Parameswar Naskar (age 25 years) used to maintain three savings accounts at the OP1 bank and there were perpetual annual deductions of Rs.17/- from each of the above 3 savings accounts to maintain insurance coverage under the ‘United Surakshya Yojana’ (USY) benefit scheme including Accidental benefit coverages. Under the said USY scheme an insurance coverage upto Rs. 1,25,000/- each is envisaged by the complainant. On 5th July 2019 all the above 3 family members cum insured died of electrocution at their home as accidental deaths as per Postmortem reports and Final reports from police. An Unnatural Death case was started at the local Police station as UD case no 25/19 dated 05.07.2019 of Dholahat PS and the post mortem reports revealed that all the above said 3 persons died of electrocution. The OP1 bank was intimated about the incident and accordingly Death claim notices were forwarded by letters from OP1 bank all dated 16.10.2019 to OP2 insurance company alongwith requisite documents in respect of the said 3 insured, holding the complainant as nominee for all the three deceased family members. The nominee also sent reminders to OP1 bank vide letter dated 19.09.2019 and 17.03.2020 even amidst Covid 19 situation for granting her the insurance claims for which she is entitled as a beneficiary. But the OP1 Bank or the OP2 insurer did not take necessary step for relief of the complainant. As the OPs did not pay any heed to settle the claim towards the beneficiary, hence the case for deficiency in service is filed. The complainant claimed Rs. 1,25,000/- for each of the 3 deceased persons as nominee totaling to Rs.3,75,000/- alongwith a compensation of Rs. 50,000/- for mental agony out of the delay to settle insurance claims and a litigation cost for Rs.20,000/-.
The complainant exhibited the UBI branch (OP1) letter dated 16.10.2019 by which the death claims of the nominee for those three deceased insured persons were sent to the OP2 Insurance company with a mention that the Application forms, NEFT mandates, Assignee verification forms, Death certificates, Postmortem reports, KYC of both claimant and deceased persons and copy of passbooks showing deduction @ Rs.17/- from the deceased account holders were attached.
W/V was filed by OP1 and also adopted as evidence. In their W/V, the OP1 raised question of maintainability of this complaint petition but without mention of any ground. The OP1 bank accepted in the W/V that it has a tie up arrangement with Insurance company OP2 for distribution of their insurance products in the fields viz. health, personal, accidental, home matters, travels etc. The OP1 bank also adduced that those three deceased family members of the complainant had been maintaining respective saving accounts at their concerned branch and annual deductions @ Rs. 17/- under the scheme of USY were being executed from each account for respective Insurance coverages including accidental benefits. It was stated that after a lot of persuasions by the complainant, the OP1 bank took initiatives to send Death claim notice / letter to OP2 Insurance company alongwith all other relevant documents for all the three deceased insured. At the time of continuing the savings accounts, the predecessors of the complainant, since deceased, had taken Life Insurance policies from the OP2 Insurance company and as per mandate, the OP1 paid the said amount every year as per customers’ instruction to OP2 Insurance company. The OP1 stated that their Branch Manager issued letter to OP2 company for compliance of the Insurance claims of this complainant but the OP2 did not turn up. Hence OP1 bank claimed not being liable for those unsettled insurance claims in their W/V.
On the other hand, the OP2 Insurance company raised the question of maintainability of this complaint petition on the ground of jurisdiction and averred by affidavit in their W/V that the insurance claim is pre-mature. The OP2 Insurance company accepted that it has a tie up arrangement for distribution of insurance products with OP1 bank for providing insurance products including coverage of accidental benefits. However the OP2 insurance company denied having any knowledge about savings accounts of these insured persons or about any perpetual annual deduction @ Rs.17/- under United Surakshya Yojana (USY) or whether that substracted amount pertains to accidental insurance cover under USY scheme. The OP2 also denied about occurrence of the death incidents dated 05.07.2019 due to electrocution and it was denied that the post mortem reports and final reports state that the deaths were due to the effect of electrocution which is accidental death. The OP2 denied on affidavit that no claim request from complainant as nominee were received by them through OP1 bank. The OP2 also claimed that complainant never submitted relevant documents in support of her claim regarding details of insurance premium and details of the deaths. The insurance company OP2 has further mentioned that inspite of specific averments made in the written version from OP1 bank, the claim settlement documents relied upon have never been supplied to them.
Perused the record and documents that has been exhibited and heard arguments advanced by the Ld. Counsels for the parties. The OP1 United Bank of India got merged with Punjab National Bank and complaint petition was amended accordingly bringing PNB into records as OP1. During adjudication process through filing of questionnaire by OP1 and OP2 and replies thereof, no scope to file Questionnaire was availed by complainant. The Complaint petition was adopted as evidence by complainant. It is stated in her Reply to the Questionaries’ from OP1 bank by the complainant that OP1 is not liable to compensate the insurance claim and there is no deficiency in service from OP1. Both sides filed BNAs and advanced arguments on the date of final hearing on 04.05.2023.
The OP1 bank did not disown the fact that yearly insurance cost @ Rs. 17/- per account was being debited from the accounts of each of the deceased account holder under the scheme of USY. The debit entries in all the 3 exhibited passbook copies lends support to the same. OP1 has only mentioned that the Complainant is not a consumer in the eyes of law, but why the Complainant is not consumer, no reasoning to that effect has been subscribed. OP2 also contended that this commission can not try this case on the ground of jurisdiction, but the place of residence as well as the place of occurrence both fall under the police station which again strictly falls under the jurisdiction of this commission. Hence the objections are not sustainable and the deceased persons were very much coming under the purview of the definition of consumers of the Consumer Protection Act 2019 and as such the claims of both OP1 and OP2 on the ground of maintainability are unfounded. The Complainant being nominee is also beneficiary to the services provided by the Bank / insurance company.
In the Final Reports of Police and the Post mortem reports of the Govt. Hospital, the cause of deaths were mentioned as ‘due to electrocution’. In the post mortem reports it is also mentioned that the visceras have been sent for chemical examination. There is no denial of OP1 that the mother, brother and sister of the complainant died on the spot due to electrocution. But it was the responsibility of the OP1 bank towards the insured to ensure providing them the policy documents at the ‘point of sale’ itself or any other requisite document / policy material, if bank in this case happens to be the master policy holder of the group insurance. The bank was to enclose or provide the insurance claim form, of the beneficiary/nominee alongwith supporting documents while sending to OP2 insurance company. But OP1 has failed to file any cogent proof in support of their claim or any proof of acknowledgement, specially when the OP2 has contested the same and denied having received any such document. The OP1 bank is also conspicuous in exhibiting their claim having provided claim form/documents in support of their contention when there is no mention even about the address of OP2 insurance company in the letter of OP1 dated 16.10.2019 except mention of only the name of OP2 company. The requirement of proper and complete documents cannot be ignored as a casual fault especially when three family members died of electrocution as per Postmortem and Final reports from authorities. It is not in dispute that the deceased insured became members of the Group Insurance Scheme namely United Surakshya Yojona (USY) by opening an account with the United Bank of India. The said Group Insurance Scheme has been introduced by the bank to cover the risk of the account holders in the event of accidental death or in case of permanent disability in any accident. The said scheme provides benefits mentioned therein having insurance coverage upto various amounts for death and permanent disability against each account holder from time to time. According to the scheme, the personal accidental insurance coverage for the depositor has been enumerated as the maximum coverage would be in case of death and in case of permanent disability. The Group Insurance Scheme provides that in order to augment share of low cost deposit, a Group Insurance Scheme named as ‘United Suraksha Yojana’ has been introduced as a value addition for various account holders viz. Savings Bank. Current Deposit, Term Deposit Account holder etc. to make it more competitive and attractive to the existing as well as new customers of the Bank. The Bank has already entered into an agreement with Bajaj Allianz General Insurance Co. Ltd., as its corporate agent for Insurance. The Group Insurance Scheme (United Suraksha Yojana) would cover accidental death plus permanent total disability as per the scale of benefits having insurance coverage against each account holder which would be enjoyed by Bank as Master Policy holder. The amount of insurance cost was Rs. 17/- per lac per year for individual account holders at relevant point of time. It is also not in dispute that the insurance coverage of the complainant was for the period of one year on and from the commencement of the policy. Unfortunately, on 5th July 2019 the complainant’s mother, brother and sister reportedly met with an accident of electrocution in which they lost their lives. The complainant being nominee raised a claim for a sum of Rs. 3,75,000/- (Three lacs Seventy five thousand) being entitled to the insured amount for three deceased family members @ Rs.1,75,000/- each because of the death by accident. But no policy document was exhibited by either side and from the exhibited document stamped and signed by the OP1 bank dated 12.08.2020 and one undated and unstamped policy details document exhibited, it appears that the Sum assured in respect of the three policies each carry an amount of Rs.1,00,000/- (Rs. One Lac) only for death claim.
It is also apparent that the neither the OP2 insurance company granted any sum for which the above complaint case has been filed. The points of decision in this dispute is whether the complainant is entitled to compensation of the sum assured. As per the said scheme, all existing and new account holders of UBI (now PNB) would be eligible for coverage under the Group Insurance Scheme of Bajaj Allianz. The proposal form along with other information like claim procedure, amount of coverage, etc regarding the Group Insurance Scheme would be made available to the customers. The OP1 bank vide exhibited document signed on 12.08.2020 certified that nominee of the three deceased persons filed claims no OC 20 2401 6401 00000357 for Late Manjuri Naskar, OC 20 2401 6401 00000355 for Late Pallabi Naskar and OC 20 2401 6401 00000356 for Late Parameswar Naskar. In the event of a valid claim arising under the policy, the sum assured would become payable as the claim amount. The claim amount would be paid to the nominee of the account as per bank records. Therefore a simple denial on point to point and page to page by the OP2 without any supportive document, does not carry much of evidentiary value. Further, in the event of closure of bank accounts, the concerned account holder will cease to be a member under the scheme from the date of next renewal of the policy as the coverage would be given on yearly basis. But this is not a case herein as the last deduction of premium was in 2019 from each account of the deceased and therefore such insurance coverages were valid till another 1 year. Therefore it tantamounts to clear deficiency in service by OP2 insurance company as well. Before the Ld. Commission, both the OP1 and OP2 have failed to give any satisfactory reply as to why adequate measures in respect of the death claims were not taken. Such laches on the part of the OPs cannot be ignored very causally specially when there was losses of several human lives and the OPs are grossly responsible for such wrongful act by causing delay in settlement of death claims and geopardising the basic purposes of this social security scheme.
It is the case of the complainant that her family members opened three separate accounts with the United Bank of India. The said scheme clearly stipulates an insurance coverage of Rs. 1,00,000/- only against each savings account maintained by the account holders. It can not be said that the nominee would not get her claims just because the bank has not provided her the policy documents being ‘master policy holder’ or the claims have not reached to Insurance company in turn, specially when system driven claim numbers got generated depicting that the OP2 insurance company was also in the knowledge of the death claims. The fundamental principle is that insurance is governed by the doctrine of uberrima fide. This postulates that there must be complete good faith on the part of the both insurer & insured. This principle has been formulated and both sides must disclose or take steps all per all facts material to the insurance claim. The relationship between an insurer and the insured is recognized as one where mutual obligations of trust and good faith are paramount. Both sides are thus under a solemn obligation to make full disclosure of material facts which may be relevant.
It is, therefore viewed, that the insurance coverage as enjoyed by the deceased persons and the complainant as their nominee under the aforesaid Group Insurance Scheme can not be denied by both the OP1 bank and the OP2 Insurance company. It appears to be established that the complainant is the nominee of her three family members who met with an accident and all died during the period under insurance cover and the post mortem report from Govt hospital and FRT issued clearly reveals the same following the said accident. As per the policy of the aforesaid Group Insurance Scheme, the complainant is entitled to compensation of the sum assured for the loss of lives. We are therefore of the view that since the insurance cover was for a sum of Rs. 1,00,000/- (One Lac) only, the complainant respondent would be entitled to a sum of Rs. 3,00/000/- by way of compensation for non settlement of insurance claims against the loss of the three lives.
For the reasons stated as above, the complaint case succeeds on contest.
Hence it is ordered that,
Ordered
That the complainant will be entitled for a sum of Rs. 3,00,000/- (Three Lac) only as total compensation for the delay in settlement of insurance claims under the Social Security Scheme of ‘United Surakshya Yojana’ (USY) due to loss of three precious lives at their tender age. The aforesaid sum will carry a simple interest @ 9% per annum after 30 days of the date of making the claim as recorded by the United Bank of India i.e. from 16.11.2019 till the entire payment is completed.
The complainant will further be entitled to a sum of Rs.20,000/- towards litigation cost.
All the aforesaid sums will be paid to the complainant by the OP1 and OP2 jointly and severally @ 50% each, within forty five thirty (45) days from date of this order in default both the aforesaid sums will carry an interest @ 12% per annum till payment.
The complainant is at liberty to put the order into execution after the expiry of 45 days in case the orders are not complied with by the O.Ps within 45 days from the date of passing this Order.
Let a copy of the order be sent / supplied free of cost to the parties concerned.
The Final Order will be available in the following website www.confonet.nic.in.
Dictated and corrected by me.
(Partha Kumar Basu)
Member
