DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II
Udyog Sadan, C-22 & 23, Qutub Institutional Area
(Behind Qutub Hotel), New Delhi- 110016
Case No. 205/2009
M/s Citifinancial Consumer Finance India Ltd.
Having its registered office at :
3, LSC, Pushp Vihar,
New Delhi-110062.
….Complainant No. 1
Mrs. Manju Joshi
Widow/o Dinender Joshi
R/o B. G.-7/89
2nd Floor, Paschim Vihar
New Delhi-110063
….Complainant No. 2
Mrs. Sarojini Joshi
w/o Sh. D.L. Joshi
R/o B.G.-7/89
2nd Floor, Paschim Vihar
New Delhi-110063
….Complainant No.3
Versus
United India Insurance Co. Ltd.
Having its office at
Divisional Office No.12,
Flat No. 42 C, 3rd Floor,
Moolchand Commercial Complex
New Delhi-110024
….Opposite Party
Date of Institution : 03.03.2009
Date of Order : 14.02.2023
Coram:
Ms. Monika A Srivastava, President
Ms. Kiran Kaushal, Member
Sh. U.K. Tyagi, Member
ORDER
President: Ms. Monika A Srivastava
The complainants have filed the present complaint seeking release of claims in favour of complainant nos. 2 and 3 under the insurance policy taken by the complainant no. 1 for the benefit of its employee under “Tailormade Group Accident Personal Policy" for a sum of Rs. 10,00,000/- i.e the insured value along with a sum of Rs.5,00,000/- on account of harassment and cost of litigation.
- It is the case of the complainants that complainant no.1 had undertaken group personal accident policy for its various employees joining the said organization and had been regularly paying and depositing the premium on the said policy and in fact a buffer premium was maintained in respect of the said policy.
- It is stated that the said policy was valid during the period 05.12. 2005 to 04.12.2006 and all new joinees were automatically covered from the date of joining subject to the premium buffer available with the insurer. It is further stated that one Sh. Dinender Joshi joined the services of the complainant company as a manager on 13.06.2006 on which date the buffer premium available was Rs.26,26,847/-. The employee was posted at Bhilwara and was automatically covered under the terms of the said policy on the date of joining the employment of the complainant company.
- It is further stated that the said employee (herein after referred to as deceased) met with an accidental death on 25.06.2006 when he accidentally drowned in Menal waterfall and expired due to drowning. A claim in this regard was filed with the OP with all requisite documents as sought for and the same is annexed as Annexure A-1 .
- In this regard, the divisional office of the OP company at Bhilwara submitted its report to the OP company at Delhi vide letter dated 06.11.2006 and was accompanied with the investigation report of the OP company wherein it was categorically stated that the death of the deceased was on account of drowning which seems to be genuine and true copy of the said letter dated 06.11.2006 is annexed as Annexure D.
- It is also stated by the complainant that after the joining of the deceased of the complainant company on 13.06.2006 and the subsequent unfortunate death of the deceased on 25.06.2006, on 04.07.2006 the complainant company submitted a list of employees to be deleted on account of their resignations for the month of June 2006, inadvertently the name of the deceased instead of being given in the addition list was mentioned in the deletion list of employees. Immediately on 07.07.2006, a necessary amendment was intimated to the OP company so as to add the name of the deceased for the month of June 2006 instead of being deleted. The said deletion and addition list along with the letter stating the said factual position and seeking necessary amendments is annexed as Annexure H. Another letter dated 07.07.2006 was also sent to the OP requesting them to rectify and update their records, the said letter is annexed as annexure I.
- It was also stated that the OP after the receipt of the letter, pursued further investigation and obtained the report of another investigator with respect to the entire history of the matter/claims although the empanelled investigator of the OP company had already submitted his report vide letter dated 26.11.2006 which included statements, enquiries from the colleagues of the deceased and having regard to the terms of the insurance policy and the fact of having adequate buffer premium available with the OP company
- It is also stated by the complainant that as per the office note of the OP company which is marked as Annexure K, it was clearly noted that after refunding the premium amount of Rs.43,339/-after deletion of 125 employees submitted by the complainant, the necessary corrections in this regard was pointed out by the complainant so as to include the name of the deceased in the addition list for the month of June 2006. It was further noted that the said rectification was carried out and the premium for the same along with that of 61 other employees amounting to Rs.27,749/- was collected from the complainant. A copy of the endorsement schedule acknowledging the said amount of Rs.27,749/- is marked as Annexure L.
- It is further stated by the complainant that they have been regularly following up with the OP but the OP has been dilly dallying and giving evasive replies. After a lot of persistent follow up and harassment at the hands of the OP, the OP, on 18.07.2007 sent a frivolous letter stating that the claims were not admissible under the policy, the copy of the said letter is marked annexure N.
- It is the case of the complainant that the rejection of the claim by the OP is arbitrary, whimsical, illegal and amounts to unfair trade practice and deficiency in services.
- It is stated that the complainant had taken the policy for the benefit of its employees and the said employees are covered under the insurance policy issued by the OP on the joining of the employment of the complainant company subject to the buffer premium amount. It is further stated that the company is a big organization with branches all over India with more than 4000 employees. The rejection of the claim of the deceased employee on technicalities is irrelevant and contrary to the expert opinions obtained by the OP company itself.
- The OP was proceeded exparte vide order dated 29.04.2013 which was then at aside by the Hon’ble State Commission vide order dated 21.10.2013.
- The OP, in their reply stated that there was no deficiency in service on their part and that the claim is liable to be dismissed with costs. It is also stated that this Commission does not have the jurisdiction to entertain the present complaint as the claim has been correctly repudiated on account of misrepresentation of facts at the time of submitting the details of deletion of name of the deceased from the policy and refund of premium.
- It is further stated that the complainant has not come to the Commission with clean hands and has suppressed material facts and had taken back the premium in respect of the deceased. It is stated that the deceased was not insured by the OP in the present policy at any point of time nor before his date of death. It is further stated that though the OP is having an open policy of the complainant company for their employees and there was cash deposit lying with the OP but there was no request from the side of the complainant that the deceased Sh. Dinender Joshi’s name should be included in the list of employees as insured by the OP under the group personal accident policy open policy which is named as ‘Tailor Made Group Accident Personal Policy’ valid for the period of 05.12.2005 to 04.12.2006.
- It is further stated that the complainant made a request to the OP to delete the name of Sh. Dinender Joshi vide letter dated 04.07.2006 and the premium amount was refunded to the complainant on 06.07. 2006 and therefore, it is clear from the fact that there was no contract in the name of the deceased as he was never included in the list of insured employees of the complainant.
- The complainant vide letter dated 07.07.2006 had again requested for the addition of his name in the list of employees along with others as if he has joined the complainant company and he is alive. Through this endorsement the deceased was sought to be covered from 12.06.2006 and his name got included as if he still alive. The complainant did not give any intimation of his death.
- It is also stated that the complainant further requested by letter dated 05.08.2006 that the name of the deceased be deleted along with 125 employees and accordingly premium was refunded. At the time of the death of the deceased, the premium had been refunded and therefore there was no subsisting contract qua the deceased. It is stated that there is no relationship of consumer under the Consumer Protection Act between the complainant and the OP.
- On merits, the OP has denied that the complainant has been deposited premium on the said policy regularly and it is not denied by them that there was cash deposits maintained by the OP but it is stated that the cash deposits will not insure the employees automatically unless and until a request in writing is made by the complainant and on his request endorsement is made by the OP and premium is calculated and deducted from the cash deposit as maintained by the OP. It is stated that though the policy was inforce but the employee would only be covered when an intimation is sent by the employer i.e the complainant along with his employee number destination and place of the services and the cash buffer is available with the OP. It is stated that information relating to joining of the employee has to be mandatorily shared with the OP in writing and as no intimation regarding the joining of the deceased was given nor any request was made to include his name in the policy, the employee was not covered as per the provisions of the section 64 VB of the Insurance Act 1938.
- OP has also denied that any investigation was carried out through the empanelled surveyor. It is reiterated by the OP that the deceased was not covered under the said tailor made group insurance policy. It is also stated that the request for addition of the name of the deceased by the complainant is an afterthought and has been done with the malafide intention to cover the deceased.
- It is further stated that the claim has been rightly repudiated and there is no arbitrariness on the part of the OP.
- In their rejoinder, the complainant has denied all that has been stated in reply by the OP.
All the parties have filed their respective evidence affidavits as well as written arguments. This Commission has gone through the entire material on record. The OP has put forward strongly that though the policy was an open policy however till the time the complainant company did not provide the name of the employee his designation as well as his place of posting and along with these there is buffer of premium, the said employee cannot be said to be insured by the OP. It is seen from the insurance policy filed on record under the column ‘special peril’ it is mentioned as under:
‘As per GPA policy. All new joinees covered from the date of joining subject to premium buffer available with the insurer.’
It is also seen that the complainant company would provide the details of their employees at the end of each month to the OP and then the OP after ensuring the buffer premium, would provide the insurance to the employees of the complainant company from the date of their joining. It is observed that the insurance was provided on a back date as the information of the joining of the complainant company was provided by the complainant company on a later date i.e at the end of each month. It is observed from the documents filed by the complainant on record that 73 employees were covered from 01.06.2006 though some of them have joined later than 01.06.2006, therefore, we see no reason why the deceased should not have been covered under this insurance.
It is also seen from the record that OP have written an office note annexed as Annexure K wherein the name of the deceased was added to the list of the people insured and in this regard the premium was also taken from the complainant company and this fact has not been denied by the OP. It is also observed from the record that though there are two reports of the surveyors appointed by the OP company however, in their written statement the OP denies appointing any surveyor.
Having regard to all these facts this Commission is of the view that the OP has been deficient in its services by not providing insurance amount to the complainants pertaining to the deceased. Therefore, the OP is directed to release the insurance amount of Rs. 10,00,000/- pertaining to the deceased to the complainants 2 and 3 within two months from the receipt of the date of this order failing which the OP would be liable to pay interest at the rate of 6% per annum on the insured amount from the date of death of the deceased till realization. The OP is also liable to pay a sum of Rs. 5,000/- as compensation to all the complainants for the deficient services.
Parties to be provided copy of order as per rules. File be consigned to the record room. Order be uploaded on the website.
