Haryana

StateCommission

A/1079/2015

SAHARA INDIA - Complainant(s)

Versus

URMILA DEVI - Opp.Party(s)

D.K.SINGAL

28 Feb 2017

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No: 1079 & 1105 of 2015

Date of Institution: 17.12.2015 & 23.12.2015

Date of Decision: 28.02.2017

 

Appeal No.1079 of 2015

 

Branch Manager, Sahara India, Kartar Singh Market, Opposite Palika Bazar, near Bus Stand, Jhajjar, District Jhajjar and also having its head office at Sahara India Parivar, Sahara India Bhawan, 1, Kapurthala Complex, Lucknow.

                                      Appellant-Opposite Party No.1

Versus

 

1.      Smt. Urmila Devi w/o late Anand Kumar s/o Sh. Rajender Singh, Resident of Village Subana, Tehsil and District Rohtak.

 

                                      Respondent-Complainant

2.      National Insurance Company Limited, Divisional Office-IV, Jeevan Bhawan, Phase-1, 43, Hazratganj, Lucknow (Uttar Pradesh).

Respondent-Opposite Party No.2

Appeal No.1105 of 2015

1.      National Insurance Company Limited, Regional Office-II, SCO No.337-340, Sector 35-B, Chandigarh through its Deputy Manager (Legal).

2.      National Insurance Company Limited, Divisional Office-IV, Jeevan Bhawan, Phase-1, 43, Hazratganj, Lucknow (Uttar Pradesh).

Appellants-Opposite Party No.2

Versus

1.      Smt. Urmila Devi w/o late Anand Kumar s/o Sh. Rajender Singh, Resident of Village Subana, Tehsil and District Rohtak.

 

                                      Respondent-Complainant

2.      Branch Manager, Sahara India, Kartar Singh Market, Opposite Palika Bazar, near Bus Stand, Jhajjar, District Jhajjar.

 

Respondent-Opposite Party No.1

 

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Mr. Balbir Singh, Judicial Member.

                                                                                                         

Argued by:          Shri D.K. Singal, Advocate for Sahara India.

Shri B.S. Taunque, Advocate for National Insurance Company Limited.

Shri Kartar Singh Malik, Advocate for Smt. Urmila Devi-complainant.

 

                                                   O R D E R

 

BALBIR SINGH, JUDICIAL MEMBER

 

        This order shall dispose of afore-mentioned two appeals bearing No. 1079 and  1105 of 2015 having arisen out of common order dated November 09^th, 2015 passed by District Consumer Disputes Redressal Forum, Jhajjar (for short ‘the District Forum’), in complaint No.259 of 2012 filed by Smt. Urmila Devi-complainant.

2.                Sahara India-Opposite Party No.1 had taken a Special Contingency Group Insurance Policy from National Insurance Company Limited (for short ‘the Insurance Company’)-Opposite Party No.2, to provide insurance coverage under Sahara Rajat Yojna Scheme (hereinafter referred to as ‘the scheme’) to the employees, agents, associates, journalist, Sanchar sathais, depositors, investors and advance booking holders for housing and various services of the company subject to the terms and conditions of the insurance policy. Anand Kumar-husband of complainant-Urmila Devi (hereinafter referred to as ‘the insured’) was covered under the above mentioned scheme being an investor as he deposited an amount of Rs.10,004/- on May 22^nd, 2003  with the opposite party No.1 under housing scheme under Sahara Rajat Yojna vide Certificate No.010041296782. The complainant-wife of insured, stood nominee. Unfortunately, Anand Kumar died on August 2^nd, 2007 due to the injuries sustained in road side accident. The complainant informed the opposite party No.1 regarding death of her husband and requested to make payment under the scheme. Required documents were produced in the office of opposite party No.1 and a surveyor was also appointed. The opposite party No.1 paid only an amount of Rs.14,640/- being amount deposited by the insured alongwith interest, vide cheque dated 22^nd November, 2007. Despite information given within time, the opposite parties did not make payment of the death claim and other benefits under the scheme.  The complainant filed complaint under Section 12 of the Consumer Protection Act, 1986 (for short ‘the Act, 1986’) with the prayer to direct the opposite parties to pay an amount of Rs.5.00 lacs with interest at the rate of 18% per annum and Rs.50,000/- as compensation.

3.                The opposite party No.1 in its written version admitted that the insured-Anand Kumar (since deceased) had deposited an amount of Rs.10,000/- under the scheme on 22^nd May, 2003 with the opposite party. The insured died on 2^nd August, 2007 and thereafter an amount of Rs.10,000/-, deposited by him, alongwith interest total amounting to Rs.14,640/- was paid to the complainant on 22^nd November, 2007 after statutory deductions. After receipt of the above mentioned amount as full and final payment, the complainant submitted accidental death insurance claim which was immediately forwarded to the Insurance Company-opposite party No.2, vide letter dated 9^th December, 2011. The role of the opposite party No.1 was only of a facilitator and as such the Insurance Company is bound to make payment of the insurance benefits.  The complainant did not submit her claim within 30 days from the date of accident.

4.                As per written version of the opposite party No.2, the payment of the death claim could not be made as the intimation was received by the opposite party No.2 on 9^th December, 2011 after a gap of four years and five months. The complainant should have claimed the insurance amount within one year from the date of accident. The claim of the complainant is barred by limitation. Moreover, no insurance premium amount was paid by the insured Anand Kumar. Regarding date of death, month and year of insured Anand Kumar and regarding providing insurance policy under the scheme, there is no dispute. The complainant cannot be treated as a “Consumer” of the Insurance Company as there is no relationship of consumer and service provider between the complainant and the opposite party No.2. As per terms and conditions of the insurance policy, the opposite party No.2 can be held liable to make payment of the amount if the claim is lodged within one year from the date of death. It was prayed that the complaint be dismissed.

5.                After evaluating the pleadings and evidence of the parties, the District Forum allowed the complaint and issued direction to the opposite parties as under:-

“..Therefore, we direct the respondents to make the payment of a sum of Rs.2,00,000/- to the complainant on account of accidental death of insured Anand Kumar along with an interest @ 9% p.a. from the date of death i.e. 2.8.2007 till realization of final payment to the complainant. The complainant is also entitled for a sum of Rs.5500/- on account of litigation expenses for the present unwanted and unwarranted litigation only due to the deficiency in service on the part of the respondents.”

6.                Counsel for the parties have been heard. Record perused.

7.                During the course of arguments there was no controversy of any type that the insured Anand Kumar was covered under the insurance policy provided by opposite parties under Sahara Rajat Yojna Scheme, being investor and depositor for a house. The insured admittedly died on 2^nd August, 2007, which is evident from the copy of Death Certificate (Exhibits P-5 and P-6) issued by Registrar of Birth & Death, Saharanapur also. There is no controversy that the insured died due to road side accident, which is evident from the copy of report under Section 173 Cr.P.C. (Exhibit P-3) and other record on the file. From the copy of letter dated 8^th February, 2005 (Exhibit R-2) addressed to the Insurance Company, it is evident that under the scheme, if the insured dies after four years up to 10 years from the date of commencement of the insurance policy, the Insurance Company is entitled to receive an amount of Rs.2.00 lacs as death claim. Much discussion is not needed of the documents Exhibits R-4 to R-7 because if the payment of the amount, less than Rs.2.00 lacs, has been made to other persons, the prayer of the complainant cannot be declined on this ground. After death of her husband, within few days, the complainant filed an application (Exhibit P-7) before the opposite party No.1, giving information that her husband died on 2^nd, August, 2007 in a road side accident and being nominee, she is entitled to receive the deposited amount with interest. She also requested that payment of the death claim also be made to her being nominee and the only legal heir of the insured-deceased. In response to that letter, the opposite party No.1 made payment of the total deposited amount of Rs.10,000/- with interest, after statutory deductions, total amounting to Rs.14,640/- on 22^nd November, 2007. In fact, the payment of the above mentioned amount cannot be treated as full and final payment. In fact, that payment was made to the complainant as the amount was deposited by her husband for purchase of a house under the scheme. The complainant being nominee was entitled to receive the above mentioned amount and payment of that amount is not concerned in any way regarding death claim of the complainant. Now findings are required to be given as to whether in such a situation, the complainant is entitled to receive an amount of Rs.2.00 lacs regarding death claim of her husband.

8.                During the course of arguments, learned counsel for the Insurance Company has argued that there was no privity of contract in between Anand Kumar-insured as well as the Insurance Company as premium amount was not paid by the insured and the premium amount was paid by the opposite party No.1. The complainant cannot be considered as a consumer and this complaint is not maintainable.

9.                We are not much impressed with this contention of the learned counsel for the Insurance Company. The insurance cover was provided to insured-Anand Kumar being depositor and investor by the opposite party No.1 to promote business of the company. The premium amount was paid by the opposite party No.1 to promote its business with the expectation that the company will earn more profits in future by utilizing in its business the huge amount to be received from the investors and depositors. The insurance cover was provided to the employees, agents, associates of the company also to make their job more attractive. In this way, the payment of the premium amount by the opposite parties can be considered as payment made indirectly by deceased-Anand Kumar (insured). So, claim of the complainant cannot be declined on this ground.

10.              During the course of arguments, main stress of the learned counsel for the appellant was that the complainant did not submit her claim application within one year period of limitation. It was argued that the complaint is hopelessly barred by limitation.  

11.              `Learned counsel for the complainant-respondent No.1 argued that the complainant had submitted her claim before the opposite party No.1 for making payment of the amount deposited by her husband alongwith interest as well as death claim amount, as per terms and conditions of the insurance policy. The application was submitted soon after the death of Anand Kumar-insured because the insurance policy was provided by the opposite party No.1. The opposite party No.1 should have informed the Insurance Company regarding claim of the complainant. Version of the Insurance Company in this case is that the complainant should have submitted her claim form in the office of the opposite party No.2-National Insurance Company, immediately the insured died. It is true that the application (Exhibit P-7) was filed by the complainant within one month from the date of death of the insured as on the basis of this application, an amount of Rs.14,640/- was paid to the complainant vide cheque dated 22^nd November, 2007.  In this application, although not in detail, the complainant has mentioned regarding death claim also.  It is evident from the copy of a duly attested affidavit of the complainant that she got executed and attested an affidavit mentioning that she wanted to receive death claim from the opposite parties. Copy of the application submitted before the opposite party No.1 (Exhibit P-9) has been produced in evidence in this case alongwith the report of the surveyor (Exhibit P-8). The opposite party No.1, although stated that the claim applications of the complainant were received in its office and the same  were immediately sent to the office of the opposite party No.2-Insurnace Company but it is not made clear on which dates the above mentioned applications Exhibit P-7 and P-9 were received in the office of the opposite party No.1. The opposite party No.2 also did not adduce any evidence to prove the exact dates of receipt of the applications submitted by the complainant. Version of the complainant is that she submitted death claim application soon after she received an amount of Rs.14,640/- from the opposite party No.1. Version of the opposite party No.2 is that it received the information regarding death of the insured and applications of the complainant on 9^th December, 2011 after a gap of four years and five months. It appears that the opposite parties want to take benefit of this situation and intentionally are concealing the true facts that on which date the claim application of the complainant was received. Moreover, when the Insurance Policy was provided by making payment by the opposite party No.1, the complainant was not at fault while submitting the claim application to the opposite party No.1. If legally and technically, the opposite party No.1 was not required to forward the claim application of the complainant to the Insurance Company, in that situation, the option before the Insurance Company was to return the application to the complainant advising her to present the same before the Insurance Company. As the opposite party No.1 forwarded the claim application filed by the complainant very late, observations can be made that the complainant was required to submit her application through the opposite party No.1 also.  Moreover, the Insurance Company also received and entertained that application but declined the claim of the complainant on the point of limitation.

12.              We are of the considered view that in such a situation as and when the claim application from the complainant was received, the opposite party No.1 should have forwarded that claim application to the opposite party No.2 without loss of time.

13.              Keeping in mind all these circumstances due to certain acts of carelessness and negligence on the part of the opposite parties, the complainant cannot be penalized by declining her claim. Moreover, the complainant is a widow and she should have been timely and properly advised by the opposite parties. The complainant deserves sympathy from this Commission as well as from both the opposite parties and all concerned. Resultantly, it is held that all it happened due to fault of the opposite parties and claim of the complainant cannot be declined on this ground alone.  No other point was raised during the course of arguments. The complainant is covered under the definition of “consumer” as provided under Section 2(1)(d) of the Act, 1986.  It is a case of deficiency in service on the part of the opposite parties. The complainant is entitled to receive the insured amount and the District Forum has jurisdiction to decide the complaint.

14.              As a result as per discussion above in detail, we found no illegality and invalidity in the impugned order dated 9^th November, 2015 passed by the District Forum. Accordingly, findings of the District Forum stands affirmed and both these appeals stand dismissed.

15.              The statutory amount of Rs.25,000/- deposited at the time of filing each of the appeals be refunded to the complainant against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

 

Announced: 28.02.2017

(Balbir Singh) Judicial Member

(Nawab Singh) President

 

CL