Delhi

StateCommission

FA/12/1095

PUNJAB NATIONAL BANK - Complainant(s)

Versus

VEENA MATHUR & ANR. - Opp.Party(s)

25 May 2015

ORDER

IN THE STATE COMMISSION : DELHI

(Constituted under Section 9 of the Consumer Protection Act, 1986)

Date of Decision:25.05.2015

First Appeal- 1095/2012

(Arising out of the order dated 12.10.2012 passed in Complainant Case No. 746/2007 by the  Consumer Disputes Redressal Forum-VII, Sheikh Sarai, New Delhi)

Punjab National Bank,

Having its Head Office

At 7 Bhikha Ji Cama Place,

New Delhi and amongst

Others a B.O. at Chetak Circle

Udaipur (Raj).

                                                                                     ….Appellant

Versus

1. Smt. Veena Mathur,

W/o Sh. Narendra Mathur,

R/o Q No.61, Top Floor

Rajouri Garden,

New Delhi-27.

 

2. Miss Rupali Mathur,

D/o Sh. Narendra Mathur,

R/o Q No.61, Top Floor

Rajouri Garden,

New Delhi-27.

 

3. Mrs. Puja Mathur,

W/o Mr. Abhishek Mathur,

R/o 86, Palam Marg,

Vasant Enclave,

New Delhi.

 

4. The New India Insurance Co. Ltd.,

91, Bhandari House, 3^rd Floor,

Nehru Place,

New Delhi-19.

                                                                             ….Respondents

 

 

CORAM

Justice Veena Birbal, President

Salma Noor, Member

 

1.     Whether reporters of local newspaper be allowed to see the judgment?

2.      To be referred to the reporter or not?

 

 

Justice Veena Birbal, President

 

1. This is an appeal under Section 15 of the Consumer Protection Act, 1986 (in short, “the Act”) challenging order dated 12.10.2012 passed by the Consumer Disputes Redressal Forum-VII, Sheikh Sarai, New Delhi (in short, “the District Forum”) in Complaint Case No. 746/2007.
2. Briefly the facts relevant for the disposal of present appeal are as under:

    A complaint under Section 12 of the Act was filed by the respondents 1, 2 & 3 herein i.e. widow and daughters of Shri Narendra Mathur who was the insurance policy holder with the respondent No.4 i.e. the New India Insurance Co. Ltd.  The case of the respondents 1 to 3/Complainants before the District Forum was that the deceased Shri Narendra Mathur had Savings Bank account with the appellant/OP-1 and a debit card was issued to him by the said bank on which a personal accidental insurance cover of Rs. 2 lacs was provided to him through respondent No.4/OP No.3.  On 11.2.2006 when the respondents 1 to 3 along with the deceased Shri Narendra Mathur were coming to Delhi from Udaipur by car, they met with an accident.  As a result of which, the deceased suffered serious injuries and was rushed to nearby hospital at Raila, Bhilware where they were given first aid.  Due to non-availability of proper medical aid, they were rushed to Gupta Orthopedic Hospital.  Shri Narendra Mathur was found to have suffered multiple fractures and his condition was serious as such was shifted to Apollo Hospital.  Shri Narendra Mathur had undergone major surgery there on 13.2.06.  He was  discharged on 16.2.06 and was advised rest for 2 months.  During the recovery period Shri Narendra Mathur developed pulmonary embolism and was again hospitalized and ultimately he died on 14.03.2006 as a result of the said accident.  Thereupon respondents 1 to 3/Complainants submitted the insurance claim with appellant at its Udaipur Branch i.e. OP-2 along with the requisite documents.  On 14.3.2007, the respondents 1 to 3/Complainants were asked to submit some more papers which were immediately sent.  However, on 7.5.2007, the respondents 1 to 3/complainants were informed that their claim was declined by respondent No.4/OP No.3 i.e. Insurance Co.  Aggrieved with the same, the complainants had filed the aforesaid complaint against appellant and respondent No.4 i.e. Insurance Co./OP No.4 before the District Forum with a prayer for settling the claim of Rs. 2 lacs along with compensation of Rs. 1 lac and also for grant of costs of litigation.

3. The appellant/OP-1 & 2 contested complaint by filing written statement alleging therein that the claim was rejected by respondent No.4 /OP-3 i.e. Insurance Co. and they had no role in the rejection of the claim, as such the complaint against them was not maintainable. 
4. Respondent No.4/OP-3 i.e. Insurance Co. contested the claim by alleging that the post-mortem of the deceased was not conducted because of family consent and according to the material on record, the cause of death was cardiac arrest and was not accident and as such the claim was rightly repudiated and same was intimated to them vide letter dated 24.04.2007.   The respondents 1, 2 & 3/Complainants filed rejoinder along with evidence alleging that the repudiation was illegal.
5. The parties had led evidence before the District Forum by way of affidavits.  After hearing the Counsel for the parties, Ld. District Forum came to the conclusion that there was sufficient material on record to show that Shri Narendra Mathur had met with an accident and was immediately rushed to nearby hospital and from there he was shifted to Indraprastha Apollo Hospital and as per material on record, the death was due to accident and exclusion clause was not applicable. The District Forum also observed that the claim was arbitrarily rejected by respondent No.4 i.e. Insurance Co. and directed the appellant bank to pay Rs.2 lacs as insured amount to the complainant along with 10% interest to the claimant and also directed the appellant to pay Rs.40,000/- towards mental agony and physical harassment.  The respondent No.4 i.e. Insurance Co. has been directed to pay Rs.10,000/- towards the cost of litigation only.
6. Aggrieved with the aforesaid order, present appeal is filed by the appellant bank i.e. OP-1 & 2 before the District Forum.  The aforesaid order has not been challenged by the Insurance Co. i.e. respondent No.4 herein. 
7. Ld. Counsel for the appellant has contended that the appellant bank duly and diligently processed the claim of respondents 1 to 3/Complainants.  It is contended that the District Forum in clear terms has held that the claim was arbitrarily rejected by the respondent No.4 i.e. Insurance Co. due to which the respondents 1, 2 & 3/complainant had suffered mental agony and harassment  and for which they are entitled for reasonable compensation. However, in the operative part of the impugned order, the District Forum arbitrarily directed the appellant to pay the compensation of Rs. 2 lac along with Rs. 40,000/- towards mental agony and harassment.  It is contended that there is no deficiency on the part of appellant bank and it is the respondent No.4/Insurance Co. which is liable to make the payment because the policy in question was issued by it.
8. The Counsel for the respondent 1 to 3/complainants also supported the stand of the appellant bank.  Ld. Counsel for respondent 1 to 3/complainant has also submitted that in another Insurance Policy of the deceased wherein the insurance was provided by the appellant through respondent No.4 under a different credit card, the respondent No.4/Insurance Co. has been directed by the District Forum to pay insured amount and compensation to the respondents 1 to 3/complainants.  It is submitted that the said decision was challenged by respondent No.4/Insurance Co. before this Commission in FA-511/2010 and the said appeal was dismissed vide order dated 13.11.2014. 
9. Ld. Counsel for respondent No.4/Insurance Co. has submitted that cause of death was cardiac arrest and not accident as such Insurance Co. is not liable to make the payment.
10. We have heard the submissions made and perused the material on record.
11. It is admitted position that the deceased Shri Narendra Mathur was having a savings bank account with the appellant bank.  It is also admitted position that a Debit Card No.5048 8435 6600 0000 1169 was issued by the appellant bank to the deceased in the said savings bank account on which a personal accidental insurance cover of Rs. 2 lacs was provided to him by the appellant bank through the Insurance Co. i.e. respondent No.4 herein.  After analyzing the evidence on record, the District Forum has categorically rejected the plea of respondent No.4/Insurance Co. that the cause of death was cardiac arrest and not accident. The said finding of District Forum is not challenged by respondent No.4/Insurance Co.  Thus finding of the District Forum about cause of death has become final.  In these circumstances, the respondent No.4/Insurance Co. now cannot challenge the said finding in the appeal of the bank. 
12. The District Forum has further observed that the bank had processed the claim of the respondents 1 to 3/complainants and it is the respondent No.4/Insurance Co. which has rejected the claim arbitrarily.  It has also come on record that in another matter between the same parties wherein credit card of deceased was different, the District Forum has held respondent No.4/Insurance Co. liable for the insurance claim. The said decision was challenged by the respondent No.4/Insurance Co. in this Commission vide FA No.511/2010 and the said appeal has been dismissed vide order dated 13.11.2014.
13.  The appellant bank had provided the insurance cover through respondent No.4/Insurance Co.  As per material on record, the appellant had processed the claim papers to respondent No.4/Insurance Co.  There is nothing on record to show that appellant bank had any role to play in the rejection of the claim of respondents 1 to 3/Complainants. The cause of death is accident.  It has also been held by the District Forum that rejection by respondent No.4/Insurance Co. is arbitrary.  In these circumstances, it is the Insurance Co. i.e. respondent No.4 which is ultimately liable to make the payment to the respondents 1 to 3/complainants.   
14. In view of above discussion, we accept this appeal and modify the impugned order to the extent that the respondent No.4/Insurance Co. shall be liable to make the payment.  We accordingly direct the respondent No.4 to pay a sum of Rs. 2 lacs as insured amount to respondents 1 to 3/complainants along with 10% interest per annum from the date of submission of the claim till realization.  Further compensation of Rs.40,000/- shall also be paid to respondents 1 to 3/complainants by the respondent No.4/Insurance Co. 
15. Appeal stands disposed of accordingly with the above modification in the impugned order.  No modification is required for the grant of Rs.10,000/- towards litigation expenses.
16. A copy of this order as per the statutory requirement be forwarded to the parties free of charge and also to the concerned District Forum and thereafter the file be consigned to Record Room.