State Consumer Disputes Redressal Commission
The Oriental Insurance Company Ltd ... vs Bimla Rani W/O Late Shri Prem Chand on 25 November, 2024
ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH.
First Appeal No.365 of 2023
Date of institution : 30.05.2023
Reserved on : 18.11.2024
Date of decision : 25.11.2024
The Oriental Insurance Company Limited, Mahavir Marg, Kapurthala
through its Manager (Legal), Regional Office SCO No.109-111, Sector
17-D, Chandigarh.
.....Appellant/Opposite Party No.1
Versus
1. Bimla Rani w/o late Sh. Prem Chand R/o H.No.341, Kazi Mohri
Batela, Tehsil Batala, District Gurdaspur.
Respondent No.1/complainant
2. Punjab Gramin Bank, Hathi Gate, Batala, District Gurdaspur
through its Manager.
....Respondent No.2/Opposite Party No.2
First Appeal under Section 15 of the
Consumer Protection Act, 1986 against the
order dated 06.04.2023 passed by the District
Consumer Disputes Redressal Commission,
Gurdaspur in CC/168/2019
Quorum:-
Mr. H.P.S. Mahal, Presiding Judicial Member
Mrs. Kiran Sibal, Member Argued by:-
For the appellant : Sh. B.S.Taunque, Advocate
For respondent No.1 : Sh. Sandeep Godara, Advocate
For respondent No.2 : Sh. Ajay Sapehia, Advocate
KIRAN SIBAL, MEMBER
The present appeal has been filed by the appellant/OP No.1 against the impugned order dated 06.04.2023 passed by District Consumer Disputes Redressal Commission, Gurdaspur (in short, "the District Commission"), whereby the complaint filed by complainant FA No.365 of 2023 2 against opposite parties (in short 'OPs'), under Section 12 of the Consumer Protection Act, 1986, was accepted and following relief was granted:-
"13. In view of what has been discussed above, the present complaint is partly allowed. Opposite party No.1 is directed to pay the insurance claim to the complainant as per insurance policy under PMSBY within a period of thirty days from the date of receipt of copy of the orders, failing which Opposite party No.1 is directed to pay the insurance claim alongwith interest @6% per annum from the date of filing of the complaint i.e. 15.5.2019 till its realization. Opposite party No.1 is further directed to pay the compensation of Rs.5,000/- in lump sum for mental agony and harassment as well as litigation expenses."
3. It would be apposite to mention that hereinafter the parties will be referred, as have been arrayed before the District Commission.
4. Brief facts for the disposal of the appeal are that the husband of the complainant; namely, Prem Chand,(DLA) was having saving account No.84630300509765 with OP No.2-bank and got insured himself with OP No.1 under an insurance scheme launched by Govt. of India under the name and style of 'Pradhan Mantri Suraksha Bima Yojna'(PMSBY). The installments of premium were debited from his said account from time to time as per policy of the Government. Unfortunately, the husband of the complainant met with an accident and expired on 16.01.2018. His post mortem was conducted at Civil Hospital Jalandhar on 17.01.2018 and also a criminal case was registered in this regard vide FIR No.0012 dated 16.01.2018 U/s 279/304-A IPC at P.S. Division No.8 Police Commissionerate at Jalandhar against Manjit Singh son of Harbhajan Singh resident of Village Para P.S. Maqsudan Distt. Jalandhar. At the time of alleged FA No.365 of 2023 3 accident, the age of the husband of the complainant was 64 years but in the post mortem report, his age had wrongly been mentioned as 65 years. The complainant submitted the death claim with OPs for grant of Rs.2 lakh under the said insurance scheme, but the said claim was repudiated, vide letter dated 21.12.2018 issued by the insurance company on the ground that the age of the DLA was 71 years. These observations regarding age of the deceased raised by insurance company are totally false, imaginary and not sustainable in the eyes of law as the date of birth of the deceased was 24.03.1954, which has been duly mentioned in his birth certificate. The complainant approached the OPs time and again with the oral as well as written request for the payment of death claim to the sum of Rs.2 Lakhs but they put off the matter on one pretext or the other on bogus and baseless observations. The complainant also served a legal notice upon OP No.1 through counsel, but all in vain. Alleging deficiency in service on the part of the OPs, the complainant filed consumer complaint before the District Commission and sought directions against the OPs to make the payment of Rs.2 lakh as death claim and further to pay Rs.50,000/- as compensation for mental agony, physical harassment as well as Rs.5,000/- as litigation expenses.
5. Upon notice, OPs appeared through counsel and contested the complaint. OP No.1 in its written reply stated that as per documents supplied to it i.e. Aadhar card and declaration, the age of DLA was 71 years, whereas under the said insurance scheme the cover is available to an account holder upto the age of 70 years. The age of DLA as 65 FA No.365 of 2023 4 years was recorded in the post mortem report on the instance of the complainant. OP No.2-Bank had verified the date of birth from his Aadhar Card before covering the DLA under PMSBY Scheme and entered the same in declaration duly signed by him. OP No.1 further stated that it had rightly repudiated the claim lodged by the complainant vide letter dated 21.12.2018, as the DLA was not covered under the said scheme. There was no deficiency in service on the part of OP No.1. After denying the other averments made in the complaint, OP No.1 prayed for dismissal of the complaint.
6. In reply to complaint, OP No.2-Bank stated that the bank has nothing to do with the repudiation of the claim of the complainant. The date of birth of the DLA is a matter of record and OP No.2 has no personal knowledge about the same. After denying the other averments made in the complaint, OP No.2 prayed for dismissal of the complaint qua it.
7. The parties led their evidence before the District Commission in support of their respective contentions and the District Commission after going through the record and hearing learned counsel for the parties, accepted the complaint against OP No.1, vide impugned order as above. Aggrieved with the same this appeal has been filed by the appellant/OP No.1.
8. We have heard learned counsel for the parties and have gone through the written arguments submitted by them as well as record of the case.
FA No.365 of 2023 5
9. Learned counsel for the appellant vehemently contended that the District Commission has failed to appreciate the fact that the date of birth of DLA as per declaration form submitted by him at the time of joining PMSBY Scheme, was already on record and the DLA entered his date of birth at column No.3 as 01.01.1947 by relying upon his Aadhar Card No.4261 4175 5428. The District Commission has failed to consider the said declaration as well as his Aadhar Card. The learned counsel has further argued that the District Commission has wrongly relied upon the birth certificate of the DLA issued on 09.03.2018 by Municipal Council Batala, which was procured by the complainant, after the death of the DLA. The learned counsel further argued that as per the terms and conditions of the PMSBY, for the scope of coverage, AADHAR would be the primary KYC for the Bank Account. The claim lodged by the complainant was also got investigated as per norms and the investigator has also mentioned the age of DLA as 71 years, therefore, there was no error on the part of the appellant/OP No.1 in considering the age of DLA as 01.01.1947 on the basis of his Aadhar Card. The learned counsel further argued on the similar lines as stated in the written reply and prayed for acceptance of the present appeal by setting aside the impugned order.
10. On the other hand, the learned counsel for respondent No.1/complainant has argued that the District Commission after appreciating the evidence and pleadings raised by the parties, has accepted the complaint filed by the complainant before it. There is no perversity and illegality in the impugned order. The learned FA No.365 of 2023 6 counsel further argued on the similar lines as stated in the complaint and prayed for dismissal of the present appeal.
11. The learned counsel for respondent No.2/OP No.2 has argued that as per instructions of the account holder requisite premium was debited from his account and amount was remitted to appellant- Insurance company. After receipt of claim form from the complainant on account of death of DLA, the same was processed with insurance company and it was for the insurance company to deal with the insurance claim. Alleging no deficiency in service on the part of respondent No.2-bank, the learned counsel prayed for dismissal of the present appeal.
12. We have given thoughtful consideration to the contentions raised by the learned counsel for the parties.
13. The factual matrix of the case is that the DLA got insured himself with appellant/OP No.1 under an insurance scheme launched by Govt. of India under the name and style of 'Pradhan Mantri Suraksha Bima Yojna'(PMSBY). It is also not in dispute that the installments of premium were debited from saving bank account (Ex.C-1) maintained with OP No.2 from time to time as per policy of the Government. The DLA met with an accident and expired on 16.01.2018 (Ex.C-3) and the complainant submitted the death claim with OPs for grant of Rs.2 lakh under the said insurance scheme, but the said claim was repudiated, vide letter dated 21.12.2018( Ex.C-7) issued by the appellant/insurance company on the ground that the age of the DLA was 71 years, whereas under the said insurance scheme the cover is available to an account FA No.365 of 2023 7 holder upto the age of 70 years. The complainant alleged that the claim was wrongly repudiated by the appellant/insurance company as the date of birth of the DLA was 24.03.1954, which has been duly mentioned in his birth certificate(Ex. C-2). Alleging deficiency in service on the part of appellant, the complainant filed consumer complaint before the District Commission, which was allowed against appellant/OP No.1, vide impugned order. Aggrieved with the same, the present appeal has been preferred by the appellant/OP No.1.
14. The foremost contention raised by the appellant/OP No.1 is that the District Commission, has failed to appreciate the fact that the date of birth of DLA, as per declaration form submitted by him at the time of joining PMSBY Scheme, was already on record and the DLA entered his date of birth at column No.3 as 01.01.1947 by relying upon his Aadhar Card No.4261 4175 5428 and even as per the terms and conditions of the PMSBY, for the scope of coverage, AADHAR would be the primary KYC for the Bank Account. On the other hand, the case of the complainant is that the claim was wrongly repudiated by the appellant/insurance company as the date of birth of the DLA was 24.03.1954, which has been duly mentioned in his birth certificate (Ex. C-2). To determine the said controversy, we have perused the evidence, pleadings of the parties as well as impugned order. From the perusal of Self declaration form (Ex. OP1/2), placed on record by the appellant-insurance company, we find that the date of birth of the DLA has been mentioned as 01.01.1947 and the Aadhar Number is also mentioned as 4261 4175 5428. Further, in the Aadhar Card (Ex.OP1/3) FA No.365 of 2023 8 the date of birth of the DLA is mentioned as "1947". At this stage we would like to discuss the revised Rules for scope of coverage under "Pradhan Mantri Suraksha Bima Yojna', placed on record by the appellant as annexure A-2 in the present appeal, are relevant, which are reproduced as under:-
Revised Rules for the Pradhan Mantri Suraksha Bima Yojana (for policy year 2016-17) Details of the Scheme:
........................................................... .......................................................... Scope of Coverage: All individual bank account holders in the age group of 18 to 70 years in participating banks will be entitled to join. In case of multiple bank accounts held by an individual in one or different banks, the person would be eligible to join the scheme through one bank account only. Aadhar would be the primary KYC for the bank account." ............................................ .............................................. Termination of cover: The accident cover for the member shall terminate on any of the following events and no benefit will be payable there under:
1) On attaining age 70 years (age nearest birthday)"
As per said terms & conditions mentioned under the policy, the accident cover for the member shall terminate on attaining the age of 70 years and the Aadhar would be the primary KYC for the bank account. Accordingly, the age of a member mentioned in the Aadhar Card has to be considered by the insurance company for his/her enrolment as member of the scheme as well as for settling the insurance claim. It is pertinent to mention here that the insured himself supplied his Aadhar Card mentioning his age year i.e. '1947' and further declared in the self declared form (Ex.OP1/2) that his date of birth was 01.01.1947. The birth certificate (Ex.C-3) mentioning the date of birth of DLA as '24.03.1954' was never supplied to the appellant/insurance company at FA No.365 of 2023 9 the time of enrolment of the DLA in the said insurance scheme and even at the time of submitting the claim form with it. The said birth certificate mentioning the date of birth as 24.03.1954 was got procured by the complainant on 09.03.2018 i.e. after the death of the DLA and even after lodging the death claim. The plea of the complainant that the date of birth in the Aadhar Card was wrongly mentioned, is not tenable as the DLA himself submitted the same with his banker and had never informed about the said fact to his banker as well as to the insurance company during his lifespan. Moreover, he never got the date of birth rectified in his Aadhar Card. The appellant/OP No.1-Insurance company, as per the terms and condition of the insurance policy, has relied on the date of birth mentioned in the declaration form as well as Aadhar card, and has repudiated the claim. Hence, we do not find any deficiency in service on the part of the appellant/OP No.1. The DLA was himself negligent for not informing the appellant-insurance company as well as his banker, regarding his exact age during his lifespan. The District Commission has overlooked the said aspect and has wrongly allowed the complaint against the appellant/OP No.1. As such, the impugned order passed by the District Commission is liable to be set aside.
15. Sequel to our above discussion, we allow the appeal of the appellant and the impugned order of the District Commission is hereby set aside. Resultantly, the complaint filed by the respondent No.1/complainant before the District Commission stands dismissed. FA No.365 of 2023 10
16. The appellant had deposited a sum of Rs.25,000/- at the time of filing of the appeal and further deposited an amount of Rs.1,02,000/- in compliance with order of this Commission. These amounts alongwith interest, which has accrued thereon, if any, shall be remitted by the registry to the appellant/OP No.1 by way of crossed cheque/demand draft after the expiry of limitation period in accordance with law.
17. The appeal could not be decided within the stipulated period due to heavy pendency of Court cases.
(H.P.S. MAHAL) PRESIDING JUDICIAL MEMBER (KIRAN SIBAL) MEMBER November 25, 2024 (Dv)