State Consumer Disputes Redressal Commission
Bharti Axa Gen. Insurance Company Ltd. vs Amarjit Kaur on 30 May, 2017
2nd Additional Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH
First Appeal No. 119 of 2017
Date of institution : 20.02.2017
Date of decision : 30.05.2017
Bharti AXA General Insurance Company Limited, Pearl Plaza, K-
24, Plot No. A, B, C, D & E, 2nd Floor, Sector 18, Noida (UP)
201301 through its Constituted Attorney Mr. Kamal Budhiraja.
....Appellant/Op No. 3
Versus
1. Amarjit Kaur aged about 46 years wife of Late Sukhwinder
Singh, resident of Kalu Patti, Village Duggan, Tehsil & District
Sangrur.
....Respondent No.1/Complainant
2. The Sangrur Central Co-operative Bank Limited, Branch
Office Sangrur through its District Manager.
3. The Sangrur Central Co-operative Bank Limited, Branch
Mastuana Sahib, District Sangrur through its Branch Manager.
Respondents No. 2 & 3/Op Nos. 1 & 2
First Appeal against the order dated
14.12.2016 of the District Consumer
Disputes Redressal Forum, Sangrur.
Quorum:-
Hon'ble Mr. Justice Paramjeet Singh Dhaliwal, President
Mr. Gurcharan Singh Saran, Judicial Member.
Present:-
For the appellant : Sh. Sanjeev Goyal, Advocate
For respondent No.1 : Sh. Munish Goel, Advocate
For respondent Nos.2&3: Sh. Mohit Sadana, Advocate
First Appeal No. 119 of 2017 2
GURCHARAN SINGH SARAN, JUDICIAL MEMBER
ORDER
The appellant/Op No.3 (hereinafter referred as Op No.
3) has filed the present appeal against the order dated 14.12.2016 passed by the District Consumer Disputes Redressal Forum, Sangrur (hereinafter referred as the District Forum) in consumer complaint No. 422 dated 14.12.2016 vide which the complaint filed by the complainant was allowed with the direction to Op No. 3 to pay to the complainant a sum of Rs. 1,00,000/- alongwith interest @ 9% p.a. from the date of filing the complaint i.e. 13.6.2016 till realization. Op No. 3 was further directed to pay a sum of Rs. 5,000/- as consolidated amount of compensation and litigation expenses. It was also ordered to comply with the order within a period of 30 days.
2. Complaint was filed by the complainant under the Consumer Protection Act, 1986 (in short 'the Act') against the opposite parties on the averments that husband of the complainant Sukhwinder Singh (in short DLA) was having Saving Bank A/c No. 50604 with Op Nos. 1 & 2. Under the said account, DLA was insured under Cooperative Bank Personal Accident Insurance Scheme for a sum of Rs. 1,00,000/-. The complainant is the nominee in the said bank account. It was a group insurance policy, therefore, no separate terms and conditions were supplied to the insured. DLA died in an accident on 3.6.2014. FIR No. 43 dated 4.6.2014 was recorded in PS Longowal under Section First Appeal No. 119 of 2017 3 304-A/279/337 IPC. Complainant being the beneficiary lodged the claim with Op Nos. 1 & 2, who further forwarded it to Op No. 3. Op No. 3 had assured to release the amount within a period of one month. Complainant visited the office of Op Nos. 1 & 2 number of times but they put of the matter with one excuse or the other. In March 2015, complainant was informed that her claim was repudiated vide letter dated 25.2.2015 on the ground that total number of account holders were more than the total number of account holders insured under the policy. The husband of the complainant paid the premium under the said policy, therefore, the complainant is entitled to get the sum insured. Alleging deficiency in service on the part of Ops, complaint was filed before the District Forum seeking directions against the Ops to pay the sum insured of Rs. 1,00,000/-, Rs. 50,000/- as compensation for mental agony and harassment and Rs. 22,000/- as litigation expenses.
3. Upon notice, Ops appeared and contested the complaint. Op Nos. 1 & 2 in their joint written reply took the legal objections that the complainant has not come to the Forum with clean hands and suppressed the material facts; Op Nos. 1 & 2 were unnecessarily dragged in this litigation, therefore, complaint qua them be dismissed with costs of Rs. 10,000/- and that the complainant had got no cause of action to file this complaint. On merits, it was admitted that the complainant approached Ops and had submitted the documents regarding the claim, which they have forwarded to Op No. 3. However, Op No. 3 repudiated the claim vide letter dated 25.2.2015. There was no fault on the part of First Appeal No. 119 of 2017 4 these Ops. In case the claim was to be paid, it was to be paid by Op No. 3. There was no deficiency in service on the part of these Ops and complaint qua these Ops be dismissed.
4. Op No. 3 in its written reply took the preliminary objections that the complaint is not maintainable as there is violation of terms and conditions of the policy. As per undertaking dated 20.1.2015 submitted by Op No. 1, total number of account holder was more than the total number of account holders covered under the policy, therefore, there is breach of condition No. 9 of the policy terms and conditions. Under the policy 70983 account holders were insured, out of which 69433 were insured for Rs. 1 Lac, 833 for a sum of Rs. 3 Lacs and 717 for a sum of Rs. 5 Lacs. Op No. 1 issued the letter confirming the list of account holders wherein 70319 members have been shown for Rs. 1,00,000/-, 1241 for Rs. 3,00,000/- and 1141 for Rs. 5,00,000/-, total 72701 account holders. The contract of insurance between the parties is governed by the policy terms and conditions. Therefore, the claim is not payable. On merits, it was denied for want of knowledge that DLA was having Saving Bank Account with Op Nos. 1 & 2. It was denied that complainant is a consumer qua this Op. They issued policy to Op No. 2 covering 70983 unnamed account holders. It was admitted that this Op received the information regarding the death of Sukhwinder Singh on 10.11.2014 with a delay of 160 days. Claim No. C0676734 was allotted and this Op sent a letter dated 11.11.2014 for supplying the required documents. During the investigation, it was found that there were 72701 account First Appeal No. 119 of 2017 5 holders and 70983 unnamed account holders were insured under the policy. In this way, Op No. 1 collected the premium from 72701 account holders and got insured only 70983 members, which is clear cut violation of Section 9 of the terms and conditions of the policy, therefore, the claim was not payable. It was rightly repudiated. There is no merit in the complaint, it be dismissed.
5. Before the District Forum, the parties were allowed to lead their respective evidence.
6. In support of his allegations, the complainant had tendered into evidence documents Exs. C-1 to C-7. On the other hand, Op Nos. 1 & 2 had tendered into evidence affidavit of Jaswinder Singh, Branch Manager Ex. Op 1&2/1 and documents Exs. Op-1&2/6. Op No. 3 had tendered affidavit of Kamal Budhiraja Ex. Op-3/1 and documents Exs. Op-3/2 to 3/4.
7. After going through the allegations in the complaint, written version filed by Ops, evidence and documents brought on the record, the complaint was allowed as referred above.
8. Aggrieved with the order passed by the learned District Forum, the appellant/Op No. 3 has filed the present appeal.
9. We have heard the learned counsel for the parties and have carefully gone through the record of the case.
10. During the course of arguments, it had transpired that DLA Sukhwinder Singh was account holder with Op No. 1. His passbook has been placed on the record as Ex. C-2. He died in road accident and in this regard, FIR Ex. C-3 was lodged. Post mortem is Ex. C-4 and in this regard, Op Nos. 1 & 2 had sent the First Appeal No. 119 of 2017 6 intimation to Op No. 3 vide letter Ex. C-6 giving the Bima Account Number of the complainant as 50604. This information has not been denied by the counsel for the Op No.3. Counsel for Op No. 3 has mainly relied upon that letter Ex. Op-3/2 in which the members under one lakh category are 70319, Rs. 3 Lakh category is 1241 and Rs. 5 Lakh category is 1141. The total comes to 72701 whereas as per the policy, it covered 70983 account holders and according to Clause 9 of the policy, it was not payable. Condition No. 9 of the policy, reads as under:-
"It is hereby warranted that the total no. of each class/band account holders as on the date of any incident giving rise to any claim under the policy should not be more than the total No. of account holders for each class/band of the bank as on such date if the no. of account holders is found to be more than the persons covered under the policy the persons in whose respect the claim is being preferred would be deemed not to be covered under the policy and no claim in respect of such person shall be admissible under the policy."
However, it was not denied that the DLA had the account with Op. According to the terms and conditions of the policy, the complainant is entitled to the claim. In case some wrong information with regard to number of persons covered under the policy and number of persons having account numbers then the Insurance Company can avail the separate remedy as available under the law. Therefore, to that extent the order can be modified, otherwise, there is no merit in the appeal. DLA was covered under First Appeal No. 119 of 2017 7 the policy and the claim was payable and it has been rightly allowed by the District Forum.
11. No other point was raised.
12. In view of the above, we do not see any merit in the appeal, the same is hereby dismissed with the observations that in case some wrong information with regard to number of account holders/insured was furnished to Op No. 3 then the Op No. 3 will have a right to stake claim against the bank in accordance with law.
13. The appellant had deposited an amount of Rs. 25,000/- and Rs. 75,000/- with this Commission in the appeal. This amount along with interest accrued thereon, if any, shall be remitted by the registry to the concerned District Forum, after the expiry of 90 days, from the despatch of the certified copy of the order to the parties; subject to stay, if any, by the higher Fora/Court; for the release of the above amount and the District Forum may pass the appropriate order in this regard.
14. Order be communicated to the parties as per rules.
(JUSTICE PARAMJEET SINGH DHALIWAL) PRESIDENT (GURCHARAN SINGH SARAN) JUDICIAL MEMBER May 30, 2017.
as