State Consumer Disputes Redressal Commission
Bajaj Allianz General Insurance Co. Ltd vs Santosh Kumar Das And Anr. on 22 September, 2011
State Consumer Disputes Redressal Commission State Consumer Disputes Redressal Commission West Bengal BHABANI BHAVAN (GROUND FLOOR) 31, BELVEDERE ROAD, ALIPORE KOLKATA 700 027 S.C. CASE NO. FA/622/2010 DATE OF FILING: 03/11/2010 DATE OF FINAL ORDER: 22/09/2011 APPELLANT Bajaj Allianz General Insurance Co. Ltd. Poddar Court, Gate No.3, 18 Rabindra Sarani, Kolkata 700 001. RESPONDENTs 1. Santosh Kumar Das, Kalyan Nagar, Mathpara, P.O- Kalyan Nagar, P.S Khardah, Dist.- North 24 Pgs. Pin- 700 112. 2. United Bank of India, Rahara Branch, Rahara, Khardah, Dist.- North 24 Pgs. Kolkata 700 118. Proforma Respondent BEFORE : HONBLE JUSTICE MR. PRABIR KUMAR SAMANTA, PRESIDENT MEMBER : MRS. S. MAJUMDER MEMBER : MR. S. COARI FOR THE APPELLANT : Mr. N. R. Mukherjee & Ms. Koyeli Mukhopadhyay, Advocates. FOR THE RESPONDENTs : In person : O R D E R :
HONBLE JUSTICE MR. PRABIR KUMAR SAMANTA, PRESIDENT This appeal is by the insurer against the judgment of the District Forum below whereby the appellant has been directed to pay to the complainant the remaining balance of the sum assured merely Rs. 55,000/- (Fifty-five thousand) by way of accidental insurance coverage. It is not in dispute that the complainant respondent became a member of a Group Insurance Scheme namely United Surakshya Yojona for opening an account with the United Bank of India. The said Group Insurance Scheme has been introduced by the appellant insurer to cover the risk of the account holder in the event of accidental death or in case of permanent disability in any accident. The said scheme provides benefits mentioned therein having insurance cover of Rs. 1,00,000/- (One lac) only against each account holder. According to the scheme, the personal accidental insurance coverage for the depositor has been enumerated as under:-
PERSONAL ACCIDENT INSURANCE COVER FOR THE DEPOSITORS :-
The maximum coverage will be in case of death Rs. 1,00,000/- and in case of permanent disability Rs. 1,25,000/- as per details given hereunder.
Nature of Events Compensation as % of sum insured Death 100 Loss of sight on both eyes 125 Loss of both hands 125 Loss of both feet 125 Loss of one eye and one hand 125 Loss of one eye and one foot 125 Loss of one hand and one foot 125 Other total permanent disablement (PTD) 100 Loss of one eye/one leg 50 It is not in dispute that the insurance cover of the complainant respondent was for the period of one year on and from the commencement of the policy on 29th February 2008. Unfortunately, on 8th December 2008 the complainant met with an accident in which his right leg had to be amputated apart from the injuries suffered by him in his skull and right arm. The complainant respondent raised a claim for a sum of Rs. 3,00,000/- (Three lacs) by alleging that he was entitled to 100% of the sum assured namely Rs.3,00,000/- (Three lacs) because of the permanent disability suffered by him. The appellant insurer ultimately granted a sum of Rs. 45,000/- (Forty-five thousand) only to the complainant against his said claim for which the above complaint case has been filed.
The points of decision in this in this are whether the sum assured was Rs. 3,00,000/-
(Three lacs) as claimed by the complainant in stead of Rs. 1,00,000/- (One lac) as contended by the appellant insurer and whether on the basis of the injury suffered by the complainant whether he was entitled to a 100% compensation of the sum assured.
The Group Insurance Scheme as disclosed in the complaint case clearly provides as under :-
In order to augment share of low cost deposit a Group Insurance Scheme named as UNITED SURAKSHA YOJANA has been introduced as a value addition for our Savings Bank. Current Deposit and Term Deposit Account holder to make it more competitive and attractive to the existing as well as new customers of the Bank.
The Bank has already entered into an agreement with Bajaj Allianz General Insurance Co. Ltd. (BAGIC), as its corporate agent for Non-Life Insurance.
The Group Insurance Scheme (United Suraksha Yojana) will cover accidental death plus permanent total disability (PTD) as per the scale of benefits having insurance coverage of Rs. 1,00,000/- against each SB CD & TD(FD, RIP, RD etc) A/c holder which will be enjoyed by our Bank as Master Policy holder. The amount of insurance premium is Rs. 13/- per lac per year for individual account holder.
To become a member under this scheme the interested new as well as existing account holders shall have to furnish their consent by signing a proposal form.
In the event of closure of SB/CD/TD accounts, the concerned account(s) holder will cease to be a member under the scheme from the date of next renewal of the policy as the coverage would be given on yearly basis.
ELIGIBILITY:-
All existing and new SB/CD/TD account holders will be eligible for coverage under the Group Insurance Scheme of Bajaj Allianz. The account holders have to pay premium of Rs.13/- only per annum and have to furnish their consent by signing proposal forms as per annexure-I. The proposal form along with other information like claim procedure, amount of coverage, etc regarding the Group Insurance Scheme will be made available to the customers from all our branches.
In case of Term Deposit account holder the annual premium is to be paid by debuting Savings /CD account of the account holder. If Term Deposit account holders do not have SB or CD account with the branch and desires to join the scheme they may be requested to open SB or CD account or they may be allowed to deposit the premium in cash which is to be kept in Deposit Suspense A/c till the amount is remitted to the Bajaj Allianz.
In the event of multiple accounts maintained by single person and opted for insurance under more than one and for all such accounts, then in the event of any valid claim arising under the policy, the benefit of the balance will become payable under each account as opted for individually. [For the purpose of clarity in case there are three accounts under one single/joint names and insurance premium is paid under all the accounts, then in the event of a valid claim arising under the policy, an amount of Rs. Three lacs will become payable as the claim amount. The claim amount will be paid to the nominee of the account as per bank.
It is not the case of the complainant that he opened altogether three separate Accounts with the United Bank of India either individually in his own name or jointly with his mother or in both capacities. The said scheme clearly stipulates an insurance cover of Rs. 1,00,000/- (One lac) only against each Account maintained by the Account Holder. Only in the event of multiple Accounts maintained by a single person and opted for insurance under more than one and for all such Accounts, then in such event, the benefit of insurance will become payable under each Account as opted for individually. It can not be said that the complainant respondent being a single account holder would still be entitled to the insurance cover of Rs. 3,00,000/- (Three Lacs) if he had paid three times the premium for insurance cover for Rs. 1,00,000/- (One Lac) each. Upon reading of the said scheme there is no scope to hold that a single Account Holder can have the benefit of an amount more than Rs. 1,00,000/- (One lac) for any reason whatsoever upon payments of multiple premiums meant for cover of Rs. 1,00,000/- (One lac). We are, therefore, of the clear view that the insurance cover as enjoyed by the complainant respondent under the aforesaid Group Insurance Scheme for maintaining a single Account by the complainant respondent in the joint name with his mother, would be for a sum of Rs. 1,00,000/- only for each of the Account Holder and not for any further Amount.
It is also not in dispute that the complainant respondent met with an accident during the period under insurance cover and the medical certificate issued to him clearly reveals that he has undergone amputation of his right leg below the knee following the said accident. As per the table of compensation provided under the aforesaid Group Insurance Scheme, the complainant respondent is entitled to a 50% compensation of the sum assured for the loss of one leg. The complainant respondent might have suffered injuries in his skull and in his right arm but has not suffered loss of any other limb or organ except for the loss of one leg as aforesaid. His permanent disability certificate issued by the concerned medical authority also does not describe him as a total permanent disabled person. In view of the rate of compensation given under the aforesaid scheme for different of loss of limbs and organs of the body including permanent disability, we do not find any scope to hold that he would be entitled to any higher percentage of compensation on the basis thereof for below knee amputation of his right leg in the said accident.
We are therefore of the view that since the insurance cover was for a sum of Rs. 1,00,000/- (One Lac) only, the complainant respondent would be entitled to a sum of Rs. 50,000/- i.e 50% of the sum assured by way of compensation for the loss of his right leg below the knee in the said accident in stead of Rs. 45,000/- as settled by the insurer.
For the reasons as above, the impugned judgment and order is set aside. It is hereby held that the complainant respondent will be entitled to a compensation for a sum of Rs. 50,000/- (Fifty thousand) against the sum assured for Rs. 1,00,000/- (One lac) for loss of his right leg below the knee in the said accident. As he has already received a sum of Rs. 45,000/- in the meantime, he will further be entitled to the sum of Rs. 5,000/- (Five thousand) only and the aforesaid sum will carry interest @ 12% p.a from the date of making of the claim till payment. The complainant respondent will further be entitled to a sum of Rs.5,000/- towards litigation cost. Both the aforesaid sum will be paid to the complainant respondent by the appellant insurer within thirty (30) days from this date in default of which both the aforesaid sums will carry an interest @ 12% per annum till payment.
(S. Majumder) (S. Coari) (Justice P.K. Samanta) MEMBER(L) MEMBER PRESIDENT