State Consumer Disputes Redressal Commission
Himachal Pradesh Gramin Bank. vs Smt. Achhari Devi. & Ors. on 20 March, 2020
H. P. STATE CONSUMER DISPUTES REDRESSAL
COMMISSION SHIMLA
First Appeal No. : 246/2018
Date of Presentation: 23.04.2018
Order Reserved on : 12.09.2019
Date of Order : 20.03.2020
......
Himachal Pradesh Gramin Bank (HPGB) Branch Sundla through
its Branch Manager Sundla Tehsil Salooni District Chamba (H.P).
...... Appellant/Opposite Party No.2
Versus
1. Smt. Achhari Devi wife of late Shri Rumel Singh R/o Village
Thall P.O. Thakrimatti Tehsil Salooni District Chamba
(H.P).
2. Daleep Singh son of late Shri Rumel Singh R/o Village Thall
P.O. Thakrimatti Tehsil Salooni District Chamba (H.P).
3. Sh. Shyam Singh S/o late Shri Rumel Singh R/o Village
Thall P.O.Thakrimatti Tehsil Salooni District Chamba
(H.P).
4. Ms. Champa Devi D/o late Shri Rumel Singh R/o Village
Thall P.O. Thakrimatti Tehsil Salooni District Chamba
(H.P).
5. Ms. Anjana D/o late Shri Rumel Singh R/o Village Thall P.O.
Thakrimatti Tehsil Salooni District Chamba (H.P).
......Respondents No.1to 5/Complainants
6. Oriental Insurance Company Ltd. Vidya Bhawan Hospital
Road Mandi (H.P) through its Divisional Manager.
......Respondent No.6/Opposite party No.1
7. Oriental Insurance Company Chamba Mohalla Hardaspura
through its Branch Manager.
......Respondent No.7/opposite partyNo.3
Coram
Hon'ble Justice P.S. Rana (R) President
Hon'ble Ms. Sunita Sharma Member
Hon'ble Mr. R.K. Verma Member
Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others.
F.A. No.246/2018
Whether approved for reporting?1 Yes.
For Appellant : Mr. G.S. Rathour Advocate.
For Respondents No.1to5: Mr. Dheeraj Bansal vice Mr.
Vivekanand Advocate.
For Respondents No.6&7 : Mr. Sanjay Singh Chauhan Advocate.
JUSTICE P.S. RANA (R) PRESIDENT :
O R D E R :-
1. Present appeal is filed against order dated 28.11.2017 passed by Learned DCF/DCC in consumer complaint No.09/2017 titled Smt. Achhari Devi & Ors Versus Oriental Insurance Company Ltd. & Others.
Brief facts of consumer complaint:
2. Complainants namely Smt.Achhari Devi, Sh.
Daleep Singh, Sh. Shyam Singh, Ms. Chamba Devi and Ms. Anjana who are legal heirs of deceased Rumel Singh filed consumer complaint under Consumer Protection Act pleaded therein that deceased Rumel Singh R/o Village Thall Post Office Thakrimatti Tehsil Salooni District Chamba H.P. was having saving bank account No.99031300302390 with Himachal Pradesh Gramin Bank (HPGB) branch Sundla Tehsil Salooni District Chamba H.P. It is pleaded that deceased Rumel Singh got Pradhan Mantri Suraksha Beema Yojna (PMSBY) policy i.e. Prime Minister Safety Insurance Scheme Policy from Oriental Insurance Company Ltd. i.e. Opposite party No.1 through opposite party No.2 i.e. 1 Whether reporters of the local papers may be allowed to see the order? Yes. 2
Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018 Himachal Pradesh Gramin Bank (HPGB) Branch Sundla Tehsil Salooni District Chamba H.P. It is further pleaded that premium to the tune of Rs.12/- (Twelve) per annum was deducted from saving bank account of deceased Rumel Singh. It is pleaded that on dated 16.06.2015 insured Rumel Singh was coming back to his home from his personal work and he sustained injuries i.e. Trauma to chest ribs by way of fall from hilly land. It is further pleaded that insured was brought to Regional Hospital Chamba H.P. for medical treatment and on dated 18.06.2015 deceased insured died due to injuries sustained by him in chest ribs. It is further pleaded that Insurance claim was submitted but Insurance company did not settle claim and committed deficiency in service.
3. Complainants sought relief to the effect that Oriental Insurance Company Ltd. and Himachal Pradesh Gramin Bank (HPGB) be directed to pay Insurance claim as per Pradhan Mantri Suraksha Beema Yojna (PMSBY) policy i.e. Prime Minister Safety Insurance Scheme Policy. In addition complainants sought relief of payment of compensation to the tune of Rs.10000/- (Ten thousand) for mental agony and harassment. In addition complainants sought litigation costs to the tune of Rs.10000/- (Ten thousand). Prayer for acceptance of consumer complaint sought.
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Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018
4. Per contra version filed on behalf of opposite party No.1 i.e. Oriental Insurance Company Ltd. pleaded therein that complainants did not complete formalities required for payment of Insurance claim. It is further pleaded that complainants did not submit copy of FIR and post mortem report for settlement of Insurance claim. It is further pleaded that Insurance claim was not submitted within 30 (Thirty) days from the date of alleged accident. It is further pleaded that Insurance company repudiated Insurance claim strictly as per laws and rules. It is pleaded that Insurance company did not commit any deficiency in service as alleged in consumer complaint. Prayer for dismissal of consumer complaint against opposite party No.1 sought.
5. Per contra separate version filed on behalf of Himachal Pradesh Gramin Bank (HPGB) pleaded therein that insured Rumel Singh died on dated 18.06.2015. It is pleaded that Insurance claim was submitted to Insurance company. It is further pleaded that dispute is inter se complainants and Insurance company. It is further pleaded that immediately Insurance claim was submitted to Insurance company by Himachal Pradesh Gramin Bank (HPGB). Prayer for dismissal of consumer complaint against Himachal Pradesh Gramin Bank (HPGB) sought.
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Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018
6. Complainants filed rejoinder and reasserted allegations as mentioned in consumer complaint. Learned DCF/DCC partly allowed consumer complaint and ordered opposite parties jointly and severally to pay Insurance claim due under the Insurance policy to complainants alongwith interest @ 9% per annum from the date of complaint till actual payment. In addition learned DCF/DCC ordered opposite parties to pay compensation to the tune of Rs.20000/- (Twenty thousand) to complainants. In addition learned DCF/DCC ordered opposite parties to pay litigation costs to the tune of Rs.3000/- (Three thousand) to complainants. Feeling aggrieved against order passed by learned DCF/DCC Himachal Pradesh Gramin Bank (HPGB) filed present appeal before State Commission.
7. We have heard learned Advocates appearing on behalf of parties and we have also perused entire record carefully.
8. Following points arise for determination in present appeal.
1. Whether appeal filed by complainants is liable to be accepted as mentioned in memorandum of grounds of appeal and whether Insurance company is liable to pay genuine claim?
2. Final order.
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Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018 Findings upon point No.1 with reasons:
9. Complainants filed affidavit of Daleep Singh Ext.
CW.1 who is one of co-complainant in evidence. There is recital in affidavit that complainants are legal heirs of deceased Rumel Singh. There is further recital in affidavit that deceased insured Rumel Singh was having saving bank account No.99031300302390 with Himachal Pradesh Gramin Bank (HPGB) Branch Sundla Tehsil Salooni District Chamba H.P. There is further recital in affidavit that deceased Rumel Singh got Pradhan Mantri Suraksha Beema Yojna (PMSBY) policy i.e. Prime Minister Safety Insurance Scheme Policy from Oriental Insurance Company Ltd. through Himachal Pradesh Gramin Bank (HPGB) Branch Sundla Tehsil Salooni District Chamba H.P.
10. There is further recital in affidavit that on 16.06.2015 insured Rumel Singh was coming back to his home from his personal work and he sustained injuries by way of fall from hilly land and sustained injuries i.e. Trauma to chest ribs. There is further recital in affidavit that insured Rumel Singh was brought to Regional Hospital Chamba H.P. for medical treatment. There is further recital in affidavit that on dated 18.06.2015 deceased insured died due to injuries sustained by him in chest ribs. There is further recital in affidavit that legal heirs of deceased Rumel Singh submitted 6 Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018 Insurance claim before Himachal Pradesh Gramin Bank (HPGB) and Oriental Insurance Company Ltd. but Insurance company repudiated the claim in illegal manner. State Commission has carefully perused all annexures filed by complainants.
11. Ramesh Kumar Branch Manager filed affidavit on behalf of Oriental Insurance Company Ltd. There is recital in affidavit that deceased insured obtained Pradhan Mantri Suraksha Beema Yojna (PMSBY) policy i.e. Prime Minister Safety Insurance Scheme Policy from Oriental Insurance Company Ltd. There is further recital in affidavit that deceased insured Rumel Singh sustained injuries by way of fall from hilly land. There is further recital in affidavit that deceased insured did not die due to accident. There is further recital in affidavit that no FIR was registered and no post mortem was conducted upon deceased insured. There is further recital in affidavit that complainants are not entitled for any Insurance claim under Pradhan Mantri Suraksha Beema Yojna (PMSBY) policy i.e. Prime Minister Safety Insurance Scheme Policy because complainants did not fulfill formalities as required in Insurance policy. There is further recital in affidavit that complainants did not submit claim within 30 (Thirty) days from the date of alleged accident. There is further recital in affidavit that Oriental Insurance 7 Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018 Company Ltd. did not commit any deficiency in service. State Commission has carefully perused all annexures filed by Insurance company.
12. Ramesh Kumar filed affidavit on behalf of Himachal Pradesh Gramin Bank (HPGB) in evidence. There is recital in affidavit that deponent is Branch Manager of Himachal Pradesh Gramin Bank (HPGB) Branch Sundla Tehsil Salooni District Chamba H.P. There is further recital in affidavit that deceased Rumel Singh was having saving bank account No.99031300302390 with deponent bank. There is further recital in affidavit that deceased insured got Pradhan Mantri Suraksha Beema Yojna (PMSBY) policy i.e. Prime Minister Safety Insurance Scheme Policy from Oriental Insurance Company Ltd. through deponent bank against his saving bank account referred above. There is further recital in affidavit that deceased Rumel Singh died on 18.06.2015. There is further recital in affidavit that Insurance claim papers were submitted by legal heirs of deceased for settlement and payment of Insurance claim for death on 08.10.2015. There is further recital in affidavit that deponent bank forwarded entire documents alongwith claim papers to Insurance company. There is further recital in affidavit that there is no delay on the part of deponent bank to submit Insurance claim to Insurance company. State Commission 8 Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018 has carefully perused all annexures filed by Himachal Pradesh Gramin Bank (HPGB).
13. Submission of learned Advocate appearing on behalf of Himachal Pradesh Gramin Bank (HPGB) that order of learned DCF/DCC directing Himachal Pradesh Gramin Bank (HPGB) to pay Insurance claim under Insurance policy to complainants alongwith interest @ 9% per annum from the date of complaint till actual payment is contrary to laws and contrary to proved facts is decided accordingly. State Commission has carefully perused Insurance policy issued by Oriental Insurance Company Ltd. Insurance policy in question was issued through Himachal Pradesh Gramin Bank (HPGB). Deceased insured was having saving bank account in Himachal Pradesh Gramin Bank (HPGB) Branch Sundla Tehsil Salooni District Chamba H.P. Premium amount was also sent to Insurance company directly by Himachal Pradesh Gramin Bank (HPGB) by way of deducting premium of Rs.12/- (Twelve) per annum from saving bank account of deceased insured Rumel Singh. State Commission is of the opinion that participation of Himachal Pradesh Gramin Bank (HPGB) is directly involved in present matter because consideration amount of premium has been deducted directly by Himachal Pradesh Gramin Bank (HPGB) from saving account of deceased insured. State Commission is of the 9 Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018 opinion that it is not expedient in the ends of justice and on the principles of natural justice to exonerate Himachal Pradesh Gramin Bank (HPGB) in the present matter completely. State Commission is of the opinion that Oriental Insurance Company Ltd. is under legal obligation to indemnify Himachal Pradesh Gramin Bank (HPGB). It is well settled law that beneficiary could file consumer complaint under Consumer Protection Act. Admittedly deceased insured Rumel Singh and his legal heirs are beneficiaries in present consumer complaint and as per Consumer Protection Act beneficiary falls within the definition of Consumer. As per Pradhan Mantri Suraksha Beema Yojna (PMSBY) policy i.e. Prime Minister Safety Insurance Scheme Policy Insurance company is under legal obligation to pay Insurance amount to the tune of Rs.200000/- (Two lac) to legal heirs of deceased insured Rumel Singh.
14. Submission of learned Advocate appearing on behalf of Himachal Pradesh Gramin Bank (HPGB) that in present consumer complaint in relief clause complainants have sought compensation to the tune of Rs.10000/- (Ten thousand) for mental agony and harassment but learned DCF/DCC has granted excessive compensation for mental agony and harassment to the tune of Rs.20000/- (Twenty thousand) to complainants is decided accordingly. State 10 Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018 Commission is of the opinion that in view of relief sought by complainants in relief clause it is expedient in the ends of justice and on the principles of natural justice to reduce compensation amount for mental agony and harassment to the tune of Rs.10000/- (Ten thousand).
15. Submission of learned Advocate appearing on behalf of Himachal Pradesh Gramin Bank (HPGB) that learned DCF/DCC has granted excessive litigation costs to the tune of Rs.3000/- (Three thousand) to complainants is decided accordingly. State Commission is of the opinion that complainants have engaged Advocate before learned DCF/DCC and have paid Advocate fee and incurred other expenses and State Commission is of the opinion that learned DCF/DCC has granted equitable litigation costs to complainants and it is not expedient in the ends of justice and on the principles of natural justice to reduce litigation costs ordered by learned DCF/DCC.
16. Submission of learned Advocate appearing on behalf of Insurance company that complainants did not file copy of FIR and also did not file post mortem report and on this ground Insurance company be exonerated from liability is decided accordingly. State Commission has carefully perused Daily Station Diary Annexure C-8 issued by Police Authority District Chamba H.P. There is recital in daily station diary report that legal heirs of deceased insured did not show any 11 Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018 suspicion upon any third person qua death of insured and on account of above stated facts post mortem of deceased insured was not conducted. State Commission is of the opinion that there is reasonable reason for non-conducting post mortem upon deceased because no suspicion was leveled against any third person relating to death of deceased insured Rumel Singh by his legal heirs.
17. Submission of learned Advocate appearing on behalf of Insurance company that deceased insured died on 18.06.2015 and claim form was submitted after period of sufficient delay on 24.09.2015 and on this ground Insurance company be exonerated from liability is decided accordingly. State Commission is of the opinion that complainants are legal heirs of deceased insured and compensation rights survive to legal heirs and State Commission is of the opinion that cause of action to legal heirs is continuous cause of action in nature till Insurance claim is not paid to legal heirs of deceased insured. State Commission is of the opinion that complainants fall within the definition of beneficial legal heirs as defined under Nomination Rules 2015. As per laws (1) Spouse (2) Children (3) Parents fall beneficial legal heirs under Nomination Rules 2015 qua Insurance claim. Hence State Commission is of the opinion that in view of above stated facts it is not expedient in the ends of justice and on the principles of natural justice to reject Insurance claim of 12 Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018 legal heirs of deceased insured who are beneficial legal heirs as per Nomination Rules 2015.
18. Submission of learned Advocate appearing on behalf of Insurance company that deceased insured has flouted terms and conditions of Insurance policy and on this ground Insurance company be exonerated from liability is decided accordingly. There is no evidence on record in order to prove that exclusion clauses of Insurance policy were read over and explained to deceased insured in his own language. It is well settled law that when Insurance company did not prove that exclusion clauses of Insurance policy were explained to deceased insured in that eventuality Insurance company is not legally competent to take benefit of exclusion clause. See 2000(2) Supreme Court Cases 734 titled Modern Insulators Ltd. Versus Oriental Insurance Company Ltd. See 2007(III) CPJ 34 NC titled National Insurance Company Ltd. Versus D.P. Jain. See 2019(6) SCC 212 Apex Court titled Bharat Watch Versus National Insurance Co. Ltd.
19. Even Hon'ble Apex Court of India in case reported in 2020 (1) CPJ 57 Apex Court titled Gurshinder Singh Vs. Shriram General Insurance Co. Ltd. & Others comprised of three judges Bench held that genuine insurance claim should not be repudiated by Insurance company merely on the ground of delay in intimating Insurance company. It is proved on record that deceased insured Rumel Singh died on 13 Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018 18.06.2015. As per legal heirs certificate Annexure C-3 placed on record it is proved on record that complainants are legal heirs of deceased. As per certificate issued by Panchayat Annexure C-9 deceased insured Rumel Singh was falling in BPL Family and as per certificate given by Pradhan Gram Panchayat Annexure C-9 deceased has sustained injuries by way of fall from hilly land and sustained multiple fractures in chest ribs. State Commission is of the opinion that present claim is genuine claim and Insurance company is under legal obligation to pay genuine claim. See AIR 2017 SC 4836 (DB) titled Om Prakash Versus Reliance General Insurance & Anr. See 2019(1) CPR 725 NC titled Assistant Commissioner Commercial Tax Versus New India Assurance Company Ltd. See 2017(9) SCC 724 titled Om Prakash Versus Reliance General Insurance & Anr. See 2019(1) CPR 471 NC titled ICICI Lombard General Insurance Company Ltd. Versus Honest Bio-vet Pvt. Ltd.
20. Submission of learned Advocate appearing on behalf of complainants that order of learned DCF/DCC is in accordance with laws and in accordance with proved facts and same does not warrant any interference from State Commission is decided accordingly. State Commission is of the opinion that order of learned DCF/DCC warrants partly interference from State Commission because complainants 14 Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018 sought compensation for mental agony and harassment to the tune of Rs.10000/- (Ten thousand) in relief clause and learned DCF/DCC has granted excessive compensation to the tune of Rs.20000/- (Twenty thousand) for mental harassment and agony and compensation is contrary to relief sought. Point No.1 is decided accordingly.
Point No.2: Final Order
21. In view of findings upon point No.1 above appeal filed by Himachal Pradesh Gramin Bank (HPGB) is partly allowed. It is ordered that Oriental Insurance Company Ltd. shall pay Insurance amount to the tune of Rs.200000/- (Two lac) to legal heirs of deceased insured alongwith interest @ 9% per annum from the date of institution of complaint till actual payment. It is further ordered that Oriental Insurance Company Ltd. will indemnify Himachal Pradesh Gramin Bank (HPGB).
22. It is further ordered that Oriental Insurance Company Ltd. shall pay compensation to complainants to the tune of Rs.10000/- (Ten thousand) only. Order of learned DCF/DCC that Oriental Insurance Company Ltd. would pay costs to the tune of Rs.3000/- (Three thousand) to complainants is affirmed. Insurance claim and compensation amount and litigations costs shall be divided among all complainants equally. Insurance company shall comply order 15 Himachal Pradesh Gramin Bank (HPGB) Vs. Smt. Achhari Devi & Others. F.A. No.246/2018 within one month after receipt of certified copy of order. Parties are left to bear their own litigation costs before State Commission. Order of learned DCF/DCC is modified accordingly.
23. Death Certificate Annexure C-1, legal heirs certificate Annexure C-3 issued by Executive Magistrate Chamba H.P., Daily station diary Annexure C-8 and certificate issued by Pradhan Gram Panchayat Annexure C-9 and Insurance claim form Annexure C-12 wherein Senior Medical Officer Regional Hospital Chamba H.P. has given endorsement that deceased insured died due to # Ribs (Right) shall form part and parcel of order. Certified copy of order be transmitted to parties forthwith free of costs strictly as per rules. Certified copy of order be sent to learned DCF/DCC forthwith and file of State Commission be consigned to record room after due completion forthwith. F.A.No.246/2018 is disposed of. Pending application(s) if any also disposed of.
Justice P.S. Rana (R) President Sunita Sharma Member R.K.Verma Member 20.03.2020 Manoj 16