Haryana

Ambala

CC/173/2023

SMT RAKSHA DEVI. - Complainant(s)

Versus

CENTRAL BANK OF INDIA. - Opp.Party(s)

BALDEV KUMAR

05 Dec 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	173 of 2023
Date of Institution	:	10.05.2023
Date of decision	:	05.12.2024

Smt. Raksha Devi aged about 62 years w/o Late Shri Ramesh Kumar, R/o Village Sohana, Post Office-Sohana, District Ambala.

  ……. Complainant

                                                Versus

1. Central Bank of India, Sohamb-Sohana, Village & Post Office-Sohana, Branch Ambala, Code-4748, through its Manager/Authorized Signatory
2. L.I.C. Office, Bye-Pass Road, Near Reebok Showroom, Barara, Haryana-133 201, through its' Manager

                                                                                   ….…. Opposite Parties

Before:        Smt. Neena Sandhu, President.

                     Smt. Ruby Sharma, Member,

          Shri Vinod Kumar Sharma, Member.           

 

Present:      Shri Nirbhay Pratap Singh, Advocate, counsel for the complainant.

                     Shri Anil Singla, Advocate, counsel for OP No.1.

                   Shri R.K. Jindal, Advocate, counsel for OP No.2.

Order:        Smt. Neena Sandhu, President.

                   Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’) praying for issuance of following directions to them:-

(a) To pay claim amount of Rs.2 lacs under the policy in question alongwith interest @18% p.a. from the date of death of husband of the complainant till realization;

(b) To pay of Rs.1,00,000/- as compensation for mental agony and harassment.

(c) To pay Rs.11,000/- towards cost of litigation.

(d) Grant any other relief which this Hon’ble Commission may deems fit.

            

2.           Brief facts of the case are Late Shri Ramesh Kumar S/o Shri Lekh Raj, the deceased husband of the complainant was having a Saving Account No. 3375246470 with the OP No. 1 since August, 2014. On 16.02.2019, the OP No. 1 with consent of deceased husband of the complainant debited Rs.172/- out of the amount lying in his said Saving Account and credited the same to LIC ACC as premium under Prime Minister Jivan Jyoti Bima Yojna i.e. PMJJBY Scheme. At that time, the OP No. 1 disclosed to the husband of the complainant that in case of even natural death of the account holder during Policy Period, his legal heir would be paid the insurance amount of Rs.2,00,000/- at once only after formal verification. The OP No. 1 debited Rs.330/- on 28.05.2019 and Rs.330/- on 27.05.2020 from his said Saving Account as premium under the said PMJJBY Scheme. Unfortunately on 21.06.2020, Shri Ramesh Kumar S/o Shri Lekh Raj, the husband of the complainant died and it was a natural death. The complainant immediately informed the OPs and requested to pay the sum assured amount of Rs.2,00,000/- to the complainant, being widow of Late Shri Ramesh Kumar. The complainant provided the photocopy of Death Certificate of her deceased husband to the OPs and it was promised to her that the sum assured amounting to Rs.2,00,000/- under PMJJBY Scheme will be released to her immediately after conducting formal verification. Thereafter the complainant repeatedly visited the OPs to get the insured amount but the OPs put the matter on hold on one pretext or the other and finally started ignoring her. Thereafter, the complainant served a legal notice dated 11.11.2022 upon the OPs. The complainant received a reply dated 16.12.2022, stating therein that the complainant is not found eligible to the claim under PMJJBY Scheme. By not paying the claim amount, the OPs have not only committed deficiency in providing service and have also indulged into unfair trade practices. Hence, the present complaint.
3.           Upon notice, OP No.1 appeared and filed written version and raised preliminary objections with regard to maintainability, not come with clean hands and suppressed the true and material facts etc.  On merits, it has been stated that the deceased husband of the complainant was having a Saving Account No. 3375246470 with the OP No. 1.  As per Government Scheme PMJJBY,  Ramesh Kumar was got insured by the Bank and an insurance policy No.8197373105 was issued in his favour by the OP No. 2 and premium amount for the same was debited from his account to the account of insurance company i.e. OP No. 2. As per Scheme, in case of the death of the insured, the sum assured under the policy is Rs.2,00,000/-, subject to terms and conditions of the policy. As informed by the complainant that unfortunately the said Ramesh Kumar died on 21.06.2020, during the subsistent of the policy. The complainant submitted the death certificate of Ramesh Kumar alongwith other documents with the OP No. 1 and it forwarded the same to the Regional Manager, Chandigarh, it further forwarded the same to the Central Office for necessary action in the matter, but on scrutinizing the documents by the officials of the Bank for submitting the claim file to OP No. 2, it was revealed that date of birth of deceased Ramesh Kumar differs in CBS (01/01/1985) and KYC (01.01.1995) and therefore, not found eligible under PMJJBY Scheme and the claim file was returned to Branch Office, Sohana. As per the Scheme, the eligible age to get insured is 18-50 years. As per the KYC documents, the date of birth of Ramesh Kumar is 01.01.1955. Hence, he was not eligible for the Scheme. It is further stated that however, deceased Ramesh Kumar misrepresented his date of birth as 01.01.1985, as mentioned by him in the account opening form etc. He was at fault by providing the wrong particulars to the Bank regarding his date of birth, due to which the claim file has been returned as not eligible under the Scheme. It is further stated that the sum assured was to be paid by the Insurance Company i.e. OP No. 2, not by OP No. 1. The OP No. 1 acted only as corporate agent of insurance company in getting the policy issued. The OP No. 1 acted promptly after receiving the information of the death of Ramesh Kumar and discharged its duty efficiently. Rest of the averments of the complainant were denied by the OP No.1 and prayed for dismissal of the present complaint qua it with costs.
4.           Upon notice, OP No.2 appeared and filed written version and raised preliminary objections with regard to maintainability, cause of action, bad for non-joinder and mis-joinder, time barred, not come with clean hands and suppressed the true and material facts etc. On merits, it has been stated that the concerned unit of answering OP has not received death claim forms from concerned Bank in respect of deceased Shri Ramesh Kumar due to mismatch of date of birth. On receipt of this complaint the concerned bank i.e Central Bank of India was asked to send status of case and it was informed to LIC that the claim has been rejected by the Bank due to difference in date of birth of life assured. As per Aadhar Card, date of birth of deceased Shri Ramesh Kumar was 01.01.1995 and at the time of taking the policy under Pradhan Mantri Jeevan Jyoti Bima Yojna his age was more than 64 years of age. As per the terms and conditions “All Savings Bank Account holders in the age group 18 years (completed) to 50 years (age nearer birthday) as on 01.06.2015 or on the subsequent date  of joining the scheme are eligible to join the Scheme” so the deceased was not eligible to enter into scheme, as such nothing is payable to the complainant under the policy in question. It has further stated that the master policy holder under PMJJBY scheme is Central Bank of India which was responsible to check the eligibility criteria for enrollment and had to deduct the premium from the bank account of the account holder Shri Ramesh Kumar as per rules of scheme. The answering OP is the insurer chosen by the bank for the scheme. It is further pertinent to mention here that as per rules of the scheme PMJJBY which was introduced by the Government of India in 2015, age criteria to become member of scheme is 18 to 50 years. At the time of enrollment of a member the bank obtains consent cum declaration form and has to obtain age proof which is retained by bank at their end. Only data is sent to LIC alongwith premium. Bank deducts premium of Rs.330/- per member per annum and remits Rs.289/- to LIC and balance Rs.41/- is charged by bank as processing fee. Hence the amount retained by Bank as processing fee holds them responsible for checking the eligibility criterion. The age of the deceased Shri Ramesh Kumar at the time of becoming member of the PMJJBY scheme was more than 50 years and he was not eligible for entering into scheme. Shri Ramesh Kumar joined the PMJJBY scheme on 16.02.2019 and his date of birth is 01.01.1955 as per Aadhar Card, so his age was 64 years 1 month and 15 days on the date of entry into scheme i.e when he was enrolled for the PMJJBY scheme, but the concerned bank while sending the date has mentioned the date of birth of Shri Ramesh Kumar as 01.01.1985. After receipt of this complaint, it contacted the Central Bank of India for status of case and it received a letter dated 17.03.2021, vide which the claim was rejected by Bank with remarks “Insurer DOB differs in CBS 01.01.1985, KYC 01.01.1995 which is not eligible in PMJJBY. Hence there is no deficiency in service on the part of answering OP as bank sent data of Shri Ramesh Kumar to LIC which shows his date of birth as 01.01.1985 instead of correct age 01.01.1955. Now at this stage as per documentary record provided by the concerned Bank, the date of birth of Shri Ramesh Kumar son of Shri Lekh Raj has been specifically mentioned as 01.01.1955 in Aadhar Card No. 9025 5239 4840. Aadhar Card being a legally valid document for enrollment of entry into scheme shows that he was not eligible to enter into the said scheme, so answering OP is not at fault in any manner. Rest of the averments of the complainant were denied by the OP No.2 and prayed for dismissal of the present complaint with costs.
5.           Learned counsel for the complainant tendered affidavit of the complainant as Annexure CW/A alongwith documents as Annexure C-1 to C-9 and closed the evidence on behalf of complainant. On the other hand, learned counsel for the OP No.1 tendered affidavit of Anoj Kumar, Branch Manager of OP No.1 Bank-Central Bank of India, Sohana Branch, District Ambala as Annexure OP-1/A alongwith documents as Annexure OP-1/1 to OP-1/12 and closed the evidence on behalf of OP No.1. Learned counsel for the OP No.2 tendered affidavit of Anju Arora,(Manager Legal and HPF) of  OP No.2-Company-LIC of India, Divisional Office, Karnal as Annexure OP-2/A alongwith documents as Annexure OP-2/1 to OP-2/13 and closed the evidence on behalf of OP No.2.
6.           We have heard the learned counsel for the parties and have also carefully gone through the case file.
7.           Learned counsel for the complainant submitted that by repudiating the genuine claim of the complainant despite the fact that the husband of the complainant had paid premium to the OPs under PMJJBY Scheme, the OPs have indulged into unfair trade practice and were also deficient in providing service.
8.           On other hand, learned counsel for OP No.1 submitted that since the husband of the complainant had concealed material facts qua his age at the time of purchasing the said scheme under PMJJBY scheme i.e. his actual date of birth was 01.01.1955, yet, he concealed that fact and in order to bring him under the age criteria of the said scheme i.e. 18 years to 50 years, he filled his date of birth as 01.01.1985, which made the complainant disentitled for the claim in question.
9.           Learned counsel for OP No.2 submitted that since it was brought to its knowledge by OP No.1 that the husband of the complainant had concealed material facts about his age, at the time of purchasing the said scheme under PMJJBY. In fact as per Aadhar card his actual date of birth was 01.01.1955, yet, he concealed that fact and in order to bring him under the age criteria of the said scheme i.e. 18 years to 50 years, he filled his date of birth as 01.01.1985, as such, his claim was rightly rejected by OP No.1.
10.           The issue for determination in this case is whether the complainant is entitled to any relief. It is important to note that the Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY) scheme, as per the eligibility criteria outlined in the Reserve Bank of India's document dated 5th May 2015 (Annexure OP-2/1), was specifically available to individuals in the age group of 18 to 50 years. The complainant’s late husband, Ramesh Kumar, was born on 1st January 1955, as evidenced by his Aadhaar Card, Annexure C-3. However, in the application form (Annexure OP-1/1), Ramesh Kumar had incorrectly stated his date of birth as 1st January 1985, which would have made him eligible for the scheme. Providing a false or incorrect date of birth in the application for a scheme, the Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY), does not entitle the complainant to claim benefits under the scheme. This discrepancy of 30 years meant that Ramesh Kumar was not within the eligible age bracket for the scheme at the time of enrollment. The scheme’s benefits are contingent upon meeting the age requirements set forth by the government and the insurance provider. Any attempt to misrepresent age in order to gain eligibility undermines the integrity of the scheme and is considered a violation of the terms and conditions. As such, the concealment of the true date of birth, whether intentional or accidental, disqualifies the insured person from claiming benefits under the PMJJBY. This misrepresentation of his age was a clear concealment of a material fact, rendering him ineligible for the benefits under the PMJJBY.
11.           In view of the aforesaid discussion, we hereby hold that the complaint filed by the complainant is devoid of merits, consequently, we dismiss the same. The parties are left to bear their own costs. Certified copies of the order be sent to the parties concerned as per rules.  File be annexed and consigned to the record room

  Announced:- 05.12.2024.

 

(Vinod Kumar Sharma)	(Ruby Sharma)	(Neena Sandhu)
Member	Member	President