BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SIRSA.
Consumer Complaint no. 119 of 2020
Date of Institution : 03.03.2020.
Date of Decision : 24.11.2023.
Jagir Singh son of Shri Sucha Singh, resident of Ward No.11, Ellenabad, Tehsil Ellenabad, District Sirsa.
……Complainant.
Versus.
1. The New India Assurance Company Ltd. through its Branch Manager Branch office at Sirsa.
2. Central Bank of India, Branch at Ellenabad, District Sirsa.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act, 1986.
Before: SH. PADAM SINGH THAKUR …………PRESIDENT
MRS.SUKHDEEP KAUR………………MEMBER.
SH. OM PARKASH TUTEJA………….MEMBER
Present: Sh. S.N. Grover, Advocate for complainant.
Sh. A.S. Kalra, Advocate for opposite party no.1.
Sh. M.S. Sethi, Advocate for opposite party no.2.
ORDER
The present complaint has been filed by complainant under Section 12 of the Consumer Protection Act, 1986 (after amendment u/s 35 of the Consumer Protection Act, 2019) against the opposite parties (hereinafter referred as OPs).
2. In brief, the case of the complainant is that complainant is holder of account no. 3929307073 maintained with op no.2 bank and as per Pardhan Mantri Jeevan Suraksha Bima Yojna, complainant also paid premium amount to op no.1 vide receipt dated 30.08.2017 against insurance policy no.30082017251864565 and amount of premium is auto debited from the account of complainant to take the benefits of scheme. The op no.1 fully covered under the Master Policy No. 111900421501000112 subject to the correctness of information provided regarding eligibility and receipt of the consideration amount. On 15.04.2018 complainant met with a motor vehicular accident with unknown tractor Hindustan and suffered injuries and a case FIR No.0082 dated 17.04.2018 under Sections 279/337/427 IPC was registered in Police Station Ellenabad against the unknown driver of the tractor. In this accident due to injuries eye sight of both the eyes of complainant have gone away. The complainant took the treatment from Civil Hospital, Sirsa and thereafter he undergone treatment from Maharaja Aggarsain Medical College, Agroha and also from PGI, Chandigarh. That on account of eye injuries, he has suffered disability to the extent of 40% as per disability certificate issued by Medical Board. It is further averred that thereafter complainant undergone the assessment of disability from department of Cardiology and as per assessment by PGI, Chandigarh, the disability of complainant is 55-60%. It is further averred that complainant applied for release/ disbursement of the sum assured amount under the policy to the ops and also approached the ops and requested them to pay amount of sum assured but ops have repudiated the genuine claim of complainant. The complainant has to make round to their office time and again and as such they have caused unnecessary harassment and have repudiated the claim without assigning any reason. The complainant also got served legal notice to the ops on 14.10.2019 but to no effect. Hence, this complaint.
3. On notice, op no.1 appeared and filed written statement raising preliminary objections that this Commission has got no jurisdiction to entertain and try the present complaint as complainant is not consumer of answering op as Master Policy No. 111900/42/15/01/00000112 was not effective and valid during the period of date and death or injury of any kind of any account holder including covering the risk of complainant who alleged suffered injuries on 15.04.2018, hence complaint against answering op is liable to be dismissed for want of cause of action against answering op. That complainant has suppressed true and material facts from this Commission. The notice dated 01.08.2019 was duly replied by answering op intimating about no risk of covering the injury of complainant in the year and month of April, 2018. The Master policy was valid only for the period from 01.06.2015 to 31.05.2016, hence complaint is liable to be dismissed with costs and complainant has filed the present complaint by referring date of notice as 14.10.2019 which is abuse of process of law. It is further submitted that without admitting liability and insurance coverage, it is submitted that complainant may be directed to produce on record the insurance policy or correct particulars i.e. number of policy and name of company with whom he got coverage. Otherwise also, complaint is barred by law of limitation as according to the term and conditions of policy if company shall disclaim liability of the insured for any claim and such claim shall not within twelve calendar months from the date of such disclaimer have been made the subject matter of a suit in a court of law, then the claim shall for all purposes deemed to have been abandoned and shall not thereafter be recoverable. It is further submitted that further coverage of any account holder is according to the scheme launched by Central Government, so it does not fall within the parameter of C.P. Act as it is not amounting to hiring the services and parties are governed by such scheme for the purpose of payment of compensation, if any and not for the purpose of giving compensation as demanded by any individual like complainant. On merits, it is submitted that the policy was valid from 01.06.2015 to 31.05.2016 only. The premium receipt as alleged by complainant is of dated 30.08.2017 whereas Master Policy was for the period of 01.06.2015 to 31.05.2016. The contention regarding payment of premium amount by way of auto debit by bank and remittance of the same to company is to be proved by complainant by leading cogent evidence. Remaining contents of complaint are also denied to be wrong and prayer for dismissal of complaint made.
4. Op no.2 also appeared and filed written statement raising certain preliminary objections. It is submitted that as per Pardhan Mantri Jeevan Suraksha Beema Yojna, an amount of Rs.12/- per year is deducted from saving bank account of complainant as premium amount and same is credited/ transferred in favour of op no.1 company on behalf of complainant. In this way, the agreement regarding insurance as per policy is in between the complainant and op no.1 company and op bank is not a necessary party. The benefit of the insurance is to be taken by complainant and same is to be paid by op no.1 company and op no.2 bank is not a mediator in between complainant and op no.1. It is further submitted that insurance policy under Prime Minister Jeewan Suraksha Yojna is not a health insurance policy. This policy is only effective in case of death of the insurance policy holder and after his/her death, the amount is payable to the legal heirs of the deceased. The compensation regarding injuries suffered in the road accident is payable to the injured or the legal heirs of the deceased under the provisions of the Motor Vehicles Act. There is no provision in this policy regarding any injury or the disability as mentioned above. Remaining contents of complaint are also denied to be wrong and prayer for dismissal of complaint qua op no.2 made.
5. The complainant in evidence has tendered his affidavit Ex.CW1/A and copies of documents i.e. FIR Ex.C1, disability certificate Ex.C2, acknowledgment slip cum certificate of insurance Ex.C3, legal notice Ex.C4, aadhar card Ex.C5, disability certificate Ex.C6, follow up and sicharge card Ex.C7 and prescription slips Ex.C8 to Ex.C13.
6. On the other hand, op no.2 has tendered affidavit of Sh. Kuldeep Branch Manager and Principal Officer as Ex.R1. Op no.1 has tendered affidavit of Sh. R.K. Indora, Sr. Divisional Manager as Ex.R2, insurance policy for the period 01.06.2015 to 31.05.2016 Ex.R3, copy of legal notice Ex.R4 and reply to legal notice Ex.R5. Ld. counsel for op no.1 has also tendered statement of account of complainant as Ex.R6 and acknowledgment Ex.R7.
7. We have heard learned counsel for the parties and have gone through the case file carefully.
8. According to the complainant, the premium amount of Rs.12/- is being deducted from the account of complainant maintained with op no.2 by the op no.2 for his insurance with op no.1 as per Pardhan Mantri Jeevan Suraksha Bima Yojna and he was also insured with the op no.1 under the said scheme from 30.08.2017 through op no.2 by paying requisite premium amount of Rs.12/- by the op no.2 bank on 30.08.2017 vide insurance policy No. 30082017251864565 and op no.1 fully covered him under the Master Policy No. 1119004215010000112. It is further the case of complainant that during the period of policy on 15.04.2018 he met with an accident and suffered injuries and after the said motor vehicular accident caused by an unknown driver of a tractor he has lost eyesight of his both the eyes and as such he is entitled to the sum insured amount from op no.1 under the policy in question. On the other hand, op no.1 has taken a plea that Master Policy No. 111900/42/15/01/00000112 issued to the complainant through op no.2 bank was only effective and valid for the period 01.06.2015 to 31.05.2016 and thereafter no insurance has been taken for the complainant for the period 2017-2018 and as such he was not insured under the above said scheme with op no.1 on the alleged date of accident i.e. on 15.04.2018. In this regard, op no.1 insurance company has also placed on file the policy Ex.R3 which was valid for the period 01.06.2015 to 31.05.2016 and has also placed on file certificate regarding payment of premiums which reveals that for the above said policy number 11190042150100000112 which was valid from 01.06.2015 to 31.05.2016, the premium amount of Rs12/- was paid only for one time and remaining policies bearing same number are of some other persons. However, complainant has also placed on file acknowledgment slip cum certificate of insurance dated 30.08.2017 of the op no.2 bank as Ex.C3 whereby Jagir Singh complainant consented and authorized the op bank for auto-debit from his saving account to join the Pradhan Mantri Jeevan Suraksha Bima Yojana with the New India Assurance Company Ltd. for cover under Master Policy No. 1119004215010000112 subject to correctness of information provided regarding eligibility and receipt of consideration amount. Further from the copy of pass book of account of complainant placed on file by op no.2 bank, it is evident that premium amount of Rs.12/- was deducted by op no.2 bank for insurance of complainant under above said PMSBY scheme. The op no.2 bank has also issued an acknowledgement of the premium amount of Rs.12/- for insuring the complainant under the said scheme for the period 2017-2018. It is also proved on record that earlier the 30% disability to the right eye of the complainant as per disability certificate Ex.C6 has been increased and concerned doctor of Maharaja Aggarsen Medical College & Hospital, Agroha (Hisar) in the back of prescription slip dated 23.05.2018 has reported and confirmed that patient has lost right eye due to trauma one month back. The said doctor has further reported that his vision in right eye is decreased due to the injury and he has developed retinal detachment. As such it is proved on record that due to retinal detachment, the complainant has lost complete eyesight of his right eye. In so far as benefit under the policy is concerned, though the policy placed on file by op no.1 is for the period 01.06.2015 to 31.05.2016 but benefits under the said policy i.e. Pradhan Mantri Suraksha Bima Yojana can be ascertained for the just and proper decision of the case and in the table of benefits of said policy it is mentioned that for total and irrecoverable loss of sight of one eye or loss of use of one hand or foot, the sum insured amount is Rs. One lakh. Since it is proved on record that op no.2 bank has charged premium amount of Rs.12/- for insurance of complainant in the name of op no.1 insurance company for insuring him with op no.1 insurance company and in this regard op no.2 bank has also asserted that premium amount for insurance of complainant for the period 2017-2018 has also been paid to op no.1 but insurance company has denied insurance coverage to the complainant for the period 2017-2018 during which complainant lost eye sight of his right eye, therefore, complainant cannot be forced to suffer for any lapses on the part of any of the ops. The complainant is legally entitled to receive amount of Rs.one lac. The premium amount of Rs.12/- has been deducted from the account of complainant for his insurance under the policy in question for the period 2017-2018 but it appears that op no.2 bank has provided wrong policy number to the complainant and as such insurance company is denying any insurance for the period 2017-2018, therefore, op no.2 bank is deficient in service. Moreover, op no.2 bank was also directed to place on record policy for the period 2017-2018 but op no.2 bank has failed to do so. As such complainant is entitled to sum assured amount of Rs. One lac from op no.2 bank and thereafter op no.2 bank can claim the said amount from op no.1 because it is the internal matter of op no.1 insurance company and op no.2 bank.
9. In view of our above discussion, we allow the present complaint qua op no.2 bank and direct the opposite party no.2 bank to pay insured amount of Rs.1,00,000/- to the complainant alongwith interest at the rate of @6% per annum from the date of filing of present complaint i.e. 03.03.2020 till actual realization within a period of 45 days from the date of receipt of copy of this order. We also direct the op no.2 bank to further pay a sum of Rs.10,000/- as compensation for harassment and Rs.5000/- as litigation expenses to the complainant within above said stipulated period. However, op no.2 bank can claim said amounts from op no.1 insurance company if same is found payable by op no.1. A copy of this order be supplied to the parties as per rules. File be consigned to the record room.
Announced: Member Member President,
Dated: 24.11.2023. District Consumer Disputes
Redressal Commission, Sirsa.
