DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BARNALA, PUNJAB.
Complaint Case No : 693/2016
Date of Institution : 13.12.2016
Date of Decision : 23.03.2018
Jayson Jose C/o Gobind International Public School, Bhadaur, Tehsil Tapa, District Barnala since deceased and represented by his legal heirs (i) Ancy Jayson widow, (ii) Jose Jayson aged 12 years minor son, (iii) Anciliya Jayson daughter, (iv) Aleena Jayson daughters of deceased Jayson Jose, minor son under the guardianship of his mother Ancy Jayson being natural guardian of the minor son R/o C/o Gobind International Public School, Bhadaur, Tehsil Tapa, District Barnala.
…Complainants
Versus
1. PNB-Oriental Royal Mediclaim Retail Banking & Marketing Section Circle Office Bathinda through its Manager/Authorized Signatory Near Model Town, Phase-I, Bathinda.
2. Punjab National Bank, Bhaduar Tehsil Tapa, District Barnala through its Manager, Near Bus Stand, Bhadour.
3. Oriental Insurance Company through Manager PNB, Bhadaur, Near Bus Stand, Bhadour.
4. M/s Medi Assit India Shilpa Vidya, III Floor, 49, First Main Road, Sarakki Industrial Layout III State JP Nagar, Bangalore-560078.
…Opposite Parties
Complaint Under Section 12 of Consumer Protection Act.
Present: Sh. Yogesh Gupta counsel for the complainants.
Opposite party No. 1 exparte.
Sh. AK Jindal counsel for opposite party No. 2.
Sh. NK Garg counsel for opposite parties No. 3 and 4.
Quorum.-
1. Shri Sukhpal Singh Gill : President
2. Ms. Vandna Sidhu : Member
ORDER
(SUKHPAL SINGH GILL, PRESIDENT):
The complainant namely Jayson Jose had filed the present complaint under Consumer Protection Act, 1986 (In short the Act) against PNB-Oriental Royal Mediclaim and others (hereinafter called as the opposite parties) but during the pendency of the present complaint the said complainant Jayson Jose has died on 30.12.2017 and LRs of deceased Jayson Jose filed an application to implead them as legal heirs of the deceased, which was allowed vide order dated 9.3.2018, so the LRs of deceased Jayson Jose become the complainants in the present complaint.
2. It is alleged that the complainant purchased PNB Oriental Mediclaim Health Insurance Policy bearing No. 233200/48/2015/3061 dated 22.1.2015 with expiry date 21.1.2016 midnight with insured value to the tune of Rs. 3,00,000/-. The premium amounting to Rs. 4,620/- was paid by the complainant.
3. It is further alleged that the complainant entitled to renew the policy for the year 2016-17 and paid the amount of Rs. 4,709/- vide demand draft No. 323656 dated 20.1.2016 issued by the Punjab National Bank Branch Bhadaur opposite party No. 2 and the said bank draft was to be sent to opposite party No. 1 by the opposite party No. 2 for the renewal of the policy. However, the opposite party No. 2 detained the said demand draft in their office and forwarded the same to the opposite party No. 1 on 11.8.2016 by re-validating on 11.8.2016.
4. It is further pleaded that the opposite party No. 1 returned the above said demand draft to the Incumbent Incharge PNB Bhadaur vide letter dated 17.8.2016 with the remarks “Policy cannot be renewed as it expired on 21.1.2016. Hence, policy copy alongwith DD No. 323656 is being returned.”
5. It is further submitted that the complainant paid the amount of Rs. 4,709/- being a renewal cum continuation fee on 20.1.2016 to the opposite party No. 2 i.e. Punjab National Bank, Bhadaur which is the sister concern of the opposite party No. 2. But the opposite party No. 1 turned down the request with the above said remarks and refused to renew the policy without any fault of the complainant. It is alleged that the opposite party No. 2 failed to discharge its duty as all the bank branches are on line and it was the duty of the opposite party No. 2 to inform the opposite party No. 1 about the payment of Rs. 4,709/-. It is further pleaded that as per the scheme if the person remains adopting the policy for 4 years in that eventuality each of the family member of the complainant becomes entitle for taking the benefit of treatment to the tune of Rs. 3,00,000/-. However, due to non renewal of policy the complainant have been deprived from the said benefit and has to wait for another three years for taking the benefit. It is further pleaded that the complainant continued to renew the policy for last three years i.e. 2013-14, 2014-15 and 2015-16.
6. It is further alleged that the complainant visited the office of the opposite parties No. 1 and 2 time and again and made many requests to renew/continue the policy but all in vain and the acts of the opposite party clearly constitute deficiency of service and unlawful trade practice on their part. Hence, the present complaint is filed seeking the following reliefs:-
1) The opposite parties may be directed to renew/continue the policy for the year 2016-17.
2) To pay Rs. 1,00,000/- as compensation on account of physical pain, mental agony and financial loss.
3) To pay Rs. 10,000/- as costs of the proceedings.
4) Any other relief which this Forum deems fit.
7. Upon notice of this complaint the opposite party No. 1 preferred to remain exparte.
8. The opposite party No. 2 filed written version taking legal objections on the grounds that the complainant has no locus standi or cause of action to file the present complaint, that the opposite party No. 2 bank is only the corporate Agent of the insurance company opposite party No. 3 and therefore opposite party No. 2 is not liable to pay any amount, that this Forum has no jurisdiction and the complaint is barred by limitation.
9. On merits, it is admitted that the opposite party bank debited the amount of Rs. 4,620/- on the request of the complainant and the said amount was credited in the account of Oriental Insurance Company Limited opposite party No. 3 and the policy has been issued by the other opposite parties. Thus, the opposite party No. 2 has no concern with the policy and there is no privity of contract between them.
10. It is further submitted that the complainant requested the opposite party No. 2 to issue demand draft in the name of opposite party No. 3 and as per bank norms the complainant filled a voucher for demand draft and the opposite party No. 2 issued a demand draft in favour of opposite party No. 3 and the said original demand draft was handed over to the complainant on the same day. Thus, it is alleged that there is no negligence on their part and finally prayed for the dismissal of the present complaint.
11. Written version also filed by the opposite parties No. 3 and 4. They have taken legal objections on the grounds that the complainant has no locus standi or cause of action to file the present complaint. The complainant is estopped from filing the present complaint and present complaint is not maintainable.
12. On merits, it is submitted that the said policy starts from 22.1.2015 and was valid up to 21.1.2016 midnight but the same was started on 16.1.2015. It is further submitted that there was a break in the year 2015-16. The premium for the next period was not received by them. Moreover, complainant never approached or contacted the opposite party and therefore, there is no deficiency in service on their part and finally prayed for the dismissal of the complaint.
13. In order to prove her case, the complainant has tendered in evidence her own affidavit Ex.C-1, copies of PNB-Oriental Royal Mediclaim Policy Schedule Ex.C-2 to Ex.C-4, copy of demand draft Ex.C-5, copy of letter dated 17.8.2016 Ex.C-6 and closed the evidence.
14. To rebut the case of the complainant, the opposite party No. 2 tendered in evidence affidavit of Parveen Singla Deputy Manager Ex.O.P-2/1, copy of voucher Ex.O.P-2/2, copy of account statement Ex.O.P-2/3, copy of transfer voucher dated 20.1.2016 Ex.O.P-2/4, copy of cheque No. 838312 dated 7.12.2016 Ex.O.P-2/5, copy of draft voucher dated 7.12.2016 Ex.OP-2/6, copy of account statement Ex.OP-2/7 and closed the evidence.
15. The opposite parties No. 3 and 4 also tendered in evidence certified copy of policy No. 233200/48/2015/3061 Ex.OP-3.4/1, copy of compliance under Section 64 VB Ex.OP-3.4/2, copy of claim settlement Advice dated 2.2.2016 Ex.OP-3.4/3, copy of request for documents dated 23.12.2015 Ex.OP-3.4/4, copy of request for documents dated 28.12.2015 Ex.OP-3.4/5, copy of request for documents dated 16.11.2015 Ex.OP-3.4/6 and closed the evidence.
16. We have heard the learned counsel for the parties and have gone through the record on the file. Written arguments also filed by all the parties.
17. It is proved beyond any doubt from the Ex.OP-2/3 and Ex.OP-2/7 that the deceased Jayson Jose had a joint bank Account alongwith his wife Ancy Jayson with the opposite party No. 2 having Account No. 6025000100000408. It is admitted fact that the deceased complainant purchased PNB- Oriental Royal Mediclaim Health Insurance Policy No. 233200/48/2015/ 3061 dated 22.1.2015 having expiry date 21.1.2016 midnight and insured value of Rs. 3,00,000/- from opposite party No. 3 by paying the premium of Rs. 4,620/- through opposite party No. 2. It is also an admitted fact that on 20.1.2016 the deceased complainant requested the opposite party No. 2 to issue a demand draft in favour of opposite party No. 3 and he had filed a voucher for this purpose. The opposite party No. 2 also issued a demand draft of Rs. 4,709/- Ex.C-5 in favour of opposite party No. 3 and as per Ex.OP-2/3 an amount of Rs. 4,709/- also debited in the joint account of the deceased complainant. It is also an admitted fact that the said draft was not received by the opposite party No. 3 in time and said draft was only sent on 11.8.2016 after re-validating the same but the opposite party No. 1 returned the draft to the Incumbent Incharge PNB Bhadaur vide letter dated 17.8.2016 with the remarks “Policy cannot be renewed as it expired on 21.1.2016, Hence policy copy alongwith DD No. 323656 is being returned.”
18. Now the main question arises that who is at fault for not reaching the above mentioned demand draft in time with the opposite party No. 3. From Ex.C-2 to Ex.C-3 which are copies of PNB Oriental Royal Medical Policy Schedule one thing is clear that the deceased complainant purchased the mediclaim policy for the last two years. From the documents Ex.C-5 copy of demand draft dated 20.1.2016, Ex.OP-2/2 copy of transfer voucher, Ex.OP-2/3 copy of Account Ledger in which amount of Rs. 4,709/- has been debited in the Joint Account of the deceased complainant, and Ex.OP-3.4/3 copy of claim settlement advice one more thing is crystal clear that deceased complainant willing to purchase the Mediclaim Policy on 20.1.2016 for the period from 22.1.2016 to 21.1.2017 by paying the amount of Rs. 4,709/- as premium of the said policy. Even, he purchased the said policy by paying the premium on 7.12.2016 vide copy of cheque Ex.OP-2/5. So, the deceased complainant is not at fault as he paid the amount of Rs. 4,709/- to the bank opposite party No. 2 in time i.e. on 20.1.2016 who itself admitted this fact in their written version.
19. The opposite party No. 2 also submitted in their written version that they debited the amount of Rs. 4,620/- on the request of the deceased complainant and credited in the account of opposite party No. 3 which proved that it is the duty of the opposite party No. 2 to take the amount from the complainant and then sent the same to the opposite party No. 3 in time. Ex.C-6 which is a letter dated 17.8.2016 was also sent by the opposite party No. 1 to the bank opposite party No. 2 with the remarks that policy cannot be renewed as it expired on 21.1.2016 and policy copy alongwith demand draft was returned to the opposite party No. 2. This letter Ex.C-6 also proved that it is the duty of the opposite party No. 2 to send the payment of premium to opposite party No. 3 through opposite party No. 1 but as they failed to send the premium of the deceased complainant in time only then the opposite party No. 1 written this letter to opposite party No. 2 and not written directly to the deceased complainant. In case it is duty of the deceased complainant to pay the amount of premium to the opposite party No. 3 or opposite party No. 1 then this letter must be addressed to the deceased complainant. So, the opposite party No. 2 is deficient in providing service to the deceased complainant in the present complaint. The opposite parties No. 3 and 4 are not deficient in providing service as they have not received the premium in time so they cannot issue the policy in favour of deceased complainant. As the insurance company is not at fault and as the period of about two years has already been lapsed from 20.1.2016 so we cannot order to renew/continue the policy of the deceased complainant from that date.
20. In the amended complaint filed by the complainants they have also claimed amount of Rs. 5,30,000/- expenses incurred on the treatment of the deceased Jayson Jose in CMC Ludhiana on 20.6.2017 and again on 27.12.2017 where he died on 30.12.2017 but these expenses were borne by the complainants during the pendency of the present complaint, so the cause of action qua the amount of Rs. 5,30,000/- arose during the pendency of the present complaint, which cannot be decided in the present complaint. However, the complainants can file a fresh complaint regarding the amount of Rs. 5,30,000/- spent on the treatment of deceased Jayson Jose.
20. In view of the above discussion, present complaint is partly allowed against the opposite party No. 2 only. Accordingly, the opposite party No. 2 is directed to pay the consolidated amount of Rs. 25,000/- on account of compensation for mental tension, harassment and litigation expenses to the complainant No. 1 on behalf of all the complainants, who is the mother of complainants No. 2 to 4 and this amount includes their share also. Compliance of this order be made within the period of 30 days from the date of the receipt of copy of this order. Copy of the order be supplied to the parties free of costs. File be consigned to the records.
ANNOUNCED IN THE OPEN FORUM:
23rd Day of March 2018
(Sukhpal Singh Gill)
President
(Vandna Sidhu) Member
