Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 71.
Instituted on : 27.01.2017.
Decided on : 13.02.2019.
Poonam aged 43 years wife of Late Shri Yoginder Singh resident of House No.434, village and post office Silana, Tehsil Kharkhoda, District Sonipat, Mb. No.7404221110.
………..Complainant.
Vs.
- State Bank of India, Main Branch Office, near district courts, Rohtak, through its Manager/authoriozed signatory.
- Reliance General Insurance Company Limited, office at 1-89/3/B to 42/KS/301, 3rd Floor, Krishe Block, Krishe Sapphire, Madhapur, Hyderabad-500081.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
SH. VED PAL, MEMBER.
SMT. SAROJ BALA BOHRA, MEMBER.
Present: Sh.V.S.Malik, Advocate for the complainant.
Sh. O.P.Chugh, Advocate for opposite party No.1.
Sh. Sameer Gambhir, Advocate for opposite party No. 2.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that wife of Late Sh. Yoginder Singh who was having his salary bank account in the bank of noticee no.1 with account No.1107542829. That the above said deceased was died in a road side accident on 09.08.2015 and FIR No.0356 dated 10.08.2015 was lodged by Sandeep son of Dharambir. That respondent no.1 issued a debit card cum ATM card to the deceased under the scheme of State Bank of India to salary accounts holders, which was insured with respondent no.2 with policy no.1111352914000038 valid from 04.01.2015 to 03.01.2016 as per rules and regulations of the Insurance Act. That complainant intimated the said accident and death of deceased/policyholder to the respondent no.1 and the respondent no.1 has demanded several documents regarding the death of the deceased which were handed over to the respondent no.1 vide claim intimation bearing no.2161007279. That opposite party No.1 and 2 has not process the insurance amount of the said Debit Card/ATM card to the complainant. That complainant sent a legal notice dated 23.11.2016 to the respondents but to no effect. That the act of opposite parties is illegal and amounts to deficiency in service. Hence this complaint and it is prayed that opposite parties may kindly be directed to pay Rs.10 lacs of policy amount alongwith interest, compensation and litigation expenses as explained in relief clause.
2. After registration of complaint, notice was issued to the opposite parties. Opposite party No.1 in its reply has submitted that it is wrong and denied that the complainant intimated the said accident and death of deceased to respondent no.1 and the documents have been handed over to the respondent no.1 vide claim intimation bearing no.2161007279. That as per clause-2 of the policy, an intimation is to be given by the claimant to RGICL within 90 days of death of the customer and as per clause 8 of the policy, RGICL will settle claims independently without the involvement of the bank. Thus the answering respondent has no concern with payment of any claim. The claim, if any, was to be lodged with the respondent no.2. That there is no deficiency in service on the part of opposite party and dismissal of complaint has been sought.
3. Opposite party no.2 in its reply has submitted that policy is a specially entered contract between the bank and the insurance company: 3rd party cannot seek any benefit by violating its agreed terms. On merits, it is submitted that the answering respondent has received the claim intimation on 18th July 2016 i.e. delay of 344 days from the date of loss and received claim documents on 03.092016 i.e. delay of 391 days from the date of loss. That as per the terms and conditions of the policy, claim to be intimated within 90 days of date of death and documents to be submitted within 180 days of date of death. Hence it is violation of terms and conditions . So the claim is not payable. The answering respondent has repudiated the claim of the complainant due to late submission of claim papers. That there is no deficiency in service on the part of opposite party and dismissal of complaint has been sought.
4. Ld. counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C16 and has closed his evidence on dated 13.07.2018. Ld. counsel for the OPs No.1 has tendered affidavit Ex.RW1/A, document Ex.RW1/1 and closed his evidence on 29.11.2018. Ld. Counsel for the OP No. 2 has tendered affidavit Ex.R2/A, docments Ex./R2/1 to Ex/R2/9 and closed his evidence on dated 24.08.2018.
5. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
6. After going through the file and hearing the parties it is observed that as per document Ex.R2/3, husband of the complainant Sh. Yoginder Singh was insured under the scheme of State Bank of India, salary accounts holders package with respondent no.2 under policy no.1111352914000038. The Personal Accident Cover as per Gold/diamond SGSP policy is Rs.500000/-. After his death, complainant filed the claim with the opposite parties but the same has been repudiated by the opposite parties on the ground of delay of 344 days in giving intimation to the company and submission of claim documents with delay of 391 days from the date of loss. The contention of ld. counsel for the opposite party No.2 is that as per the terms and conditions of the policy, claim is to be intimated within 90 days of date of death and documents to be submitted within 180 days of date of death. Hence it is violation of terms and conditions. So the claim is not payable. Ld. counsel for opposite party no.2 has also placed reliance upon the law of Hon’ble Supreme Court of India in Civil Appeal No.6739 of 2010 in case titled as Oriental Insurance Co. Ltd. Vs. Parvesh Chander Chadha, order dated 04.12.2014 of Hon’ble National Commission in Revision Petition No.3049 of 2014 in case titled HDFC Ergo Gen. Ins. Co. Ltd. Vs. Sh.Bhagchand Saini, order dated 17.03.2017 in Revision Petition No.2714 of 2016 in case titled as Har Sharan Prasad Patel Vs. M/s Rel. Gen. Ins. Co. Ltd., IV(2012)CPJ441(NC) titled New India Assurance Co Ltd. Vs. Trilochan Jane, II(2015)CPJ750(NC) titled as Shriram General Insurance Co. Ltd. Vs. Gurshinder Singh & Anr. and Revision Petition.no.2479 of 2015 decided by Hon’ble National Commission on dated 11.01.2016 in case titled as Reliance Gen. Ins. Co. Vs. Jai Parkash.
7. After going through the file and hearing the parties it is observed that the facts of aforesaid law cited above by ld. counsel for the opposite party no.2 are different from the facts of the present case and are not fully applicable to this case as in the present case the contract/agreement was between the bank and the insurance company and the account holder was not the party to that contract. The policy was issued by the OP No.2 to opposite party No.1. Hence it was the duty of the opposite party No.2 to supply the policy and its terms and conditions to its account holders but in the present case it is not proved on file that any policy or its terms and conditions were ever supplied to the deceased Yoginder Singh or any of the account holders. Hence the account holder was not having any knowledge of terms and conditions of the policy. As such, the delay, if any was due to deficiency in service on the part of OP No.1. Hence both the parties are liable to compensate the complainant. Since there was delay of 344 days in giving intimation to the opposite parties, hence it would be suffice to allow the complaint on non-standard basis i.e. 80% of the claim amount of Rs.500000/-. It is also observed that LRs of deceased i.e. Sh. Ashish s/o Sh. Yoginder Singh and Smt. Jantri Devi mother of Yoginder as per their respective affidavits Ex.C9 and Ex.C11 have stated that they have no objection to pay the insurance claim amount in favour of Smt. Poonam.
8. In view of the facts and circumstances of the case, we hereby allow the complaint and direct the opposite party no.2 to pay the 80% of claim amount i.e. to pay Rs.400000/-(Rupees four lacs only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 27.01.2017 till its realization and opposite party no.1 shall pay a sum of Rs.50000/-(Rupees fifty thousand only) as compensation on account of deficiency in service as well as litigation expenses to the complainant. Order shall be complied within one month from the date of decision.
9. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
13.02.2019.
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Nagender Singh Kadian, President
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Ved Pal Hooda, Member.
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Saroj Bala Bohra, Member.
