Orissa

Debagarh

CC/61/2019

Snehalata Bhoi, W/O-Late Janmajaya Bhoi - Complainant(s)

Versus

The B.M. Punjab National Bank, Deogarh Branch, Deogarh - Opp.Party(s)

10 Dec 2021

ORDER

IN THE COURT OF THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, DEOGARH

C.C. Case No- 61 /2019

            Present-Sri Dipak Kumar Mahapatra, President, Smt. Arati Das, Member.

 

Snehalata Bhoi, aged 45 years,

W/O Late Janmajay Bhoi ,

R/O-vill/P.O. Jharagogua,

P.S/Dist- Deogarh.                                                                                        .…….Complainant.

                                                                                    Vrs.

1. The Branch Manager,

          Punjab National Bank, Deogarh Branch, Deogarh,

         Office at Municipality Sahi, P.O/P.S. & District Deogarh.

 

2. The Oriental Insurance Company Limited.

           Represented through the Divisional Manager,

          Oriental Insurance Co. Ltd.

          Divisional Office at Trilok Bhawan,

          Sarlakani Chouk, Sakhipara Road, Sambalpur.                                                       .……O.Ps.

 

Counsels:-

For the Complainant             :- Sri R.L. Pradhan, Advocate.

For the O.P-1                         :- Sri S.K.Mishra & Associates, Advocates.

For the O.P-2                         :- Sri R.K.Sahoo, Advocate.

Date of Hearing: 05.11.2021, Date of Order: 10.12.2021

SRI DIPAK KUMAR MAHAPATRA,PRESIDENT:-Brief facts of the case is that, the husband of the complainant Janmajay Bhoi had an savings bank account having No.6765001700001911 at Punjab National Bank, (O.P.No.1) Deogarh Branch and was insured under PMSBY Scheme for accidental death on payment of premium of Rs.12/ per annum which is auto debited from his account. On dtd. 21.05.2016 the husband of the complainant died in a motor vehicular accident. Being the nominee, the complainant lodged death claim of his deceased husband before the O.P.No.1 within stipulated time period and submitted the bank passbook, true copies of Inquest report, P.M.Examination report, dead body challan, F.I.R. etc, relating to Kuchinda P.S. U.D.  case No. 12 dt.21.05.2016. Thereafter on dtd. 25.07.2016 an amount of Rs.1,53,271.75 (Rupees one lakh fifty-three thousand two hundred seventy-one only) which was outstanding in the above noted account of husband of complainant is transferred to S/B account No.6765001700001683 of the complainant.  In spite of several approaches the O.P. No.1 avoided time to time and asks the complainant to submit copies of police papers to which the complainant has submitted relevant papers again & again. After running for years to the O.P.No. 1, in the last week of May 2019 the complainant received a repudiation letter from O.P.No.2 for the ground that her claim is received from O.P. No. 1 after inordinate delay of 35 months from the date of accident. Due to the deficiency in service by the O.P.No. 1, the complainant sustained financial loss, mental pain and agony.

As per the O.P-1, he admits that the account vide account no. 6765001700001911 was in the name of Janmajaya Bhoi with their branch.  On 25.07.2016, the petitioner came to the branch of the O.P-1 and informed about the death of her husband & filed the death certificate only for settlement the saving account as a nominee. On asking to submit relevant documents, but she submitted the documents on dtd. 01.04.2019.

As per the O.P. No-2, he admitted that the OP No-2 had sent copy of a letter dated 10.05.2019 to the Complainant by expressing its inability to entertain a claim under PMSBY scheme after about 35 months from the date of the alleged accidental death as stated by the complainant.  But it is not known to the OP No-2 that 'after running for years to the OP No-1 the claimant had received the said letter of the OP No-2' hence the same is denied. The OP No-2 states that he cannot be held jointly and severally liable either for payment of any dues or compensation, even if presumed any dues or liability pending against any one of them, as they have no Principal-Agent relationship in implementing the PMSBY Scheme. The OP No-2 added that PMSBY is a Government Scheme and Government has laid down certain rules/guidelines for its operation. The OP No-2, being a public sector insurance company, can not deviate from such guideline. According to that guidelines, the 'Participating Bank' (here the Punjab National Bank) will be the 'Master Policy Holder' on behalf of the participating subscribers. Thus in no way the OP No-1 can be held as agent of the OP No-2 while implementing the PMSBY scheme. Hence OP No-2 cannot be held responsible for any negligent act, if any, of the OP No 1. Further as per the said Policy guidelines, the claimant has to inform about the accidental death forthwith and has to apply to the concerned bank within one month of the accident for claim settlement by submitting all the relevant documents listed thereon. The bank has to send all these to the Insurance Company within 30 days and the insurance company has to take a decision within 30 days from the day of receiving the same. Thus at best the claim-settlement process should be completed within three months from the date of the accidental death of the account holder. But as the claim-settlement proposal/application had reached to the OP No-2 after 35 months from the date of the cause of action, hence this consumer case is clearly a time barred one under the consumer protection Act. The facts and circumstances of the case reveals that she had failed to apply within one month from the date of the accident, thus she herself violated the policy-guidelines of government relating to PMSBY and hence she is not entitled to be duly considered. That, the letter dated 10.05.2019 of OP No-2 was duly sent to the Corporate Office of the OP No-1 at New Delhi immediately after receiving the claim settlement proposal with respect to death of one Janmajay Bhoi vide letter dated 03.04.2019 of OP No-1 on 12.04.2019 . The copies of the said letter were duly sent to the OP No-1 and one Snehalata Bhoi of Rangiatikira, Jharagogua, Deogarh. Thus the OP No-2 has acted with utmost promptitude after receiving the said proposal for settlement of the claim. There is no deficiency of service or negligence on the part of the OP No-2. That, the OP No-2 is neither a necessary nor a proper party in this consumer dispute under the alleged facts and circumstances. Hence OP No- 2 is no way liable in this case and proper cost should be awarded to the OP No-2 being unnecessarily dragged to this litigation causing wastage of its public time and resources.

POINTS OF DETERMINATION:-

1. Whether the Complainant is comes under the purview of Consumer Protection Act-2019?
2. Whether the O.Ps has committed any Deficiency in Service to the Complainant?

From the above discussion and materials available on records we inferred that the Complainant comes under the purview of Consumers as she is the married wife of the deceased account holder who was having a savings bank account at Punjab National Bank who is the O.P-1 in this case. The O.P-2 repudiated the death claim of her husband for the only reason that the claim documents were reached to the O.P-2 with a delay of 35 days from the stipulated time period fixed by the Authority. According to the circular dated September 20th, 2011 (Annexure-A) issued by INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY Ref:-IRDA/HLTH/MISC/CIR/216/09/2011 Date: 20.09.2011 CIRCULAR To: All life insurers and non-life insurers -Delay in claim intimation/documents submission with respect to (i).     All life insurance contracts and (ii).  All Non-life individual and group insurance contracts The Authority has been receiving several complaints that claims are being rejected on the ground of delayed submission of intimation and documents. The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc. However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances. The insurers’ decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such limitation clause does not work in isolation and is not absolute. One needs to see the merits and good spirit of the clause, without compromising on bad claims. Rejection of claims on purely technical grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation. Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time. The insurers are advised to incorporate additional wordings in the policy documents, suitably enunciating insurers stand to condone delay on merit for delayed claims where the delay is proved to be for reasons beyond the control of the insured. This matter has been well settled in the case of  “Shriram General Insurance ... vs Rajesh Kumar Son Of Sh. Murari Lal”, on 10 March, 2014 by State Consumer Disputes Redressal Commission, Haryana, Panchkula.  Hence the Insurance Company is held liable for any deficiency in services to the complainant and we order as under.

                                                                                          ORDER

The Complaint petition is allowed. The O.P-2 is directed to release the appropriate Compensation amount in favour of the Complainant, under PMFB Yojana-2019 and settle the claim with 9% interest  per annum from the date of filling of this case i.e dtd. 18.02.2021 till its realization." The O.P is further directed to pay Rs. 20,000/-(Rupees Twenty Thousand) as compensation towards harassment, mental pain and agony, and Rs. 5,000/- (Rupees Five Thousand) towards the cost of litigation. All the above orders are to be carried out within 30 (Thirty) days of receiving of this order, failing which, the complainant is at liberty to proceed in due process of law.      

Order pronounced in the open court today i.e, on 10^th day of December-2021 under my hand and seal of this Commission.

Office is directed to supply copies of the Order to the parties free of costs receiving acknowledgement of the delivery thereof.

I agree,                                                                                             

 

MEMBER.                                                                                          PRESIDENT.

                                                      Dictated and Corrected

                                                                      By me.

                    President