SRI. MARUTHI VADDAR

          MEMBER

1.     This complaint was brought U/s12 of the erstwhile Cp Act 1986 by Smt.Nisha.P Talreaj R/o Mysuru against opposite parties the branch manager Corporation Bank Siddartha layout branch Mysuru and the branch manager the new India Assurance Company ltd., Mangalore alleging deficiency in service praying this commission to pass an order directing the opposite parties to settle the entire claim of Rs.2,00,000/- alongwith interest at 18% p.a. from the date of claim till the date of payment and Rs.50,000/- towards harassment and mental agony alongwith cost and such other relief as this Hon’ble commission deems fit in the interest of justice and equity.
2.  Brief facts of the complaint in a nutshell as here under:-

      It is stated in the complaint that the 1^st opposite party has asked the husband of the complainant, Sri.Prakash.K Talreja to take PMSBY         policy (pradhan mantri Suraksha Bima Yojan) by explaining that the risk coverage available is Rs.2,00,000/- for accidental death and             permanent total disability and Rs.1,00,000/- for  permanent partial disability for a premium amount of Rs.12/- p.a. and was debited from        the account No.037600101005029 on 7/5/2015 and the passbook entry revealed the membership No.as 2015110104. The said amount of       Rs.12/- was debited on 31/5/2016 and subsequently on 31/5/2017.

3. It is further stated that the complainant husband met with an accident on 18/9/2015 and was admitted to Apollo BGS Hospital Kuvempunagar Mysuru with head injury. He was discharged  on 13/10/2015 with the need for prolonged treatment in the form of physiotherapy/rehabilitation, nursing care, skin/bowel/bladder care and subsequently admitted number of times and was discharged and there after died on 11/8/2017 leaving behind the complainant and a daughter and a son. On 12/9/2017 the Complainant contacted the 1^st opposite party and gave claim form along with all relevant documents and requested to settle the benefits under the said PMSBY. The complainant had received copy of letter dated.3/4/2018 which was addressed to Nodal officer of the 2^nd opposite party and on going through the contents it was understood that the Head office of the 1^st opposite party has forwarded the claim alongwith relevant documents to the 2^nd opposite party. The second opposite party has neither repudiated the said claims nor have credited the proceeds of the claim and have remained silent till day along with the 1^st opposite party. The 1^st opposite party is always pleading time on one or the other reasons. Hence this complaint. The act of the opposite parties in remaining silent on receipt of the genuine claim form alongwith documents amounts to deficiency in service and unfair trade practice.
4.  After registration of the complaint, notices were ordered to be issued to the opposite parties and in response to the notices opposite parties have appeared through their counsel and have filed written version. Opposite party NO.1 contends that the complaint filed by the complainant against the opposite party is not maintainable either inlaw or on facts. 1^st opposite party admits about the having of the SB account by the husband of the complainant. The husband of the complainant had voluntarily obtained the above said policy for a premium amount of Rs.12/- p.a and it was debited from the SB account of the said husband of the complainant towards the aforesaid policy. Regarding the accident to Sri.Prakash K. Talreja dated.18/9/2015 and the injuries sustained by him are not known to the 1^st opposite party. But it is true that complainant had given a claim form to the 1^st opposite party on 12-9-2017 to settle the PMSBY policy due to the death of said Prakash. The said policy amount was covered by second opposite party. Immediately, this 1^st opposite party has forwarded all the papers along with the claim form to the 2^nd opposite party.
5. It is further contended that 2^nd opposite party has rejected the claim of the complainant stating that “As per the terms and conditions mentioned in the PMSBY policy, for death/injury it shall be within 12 calendar months from the date of accident. In the present case, the said Prakash met with an accident on 18-9-2015 and he died on 11-8-2017. Hence the death of the said Prakash has taken place more than 23 months after the date of accident. Hence the claim is rejected. 1^st opposite party is only an agent between the complainant and 2^nd opposite party. If the complainant proves that her claim is valid as per the terms and conditions mentioned in the PMSBY policy before this commission, the adjudged award amount shall be fastened only against the 2^nd opposite party. Hence prays to dismiss the complaint as against the 1^st opposite party with exemplary costs.
6. The 2^nd opposite party has also filed its written version and contends that the complaint is not maintainable either in law or facts and liable to be dismissed the complaint is hopelessly bared by time. The alleged accident has occurred on 18-9-2015 but the complaint is filed on 19-2-2020 which is not maintainable. The opposite party is a Regd general insurance company and is governed  by the rules and regulations of IRDA and GIC. The 2^nd opposite party admits about the issuance of the personal accident insurance cover in favour of the deceased through 1^st opposite party and the sum insured is to the tune of Rs.2,00,000/- in case of death and Rs.1,00,000/- in case of permanent disability arising out of an accident. The liability of this opposite party under the said policy is strictly in accordance with the terms and conditions attached to the said policy. The deceased met with an accident on 18-9-2015 and he died on 11-8-2017 i.e., after one year and eleven months after the date of accident the complainant has not produced the post mortem report to show the cause of death. As per the terms and conditions of the said policy the insurance company would be liable to pay the sum insured if the death has occurred solely or directly from the injuries within 12 calendar months from the date of occurrence of the injury. Hence the claim is not payable.
7. Opposite party 2 further submitted that on the perusal of the documents it is seen that she has preferred a claim with the 1^st opposite party bank only on 12-9-2017 along with FIR, death certificate to the 1^st opposite party and the 1^st opposite party has sent the said papers only on 3-4-2018. The accident occurred on 18-9-2015 but as per this records the claim is preferred after more than 2 ½  years from the date of alleged accident and the complaint is filed on 19-2-2020 which is more than four years after the alleged accident. It is mandatory that the claim shall be accompanied by a post mortem report in case of death. In this case, it is clearly seen that no post mortem report is submitted either to the 1^st opposite party or to this opposite party or before this commission which is a vital document to entertain the claim. The complainant is not entitled to the claim of Rs.2,00,000/- with interest @18% p.a. and Rs.50,000/- towards mental agony as there is no deficiency of service on this opposite party. Hence prayed to dismiss the complaint with costs.
8. The complainant filed affidavit evidence and produced the documents as Ex.p1to p6. On the otherhand opposite party No.1 and 2 have filed their affidavit evidence and the same was taken  as Rw1 and Rw2 and have produced a policy copy.
9. Opposite parties 1 and 2 have filed their written arguments. 

10. Now the points that arise for the consideration of this commission are:-  

             1.Whether the complainant proves  the alleged deficiency in service on the part of the opposite parties and thereby she is entitled to the reliefs as sought?

2.What order?

11. Our findings to the aforesaid points is as here under :-

          Point No.1:-  Negative

   Point No.2 :- As per  the final order for the following

:: R E A S O N S ::

12.Point No.1:-  It is the specific case of the complainant that her deceased husband had obtained Pradhan Mantri Suraksha Bima Yojana policy from 2^nd opposite party through 1^st opposite party. The risk coverage is Rs.2,00,000/- for accidental death and permanent total disability and Rs.1,00,000/- for partial disability for a premium amount of Rs.12/- p.a. and the said amount of Rs.12/- was debited from the deceased’s A/c No.037600101005029 on 7/5/2015 and the passbook entry was revealed the membership no as 2015110104 and the said amount of Rs.12/- was debited on 31/5/2016 and 31/5/2017.

13. . It is the further case of the complainant that her husband was met with an accident, on head injury he was admitted to Apollo BGS Hospital Kuvempunagar Mysuru. He was discharged on 13/10/2015 with the need for prolonged treatment and subsequently admitted number of times and was discharged and there after died on 11/8/2017 leaving behind his legal heirs. On 12/9/2017 the complainant contacted the 1^st opposite party and gave claim form alongwith all relevant documents and requested to settle the benefits under the said policy. To prove the same the complainant filed her affidavit evidence and reiterated the averments of the complaint. Ex.p1  is the passbook copy in which the premium of Rs.12/- was deducted from the deceased A/c. Ex.p2 is the copy of the FIR and complaint dated.19/8/2015 for the RTA U/s 279, 337 IPC Regd against the driver of KA 01 EQ6335 for the accident caused to the deceased Ex.p3 is the discharge summary of the deceased, Ex.p4 death certificate, Ex.p5 is the claim form Ex.p6 letter sent by 1^st opposite party to second opposite party.
14. . According to 1^st opposite party, 1^st opposite party admitted the SB A/c obtained by the deceased and the premium paid by the deceased towards PMSBY policy and claim form submitted by the complainant to 1^st opposite party and 1^st opposite party forwarded all the papers with claim form to 2^nd opposite party. The 1^st  opposite party further submitted that if the complainant proves that her claim is valid as per the terms and conditions mentioned in the policy, the adjudged award amount shall be fastened only against the 2^nd opposite party.
15. . As per 2^nd opposite party, 2^nd opposite party admits about the issuance of the personal accidental insurance cover to the deceased through 1^st opposite party. The liability of this opposite party is strictly in accordance with the terms and conditions attached to the said policy. Opposite party further said that the deceased met with an accident on 18-9-2015 and he died on 11-8-2017 i.e., after one year and eleven months  after the date of accident. The complainant has not produced the post marten export to show the cause of death. As per the terms and conditions of the said policy the insurance company would be  liable only to pay the sum insured if the death has occurred  solely  or directly from the injuries within 12 calendar months from the date of occurrence of the injury. On the perusal of the documents it is seen that the complainant has preferred a claim with the 1^st opposite party bank on 12-9-2017 alongwith FIR, death certificate and the 1^st opposite party has forwarded the said papers only on 3-4-2018. The claim is preferred more then 2 ½ years from the date of alleged accident and the complaint is filed on 19-2-2020 which is more than four years after the alleged incident. Hence the claim is not payable.
16. . After looking into the rival contentions of both parties, it is observed that the deceased has obtained PMSBY policy from 2^nd opposite party through 1^st opposite party and the risk coverage is Rs.2,00,000/- for accidental death and permanent total disability and Rs.1,00,000/- for partial disability for a premium amount of Rs.12/- p.a. and the said amount was debited from the deceased’s A/c on 7-5-2015, 31-5-2016 and on 31-5-2017. The deceased Prakash Talreja was met with accident on 18/9/2015 and on head injury he was admitted to Apollo BGS Hospital and was discharged on 31/10/2015 with the need for prolonged treatment for physiotheraphy/rehabilitation nursing care, skin/bowel/bladder care. FIR was registered on 19/8/2015 against the unknown accused bearing the driver of KA 01 EQ6335 U/s 279, 337 of IPC and the deceased sustained head injury-left parietal/right Basiforntal ICH, diffuse Axonal injury, diabetes mellitus, Hypertension, Frature 2^nd RIB, and subsequently admitted number of times and was discharged and thereafter died on 11/8/2017 and after his death the complainant preferred claim of the said insurance amount from opposite parties. As per the terms and conditions of the policy, upon the happening of any event which may give rise to a claim under this policy, written notice with full particulars must be given to the company. According to this, the complainant has to inform the opposite parties after the injury done to the deceased but she has informed to the opposite parties with her claim form only on 12-9-2017. As per the opposite party No.2 it is mandatory that the claim shall be accompanied by a post mortem report in case of death. In the present case, the death is occurred and the complainant has to produce the post mortem report of the death of the deceased/injured. But no such document has been produced by the complainant and the complaint produced FIR, complaint etc., these documents are not necessary to claim the insurance amount. Since from 16/3/2022 the complainant and her counsel remained absent and has not filed written argument/submit oral arguments inspite of giving sufficient opportunities. Hence it is noticed that the complainant is not interested to proceed with the matter and failed to prove the case against opposite parties and hence the complaint of the complainant is deserved to be dismissed. Hence we answered this point as negative. 

12. Point No.2:- For the aforesaid reasons, we proceed to pass the following

:: ORDER ::

The complaint of the complainant is hereby dismissed.

There shall be no order to costs.

Furnish free copy of the order to both the parties.

      (Dictated to the Stenographer transcribed, typed by her, corrected by us and then pronounced in open Commission on this the             28^th  April 2023)