Date of filing: 29.11.2021
Date of Disposal: 15.06.2023
BEFORE THE III ADDITIONAL BANGALORE URBAN
DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BENGALURU – 560 027.
DATED THIS THE 15th DAY OF JUNE, 2023
CONSUMER COMPLAINT NO.444/2021
PRESENT:
SRI.RAJU K.S,
1) Smt. Vanitha S.N,
Aged About 51 Years,
W/o. Vittalmurthy H.S,
2) Sri Vittalmurthy H.S,
Aged About 60 Years,
Both residing at:
Devegowdana Koppalu,
Pattasomanahalli Post,
Pandavapura Taluk,
Mandya District-571434.……COMPLAINANTS.
(Rep. by Sri. M. Laxmana, Advocate)
- V/s -
1) The Branch Manager,
Axis Bank, No.1388, 12th Cross,
Ananthanagar, Kammasandra,
Phase-1, Hebbagodi Panchayath,
Electronic City,
(Rep. by Sri. Ganesh Bhat.Y.H, Advocate)
2) The Branch Manager,
The New India Assurance Company
Limited, Regional Office,
No.301, 2B, Unity Building Annexe,
-
Mission Road, Bangalore-560027.
(Rep. by Dr.P.Ravishankar, Advocate)
//JUDGEMENT//
BY SRI. RAJU. K.S, MEMBER
01. The complainant has filed this complaint under Section- 35 of the Consumer Protection Act, 2019 seeking for a direction to opposite parties to pay a sum of Rs.1,00,000/- compensation for mental agony, pain and suffering along with death claim of debit card premium in respect of the deceased H.V. Akshay Kumar with interest at 18% per annum from the date of filing of the complaint.
02. The case of the complainants is that, complainant No.1 is the mother and complainant No.2 is the father of one Sri H.V. Akshay Kumar who is no more. The said H.V. Akshay Kumar was died on 07.02.2021 in a road traffic accident. The said H.V. Akshay Kumar was having one debit card with the opposite party No.1 and it was duly insured by the opposite party No.1 with the opposite party No.2. The opposite party No.1 has collected the amounts from its account holder and insured with the 2nd opposite party as per RBI guidelines.
03. After demise of the said H.V. Akshay Kumar the complainants filed claim form with the opposite party No.1 and the opposite party No.1 rejected the claim of the complainants vide their letter dated: 08.09.2021 by stating that, “the death claim is rejected on the grounds of delay in submission of the claim documents as per agreed terms and conditions”.
04. Since the complainant residing in Pandavapura Taluk and opposite party No.1 is having office in the Bangalore City, there is delay in filing the claim form in time. Further it is submitted that, due to COVID-19 lockdown the complainants not filed claim form within stipulated time as prescribed by the opposite parties. Rejection of the claim of the complainants is highly illegal, arbitrary and it attracts deficiency of service by the opposite parties. Since the deceased H.V. Akshay Kumar is only bread earner of the family of the complainants and from his death the complainant’s family suffering with mental agony. In that event the opposite parties have to honour the claim of the complainants. But the opposite parties have repudiated the claim of the complainants without any valid reason. Hence there is no other way the complainants filed this complaint as sought for.
05. The opposite party No.1 has filed their version and denied the allegations of the complainant. The opposite party No.1 specifically stated that, the deceased H.V. Akshay Kumar having savings bank account No.917010014584161 and he was provided debit card bearing No.5346800025305686. Further the said debit card having personal accident coverage by the opposite party No.2 subject to terms and conditions. The complainant No.1 on 22.07.2021 had lodged the claim form and informed the death of her son Akshay Kumar H.V. On the same day the opposite party No.1 – Bank had furnished document relating to the process of personal accident claim and informed the complainants have to furnish duly filled claim form with supporting documents. After furnishing of the same the claim form was duly processed to the opposite party No.2 – insurance company. The opposite party No.2 – insurance company on 07.08.2021 repudiated the claim by saying “delay in submission of the claim documents as per agreed policy T & C (171)”. Further the opposite party No.1 stated that, being the commercial bank and corporate agent of the opposite party No.2 the Bank role is only facilitator and actual insurance is issued by the opposite party No.2. Further there is no role by the opposite party No.1 – Bank in the repudiation of the claim and there is no deficiency of service by the opposite party No.1. There is no privity of contract between the complainants and opposite party No.1-Bank and pray for reject the claim of the complainants.
06. The opposite party No.2 has filed their version and specifically stated that, the above said insurance policy is subject to agreed terms and conditions. There is no privity of contract in between complainant and opposite party No.2 and the complaint is not maintainable against opposite party No.2. Hence there is no deficiency of service by the opposite party No.2. The opposite party No.1 has processed the claim of the complainants and there is no role by the opposite party No.2 in the process of the claim made by the complainants. Hence, it is sought for dismissal of the complaint against opposite party No.2.
07. Complainant No.1 has filed affidavit in the form of her evidence in chief and got marked EX.P.1 to P.10 documents. The authorized representative of opposite party No.1 (RW-1) has filed his affidavit in the form of his evidence in chief and got marked EX.R.5 to R.9 documents. The authorized representative of opposite party No.2 (RW2) has filed affidavit in the form of her evidence in chief and got marked EX. R.1 to EX.R.4 documents.
08. The counsel for opposite party No.2 files their written arguments. Heard the arguments.
09. The points that would arise for consideration are as under:-
(1) Whether the complainants have proved the deficiency of service in rejecting the claim of the complainants by the opposite parties?
(2) Whether the complainants are entitle for the relief as sought in the complaint ?
(3) What order ?
10. Our findings on the aforesaid points are as follows:
Point No.1 : In affirmative
Point No.2 : Partly affirmative
Point No.3 : As per the final order
for the following:
REASONS
11. POINT NO.1:- In this complaint there is no dispute with regard to the complainants deceased son H.V. Akshay Kumar having debit card No. 5346800025305686 under savings bank account No.917010014584161 with the opposite party No.1. Further there is no dispute with regard to the said SB account is indemnified by the opposite party No.2. Further the said H.V. Akshay Kumar was died on 07.02.2021 in a road traffic accident. Complainants informed the death of the said H.V. Akshay Kumar on 22.07.2021 vide EX.P.1 and the insurance claim was raised under S.R. No.68497267.
12. As per para-4 of the version of opposite party No.1 the said claim is rejected by opposite party No.2 – insurance company due to “delay in submission of the claim documents as per agreed policy”. As per EX.P.2 the opposite party No.1 processed the claim of the complainants and requested to submit requisite documents with claim form. EX.P.5 is the Death Certificate of the said H.V. Akshay Kumar. AS per EX.P.10 the claim of the complainants is rejected due to delay in submission of the claim documents as agreed policy terms and conditions vide opposite party No.1 letter dated: 08.10.2021. The submission of the opposite party No.1 that, they processed the claim form and sent the same to the opposite party No.2 – insurance company for further action is utterly false. The opposite party No.1 did not processed the claim of the complainant and the same is not sent to the opposite party No.2 – insurance company. The opposite party No.2 not processed any claim of the complainants due to the claim form is not sent to them.
13. As per EX.P.1 the claim of insurance was sent to the opposite party No.1 – Bank on 16.07.2021. The opposite party No.1 nowhere stated stipulated time for submission of claim form. Even in EX.P.10 repudiation letter the opposite party No.1 not stated any period for submission of the claim documents. As per EX.R.2 Clause-7 specifies that, the claim submission within 60 days 100% claim amount, claim submission within 61 to 90 days 80% of the claim amount, greater than 90 days the claim amount will not be payable by the insurer to Axis Bank i.e., opposite party No.1. It is the EX.R.2 produced by the opposite party No.1 and contents of the documents are specified by the opposite party No.1 itself. Moreover it is the period of pandemic and the whole country was lock-downed at this period. The people movement was restricted at this period.
14. There is an onerous responsibility on the part of the insurer and their agent while dealing with an exclusion clause. The insurer is statutorily mandated as per IRDA Regulation to secure the interest of the insured person. If there is any exclusion Clause with regard to the policy condition the same shall be intimated to the insured person. In the present complaint neither the Bank nor the insurance company i.e., opposite party No.1 & 2 were not intimated policy conditions prior. Admittedly due to pandemic lockdown reason the complainants not produced claim form at earliest. Hence there is no delay in filing the claim form. In our view, the claim is to be honoured by the opposite parties and there is deficiency in service in rejecting the claim of the complainants. Hence we answered point No.1 in affirmative by allowing the claim of the complainants.
15. POINT NO.2:- In this complaint neither the complainants nor the opposite parties did not specified what was the insured amount by virtue of debit card. At the time of argument the counsel for opposite party No.2 has stated that, the insurance amount is Rs.5,00,000/-. Anyhow the complainants are entitled to the whole insured amount payable by the opposite parties. The opposite parties jointly and severally pay the insurance amount to the complainants. In addition to that, the complainants entitle for Rs.20,000/- compensation for mental agony and inconvenience caused by the opposite parties. Further the complainants are also entitle for Rs.10,000/- towards litigation cost. Hence we answered point No.2 partly affirmative.
16. POINT NO.3:- In view of the discussion made above, we proceed to pass the following:-
ORDER
The complaint is allowed-in-part.
The opposite parties are hereby directed to pay jointly and severally the insurance amount to the complainants as assured with interest at the rate of 9% per annum from the date of claim till realization.
The opposite parties are also directed jointly and severally to pay to the complainants a sum of Rs.20,000/- towards compensation for mental agony and inconvenience and a sum of Rs.10,000/- towards litigation costs.
The opposite party No.1 & 2 shall comply the order within 30 days. In case opposite party No.1 & 2 fail to comply the order within the above said period, the above said amount of Rs.30,000/- carries interest at the rate of 9% per annum from the date of order till realization.
Supply free copy of this order to both the parties and return extra copies of the pleading and evidence to the parties.
Applications pending, if any, stand disposed-off in terms of the aforesaid judgment.
(Dictated to the Stenographer, typed by him, the transcript corrected, revised and then pronounced in the open Commission on 15th day of June, 2023)
//ANNEXURE//
Witness examined for the complainant side:
Smt. Vanitha S.N, the complainant No.1 (PW.1) has filed affidavit in the form of her evidence in chief.
Documents marked for the complainants side:
1. Request an approval accident insurance claim dt.16.07.2021 – EX.P.1.
2. Axis Bank letter dt.22.07.2021 with unfilled claim form – EX.P.2.
3. Copy of Debit card – EX.P.3.
4. Copy of bank statement dt.08.09.2021 – EX.P.4
5. Notarized copy of death certificate of H.V. Akshaya Kumar – Ex.P.5.
6. Copy of affidavit dt.07.09.2021 with ID card – EX.P.6.
7. Copy of ration card – Ex.P.7.
8. Copy of Aadhar card – EX.P.8.
9. Copy of PAN card – Ex.P.9.
10. Repudiation letter dt.08.09.2021 – EX.P.10.
Witness examined for the opposite party No.1 side:
Sri. Sanjoyu Banerjee, Branch Head in opposite party No.1 (RW-2) has filed affidavit in the form of his evidence in chief.
Documents marked for the Opposite Party No.1 side:
1. Certificate U/s. 65(B) of Indian Evidence Act – Ex.R.5.
2. Copy of letter addressed by complainant dt.16.07.2021 – EX.R.6.
3. Copy of letter dt.22.07.2021 addressed by OP-1 with enclosures – EX.R.7.
4. Copy of view service request – Ex.R.8.
5. Copy of letter dt.08.09.2021 – Ex.R.9.
Witness examined for the opposite party No.2 side:
Smt. Radhika M.A, Deputy Manager at opposite party No.2 (RW-1) has filed affidavit in the form of her evidence in chief.
Documents marked for the Opposite Party No.2 side:
1. Letter of authorization – EX.R.1.
2. Computer downloaded service level agreement – EX.R.2.
3. Computer downloaded copy of rejection of claim in letter dt.08.09.2021 by OP No.1 – EX.R.3.
4. Computer downloaded copy of policy terms and conditions – Ex.R.4.
