Gompa Appalakonda vs BAJAJ ALLIANZ GENERAL INSURANCE CO LTD

THIS revision is directed against the order of the State Commission Andhra Pradesh dated 26.09.2012 in First Appeal No. 937 of 2011 whereby the State Commission reversed the order of the District forum and dismissed the consumer complaint filed by the complainant.

BRIEFLY stated facts relevant for the disposal of the revision petition are that Late Gompa Nagendra Yadav son of the petitioner opened a Saving bank account with respondent UTI Bank ( now AXIS Bank) on 14.12.2005 and an International Debit Card was simultaneously issued in his favour. It is the case of the complainant that holder of said International Debit Card was entitled to personal accident insurance cover of Rs.2.00 lacs pursuant to arrangement between respondent bank and the respondent insurance company. The respondent bank charged Rs.105/ - towards the issue of debit card. On 24.12.2005, Gompa Nagendra Yadav fell from a moving train and died. The petitioner came to know about the accident insurance cover only on 01.09.2008 and lodged the insurance claim on 10.09.2008. The respondents repudiated the insurance claim on 15.09.2008. According to the complainant, repudiation of claim amounts to deficiency in service.

OPPOSITE Party No.1 resisted the complaint on the plea that insurance claim was repudiated in accordance with the terms and conditions of the insurance policy. It was pleaded that as per the terms and conditions of the insurance policy, the insurance cover was contigent to the card holder indulging in point of sale transaction by using the debit card and since the deceased did not indulge in any such transaction, he was not entitled to the insurance cover. Respondent no.1 also pleaded that claim was rightly repudiated because it was submitted much later after the expiry of the stipulated period of 14 days from the date of occurrence. The opposite party bank in its written statement admitted that son of the complainant opened a saving bank account with the bank and he was issued an International Debit Card. According to opposite party bank, it had nothing to do with the insurance, as such, does not liable for the insurance claim. Learned District Forum on the consideration of the pleadings and appraisal of evidence allowed the complaint and directed the opposite party insurance company to pay the policy amount of Rs.2.00 lacs to the petitioner complainant with 9% interest thereon w.e.f.15.09.2008 besides compensation of Rs.10,000/ - and cost of Rs.5000/ -. The complaint against opposite party no.3 Bank was dismissed.

THE respondent insurance company being aggrieved of the order of the District Forum approached the State Commission in appeal and the State Commission vide impugned order allowed the appeal and dismissed the complaint. This led to filing of the revision petition.

LEARNED counsel for the petitioner has contended that State Commission has fallen in error in failing to appreciate that opposite parties were deficiency in service in failing to explain the terms and conditions of the insurance cover under the scheme in particular that the insurance cover would come into operation only after first point of sale transaction was conducted by the deceased by using the subject debit card. Learned counsel has thus urged us that revision petition be allowed the order of District Forum be restored.

LEARNED counsel for respondent no.1 and 2 as also respondent no.3 have argued in support of the impugned order.

I have considered the rival contentions and perused the record.

THE key question which requires determination in this revision petition is whether or not the deceased was covered by the insurance policy on the date of his death? Respondent no.1 and 2 has placed on record copy of Special Contigency Policy For Covering Debit Card. This policy contains an Exclusion Clause, which reads as under: "The policy becomes operational only after the Ist transaction through a POS (Point of Sale) however, the same shall not be required for Khan Market Police Station, Delhi Branch customers".

On reading of the above, it is clear that the operation of the insurance cover was contigent to the debit card holder using card for a transaction through a Point of Sale. Only exception to this clause was in respect of the customers of Khan Market Police Station Delhi Branch customers. Undisputedly, the deceased card holder was not a customer of Khan Market Police Station Branch. It is not the case of the petitioner that prior to his death, the deceased had used the debit card for any transaction through a Point of Sale i.e. merchant outlet. That being the case, the contigent insurance cover had not commenced. Therefore, the opposite party insurance company was justified in repudiating the insurance claim. Thus, the impugned order of the State Commission cannot be faulted.

LEARNED counsel for the petitioner has tried to wriggle out of this situation by arguing that at the time of issue of debit card, the terms and conditions of the insurance cover were not explained to the card holder by the bank officials. This plea of the petitioner is not acceptable for the reason that at the time of opening of the Saving bank account and issue of the debit card, the petitioner was not present and as such she could not have known whether or not the terms and conditions of the insurance cover under the scheme were explained to the deceased card holder. Otherwise also, perusal of the copy of the affidavit evidence of the petitioner filed in the consumer complaint would show that in this affidavit, the petitioner has no where stated that the terms and conditions of insurance claim under the debit card particularly the Exclusion Clause reproduced above were not explained to the card holder. Therefore, the above plea of the petitioner cannot be sustained.

IN view of the discussion above, I am of the opinion that order of the State Commission dismissing the complaint in view of the above noted Exclusion Clause cannot be faulted on facts. No jurisdictional error has been pointed out by learned counsel for the petitioner. Therefore, I have no reason to interfere with the impugned order in exercise of revisional jurisdiction. Revision petition is accordingly dismissed.