Haryana

Karnal

CC/41/2021

Kailasho Devi - Complainant(s)

Versus

Bajaj Allianz General Insurance Company Limited - Opp.Party(s)

Neeraj Sharma

20 May 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 41 of 2021

                                                        Date of instt.21.01.2021

                                                        Date of Decision:20.05.2024

 

1. Kailasho Devi wife of Shri Joginder Singh age 60 years, Aadhar card no.5671 4096 5125.
2. Nawab minor son of late Shri Ravi through his grandmother Smt. Kailasho Devi being natural guardian and next friend of minor Nawab, age one year. Aadhar card no.242 1729 1048.

 

                                                                        …….Complainants.

                                              Versus

 

1. Bajaj Allianz General Insurance Co. Ltd. through its Manager, Division Office, Karnal.
2. Bajaj Allianz General Insurance Co. Ltd. through its Manager Head Office: Bajaj Allianz House, Airport Road, Yerwada, Pune.

 

                                                                        …..Opposite Party.

 

Complaint under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr.  Suman Singh…..Member

 

 Argued by: Ms. Sonia, counsel for the complainant.

                    Shri  Atul Mittal, counsel for the OPs.

 

                     (Jaswant Singh, President)

ORDER:   

                

                The complainants have filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that Shri Ravi (since deceased)was the real son of the complainant no.1 and father of the complainant no.2. The complainants are fully dependent upon the said Shri Ravi. Said Ravi was insured, vide policy no.OG-20-3264-8428 for a sum assured of Rs.5,00,000/-.  Ravi regularly paid the premium against the said policy. Ravi died due to electric current on 26.09.2019 and his postmortem was conducted at Kalpana Chawla Government Medical College Hospital, Karnal. After the death of Ravi, his wife Smt. Mamta has remarried and now complainants are residing together and having no source of income. The intimation regarding the death of insured was given to the OPs. Complainants lodged a claim with the OPs and submitted all the required documents for settlement of the claim but OPs did not settle the claim despite repeated requests of complainants. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

 2.            On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action; locus standi; jurisdiction and concealment of true and material facts. On merits, it is pleaded that complainant had intimated the claim under GLOBAL PERSONAL GUARD policy in lieu of death of insured Ravi on 26.09.2019. The claimants are stated that insured died due to electric shock which is a concocted story in order to seek wrongful gains as the claim was falsely raised after five months from the date of loss i.e. 13.02.2020. There is delay in informing the OP, which amounts to violation of policy terms and conditions. The matter was thoroughly investigated and while investigation complainant was asked to submit the below mentioned necessary documents in order to process the claim but the claimants failed to submit necessary documents required for processing the claim:

1. Attested copy of FIR/Panchnama/Inquest Panchnama.
2. The contact details of nominee, that insured’s wife.
3. The final police report.

                It is further pleaded that as per the PMR is reflect that FIR is registered under section 302, 34 and 201 IPC in Madhuban Police Station and claimants are stating that deceased died due to electric shock which is hard to believe and it appears that false claim is filed by claimants before Commission by suppressing the true facts and till date no FIR is submitted by claimants. That final police report is also not shared by the claimants to support their claim. Hence, the OPs are not liable to pay any claim. The intimation was given to OPs by the wife of insured and nominee of the policy in question, vide letter dated 13.02.2020. Lateron, upon investigation claimants claimed that insured’s wife re-married on 21.01.2020 and did not gave any contact details. The claimants are concealing the material facts. Thereafter, several reminders and letters dated 27.03.2020 and 06.04.2020 were issued to claimants for seeking submission of required documents for processing the claim but claimants failed to submit any response to above-mentioned letters. The claim was rightly closed without any payment on the ground of non-submission of above-mentioned documents, vide closure letter dated 16.04.2020. There is no deficiency in service and unfair trade practice on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of Kailasho Devi Ex.CW1/A, copy of aadhar card of Kailsho Devi Ex.C1, copy of insurance policy Ex.C2, copy of post mortem report Ex.C3, copy of information supplied by the hospital/police record Ex.C4, copy of death certificate Ex.C5, copy of insurance policy Ex.C6, copy of health and wellness card Ex.C7, copy of affidavit of Mamta Ex.C8, copy of postmortem report Ex.C9, copy of aadhar card of Mamta Ex.C10, copy of aadhar card of second husband of Mamta Ex.C11, photograph of second marriage Ex.C12 and closed the evidence on 29.03.2023 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Saurav Khullar, working as Assistant Manager Ex.OW1/A, copy of insurance policy Ex.OP1, statement of Ashok Kumar Ex.OP2, statement of Prem Dass Ex.OP3 and closed the evidence on 18.09.2023 by suffering separate statement.

 6.            We have heard the learned counsel for the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for complainants, while reiterating the contents of the complaint, has vehemently argued that Ravi (since deceased) was insured with the OPs, for a sum assured of Rs.5,00,000/-. On 26.09.2019, Ravi died due to electric shock and his postmortem was conducted at Kalpana Chawla Government Medical College Hospital, Karnal. After the death of Ravi, his wife Smt. Mamta remarried. The intimation regarding the death of insured was given to the OPs. Complainants lodged a claim with the OPs and submitted all the required documents for settlement of the claim but OPs did not settle the claim despite repeated requests of complainants and lastly prayed for allowing the complaint.

 8.            Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that the complainant had intimated the claim in lieu of death of insured Ravi. The claim was falsely raised after five months from the date of loss i.e. 13.02.2020. There is delay in informing the OPs, which amounts to violation of policy terms and conditions. The matter was thoroughly investigated by the OPs and asked the complainant to submit the necessary documents in order to process the claim but the complainants failed to submit documents. Thus, the claim of complainants was rightly closed and prayed for dismissal of the complaint.

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, Ravi (since deceased) purchased a GLOBAL PERSONAL GUARD policy and his wife Mamta was the nominee in the said policy. It is also admitted that the sum assured in the said policy is Rs.5,00,000/-.

11.           The claim of the complainants has been closed by the OPs on 16.04.2020, on the ground of non-submission of the Attested copy of FIR/Panchnama/Inquest Panchnama, the contact details of nominee and the final police report. The complainants have alleged that they have completed all the formalities. The onus to prove their case was relied upon the complainants but they have miserably failed to prove the same by leading any cogent and convincing evidence. If the complainants have submitted the required documents/queries, they would have placed on file copies of the said documents.

12.           In the insurance policy Ex.C2, Mamta is the nominee. Since, Mamta is the nominee in the policy in question, the present complaint is neither filed by said Mamta nor complainants have impleaded said Mamta as a party the reason  known best to them. Further, complainants alleged that said Mamta had remarried and in this regard they have placed on file only photocopy of affidavit of Mamta Ex.C8. Complainants neither examined said Mamta nor tendered her original affidavit in the evidence. Complainants have also not submitted the contact details of the nominee. It appears that said Mamta has not left her right with regard to the claim. Except affidavit of the complainant no.1, complainants have not examined any reputed person from the locality to prove their version. Thus, photocopy of affidavit of Mamta has no value in the eyes of law.

13.           Admittedly, on the death of Ravi, the FIR no.346 dated 26.09.2019 under section 302, 34 and 201 IPC in Madhuban Police Station was registered. Complainants have neither placed on the file copy of said FIR nor final report under section 173 Cr.P.C. submitted by the Police. Insured died on 26.09.2019 but intimation was given to the OPs on 13.02.2020. The delay has not been explained by the complainants.

 14.          Thus, in view of the above discussion, the present complaint is devoid of merits and deserves to be dismissed and same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:20.05.2024                                                                     

                                                                President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Suman Singh)    

                     Member                    Member