Haryana

Karnal

CC/366/2021

Parveen - Complainant(s)

Versus

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

Narender Shandilya

12 Jun 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No.366 of 2021

                                                        Date of instt.29.07.2021

                                                        Date of Decision:12.06.2024

 

1. Parveen son of Shri Jaipal
2. Sudesh wife of late Shri Jaipal

Both residents of village Gangatehri, tehsil Assandh, District Karnal.

 

                                                                   …….Complainants.

                                              Versus

 

Bajaj Allianz General Insurance Company Ltd. Pary Hotel, opposite GPO, First floor, staff Rd, Ambala Cantt. through its Divisional Manager.

                                                                     …..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: Shri Narender Sandilya, counsel for the

    complainants.

                    Shri Atul Mittal, counsel for the OP.

 

                     (Jaswant Singh, President)

ORDER:   

                

                The complainants have filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that brother of complainant no.1 and son of complainant no.2 namely Amit was owner of a motorcycle bearing registration no.HR-40-H-2732 and he got insured his motorcycle with the OP, vide policy no.OG-21-9999-9960-00000042, valid from 26.11.2020 to 25.11.2022. The name of nominee Amit was wrongly mentioned as Jaipal predeceased Amit and there is no other legal heir of Amit except the complainants. On 16.01.2021 Amit met with an accident and he sustained multiple injuries in the same and lateron succumbed to the injuries. As per the terms of the abovesaid policy, in case of death of insured, the OP is liable to pay a sum of Rs.3,00,000/- under Global Personal Guard for one year head to the legal heirs of the deceased insured, however, till today, no amount was paid by the OP to the complainants. Since the deceased died during the subsistence of policy, the OP is under a legal obligation to pay the abovesaid amount to the complainants, who is brother and mother of deceased Amit. The complainants lodged the claim with the OP and also submitted all the relevant documents for settlement of the claim. Thereafter, complainants requested the OP several times to release the claim but OP did not pay any heed to the request of complainants and lingered the matter on one pretext or the other. Then complainant sent a legal notice dated 23.04.2021 to the OP but it also did not yield any result. In this way there is deficiency in service and unfair trade practice on the part of the OP.  Hence this complaint.

2.             On notice, OP 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 the complainants are claiming the claim with regard to death of Amit wherein as per policy the nominee of deceased insured is Mr. Jaipal. None of complainants are mentioned in the policy as nominee. The complainant failed to furnish any documents in regard to succession of deceased. The complainant is making false representation as the insurers never denied any claim of complainant. The complainant raised his claim on the online portal whereby it was obligatory to submit the relevant documents in support of claim within one month. On failure to do so the claim was auto closed in the system. The complainants thereafter never approached the OP for the claim. The claim was automatically closed due to non-submission of documents and the OP is not liable in such scenario. Thus, the complaint is not maintainable and is liable to be dismissed. There is no deficiency in service and unfair trade practice on the part of the OP. 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 his affidavit Ex.CW1/A, copy of Police Rukka Ex.C1, copy of prescription slip of deceased Amit Kumar Ex.C2, copies of invoices Ex.C3 and Ex.C4, copies of lab report Ex.C5 and Ex.C6, copy of treatment record Ex.C7, copy of MLR of deceased Ex.C8, copy of insurance policy Ex.C9, copy of letter of policy Ex.C10, photographs of motorcycle  Ex.C11 to Ex.C14 and closed the evidence on 05.04.2022 by suffering separate statement.

5.             On the other hand, learned counsel for the OP has tendered into evidence affidavit of Saurav Khullar General Manager Ex.OW1/A, copy of insurance policy Ex.OP1, copy of terms and conditions of the insurance policy Ex.OP2 and closed the evidence on 14.07.2023 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 the complainant, while reiterating the contents of complaint, has vehemently argued that Amit brother of complainant no.1 and son of complainant no.2 was the registered owner of motorcycle bearing registration no.HR-40-H-2732 and the said motorcycle was insured with the OP. On 16.01.2021, Amit died in a road side accident. The name of nominee Jaipal was wrongly mentioned as he had already died. Except the complainants there are no other legal heirs of deceased Amit. Complainants informed the OP about the death of Amit and lodged the death claim with the OP and submitted all the required documents and also requested the OP to release the amount of Rs.3,00,000/- as insured amount payable under the policy but the officials of the OP did not pay any heed to the request of the complainants and ultimately refused to pay the claim and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel for the OP, while reiterating the contents of written version, has vehemently argued that the present complaint is pre-mature as the complainants never lodged the claim regarding the death of insured before the OP and lastly prayed for dismissal of the complaint.

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

10.           The complainants have alleged that on 16.01.2021 insured Amit expired in roadside accident. They submitted claim alongwith relevant documents to the OP for settlement of the death claim insured Amit. The onus to prove their case was relied upon the complainants but they have miserably failed to prove their case by leading any cogent and convincing evidence. There is nothing on the file to prove that after the death of Amit, complainants have submitted the claim with the OP. No date, month and year has been mentioned by the complainant for submission of the claim with the OP. If the complainants had submitted the claim with the OP and supplied the required documents, they would have placed on file the copy of said documents. Complainants have placed on file only copy of Police Rukka Ex.C1, copy of prescription slip of deceased Amit Kumar Ex.C2, copies of invoices Ex.C3 and Ex.C4, copies of lab report Ex.C5 and Ex.C6, copy of treatment record Ex.C7, copy of MLR of deceased Ex.C8, copy of insurance policy Ex.C9, copy of letter of policy Ex.C10, photographs of motorcycle Ex.C11 to Ex.C14, except these documents there is nothing on file to prove that they have submitted the claim with the OP and it has been proved on record that complainants have not submitted the claim form alongwith relevant documents with the OP. Hence, in view of the above, at this stage, the present complaint is premature and not maintainable. Furthermore, no post mortem report has also been placed on file to ascertain the cause of death of Amit. Admittedly, Shri Jaipal was the nominee of Amit. Complainants have alleged that said Jaipal had already expired but death certificate of Jaipal has not placed on file by the complainants.

 11.          In view of the above observation, the present complaint is disposed of, with the liberty to the complainants to submit the claim form alongwith required documents to the OP and on receipt of the same, OP is hereby directed to settle the claim of the complainants within 45 days from the date of receipt of copy of the order. No order as to costs. This order shall be complied with accordingly. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 12.06.2024

                                                                    President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Suman Singh)

                          Member                     Member