Punjab

Sangrur

CC/329/2018

Manpreet Kaur - Complainant(s)

Versus

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

Sh.Gurbachan Singh Nehal

16 Aug 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR .

                                                                        Complaint No. 329

 Instituted on:   08.08.2018

                                                                         Decided on:     16.08.2019

 

1. Manpreet Kaur aged about 25 years wife of late Sh. Amritpal Singh son of Darshan Singh;

2. Ishmeet Singh aged about 3 years son of Late Sh. Amritpal Singh, minor under the guardianship of his mother Manpreet Kaur, both residents of Patti Malkani, VPO Badbar, Tehsil & District Barnala now resident of Tapinder Singh son of Sh. Jeet Singh, resident of Village Palasaur, Tehsil Dhuri 148 024, Distt. Sangrur.

                                                          …. Complainants.   

                                                 Versus

1.     Bajaj Allianz General Insurance Company Limited, Registered Office: GE Plaza, Airport Road, Yerwada, Pune 411 014 through its Managing Director 411006.

2.     Bajaj Allianz General Insurance Company Limited, Feroze Gandhi Market, Ludhiana through its Managing Director 141 001.

             ….Opposite parties. 

Counsel for the complainants: Shri G.S.Nehal, Adv.              

Counsel for the OPs              : Shri Bhushan Garg, Adv.

 

 

Quorum                                           

Shri Amrinder Singh Sidhu, President

Ms. Vandana Sidhu, Member

 

 

ORDER BY:     

Shri Amrinder Singh Sidhu, President.

1.             The complainants filed this complaint pleading that the husband of the complainant number 1 and father of the complainant number 2 namely Amritpal Singh (referred to as deceased in short) obtained Family Health Insurance policy namely Star Package policy from the opposite parties under which all the family members  were insured for Rs.1,50,000/- on floater basis and for an amount of Rs.2,00,000/- under personal accident coverage under policy bearing number OG-16-1214-8421-00000045 for the period from 22.8.2015 to 21.8.2016 but no terms and conditions of the policy were issued to the husband of the complainant number 1.  The case of the complainants is that on 8.8.2016 the husband of the complainant number 1 was returning to his village on motorcycle bearing registration number PB-19-L-7333 from the loan fair held at village Bhure and husband of the complainant number 1 was followed by his friend Lokesh Kumar son of Rameshwar Dass, resident of village Badbar on a separate motorcycle.  When they reached near Rest House, Near Harigarh bridge, then in the meantime a stray animal came in front of the motorcycle of Amritpal Singh and the motorcycle became out of control and the motorcycle fell on the side of the canal and due to accident Amritpal Singh fell into the river.  Lokesh Kumar tried to save Amritpal Singh, but due to strong current of water, Amritpal Singh swept away. Later on his dead body was found at village Bugran, Tehsil Dhuri, District Sangrur, of which DDR number 12 dated 10.8.2016 was lodged at PS Dhanaula and postmortem on the dead body was also conducted at Civil Hospital Barnala. Further case of the complainants is that husband of the complainant number 1 died an accidental death, therefore, the complainant lodged the claim with the Ops for release of the claim amount but the Ops vide letter dated 29.6.2017 closed the claim file on the ground that the final police report has not been submitted, whereas the complainant number 1 has already submitted all the documents with the Ops.  Lastly, the complainants have prayed that the Opposite parties be directed to release the claim amount of Rs.2,00,000/- along with interest @ 18% per annum from the date of death of Amritpal Singh till realization and to pay Rs.50,000/- on account of mental tension, agony and physical harassment and an amount of Rs.22,000/- on account of litigation expenses.

2.             After the notice being served upon the opposite parties, the opposite parties appeared through Advocate Shri Bhushan Garg and filed written version. In written version taking preliminary and legal objections that the complaint filed by the complainant is gross abuse of process of law and is absolutely false, frivolous and vexatious, that the complaint is not tenable, that the complainant has not come to the Forum with clean hands. That the complaint is not maintainable and that the complainant has not obtained succession certificate before filing the present complaint, that all LRs of deceased are required to be made party in this case, that the claim of the complainant was duly processed by the Ops by way of appointment of JD Health Care Services, Kharar, who had minutely investigated the matter and submitted his report. Investigator revealed from the investigation from the villagers that Amritpal Singh has committed suicide due to financial issues but nobody had given in written.  Further the Ops on scrutinizing documents submitted by the insured, the investigating report and observing on above mentioned facts issued letters dated 31.1.2017, 15.2.2017 and 2.3.2017 to provide the required documents but due to non reply or non cooperation from the complainant, the claim of the complainant was closed by the Ops vide letter dated 23.8.2018, that the complaint of the complainant is premature and the same is liable to be dismissed.

3.             On merits, it is denied that the Ops issued only health card rather Ops issued policy alongwith the terms and conditions.  It is stated that Amritpal Singh deceased obtained Star package policy from the Ops bearing number OG-16-1214-8421-00000045 for the period from 22.8.2015 to 21.8.2016 for Rs.2,00,000/-. It is stated that as per investigation report the deceased has committed suicide which is not covered under the policy and the claim is not payable if death was result of suicide.  It is further stated that the flow of water of the river from Harigarh village Bridge is towards Bathinda side and not towards Dhuri side. Either complainant is lying false that body of deceased Amritpal Singh found at Village Bugran, Tehsil Dhuri, District Sangrur or Lokesh Kumar who lodged the false DDR after two days of the alleged accident who stated that when they reached near Harigarh Bridge, deceased Amritpal Singh while saving accident of his vehicle when a stray animal suddenly came before, fallen the side of canal Harigarh Bridge and after that he fell into the canal. Lastly, the Ops have prayed for dismissal of the complaint.

4.             The complainant has tendered documents Ex.C-1 to Ex.C-9 and closed evidence. The opposite parties have produced Ex.OP-1 to Ex.OP-6 and closed evidence.

5.             We have gone through the pleadings of the parties and documents placed on record by the parties as well as heard the arguments advanced by the learned counsel for the parties.

6.             The learned counsel for the complainant has contended that the husband of complainant number 1 Shri Amritpal Singh obtained Family Health Insurance policy namely Star Package policy from the opposite parties under which all the family members  were insured for Rs.1,50,000/- on floater basis and for an amount of Rs.2,00,000/- under personal accident coverage under policy bearing number OG-16-1214-8421-00000045 for the period from 22.8.2015 to 21.8.2016 but no terms and conditions of the policy were issued to the husband of the complainant number 1.  Further the learned counsel for the complainant has contended that on 8.8.2016 the husband of the complainant number 1 was returning to his village on motorcycle bearing registration number PB-19-L-7333 from the loan fair held at village Bhure and husband of the complainant number 1 was followed by his friend Lokesh Kumar son of Rameshwar Dass, resident of village Badbar on a separate motorcycle.  When they reached near Rest House, Near Harigarh bridge, then in the meantime a stray animal came in front of the motorcycle of Amritpal Singh and the motorcycle became out of control and the motorcycle fell on the side of the canal and due to accident Amritpal Singh fell into the river.  Lokesh Kumar tried to save Amritpal Singh, but due to strong current of water, Amritpal Singh swept away. Later on his dead body was found at village Bugran, Tehsil Dhuri, District Sangrur, of which DDR number 12 dated 10.8.2016 was lodged at PS Dhanaula and postmortem on the dead body was also conducted at Civil Hospital Barnala. Further the learned counsel for the complainant has contended that the husband of the complainant number 1 died an accidental death, therefore, the complainant lodged the claim with the Ops for release of the claim amount but the Ops vide letter dated 29.6.2017 closed the claim file on the ground that the final police report has not been submitted, whereas the complainant number 1 has already submitted all the documents with the Ops.             

7.             On the other hand, the learned counsel for the Ops has contended that Shri Amritpal Singh deceased/insured obtained Star package policy from the Ops bearing number OG-16-1214-8421-00000045 for the period from 22.8.2015 to 21.8.2016 for Rs.2,00,000/-. It is stated that as per investigation report the deceased has committed suicide which is not covered under the policy and the claim is not payable if death was result of suicide.  It is further stated that the flow of water of the river from Harigarh village Bridge is towards Bathinda side and not towards Dhuri side. Either complainant is lying false that body of deceased Amritpal Singh found at Village Bugran, Tehsil Dhuri, District Sangrur or Lokesh Kumar who lodged the false DDR after two days of the alleged accident who stated that when they reached near Harigarh Bridge, deceased Amritpal Singh while saving accident of his vehicle when a stray animal suddenly came before, fallen the side of canal Harigarh Bridge and after that he fell into the canal. Lastly, the learned counsel for the Ops has contended that the claim is not payable to the complainants as the deceased died a suicide death.

8.             It is proved on record vide Ex.C-1 that the deceased Shri Amritpal Singh was insured with the Ops for Rs.2,00,000/-in case of accidental death.  In the present case it is the case of the complainants that Amritpal Singh died an accidental death when a stray animal came in front of the motorcycle of Amritpal Singh and the motorcycle became out of control and the motorcycle fell on the side of the canal and Amritpal Singh fell into the canal, which could not be saved despite best efforts.  Ex.C-4 is the copy of DDR, which clearly reveals that Shri Amritpal Singh died due to felling in the canal and Ex.C-5 is the copy of postmortem examination report and Ex.C-6 is the copy of death certificate of Amritpal Singh.   On the other hand, the learned counsel for the Ops has contended that Shri Amritpal Singh has committed suicide due to financial issues, but we are unable to go with this contention of the learned counsel for the Ops as the Ops have not produced iota of evidence to support this contention nor the Ops have produced any conclusive evidence to show that Shri Amritpal Singh died due to suicide committed by him. Moreover, Ops even failed to prove that insured was suffering from financial crises as alleged by Ops.  As such, we are of the considered opinion Shri Amritpal Singh has died due to accidental death and the Ops are deficient in rendering service by not paying the claim amount to the complainants.

9.             As such, we allow the complaint and direct the Ops to pay to the complainants an amount of Rs.2,00,000/- along with interest @ 9% per annum from the date of filing of the present complaint i.e. 8.8.2018 till realization.  It is further directed to pay a lump sum compensation of Rs.5000/- for mental agony, harassment and litigation expenses.  This order be complied with by the opposite parties within 30 days from the date of receipt of certified copy of this order. A certified copy of this order be issued to the parties free of cost as per rules. File be consigned to records.

                        Pronounced.

                        August 16, 2019.

 

                        (Vandana Sidhu)      (Amrinder Singh Sidhu)

                                Member                       President