BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I, U.T. CHANDIGARH

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The Haryana State Cooperative Supply and Marketing Federation Limited, Corporate Office, Sector 5, Panchkula, through its General Manager (F & A).

…..Complainant

                                V E R S U S

1]     Bharti AXA General Insurance Company Ltd. SCO No.350-51-52, 1^st Floor, Sector 34-A, Chandigarh, through its authorized signatory.

2]     Bharti AXA General Insurance Company Ltd., 1^st Floor, FEMS Icon, Survey No.28, Doddanakundi Village, K.R. Puram Hobli, Banglore 37, through its Managing Director

                                        ……Opposite Parties

CORAM:   SH.RAJINDER SINGH GILL 

PRESIDING MEMBER

DR.(MRS.) MADANJIT KAUR SAHOTA   

MEMBER

Argued by: Sh.Sanjeev Kumar, Counsel for complainant.

Sh.T.K.Joshi, Counsel for OPs.

PER RAJINDER SINGH GILL, PRESIDING MEMBER

              Precisely put, the complainant Society had availed a Group Personal Accident Policy for its employees from the OPs in the year 2009-2010 and 2010-2011 on payment of regular premium (Ann.C-1 to C-5).  It is submitted that the complainant submitted GPA claim of its 25 employees along with requisite documents for release of claim, out of which 2 claims were accidental death claims and 23 were accidental claims.  It is also submitted that the OPs instead of settling the claims, put of the matter on one pretext or the other.  The complainant wrote may letters to the OPs for settling the claims, but of no use. Hence, this complaint alleging the said act of OPs as gross deficiency in service.

2]           OPs filed joint reply and admitted the issuance of insurance cover to the complainant society.  It is stated that the complainant failed to register the claims with the OPs and even in the cases which were registered with the insurance company, the complainant failed to submit the claim documents.  It is also stated that the claims of the persons, as mentioned in Para NO.3 of the Reply, were not registered with the OPs by the complainant.  It is averred that only 8 claims were registered with the OPs. After considering these 8 claims, 5 claims were closed due to non submission of claim documents; two claims were closed due to breach of policy conditions & non-submission of claim documents and one claim was closed as No Claim due to non-coverage of claimant under the policy.  The complainant was duly informed about this fact.  However, the details of said 8 claims has also been mentioned in Para No.3 of the Reply.  It is also averred that the communication so made by the complainant in respect of its claims, have been duly replied.  It is pleaded that the complainant society has failed to register the claims with the Insurance Company and also failed to submit necessary documents.  Denying rest of the allegations, it is prayed that the complaint be dismissed. 

3]           Parties led evidence in support of their contentions.

4]           We have heard the ld.Counsel for the parties and have perused the record.

5]           The main contention of the ld.Counsel for the complainant is that the claim of its 25 employees, duly insured with OPs, have not been settled by the them till, which is gross deficiency in service on their part.

6]           On the other hand, the ld.Counsel for the OPs argued that they did not receive the claim of 17 persons as detailed in the reply.  It is also argued that 8 claims registered with them by the complainant society were also considered and Closed for one reason or the other, as detailed in the reply, and the same have duly been intimated to the Complainant, but the complainant itself failed to supply the requisite document & to do the needful to settle the said 8 registered claims.  Moreover, the complainant society even did not placed on record the required documents along with the present complaint.  Therefore, the allegations of any deficiency on the part of OPs, is baseless.  Rather, the complainant society is at fault. 

7]           We find force in the contention of the ld.Counsel for the OPs.  The complainant society was under legal obligation to supply all requisite documents, as asked for by the OP Company, for settlement of each & every claim.  Mere filing of claims with OPs would not give any right to the complainant to get the claim straightway.  The necessary procedure, under the policy and its terms & conditions, have to be followed and complied with by the complainant. 

8]           The perusal of the file reveals that the complainant society had not placed on record the claim forms and all such necessary documents, allegedly filed with the OPs along with the claim cases.  Only the forwarding letters have been placed on record showing that the claim were furnished with OPs, which, in our opinion, would not be sufficient enough to hold that complete claim forms along with requisite documents were actually sent to the OPs or not.  The complainant society, duly registered under the Haryana Cooperative Societies Act, a semi-government organization, certainly had retained & is in possession of record of all such claim cases along with documents, which they allegedly sent to the OPs.  Hence, there seems to be no hitch with the Complainant Society to furnish such documents afresh with the OPs to claim the benefit under the policy in question. 

9]           In the given circumstances, we deem it appropriate to direct the complainant society to file their claims afresh with the OPs along with all requisite documents, as desired/asked for & required for by them, as per the terms & conditions of the Policy, for settlement of the claims.  The OPs shall also consider such claims cases afresh and decide the same afresh within a reasonable time of 2 months from the date of its filing.  However, all claim cases, as mentioned in the complaint, must be filed within a period of 6 months from the date of receipt of copy of this order.  We order accordingly.  The complaint stands disposed of in the above terms. 

              Certified copies of this order be sent to the parties free of charge. The file be consigned.