Haryana

Yamunanagar

CC/761/2010

Paramjit Kaur W/o Amrik Singh - Complainant(s)

Versus

Chola Mandalam MS General Insurance Compnay Ltd. - Opp.Party(s)

Nitin Arora

30 Aug 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

                                                                                    Complaint No. 761 of 2010

                                                                                    Date of institution: 16.08.2010

                                                                                    Date of decision: 30.08.2016.

Smt. Paramjit Kaur widow of late Amrik Singh, resident of Village Kherakalan, P.O. Talakor, Tehsil Jagadhri, District Yamuna Nagar.                              

                                  …Complainant.

                                                     Versus

1. Chola Mandalam MS General Insurance Company Ltd. Ist Floor, Plot No.8, Pusa Road, near Metro Pillar No.81, New Delhi-011 39813100.
2. D.E.T. Bharat Sanchar Nigam Ltd. Telephone Exchange, Yamuna Nagar.

                                                                                                                     …Respondents.                                       

 

Before: SH. ASHOK KUMAR GARG…………….. PRESIDENT.

            SH. S.C.SHARMA………………………….MEMBER.

 

Present:    Sh. V.K.Arora, Advocate, counsel for complainant.  

                 Sh. Rajiv Gupta, Advocate, counsel for respondent No.1.

                 Sh. Sushil Garg, Advocate, counsel for respondent No.2.             

 

 

ORDER

 

1.                     The present complaint has been filed by the complainant under section 12 of the Consumer Protection Act, 1986 praying therein that respondent No.1 (hereinafter referred as OP No.1 ) be directed to pay the insured amount of Rs. 50,000/- alongwith interest on account of death of Amrik Singh husband of the complainant and also to pay compensation as well as litigation expenses. 

 2.                    The present complaint has been filed by Smt. Paramjit Kaur being widow of deceased Amrik Singh with the averments that a landline telephone connection bearing No. 286874 was standing in the name of her husband deceased Amrik Singh and he was paying the bills regularly. As per terms and conditions of the scheme/policy of Op No.2 i.e. Bharat Sanchar Nigam Ltd. Telephone Exchange, Yamuna Nagar, every consumer of Bharat Sanchar Nigam Limited having landline telephone connection was covered under the insurance with OP No.1 for a sum of Rs. 50,000/- per connection in case of accidental death or permanent total disability due to accident and this fact was duly printed on the back side of the telephone bills sent to every customer. Photo copy of bill for the period from 01.04.2009 to 31.05.2009 is (Annexure C-1). Unfortunately, the husband of the complainant met with a roadside accident on 28.01.2009 on Jagadhri- Ambala Road and succumbed to the injuries on 28.02.2009 and in this regard an FIR bearing No. 21 dated 28.01.2009 under section 279/337 and 304-A IPC was registered with the police station Chhappar (Copy of FIR is Annexure C-2). After that complainant lodged the claim on account of death of her husband Amrik Singh with OP No.2 who forwarded the documents to OP No.1 as per policy of the BSNL. However, OP No.1 sent a letter dated 26.02.2010 to the complainant informing her that claim of the complainant was repudiated on the ground that time limit fixed for submission of claim was 60 days from the date of accident. The repudiation done by the OPs is totally illegal, arbitrarily and the same is liable to be set aside. It has been further mentioned that no such terms and conditions have ever been mentioned on the telephone bills sent to the complainant nor any policy or intimation was ever sent to the complainant or her husband regarding the stipulation of 60 days. Even otherwise, such condition is against the provision of law and natural justice and equity and good conscious. The complainant made several requests to make the payment of the sum insured of Rs. 50,000/- to the OP No.1 but the Op No.1 did not pay any heed. Hence, this complaint.

3.                     Upon notice, OPs appeared and filed its written statement separately. OP No.1 filed its written statement by taking some preliminary objections such as complaint is not maintainable; there is no negligence or deficiency in service; no cause of action ever arose in favour of the complainant; in this case a claim intimation regarding the death of Amrik Singh was received by the company for payment of claim amount under BSNL personal accident insurance policy. The claim was duly processed by the Insurance Company as per terms and conditions of the Insurance Policy taken by BSNL from OP No.1 Insurance Company. During process, it was found that claim has been intimated to the insurance company beyond the permissible time limit. As per condition No.5 of the insurance policy, the time limit fixed for submission of claim by the BSNL customer was 60 days from the date of occurrence of the accident. However, in this case, the reported date of loss is 28.01.2009 whereas OpNo.1 Insurance Company received the intimation on 13.02.2010 and accordingly the Op Insurance company vide its letter dated 26.02.2010 has rightly repudiated the claim of the complainant and on merit controverted the plea taken in the complaint and reiterated the stand taken in the preliminary objections and lastly prayed for dismissal of complaint against OP No.1.

4.                     OP No.2 filed its written statement by taking some preliminary objections and on merit it has been admitted that a land line connection bearing No. 286874 exists in the name of one Amrik Singh son of Katha Singh, resident of village Khera Kalan, PO Talakor, District Yamuna Nagar. It has been further admitted that there was a scheme of insurance to cover the landline subscriber with the OP No.1 Insurance Company by covering the subscriber as per terms and conditions of the insurance policy subject to completing the requisite formalities. it has been further submitted that upon receiving the documents by the OPNo.2 the same were sent to the OpNo.1 for settlement of the claim as per terms and conditions of the policy. However, it is correct that claim has to be settled only if the intimation is received within 60 days from the date of accident. Rest contents of the complaint have been denied. Lastly, prayed for dismissal of complaint.

5.                     In support the case, counsel for the complainant tendered into evidence affidavit of complainant Smt. Paramjeet Kaur as Annexure CX and photo copies of documents such as copy of telephone bill as Annexure C-1, copy of FIR No.21 dated 28.01.2009 as Annexure C-2, copy of death certificate of Amrik Singh as Annexure C-3, copy of postmortem report dated 01.03.2009 as Annexure C-4, copy of repudiation letter dated 26.02.2010 issued by Op No.1 as Annexure C-5, Photo copy of affidavit dated 25.03.2009 as Annexure C-6 and closed the evidence on behalf of complainant.

6.                     On the other hand, counsel for the Op No.1 tendered into evidence affidavit of Sh. Rakhi Anand Manager (Legal) as Annexure RW/A, copy of insurance group personal accident policy as Annexure R-1, photo copy of repudiation letter dated 26.02.2010 as Annexure R-2 and closed the evidence on behalf of Op No.1.

7.                     Counsel for Op No.2 tendered into evidence copy of BSNL Personal Accident Insurance Scheme as Annexure R2/1 and closed the evidence on behalf of OP No.2.

8.                     We have heard the learned counsel for both the parties and have gone through the pleadings as well as documents placed on file very minutely and carefully.

9.                     It is not disputed that deceased Amrik Singh was having a telephone connection bearing No. 286874 in his name and further it is also not disputed that said Sh. Amrik Singh met with a road side accident on 28.01.2009 and succumbed to the injuries on 28.02.2009 which is duly evident from the copy of FIR Annexure C-2 and copy of postmortem report as Annexure C-4 and copy of death certificate Annexure C-3. It is also not disputed that Op No.2 BSNL launched a scheme covering the risk of accidental death or permanent total disabilities due to accident in respect of customers of landline connection and obtained an insurance policy from Op No.1 insurance company covering the risk to the tune of Rs. 50,000/- per connection valid from 14.01.2009 to 13.01.2010 which is duly evident from the copy of insurance policy Annexure R-1.

10.                   The only plea of the OP Insurance Company is that as the claim was not lodged within a period of 60 days from the date of accident. Hence, the claim of the complainant has been rightly repudiated as per terms and conditions of the insurance policy vide its repudiation letter dated 26.02.2010 (Annexure R-2) whereas on the other hand, learned counsel for the complainant argued at length that complainant was lodged her claim with Op No.2 on 25.03.2009 i.e. within a stipulated period of 60 days which is evident from the copy of affidavit (Annexure C-6) and further argued that no such terms and conditions was mentioned on the telephone bill sent to the complainant nor any policy or intimation was ever supplied to the complainant or her husband regarding this stipulation condition of 60 days and referred the case law titled as Oriental Insurance Company Ltd. Versus Satpal Singh & Others, 2014(2) CLT Page 305, New India Assurance Company Ltd. New Delhi Versus Pabbati Sridevi & Others 2013(1) CLT page 589 and M/s Modern Insulators Ltd. Versus Oriental Insurance Co. Ltd. 2000(1) CPJ Supreme Court. Lastly, prayed for acceptance of complaint.

11.                   After hearing both the parties, we are of the considered view that the claim of the complainant has been wrongly repudiated by the OP No.1 Insurance Company on the flimsy ground whereas from the perusal of copy of affidavit dated 25.03.2009 (Annexure C-6) it is clearly evident that Op No.2 was duly informed within a stipulated period of 60 days from the date of death i.e. 28.02.2009. We have also perused the written statement filed by OP No.2 carefully and minutely wherein not a single word has been mentioned by Op No.2 that complainant has not lodged the claim with Op No.2 within a period of 60 days or the Op No.2 has not forwarded the case to the Op No.1 within the stipulated period. Even, the Op No.1 Insurance Company has also not filed any cogent evidence to prove that in fact the claim of the complainant was not lodged within a period of 60 days by OP No.2. Mere tendering the copy of insurance policy (Annexure R-1) and repudiation letter (Annexure R-2) it cannot be presumed that claim was lodged after a period of 60 days. Moreover, from the perusal of the telephone bill Annexure C-1, it is also clearly evident that no such type of condition has been printed on the telephone bill itself. It is also not the case of Op No.1 Insurance Company that they ever supplied the terms and conditions of the Insurance policy to the complainant or published the same at large in any newspaper. The case law referred by the counsel for the complainant are fully applicable in the present case.

12                    In the circumstances noted above, we are of the considered view that a genuine claim of the complainant has been wrongly repudiated by the Op Insurance Company just on the ground of late intimation whereas the IRDA has specifically issued directions to all the insurance companies That the insurer cannot reject claims amount for delay in intimation”. As such the complainant is entitled for relief.

13.                   Resultantly, we partly allow the complaint of complainant and direct the OP No.1 Insurance Company to pay a sum of Rs. 50,000/- to the complainant alongwith interest at the rate of 7% per annum from the date of filing of complaint till its realization and further to pay Rs. 2000/- as compensation for mental agony, harassment as well as litigation expenses. Order be complied within a period of 30 days after preparation of copy of this order, failing which complainant shall be entitled to invoke the jurisdiction of this Forum as per law.   Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced in open court 30.08.2016.           

                                                                                    (ASHOK KUMAR GARG )

                                                                                    PRESIDENT,

                                                                                   

 

                                                                                    (S.C.SHARMA )

                                                                                    MEMBER.