Punjab

Faridkot

CC/19/40

Harjinder Kaur - Complainant(s)

Versus

Directorate of Health and family welfare - Opp.Party(s)

Kailash Kumar Goyal

10 Dec 2019

ORDER

      DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FARIDKOT

 

Complaint No. :        40 of 2019

Date of Institution:   18.02.2019

Date of Decision :    10.12.2019

 

1. Harjinder Kaur aged about 35 years wife of Late Kulveer Singh  alias Kulbir Singh son of Ghinna Singh.
2. Satveer Kaur aged about 18 years daughter of Kulveer Singh,
3. Avtar Singh aged about 17 years minor son of Kulveer Singh.

Minors through their mother Smt Harjinder Kaur (as their natural guardian and next friend)

All residents of Street No.3, Near Baba Jiwan Singh Gurudwara, Baja Khana, District Faridkot.

...Complainant

Versus

 

1. Directorate of Health and Family Welfare Punjab, Parivar Kalyan Bhawan, Sector 34-A, Chandigarh through its Authorized Signatory.
2. Director, Bhagat Puran Singh Sehat Beema Yojna, c/o Directorate of Health and Family Welfare Punjab, Parivar Kalyan Bhawan, Sector 34-A, Chandigarh through its Authorized Signatory.
3. Senior Medical Commissioner, (Designated under Bhagat Puran Singh Sehat Beema Yojna) Office of Civil Surgeon, Faridkot, Tehsil and District Faridkot.

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4. United India Insurance Company Limited, SCO 72, Phase IX, Mohali, Division Office, Mohali through its Branch Manager/ Authorized Signatory.

 .....Opposite Parties

Complaint under Section 12 of the

Consumer Protection Act, 1986.

 

Quorum: Sh. Ajit Aggarwal, President,

               Smt. Param Pal Kaur, Member.

 

Present: Sh  Kailash Goyal, Ld Counsel for complainant,

              Sh Manpreet Singh, Ld Counsel for OP-1 to OP-3,

              Sh Ashok Monga, Ld Counsel for OP-4.

 

ORDER

(Ajit Aggarwal, President)

                                      Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against OPs for deficiency in service in not making payment of Rs.5,00,000/-of insurance claim on account of death of Kulveer Singh and for further directing OPs to pay Rs.1,00,000/- as compensation for harassment, inconvenience, mental agony and litigation expenses of Rs15,000/-.

2                                    Briefly stated, the case of the complainant is that Kulveer Singh predecessor in interest was insured under Bhagat Puran Singh Scheme vide card no 03045000852035635 and policy was issued to him. It is submitted that during the subsistence of said policy, husband of

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complainant died in a vehicular accident  on 2.02.2015 and FIR No.9 dated 2.02.2015 to this effect was got recorded under Section 279/304/427 IPC at Police Station City Kotkapura. Thereafter, complainant completed all the requisite formalities and submitted documents to OP-1 to 3 for processing the claim, but all in vain. OPs have neither repudiated the claim of complainants nor have paid a single penny on account of death of Kulveer Singh predecessor in interest. Despite repeated requests, OPs have not paid any heed to hear the genuine requests of complainant, which amounts to deficiency in service and trade mal practice on the part of OPs and it has caused harassment and mental agony to complainants for which they have prayed for accepting the complaint alongwith compensation and litigation expenses besides the main relief. Hence, the present complaint.

3                                                          The counsel for complainant was heard with regard to admission of the complaint and vide order dated 25.02.2019, complaint was admitted and notice was ordered to be issued to the opposite parties.

4                                              On receipt of the notice, OP-1 to OP-3 filed written statement through counsel wherein  they have denied all the allegations of complainant being wrong and incorrect and asserted that as per Section 10(3) of the policy, if grievance of the beneficiary is not satisfied, he was required to approach DGRC, who was to decide the

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matter within 30 days of filing the appeal and in case of non satisfaction of beneficiary with the decision of DGRC, beneficiary should have approached SCRC, who would decide the matter after 30 days of appeal. But in present case, complainant /beneficiary has not filed any complaint or appeal. It is further averred that complainant is not their consumer and there is no relationship of consumer and service provider between them and moreover, complainant has not given any consideration to answering OPs to get benefits of scheme. Moreover, answering Ops have no role to play in making payment of insurance claim as matter is between complainant and Insurance Company. However, on merits, OP-1 to 3 have denied all the allegations of complainant are denied being wrong and incorrect and it is reiterated that there is no deficiency in service on the part of answering Ops and prayed for dismissal of complaint with costs.

5                                                        On receipt of the notice, OP-4 filed written statement wherein they have denied all the allegations of complainant being wrong and incorrect and asserted that complainants are not their consumers and there is no relationship of consumer and service provider between them. It is averred that complainant did not give them requisite immediate intimation preventing them to gather first hand information and to inspect the spot, which is violation of terms and conditions of the policy in question. Complaint involves complicated questions of law and facts requiring lengthy evidence, which is not possible in summary proceedings of this Forum. No cause of action arises 

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against answering Ops and present complaint is vague and is based on wrong facts and complainant has no locus standi to file the same. It is further averred that complainant was not insured with them at the relevant time and neither complaint does not discloses any detail that how complainant sought relief of Rs. 5 lacs. It is further averred that complainant was not insured with them at the relevant time and neither complainant nor other respondents provided them proper insurance particulars and therefore, they are not liable to make payment of any insurance claim. It is brought before the Forum that as per agreement between Punjab Government and answering OP, insurance coverage was to be given to families who were enrolled under Bhagat Puran Singh Sehat Beema Yojna during the period from 1.11.2016 to 31.10.2017 and thus, insurance was to be implemented from 1.11.2016 till 31.10.2017, but in present case, accident of husband of complainant occurred on 2.02.2015 i.e much prior to the commencement of period of insurance from 1.11.2016 to 31.10.2017 and as per terms and conditions of the policy, policy cover for deceased Gurdeep Singh has already been expired  as he died on 2.02.2015 which is much prior to the insurance policy period starting from 1.11.2016 to 31.10.2017. All the other allegations are denied being wrong and incorrect and asserted that there is no deficiency in service on the part of answering OP and prayed for dismissal of complaint with costs.

 

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6                                              Parties were given proper opportunities to prove their respective case. Ld counsel for complainant tendered in evidence affidavit of complainant no. 1 Harjinder Kaur Ex.C-1 and documents Ex C-2 to 8 and then, closed the evidence on behalf of complainant.

7                                                In order to rebut the evidence given by complainant, the ld Counsel for OP-1 to OP-3 tendered in evidence affidavit of  Dr Rohini Goyal as Ex OP-1 to 3/1 and then, closed the same on behalf of OP-1 to OP-3.

8                                          Case was fixed on the stage of evidence. Ld counsel for complainant as well as OP-1 to OP-3 concluded their evidence and evidence of OP-4 is yet to come. Meanwhile, we have very carefully gone through the affidavits and documents placed on the file and after careful perusal of the record available on file and  after carefully going through the evidence led by parties, it is observed that case of the complainant is that Kulveer Singh predecessor in interest was insured under Bhagat Puran Singh Sehat Bima Yojana and during the subsistence of said policy, said Kulveer Singh met with an accident and died on spot. Grievance of the complainant is that despite repeated requests and completion of all requisite formalities, OPs have not made payment of her genuine insurance claim on account of death of Kulveer Singh, which amounts to deficiency in service. During the proceedings of complaint

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case, ld counsel for OP-4 Insurance Company brought before the Forum that at the time of death of husband of complainant, insurance contract was not with their company and Kulveer Singh predecessor in interest was not insured with them and therefore, OP-4 Insurance Company is not liable for any kind of payment on account of death claim for death of Kulveer Singh predecessor in interest. Ld Counsel for OP-4 brought before the Forum that death claim lodged by complainants does not relate to the period of insurance during which OP-4 is liable to settle the claim as Kulveer Singh predecessor in interest /husband of complainant no. 1 was not insured with OP-4 Insurance Company at the time of his death because as per agreement entered between Punjab Government and OP-4, insurance cover was to be given to families who were enrolled under Bhagat Puran Singh Sehat Beema Yojna during the period from 1.11.2016 to 31.10.2017 and thus, insurance was to be implemented from 1.11.2016 to 31.10.2017, but accident of husband of complainant occurred on 2.02.2015 i.e much prior to the commencement of period of insurance from 1.11.2016 to 31.10.2017 and as per terms and conditions of the policy, policy cover for deceased Kulveer Singh was already expired  as he died on 2.02.2015 which is much prior to the insurance policy period starting from 1.11.2016 to 31.10.2017.

9                                                Though case reached at the stage of evidence and ld counsel for OP-4 strived well to convince the Forum as well as complainant counsel that insurance claim sought by complainants

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is not payable by OP-4 Insurance Company and being convinced with his pleadings, complainant suffered statement in the Forum that he wants to withdraw his complaint. Ld counsel for complainant stated that as OP-4 was not insurer at the time when death of predecessor in interest occurred and thus, it is clear that OP-4 Insurance Company is not liable for making payment of claim sought by complainants. He withdrew the present complaint and prayed for liberty to file it afresh against appropriate Insurance Company on same cause of action. Statement recorded. Hence, in view of statement given by complainant through his counsel, complaint in hand is hereby dismissed as withdrawn with liberty to file afresh complaint on same cause of action against proper Insurance Company. No orders as to costs. Copy of the order be supplied to parties free of cost as per law. File be consigned to record room.

Announced in Open Forum

Dated : 10.12.2019       

(Param Pal Kaur)            (Ajit Aggarwal)  

 Member                         President