Punjab

StateCommission

A/268/2018

Oriental Insurance Company Ltd. - Complainant(s)

Versus

Gurmit Kaur - Opp.Party(s)

J.P. Nahar

19 Nov 2018

ORDER

                                                               FIRST ADDITIONAL BENCH

 

 

STATE  CONSUMER  DISPUTES  REDRESSAL COMMISSION,     PUNJAB

          SECTOR 37-A, DAKSHIN MARG, CHANDIGARH

 

                   First Appeal No. 268 of  2018

 

                                                          Date of Institution   : 07.05.2018       

                                                         Order Reserved on : 16.11.2018

                                                          Date of Decision     : 19.11.2018

 

1.      The Oriental Insurance Company Limited, 4-E/14 Azad Bhawan, Jhandewalan Extension, New Delhi 110055, through its Divisional Manager.

 

2.      The Oriental Insurance Company Limited, SCO No. 18-19, Chandigarh Road, Near Mini Secretariat, Hoshiarpur 146001 (Punjab) through its Divisional Manager.

 

Now both through their authorized signatory, Alka Bansal, Manager, The Oriental Insurance Company Ltd., Regional Office, SCO No. 109-111, Sector 17-D, Chandigarh.

 

 

                                            ...Appellants/Opposite parties no.1 and 2          

                   Versus

 

1.      Gurmit Kaur w/o Late S. Balbir Singh C/o Col. Gurcharan Singh, Street No.10, Dashmesh Nagar, Dagana Road, Hoshiarpur (Punjab).

                                                …Respondent no.1/Complainant

 

2.      Branch Manager, Punjab National Bank, Branch office : TSS Senior Secondary School, Shimlapuri-Ludhiana.

 

                                                …Respondent no.2/Opposite party no.3

 

 

                                                … Respondents/Opposite parties

 

First Appeal against order dated 08.03.2018 passed by the District Consumer Disputes Redressal Forum,  Hoshiarpur.

Quorum:-

          Shri J. S. Klar, Presiding Judicial Member

            Smt. Kiran Sibal, Member

Present:-

          For the appellants                 :  Sh.J.P Nahar, Advocate

          For the respondent no.1       :  Sh.Vivek Khadwal, Advocate

          For respondents no.2           :  Sh.Virender Sood, Advocate

         

. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

J.S KLAR, PRESIDING JUDICIAL MEMBER :-

         

                    Challenge in this appeal by appellants is to order dated 08.03.2018 of District Consumer Disputes Redressal Forum Hoshiarpur, directing them to pay the amount of Rs.2 lac to respondent no.1 Gurmit Kaur of this appeal as insurance claim with interest @ 9% per annum from the date of repudiation of the claim i.e. 02.06.2017 till realization of the claim, besides compensation of Rs.20,000/-. Respondent no.1 of this appeal is complainant in the complaint and appellants of this appeal are opposite parties no.1 and 2 in the complaint and respondent no.2 of this appeal is opposite party no.3 therein and they be referred as such hereinafter for the sake of convenience.

2.                The complainant Gurmit Kaur has filed the complaint U/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against OPs before District Forum Hoshiarpur on the averments that OP no.3 deducted premium of Rs.12/-, from the joint account no.0763010100018522 of her late husband Balbir Singh with her, on 25.05.2016 towards renewal of policy for the financial year 2016-2017, which was for the period 25.05.2016 to 24.05.2017. Her husband met with road side accident, while driving bike bearing registration no. PB-07-AX-7456 on 18.07.2016  in the area of village Sherpur Kacha Hoshiarpur-Dasuya Road. DDR no.35 dated 3.09.2016 was lodged about this accident with police at police station Hoshiarpur. Balbir Singh her husband was taken to DMC Hospital at Ludhiana in an ambulance for his medical treatment, where his condition remained serious. He sustained multiple injuries and head injury in the road side accident.  He was discharged from DMC Ludhiana on 18.07.2016 and he was taken to PGI Chandigarh  by his family for his better treatment. He died on the way to PGI Chandigarh. His dead body was brought back to his house at Hoshiarpur and was cremated on the next day on 19.07.2016. The complainant being legal heir and  joint account holder with her late husband lodged insurance claim with OPs, which was repudiated by them illegally and arbitrarily. Therefore, she prayed for Rs. 2 lac towards Prime Minister Security Bima Yojna as claim amount along with interest @ 10% from the date of submission of her application dated 20.09.2016 to OPs, besides compensation of Rs.50,000/- for mental harassment.

3.                Upon notice, OPs no.1 and 2 appeared and filed their joint written reply and contested the complaint of the complainant vehemently by raising preliminary objections that complaint is not maintainable, as there is no direct contract between complainant and OPs no.1 and 2. The complainant has already opted the Forum of Insurance Ombudsman Chandigarh and had filed complaint no.CHD-G-050-1718-0337 against OPs thereat. The Insurance Ombudsmen is a statutory body enacted by government to discharge the judicial functions, so complainant has no right to opt the platform of two Forums at the same time for redressal of her alleged grievance. As per terms and conditions of Pradhan Mantri Suraksha Beema Yojna, the post mortem report of the deceased was essential for settlement of his death claim, but complainant has not supplied the same to OPs, so her claim was rightly repudiated by them on this point. Rest of the averments of the complainant were controverted by OPs even on merits in the written reply and they prayed for dismissal of the complaint.

4.                OP no. 3 appeared and filed its separate written reply and contested the complaint of the complainant by raising preliminary objections that complaint is not maintainable. The complainant has not come to the Forum with clean hands. Any deficiency in service was denied by OP no.3 on its part. On merits, it was averred that no insurance certificate/policy was issued by OP no.3 to complainant  and OP did not give any undertake to pay any sum assured along with bonus to complainant. Rest of the averments of the complainant were denied by OP no.3 in the written reply and it prayed for dismissal of the complaint.

5.                The complainant tendered in evidence her affidavit Ex.C-1,  her additional affidavit as Ex.C-2 along with copies of documents Ex.C-2 and Ex.C-19 and closed the evidence.  As against it, OPs no.1 and 2 tendered in evidence affidavit of Sukhwinder Singh Senior Divisional Manager Oriental Insurance Company Limited as Ex.OP-1&2/1 along with copies of documents Ex.OP-1&2/2 to Ex.OP-1&2/7 and closed the evidence. OP no.3 tendered in evidence affidavit of Santosh Kumar Sharma Chief Manager PNB as Ex.OP-3/1 and closed the evidence.  On conclusion of evidence and arguments, the District Consumer Forum Hoshiarpur accepted the complaint of the  complainant by virtue of order dated 08.03.2018. Aggrieved by above order of the District Forum Hoshiarpur, opposite parties no.1 and 2 now appellants, have carried this appeal against the same.

6.                We have heard learned counsel for the parties and have also examined the record of the case.

7.                The submission of counsel for appellant is that it was essential of the complainant to attach the postmortem report with the claim form for settlement of the claim. The claim of the complainant was repudiated by OPs primarily on the ground of absence of postmortem report for settlement of the claim, which was sine quo non for settlement of this claim by OPs. The counsel for appellants drew our attention to condition no.4 of Pradhan Mantri Suraksha Bima Yojana in this regard. Condition no.4 states in concise terms that claim form shall be supported, in case of death of the insured, by the original FIR/Post mortem report and death certificate. Now what is the affect of absence of postmortem report in this case has to be examined by us in this case. Ex.C-6 is the death certificate  of the insured Balbir Singh  on the record. Vide Ex.C-6 Balbir Singh insured expired on 18.07.2016. Instead of post mortem report, the complainant relied upon her affidavit Ex.C-1 and Ex.C-2 stating on oath  the fact of death of Balbir Singh her husband in accident. Police report is Ex.C-4  dated 03.09.2016 in this regard regarding road accident which led to her husband's death. DAMA Summary prepared by DMC Hospital Ludhiana is Ex.C-5 showing that Balbir Singh (since deceased) was taken to above hospital on 18.07.2016 for treatment of injury sustained by him in the road-side accident. Medical certificate issued by DMC Ludhiana is Ex.C-12 on the record. He was brought to DMC Ludhiana with head injury in road accident case. The version of the complainant is that while on enroute to PGI Chandigarh therefrom  for his better treatment, her husband  expired on the way.   Similarly, affidavit of Sukhwinder Singh Senior Divisional Manager Oriental Insurance Company Ltd as Ex.OP-1&2/1 has been perused by us with the memorandum of understanding of Pradhan Mantri Suraksha Bima Yojana Ex.OP1&2/2 and repudiation letter Ex.OP-1&2/3 and other documents on the record.

8.                The main question cropping up for adjudication in this case is as to what is the effect of absence of postmortem report of deceased in this case. The matter is not res integra on this point. Haryana State Consumer Disputes Redressal Commission Panchkula has held in “National Insurance Co. Ltd versus Rita Devi” reported in 2006(2) CPC 599 that death of the insured by electrocution is well established. Non-production of postmortem report cannot be made a ground of repudiation of claim. Dogmatic approach of OP/insurance Company in denying the claim is unjustified as observed in above case. Our own State Commission has held in Parkash Kaur & others versus Lombard General Insurance Company & another” 2009(1) CLT-75 that death of insured is proved by snake bite due to certificate issued by SDM, there was no postmortem report and insurance company was directed to make the payment of insurance claim.  Similar observation was also recorded by our State Commission in Life Insurance Corporation of India and others versus Smt. Nidhi Sahi” reported in 2005(1) CPC-533  that where death is proved and supported by statement of witness, who was pillion rider of the scooter at the time of accident and hence claim cannot be repudiated even in the absence of FIR and postmortem report. This observation was also recorded by our State Commission in First Appeal no. 204 of 2018 decided on 26.09.2018. Consequently, the repudiation of the claim of the complainant on this point due to ‘lack of postmortem report’ is repelled because the factum of death of Balbir Singh is proved on the record by the police report and DAMA Summary prepared by DMC Ludhiana lending credence to it to the effect that he sustained head injury in road side accident, which proved fatal to him. The repudiation of the insurance claim by OPs is not appropriate for non-production of report of autopsy of deceased. The death certificate of deceased Balbir Singh Ex.C-6 issued by Local Registrar Birth & Death Municipal Corporation Hoshiarpur is on the record proving his date of death on 18.07.2016. Clause 4 of the Scheme as referred to above has been essentially complied with by the death certificate Ex.C-6 of Balbir Singh insured. The District Forum has correctly passed the order in this case, which suffers from no illegality or material infirmity calling for any interference therein in this appeal

9.                As a result of our above discussion, there is no merit in the appeal and same is hereby dismissed.

10.              The appellants had deposited an amount of Rs.25,000/- in this Commission at the time of filing the appeal and further deposited Rs.1,75,000/- as per compliance of the order of this Commission. Both these amounts with interest, if any, accrued thereon, be remitted by the registry to the respondent no.1/complainant of this appeal  by way of crossed cheque/demand draft after the expiry of 45 days. Remaining amount, as per order of the District Forum shall be paid by the appellants to respondent no.1/complainant with 45 days from the date of receipt of copy of this order

11.              Arguments in this appeal were heard on 16.11.2018 and the order was reserved. Certified copies of the order be communicated to the parties as per rules.

12.              The appeal could not be decided within the statutory period due to heavy pendency of court cases.

 

                                                                       (J. S. KLAR)

                                                          PRESIDING JUDICIAL MEMBER

                    

                                                                    (KIRAN SIBAL)

                                                                         MEMBER

November  19,  2018                                                          

(ravi)