DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,<br /> BATHINDA (PUNJAB)<br /> <br /> CC No. 187 of 06.07.2007<br /> Decided on : 07-11-2007 <br /> <br /> 1.Ajmer Kaur Wd/o Darshan Singh deceased <br /> 2.Baldev Singh S/o Darshan Singh deceased <br /> 3.Sikander Singh, Kulwinder Singh S/o Darshan Singh deceased <br /> 4.Virpal Kaur daughter of Darshan Singh deceased<br /> 5.Veer Vajinder Kaur daughter of Darshan Singh deceased<br /> residents of Village Bhokhra, Tehsil & District Bathinda.<br /> ... Complainants<br /> Versus<br /> <br /> 1.ICICI Lombard General Insurance Co. Ltd. SCO 24-25, Sector 8-C, Chandigarh through its General Manager.<br /> 2.ICICI Lombard General Insurance Co. Ltd., Ahluwalia Complex, Guru Kanshi Marg, near Power House Road, Bathinda, through its Branch Manager.<br /> 3.The Bathinda Central Co-operative Bank Limited, Branch Office, Goniana Mandi, District Bathinda through its Manager.<br /> ...Opposite parties<br /> <br /> Complaint under Section 12 of the Consumer Protection<br /> Act, 1986.<br /> <br /> QUORUM :<br /> Sh. Lakhbir Singh, President<br /> Dr. Phulinder Preet, Member<br /> <br /> For the Complainant : Sh. Hardev Singh Grewal, Advocate.<br /> For the Opposite parties : Sh. Vinod Garg, Advocate, for opposite parties No. 1 & 2.<br /> Sh. Hargurjit Singh Sidhu, Advocate, for opposite party No. 3. <br /> <br /> O R D E R<br /> <br /> LAKHBIR SINGH, PRESIDENT <br /> 1. Darshan Singh S/o Nikka Singh R/o Village Bhokhra (now deceased) was the husband of complainant No. 1 and fathers of complainants. He was the member of The Bhokhra Co-op Agricultural Service Society Limited, Bhokhra. He had Saving Bank A/c No. 4724 with opposite party No. 3 which was opened by him on 7.5.04. Opposite party No. 3 had launched scheme that if any account holder would keep Rs. 1,000/- every time in his/her account, it would get him/her insured for accidental benefits to the tune of Rs. 1.00 Lac with the Insurance Company. He was always keeping more than Rs. 1,000/-. He was intimated by opposite party No. 3 that he and other such like account holders were insured with opposite parties No. 1 & 2 for accidental benefits covering the risk to the tune of Rs. 1.00 Lac for each. Insurance was valid from 1.6.05 to 31.5.06. Complainant No. 1 was his nominee. On 10.8.05 he had taken the buffaloes to the village pond for making them to drink water. When he was returning home, cattleheads felt frightened and abruptly ran backwards. One of the buffaloes hit him. He sustained injury and died at the spot. Complainants were under deep shock due to his sudden death. At the asking of the co-villagers, dead body was cremated on the same day. Intimation was given to police officials of Police Station Nahianwala regarding his death due to the fact that he was hit by buffalo. Enquiry was conducted by the Police Officials. Statements of Major Singh, Ex. Panch, Amarjit Kaur Panch, Roop Singh Panch, Chuhar Singh and Joginder Singh were recorded. Village Panchayat verified his death on 10.8.05 to be on account of hitting by a buffalo by Panchayatnama. It was signed by the Sarpanch and members of the Panchayat. S.I. Jagrup Singh submitted his report to S.H.O Police Station Nahianwala. On the basis of his order, Daily Diary Report No. 38 was recorded on 19.8.05 in the Daily Diary Register. Complainant No. 1 gave information to opposite party No. 3 regarding death of her husband due to hitting by the buffalo. Copy of the Daily Diary Report and other relevant documents were submitted. Her signatures were obtained by opposite party No. 3 on Personal Accident Insurance Form and other papers. Opposite party No. 3 through its Head Office , Bathinda had submitted all the relevant papers to opposite parties No. 1 & 2 for finalisation of the claim and making payment of an amount to the tune of Rs. 1.00 Lac. Opposite party No. 3 was approached by complainants No. 1 & 2 many a times for getting the claim, but they continued putting of the matter on one pretext or the other. Three months prior to the day of filing of the complaint, complainant No. 2 was apprised by opposite party No. 3 that claim has been rejected by opposite parties No. 1 & 2. No written information was received by them (complainants) about the rejection of the claim from the opposite parties. They allege deficiency in service and unfair trade practice on the part of the opposite parties. In these circumstances, this complaint under Section 12 of the Consumer Protection Act, 1986 (Here-in-after referred to as `Act') has been preferred by the complainant seeking direction from this Forum to the opposite parties to pay them Rs. 1.00 Lac being insurance claim alongwith interest @18% P.A. from the date of lodging the claim till payment and Rs. 50,000/- as compensation for mental tension, agony and loss of physical health besides cost of the complaint.<br /> 2. Opposite parties No. 1 & 2 filed their version taking legal objections that complaint has been filed merely to injure their interest and reputation; no insurance claim was lodged by the complainants with them nor was it forwarded by opposite party No. 3 to them; complainants are not consumers; they have got no locus standi to file the complaint and terms and conditions of the policy are binding upon the parties. Even otherwise, complainants have violated the terms and conditions of the policy and as such, complaint is not maintainable. As per terms and conditions, FIR and Post Mortem examination are mandatory. In this case, alleged occurrence is dated 10.8.05 whereas Daily Diary Report was recorded on 19.8.05. Post mortem examination of the dead body of Darshan Singh has not been got conducted. Complainants have failed to prove his death due to accident. On merits, their version is that policy No. 4005/003960 covers death caused only by accident. Since claim has not been lodged with them, it has not been got investigated. According to them, matter regarding insurance of deceased Darshan Singh is a matter of record. They do not admit the remaining averments in the complaint.<br /> 3. Opposite party No. 3 filed separate reply stating that complainants are not consumers. They have failed to comply with the terms and conditions of the insurance policy. Complainants did not submit F.I.R./ Police report and the Post Mortem report of deceased Darshan Singh on account of which insurance claim could not be forwarded to opposite parties No. 1 & 2. It admits that it had launched a scheme that if any account holder will keep Rs. 1,000/- in his/her account, it would get the account holder insured for accidental benefits to the tune of Rs. 1.00 Lac. Darshan Singh was keeping more than Rs. 1,000/- in his account and that he was intimated that he was insured with opposite parties No. 1 & 2. It denies the remaining averments in the complaint.<br /> 4. In support of their averments contained in the complaint, complainants have produced in evidence three affidavits of S/Sh. Major Singh, Ex. Panch, Roop Singh Panch, Baldev Singh, (Ex. C-1 to Ex. C-3) respectively, photocopy of Pass book of Bank (Ex. C-4), Death Certificate of Darshan Singh (Ex. C-5), copy of report of Sh. Jagrup Singh, Sub Inspector (Ex. C-6), copy of DDR No. 38 dated 19.8.05 (Ex. C-7), copy of Panchayatnama (Ex. C-8), copy of report of S.H.O. Police Station Nahianwala (Ex. C-9), photocopy of Mutation No. 5977 (Ex. C-10) and photocopy of letter dated 11.1.06 (Ex. C-11).<br /> 5. In rebuttal, on behalf of opposite parties No. 1 & 2 affidavit of Sh. Sat Parkash, Area Head Channels (Ex. R-1), photocopies of Group Personal Accident Insurance Policy Part-I and Part-II of schedule (Ex. R-2 & Ex. R-3) and on behalf of opposite party No. 3 affidavit of Sh. Swaran Pal Singh, Branch Manager (Ex. R-4) have been tendered in evidence.<br /> 6. We have heard learned counsel for the parties. Besides this, we have gone through the record and written briefs of arguments submitted on behalf of complainants and opposite parties No. 1 & 2.<br /> 7. Mr. Grewal, learned counsel for the complainants argued that opposite parties are wrongly denying that insurance claim regarding death of Darshan Singh was not submitted by the complainants. In fact claim has been illegally and arbitrarily repudiated by opposite parties No. 1 & 2 although there is abundant evidence to prove that the death of Darshan Singh was accidental.<br /> 8. Mr. Garg, learned counsel for opposite parties No. 1 & 2 argued that policy purchased by opposite party No. 3 for its account holders including the deceased Darshan Singh was Group Personal Accident Insurance Policy as is evident from Ex. R-2. He also made reference to part II of the schedule, copy of which is Ex. R-3. His next argument is that complainants have failed to prove that the death of Darshan Singh was accidental. As per terms and condition of the policy, lodging of the police report and conducting of the post mortem on the dead body are mandatory. This fact is evident from copy of the Pass Book Ex C-4 placed and proved on record by the complainants. Daily Diary Report was recorded on 18.8.05 whereas incident is alleged to be of 10.8.05. In these circumstances, claim is not payable.<br /> 9. We have given our thoughtful consideration to the rival contentions.<br /> 10. True that policy purchased by opposite party No. 3 for its account holders including deceased Darshan Singh is a Group Personal Accident Insurance Policy. It covers death solely and directly caused by any accident. Complainants were required to prove the death of Darshan Singh by way of accident. As per terms and conditions in the Pas Book, copy of which is Ex. C-4, police report and post mortem reports are necessary for getting the insurance claim. Apart from this, Death Certificate is required. Complainants have placed on record Death Certificate Ex. C-5. In our view, opposite parties have not come with clean hands. They are denying that the insurance claim was submitted. With the affidavit Ex. R-1 of Sh. Sat Parkash, Area Head Channels and Authorised Signatory of opposite party No. 1 and repudiation letter dated 11.1.06 of opposite parties No. 1 & 2 to opposite party No. 3, cat has come out of the bag. From Ex. R-1, it becomes clear that claim was lodged and that has been treated as No Claim on 11.1.06. According to the repudiation letter , copy of which is Ex. C-11, claim has been treated as No Claim for want of Post Mortem Report, F.I.R. and certified copy of the Loanee Account. There is no document of opposite parties No. 1 & 2 that any document was demanded from the complainants. Rather opposite parties went to the extent of denying the submission of insurance claim by the complainants in the replies of the complaint. Complainants were required to prove that death of Darshan Singh was due to accident. In our view, there is overwhelming evidence to show that his death was accidental. All of a sudden buffaloes started running backwards and one of them hit him on account of which, he died at the spot. For this purpose, there are affidavits of S/Sh. Major Singh Ex. Panch, Roop Singh, Panch and Baldev Singh complainant which are Ex. C-1 to Ex. C-3 respectively. They all stated that buffalo had felt frightened and due to the hitting of the buffalo, Darshan Singh died instantaneously. True that Daily Diary Report No. 38 was recorded in Police Station, Nahianwala on 19.8.05. In our view, this itself is no ground to discard the version of the complainants about the accidental death of Darshan Singh. Sh. Jagrup Singh, Sub Inspector of Police Station Nahianwala inquired into the matter and verified the facts in the affidavit of Baldev Singh, complainant. He contacted various respectables during enquiry. Statements of S/Sh. Joginder Singh, Chuhar Singh, Roop Singh, Panch Amarjeet Kaur, Panch and Major Singh Ex. Panch were recorded. Panchayat of village Bhokhra gave writing (Panchayatnama) Ex. C-8 confirming that buffalo had hit Darshan Singh on account of which he died on 10.8.05. After enquiry Sh. Jagrup Singh, Sub Inspector also concluded vide Ex. C-6 that buffalo had hit Darshan Singh on account of which he received internal injury which led to his death. S.H.O. Police Station, Nahianwala sbmitted report Ex. C-9 from which the accidental death of Darshan Singh is established. Complainants are villagers. They are the legal heirs of deceased. Their plea that his sudden death made them bewildered and at the asking of co-villagers, dead body was cremated, appears plausible and probable. Moreover, in this case there was no suspicion regarding the cause of death of Darshan Singh. This may also be the reason of not getting the dead body subjected to autopsy. We are of the view that simply because FIR was not recorded and in its place DDR was recorded on 19.8.05 and dead body was not subjected to post mortem examination, opposite parties No. 1 & 2 were not right to repudiate the claim particularly when there is enough evidence to establish that death of Darshan Singh was accidental. In this view of the matter, we get support from the observations of the Hon'ble State Commission, Punjab, in the case of National Insurance Company Limited Vs. Amarjit Kaur & Others, First Appeal No. 1314 of 2005 decided on 7.11.2005 in which it was held as under :-<br /> “...in this case a DDR was lodged in which it is mentioned that Baljit Singh had died of a snake bite. The duty of the relations is that to report the matter to the police (if at all required) and is upto the police authorities whether to record DDR or FIR. The Bob of the victim is to set the law in motion and he is not much concerned whether the police records an F.I.R. or DDR Similar view we have taken in Appeal No. 789 of 2005 United India Insurance Company Limited Vs. Anil Sehgal of Jalandhar City – decided on 13.7.2005. Apart from the above, there is a report of the sub Divisional Magistrate, Sangrur dated 5.12.2004 that Baljit Singh had died of Snake bite. Moreover, Smt. Amarjit Kaur, complainant and Nirmal Singh and Harjit Sigh had filed affidavits (Ex. C-1 to Ex. C-3) to the effect that Baljit Singh had died of snake bite. Even in the register of Birth & Death (Ex. C-6), the cause of death is mentioned as snake bite. Simply because the postmortem report was not forthcoming and only DDR was there, we do not find that the insurance company was right in repudiating the claim. It is well known that in any cases the parties concerned do not want postmortem to be done in case where there is no suspicion. According to the complainant, Baljit Singh had died of snake bite and the post mortem was not done. It may be for the reasons that the complainant and other relations felt that there was no doubt that Baljit Singh had died of snake bite...,”<br /> Similar view has been held by the Hon'ble State Commission Tamil Nadu in the latest pronouncement in the case of New India Assurance Company Limited and Another Vs. R. Thiru Murugan IV(2007) CPJ 56.<br /> 11. In view of our aforesaid discussion and what has been held by the Hon'ble State Commission, repudiation of the claim made by opposite parties No. 1 & 2 through letter dated 11.1.06, copy of which is Ex. C-11 is set aside leading to deficiency in service on their part. Once it is so, complaints being legal heirs of the deceased have got locus standi and cause of action to file the complaint.<br /> 12. Question that now arises is as to what relief be accorded to the complainants under the circumstances. Since repudiation of the claim/treating of the claim as No Claims stands set aside, it is a case for direction to opposite parties No. 1 & 2 to pay Rs. 1.00 Lac to the complainants alongwith interest @ 9% P.A. with effect from the date of repudiation i.e. 11.1.06 till payment. Complainants are craving for compensation of Rs. 50,000/- for mental tension, agony and loss of physical health. There is no case to allow it in view of the relief which is going to be accorded as above.<br /> 13. No other point was urged before us at the time of arguments.<br /> 14. In the result, complaint is allowed against opposite parties No. 1 & 2 with cost of Rs. 1,000/-. It stands dismissed qua opposite party No. 3. Opposite parties No. 1 & 2 are directed to do as under :-<br /> i) Pay Rs. 1.00 Lac to the complainants alongwith interest @9% P.A. from 11-01-2006 till realisation. <br /> This amount on payment would be shared by the complainants equally.<br /> Compliance of this order be made within 30 days from the date of its receipt. Copy of this order be sent to the parties concerned and file be consigned to record room.<br /> Pronounced :<br /> 07-11--2007 <br /> (Lakhbir Singh )<br /> President <br /> <br /> <br /> (Dr. Phulinder Preet)<br /> Member <br />