Haryana

Yamunanagar

CC/675/2010

Smt. Renu Saini wd/o Sh.Sukhbir Singh, - Complainant(s)

Versus

ICICI Lombard General Insurance Co. Ltd. - Opp.Party(s)

PP Saini,

29 Jul 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

 

                                                                                    Complaint No. 675 of 2010.

                                                                                    Date of institution: 21.07.2010.

                                                                                    Date of decision: 29.07.2016

Smt. Ranu Saini aged about 30 years widow of Sukhbir Singh, resident of village Ambli, P.S. Chhapper, Tehsil Jagadhri, Distt. Yamuna Nagar. 

                                                                                                                                                      …Complainant.

                                                             Vs

1. I.C.I.C.I. Lombard General Insurance Company Ltd.  through Customer Service Manager: Interface Building No.11, 401/402, 4^th Floor, New Link Road Malad, Mumbai-400064. 
2. Branch Office: ICICI Lombard General Insurance Co. Ltd. Commercial Belt, Sec-17, HUDA, Jagadhri, Distt. Yamuna Nagar.
3. India Infoline Ltd. Seminar Sales/Venue Channels, Building No. 35-A, Nirlon Complex, Off Western Express Highway, Next to Hub Mall, Goregaon East, Mumbai-400063.                                                                                                                                                                                                                                                                             …Respondents. 

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

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

 

Present:  Sh. P.P.Saini Advocate, counsel for complainant.  

               Sh. K.K.Gupta, Advocate, counsel for respondents No.1 & 2.

               Respondent No.3 already ex-parte.  

             

ORDER

1.                     The present complaint has been filed by Smt. Renu Saini widow of Sukhbir Singh Saini ( being the LR and nominee) under section 12 of the Consumer Protection Act. 1986, praying therein that respondents (hereinafter referred as OPs) be directed to pay the insured amount of Rs. 1,00,000/- under the GPA Policy as well as compensation and litigation expenses. 

2.                     Brief facts of the complaint, as alleged by the complainant, are that husband of the complainant Sukhbir Singh Saini died on 11.09.2008 due to electrocution while he was working on the electricity pole to repair broken electricity wires. Before his death, Sukhbir Singh Saini (deceased) being a member of Group Insurance Policy Holder  i.e. India Infoline Insurance Service Limited purchased Group Personal Accident Policy  bearing No. 4005/0009017 dated 24.04.2008 for a sum of Rs. 1,00,000/- which was valid for one year from the first day of the subsequent month from the date of registration i.e. 24.04.2008 to 23.04.2009 from the office of OPs No.1 & 2 AT Ambala City ( Photo copy of insurance policy is Annexure C-1). After the death of her husband, the complainant informed the Branch Office of OPs at Jagadhri/Yamuna Nagar and Ambala City personally and also through telephone but the OP No.2 instead of doing anything directed the complainant to pursue her case with OP No.1. Thereafter, the complainant approached to Op No.1 and requested to settle her claim. OP No.1 sent a letter dated 10.01.2009 (Annexure C-2) to the complainant and demanded some documents which were duly submitted by the complainant alongwith filled up claim form vide forwarding letter dated 16.03.2009 (Annexure C-3). Alongwith this forwarding letter, complainant sent duly filled form, two recent photographs of the complainant, certificate of Redix Hospital alongwith Rukka of Redix Hospital, Attested copy of FIR bearing No.167 dated 04.10.2008 registered in the police station Chhappar, Yamuna Nagar under section 304-A IPC, Panchnama, Postmortem report bearing No. VKD/57/2008, death certificate (original), attested copy of ration card and original certificate of insurance policy bearing No. 4005/000/9017 to OP No.1 through registered AD post which was duly received by OP No.1 on 25.03.2009 (Copy of acknowledgement and AD with receipts are Annexure C-4). Thereafter, the complainant contacted the OP No.1 so many times on telephone and on every time they told that her claim will be settled within 15 days but till date nothing has been done. After a lapse of more than 9 months, the OP No.1 sent a letter dated 04.01.2010 (Annexure C-5) to the complainant demanding a document i.e. certificate of enrollment detail issued by India Infoline. After receiving this letter, complainant visited the office of Op No.1 at Yamuna Nagar in this regard but the official of OP No.2 refused to give any such certificate/ Annexure to the complainant. However, this document was their official document, if OP No.1 was in need of said document i.e. “So Called Annexure” they could easily collect the same from the office of OPs No.2 & 3 at their own level. As all the documents have already been submitted with the OPs No.1 & 2 and despite that the claim of the complainant has not been settled by the Ops which constitute deficiency in service on the part of OPs. Hence, this complaint.

3.                     Upon notice, OPs No.1 & 2 appeared and filed its written statement by taking some preliminary objections such as complaint is not maintainable; complainant has no locus standi; complainant is estopped from filing the present complaint due to her own act and conduct; complainant has concealed the true and material facts; there is no relationship of consumer and supplier between  the parties; complaint is time barred by limitation and on merit it has been denied that complainant has sent her claim to OPs No.1 & 2, as alleged. It has been further submitted that complainant has not submitted the documents as per instructions and terms and conditions of the policy. As such, complaint of the complainant is premature and not maintainable and the same is liable to be dismissed. The complainant has not sent any detail of enrollment with the OP No.3, so, OPs No.1 & 2 could not entertain the said matter. Lastly, prayed for dismissal of complaint as there was no negligence or deficiency on the part of OPs No.1 & 2.

4.                     OP No.3 failed to appear despite service through publication, hence OP No.3 was proceeded ex-parte vide order dated 25.03.2015.

5.                     In support of her case, complainant tendered into evidence her affidavit as Annexure CW/A and documents such as Photo copy of insurance policy as Annexure C-1, Copy of letter dated 10.01.2009 as Annexure C-2, Photo copy of letter dated 16.03.2009 for sending documents as Annexure C-3, Acknowledgement and Postal receipt as Annexure C-4, Copy of letter dated 04.01.2010 issued by OPs No.1 & 2 as Annexure C-5, Photo copy of claim form as Annexure C-6, Photo copy of certificate issued by Doctor of Redix Hospital as Annexure C-7, Copy of Rukka as Annexure C-8, Photo copy of postmortem report as Annexure C-9, Photo copy of death certificate as Annexure C-10, Photo copy of FIR as Annexure C-11, Photo copy of inquest report as Annexure C-12, Photo copy of ration card as Annexure C-13 and Photo copy of courier receipt as Annexure C-14 and closed her evidence.

6.                     On the other hand, counsel for the OPs No.1 & 2 tendered into evidence affidavit of Sh. Meenu Sharma, Legal Manager of ICICI Lombard Yamuna Nagar as Annexure RW/A and documents such as photo copy of letter dated 10.01.2009 as Annexure R-1 and Photo copy of letter dated 04.01.2010 as Annexure R-2 and closed the evidence on behalf of OPs No.1 & 2.

7.                     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.

8.                     It is not disputed that deceased Sukhbir Singh Saini being a member of India Infoline Insurance Service Limited ( Group policy holder) obtained an insurance policy bearing No. 4005/0009017 on 24.04.2008 for a sum insured of Rs. 1,00,000/- from the office of OPs No.1 & 2 i.e. Ambala City. It is also not disputed that husband of the complainant died due to electrocution while working on the electricity pole on 11.09.2008 during the currency of insurance policy in question which is duly evident from the copy of postmortem report (Annexure C-9) and copy of death certificate (Annexure C-10), copy of Rukka (Annexure C-8), Copy of FIR (Annexure C-11) copy of inquest report (Annexure C-12), and copy of certificate issued by Redix Hospital (Annexure C-7). The only plea of the Ops No.1 & 2 is that the complainant has not submitted the documents as per instructions and terms and conditions of the insurance policy. Learned counsel for the OPs insurance company draw out attention towards letter dated 04.01.2010 (Annexure R-2) vide which the complainant was asked to submit only one document i.e. Certificate/Annexure from India Infoline showing enrollment details and argued that as the complainant has not submitted this document, so, there is no deficiency in service on the part of OPs but the arguments advanced by the counsel for the OPs is not tenable because it was the duty of the OPs No.1 & 2 to mention the enrollment details in the policy itself at the time of issuance of policy in question. Even, the OPs No.1 & 2 has not bothered to place/file any terms and conditions of the insurance policy to prove that the complainant was duty bound to submit the same. Moreover, the OPs No.1 & 2 has also not filed any cogent evidence to prove that they have ever tried to collect the said information from the OP No.3 i.e. from India Infoline Insurance Service Limited at their own level. When an insurance policy has been issued by OPs No.1 & 2 then how the OPs No.1 & 2 denied to settle the genuine claim of the complainant which is duly supported by documentary evidence i.e. copy of postmortem report (Annexure C-9), copy of death certificate (Annexure C-10), copy of FIR (Annexure C-11) and copy of inquest report (Annexure C-12), Copy of ration card (Annexure C-13) and copy of hospital certificate (Annexure C-7).

9.                     We have gone through the written statement filed by OPs No.1 & 2 wherein no specific plea has been taken by the OPs No.1 & 2 that no Insurance policy was issued in favour of the deceased Sukhbir Singh Saini covering the risk of death and it is also nowhere denied that the complainant has not submitted the required documents except So Called Annexure i.e. enrollment detail  which has been discussed above.  

10.                   As a matter of fact in the reality, insurance companies in India are functioning arbitrarily with a view to escape and avoiding its legal and factual liabilities to make the payment of sum assured and doing fake acting in dramatically, opposite of the principle of fair play and decency and in that series it is not even caring that their wrong actions are causing wrongful losses to their customers.

11.                   In the present case instead of acting fairly the insurance company is trying to escape from its liability by making one pretext or the other, which cannot be allowed to do so.

12                    Keeping in view the facts and circumstances mentioned above we are of the considered view that there is a deficiency in service on the part of OPs No.1&2. Hence, we have no option except to partly allow the complaint of complainant. However, the complaint against OP No.3 is hereby dismissed as no deficiency in service proves against OP No.3.

13.                   Resultantly, we partly allow the complaint of complainant and direct the OPs No.1 & 2 to pay insured amount of Rs. 1,00,000/- alongwith interest at the rate of 7% per annum from the date of filing of complaint till its realization to the complainant being widow and nominee of deceased Sukhbir Singh Saini and further to pay Rs.10,000/- as compensation for mental agony, harassment as well as litigation expenses. Order be complied within 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.  29.07.2016.

                       

                                                                                    (ASHOK KUMAR GARG )

                                                                                    PRESIDENT,

 

                                                                                     

                                                                                    (S.C.SHARMA )

                                                                                     MEMBER.