Punjab

Fatehgarh Sahib

CC/113/2014

Amandeep kaur - Complainant(s)

Versus

Iffco tokio GEn Insu - Opp.Party(s)

Sh Bs Boparai

06 Oct 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FATEHGARH SAHIB.

Consumer Complaint  No. 113 of 2014

                                           Date of institution : 21/08/2014                          

                                                 Date of decision    : 06.10.2015

Amandeep Kaur aged about 36 years, wife of Late Sh. Bhupinder Singh son of Gurmit Singh, resident of village Gadhera, Tehsil Bassi Pathana, District Fatehgarh Sahib.

……..Complainant

Versus

1. IFFCO TOKIO General Insurance Co. Ltd., having its office at Plot No.2, Sector 28, Madhya Marg, Chandigarh through its Branch Manager.
2. The Fatehgarh Sahib Central Co-Operative Bank Ltd., Branch Grain Market, Sirhind, District Fatehgarh Sahib through its Branch Manager.
3. The Fatehgarh Sahib Central Co-operative Bank Ltd., Branch Badali Ala Singh, Tehsil and District Fatehgarh Sahib through its Branch Manager.

…..Opposite Parties

Complaint under Sections 11,12 & 14 of the Consumer Protection Act.                                          

Quorum

Sh. Ajit Pal Singh Rajput, President                                     

  Sh. Amar Bhushan Aggarwal, Member

Present :  Sh.B.S.Boparai, Adv. for the complainant.         

                Sh. Vinay Sood, Adv.Cl. for the OPs.

ORDER

 

By Sh. Ajit Pal Singh Rajput, President.

                      Complainant, Amandeep Kaur, wife of Late Sh. Bhupinder Singh son of Gurmit Singh, resident of village Gadhera, Tehsil Bassi Pathana, District Fatehgarh Sahib, has filed this complaint against the Opposite Parties ( hereinafter referred to as the OPs) under Sections 11, 12 & 14 of the Consumer Protection Act. The brief facts of the complaint are as under:

2.                   The husband of the complainant namely; Bhupinder Singh( now deceased), had opened a saving bank account No.2345 with OP No.3 on 30.10.2016 and at the time of opening of the said account the OP No.3 insured the deceased Bhupinder Singh for a sum of Rs.1,00,000/-(one lakh only) with OP No.1 vide insurance policy Sr. No.498 dated 01.12.2006. The deceased Bhupinder Singh met with an accident and died on 27.01.2009. An FIR No.13 dated 27.01.2009 at P.S.Sirhind, was registered and the complainant approached OP No.3 and submitted all the necessary documents i.e. death certificate, postmortem report and copy of FIR. After doing all the formalities, OP No.3 forwarded the case to OP No.2, who forwarded the same to OP No.1 vide letter No.4454 dated 30.08.2010 for releasing the claim amount to the complainant. When no action was taken by OP No.1, then OP No.2, on the request of complainant, sent so many reminders to OP No.1 for settling the claim of deceased Bhupinder Singh but neither any reply was given by OP No.1 nor it settled the claim, rather it kept on postponing the matter on one pretext or the other. The complainant also served a legal notice on 26.07.2013 to settle the claim but in vain. There is deficiency in service and unfair trade practice on the part of OPs. Hence, this complaint for giving directions to the OPs to pay the claim amount i.e. Rs.1,00,000/-  and Rs.50,000/- as compensation on account of physical pain, mental agony, harassment caused to the complainant and damages including punitive damages.

3.                   The complaint is contested by the OPs. In reply to the complaint OP No.1 stated that OP No.2 and 3 opted to purchase SBBY Insurance Policy from it to insure its account holders. The complainant’s husband after understanding the terms and conditions of the policy paid the requisite premium to OPs No. 2 and 3 and thereafter OPs No.2 and 3 paid  the entire premium to it and got the said policy under group policy.  OP No.1 further stated that the claim of the complainant was declined, vide letter dated 17.02.2014, as per the terms and conditions of the policy. OP No.1 has provided service and as such there is no deficiency in service on the part of it.  After denying the other allegations made in the complaint, it prayed for dismissal of the complaint.

4.                   OPs No. 2 and 3 also contested the complaint and filed joint written reply. In reply to the complaint they stated that Bhupinder Singh, deceased, was having account with OP No.3 and was insured with OP No.1 under the said policy. They further stated that on receipt of documents from the complainant, the same were sent immediately to OP No.1 on 23.08.2010 and thereafter reminders were also issued by it to OP No.1. After denying all other allegations made in the complaint, they prayed for dismissal of the complaint.

5.                   In order to prove his case, the complainant has tendered in evidence attested copy of pass book Ex. C-1, attested copy of legal notice Ex. C-2, attested copies of postal receipts Ex. C-3 to Ex. C-5,  letter dated 19.07.2013 Ex. C-6, attested copy of letters Ex. C-7 and C-8, attested copy of death certificate Ex.C-9, affidavit of complainant Ex. C-10, copy of order dated 14.01.14 Ex. C-11 and closed the evidence. In rebuttal the OPs have tendered in evidence affidavit of Meenu Sharma, Legal Manager, Ex. OP-1, affidavit of Pallavi Roy Ex. OP-1/1, true copy of policy along with terms and conditions Ex. OP1/2, true copy of repudiation letter Ex. OP1/3, true copy of letter dated 22.03.2011 Ex. OP1/4, true copy of letter dated 25.02.2011 Ex. OP1/5, true copy of statement of complainant Ex. OP1/6, true copy of Voter Card Ex. OP1/7, true copy of DL Ex. OP1/8, true copy of voter card of complainant Ex. OP1/9, true copy of statement of Gursewak Singh Ex. OP1/10, true copy of statement of Chanan Ram Ex. OP1/11 and closed the evidence.

6.         The ld. counsel for the complainant has submitted that the OP No.1 repudiated the claim of the complainant’s deceased husband, vide letter dated 17.02.2014, i.e Ex.OP1/3 by stating that “Since, intimation of claim was received after one and a half year from date of death, which is violation”. The ld. counsel stated that it is established from the letter i.e Ex.OP1/3 that the claim was reported on 05.08.2010 and the same was repudiated and intimated to the complainant vide letter dated 17.02.2014 i.e after a period of Four years and this fact has been admitted in the statement of Pallavi Roy, authorized signatory of OP No.1 in para No. 6 and 8 i.e Ex-OP1/1. He stated that the delay in intimation was explained to the expert appointed by the OP No.1 and the expert in his report i.e Ex-OP1/5 concluded/ observed in para no. 10(f) “All the connected documents corroborated the factual position of the case hence recommended as per policy terms and conditions”. The ld. counsel pleaded that the delay in intimation was not intentional; complainant was under tremendous shock due to the sudden demise of her husband and had gone in depression and thereafter she found the passbook and when she visited the OP No. 2 & 3, they intimated her about the policy. The ld. counsel further submitted that the OP No.2 &3 have admitted in their written version in para no.4 that they had sent reminders to OP No.1 for settlement of the claim, same is evident from Ex.C-6 to Ex.C-7. The ld. counsel argued that the OP No.1 has committed deficiency of service by not deciding the claim of the complainant for about Four years and thereby repudiating the claim by ignoring the well reasoned delay in intimation and the expert report i.e Ex.OP1/5. The ld. counsel further argued that the act and conduct of OP No.1 clearly proves that the claim had been repudiated in an arbitrary manner.

7.                   On the other hand, the ld. counsel for the OP No.1 stated that the claim was repudiated keeping in view the terms and conditions of the policy. He stated that in the intimation letter i.e Ex.OP1/3 it has been stated that “We bring to your kind attention to Conditions (Sr. No.2) “ Claim Procedure and Requirements” of the wording attached to the policy schedule which stipulates that “ An event, which might become a claim under the policy, must be reported to us as soon as possible. In case of death, written notice also of death must, unless reasonable cause is shown, be given before internment/ cremation and in any case, within one calendar month after the death”. The ld. counsel submitted that since the complainant breached the condition of the policy, therefore she cannot be held entitled to payment. The ld. counsel argued that the expert in his report i.e Ex-OP1/5 has only recommended as per terms and condition, hence the claim was repudiated due to violation of condition of the policy. The ld. counsel referred to the judgments of Hon’ble Apex Court in case titled as Life Insurance Company Limited Vs. Smt. S. Sandhu decided on 04.05.2006 and in the case of United India Insurance Company Limited Versus M/s Harchand Rai Chandan Lal etc. decided on 24.09.2004 and submitted that the present complaint deserves to be dismissed in view of his submissions.

8.                   The ld. counsel on behalf of OP no.2 &3 submitted that they have not committed any sort of deficiency of service. He stated that the complainant filed the claim and OPs No.2 & 3 forwarded the same to OP No.1, the same is established from Ex.C-6 to C-8.

9.                   After hearing the Ld. Counsel for the parties and going through the pleadings, evidence produced by the parties and the oral arguments and written submissions, we find that there is force in the submissions of the ld. counsel for the complainant. It is well established from Ex.C-6 to C-8 that the complainant had lodged the claim with OP No.2 & 3 on 30.08.2010 and thereafter the expert after investigation submitted his report i.e Ex.OP1/5 on 25.02.2011.The complainant was intimated with regard to repudiation of the claim on 17.02.2014, as it is evident from Ex.OP1/3. In our view, it is well established from the evidence on record that the delay in intimation with regard to repudiation of the claim is of three years and this act of the OP No.1 amounts to deficiency of service. The OP No.1 decided the claim and intimated the same to the complainant on the directions of this Forum, as the same stands proved from intimation letter i.e Ex.OP1/3. From the statement of complainant i.e Ex.C-1 and the expert report i.e Ex.OP1/5 the complainant has fully explained the delay. The OP No.1 failed to consider the fact that complainant was under tremendous shock due to the sudden demise of her husband and had gone in depression, thereafter she found the passbook and she visited OP No. 2, who informed her about the policy which her deceased husband had bought. The case law relied upon by the ld. counsel for the OP No.1 in his written arguments cannot be considered as the detailed copies of the judgments were neither produced nor placed on record. It has come to our notice that the IRDA had issued circular with regard to delay in intimation of claim and the same is reproduced;

“The circular dated September 20^th, 2011 ( Annexure-A) issued by ' INSURANCE REGULATORY AND development AUTHORITY' is as under:-

“ Insurance Regulatory and Development Authority

Ref. IRDA/HLTH/MISC/CIR/216/09/2011 date:20.09.2011

CIRCULAR

To:    All life insurers and non-life insurers

Re:    Delay in claim intimation/documents submission with respect to

i.         All life insurance contracts and

ii.        All Non-life individual and group insurance contracts.

The Authority has been receiving several complaints that claims are being rejected on the ground of delayed submission of intimation and documents.

The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc. However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances.

The insurers' decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such limitation clause does not work in isolation and is not absolute. One needs to see the merits and good spirit of the clause, without compromising on bad claims. Rejection of claims on purely technical grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation.

Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time.

The insurers are advised to incorporate additional wordings in the policy documents, suitably enunciating insurers' stand to condone delay on merit for delayed claims where the delay is proved to be for reasons beyond the control of the insured.

J. Harinarayan

CHAIRMAN”

10.       Accordingly in view of our aforesaid, discussion and the circular issued by IRDA, we are of the considerate view that the OP No.1 acted negligently in intimation of repudiation of the claim and repudiated the same in an arbitrary, technical and hasty manner. In our opinion the OP No.1 has committed deficiency of service and caused unnecessary mental agony and harassment to the complainant. Hence the present complaint is accepted. The OP No.1 is directed to make the payment towards the Policy of the complainant’s deceased husband alongwith 9% interest p.a from the date of last reminder sent  to OP No.1 i.e 19.07.2013 Ex. C-6. The complainant is also held entitled to Rs.10,000/- on account of compensation for mental agony alongwith litigation cost. The OP No.1 is directed to comply with the order of this Forum within a period of 45 days from the date of receipt of this order, in case the OP No.1 fails to comply with this order the OP shall also be held liable to pay 9 % interest p.a till its realization.

11.                 The arguments on the complaint were heard on 29.09.2015 and the order was reserved. Now the order be communicated to the parties. Copy of the order be sent to the parties free of cost and thereafter the file be consigned to the record room.

Pronounced

Dated: 06.10.2015

(A.P.S.Rajput)     

   President

 

  (A.B.Aggarwal)           

   Member