DISTRICT CONSUMER DISPUTES REDRESSAL FORUM FATEHGARH SAHIB

Consumer Complaint  No.     83 of 2017

                                       Date of institution                    :         04.12.2017

                                      Date of decision                       :         06.05.2019

HarpreetKaur aged about 38 years widow of Sh.Kulwinder Singh S/o Sh.Gurdeep Singh, Resident of Village Bhamian, Post Office Dulwan, Tehsil Khamano, District Fatehgarh Sahib, having Adhar Card Number 2976 2520 2809.

……..Complainant

Versus

1. IffcoTokio General Insurance Company Limited, 1^st Floor, Sohan Singh Complex, Near Railway Crossing, Shashtri Nagar, Ludhiana through its Authorized Person/Manager.
2. The Manager, The Fatehgarh Sahib Central Coop. Bank Limited, Sirhind, Branch Bharri, Tehsil Khamano, District Fatehgarh Sahib.
3. The District Manager, The Fatehgarh Sahib Central Coop. Bank Limited, Sirhind, H.O. Sirhind, District Fatehgarh Sahib.

…..Opposite Parties

Complaint Under Sections 12of the Consumer Protection Act 1986.

Quorum

Sh. Kuljit Singh, President.

Sh. InderJit, Member

Present :      Sh.S.S. Mann, Advocate counsel for the complainant.                               Sh.VinaySood, Adv. counsel for OP-1.

Sh.AnkushKhatri, Adv. counsel for OP No.2&3.

ORDER

By Kuljit Singh, President

1. Complainant– HarpreetKaurhas filed this complaint against the Opposite Parties (hereinafter referred to as the OPs) under Sections 12 of the Consumer Protection Act. The brief facts of the complaint are as under:
2. Complainant is an illiterate lady and can only put her signature in Punjab Language and very poor lady having no any movable or immovable property in her name and also having no source of income for her livelihood and is living by doing the labour. Sh.Kulwinder Singh her husband was holding account of OP-2 bearing No.060934028000079.  He became a member of OP-1 under Sehkari Bank BimaYozna Scheme through OP No.2&3.  Said Kulwinder Singh met with a road accident on 10.09.2016 and he suffered head injuries and he got treated himself medically from private doctor but he was not feeling well then he remained admitted in PGI Hospital Chandigarh where he was medically treated from 09.10.2016 to 19.10.2016 and then he was released from the hospital.  Thereafter, the pain again started in the injuries suffered by him during the said accident and he again remained admitted in PGI, Chandigarh from 05.11.2016 to 11.11.2016. Thereafter, said Kulwinder Singh remained under treatment at home and he died at his residence on 26.11.2016.  Complainant being legally wedded wife and Sh.Gurinder Singh being son of said Kulwinder Singh are the LR of deceased Kulwinder Singh. Said Gurinder Singh has given no objection affidavit that if death claim of deceased Kulwinder Singh be given to his mother HarpreetKaur.  Complainant has approached to OP-2 and completed all formalities to get insurance claim of Rs.5 Lac under said scheme being L.R. of deceased Kulwinder Singh.  OP-2 with motive not to issue death insurance claim under said scheme, has issued letter dated 01.02.2017 to complainant demanding post mortem report and copy of FIR.  Complainant approached to OPs and stated that she is an illiterate lady and having no knowledge about the proceedings and she could not lodged the FIR with regard to death of her husband and she could not get postmortem of the dead body.  OPs demanded affidavit and a certificate from the Panchayat.  Then complainant has given detailed affidavit dated 17.03.2017.  Thereafter, OP-3 again sent letter dated 05.06.2017 demanding said documents i.e. postmortem and copy of FIR etc.  Whenever, the detail with regard to same had already been given by complainant.  It has been prayed that OPs be directed to pay death insurance claim amount of Rs.5,00,000/- alongwith interest from the date of death of deceased Kulwinder Singh till realization and also directed to pay Rs.50,000/- as compensation for harassment.
3. Notice of complaint was issued to OPs.  OP No.1 appeared and contested the complaint, by raising certain preliminary objections that complaint is not maintainable as all the legal heirs of deceased had not been impleaded as party; complaint is misuse and abuse of process of law; complaint is false and vexatious; complainant has not come to this Forum with clean hands; no cause of action has arisen to complainant; there is complete disregard to terms and conditions of policy; on receipt of intimation of loss one investigator namely Sh.VikashGulati was appointed, who vide his report dated 23.07.2018, had submitted that there is no evidence of any alleged accident of Kulwinder Singh having received injuries in accident.  No FIR or DDR of alleged accident was ever lodged by Kulwinder Singh or his family members. The postmortem of dead body was not got conducted by complainant with regard to cause of death of Kulwinder Singh. During investigation, the investigator had collected the medical record from PGI Chandigarh. As per discharge dated 11.11.2016, the deceased was suffering from “BASAL GANGLIA SOL” and was treated for that in PGI. He was discharged on 11.11.2016 and died on 26.11.2016. Kulwinder Singh had left PGI against medical advice. As per discharge summary deceased was diagnosed as a case of “ESOPD, I.E. PATIENT WAS SUFFERING BASAL GANGLIA, WHICH IS A DISEASE RELATED TO BRAIN”, which had no concern with accidental injuries. During the stay in PGI, Kulwinder Singh was treated for aforesaid sufferings, the disease which is not covered under the policy. Deceased was insured for accidental injuries. On merits, answering OP has denied all the averments of complaint except treatment of above said sufferings of deceased – Kulwinder Singh which is not covered under insurance policy. It has been prayed that complaint be dismissed with costs.
4. As per statement of counsel for OPs as mentioned in order dated 06.08.2018 of this Forum, the written reply of OP-1 to be read as written reply of OP No.2&3 also and no need to reiterate the same.
5. In order to prove the case, both the parties tendered their respective documents and closed the evidence.
6. We have heard learned counsel for the parties and have also examined therecord of the case very carefully.
7. It is not disputed that Sh.Kulwinder Singh since deceased was insured with the OP-1 for Rs.5,00,000/- being account holder of OP-2.  Insurance premium was deducted by OP No.2 from his account and remitted to OP-1.  Fact regarding death of insured and lodging of the claim are also admitted.  Grievance of the complainant is that OP-1 – Insurance Company is delaying payment of the claim amount and vide letter dated 05.06.2017 has demanded copy of postmortem report and FIR whereas the information regarding said documents had already been given to the OPs.
8. Learned counsel for complainant has vehemently contended that Sh.Kulwinder Singh husband of complainant died due to accidental injuries and as such the complainant are entitled to claim amount of Rs.5,00,000/-. Whereas the plea taken by the OP-1 in the written statement is that their investigator collected medical record from PGI, Chandigarh and as per record of insured was suffering from Basal Ganglia SOL.  He took treatment from PGI from 05.11.2016 to 11.11.2016 and died on 26.11.2016.  Deceased was insured for accidental injuries and the disease suffered by deceased has no concern with accidental injuries and as such the claim is not payable.
9. Now the question for determination in this case is that whether husband of the complainant suffered from accidental injuries resulting into his death?
10. After lodging of claim, OP No.2 wrote letter dated 01.02.2017 Ex.C-10 to the complainant that insurance company had demanded copy of FIR, Medical report and death certificate.  The complainant submitted death certificate Ex.C-6 and also submitted copies of affidavit Ex.C-7 of Sh.Gurinder Singh son of complainant to the fact that his father Kulwinder Singh died due to injuries received in an accident.  Similarly, affidavit Ex.C-11 is also on file given by complainant showing that her husband met with an accident on 10.09.2016 because a dog came in front of his motorcycle and he fell down and received injuries in head.  FIR was not lodged because, it was not a police case.  Death occurred on 26.11.2016 in home.  Complainant has also placed on file Ex.C-12 a certificate issued by Sarpanch Gram Panchayat wherein it has been certified that Sh.Kulwinder Singh on 10.09.2016 at about 7:00 PM was coming to home on his motorcycle No.PB-23S-3488.  A dog came in front of his motorcycle and he fell down and received injuries in head.  Death occurred due to injuries received in an accident.  Due to lack of knowledge to family members postmortem could not be conducted nor the FIR has been lodged.  Family is living below poverty line.  This documents is dated 21.03.2017 and is also signed by Karnail Singh Panch,Parminder Singh Panch, Avtar Singh Nambardar and GurmailKaurPanch.  It is not understood when the complainant has already submitted the documents as mentioned above, as to why OP – Insurance is time and again demanding the same documents through Co-operative Bank OP-2. OP17 placed on file by OP shows that death occurred due to fall from motorcycle. Certificate of Nambardar and Members of Gram Panchayat has also been placed by the OP on file.  Ex.OP-20 report of investigator placed on record by the OP also shows that he recorded statement of claimant (wife of deceased and statement of neighbors). He also mentioned date and time of accident as 10.09.2016 at about 7:00 PM.  It is also mentioned that deceased fell down on the road and sustained grievous injuries over his head.  He was taken to local clinic of village Bhamian and then taken to his home. On 09.10.2016 he was taken to PGIMER Chandigarh.  No police report lodged about the incident.  Postmortem was also not conducted.  Investigator has also mentioned that he has recorded statement of neighbors and has been witnessed by Parminder Singh S/o Bhag Singh, Gian Singh S/o Gurdev Singh and Avtar Singh Nambardar of Village Hamian.  Their Mobile numbers have also been mentioned. When all the persons whose statements have been recorded by the investigator stated that deceased fell from motorcycle and received head injuries, as to why the investigator has not made any effort to visit the local clinic where deceased was taken firstly on occurring of accident and took copies of record.  Mere mentioning in the discharge summary that deceased was addicted to alcohol and tobacco and was suffering from Basal Ganglia which is a brain disease is not sufficient to repudiate the claim on this ground.  Investigator has not produced on record any previous treatment record of Kulwinder Singh showing that he was suffering from pre-existing disease and ever took treatment for that disease.
11. Basal Ganglia is a tumor of brain which might have occurred due to blood clotting in the brain on account of fall of deceased from the motorcycle and receiving of head injuries.  All the documents placed on file and described above show that death occurred due to accidental injuries and as such the claim is payable by the Insurance Company. 
12. Sequel to the above discussion, the complaint is accepted and the OP – Insurance company is directed to pay claim amount to the complainant alongwith interest @9% Per annum from the date of report of investigator till payment. The payment of claim amount be paid in equal share to Legal heirs of deceased. Amount falling to the share of minor will remain deposited in the shape of FDR till he become major. OP-Insurance Company is further burdened to pay Rs.20,000/- as compensation to the complainant for causing mental tension, pain and harassment by not making payment of the claim and Rs.5,000/- as litigation costs to complainant.
13. Entire compliance of this order be made by OP-1 within a period of thirty days from the date of receipt of copy of this order.
14. Copy of order be sent to the parties free of cost and thereafter the file be consigned to record room

Pronounced:06.05.2019                                      (Kuljit Singh)

                                                                  President

                                                          (Inderjit)

                                                         Member