DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BARNALA, PUNJAB.

 

Complaint Case No : CC/116/2018

Date of Institution : 18.09.2018

Date of Decision : 05.08.2019

Mukhtiar Singh aged about 67 years son of Mukand Singh resident of Vidhia Patti, Khudi Kalan, Tehsil and District Barnala-148107.                        …Complainant

Versus

1. Iffco-Tokio General Insurance Company Limited, 5-C/1, Ground Floor, Sheetal Complex, Rajbaha Road, Patiala, Tehsil and District Patiala-147001 through Divisional Manager.

2. The Sangrur Central Co-operative Bank, Branch Farwahi Bazaar, Barnala-148101 through its Manager.

3. The Sangrur Central Co-operative Bank, Patiala Gate, Head Office, Sangrur-148001 through its Manager.

…Opposite Parties

Complaint Under Section 12 of Consumer Protection Act, 1986.

Present: Sh. S.D. Bansal counsel for complainant.

Sh. AK Jindal counsel for opposite party No. 1

Sh. SS Dhaliwal counsel for opposite parties No. 2 and 3.

Quorum.-

1. Sh. Kuljit Singh : President

2. Sh. Tejinder Singh Bhangu : Member

3. Smt. Manisha : Member

(ORDER BY KULJIT SINGH, PRESIDENT):

1.    The complainant namely Mukhtiar Singh has filed the present complaint under Consumer Protection Act (In short the Act) against Iffco-Tokio General Insurance Company Limited, Patiala and others. (hereinafter referred as opposite parties). 

2. The facts leading to the present complaint as stated by the complainant in his complaint are that the complainant has opened a saving bank account bearing No. 1355 with the opposite party No. 2 bank. The opposite parties No. 2 and 3 under Bima Yozna Scheme got a Group Personal Accident Insurance Policy No. 51666478 of Rs. 1,00,000/- from 1.6.2016 to 31.5.2017 of its account holders from opposite party No. 1. The opposite party No. 2 deducted Rs. 40/- annually from the said account of the complainant. 

3. It is further alleged that on 9.5.2017 the complainant met with an accident at his house and four fingers and thumb of right hand of the complainant has been cut by Hinge machine. The complainant admitted in the Civil Hospital, Barnala from 9.5.2017 to 22.5.2017 and surgery of right hand of the complainant has been done on which he spent Rs. 50,000/-. Further, due to said accident the complainant become 50% permanent disable person and a certificate for the person with disabilities has been issued to the complainant by the doctors of Civil Hospital, Barnala. A DDR was also recorded regarding this accident bearing No. 16 dated 9.5.2017 at PS Handiaya, District Barnala. After the said accident the complainant went in the bank of opposite party No. 2 and filled the claim form under the said policy and submitted all the requisite documents. But opposite parties have denied the claim of the complainant as No Claim vide letter dated 2.4.2018 and intimation regarding this has been given by the opposite party No. 2 to the complainant through letter dated 7.4.2018. This act of the opposite parties is deficiency in service and unfair trade practice on their part. Hence, the present complaint is filed seeking the following reliefs.-

1) The opposite parties be directed to pay Rs. 1,00,000/- alongwith interest till now with future interest on account of disability.  

2) To pay Rs. 50,000/- alongwith interest till now with future interest on account of expenses on treatment, clothing and transport.

3) To pay Rs. 1,50,000/- alongwith interest on account of loss of income.

4) To pay Rs. 1,50,000/- as compensation for harassment.

5) To pay Rs. 10,000/- as litigation expenses.  

6) Any other relief which this Forum deems fit and proper. 

4. Upon notice of this complaint, the opposite party No. 1 filed written version taking legal objections interalia on the grounds  that intricate questions of law and facts are involved in the present complaint so the appropriate remedy is only civil court. The complainant has concealed the material facts and documents from this Forum. The present claim relates to settlement of disability claim of complainant who allegedly suffered injuries on 9.5.2017 in the accident but as per policy accidental death, permanent total disability and loss of complete limbs/eyes is covered and in this only four fingers and proximal phalanx of thumb got amputated which is not covered under the policy, so the answering opposite party informed the opposite parties No. 2 and 3 vide letter dated 2.4.2018 that the claim does not fall under the purview of insurance policy. As per terms and conditions of insurance policy, the nature of claim is permanent partial disablement and falls under table of benefits No. 5. The insurance policy was opted for coverage of benefits under Table B1 which covers table of benefits No. 1 to 4. The answering opposite party got the matter thoroughly investigated from Er. Vikas Gulati, Investigators who investigated the claim and submitted the report dated 10.2.2018. 

5. On merits, it is admitted that complainant was having saving bank account with opposite parties No. 2 and 3 and insurance was issued in the name of opposite parties No. 2 and 3 for their account holders. Rest of the averments of the complaint are denied by the opposite party No. 1 and reiterated the legal objections in the reply on merits also. Lastly, opposite party No. 1 prayed for the dismissal of the present complaint.

6. The opposite parties No. 2 and 3 also filed written version taking legal objections on the grounds of groundless complaint, no jurisdiction and hopelessly time barred. They also submitted that in the present complaint the answering opposite party is only the financing institution for complainant and he never insured the complainant nor he is a mediator in the present complaint. 

7. On merits, it is admitted that complainant opened a saving bank account with answering opposite party No. 2 and answering opposite parties under Bima Yozna Scheme got a Personal Accident Insurance Policy No. 51666478 of Rs. 1,00,000/- from 1.6.2016 to 31.5.2017 and complainant is account holder of answering opposite parties and they deducted Rs. 40/- annually from his account. It is also admitted by them that complainant filled the claim form under the said policy and submitted the same with all requisite documents. It is submitted by them that the answering opposite parties sent all requisite documents submitted by the complainant to the opposite party No. 1 who refused to pay the claim of the complainant. So, there is no unfair trade practice and deficiency in service on the part of the answering opposite parties. Lastly, they prayed for the dismissal of the present complaint with costs.

8. In support of his case, the complainant tendered into evidence copy of passbook as Ex.C-1, copy of insurance policy as Ex.C-2, copy of admission record as Ex.C-3, copy of DDR as Ex.C-4, copy of disability certificate as Ex.C-5, copy of no claim letter dated 2.4.2018 as Ex.C-6, copy of letter dated 7.4.2018 as Ex.C-7, affidavit of complainant as Ex.C-8 and closed the evidence. 

9. To rebut the case of the complainant, the opposite party No. 1 tendered into evidence copy of Surveyor report alongwith documents as  Ex.O.P-1/1, copy of policy schedule as Ex.O.P-1/2, affidavit of Rajiv Ranjan General Manager as Ex.O.P-1/3, copy of no claim letter dated 2.4.2018 as Ex.O.P-1/4, copy of summary of benefits as Ex.OP-1/5, affidavit of Er. Vikas Gulati as Ex.OP-1/6 and closed the evidence. The opposite parties No. 2 and 3 tendered in evidence affidavit of Rajinder Kumar Branch Manager Ex.OP-2.3/1 and closed the evidence. 

10. We have heard the learned counsel for the parties and have gone through the record. Written arguments filed by the parties have also been gone through.

11. It is an admitted fact between the parties that the complainant has a saving bank account with the opposite parties No. 2 and 3 and he was insured with the opposite party No. 1 and amount of premium of Rs. 40/- was deducted from his account annually which is mentioned in copy of passbook Ex.C-1. It is admitted by the opposite parties No. 2 and 3 that complainant submitted claim form alongwith requisite documents with them and they sent the same to the opposite party No. 1 who refused to pay the claim of the complainant. 

12. Now the main question before us whether the complainant is entitled to the insurance claim or not ?

13. To prove that the complainant is entitled to the insurance claim the complainant copy of DDR Ex.C-4 in which it is mentioned that the complainant met with an accident on 9.5.2017 at his house in which his fingers amputated. He also relied upon copy of Disability Certificate Ex.C-5 in which it is mentioned that complainant is 50% disable as his right hand all fingers and proximal phalanx has been amputated. He also relied copy of letter dated 2.4.2018 Ex.C-6 vide which the insurance company repudiated the claim of the complainant.

14. On the other hand the opposite party No. 1 relied upon report alongwith documents Ex.OP-1/1 in which all investigation record has been submitted by the opposite party. They also relied upon copy of policy schedule Ex.OP-1/2 vide which the opposite party relied upon that the complainant is not entitled to the insurance claim as per terms and conditions of the policy. 

15. We have perused the copy of policy schedule which is most important document of the present case as the policy wording at Table of benefits Clause 5 (e) it is mentioned that in case of loss of four fingers the percentage of capital sum insured was 35% which means that in case of loss of four fingers the insured was entitled for the benefit of 35% of Rs. 1,00,000/- which comes Rs. 35,000/- and the case of the complainant  also falls  in this clause as he has also lost four fingers in an accident and from this document it is clearly proved on the record that the complainant is entitled to the amount of Rs. 35,000/- from the opposite party No. 1. But the opposite party No. 1 has not given this benefit to the complainant whereas it is in their knowledge that the complainant is entitled to this benefit, which is clear cut unfair trade practice and deficiency in service on the part of opposite party No. 1. 

16. The Hon'ble Punjab and Haryana High Court at Chandigarh in case titled New India Assurance Company Limited Versus Smt. Usha Yadav and others 2008(3) RCR (Civil) Page-111 held as under.-

:It seems that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.

The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs. 5,000/- for luxury litigation being rich.”

This citation is fully applicable to the facts of the present case as in the present matter also the opposite party No. 1 earned premium in lacs of rupees but when a person applied for his genuine claim then they repudiated the same on flimsy grounds so there is deficiency in service on their part.

17. As a result of the above discussion, present complaint is partly allowed against the opposite party No. 1 and the opposite party No. 1 is directed to pay the amount of Rs. 35,000/- to the complainant on account of insurance claim alongwith interest at the rate of 6% per annum after three months from the date of lodging the claim by the complainant with the opposite party No. 1 till realization and to pay Rs. 5,000/- as compensation to the complainant for mental tension and harassment and Rs. 3,000/- on account of  litigation expenses.  Compliance of order be made within the period of 30 days from the date of the receipt of the copy of this order. Copy of the order be supplied to the parties free of costs. File be consigned to the records after its due compliance.

  ANNOUNCED IN THE OPEN FORUM:

5th Day of August 2019

 

 

            (Kuljit Singh)

           President

 

 

           (Tejinder Singh Bhangu)                Member

 

 

(Manisha)

Member