Punjab

Faridkot

CC/19/220

Sukhjinder Kaur - Complainant(s)

Versus

IFFCO TOKIO General Insurance co. Ltd. - Opp.Party(s)

Ashu Mittal

26 Jul 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, FARIDKOT

C. C. No. :                     220 of 2019

Date of Institution:          06.09.2019

Date of Decision :            26.07.2023

1. Sukhjinder Kaur aged about 34 years, widow of Sukhwinder Singh son of Visakha Singh r/o Village Sadhu Wala, District Faridkot.
2. Khushwinder Singh aged about 10 years son of Sukhwinder Singh son of Visakha Singh r/o Village Sadhu Wala, District Faridkot through his natural guardian Sukhjinder Kaur widow of Sukhwinder Singh.

                                                                             ......Complainants

                                                               Versus

1. IFFCO TOKIO General Insurance Co. Ltd. through its Managing Director Registered Office IFFCO Sadan, C-1, District Centre Saket New Delhi-110017.
2. IFFCO TOKIO General Insurance Co. Ltd. through its Managing Director Address Plot No.2 (B&C) Sector 28 A Chandigarh.                                                                      

.........OPs

3. PUNSUP the Punjab State Civil Supplies Corporation Ltd. Regd Office SCO 36-40 Sector 34-A, Post Box No.4, Chandigarh.

.................Proforma Party

Complaint under Section 12 of the

Consumer Protection Act, 1986.

(Now, Section 35 of the Consumer Protection Act, 2019)

 

Quorum:        Smt Param Pal Kaur, Member,

Sh Vishav Kant Garg, Member.

 

Present: Sh Ashu Mittal, Ld Counsel for complainant,

              Sh Satish Kumar Jain, Ld Counsel for OP-1 & 2,

              Sh Sandeep Khosla, Ld Counsel for OP-3.

ORDER

(Param Pal Kaur, Member)        

                            Complainant has filed the present complaint against OPs seeking directions to OPs to make payment of insurance claim of Rs.10,00,000/-on account of

accidental death of Sukhwinder Singh and for further directing them to pay compensation for harassment, inconvenience, mental agony besides litigation expenses of Rs.22,000/-.

cc no.- 220 of 2019

 

2                                          Briefly stated, the case of the complainant is that late Sukhwinder Singh husband of complainant was working in the office of PUNSUP Punjab State Civil Supplies Corporation/OP-3 on monthly salary of Rs.24,158/-. Sukhwinder Singh met with an accident on 10.07.2016 at about 7.30 a.m. and died due to drowning due to falling of his motorcycle suddenly in Gang Canal in Village Pindi Balochan, District Faridkot. Matter was reported to Police Station, Sadiq where Police did the proceedings under Section 174 of Cr.P.C. and DDR to this effect was also recorded on 27.07.2016  and post mortem of deceased was conducted at Guru Gobind Singh Medical College and Hospital, Faridkot. Intimation regarding said accident was also given to OP-3. Deceased was employee of OP-3 and was covered under Group Personal Accident Policy that was issued by OP-3 and his death occurred during the course of his employment. After death of Sukhwinder Singh, complainant submitted all the relevant documents to OP-3, who further forwarded the same to OP-1. Ld counsel for complainant submitted that after death of Sukhwinder Singh, complainant got job on compassionate ground and then, she came to know that OPs repudiated the claim of complainant on the ground that her husband did not die any accidental death, rather he died due to committing suicide by jumping into the canal and in case of suicide, Insurance Company is not liable for making payment of claim on account of death of insured. Ops have repudiated the claim of complainant on false grounds that Sukhwinder Singh committed suicide though they have no proof regarding this. Ops have taken lame excuse to escape their liability of making payment of insurance claim of complainant and have illegally and unlawfully repudiated the same. Complainant made several requests to OPs to make payment of insurance claim on account of death of Sukhwinder Singh husband of complainant, but they paid no heed to genuine requests of complainant and did not do anything needful to redress the grievance of complainant, which amounts to deficiency in service and trade mal

 

cc no.- 220 of 2019

practice on the part of OPs. He has prayed for accepting the present complaint alongwith compensation and litigation expenses besides the main relief. Hence, the present complaint.

3                                            The counsel for complainant was heard with regard to admission of the complaint and vide order dated 11.09.2019, complaint was admitted and notice was ordered to be issued to the opposite parties.

4                                                OP-1 and OP-2 filed reply taking preliminary objections that on receipt of information from complainant regarding death of Sukhwinder Singh, they immediately appointed Investigator, who gave finding that Sukhwinder Singh husband of complainant had committed suicide by jumping into river and as per terms and conditions of the  Insurance Policy in question, complainant is not entitled for any claim and therefore, being non maintainable, claim of complainant was rightly repudiated. Moreover, complainant has not disclosed all the legal heirs of Sukhwinder Singh and therefore, it is not maintainable in present form in the eyes of law. However, on merits, ld counsel for OPs have denied all the allegations of complainant being wrong and incorrect and admitted before the Forum that deceased Sukhwinder Singh was employee of OP-3 and was insured with them under present insurance policy in question. It is averred that Investigator appointed by them gave his report that no such alleged accident ever occurred on 10.07.2016, rather deceased had committed suicide and this fact was admitted by complainant herself during investigation. It is denied that deceased met with accident near Gang Canal and suddenly fell into same, rather complainant has taken false plea to get compensation from answering OPs. Immediate intimation regarding alleged accident was not given to Police, rather false report was lodged with Police by the complainant on the basis of which General Diary dated 27.07.2016 was recorded by Police. Moreover, complainant did not inform Ops immediately about that accident. It is also denied that complainant came to know about this accident after obtaining job. All the allegations

cc no.- 220 of 2019

levelled by complainant are denied and it is further averred that claim of complainant regarding death of her husband was repudiated by them on the ground that Sukhwinder Singh did not die accidentally instead he had committed suicide by jumping into canal and as per terms and conditions of the Insurance Policy in question, claim lodged by complainant falls under policy exclusion clause 4 (A) of  terms and conditions of the Policy and Insurance Company is not liable for payment of compensation for committing suicide or for intentional self injury. Moreover, claim has been legally repudiated on 06.02.2017 on the basis of statement of complainant who is wife of deceased Sukhwinder Singh. Allegations with regard to relief sought too are denied being wrong and incorrect and prayer for dismissal of complaint with costs is made.

5                                               OP-3 filed written statement wherein they have denied all the allegations of complainant being wrong and incorrect and asserted that there is no deficiency in service on their part. However, it is admitted by OP-3 in their written statement that deceased Sukhwinder Singh husband of complainant was working in their office and this fact is also not denied by them that said Sukhwinder Singh met with an accident and died on 12.07.2016 by falling from his motor cycle in canal.Op-3 admitted that deceased was insured under Group Personal Accident Policy and averred that answering OP is not liable for making payment of insurance to family of deceased. It is reiterated that there is no deficiency in service on the part of OP-3 and also denied all the allegations levelled by complainant being wrong and incorrect. Prayer for dismissal of complaint with costs is made.

6                                       Parties were given proper opportunities to prove their respective case. Ld Counsel for complainant tendered in evidence affidavit of complainant Ex.C-11 and 12, documents Ex C-1 to C-10 and then, closed the evidence on behalf of complainant.

cc no.- 220 of 2019

7                                              In order to rebut the evidence of the complainant, the ld Counsel for OP-1 and 2 tendered in evidence affidavit of Sameer Gupta as Ex OP-1, 2/1 and document Ex OP-1, 2/2  to Ex OP-1,2/8 and then, closed the evidence. Despite availing sufficient opportunities, OP-3 did not tender any evidence and therefore, vide order dated 14.12.2021, evidence of OP-3 was closed by order.

8                                              We have heard the learned counsel for the complainant as well as Opposite parties and have very carefully gone through the affidavits and documents placed on record by respective parties.

9                                                From the careful perusal of record and after going through evidence and documents produced on file by respective parties, it is observed that grievance of complainant is that her husband was insured with OPs under the policy in question and during the validity of insurance period, he met with an accident. His motor cycle slipped and he fell into Gang canal and he passed away. After his death, complainant no. 1 submitted claim alongwith bills and relevant documents to OPs, but they repudiated her genuine insurance claim on false ground that deceased insured committed suicide, which is totally incorrect. Though Ops admitted that husband of complainant was insured with OPs under the policy in question. OPs stressed mainly on the point that deceased insured did not die in any accident, rather he committed suicide and therefore, they have rightly repudiated the claim as per terms and conditions of the policy, claiming there is no deficiency in service on their part.

10                                             It is noticed that Er Vikas Gultai Insurance Claim Investigator appointed by Ops themselves, has mentioned in his report Ex OP-1,2/4, a list of 7 persons to whom, he met during the course of his investigation and no person in said list ever stated that death of deceased Sukhjinder Singh occurred due to committing suicide nor anybody disclosed any thing regarding any kind of burden,

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work pressure or domestic tension over him that forced him to commit suicide. Deceased was not having any kind of health issue. As per Investigation Report, even financial condition of the family prior to death of deceased insured is also mentioned as good and there is not an iota of doubt that he was under any kind of financial burden or loss that led him to commit suicide. Deceased insured was 32 years old man working in Punsup and was living happily with his wife and son and relations of deceased were cordial with his family, friends and neighbours and thus, there appears to be no cause for committing suicide.

 11                          After having gone through the record and considering the arguments of the parties, it is clear enough that complainants are duly entitled for the insurance claim as the OPs have failed to produce on record any authentic document justifying the repudiation of the genuine claim of the complainants. In the absence of any authentic proof of commitment of suicide, plea taken by Ops that deceased committed suicide, has no legs to stand upon. It is observed that in the  absence of any cogent proof of committing suicide, it is presumed that OPs are just trying to escape their liability of making payment of insurance claim to the complainants. Moreover, perusal of DDR/General Diary Details Ex C-3 clearly reveals the fact that motorcycle of deceased insured slipped in muddy water collected due to rain  beside the Gang canal. Due to slipping of tyre of his motorcycle, he fell into canal and died therein. Even Ex C-8 letter issued by Department of deceased insured to Insurance Company also reflects the fact that Sukhwinder Singh accidentally fell from his bike into the canal on 12.07.2016 and his death occurred due to drowning and he passed away on same day. Statement relied upon by OPs for repudiating the claim has no relevance in the eyes of law as  his wife was not an eye witness to said accident and thus, narration given by her about whatever she heard from someone regarding death of her husband, does not otherwise seems to be correct because she was not available on the said spot at the time of accident or death.  No where from the record, it can be made out that

cc no.- 220 of 2019

deceased was under pressure at his office or at home. Even it has not come out from the report of Er Vikas Gultai Insurance Claim Investigator that there was any dispute or problem at his house that forced him to commit suicide.

12                                           By repudiating the claim of complainants on false ground of suicide by deceased, OP-1 and 2 cannot escape from their liability of making payment of genuine insurance claim to the complainants. On the other hand, complainants have placed on record sufficient and cogent evidence to prove their pleadings and all documents placed on record by them are authentic and are beyond any doubt. Therefore, complaint filed by complainants stands hereby allowed against OP-1 and 2 with direction to them to pay the death claim of Rs.10,00,000/- to complainants alongwith interest at the rate of 6% from the date of death of deceased insured till final realization. OP-1 and 2 are further directed to pay Rs.10,000/-to complainants as consolidated compensation for harassment and mental agony suffered by them and for litigation expenses incurred on present complaint. Compliance of this order be made within 45 days of receipt of the copy of the order. As OP-3 has no role in making payment of insurance claim, therefore, complaint against OP-3 stands hereby dismissed.  Copy of order be given to parties free of cost. File be consigned to record room.

Announced in Commission

Dated : 26.07.2023

 

Member                     Member          

                                                (Vishav Kant Garg)   (Param Pal Kaur)