DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, JALANDHAR
Complaint No.266 of 2017 Date of Instt. 03.08.2017 Date of Decision: 20.04.2021
Daljit Kaur wd/o Kamaljit Singh, aged 40, r/o Nawan Pind Naicha, P.O Goraya, Police Station, Phillaur, Jalandhar Punjab.
….. Complainant
Versus
1. IFFCO Tokio General Insurance Company Limited, 2nd Floor, Plot No. EH-198, Civil Lines, Nirmal Complex, Swagat Palace, G.T Road, Jalandhar 144 001 through its Branch Manager.
2. Managing Director of IFFCO Tokio General Insurance Company Limited office at IFFCO Sadan, C-1, District Center, Saket, New Delhi 110 017.
…Opposite Parties
Complaint under the Provisions of Consumer Protection Act
QUORUM:
SH. KULJIT SINGH, PRESIDENT
SMT. JYOTSNA, MEMBER
ARGUED BY:
For Complainant : Smt. Satinder Kaur
For OPs no.1&2 : Sh.A.P.S. Pathania, Advocate
ORDER:-
KULJIT SINGH, PRESIDENT
1. The instant complaint has been filed by the complainant, wherein alleged that the OPs are well known in the field of insurance purpose qua various kinds of insurance under the name and style of IFFCO Tokio General Insurance Company Limited. The complainant is a rustic villager and does never know the technicalities of the Law and repose confidence in the public and faith on the society. The complainant belongs to a poor family having no source of income and due to this her husband had no option except to opt to go abroad on work visa for earning so that he would be able to provide a better life to his family and for this, the husband of the complainant applied for work visa with ECR countries. The husband of the complainant applied for a passport with the passport authority Jalandhar and the same was issued to him which was valid from 07.10.2009 to 06.10.2019 and after that he approached for work visa and for this he regularly remained in contact of various persons and after a long and hard process her husband succeeded in getting work visa for kingdom of Saudi Arabia on driver post and sponsorship for the same was granted by a citizen of Kingdom of Saudi Arabia namely Mubarak Nisar Ayez Ali Rasheed. The complainant’s husband went to kingdom of Saudi Arabia for job. Thereafter, her husband sent some money for the subsistence of the family but after some time her husband died there and she received no information regarding her husband’s death. Rather one of the villagers of the complainant’s village got an information on internet that a person of Goraya village died at Kingdom of Saudi Arabia and no person had ever claimed the dead body and after that a contact was made to other villagers of Goraya village who were also at Saudi Arabia, then they confirmed the death of the complainant’s husband. Only after that she came to know that her husband had died there in a road accident. That the complainant is an illiterate person. She can only sign that too in Punjabi. The complainant approached her village mate Hargopal Kataria who is a social person of the village for helping her in order to get the dead body of her husband and that person sent many mails to the concerned department on behalf of the complainant asking them to devolve the dead body of Kamaljit Singh into India to his family and on this the concerned department reverted and conveyed the family to deposit the requisite travel expenses of the dead body to India and on this the complainant deposited the amount with the concerned department and received the dead body of the deceased namely Kamaljit Singh and cremation was done by the family members of the deceased in India. The complainant is a simple and rustic villager, she neither had any knowledge about the insurance policy of her husband nor does she know of any monetary help to be provided to her by the Government in case of such crucial circumstances. Only after having got entire documents from the concerned country such as post mortem report, police report, cancelled passport and other related documents of the deceased, she comes to know of the policy of her husband. She showed all the documents to some near dear of family. He told her that on the passport the name of the insurance company alongwith the policy number is mentioned and on this the complainant sent a duly filled claim form and other documents which were received by her from the Kingdom of Saudi Arabia, to the OP for making the payment under the policy, but the OP repudiated the claim under the policy and sent a letter to her with various allegations dated 18.01.2016. Tht the OP had never ever provided any terms and conditions of the policy either to the complainant or to the policy holder at any stage and further it is a strict obligation on the OP to prove the fact that they have provided the terms and conditions of the policy to the complainant or to the policy holder. It is considerable fact that policy number comes into the knowledge of the complainant only when she got the passport of her deceased’s husband as the same was written on the passport and was told to her by some near dear of her family as the poor lady herself is an illiterate personality. The said policy has been framed by the Government of India, to provide security to the family of that citizen of India who went to ECR countries for work and for the same the insurance companies are under obligation to provide social security to the citizens of India in form of monetary benefits at the earliest to run their life. But the OPs adopted such an unethical behavior and repudiated the liability with its own version. Further, it is pertinent to mention here that for those Indians who went to ECR countries on work visa it is a mandatory provision to provide coverage to them under Parvasi Bhartiya Bima Yojana which is subsidized by the Government of India. The OPs have never applied its mind that the policy holder died in a Motor Vehicle Accident at Kingdom of Saudi Arabia and this fact is crystal clear from the Post Mortem Report as the report described the deadly injuries. As per the PMR, the entire injuries showed that lower part of the body of the deceased was damaged and due to these said injuries he died. Further it is to be noted that even a single abrasion has not been found on the upper part of the body and it is not possible that when any person commits suicide then his body do not receive any injury on the face or on the other upper part of the body, so the Investigation report of the police of Kindgom of Saudi Arabia was totally manipulated by the employer just to save himself from a legal liability and moreover the deceased was an outsider at that place and no person was available there to save his rights. On the other side the insurance company does not go through the contents of the said fact and instead of applying its mind, it adopted such an irresponsible behavior just to repudiate the liability under the policy, under the garb that the deceased had committed suicide. The complainant approached the Branch Office of the OP at Jalandhar many times for the withdrawal of such an illegal repudiation letter and for the payment of the entire amount under the policy to the complainant at the earliest, but the OP did not pay any heed to the request of the complainant at any time. Due to the above adamant act and conduct of the OP, the complainant has suffered mental tension and harassment and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to pay the amount of Rs.10,00,000/- alongwith all benefits and interest @ 18% per annum from the date of death of the deceased insured till actual realization and the OP may kindly be directed to pay Rs.1,00,000/- as compensation to the complainant on account of mental tension and harassment and further OPs be directed to pay Rs.25,000/- as litigation expenses.
2. Notice of the complaint was given to the OPs, who filed reply and contested the complaint by taking preliminary objections that the complaint is not maintainable in the present form. There is no deficiency in service or negligence or unfair trade practice on the part of the answering OPs. As a matter of fact vide letter dated 18.01.2016 the claim of the complainant was repudiated on the ground that “as per investigations report (public security, ministry of interior, Kindom of Saudi Arabia) the death of Mr.Kamaljit Singh was due to suicide, that is throwing himself intentionally under the dump truck”. In view of this fact the claim of the complainant was not as per the terms of insurance policy and it had fallen under the terms of the insurance policy and it had fallen under the policy exclusions. Hence the claim of the complainant was closed in the records of the insurance policy. The report of the investigator, Kingdom of Saudi Arabia Ministry of Interior Public Security is attached alongwith the repudiation letter. That the complainant has not locus-standi to file the present complaint. Hence the complaint is absolutely false and the answering OPs have been unnecessarily dragged in this litigation. That the complainant has filed a false, frivolous and baseless complaint against the answering OPs. The complainant was made aware that as per the terms of op her claim does not cover and she is not entitled for any amount. That the present complaint is stopped under the principle of estoppels. That this Commission has got no jurisdiction to entertain, try and decide the present complaint as the complicated questions of dispute are required to be adjudicated and detailed evidence by both the parties is required to be led hence this Commission is not competent to decide the present dispute. That the claim of the complainant is false and wrong and the complainant has concealed the true and material facts from this Forum. The complainant has not submitted the documents and information well within reasonable time period. On merits, it is admitted that the OP is well known in the field of insurance purpose qua various kinds of insurance under the name and style of Iffco Tokio General Insurance Company Limited, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
3. In order to prove her case, the counsel for the complainant tendered into evidence affidavit Ex.CA alongwith some documents Ex.C-1 to Ex.C-11 and closed the evidence.
4. In order to rebut the evidence of the complainant, the counsel for the OPs No.1 & 2 tendered into evidence affidavit Ex.OPA.
5. We have heard the argument of learned counsel for the respective parties and also gone through the case file very minutely.
6. The glance at evidence is required by us to settle the controversy in this case. The complainant has tendered in evidence her affidavit Ex.C-A in supper of her case. She testified her grievances in her affidavit. She alleged deficiency in service and unfair trade practice on the part of OPs. Ex.C-1 is copy of repudiation letter on the record. In this letter, OPs repudiated the claim of the complainant on the ground that, as per general Exclusion No. 6 of the Policy, we will not pay for claim arising out of illness or accident that insured person has caused intentionally, including committing or attempting suicide or as a result of drug additional, alcoholism or whilst under influence of intoxicating liquor. Ex.C-2 is copy of passport of the husband of the complainant. Ex.C-3 is copy of fax dated 15.04.2015 on the record addressed from Embassy of India Riyadh to Superintendent of Police, Jalandhar Ex.C-5 is copy of claim form submitted by complainant. Ex.C-6 is copy of Forensic Medicine Reprot No. 22 PM/1436 H prepared by Kingdom of Saudi Arabia Ministry of Health, General Directorate of Health Affiars AL-Qassim Region. In this letter, it is categorically stated that , there is no criminal suspicious with the person death. Ex.C-8 is copy of Forensic Medical Report, this report it is specifically stated that he was not knew that whether the run over accident was by mistake or the deceased has committed a suicide with throwing himself under the truck tires, the initial medical report was issued from Dr. Sulaiman Alhabib Hospital includes the dripping deep wound at the forefront of the right thigh with the presence of multiple fractures in the bones of the pelyis, the revive of the heart was done, the breathing and heart was stopped. This report was signed by Forensic Physician. In this report, there is no mention that the insured commit suicide. Ex.C-9 is copy of Confidential & Urgent report. Similarly, we have also examined other documents Ex.C-10 and Ex.C-11 on the record.
7. To counter this evidence of the complainant, OPs tendered in evidence affidavit of Neeraj Kumar Jain working as Vice President Iffco Tokio General Insurance Co. Ltd as Ex.OP-A on the record. This witness stated that as per investigation report, death of Kamaljit Singh was died due to suicide throwing himself intentionally under the dump truck.
8. It is an established fact that husband of the complainant insured with OPs and taken insurance policy under the name and style of Iffco Tokio General Insurance Company Limited from OPs. Unfortunately, husband of the complainant died. The complainant submitted claim of her husband with OPs. But OPs repudiated the claim of the complainant on the ground that as per investigations report (Public Security, Ministry of Interior, Kingdom of Saudi Arabia) the death of Mr. Kamaljit Singh was due to suicide, that is throwing himself intentionally under the dump truck. But in Forensic Medicine Report Ex.C-6 it is mentioned that “we did not know in this accident was by mistake or the decease wanted to commit a suicide accident by throwing himself under the truck. The medical report issued from Dr. Sulaiman AL Habib Hospital including that there was a deep bleeding wound in the frontal part of Rt. Femur in addition to multiple fractures in Pelvis Bones. CPR and the required actions were done but he developed a cardiac and respiratory failure. From perusal of this document, it is nowhere mentioned that the complainant (since deceased) died due to commit suicide. In this report, it has also been specifically mentioned that “from radiology examination dated 17.12.2014 on the dead body, it has been revealed that there was multiple fractures in pelvis, Rt. Leg bone and the rest bones were free of fractures.”
9. From perusal of Forensic Report Ex.C-6 , it has transpired that the wound edges were spaced and the tissues and muscles of Rt. Femur are visualized. This wound is in an inclined shape as it distal part reaches the proximal part of Rt. Knee within 3 cm and its proximal part is opposite the Rt., lilac in 43 cm long. We also felt multiple fractures in pelvis bones. Ex.C-6 is the vital document on the record. The complainant alleged in her complaint that she neither had any knowledge about the insurance policy of her husband nor does she know of any monetary help to be provided to her by the Government in case of such crucial circumstances. Only after having got entire documents from the concerned country such as post mortem report, police report, cancelled passport and other related documents of the deceased, she comes to know the policy of her husband. She showed all the documents to some near dear of the family. The complainant sent duly filled claim form and other documents which were received by her from the Kingdom of Saudi Arabia to OPs for making the payment under the policy, but OPs repudiated the claim under the policy and sent a letter to her with various allegations dated 18.01.2016.
10. From perusal of entire record on the file, it is not possible that when any person commits suicide then his body do not receive any injury on the face or on the other part of the body. So the investigation report of the police of Kingdom of Saudi Arabia was totally manipulated by the employer just to save him from a legal liability and moreover the deceased as an outsider at that place and no person was available there to save his rights. On the other hand, OP/Insurance Company does not go through the contents of the facts and instead of applying its mind, it adopted such an irresponsible behavior just to repudiate the liability under the policy. The act of OPs is adamant and not valid.
11. OPs have not produced any document on the record except affidavit of Neeraj Kumar Jain Vice President Iffco Tokio General Insurance Co. Ltd as Ex.OP-A. This witness is working in the OPs company so in this way he cannot take plea against them. The clear cut deficiency in service or unfair trade practice attributed on the part of OPs. The cause of death of insured (deceased husband of the complainant) not cleared by OPs that it is accident or commit suicide. If this is suicide case then why wound edges were spaced and the tissues and muscles of Rt. Femur are visualized on the parts of the body of the deceased. The OPs repudiated on the claim of the complainant on flimsy ground. OPs pleaded that the insured died due to suicide i.e. throwing himself intentionally under the dump truck as per Investigator Report Ex.C-7. But from perusal of investigator report Ex.C-7, it has clear that in this report it has not been specifically stated that the reason of the death of the life assured is committing suicide. In this report, it has mentioned that we did not find any criminal suspicions with regard to death. In Forensic Medical Report prepared by Forensic Physician Ex.C-8, it has been mentioned that he was not knew that whether the run over accident was by mistake or the deceased has committed a suicide with throwing himself under truck tires. Dr.Sulaiman Alhabib Hospital includes the dripping deep wound at the forefront of the right thigh with the presence of multiple fractures in the bones of the pelvis, the revive of the heart was done, the breathing and heart was stopped. But in the case of suicide, all this had not happened. Basically, the insurance companies collect the premiums from the insured and find ways to decline the claims without any valid reasons. This fact is settled by Hon’ble Punjab and Haryana High Court at Chandigarh in case titled as New India Assurance Company Limited versus Smt. Usha Yadav and others reported in 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 the claims. All conditions which generally 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 cost of Rs.5000/- for luxury litigation being rich.”
12. From perusal of entire record of the case and after hearing submissions of counsel for the parties, we are of the considered opinion that the OPs are not only deficient in providing their services but also indulged in unfair trade practice on its part. As such, we allow the complaint of the complainant and direct OPs to pay the assured amount to complainant as per policy document with interest @ 6% p.a. from lodging the claim till its realization. The complainant is also entitled Rs.7000/- as compensation for mental harassment as well as costs of litigation. The opposite parties are also directed to deposit Rs.3000/- as costs in the Consumer Legal Aid Account maintained by this Commission.
13. The compliance of the order be made within 45 days from receipt of copy of this order.
14. The complaint could not be decided within the stipulated timeframe, due to heavy pendency of the court cases and spread of Covid-19.
15. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room after due compliance.
Announced in open Commission
20th of April 2021
Kuljit Singh
(President)
Jyotsna
(Member)
