Punjab

Faridkot

CC/19/128

Jagdish Kaur - Complainant(s)

Versus

IFFCoTOKIO General Insurance Co. - Opp.Party(s)

Sukhwinder Singh

10 Feb 2020

ORDER

 DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FARIDKOT

C. C. No. :                128 of 2019

Date of Institution:      08.05.2019

Date of Decision :       10.02.2020

 

1. Jagdish Kaur w/o Late Simerjit Singh s/o Bachittar Singh, r/o Village Aulakh, Tehsil Kotkapura, District Faridkot.
2. Bhavkirat Kaur minor d/o Late Simerjit Singh.
3. Gurkirat Kaur minor d/o Late Simerjit Singh
4. Gurnoor Singh minor s/o Late Simerjit Singh

(through their mother and natural guardian Jagdish Kaur wife of late Simerjit Singh s/o Bachittar Singh, r/o Village Aulakh, Tehsil Kotkapura, District Faridkot.)

 

5. Gurwinder Kaur w/o Bachittar Singh r/o Village Aulakh, Tehsil Kotkapura, District Faridkot.

                                                                             ...Complainants

Versus

 

1. Manager, IFFCO TOKYO General Insurance Company Ltd, 1^st Floor, Sohan Singh Complex, Shastri Nagar, Near Railway Crossing, Ludhiana 141002.
2. Managing Director, The Faridkot Central Co-operative Bank, Main Brnach, Faridkot.
3.  Maneger, The Faridkot Central Co-operative Bank Ltd, Panj Grain Kalan, Tehsil Kotkapura, District Faridkot.

......OPs

Complaint under Section 12 of the

Consumer Protection Act, 1986.

 

Quorum: Sh Ajit Aggarwal, President,

                Smt Param Pal Kaur, Member.

 

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Present: Sh Sukhwinder Singh, Ld Counsel for complainant,

              Sh Neeraj Maheshwary, Ld Counsel for OP-1,

              Ms Nitasha Mittal, Ld Counsel for OP-2 and OP-3.

ORDER

(Ajit Aggarwal, President)

                                                          Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against OPs seeking directions to OPs to make payment of insurance claim on account of death of Simerjit Singh and for further directing them to pay Rs. One lac as compensation for harassment, inconvenience, mental agony besides litigation expenses.

2                                              Briefly stated, the case of the complainant is that late Simerjit Singh predecessor in interest of complainants had a saving account bearing no.031634028000113 in the bank of OPs at Panj Grain Kalan and he was insured under Co-operative Bank Insurance Plan Saving Scheme. It is submitted that Simerjit Singh died on 11.04.2016 due to falling from motorcycle and due intimation regarding his death was given to OPs, but they have not made payment of insurance claim. Complainant visited the office of OPs several times, but despite her repeated requests, OPs have not paid a single penny on account of insurance of Simerjit Singh. All this amounts to deficiency in service and trade mal practice on the part of OPs. It is submitted that earlier complainant filed complaint before this Forum for directions to OPs to

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grant the genuine insurance claim on account of death of Simerjit Singh, but said complaint was dismissed on the ground that Iffco Tokyo General Insurance Company was not made party in that case and now, complainant has filed the present complaint and 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 13.05.2019, complaint was admitted and notice was ordered to be issued to the opposite parties.

4                                    On receipt of the notice, OP-1 filed written statement taking preliminary objections that vide order dated 12.03.2019, complaint was  dismissed on merits by this Forum and therefore, second complaint on same cause of action is not maintainable and is liable to be dismissed. Moreover, as per terms and conditions of the policy in question, legal heirs are entitled for claim only in case of road accident, fire, flood, snake bite electrocution, but in present case, Simerjit Singh did not die in any road accident and therefore, complainants are not entitled for relief sought by them. Complainant has concealed the material fact from this Forum that she has not furnished requisite documents like Post Mortem Report, copy of FIR mandatory for processing the claim. Post Mortem Report, copy of FIR are mandatory for processing the claim of complainant, but these documents are not furnished by complainant. On

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merits, OP-1 has denied all the allegations of complainant being wrong and incorrect but admitted before the Forum that information regarding death of Simerjit Singh was received. As per OP-1, claim of complainant was thoroughly investigated by M/s Insauto, Investigator, who after thorough investigation gave report dated 21.09.2016, where it is held that complainants failed to provide Post Mortem Report, copy of FIR to prove the fact that death of Simerjit Singh occurred in an accident and therefore, claim of complainants was closed as No Claim vide letter dated 14.10.2016. It is reiterated that there is no deficiency in service on the part of OP-1 and prayed for dismissal of complaint with costs.

5                                         Ld Counsel for OP-2 and OP-3 filed written statement wherein took preliminary objections that complaint filed by complainant was already dismissed by this Forum on 12.03.2109 and therefore, present complaint is not maintainable on same cause of action. It is averred that as per terms and conditions of the present policy legal heirs are entitled for claim only in case of road accident, fire, flood, snake bite electrocution, but in present case, said Simerjit Singh did not die in any road accident and therefore, complaint is not maintainable. On merits, they have denied all the allegations of complainants being wrong and incorrect and asserted that mere certificate given by Sarpanch is not sufficient to procure claim under present policy. Account holder did not die in any road accident because in case of accidental death, Police Report, MLR, Post Mortem Report and copy of FIR like documents are

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essential to be submitted, but in present case complainant has not furnished either Post Mortem Report or copy of FIR. All the other allegations of complainants are denied and it is further averred that there is no deficiency in service on the part of answering OPs. Prayer for dismissal of complaint is made with costs.

6                                              Parties were given proper opportunities to prove their respective case. The complainant tendered in evidence her affidavit Ex.C-1, and documents Ex C-2 to C-7 and then, closed the same.

7                                              In order to rebut the evidence of the complainant, the ld Counsel for OP-1 tendered in evidence affidavit of Sameer Gupta Ex OP-1/5, affidavit of Manish Pasricha Ex OP-1/7 and documents Ex OP-1/1 to OP-1/4 and Ex OP-1/6 and then, closed the evidence on behalf of OP-1. Ld Counsel for OP-2 and OP-3 tendered in evidence affidavit of Vikramjit Singh Ex OP-2, 3/1 and also closed the same on behalf of OP-2 and OP-3.

8                                              We have heard the learned counsel for the parties and have very carefully gone through the affidavits and documents on the file.

9                                                From the careful perusal of record and after going through evidence and documents produced on file by complainant as well as OPs, it is observed that case of complainant is that her husband was insured with Ops and he died by falling from

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motorcycle. She gave due intimation regarding his death to OPs and requested them to pay the insurance claim on account of death of her husband, but till now, OPs have not made single penny despite her repeated requests, which amounts to deficiency in service and trade mal  practice on the part of OPs. In reply, plea taken by OP-1 is that for the purpose of  obtaining claim on account of accidental death, Post Mortem Report and copy of FIR are necessary documents for processing the insurance claim, but complainant herself failed to produce such documents before Insurance Company and therefore, claim of complainant was closed as No Claim. There is no deficiency in service on the part of OP-1. OP-2 and OP-3 also took same plea that complainant did not provide requisite documents for processing the claim and there is no deficiency in service on their part.

10                             Grievance of the complainants is that complainants have not got the insurance claim on account of death Simarjit Singh. From the careful perusal of record, pleadings and arguments put forward by Ops, it is observed that Insurance Company has stressed mainly on copy of post mortem report and FIR which alleged to have not been submitted by complainants. There is no doubt that death of Simerjit Singh occurred by falling from motorcycle. The OP-1 admitted that complainants lodged claim regarding death of Simerjit Singh with them and on it, they appointed Investigator to investigate the claim of the complainants. Ops produced copy of Investigation Report Ex OP-1/3. Investigator visited the

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spot and recorded statements of complainants and other villagers. In his Investigation Report, he submitted that as per statement of complainant no.1, her husband died due to accident on 11.4.2016. He further submitted that from the statement of villagers, it is confirmed that Simerjit Singh died on 11.04.2016, due to road accident. He further recorded the statement of Pirthi Pal Singh who stated that on 11.04.2016, at about 8.00 P.M. on Bagheana Road, Faridkot, they saw that motorcycle of Simerjit Singh met with an accident. He and one Biker Singh were present at the spot and when they reached to Simerjit Singh, they found that he was dead. They informed the family of Simerjit Singh about the accident and then, alongwith family members of Simerjit Singh, they went to spot and took the dead body of Simerjit Singh at his home. Now, as per statements of villagers and eye witnesses of the accident, it is duly recorded by the Investigator of Insurance Company. It is clear that Simerjit Singh husband of complainant no.1 died in road accident which is proved from the Investigation Report of the Investigator. It is admitted that no post mortem examination was conducted upon the dead body of insured, but merely on account of non-production of post mortem report, it cannot be concluded that the death of the insured was not as a result of accident. Non production of documents like Post Mortem Report or medical evidence, has drawn the attention of the Fora under the Act time and again. In 2005 (1)CPC533(Life Insurance Corporation of India and others Vs. Smt. Nidhi Sahi), case of complainant was that the death of insured occurred in the

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scooter accident and her claim was mainly challenged on the ground that no FIR was lodged nor any Post Mortem Examination had been performed on the body of the deceased. The factum of death was duly proved and was supported by certificate issued by Sarpanch, Gram Panchayat, Village Aulakh, wherein it is clearly mentioned that death of Simerjit Singh occurred due to falling form motorcycle on 11.04.2016 on the way from Village Aulakh to Village Bagheana. He died immediately on the spot by falling from his motorcycle and this fact is certified by village Panchayat and is beyond any doubt. In the light of judgment In 2005 (1) CPC 533 ( Life Insurance Corporation of India and others Vs. Smt. Nidhi Sahi) (supra) it is crystal clear that even in the absence of the FIR or the Post Mortem Report, the factum of death in a particular way can be proved by producing other evidence. Similarly in 2006 (II) CPC 599 (National Insurance Company Limited Vs. Rita Devi It was held that non-production of the Post Mortem Examination report cannot be made a ground for repudiation of the claim. The facts were similar in 2009 (1) CLT 74 ( Parkash Kaur and others Vs. ICICI Lombard General Insurance Company Limited) In that case the insured had died due to snake bite and evidence was produced for proving that fact. However, there was no post mortem report or police report for proving that fact. It was held therein that the insurance claim on account of death cannot be repudiated simply on the ground that the post mortem report or the police report was not produced especially when the death in accident is proved from other

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evidence. Thus, OPs cannot deny to pay the claim on the ground of non production of post mortem report.

11.                           In the light of above discussion and case law produced by complainant party, this Forum is of considered opinion that there is deficiency in service on the part of OP-1 in not clearing the genuine insurance claim of complainants on account of death of Simerjit Singh. therefore, complaint in hand is hereby allowed again OP-1 and OP-1 is directed to make payment of Rs. One lakh i.e sum assured on account of death of Simerjit Singh to complainant alongwith interest at the rate of 7% per anum from the date of death till final realization. OP-1 is further directed to pay Rs.5,000/-to complainants as consolidated compensation for harassment and mental agony suffered by complainants and for litigation expenses. Compliance of this order be made within one month of receipt of the copy of the order, failing which complainant shall be entitled to proceed under section 25 and 27 of the Consumer Protection Act. As OP-2 and OP-3 have no role in making payment of insurance claim, therefore, complaint against OP-2 and OP-3 stands dismissed accordingly. Copy of order be given to all parties free of cost. File be consigned to record room.

Announced in Open Forum

Dated : 10.02.2020                              (Param Pal Kaur)                  (Ajit Aggarwal)

                                                     Member                    President