DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,<br /> BATHINDA (PUNJAB)<br /> <br /> CC. No. 78 of 12-03-2009<br /> Decided on : 03-09-2009 <br /> <br /> Baljit Kaur Wd/o Raj Kumar Verma @ Davinder Kaur R/o St. No. 21/3, Partap Nagar, Bathinda.<br /> .... Complainant<br /> Versus<br /> <br /> Life Insurance Corporation of India, Bibi Wala Road, Bathinda, through its Branch Manager <br /> ... Opposite party<br /> <br /> Complaint under Section 12 of the Consumer Protection<br /> Act, 1986.<br /> <br /> QUORUM <br /> <br /> Sh. George, President<br /> Sh. Amarjeet Paul, Member<br /> <br /> For the Complainant : Sh. Naresh Garg, counsel for the complainant <br /> For the Opposite parties : Sh. Sanjay Goyal, counsel for the opposite parties.<br /> <br /> <br /> O R D E R<br /> <br /> GEORGE, PRESIDENT<br /> <br /> 1. The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 (here-in-after referred to as 'Act') with the allegations that her husband purchased Insurance policy No. 161040546 from the opposite party for an amount of Rs. 50,000/- on 28-07-96 with accidental benefit. On 2-6-07 policy holder Sh. Davinder Kumar @ Raj Kumar Verma met with an accident near Ambala and ultimately brought to Bathinda and was admitted in Nova Heart Hospital, Bathinda, where he succumbed to his injuries on 26-6-07. The complainant submitted all the relevant papers alongwith original Insurance policy and Form No. 3816 duly filled by the Doctor of Nova Heart Institute, Bathinda and Form No. 3785 R, 3783R and 3801 vide registered letter. The opposite party on the basis of documents supplied, finally settled death Insurance claim of Rs. 50,000/- after a lapse of about nine months in violation of the law laid down by the Hon'ble Apex Court. Further the opposite party without any reasonable cause withheld the second benefit i.e. accidental benefit for which the complainant was entitled due to the death of her husband in an accident, to the tune of Rs. 50,000/-. The opposite party kept on harassing the complainant by demanding unnecessary documents vide opposite party letters Ex R-3 to Ex. R-5. Her husband met with an accident near Ambala wherefrom he was taken to Bathinda and he remained admitted in the hospital at Bathinda. Her husband did not expired at spot and therefore, there was no question of Police Inquest Report (Panchnama). The opposite party was supplied with the post mortem report conducted at Civil Hospital, Bathinda and Form No. 3816 duly filled by the doctor under whose treatment her husband remained and died, but the officials of the opposite party unnecessarily and intentionally to harass her kept on demanding documents which were not in her possession nor she could reasonably procure the same and therefore, she is entitled for the accidental benefit alongwith interest, reasonable amount of compensation and costs.<br /> 2. The allegations made in the complaint are contested by the opposite party raising inter-alia objections that the complainant has no cause of action and no locus standi; complainant has not approached this Forum with clean hands; the complaint has been filed on false and frivolous allegations; there is no deficiency in service on the part of the opposite parties and the complaint is not maintainable.<br /> On merits, while denying all the allegations of the complainant, the opposite party has asserted that the payment of double accident benefit can be made only if the complainant complies with the requirement thereof. However, the complainant in his complaint has mentioned that motor accident claim has been decided in her favour, so on the basis of award of Hon'ble Motor Accident Claims Tribunal, the opposite party issued cheque No. 056677 dated 30-04-09 for Rs. 50,000/- in favour of the complainant for payment after completing the necessary requirements for admission of claim and therefore, nothing remains due from the opposite party and complaint is liable to be dismissed.<br /> 3. Parties in order to prove their contentions have led respective evidence. <br /> 4. The complainant has produced in evidence her two affidavits Ex. C-1 & Ex. C-2, photocopy of policy Ex. C-3, photocopy of letter dated 23.7.07 Ex. C-4 and photocopy of postal receipt Ex. C-5.<br /> 5. To controvert the evidence of the complainant, the opposite party produced on record an affidavit of Sh. Paramveer, Manager Ex. R-7, photocopy of cheque dated 30-04-09 Ex. R-1, photocopy of payment receipt Ex. R-2, photocopies of letters dated 20-10-08, 28-04-08 and 19-01-08 Ex. R-3 to Ex. R-5 and photocopy of policy Ex. R-6.<br /> 6. After hearing the parties and going through the averments made in the complaint as well as in the reply filed by the opposite party, it is apparently clear that the complainant's husband was insured with the opposite party for an amount of Rs. 50,000/- with accidental benefit. He met with an accident on 2-6-07 near Ambala and ultimately he died at Nova Heart Institute, Bathinda on 26-06-07. On 23-07-07 all the relevant documents including Form No. 3816 duly filled by Dr. Nova Heart Institute and Form No. 3785R, 3783R and 3801, original Insurance policy, attested copy of P.M.R., original death certificate etc., were sent to the opposite party vide registered letter and the opposite party took about nine months time to pay the claim. However, the opposite party withheld the amount of Rs. 50,000/- of accident benefit and demanded further documents such as Police Inquest Report (Panchnama) and post mortem report of civil hospital, Bathinda. The complainant made several requests for the release of an amount of Rs. 50,000/- of accidental benefit but it was not finally paid. Resultantly, the complainant moved the present complaint on 12-3-09. As per reply filed by the opposite party, the complainant failed to supply all the documents required by it and therefore, the claim could not be settled in respect of accidental benefit. However, after receiving notice of complaint and going through the same, it came to know that motor accidental claim has been decided in her favour so on the basis of award of Hon'ble Motor Accident Claims Tribunal, the opposite party issued cheque No. 056677 dated 30.4.09 in favour of the complainant for payment of double accident benefit meaning thereby that complainant supplied all the relevant documents as referred to above vide registered letter dated 23.7.07 as per Ex. C-4. One part of the claim was honoured by the opposite party that too after lapse of nine months but the second part of the claim was retained by the opposite party and it called for further documents such as Panchnama and post mortem report etc., despite the fact that it was an open fact that deceased met with an accident near Ambala and he was brought to Bathinda where he remained admitted in an hospital till 26-06-07 and he succumbed to his injury in the hospital at Bathinda which fact is apparent from the documents, the complainant submitted for settlement of her claim to the opposite party vide her registered letter dated 23-7-07. There was no question for asking the complainant by the opposite party to supply P.I.R. i.e. Police Inquest Report (Panchnama) etc., as the opposite party was already supplied with sufficient material by the complainant for settlement of the accidental benefit claim but not for good reason claim was not settled by the opposite party from 23-07-07 till 18-05-09.After institution of the present complaint on 12-03-09, claim was paid vide cheque dated 30-04-09 for Rs. 50,000/-. The opposite party has not shown/proved any reasonable ground as to why the claim remained unsettled for about two years and the same was settled after filing of the present complaint whereas the complainant has not submitted even a single paper/document in addition to the documents he has already submitted vide his letter dated 23.7.07 Ex. C-4. It has been held by the Hon'ble Apex court in plenty of judgements that Insurance companies are required to settle the claim of their customers within a period of 2-3 months and any delay caused beyond this period definitely itself amounts to deficiency in service. In the present case, the delay has been caused in settling the claim which is beyond any plausible reason and therefore, the complainant is definitely entitled for reasonable and adequate amount of compensation for putting the complainant to unnecessary harassment, mental agony and inconvenience.<br /> 7. Taking into consideration the entire facts, circumstances and the delay caused in settling the legitimate claim of the complainant, we are of considered view that complainant is entitled for interest on the amount of claim for delay and compensation for harassment, mental tension agony and inconvenience alongwith litigation expenses. Accordingly, we accept the complaint and direct the opposite party to the pay to the complainant Interest @9% P.A. on the amount of Rs. 50,000/- w.e.f. 23-10-2007 till the date of payment i.e. 18-05-09 alongwith compensation to the tune of Rs. 25,000/- and litigation expenses amounting to Rs. 5,000/- within 45 days from the date of receipt of copy of this order.<br /> 8. The amount of compensation and litigation expenses may be recovered from the opposite party i.e. Branch Manager, Life Insurance Corporation of India, Bibi Wala Road, Bathinda, who remained posted at the that relevant time and dealt with the Insurance claim of the complainant and was responsible for causing delay in settlement of genuine and valid Insurance claim of the complainant. For this, we are fortified by the observations of the Hon'ble Supreme Court in the case Lucknow Development Authority Vs. M K Gupta AIR 1994 Supreme Court 787. <br /> The copy of this order be sent to the parties concerned free of cost and the file be indexed and consigned.<br /> Pronounced :<br /> 03-09-2009 <br /> (George)<br /> President<br /> <br /> <br /> (Amarjeet Paul)<br /> Member <br />