Punjab

Sangrur

CC/1194/2015

Tarsem Singh - Complainant(s)

Versus

Liberty Videocon Gen.Ins.Co. Ltd. - Opp.Party(s)

Shri P.L.Bansal

20 Jul 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR

                            

                                                                        Complaint No. 1194

Instituted on:  01.10.2015

                                                                        Decided on:    20.07.2016

 

Tarsem Singh son of Karnail Singh son of Maghar Singh, resident of VPO Nilowal, Tehsil Sunam, District Sangrur.   

                                                          …. Complainant

       

                                                                                   Versus

 

1.     Liberty Videocon General Insurance Company Limited, 10^th Floor, Tower A, Peninsula Business Park, Ganpatrao Kadam Garg, Lower Parel, Mumbai through its Manager.

2.     The Sangrur Central Co-operative Bank Ltd. Branch Office, Sunam, District Sangrur through its Branch Manager.                                                                  

                                                        ….Opposite parties.

 

 

FOR THE COMPLAINANTS:         Shri Sandip Kumar Goyal, Advocate                           

FOR OPP. PARTY No.1         :         Shri Vinay Jindal,  Advocate                    

FOR OPP. PARTY No.2         :         Shri Pawan Gupta, Advocate                    

 

 

Quorum

         

                        Sukhpal Singh Gill, President

K.C.Sharma, Member

Sarita Garg, Member

                 

ORDER BY:     

 

K.C.Sharma, Member.

 

1.             Shri Tarsem Singh, complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the father of the complainant namely, Shri Karnail Singh (referred to as DLA in short) was insured with the OP number 1 vide policy number 4112-200501-13-5000002-00-000 by paying one time premium as the DLA was the member of The Bakhtaru Nagar M.P.C.A.S at Bakshiwala (Sunam) under which nominee was entitled for Rs.50,000/- in case of death of the DLA.   

 

2.             Further case of the complainant is that on 13.7.2013, the DLA unfortunately met with an accident with the train in between Sunam and Chhajli and died on the spot.  It is further averred that after his death, the complainant intimated the Ops about the death and submitted the required documents such as FIR, postmortem report, affidavit, copy of KCC card, copy of voter card, copy of death certificate along with other documents to OP number 2 on 7.8.2014 under receipt.  But, the grievance of the complainant is that his genuine claim was repudiated without any reason.  Thus, alleging deficiency in service on the part of OPs, the complainant has prayed that the OPs be directed to pay to the complainant a sum of Rs.50,000/- as claim amount under the policy along with interest @ 12% per annum and further claimed compensation for mental agony, harassment and litigation expenses.

 

3.             In reply filed by OP No.1,  legal objections are taken up on the grounds that the complainant never submitted copy of pass book evidencing deduction of premium towards the policy, that the complainant has not impleaded all the legal heirs of deceased Karnail Singh, that intricate questions of law and facts are involved in the present case, that the complainant has violated the terms and conditions of the policy whereby it is a condition precedent that written notice of claim must be given by the insured/nominee to the company within a period of 15 days after an actual date and time of accident, but in the present case the intimation was given after an inordinate delay of 148 days, as such, the claim was repudiated vide letter dated 09.12.2014.  On merits, it is submitted by the OP that the claim was intimated and incomplete documents were submitted to the OP on 29.11.2014.   It is stated further that the OP number 1 written so many letters to the complainant for submission of the documents, but the complainant failed to submit the same, as such the claim of the complainant was rightly repudiated. However, any deficiency in service on the part of the OP has been denied.

 

4.             In reply filed by the OP No.2, legal objections are taken up on the grounds that the complaint is not maintainable, that the complainant has no locus standi to file the present complaint that the complainant has no cause of action to file the present complaint. On merits, it is admitted that the DLA was a member of the M.P.C.A.S at Bakshiwala (Sunam).  However, the remaining allegations leveled in the complaint have been denied. It is admitted that the complainant supplied the documents which were forwarded to OP number 1. It is stated further that the repudiation of the claim is illegal one. However, any deficiency in service on the part of the OP number 2 has been denied.

 

5.             The complainant has tendered documents Ex.C-1 affidavit, Ex.C-2 copy of list of documents submitted to Op number 2 with receipt, Ex.C-3 copy of claim form, Ex.C-4 copy of affidavit, Ex.C-5 copy of inquest report, Ex.C-6 copy of PMR, Ex.C-7copy of ration card, Ex.C-8 copy of voter card, Ex.C-9 copy of Kisan credit card, Ex.C-10 copy of aadhar card, Ex.C-11 copy of death certificate, Ex.C-12 copy of list of members, Ex.C-13 copy of repudiation letter, Ex.C-14 copy of letter to OP 1, Ex.C-15 copy of receipt, Ex.C-16 copy of reply and close evidence. On the other hand, the learned counsel for OP number 1 has produced Ex.OP1/1 affidavit, Ex.OP1/2 copy of insurance policy,Ex.OP1/3 copy of letter dated 12.3.2015, Ex.OP1/4 copy of repudiation letter, Ex.OP1/5 copy of detail of documents, Ex.OP1/6 copy of letter dated 16.4.2015, Ex.OP1/7 copy of letter dated 27.6.2015, Ex.OP1/8 copy of letter dated 15.7.2015, Ex.OP1/9 copy of letter dated 14.8.2015, Ex.OP1/10 copy of letter dated 3.9.2015, Ex.OP1/11 copy of postal receipt,Ex.OP1/12 copy of terms and conditions, Ex.OP1/13 copy of letter and close evidence. The learned counsel for OP number 2 has produced Ex.OP2/1 affidavit and closed evidence.

 

6.             After hearing the arguments of learned counsel for the parties and on perusal of the documents placed on record, we find that the DLA was insured for Rs.50,000/- under Kissan Credit Card as he was a member of The Bakhtaur Nagar M.P.C.A.S. at Bakshiwala. The DLA died on 13.07.2014 in a railway accident.  Thereafter the complainant lodged the claim with OP No. 1 through OP number 2 on 7.8.2014 and forwarded various documents such as claim form, copy of FIR, postmortem report, copy of the KCC card, copy of voter card, copy ration card, copy of death certificate of the DLA and the list of KCC members, as is evident from the document Ex.C-2 on record.  It is on the record and is evident from the reply of the complaint that the OP number 1 repudiated the claim of the complainant vide letter dated 09.12.2014, a copy of which on record is Ex.C-13 on the ground that the DLA expired on 13.7.2014 while the documents were received on 29.11.2014. The learned counsel for OP No.1 has vehemently argued that as per the terms and conditions of the policy the claimant should have submitted the claim within 15 days of the actual date of the accident.

 

7.             The OP No.2 has admitted that the complainant has approached it and had lodged the claim and the same was forwarded to OP number 1 immediately.  On carefully examining the terms and conditions of the policy contained in document Ex.OP1/12 under the head “Notification of claim”  we find  that though the intimation was to be given in 15 days but then it has also been mentioned in this document that “ however, the company may condone the delay on merits of the claim subject to getting satisfied  that the delay in notification was due to reasons beyond the control of the insured/ insured person/ nominee”. In the present complaint, the insured died suddenly due to a road accident and the complainant had submitted the claim and in such circumstances, it cannot be said that the complainant has submitted the claim with deliberate delay. Moreover, this condition does not even say that if the notice is not given within 15 days then the claim shall stand repudiated.  In support of his version learned counsel for the complainant has submitted the judgment of Hon’ble Tamilnadu  State Commission, Chennai delivered in case A.P. No.850/99 titled as  The Branch Manager, New India Assurance Company Limited Vs. Soosai, 2004(1) CLT 672, wherein it has been held that “ this condition does not say that if notice is not given within a month, the claim shall stand repudiated. On the other hand, it would only require that a notice to be given within a month after the event. It does not bar or state that failure to issue any notice within the prescribed period of one month would estop or eschew or prohibit anyone from making a claim. Even if there is such a condition, it cannot be upheld since it is unconscionable. The contract of insurance being one based upon honesty and good faith, such trivial technicalities cannot be allowed to sway the ultimate aim and goal of insurance. Therefore, we are unable to accept the contentions of the learned counsel for the  appellant and that the repudiation is justified on account of the proviso and the conditions”.

 

8.             In the present complaint, the learned counsel for the OP number 1 has contended vehemently that the OP number 1 has demanded various documents from the complainant vide letter dated 16.4.2015 Ex.OP1/6, letter dated 27.6.2015 Ex.OP1/7, letter dated 15.7.2015 Ex.OP1/8 , letter dated 14.8.2015 Ex.OP1/9, but the OP number 1 has not produced any postal receipt to show that actually the said letters were sent to the complainant and were delivered to the complainant. It is worth mentioning here that once the OP number 1 repudiated the claim of the complainant vide letter dated 09.12.2014, Ex.OP1/4, then what was the necessity arose to the OP number 1 to sought various documents from the complainant vide letters Ex.Op1/6, Ex.OP1/7, Ex.OP1/8 and Ex.OP1/9 and in the last again vide letter dated 3.09.2015, Ex.OP1/10 the Op number 1 repudiated the claim of the complainant.  As such, we feel that it is a false story concocted by the Op number 1 only to avoid the liability of the rightful claim of the complainant.

 

9.             Further we have perused the copy of the post mortem examination report Ex.C-6 in respect of DLA and further Ex.C-5 is the  copy of DDR to show that the DLA died an accidental death in a railway accident. So, in the light of above, we find that if there is any delay in intimating the claim to the Ops, but on that ground the claim of the complainant cannot be thrown out, as it is evident from the document Ex.C-5 and Ex.C-6 that the DLA died an accidental death. Further we feel that by this way, no prejudice has been caused to the OP number 1.  Moreover, the procedural law is always directory and not mandatory. To support such a contention reliance can be placed on the citation of the Hon’ble National Commission pronounced in National Insurance Company Limited versus Kulwant Singh IV(2014) CPJ 62 (NC), wherein it has been clearly stated that the insurance company should not have repudiated the claim merely on account of delay, particularly when there was absolutely no delay in lodging FIR with the police.             

 

10.           So, in view of the above discussion, we find that the OP No.1 is not only deficient in service but also indulged in unfair trade practice and has enforced the complainant to seek legal remedy in order to receive his rightful claim which has been supported by cogent evidence. The Hon’ble Punjab & Haryana High Court  in case tilted as New India Assurance Company Limited Vs. Smt. Usha Yadav and others 2008 (3) R.C.R. 9 ( civil) 111 has held that the insurance companies  are in the habit to take these type of projections to save themselves from paying the insurance claim. The Insurance companies are only interested in earning the premiums and find ways and means to decline claims.

 

11.           Further, the Hon’ble Supreme Court of India in Madras Port Trust Vs. Hymanshu International, (1979) 4 SCC 176 whereby, it deprecated the practice  often adopted by governmental and public authorities, of denying  just claims of citizens  on technical pleas, even though the claim lodged with them was otherwise well founded”. The relevant observations are extracted here in below:-

“ ……2. We do not think that this is a fit case where we should  proceed to determine whether the claim of the respondent was  barred by Section 110 of the Madras Port Trust Act (II of 1905) . The plea  of limitation based on this Section is one which the court always looks upon with disfavour and it is unfortunate that a public authority like the Port Trust should, in all morality and justice, take up such  a plea to defeat  a just claim of the citizen.  It is high time that governments and public authorities adopt the practice of not relying upon technical  pleas for the purpose of defeating legitimate claims of citizens and do what  is fair and just to the citizens”. Here, it is obvious that the claim of the complainant was a just claim supported by the cogent and reliable evidence  of the complainant. Moreover, IRDA’s circular dated 20.09.2011, 14.4 clearly  says that genuine claims cannot be rejected on account of delay in intimation,  and that, the insurer’s decision to reject a claim must be based on “ sound logic” and “ valid grounds”. 

 

12.           In the light above facts, we allow the complaint of the complainant and direct OP No.1 to pay him a sum of Rs.50,000/- being insured amount along with interest 9% per annum from the date of filing of complaint i.e. 01.10.2015 till realization. We further order the OP No.1 to pay to the complainant a sum of Rs.5,000/- on account of mental agony, harassment and also to pay a sum of Rs.5,000/- as litigation expenses.

 

13.           This order of ours shall be complied with within 30 days from the receipt of copy of the order.  Copy of the order be supplied to the parties free of charge. File be consigned to records in due course.     

Pronounced.

 

                July 20, 2016.

 

                                        (Sukhpal Singh Gill)                                                                                                                                      

                                                                President

 

 

                                                             (K.C.Sharma)

                                                                 Member

 

 

                                                             (Sarita Garg)

                                                                  Member