Nidhi Verma, Member
1 The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 34, 35 and 36 against the opposite parties on the allegations that the complainant is widow of deceased Mukhtiar Singh who was insured with the opposite party No. 1 through opposite party No. 2 in regard to his saving account No. 190734036141704 Branch Harike, Which was running in the name of deceased Mukhtiar Singh by paying premium to the opposite party No. 1 through opposite party No. 2. As per the insurance policy of opposite party No. 1, the deceased was insured with Life Insurance Policy of this party with a cover of Rs.5 Lakh in case of death of the insured. Unfortunately, Mukhtiar Singh died in a road side accident on 27.1.2019 and regarding it all the necessary formalities were completed by the kins of the deceased through the concerned departments and a rapat rojnamcha was also entered regarding this occurrence by the police station Makhu. The complainant after completing all the formalities which are required in such like cases informed the opposite party No.2 regarding the death of Mukhtiar Singh and as such she lodged the insurance claim of Rs.5 Lakh as per the above mentioned insurance policy of the opposite party No.1 and the opposite party No.2 after obtaining all the documents required for the same forwarded these documents to the opposite party No.1 immediately and also requested the opposite party No.1 to release the insurance claim of Rs.5 Lacs to the complainant. The opposite party No.1 asked for affidavit/consent of the other legal heirs, so the complainant also got prepared these affidavits/consent and again forwarded these to the opposite party No.1 through opposite party No.2 and the opposite party No.1 assured the complainant through opposite party No.2 that the claim amount will be released to her in a couple of months, so the complainant awaited for the same. Inspite of awaiting for two months, no insurance claim was released to her so the complainant again approached the opposite party No.2 which again forwarded the request of release of claim to the opposite party No. 1 but nothing was done by the opposite party No. 1 regarding it. The complainant has prayed the following reliefs may kindly be granted to the complainant.
- The opposite party No. 1 may kindly be directed to release the insurance claim of Rs. 5,00,000/- to the complainant immediately,
- The opposite party No. 1 may kindly be directed to pay compensation of Rs. Lakh for causing harassment of the complainant.
- The opposite parties may kindly be directed to pay litigation expenses of Rs. 50,000/- to the complainant.
Alongwith the complaint, the complainant has placed on record affidavit of complainant Ex. C-1, Self attested copy of pass book Ex. C-2, self attested copy of Rapat Rojnamcha Ex. C-3, Self attested copy of Medical Certificate Ex. C-4, Self attested copy of letter dated 19.3.2019 Ex. C-5, Self attested copy of affidavit Ex. C-6, Self attested copy of claim form Ex. C-7, Self attested copy of statement of physician Ex. C-8, self attested copy of death certificate Ex. C-9.
2 Notice of this complaint was issued to the opposite parties and opposite party No. 1 appeared through counsel and filed written version by interalia pleadings that the complaint is barred by limitation as it is not filed within the prescribed limitation given in the Act. Thus the complaint is liable to be dismissed with costs. The complainant party has not approached this commission with the clean hands and has suppressed material facts from this commission. The complainant party has misled and withheld material facts from this commission and presented a concocted story just in order to have monitory benefits. The complaint is pre mature and deserves to be dismissed on this ground alone. The complainant party has not provided till date copy of FIR, post mortem report, nor any other proof regarding the death of deceased in road accident, or any medical record from Hospital which shows any proves that deceased Mukhtiar Singh died in the alleged accident, neither the complainant party has placed on record any death certificate was provided to pursue this case. The complainant party has not produced any document or any justification why they had lodged the claim and information at delayed stage, no explanation is since for neither delay nor is any satisfactory reply given to explain delay. The complainant party has not placed on record any documentary proof of identification proof, their address neither any proof etc. was produced. Neither the complainant party has submitted any mandatory documents nor she has supplied any record of death, above all no record of police proceedings to prove their alleged submission i.e. Rapat or any other documents are not attached or forwarded even till today. The documents placed on record by the complainant party itself creates doubt and suspicion as the alleged report No.034 dated 14.2.2019 as per the contents of the complaint deceased met with an accident on 27.1.2019 and the alleged rapat was lodged after a delay of more than 18 days and as per the contents of the alleged complaint deceased Mukhtiar Singh was shown as a Numbardar of village and as well as the complainant alleged that he was a daily wage worker and further the alleged certificate produced by the complainant party of Medi Care Hospital is of dated 1-2-2019 which shows that the same is created one just in order to seek benefits from the opposite party. The opposite party No. 1 is not liable for misleads an unethical acts of complainant and hence the present complaint be dismissed with heavy costs. The Policy issued subject to certain terms, conditions and exclusions. Admissibility if any claim under the Policy is governed by the said terms of the insurance contract. The policy under which the deceased was covered is a personal accident policy. The complainant has not provided the necessary documents required to examine the admissibility of the claim under the Policy.
1. FIR/MLC from police authorities
2. Driving license of victim in case death or injury because of Road traffic accident and the victim was driving the vehicle involved
3. Death certificate issued by competent authority Postmortem report
4. Post Mortem Report.
The complainant despite issuing letters failed to furnish the requisite documents, the claim was closed for noncompliance on the part of the complainant under intimation to the complainant. The opposite party No.1 has denied the other contents of the complaint and prayed for dismissal of the same. Alongwith the written version, the opposite party No. 1 has placed on record affidavit of opposite party No. 1 Ex. OP2/1, Self attested copy of reimbursement claim deficiency letter reminder 1 Ex. OP2/2, Self attested copy of reimbursement claim deficiency letter reminder 2 Ex. OP2/3, Self attested copy of reimbursement claim deficiency letter reminder 3 Ex. OP2/4, Self attested copy of deficiency letter Ex. OP2/5, Self attested copy of insurance policy Ex. OP2/6.
3 The opposite party No. 3 appeared through counsel and filed written version by interalia pleadings that the complainant has approached the opposite party No. 2 and gave each and every material fact to the opposite party No. 1 by opposite party No. 2 of insurance policy taken by deceased. Mukhtar Singh had died. A Rapat Roznamcha was also entered regarding this occurrence by the police vide G.D. No. 34 dated 14.2.2019. All the formalities which are required in such like cases informed the opposite party No. 2. The complainant has claimed the claim from the insured company through the opposite party No. 2 on 9.3.2019 and every document, formalities like indemnity bond was also furnished alongwith other documents as per instructions of the insurance company but failed to pay the claimed amount inspite of so many requests and nothing has been suppressed. Alongwith written version, the opposite party No. 2 has placed on record affidavit Ex. OP-1, Self attested copy of pass book Ex. OP-2, self attested copy of Rapat Rojnamcha Ex. OP-3, Self attested copy of Medical Certificate Ex. OP-4, Self attested copy of letter dated 19.3.2019 Ex. OP-5, Self attested copy of affidavit Ex. OP-6, Self attested copy of claim form Ex. OP-7, Self attested copy of statement of physician Ex. OP-8, self attested copy of death certificate Ex. OP -9.
4 We have heard the Ld. counsel for complainant, opposite party No. 1 and have also carefully gone through the documents on the file.
5 In the present complaint, the complainant is widow of deceased Mukhtiar Singh who was insured with the opposite party No.1 through opposite party No. 2 in regard to his saving account number 190734036141704 branch Harike. On dated 27.01.2019 Mukhtiar Singh died in a road side accident and regarding it all the necessary formalities were completed by the kins of the deceased through the concerned departments and a rapat rojnamcha was also entered regarding this occurrence by the police station Makhu. The complainant lodged the insurance claim of Rs 5lakh and forwarded all the documents required for the same to the O.P No. 1 through O.P No.2 .After awaiting for 2months , the complainant approached the O.P No.2 which again forwarded the request of release of claim to the O.P No.1 but nothing was done by the O.P No.1 regarding this. Later , on dated 07.01.2021 O.Ps flatly refused to release any claim to the complainant in regards of the life insurance policy of deceased Mukhtiar Singh.
6 O.P No.1 stated in their written version that the complainant has not provided till date copy of FIR , Post mortem report, nor any other proof regarding the death of deceased in road accident, or any medical records from Hospital which shows and proves that deceased Mukhtiar Singh died in the alleged accident, neither the complainant party has placed on record any death certificate to pursue this case. Further, the documents placed on record by the complainant party itself creates doubt and suspicious as the alleged report No. 034 dated 14.02.2019 as per the contents of the complaint deceased met with an accident on 27.01.2019 and the alleged rapat was lodged after a delay of more than 18 days and further certificate produced by the complainant party of Medi Care Hospital is of 01.02.2019 which shows that the same is created one just in order to seek benefits from the O.P. However, the complainant has not provided the necessary documents required to examine the admissibility of the claim under the policy .
- FIR/MLC from police authorities.
- Driving licence of victim in case death or injury because of Road traffic accident and the victim was driving the vehicle involved.
- Death certificate issued by competent authority.
- Postmortem report.
The complainant despite issuing letters failed to furnish the requisite documents, the claim was closed for non compliance on the part of the complainant under intimation to the complainant.
7 O.P No.2 stated in their written version that the complainant has claimed the claim for the insured company through the respondent on 09.03.2019 and every documents formalities like indemnity bond was also furnished along with other documents as per instruction of the insurance company i.e. O.P No.1 but failed to pay the claimed amount inspite of so many requests and nothing has been supressed. O.P No 2 admitted the facts that the complainant has approached the replying respondent i.e. O.P No. 2 and gave each and every material facts to the O.P No. 1 by the O.P No.2 of insurance policy taken by deceased.
8 However, after gone through the facts and circumstances of the case we are of the considered opinion that the main controversy involved in the present case is that the O.P No.1 closed the case for non compliance on the part of the complainant under intimation to the complainant. As per O.P No. 1, the complainant has not provided the necessary documents required to examine the admissibility of the claim under the policy.
- FIR/MLC from police authorities.
- Driving licence of victim in case death or injury because of Road traffic accident and the victim was driving the vehicle involved.
- Death certificate issued by competent authority.
- Post-mortem report.
The complainant failed to furnished the requisite documents, after number of reminders (Ex. Op 1/2 , 1/3 ,1/4, 1/5 ) . After gone through the reminder documents placed on record by the O.P No.1 , it is observed that all the reminder letters ( reminder 1, reminder 2 ,reminder 3 and deficiency letter) are of same i.e. date 03/07/2019 , which itself prove that the reminder letters are fabricated one. Further, O.P No.1 has not placed on record any postal receipts or any other proof that same reminder letters are delivered/ received to the complainant. However, O.P No.1, itself stated that the claim was closed for noncompliance on the part of the complainant under intimation to the complainant, but O.P No 2 stated that all the required documents and formalities were completed by the complainant through the O.P No.2 as per instruction of the insurance company (O.P No.1) but still claim is pending inspite of so many requests and nothing has been suppressed. To prove their version O.P No 2 placed on records :-
- Passbook of the deceased (Ex. OP2/2)
- Rapt Roznomacha (Ex.OP2/3)
- Medical certificate of Medicare Hospital, Makhu (Ex. OP2/4)
- Affidavit regarding legal heirs of deceased (Ex.OP2/6)
- Claim form (Ex. OP2/7)
- Statement of Physician (Ex.OP2/8)
- Death certificate (Ex. OP2/9)
9 Hence , from the above documents placed on record by the O.P No.2 , it is very much clear that the complainant furnished the documents as mentioned in Ex. OP2/1 to Ex. OP2/9.
10 The opposite party No. 1 has taken specific objection in Para No. 4 of the written version that the present complaint is pre mature and has also pleaded in Para No. 4 of the on merits the opposite party No. 1 has pleaded that the complainant has not provided the necessary documents required to examine the admissibility of the claim under the Policy
- FIR/MLC from police authorities.
- Driving licence of victim in case death or injury because of Road traffic accident and the victim was driving the vehicle involved.
- Death certificate issued by competent authority.
- Post-mortem report.
In case “Balu Waman Kadam vs. ICICI Lombard General Insurance Co.” IV (2013) CPJ 16A (CN) (Mah.), the matter was similar, wherein the Insurance Company was asking the complainant to submit the documents again and again and the complainant was alleging that he had already submitted the requisite documents to the Insurance Company. In such circumstances, the Hon’ble State Consumer Disputes Redressal Commission Maharashtra disposed of the matter, by directing the Insurance Company to reconsider the claim of the complainant within one month on receipt of the required documents from the complainant.
11 While relying upon the above said authority, the Hon’ble State Commission, Punjab, Chandigarh passed the similar orders in case M/s Trends, through its Proprietor vs The Oriental Insurance Company Limited & Anr. Consumer Complaint No.245 of 2015 decided on 04.08.2017; and M/s Gurbir Rice Mills v. United India Insurance Company Ltd. & Ors. Consumer Complaint No.404 of 2016, decided on 09.10.2017, directing the Insurance Company to reconsider the claim of the complainant after submission of requisite documents by the complainant to it.
12 In view of our above discussion as well as keeping in view the ratio of above said judgments, we are of the opinion that the ends of justice would be met, if the Insurance Company be directed to decide the claim of the complainant, after the complainant submit all the requisite documents.
13 In view of the above discussion, the present complaint is disposed of with the direction to the complainant to submit the requisite documents as alleged in Para No. 4 of on merits of written version of opposite Party No. 1 to opposite party No. 1 for deciding the claim within a period of 15 days from the date of receipt of copy of order and on approaching the complaint for supplying the requisite documents, the opposite party No. 1 will issue proper receipt acknowledging the same. The opposite party No. 1 shall decide the claim of the complainant within a further period of two months therefrom and in case of failure on the part of the opposite party No. 1 the claim case of the complainant deemed to have been accepted. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Commission and due to COVID-19. Copies of the order be furnished to the parties as per rules. File is ordered to be consigned to the record room.
Announced in Open Commission.
06.07.2023
