DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA (PUNJAB)
CC No. 26 of 17-01-2011 Decided on : 19-05-2011
Jaspreet Kaur aged about 32 years Wd/o Manjit Singh R/o Village Joganand Opp. Govt. School, Tehsil & District Bathinda. .... Complainant Versus Life Insurance Corporation of India, Jeevan Jyoti Building, Bibi Wala Road, Bathinda through its Branch Manager .... Opposite party
Complaint under Section 12 of the Consumer Protection Act, 1986.
QUORUM Ms. Vikramjit Kaur Soni, President Sh. Amarjeet Paul, Member
For the Complainant : Sh. Naresh Garg, counsel for the complainant For the Opposite parties : Sh. Inderjit Singh counsel for the opposite party No. 2. Opposite party Nos. 2 & 3 exparte.
O R D E R
VIKRAMJIT KAUR SONI, PRESIDENT
This complaint has been filed by the complainant under Section 12 of the Consumer Protection Act, 1986 as amended upto date (here-in-after referred to as 'Act'). In brief, the case of the complainant is that Manjit Singh (now deceased) husband of the complainant purchased one Insurance policy from the opposite party vide No. 300058351 for the sum assured of Rs. 1,00,000/- alongwith Double Accident Benefits. The complainant is the nominee as declared by insured Manjit Singh. The original policy was submitted with the opposite party at the time of lodging the claim. On 23-10-2009, Manjit Singh met with an accident at Joga Nand Road while he was going on his motorcycle No. PB-03-M-6119. In this regard, FIR No.18 dated 24-10-2009 was duly registered at Police Station Thermal, Bathinda. On 25-10-2009 Manjit Singh succumbed to injuries and died and in this regard entry was duly registered by the above said police at Rapat No. 8 dated 26-10-2009 in the said DDR. The post Mortem of Manjit Singh was also conducted at Civil Hospital, Bathinda. The claim of death of Manjit singh was duly lodged with the opposite party and the necessary papers i.e. copy of the DDR, original Insurance policies, copy of the PMR, copy of the police file and death certificate etc., were also submitted to the opposite party. The official of opposite party also took the signatures of the complainant on blank Form No. 3783-A and Form No. 3801 etc., The opposite party also obtained Form No. 3816 from the concerned doctor. The complainant lodged the claim with the opposite party and it released part claim of Rs. 1,29,319/- in March, 2010 to the complainant being legal heir cum nominee. The complainant inquired many times regarding the balance claim of Rs. 1,00,000/- which is other benefit under Accident Double Benefit in the policy in question from the opposite party, but it neither replied nor paid any single penny to the complainant. The opposite party after one year issued one letter dated 20-12-2010 and demanded again Form No. 3816 alongwith Liquor Report position and said that claim is still pending with them for Accident Double Benefit. The complainant alleged that necessary documents have already been supplied to the opposite party and it after admitting all the documents and forms paid the part payment to the complainant and after a lapse of more than one year, opposite party demanded again the unnecessary documents which are not in the possession of the complainant. The said letter dated 20-12-2010 clearly shows the intention of the opposite party as the same has been issued knowingly with malafide intention and just to delay the claim of the complainant as no such Form No. 3816 has been attached with this letter. The claim of the complainant is still pending with opposite party despite that the higher authorities of the opposite party demanded the Form No. 3816 from Hospital including Liquor position from opposite party directly on 31-03-2010. Hence, the complainant has filed the present complaint. The opposite party filed its written reply and admitted that policy No. 300058351 for a sum of Rs. 1,00,000/- was issued with double accident benefit to Manjit Singh and the complainant was nominee under the said policy and that policy bond, death certificate, F. No. 3783, DDR, PMR, DDR disposal report were submitted at the time of lodging the claim. It has been pleaded that DLA was insured with the opposite party and on the receipt of claim regarding the accidental death of insured, claim was processed and an amount of Rs. 1,29,319/- has already been released to the complainant on account of sum assured and bonus accrued thereof. However, the claim in respect of accident double benefit could not be finalized so far due to non-completion and non-submission of requisite formalities/papers by the complainant. The complainant was time and again requested to submit Form No. 3816 and Liquor Position report and letter dated 20-12-2010 alongwith unfilled Form No. 3816 was also sent to the complainant, but she failed to submit the same and ultimately, opposite party itself applied by registered post to the Civil Hospital Authorities to get Form No. 3816 as the DLA remained admitted in Civil Hospital, Bathinda for treatment and the claim is still under consideration. Parties have led their evidence in support of their respective pleadings. Arguments heard. Record alongwith written submissions submitted by the parties perused. The learned counsel for the complainant argued that the opposite party has paid the claim of basic sum assured against policy No. 300058351 but the accident benefit claim against the same policy has been withheld by it without any sufficient reason. The opposite party is demanding unnecessary documents whereas all the documents have already been submitted while filing the claim and on the basis of those documents, the basic sum assured has already been paid to the complainant. In support of his arguments, he has placed reliance on various authorities on different aspects. On the other hand, the learned counsel for the opposite party submitted that opposite party is a service oriented organization for the benefits of people and in the claim, public money is involved. The false claim cannot be paid at the cost of public exchequer without proof in support of claim. However, the claim in respect of accident double benefit could not be finalized so far due to non-completion and non-submission of requisite formalities/papers by the complainant. The complainant was time and again requested to submit Form No. 3816 and Liquor Position report. A letter dated 20-12-2010 alongwith unfilled Form No. 3816 was also sent to the complainant, but she failed to submit the same. The opposite party itself applied by registered post to the Civil Hospital Authorities to get Form No. 3816 as the DLA remained admitted in Civil Hospital, Bathinda for treatment and the claim is still under consideration. These are the admitted fact that deceased husband of the complainant was insured under policy vide No. 300058351 for the sum of assured of Rs. 1,00,000/- with double accident benefit and the complainant was nominee under the said policy. The opposite party has paid the claim of basic sum assured alongwith bonus against the said policy but the accident benefit claim under the same policy is still pending with the opposite party. The opposite party has admitted in para No.4 of legal objections of its written reply that an amount of Rs. 1,29,319/- has already been released to the complainant on account of sum assured and bonus accrued thereto. However, the claim in respect of accident double benefit could not be finalized so far due to non-completion and non-submission of requisite formalities/papers by the complainant. The complainant was time and again requested to submit Form No. 3816 and Liquor Position Report. One part of the claim was honoured by the opposite party under policy in question but the second part of the claim was retained by the opposite party and it called for further documents such as Form No. 3816 and Liquor Position Report, despite the fact that it was an open fact that deceased met with an accident and died at the spot, the fact is apparent from the documents the complainant submitted for settlement of her claim to the opposite party i.e. post mortem report and FIR etc., The fact which the opposite party wants to verify i.e. accidental death and Liquor position could be verified from the documents which have already been supplied to the opposite party at the time of lodging the claim and on the basis of those documents the opposite party paid basic claim. However, a perusal of documents placed on file reveals that it is nowhere mentioned in the police report or post mortem/doctor's report that at the time of accident, the deceased husband of the complainant was under the influence of liquor and moreover, it is also not the allegation of the opposite party. Despite this, the opposite party has not paid the claim of the complainant without any sufficient cause. Hence, the Insurance Company cannot frustrate the claim of the complainant on mere technicalities and false grounds. The support can be sought by the precedent laid down by the Hon'ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh, in case titled The Oriental Insurance Co. Ltd.& Another Vs. M/s Puneet Pasricha, First Appeal No.1579 of 2004, decided on 05.03.2010 wherein the Hon'ble State Commission has held that :- “......The appellants cannot be permitted to frustrate the insurance claim on the technicalities.” With utmost regard and humility to the authorities relied upon by the learned counsel for the opposite party, they are distinguishable on facts. In view of what has been discussed above, this Forum is of the considered view that there is deficiency in service on the part of the opposite party in not paying the claim of the complainant without any sufficient cause and withheld the same even when the one part of the claim under the policy in question stands paid. Hence, this complaint is accepted with Rs. 2,000/- as compensation and cost. The opposite party is directed to pay to the complainant Rs. 1,00,000/- alongwith interest @ 9% P.A. from the date when the first claim under the same policy was paid, till realisation, as this claim was withheld on false grounds. The compliance of this order be made within 45 days from the date of receipt of copy of this order. A copy of this order be sent to the parties concerned free of cost and the file be consigned to record.
Pronounced : 19-05-2011 (Vikramjit Kaur Soni) President
(Amarjeet Paul) Member
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