DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA (PUNJAB)
CC No. 24 of 14-01-2011 Decided on : 16-05-2011
Ramandeep Kaur aged about 30 years Wd/o Jagsir Singh R/o Village Khasoo Khana, Tehsil Talwandi Sabo, 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. Sanjay Goyal, counsel for the opposite party.
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 Jagsir Singh (now deceased) husband of the complainant purchased two Insurance policies from the opposite party one vide No. 300333258 for the sum assured of Rs. 5,00,000/- and another vide No. 300333257 for the sum assured of Rs. 1,00,000/- alongwith double accident benefits. The complainant is the nominee as declared by insured Jagsir Singh. The original policies were submitted with the opposite party at the time of lodging the claim. On 14-11-2006, Jagsir Singh met with an accident at Bus Stand, Ludhiana and died at the spot. In this regard, FIR No. 307 dated 14-11-2006 U/s 304-A, 279 IPC was duly registered at Police Station Divn No. 5, Ludhiana. The post Mortem of Jagsir Singh was also conducted at Ludhiana. The claim of death of Jagsir singh was duly lodged with the opposite party and the necessary papers i.e. copy of the FIR, original Insurance policies, copy of the PMR, copy of the police file and death certificate etc., were also submitted to the opposite party. The complainant being the nominee cum legal heir lodged the claim with the opposite party and it released the full claim of Rs. 5,00,000/- in policy No. 300333258 on 31-03-2007 and part payment of Rs. 1,08,300/- in policy No. 300333257 on 28-03-2007 to the complainant. The complainant inquired many times regarding the balance claim of Rs. 1,00,000/- which is other benefit under Accident Double benefit in policy No. 300333257 from the opposite party, but it neither replied nor paid any single penny to the complainant from the balance claim in policy No. 300333257. The complainant applied under RTI Act on 07-12-2010 and demanded the status of her claims in the said policies. The opposite party replied vide letter dated 24-12-2010 that claim in policy No. 300333257 is still pending with them for the accident double benefit as some documents demanded by it. The complainant also got issued legal notice, but no reply was given by the opposite party till date. Hence, the complainant has filed the present complaint. The opposite party filed its written reply and admitted that policy No. 300333257 for a sum of Rs. 1,00,000/- was issued with double accident benefit and policy No. 300333258 for a sum of Rs. 5,00,000/- is without accident benefit cover and the complainant was nominee under the said policies. It has been pleaded that claim under policy No. 300333257 is pending due to non receipt of police inquest report duly attested by the issuing authority and also PMR required duly attested by the issuing authority. The claim of basic sum assured was paid without any delay. The accident benefit is pending for want of required documents. 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. 300333257 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. The claim in question is pending due to non receipt of police inquest report duly attested by the issuing authority and also PMR duly attested by the issuing authority. The complainant cannot take benefits of her own wrongs and hence, there is no deficiency in service on the part of the opposite party. These are the admitted fact that deceased husband of the complainant was insured under two policies vide Nos. 300333258 for the sum of assured of Rs. 5,00,000/- and another vide No. 300333257 for the sum assured of Rs. 1,00,000/-. The policy No. 300333257 for a sum of Rs. 1,00,000/- was issued with double accident benefit and policy No. 300333258 for a sum of Rs. 5,00,000/- is without accident benefit cover and the complainant was nominee under the said policies. The opposite party has paid the claim of basic sum assured against the said policies but the accident benefit claim under policy No. 300333257 is still pending with the opposite party. The opposite party has admitted in para No. 8 & 9 of its written reply that claim for basic sum assured was paid under the policies and that policy No. 300333257 is pending due to non receipt of police inquest report duly attested by the issuing authority and also PMR required duly attested by the issuing authority. One part of the claim was honoured by the opposite party under policy No. 300333257 but the second part of the claim was retained by the opposite party and it called for further documents such as PoliceInquest report duly attested by the issuing authority and post mortem report etc., 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., Not only this, the complainant filed Claim Petition under Section 166 of the Motor Vehicles Act, 1988 before Shri Kuldip Singh, Motor Accident Claims Tribunal Bathinda, vide Ex. C-12 in which an award of Rs. 4,28,000/- was passed vide order pronounced on September 9, 2008. There was no question for asking the complainant by the opposite party to supply P.I.R. i.e. Police Inquest Report and PMR duly attested by the authorities as the opposite party was already supplied with sufficient material by the complainant for settlement of claim. 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.” 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 for about five years as the accident has taken place on 14-11-2006 and even when the one part of the claim under the policy in question stands paid on 28-03-2007. Hence, this complaint is accepted with Rs.5,000/- 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 : 16-05-2010 (Vikramjit Kaur Soni) President
(Amarjeet Paul) Member
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