Punjab

Fatehgarh Sahib

CC/36/2014

yohannan - Complainant(s)

Versus

LIC of india - Opp.Party(s)

Sh GS Nagra

08 Apr 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FATEHGARH SAHIB.

                                 Consumer Complaint No.36 of 2014

                                                                                                                                               Date of institution:  19.03.2014

                                                                                                                                              Date of decision  :   08.04.2015

Yohannan aged about 50 years son of Mathew (Nominee/beneficiaries with respect to policy No.165271312) resident of H.No.335, Sector 4-B, Guru Nanak  Colony, Mandi Gobindgarh, Tehsil Amloh, District Fatehgarh Sahib.

……..Complainant

Versus

 

1. Life Insurance Corporation of India through its Chairman/M.D./G.M. Jeevan Bima Marg, Yogak Shema H.O. Mumbai.
2. L.I.C. Branch Office Mandi Gobindgarh, Near UCO Bank, Opposite Bus Stand, G.T.Road, Mandi Gobindgarh, District Fatehgarh Sahib through its Branch Manager.
3. Divisional Office L.I.C. Sector 17-B, Chandigarh.

…..Opposite Parties

Complaint Under Sections 12 to 14 of the Consumer Protection Act

Quorum

                                   Sh. Ajit Pal Singh Rajput, President.           

                                   Smt. Veena Chahal, Member.

Present :   Sh.G.S.Nagra, Adv. Cl. for the complainant    

                Sh. M.L. Singhi, Adv. Cl. for the OPs.

ORDER

By Sh. Ajit Pal Singh Rajput, President.

                 Complainant, Yohannan, aged about 50 years son of Mathew (Nominee/beneficiaries with respect to policy No.165271312) resident of H.No.335, Sector 4-B, Guru Nanak Colony, Mandi Gobindgarh, Tehsil Amloh, District Fatehgarh Sahib, has filed this complaint against the Opposite parties (hereinafter referred to as “the OPs”) under Sections 12 to 14 of the Consumer Protection Act. The brief facts of the complaint are as under:

2.              The son of the complainant, namely; Jithin Joy (now deceased) was holding a policy bearing No. 165271312 issued by the OPs. The said policy was for the sum assured of Rs.8,00,000/- with effect from 26.12.2012 and the annual premium amount was Rs. 48,918/-. On 04.03.2013, the said Jithin Joy was suddenly expired and his death certificate was issued by the Health Department Punjab. The intimation regarding the death was given to the opposite parties well within time and thereafter the OPs advised the complainant to submit some documents regarding his death. All the relevant documents were given to the opposite parties by the complainant himself at their office at Mandi Gobindgarh. After some time, one surveyor of the opposite parties visited on the address of the complainant and enquired about the reasons and other formal things regarding the death of Jithin Joy. Thereafter in the month of September 2013, the complainant approached the opposite parties and they assured the complainant that the process of giving final report to the Head Quarter is on the way and when the report came from the Head Quarter, the amount of insurance claim was forwarded to the complainant immediately. Thereafter, the complainant again approached the opposite parties in the month of October, 2013 and November, 2013 and requested the opposite parties to release the amount but they put the matter on one pretext or the other and did not clarify the status of the report/amount from their Head Quarter. Thereafter in the month of December 2013, when the complainant again visited the office of opposite party at Mandi Gobindgarh, the opposite party brutally refused to clear the amount and told that the case of the complainant was not genuine and based upon the false facts, so the claim is not accepted. Thereafter the complainant again visited opposite party No.2 on 02.02.2014 and received reply from the opposite party that the claim of the complainant is not accepted as the insured person, Jithin Joy, has committed suicide. The fact regarding committing of suicide is self created as the opposite parties want to refuse the genuine claim of the complainant, which amounts to deficiency in service and unfair trade practice on the part of the opposite parties. Hence this complaint for giving directions to the OPs to pay the claim amount of Rs. 8,00,000/- and to pay Rs.1,50,000/-, as compensation for harassment( mentally, physically and emotionally) suffered by the complainant.

3.              The complaint is contested by the opposite parties, who filed joint written reply. In reply to the complaint the opposite parties stated that during investigation it was found that the life assured died under suspicious circumstances, whereas there is no evidence of death due to leakage of gas from Geyser. It is further stated that in case of any un-natural death a police report was required and matter had to be investigated regarding cause of death. The death must have been declared by a medical practitioner. The death certificate was issued by authorities on 05.03.2013 after un-natural death of life assured on 04.03.2013 without any documentary evidence i.e. without any hospital record, police record or cremation ground record, whereas the life assured was buried in Kerala on 07.03.2013. There is also suspicion that why death was not recorded by police as well as hospital authorities, when dead body was medically treated before taking it to Kerala. From all these facts and investigation report, the competent authorities had rightly rejected the claim under terms and condition of the policy. Thus, there is no deficiency of service on the part of the OPs. After denying the other averments made in the complaint, they prayed for dismissal of the complaint.

4.              In order to prove the case, the complainant tendered his affidavit Ex.C-1, copy of insurance policy Ex. C-2, copy of death certificate Ex. C-3, copy of order dated 23.01.2014 Ex. C-4, copy of postal receipt Ex. C-5, copy of repudiation letter Ex. C-6 and affidavit of Charanjit Singh Bajwa Ex. C-7 and closed the evidence. In rebuttal the opposite parties tendered copy of letter dated 06.08.2013 Ex. OP1/1, copy of repudiation letter dated 24.02.2014 Ex. OP1/2, copy of proposal form Ex. OP1/3, affidavit Ex. OP1/4 and closed the evidence.

5.              We have heard the ld.counsel for the parties and have carefully gone through the record.

6.              After going through the pleadings, evidence and submissions of the ld. counsel for the parties, we feel the present complaint cannot be decided in a summary manner, as in order to prove the death was natural or unnatural, it will require voluminous evidence, which includes oral and cross examination etc, in order to come to a conclusion. We may in this case refer to a decision of three-Judge Bench of the Supreme Court in the case of Synco Industries v. State Bank of Bikaner and Jaipur and Ors. I (2002) CPJ 16 (SC), in which Hon’ble Supreme Court observed where complicated questions of law and facts are involved Forum under the Consumer Protection Act may not be a proper Forum to dispose of such a case in summary fashion. We feel in the present case also there are complicated questions of facts are involved which cannot be adjudicated upon by this Form. Accordingly, we are unable to decide the case in hand on merits hence; we return the present complaint. The complainant is granted the liberty to approach the appropriate Court of law and may be entitled to the benefit of the observations of the Supreme Court in Laxmi Engineering Works v. P.S.G. Industrial Institute II(1995) CPJ 1 (SC) : 1995 3 SCC 583 for the purpose of exclusion of time spent before this Forum. The present complaint is disposed of with the aforementioned observation. Parties to bear the cost.

7.                  The arguments on the complaint were heard on 07.04.2015 and the order was reserved. Now the order be communicated to the parties. Copy of the order be sent to the parties free of cost and thereafter the file be consigned to the record room.

    Pronounced

    Dated:08.04.2015

(A.P.S.Rajput)                           President

 

    (Veena Chahal)                          Member