Order dictated by:
Sh.Anoop Sharma, Presiding Member.
1. Smt.Kulbir Kaur has brought the instant complaint under section 11 and 12 of the Consumer Protection Act, 1986 on the allegations that Avtar Singh husband of the complainant got himself insured from Opposite Party vide policy No.473293567 and sum assured under the policy was Rs.10 lacs. During the life time, said Avtar Singh was used to pay premiums towards the policy. Unfortunately, on 27.9.2013 the said Avtar Singh died. The complainant was made nominee in policy which was got issued by deceased, therefore, the complainant is entitled to the claim covered under the policy. Immediately after the death of deceased Avtar Singh, the complainant lodged claim with Opposite Party, but Opposite Party did not release the claim amount till date. It is also pertinent to mention over here that there was one another insurance policy bearing No. 471426355 purchased by deceased Avtar Singh from Batala Branch of Opposite Party , the claim under which for Rs.1 lac has been remitted to the complainant. The complainant contacted the Opposite Parties through various letters alongwith requisite documents for disbursing the claim amount to her. Opposite Party sent a letter dated 25.11.2014 demanding treatment record of deceased from Guru Nanak Dev Hospital, Amritsar. But however, the deceased never admitted in Guru Nanak Dev Hospital, Amritsar for any treatment and this fact was specifically disclosed to Opposite Party that Avtar Singh never taken any treatment from Guru Nanak Dev Hospital, Amritsar, but inspite of that the claim has not been disbursed till date. Vide instant complaint, the complainant has sought the following reliefs.
a) Opposite Party may kindly be directed to release the amount covered under the policy alongwith other benefits accrued on the policy alongwith interest @ 18% per annum in favour of the complainant.
b) Compensation to the tune of Rs.50,000/- may also be awarded to the complainant.
c) The costs of the complaint may also be awarded to the complainant.
Hence, this complaint.
2. Upon notice, Opposite Party appeared and contested the complaint by filing written statement taking preliminary objections therein inter alia that the complainant has filed a baseless, frivolous and an imaginary claim with an ulterior motives and the complainant has not come to this Forum with clean hands and has suppressed the material facts from this Forum. On merits, it is denied that immediately after the death of deceased Avtar Singh the complainant lodged the claim with the Opposite Party. It is denied that the complainant contacted the official of the Opposite Party through various letters alongwith requisite documents for disbursing the claim amount. It is submitted that the Opposite Party received the letter from claimant for illness treatament during the year 2006-2007 in Guru Nanak Dev Hospital, Amritsar for 10 days and the Opposite Party demanded the treatment record of Avtar Singh from Guru Nanak Dev Hospital, Amritsar for that period, but till today no record has been received by Opposite Party due to which the claim of the complainant is not settled. Remaining facts mentioned in the complaint are also denied and a prayer for dismissal of the complaint with cost was made.
3. In her bid to prove the case, complainant tendered into evidence affidavit Ex.C-1 in support of the allegations made in the complaint and also produced copies of documents Ex.C2 to Ex.C4 and closed her evidence.
4. On the other hand, to rebut the evidence of the complainant, the Opposite Party tendered into evidence the affidavit of Sh.Rajinder Kumar, Manager Legal Ex.OP1 alongwith copies of documents Ex. OP2 to Ex.OP20 and closed the evidence on behalf of the Opposite Party.
5. We have heard the ld.counsel for the parties and have carefully gone through the evidence on record.
6. The complainant has submitted her affidavit Ex.C1 in which she has reiterated the facts as detailed in the complaint and submitted that Avtar Singh husband of the complainant got himself insured from Opposite Party vide policy No.473293567 and sum assured under the policy was Rs.10 lacs. During the life time, said Avtar Singh was used to pay premiums towards the policy. Unfortunately, on 27.9.2013 the said Avtar Singh died. The complainant was made nominee in policy which was got issued by deceased, therefore, the complainant is entitled to the claim covered under the policy. Immediately after the death of deceased Avtar Singh, the complainant lodged claim with Opposite Party, but Opposite Party did not release the claim amount till date. It is also pertinent to mention over here that there was one another insurance policy bearing No. 471426355 purchased by deceased Avtar Singh from Batala Branch of Opposite Party , the claim under which for Rs.1 lac has been remitted to the complainant. The complainant contacted the Opposite Parties through various letters alongwith requisite documents for disbursing the claim amount to her. Opposite Party sent a letter dated 25.11.2014 demanding treatment record of deceased from Guru Nanak Dev Hospital, Amritsar. But however, the deceased never admitted in Guru Nanak Dev Hospital, Amritsar for any treatment and this fact was specifically disclosed to Opposite Party that Avtar Singh never taken any treatment from Guru Nanak Dev Hospital, Amritsar, but inspite of that the claim has not been disbursed till date.
7. On the other hand, ld.counsel for Opposite Party has repelled the aforesaid contention of the ld.counsel for the complainant on the ground that the Opposite Party received the letter from claimant for illness treatment during the year 2006-2007 in Guru Nanak Dev Hospital, Amritsar for 10 days and the Opposite Party demanded the treatment record of Avtar Singh from Guru Nanak Dev Hospital, Amritsar for that period, but till today no record has been received by Opposite Party due to which the claim of the complainant is not settled. But the Opposite Party has failed to produce any document showing the admission of deceased Avtar Singh in any hospital. Document Ex,OP11 which is the Claim Enquiry Report produced by the Opposite Party itself on the record and duly signed by the then Branch Manager of Opposite Party fully proves that sum assured of the policy was Rs.10 lacs and the policy holder died of Heart Attach on 27.9.2013 and it is time and again mentioned in the said Enquiry report that the life assured have no such previous record of ailment. If the Opposite Party claims that the life assured was taking some treatment from Guru Nanak Dev Hospital, Amritsar, the onus was upon the Opposite Party not to issue the policy to the life assured without verifying the facts regarding his ailment if any at the time of proposal. Moreover, the onus is upon the Opposite Party to prove their case at their own and has to stand on its own legs and they can not call the documents from the complainant at this stage which are allegedly for the year 2006-2007 i.e. about 10 years back. Moreover, in other policy, the claimant has already received the claim regarding that policy in lieu of death of Avtar Singh husband of the complainant. Perusal of the case shows that the Opposite Party are delaying the genuine claim of the complainant without any reasonable cause.
- In such a situation, the repudiation made by Opposite Party regarding genuine claim of the complainant appears to have been made without application of mind. It is usual with the insurance company to show all types of green pesters to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation. This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible. It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-
“It seams that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy. The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.
- From the aforesaid discussion, it transpires that Opposite Party has wrongly repudiated the genuine claim of the complainant. Opposite Party is directed to make the payment of insurance claim of the complainant to the tune of Rs. 10 lacs (ten lacs only). The costs of the litigation are assessed at Rs.2,000/-. Compliance of this order be made within 30 days from the receipt of copy of the order; failing which, awarded amount shall carry interest @ 9% p.a from the date of filing of the complaint until full and final recovery. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum.
Announced in Open Forum
Dated: 23.05.2017.
