Punjab

Faridkot

CC/17/315

Gurpreet Kaur - Complainant(s)

Versus

M.D India Helath Insurance T.P.A Private LTD. - Opp.Party(s)

Lalwinder Singh Chauhan

10 Jun 2019

ORDER

      DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FARIDKOT

 

Complaint No. :      315 of 2017

Date of Institution:   20.09.2017

Date of Decision :    10.06.2019

 

Gurpreet Kaur aged about 28 years, wife of Jaswinder Singh son of Resham Singh r/o  Bargari Road Village Jhakhar Wala Tehsil Jaitu, District Faridkot.

 

...Complainant

Versus

1. M D India, Health Insurance, TPA Pvt Ltd,  Maxpro Info Park D -38, Industrial Area, Phase-I,  Mohali, Punjab.
2. United India Insurance Company Ltd, SCO-72, Phase-9 Mohali, Punjab.
3. M.D. PHSC and Secretary Health (Chairman) State Level Disputes Redressal Committee, Bhagat Puran Singh Health Insurance Scheme, SAS Nagar, Mohali, Punjab.
4. Deputy Medical Commissioner, Faridkot District  Level Disputes Redressal Committee, Bhagat Puran Singh Health Insurance Scheme, Tehsil and  District Faridkot.                                         

 .....Opposite Parties

Complaint under Section 12 of the

Consumer Protection Act, 1986.

 

Quorum: Sh. Ajit Aggarwal, President,

               Smt. Param Pal Kaur, Member.

 

cc no. - 315 of 2017

 

Present: Sh  Lalwinder Singh Chauhan, Ld Counsel for complainant,

              Sh Ashok Monga, Ld Counsel for OP-1 and 2,

              Sh Atul Gupta, Ld Counsel for OP-3 and 4,

 

ORDER

(Ajit Aggarwal, President)

 

                                      Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against OPs for deficiency in service in not making payment of Rs. 5 lakhs of insurance claim and for further directing OPs to pay Rs.10,000/- as compensation for harassment, inconvenience, mental agony and litigation expenses besides Rs.5 lakhs as insurance claim.

2                                    Briefly stated, the case of the complainant is that her husband Jaswinder Singh was insured under Bhagat Puran Singh Scheme vide card no.93045000556035605 and policy bearing no.11210048161800000091 was issued to him for the period from 1.11.2016 to 31.10.2017. it is submitted that during the subsistence of said policy, her husband was murdered on 2.01.2017 regarding which FIR No.2 dated 3.01.2017 under section 302/307/148/149 IPC 3 Sc/St Act 1989 was recorded in Police Station Baja Khana. As per insurance policy in question, she is entitled to receive Rs.5 lakhs as insurance claim on account of death of her husband. Complainant lodged the claim and duly submitted requisite documents to the Investigator of OP-2 for obtaining insurance claim, but despite submission of all documents and

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completion of requisite formalities, Ops have not cleared the claim. Complainant also served legal notice dated 5.06.2017 to OP-1 and OP-2 and to OPs 1 to OP-4 on 21.08.2017, but till now, they have not given any response regarding insurance claim of complainant. Action of Ops in not making payment of claim amount of Rs.5,00,000/ amounts to deficiency in service and it has caused harassment and mental agony to complainant for which she has prayed for accepting the complaint alongwith compensation and litigation expenses. Hence, the present complaint.

3                                       The counsel for complainant was heard with regard to admission of the complaint and vide order dated 3.10.2017, complaint was admitted and notice was ordered to be issued to the opposite parties.

4                                              On receipt of the notice, OP-1 and OP-2  filed written statement wherein  they have denied all the allegations of complainant being wrong and incorrect and asserted that complainant is not their consumer and there is no relationship of consumer and service provider between them. it is averred that complainant did not give them requisite immediate intimation preventing them to gather first hand information and to inspect the spot, which is violation of terms and conditions of the policy in question. Complaint involves complicated questions of law and facts requiring lengthy evidence, which is not possible in summary procedure of this Forum. No cause of action arises

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against answering Ops and present complaint is vague and is based on wrong facts and complainant has no locus standi to file the present complaint. It is further averred that deceased was not insured with them at the relevant time and neither complainant nor OP-3 and OP-4 provided them proper particulars and therefore, they are not liable to make payment of any insurance claim. There are several regional offices, divisional offices and branch and micro offices and it is not possible to locate the insurance particulars without supply of the same by complainant or by OP-3 and OP-4. Even complaint is bad for non joinder of necessary parties as complainant has not made parents and other siblings of Jaswinder Singh as party in present complaint. It is further averred that husband of complainant was murdered and thus, claim of complainant is not covered under Bhagat Puran Singh Insurance Scheme. All the other allegations are denied being wrong and incorrect and asserted that there is no deficiency in service on the part of answering Ops and prayed for dismissal of complaint with costs.

5                                     OP-3 and OP-4 also filed reply through counsel and have denied all the allegations of complainant being wrong and incorrect and asserted that complainant did not pay the premium of Rs.30/- which is pre requisite condition for availing the benefits under Bhagat Puran Singh Sehat Bima Yojna and even complainant alone is not entitled to seek the claim as deceased did not die in any accident, rather he was murdered and as per terms and conditions of the policy, murder is not covered under this scheme. All the other allegations are

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totally denied being wrong and incorrect and it is reiterated that there is no deficiency in service on the part of answering Ops. Prayer for dismissal of complaint is made.

6                                        Parties were given proper opportunities to prove their respective case. The complainant tendered in evidence his affidavit Ex.C-1 and documents Ex C-2 to 15 and then, closed his evidence.

7                                                In order to rebut the evidence given by complainant, the ld Counsel for OP-1 and 2 tendered in evidence, document Ex OP-1, 2/1 and closed the evidence on behalf of OP-1 and 2. Ld counsel for OP-3 and 4 tendered in evidence affidavit of Jagraj Singh Ex OP-3, 4/1 and closed the same on behalf of OP-3 and 4.

8                                              We have heard the learned counsel for the parties and have very carefully gone through the affidavits and documents on the file.

9                                               The case of complainant is that her husband was insured under Bhagat Puran Singh Scheme for the period from 1.11.2016 to 31.10.2017 and during the subsistence of said policy, her husband was murdered on 2.01.2017  and FIR No.2 dated 3.01.2017 to this effect was got recorded under section 302/307/148/149 IPC 3 Sc/St Act 1989 in Police Station Baja Khana. Complainant lodged the claim, duly submitted requisite documents to the OPs and completed all

 

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formalities, but despite all this Ops have not made payment of insurance claim. Legal notices issued by complainant for passing her genuine insurance claim, also served no purpose. It amounts to deficiency in service on the part of OPs. In reply, OP-1 to OP-4  have denied all the allegations of complainant being wrong and incorrect and asserted that there is no deficiency in service. Ld counsel for OP-1 and OP-2 brought before the Forum document Ex OP-1, 2/1 which is copy of e-mail dated 9.11.2018, issued by United India Insurance Company to their counsel in which it is clearly stated that claim of complainant for Rs.5 laksh has been paid to complainant Gurmeet Kaur. All this amount of Rs.5,00,000/-has been credited in the account of Gurmeet Kaur/ complainant bearing no.65281629386 on 7.09.2018. It is observed that during the proceedings of complaint, OPs have made entire payment of insurance claim of Rs.5,00,000/- (Five lakhs) to complainant on account of death of Jaswinder Singh her deceased husband. Grievance of complainant has been redressed by OPs and thus, there seems to be no deficiency in service on the part of OPs.

10                                        In the light of above discussion and keeping in view document Ex OP-1, 2/1, it is clear that insurance claim worth Rs.5 lakhs sought by complainant on account of death of her husband, has been duly paid by Insurance Company and her grievance has been fully redressed by them. Therefore, in these circumstances, complaint

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filed by complainant stands hereby dismissed being infructuous. However, in peculiar circumstances of the case, there are no orders as to costs. Copy of the order be supplied to parties free of cost. File be consigned to record room.

Announced in Open Forum

Dated : 10.06.2019         

          (Param Pal Kaur)              (Ajit Aggarwal)

                                         Member                              President