Punjab

Faridkot

CC/17/335

Sarabjeet Kaur - Complainant(s)

Versus

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

Lalwinder Singh Chauhan

25 Feb 2019

ORDER

 DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FARIDKOT

 

Complaint No. :    335 of 2017

Date of Institution:   6.10.2017

Date of Decision:    25.02.2019

 

Sarabjit Kaur aged about 38 years w/o Jasvir Singh s/o Amrik Singh r/o Bargari Road Village Jakhar Tehsil Jaitu, District Faridkot.

...Complainant

Versus

1. MD India Health Insurance TPA Pvt Ltd. Max Pro Info Park, D-38, 1^st Floor, Phase – I, Industrial Area, Mohali, Punjab 160055.
2. United India Insurance, C O , L T D, S C O-72, Phase -9, Mohali (Punjab)-160062.
3. Managing Director, P H S C and Secretariat Health (Chairman) State Level Disputes Redressal Committee, Bhagat Puran Singh Health Insurance Scheme, S A S Nagar, Mohali Punjab -160056.
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.

 

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 & 4.

 

ORDER

(Ajit Aggarwal, President)

 

Complaint No. - 335 of 2017

                                        Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against OPs seeking directions to OPs to make payment of Rs.5 lacs on account of death of her husband against  insurance policy and for further directing OPs to pay Rs.1,00,000/- as compensation for harassment, inconvenience, mental agony besides litigation expenses of Rs.5,000/-.

2                                     Briefly stated, the case of the complainant is that husband of complainant was insured under Bhagat Puran Singh Health Insurance Scheme and was having card no.93045000110035605 against policy no.11210048161800000091 valid for the period from 1.11.2016 to 31.10.20017 and as per insurance policy in the event of death of head, family was entitled for sum of Rs. 5 lacs. It is further submitted that during the subsistence of policy in question husband of  complainant got electrocuted on 15.05.2017 at about 4.30 a.m through an electric transformer installed in the fields of Bhupinder Singh. He was immediately brought to Guru Gobind Singh Medical College and Hospital, Faridkot from where, he was referred to Chandigarh for better treatment. He was got admitted in Land Mark Hospital, Chandigarh, where he died on 3.06.2017. Thereafter, complainant contacted OPs on their toll free number regarding death of her husband, but they did not pay even a single penny on account of insurance claim for the death of her husband. Legal notice issued by complainant to Ops also served no purpose. All this amounts to deficiency in service. They have caused unnecessary harassment to

Complaint No. - 335 of 2017

her by not paying the genuine  claim on account of death of her husband and this act of OPs amounts to trade mal practice and deficiency in service and it has caused harassment and mental agony to complainant for which she has prayed for directions to OP to pay Rs.1,00,000/-as compensation alongwith Rs.5000/-as cost of litigation besides the main relief. Hence, the present complaint.

3                                       The counsel for complainant was heard with regard to admission of the complaint and vide order dated 12.10.2017, complaint was admitted and notice was ordered to be issued to the opposite parties.

4                                                       On receipt of the notice, OP-1 and 2 filed written statement taking preliminary objections that complainant is not their consumer and therefore, present complaint is liable to be dismissed. It is averred that complaint involves complex questions of law and facts, which require voluminous evidence and it can not be decided by this Forum having limited jurisdiction and limited time span and therefore, it is liable to be referred to competent Civil Court. It is further averred that complainant has concealed the material facts from this Forum as well as OPs as she did not provide requisite information or documents to OPs.  No detail is given that as to how complainant reached to the amount of Rs.5 lacs, one lac and five thousands. It is sternly denied that deceased was insured with OPs and even complainant has no locus standi to file the present complaint. However, on merits

Complaint No. - 335 of 2017

they have denied all the allegations of complainant being wrong and incorrect and asserted that there is no deficiency in service on their part. It is further averred that no proper particulars of insurance have ever been produced by complainant with them and even deceased was not insured with them. it is also denied that death of husband of complainant occurred due to electric shock as complainant has not placed on record death certificate or copy of post mortem showing the death of her husband occurring due to electric shock. OP-1 and 2 have denied all the allegations of complainant being wrong and incorrect and prayed for dismissal of complaint with costs.

5                                       Ld Counsel for OP-3 and OP-4 also filed written statement taking preliminary objections that complainant has not approached Grievance Redressal Committees constituted at District Level and State Level for providing relief under such cases. It is averred that husband of complainant did not pay the requisite premium for the purchase of said scheme and even complainant has not impleaded parents of deceased as parties in present complaint and even there is no mention regarding siblings of deceased Jasvir Singh husband of complainant. it is denied that husband of complainant died due to electrocution and even for death due to electrocution, complainant should file suit against Punjab State Power Corporation and not against them. however, on merits, OP-3 and 4 have denied all the allegations of complainant being wrong and incorrect and asserted that requisite premium of Rs.30/-was not got deposited by deceased Jasvir Singh with

Complaint No. - 335 of 2017

them for availing the benefits of Bhagat Puran Singh Sehat Bima Yojna. Moreover, complainant alone is not entitled for seeking relief as she is mere nominee, who is trustee on behalf of all eligible legal heirs. It is further submitted that complainant is not the consumer of answering OPs. Allegations regarding death of Jasvir Singh due to electrocution are totally denied. there are no documents on record to show that he was admitted in Guru Gobind Singh Medical College and Hospital, Faridkot and then referred to Chandigarh. Even no Daily  Diary Report or Post Mortem Report is placed on record by complainant. even no intimation regarding death of deceased Jasvir Singh was ever given to them. All the other allegations and allegation with regard to relief sought too are denied being incorrect and prayed for dismissal of complaint with costs.

6                                              Parties were given proper opportunities to prove their respective case. Ld Counsel for complainant tendered in evidence affidavit of complainant as Ex.C-1 and documents Ex C-2 to 18 and then, closed the evidence.

7                                              In order to rebut the evidence of the complainant, ld counsel for OP-1 and 2 tendered in evidence, affidavit of R N Bansal as Ex OP-1, 2/1 and then, closed the same on the part of OP-1 and OP-2.  Ld Counsel for OP-3 and 4  tendered in evidence affidavit of Jagraj Singh as Ex OP-3, 4/1 and closed the same on behalf of OP-3 and 4.

 

Complaint No. - 335 of 2017

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

9                                              Ld Counsel for complainant has vehementally argued that being a member of Bhagat Puran Singh Sehat Bima Yojna having card no. 93045000110035605 against policy no.11210048161800000091, husband of complainant was insured under this scheme. It was valid from 1.11.2016 to 31.10.20017 and during the subsistence of policy in question, husband of  complainant got electrocuted through an electric transformer. He was immediately brought to Guru Gobind Singh Medical College and Hospital, Faridkot from where, he was referred to Land Mark Hospital, Chandigarh, where he died on 3.06.2017. Thereafter, complainant intimated regarding death of her husband to OPs, but they did not pay insurance claim for the death of her husband. Legal notice issued to Ops also served no purpose. OPs have caused unnecessary harassment to her by not paying the genuine claim on account of death of her husband and this act of OPs amounts to deficiency in service and has caused harassment to her for which she has prayed for which she has prayed for accepting the present complaint alongwith compensation and litigation expenses besides main relief. She has stressed on document Ex C-1 to 18.

10                                              To controvert the allegations of complainant, ld counsel for OP-1 and 2 argued that complainant is not

Complaint No. - 335 of 2017

their consumer and therefore, present complaint is liable to be dismissed. It is averred that complainant has no locus standi to file the present complaint and have denied all the allegations of complainant being wrong and incorrect and asserted that there is no deficiency in service on their part. It is further argued that no proper particulars of insurance have ever been produced by complainant with them and even deceased was not insured with them. It is denied that death of Jasvir Singh occurred due to electric shock as complainant has not placed on record death certificate or copy of post mortem showing the death of her husband occurred due to electrocution. They have denied all the allegations being wrong and incorrect and prayed for dismissal of complaint with costs.

11                                       Ld Counsel for OP-3 and OP-4 argued before the Forum that complainant has not approached Grievance Redressal Committees constituted at District Level and State Level for obtaining relief under her claim. Further argued that husband of complainant did not pay the requisite premium for the purchase of said scheme and even complainant has not impleaded parents and siblings of deceased as parties in present. There is no proof that husband of complainant died due to electrocution and even for death due to electrocution, complainant should file suit against Punjab State Power Corporation and not against them. Moreover, requisite premium of Rs.30/-was not got deposited by deceased Jasvir Singh with them for availing the benefits of Bhagat Puran Singh Sehat Bima Yojna. Even complainant alone is not entitled for seeking relief as she is mere nominee, who is trustee on behalf of all

 

Complaint No. - 335 of 2017

eligible legal heirs and is not their consumer. Allegations regarding death of Jasvir Singh due to electrocution are totally denied and no Daily  Diary Report or Post Mortem Report is placed on record by complainant. No intimation regarding death of deceased Jasvir Singh was ever given to them. All the other allegations are denied with prayer to dismiss the complaint.

12                                         After careful perusal of the record available on file and going through the evidence led by parties, it is observed that case of the complainant is that her husband was insured under Bhagat Puran Singh Health Insurance Scheme and was duly allotted card for availing the policy. During the subsistence of policy in question, her husband died due to electrocution and after his death, complainant duly intimated OPs and completed all requisite formalities and requested Ops to pay insurance claim on account of death of her husband. Grievance of complainant is that despite repeated requests OPs did not make payment of insurance claim under the policy in question. On the other hand plea taken by OPs is that complainant is not their consumer and even husband of complainant was not insured with them. They have even denied the death of her husband due to electrocution. Therefore, in order to prove her pleadings, complainant has stressed on document ExC-10 copy of Bhagat Puran Singh Health Insurance Scheme that clearly depicts that policy in question was issued in the name of

 

 

 

Complaint No. - 335 of 2017

deceased Jasvir Singh and it also reveals the card number 93045000110035605 against policy no.11210048161800000091 which   is valid for the period from 1.11.2016 to 31.10.20017. Ex C-11 is copy of card issued under Bhagat Puran Singh Sehat Bima Yojna to complainant and it also reveals the photograph of deceased Jasvir Singh affixed over it. Ex C-12 is copy of adahar card of complainant to prove that she was the wife of deceased Jasvir Singh. Ex C-14 is copy of death certificate issued by Municipal Corporation, Chandigarh wherein it is clearly mentioned that death of her husband occurred on 3.06.2017  in Landmark Hospital, Chandigarh. Ex C-14 copy of Rapat No. 35 dated 27.05.2017 proves the pleadings of complainant that death of her husband occurred due to electrocution from an electric transformer erected in his fields. Ex C-15 is copy of brochure showing salient features of Bhagat Puran Singh Health Insurance Scheme wherein it is clearly pronounced that in the event of accidental death or disability of two parts, sum of Rs.5 lacs would be given to the family of deceased or to the beneficiaries and validity of policy is also mentioned over here as commencing from 1.11.2016 to 31.10.2017. Ex C-17 copy of Death Summary issued by Landmark Hospital, Chandigarh clearly discloses all the facts that death of husband of complainant occurred due to electric shock on 16.05.2017 as he fell from height. Initially he was treated at Delhi Heart Institute where bilateral chest drain tubes were inserted. Patient was on inotropes with respiratory failure with multiple spine

 

Complaint No. - 335 of 2017

fractures C3-5 with D4 D5 cord transaction. Legal notice alongwith postal receipts issued by complainant to OPs Ex C-2 to Ex C-9 clearly reveal the fact that  complainant was aggrieved by the act of OPs in not making payment of insurance claim to her. Death summary Ex C-17 issued by authorities of Landmark Hospital, Chandigarh is an authentic document. Document Ex C-10 copy showing membership and card number issued to deceased Jasvir Singh under Bhagat Puran Singh Sehat Bima Yojna is beyond any doubt. Complainant has placed on record sufficient and cogent evidence to prove her pleadings. There is no reason to doubt that complainant has suffered huge harassment and mental agony by action of OPs in not making payment of insurance claim on account of death of her husband.

13                                    From the above discussion and in the light of evidence produced by the respective parties, we are of considered opinion that complainant has succeeded in proving her case and therefore, present complaint is hereby accepted. OP-1 and OP-2 are directed to pay Rs.5 lacs to complainant on account of insurance claim for death of husband who was insured with OPs alongwith interest at the rate of 9 % per anum from the date of filing the present complaint till final realization. OP- 1 and 2 are further directed to pay Rs.5,000/-to complainant as compensation for harassment and mental agony suffered by him as well as litigation expenses. Compliance of this order be made within one month of the receipt of the copy of the order, failing which

 

Complaint No. - 335 of 2017

complainant shall be entitled to proceed under Section 25 and 27 of Consumer Protection Act. Complaint against OP-3 and OP-4 stands hereby dismissed. Copy of the order be supplied to parties free of cost as per law. File be consigned to record room.

Announced in Open Forum

Dated : 25.02.2019       

(Param Pal Kaur)            (Ajit Aggarwal)  

 Member                         President