Punjab

Faridkot

CC/19/153

Jasvir Kaur - Complainant(s)

Versus

Managing Director India Health Insurance TPA Pvt. Ltd, - Opp.Party(s)

Sanjiv Deora

27 Oct 2021

ORDER

  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FARIDKOT

 

Complaint No. :        153  of 2019

Date of Institution:      24.06.2019

Date of Decision:        27.10.2021

 

Jasvir Kaur aged about 52 years wife of deceased Jarnail Singh son of Ajmer Singh r/o Village Burj Jawahar Singh Bhai Ka, Tehsil Kotkapura, District Faridkot.

...Complainant

Versus

1. MD India Health Insurance TPA Pvt Ltd. Max Pro Info Park, D-38, Phase – I, Industrial Area, Mohali, Punjab 160055.
2. United India Insurance Company Ltd., SCO 72, Phase 9, Mohali, Punjab-160062 (regarding issuing of insurance policy card no.0304 5000 0180 3560 3 under Bhagat Puran Singh Sehat Bima Yojna in the name of deceased Ajmer Singh son of Jarnail Singh resident of Village Burj Jawahar Singh District Faridkot)
3. Secretary Health and Family Welfare Punjab, Mini Secretariat, Sector – 9, Chandigarh.
4. State of Punjab through Deputy Commissioner, Faridkot.

cc no. - 153 of 2019

5. Director, Bhagat Puran Singh Sehat Beema Yojna  Backside Civil Hospital, Phase VI, Mohali.

.....Opposite Parties

Complaint under Section 35 of the

Consumer Protection Act, 2019.

 

Quorum:   Smt Param Pal Kaur, Member.

                  Sh Vishav Kant Garg, Member.

 

Present: Sh Sanjiv Deora, Ld Counsel for complainant,

              Sh Aseem Dhir, Ld Counsel for OP-3, 4 & 5,

              Sh Ashok Monga, Ld Counsel for OP-2,

   OP-1 Ex-parte.

ORDER

(Param Pal Kaur, Member)

                                        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/.

 

cc no. - 153 of 2019

 

2                                     Briefly stated, the case of the complainant is that Jarnail Singh husband of complainant was insured under Bhagat Puran Singh Health Insurance Scheme and he paid Rs.30/-to OPs. He was issued card no.0304 5000 0180 3560 3 valid for the period from 1.11.2016 to 31.05.2019 and as per insurance policy in the event of death of head of family, family is entitled for sum of Rs. 5 lacs. It is further submitted that during the subsistence of policy in question, husband of complainant died in an accident on 24.05.2019 in respect of which, FIR No.35 dated 24.05.2019 was got registered in Police Station Bajakhana, District Faridkot and his post mortem was conducted at Guru Gobind Singh Medical College and Hospital, Faridkot. Thereafter, complainant contacted OPs on their toll free number regarding death of her husband and also furnished all documents required for processing the death claim to Investigator of OPs, but they did not pay even a single penny on account of insurance claim for the death of her husband and repudiated the claim on the ground that accident of her husband does not come under the definition of insurance of Bhagat Puran Singh Sehat Bima Yojna. Complainant

cc no. - 153 of 2019

 

made several requests to OPs to make payment of genuine insurance claim, but all in vain, which amounts to deficiency in service. They 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 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.5,000/-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 1.07.2019, complaint was admitted and notice was ordered to be issued to the opposite parties.

4                             Notice issued to OP-1 through registered cover did not receive back undelivered and was presumed to be served. Despite

 

cc no. - 153 of 2019

repeated calls, no body appeared on behalf of OP-1 either in person or through counsel on date fixed to contest the allegations levelled by complainant. Statutory period expired and therefore, vide order dated 16.12.2019, OP-1 was proceeded against exparte.

5                         On receipt of the notice, OP-2 filed written statement taking preliminary objections that complainant is not their consumer and there is no relationship of consumer or service provider between complainant and answering OP. No cause of action arises against answering OP. Moreover, no information regarding death of Jarnail Singh insured was given to them thereby preventing them to gather first hand information, which is a violation of terms and conditions of the policy in question 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.  No proper particulars of insurance have been produced on record either

 

 

cc no. - 153 of 2019

by complainant or by other OPs. It is averred that answering OP has numerous regional offices, divisional and branch officers and it is not possible for them to locate the insurance particulars without supplying the said documents and therefore insurance of alleged deceased is denied. Even as per law and provisions of scheme, complaint filed by complainant is time barred. It is also averred that complainant did not provide them any document. However, on merits, OP-2 has denied all the allegations of complainant being wrong and incorrect and it is reiterated that there is no deficiency in service on their part and made prayer for dismissal of complaint with costs.

6                             Ld Counsel for OP-3 to OP-5 appeared through counsel, but despita availing several opportunities, they did not file any written statement and therefore, vide order dated 22.01.2021, defence of OP-2 to OP-5 was struck off.

7                         Parties were given proper opportunities to prove their respective case. Ld Counsel for complainant tendered in evidence

cc no. - 153 of 2019

affidavit of complainant as Ex.C-1 and documents Ex C-2 to Ex C-5 and then, closed the evidence.

8                                      In order to rebut the evidence of the complainant, ld counsel for OP-2 tendered in evidence, affidavit of Hem Lata Panwar as Ex OP-2/1 and documents Ex OP-2/2  to Ex OP-2/4and then, closed the same on the part of OP-2.  

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

10                        It is observed that with the intervention of Commission, Ops have made payment of genuine insurance claim of complainant, just after some time of filing the present complaint. Dispute between the parties has been amicably resolved and therefore, request for compensation does not seem appropriate. OP-2 has made payment of Rs.5,00,000/- to complainant Jasvir Kaur. Complainant /Jasvir Kaur has also suffered statement to this effect. Hence, Keeping in view the statement suffered by complainant regarding receipt of

cc no. - 153 of 2019

Rs.5 lacs by her from Ops as insurance claim on account of death of her husband, it is observed that grievance of complainant against Insurance Company has been redressed. Therefore, complaint in hand is hereby disposed of. Copy of the order be supplied to parties free of cost as per law. File be consigned to record room.

Pronounced on

Dated : 27.10.2021

(Vishav Kant Garg)       (Param Pal Kaur)

 Member                         Member