Punjab

StateCommission

FA/100/2014

BHARTI AXA GENERAL INSURANCE COMPANY LIMITED - Complainant(s)

Versus

Mangat Raj & others - Opp.Party(s)

Sanjeev Goyal

04 Feb 2015

ORDER

2^nd Additional Bench

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB

DAKSHIN MARG, SECTOR 37-A, CHANDIGARH

 

First Appeal No. 100 of 2014

                                                           

                                     Date of institution: 3.2.2014  

                             Date of Decision:  4.2.2015

 

1. Bharti Axa General Insurance Company Limited, First Floor, Ferns Icon, Survey No. 28, Doddanakundi village K.R. Puram, Hobli Bangalore-37.
2. Bharti Axa General Insurance Company Limited, The Mall Bathinda, through its Branch Manager, both through their Authorized Signatory / Duly Constituted Attorney Mr. Kamal Budhiraja available at Regional Office at Bharti AXA General Insurance Company Limited, Pearl Plaza, K-24, 3^rd Floor, Plot # A, B, C, D & E, Sector 18, Noida.

…..Appellants/OP Nos. 1 & 2

                                      Versus

1. Mangat Raj aged about 52 years son of Dharam Chand son of Naraina Ram,
2. Parkash Sharma wife of Mangat Raj son of Dharam Chand,

Both residents of Quarter No. A-113, NFL Colony, Bathinda.

…..Respondents/Complainants

3. M/s Regional Polytechnic College, Behman Dewana, District Bathinda, through its Principal.

…Respondent No.3/OP No.3

 

First Appeal against the order dated 28.10.2013 passed by the District Consumer Disputes Redressal Forum, Bathinda.

 

 

Quorum:-

 

              Shri Gurcharan Singh Saran, Presiding Judicial Member

              Shri Jasbir Singh Gill, Member

    Shri Harcharan Singh Guram, Member

 

 

 

Present:-

 

          For the appellants            :         Sh. Sanjeev Goyal, Advocate

          For respondents No.1&2  :         Sh. D.K. Dogra, Advocate for

                                                          Sh. Inderjeet Sharma, Advocate

          For respondent No.3        :         Sh. Vikas Kuthiala, Advocate

 

 

Gurcharan Singh Saran, Presiding Judicial Member

ORDER

The appellants/opposite parties No.1&2(hereinafter referred as “OP Nos.1&2”) have filed the present appeal against the order dated 28.10.2013 passed by the District Consumer Disputes Redressal Forum, Bathinda(hereinafter referred as “the District Forum”) in consumer complaint No. 250      dated 11.6.2013 vide which the complaint filed by respondents No.1&2/complainants(hereinafter referred as ‘the complainants’) was disposed of with the direction to OP Nos. 1 & 2 to lodge a claim with Op Nos. 1 & 2 and to pay the claim of Rs. 2 lac alongwith interest @ 9% p.a. from the date of institution within a period of 15 days from the receipt of the claim form whereas Op No. 3 was directed to pay compensation of Rs. 20,000/-.

2.                The complaint was filed by the complainants under the Consumer Protection Act, 1986 (in short ‘the Act’) against the opposite parties on the allegations that their son Sanjog Kumar was student of Regional Polytechnic College, Behman Diwana OP No. 3 doing Diploma in Civil Engineering having date of birth 4.2.1990. Op No. 3 had got a group insurance for their students from Op Nos. 1 & 2 bearing No. APG/10468699/91/01/D59112, which provides insurance amount of Rs. 2 lacs for each student and Sanjog Kumar was also enrolled as Member of the Group Insurance Scheme and the policy was valid for the period 1.1.2011 to 9.1.2012. The premium of Rs. 88,574.21p was paid by Op No. 3 to OP Nos. 1 & 2 and it was the duty of OP No. 3 to inform OP Nos. 1 & 2 in case of mishap. On 26.10.2011 on the date of Diwali Sanjog Kumar had gone to Market for celebrating Diwali and on coming back to the house, he went to Swimming Pool for bathing, which is situated in NFL Colony, Bathinda and on bath, he died due to drowning. DDR No. 16 dated 27.10.2011 was lodged in P.S. Thermal Plant, Bathinda. Post Mortem was conducted on 27.10.2011 in Civil Hospital, Bathinda. Intimation regarding death of Sanjog Kumar was given to OP No. 3 and they attended even the funeral ceremony and Bhog Ceremony of the deceased. Death certificate and other documents were also submitted to Op No. 3 but Op Nos. 1 & 2 did not pass the claim and were making lame excuses on one pretext or the other. Accordingly, the complaint was filed for a relief as under:-

a)      the complaint be accepted with costs of Rs. 15,000/-

b)      the opposite parties be directed to make the insured sum of Rs. 3 Lac (i.e. Rs. 2 Lac for Sanjog Kumar’s death and Rs. 1 Lac for his earning parents).

c)      the opposite parties be directed to pay interest @ 18% per annum from the date of death i.e. 26.10.2011 upto date of payment.

d)      the opposite parties be directed to pay compensation of Rs. 1 Lac on account of mental tension, harassment and botheration suffered by the complainants.

3.                The complaint was contested by the Ops. Op Nos. 1 & 2 in their written reply took the preliminary objections that the complaint was not maintainable as OP No. 3 did not lodge the claim and as per the terms and conditions of the policy, Op Nos. 1 & 2 were required to be informed and opportunity has been given to OP Nos. 1 & 2 to investigate about the incident. As per policy, 1181 students alongwith parents were insured under the policy and as per terms and conditions the total number of each class, band, students, parents and staff members as on the date of incident giving rise to any claim under the policy should not be more than total number of students, parents and staff members for each class, band on the rolls of the Company on the such date and in case the number increases then that person should be deemed un-covered under the policy; the complaint was false, frivolous, liable to be dismissed under Section 26 of the Act. On merits also, the same pleas were reiterated and ultimately, it was submitted that the complaint was without merit and it be dismissed.

4.                OP No. 3 in its reply took the legal objections that the complaint was not maintainable, which is premature because the complainant never intimated this OP regarding the death of the deceased Sanjog Kumar; the complaint has been filed on the basis of wrong facts; the matter in hand requires elaborate evidence and cross-examination and as such, the matter be decided by Civil Court and that the complaint against this Op was not maintainable. Otherwise, policy issued by Op Nos. 1 & 2 had been admitted. However, it was stated that Op No. 3 was never informed regarding the death of Sanjog Kumar and straightway filed the complaint. Therefore, the complaint was without merit and it be dismissed.

5.                The parties were allowed by the learned District Forum to lead their evidence.

6.                In support of his allegations, the complainant had tendered  into  evidence his affidavit Ex. C-1, policy information Ex. C-2, affidavit of Mangat Raj Ex. C-3, affidavit of Navdeep Kashyap Ex. C-4, DDR Ex. C-5, Post Mortem Report Ex. C-6, letter Ex. C-7, Policy information Ex. C-8. OP Nos. 1 & 2 tendered into evidence affidavit of Kamal Budhiraja Ex. Op-1/1 and Op No. 3 had tendered into evidence affidavit of Gurlabhi Singh Ex. Op-3/1.

7.                After going through the allegations in the complaint, written replies filed by the OPs, evidence and documents brought on the record, it was observed by the learned District Forum that the complainant will lodge the claim directly to Op Nos. 1 & 2 within a period of 15 days and OP Nos. 1 & 2 will pay the genuine claim within a period of 15 days to the complainant to the tune of Rs. 2 lacs alongwith interest as referred above and complaint was also allowed against Op No. 3 as stated above.

8.                In the grounds of appeal filed by Op Nos. 1 & 2, it has been mentioned that it is clearly admitted by the learned District Forum that no claim was lodged by the complainant or OP No. 3 with Op Nos. 1 & 2, therefore, the complaint was premature and the complainant  was  directed to directly lodge his claim with Op Nos. 1 & 2 but no opportunity was granted to OP Nos. 1 & 2 to investigate the matter as per the terms and conditions of the policy and Op Nos. 1 & 2 were directed to pay the amount of Rs. 2 lacs alongwith interest within a period of 15 days, which is against the principle of natural justice. The appellants/OP Nos. 1 & 2 should be given liberty to investigate the case and then to make the payment as per terms and conditions of the policy.

9.                The counsel for the complainants/respondents No. 1 & 2 was not in a position to rebut these arguments. Even otherwise the prudence demands that opportunity should be granted to Op Nos. 1 & 2 to examine the claim of the complainants and then to decide the claim according to the terms and conditions of the policy, therefore, the order so passed by the learned District Forum requires modification.

10.              In view of the above, we accept the appeal filed by OP Nos. 1 & 2. The order passed by the learned District Forum is modified to the extent that on filing of the claim by the complainants directly with Op Nos. 1 & 2, OP Nos. 1 & 2 will investigate the matter within a period of two months from the date of passing of this order according to the terms and conditions of the policy. In case the claim is admissible then the same shall be paid to the complainant by Op Nos. 1 & 2 within a period of 30 days.

11.              The appellants had deposited an amount of Rs. 25,000/- with this Commission at the time of filing the appeal and Rs. 1,75,000/- in compliance with the order dated 10.2.2014. These amounts with interest accrued thereon, if any, be remitted by the registry to appellant No.2 by way of a crossed cheque/demand draft after the expiry of 45 days, subject to stay, if any, by the higher Fora/Court.

12.              The arguments in this appeal were heard on 2.2.2015 and the order was reserved. Now the order be communicated to the parties as per rules.

13.              The appeal could not be decided within the statutory period due to heavy pendency of Court cases.

 

 (Gurcharan Singh Saran)

Presiding Judicial Member

 

                                                                              (Jasbir Singh Gill)

                                                                                                    Member

 

February 4, 2015.                                                   (Harcharan Singh Guram)

as                                                                                                Member