Order by:
Sh.Mohinder Singh Brar, Member.
1. The present complaint was previous filed by the complainant, however vide separate statement dated 10.05.2022 ld. counsel for complainant had withdrawn the complaint with the permission to file fresh on the same cause of action. So, vide order 10.05.2022 complainant was given liberty to file fresh complaint on the same cause of action. Resultantly, the complainant has filed the present complaint.
2. The complainant has filed the instant complaint under section 35 of the Consumer Protection Act, 2019 on the allegations that the son of complainant namely Jasmail/Jasmel Singh was also holding Card which was issued under Bhagat Puran Singh Sehat Sewa Yozna Vide Card bearing No. 9304 2000 2230 3396 5. Jasmail Singh was unmarried and issueless. Angrej Singh father of Jasmail Singh was died before the death of Jasmail Singh and Jasmail Singh left behind his mother now complainant, his sister Jaspreet Kaur who was married with Kuldeep Singh. Moreover, as per law only mother is entitled for the compensation of the death of Jasmail Singh. Further alleges that Jasmail Singh/Jasmel Singh are one and the same person and there is only difference to narrate and spell the words and names and it usually occur in the ordinary course of work and nature. Further alleges that as per the aforesaid Bhagat Puran Singh Sehat Sewa Yozna, in case of the death of the head of the family or in case of the 100% disability of the head of the family a sum of Rs. 5,00,000/- is payable by the Opposite Parties as compensation to the family of the deceased which insured under the scheme. Jasmail Singh/Jasmel Singh was un-married and issueless. He was working as Conductor. Unfortunately on 09.02.2019 Jasmail Singh now deceased son of complainant met with an accident when he was returning to his home on his motorcycle bearing no. PB04C-1182 and he died due to this accident. The DDR/GD/Rapat No.017 was got lodged in this regard with the Police of P.S.Baghapurana and postmortem of Jasmail Singh was conducted at GGS Medical College & Hospital at Faridkot on dated 10.02.2019. Due to the accident, the son of complainant suffered injuries and he first taken to Adesh Hospital, Bhucho Mandi, and after this he was refer to Guru Singh Medical College/Hospital, Faridkot and he died on 10.02.2019 at about 7:00 AM during treatment. The applicant is entitled to Rs. 5,00,000/as insurance claim under Bhagat Puran Singh Sehat Sewa Yozna and complainant applied for the insurance claim regarding the accidental death of her son Jasmail Singh with the Opposite Parties through medical helpline No. 104 in the month of February vide file/registration no.1816 and after investigation, officer of the Opposite Party No. 3 also conducted the investigation regarding the accidental death of Jasmail Singh and collected all the documents from the complainant. Opposite parties even after conducting the investigation and collecting the necessary documents from the complainant and as per their desire, complainant has fulfilled all the requirements of Opposite Parties. But Opposite Parties flatly refused the genuine claim of the complainant on the ground that due to alcohol the claim is not covered under the policy. The non-response of the Opposite Parties and non-payment of the Insurance claim is clear cut deficiency in services on the part of the Opposite Parties. Further alleges that the name of son of complainant i.e. Jasmail Singh/Jasmel Singh was wrongly typed as Jagmail Singh due to inadvertently typographical mistake in the ordinary course of work in the DDR No.017 dated 10.02.2019, P.S Baghapurana. The actual name of the son of complainant is Jasmail Singh/Jasmel Singh which is written/mentioned in the Medical Record, Aadhaar Card, Death Certificate, Bank Account, Form No.25/35 (1) dated 10.02.2019 and also written/mentioned in the statement of Nirbhai Singh and Roshan Singh dated 10.02.2019. Hence, this complaint. Vide instant complaint, the complainant has sought the following reliefs:-
a) Opposite Parties may be directed to pay an amount of Rs.5,00,000/- as sum insured with regard to death of son of complainant alongwith interest @ 12 % p.a. till its realization.
b) To pay an amount of Rs.1,00,000/- as compensation on account of mental tension, agony and harassment suffered by the complainant.
c) To pay an amount of Rs.10,000/- as litigation expenses.
d) And any other relief which the Commission deem fit and proper be granted to the complainant in the interest of justice and equity.
2. Upon service of notice, none has come present on behalf of opposite parties no.1 & 3, hence opposite parties no.1 & 3 were proceeded against exparte.
3. Opposite Party No.2 appeared through counsel and contested the complaint by filing written reply taking preliminary objections therein inter alia that the complaint is not maintainable. The complainant has got no locus standi to file the present complaint. No cause of action arose to the complainant against the answering Opposite Parties. The complainant has not complied with the terms and conditions of the Insurance Policy. The complaint is barred by the law of limitation. There is no deficiency of service on the part of the opposite party. Thus the complaint may kindly be dismissed on this score. This Commission has got no jurisdiction to try the present complaint as voluminous evidence is required to decide the complaint. The complicated questions of law and facts are involved in the present complaint. The complainant has not come to this Commission with clean hands. The complainant has concealed, suppressed and misstated material facts from this Commission. Infact, the true facts are that after receiving the claim regarding the death of Jasmail Singh, the answering Opposite Party immediately appointed Sh. Ravi Mani Advocate/Investigator to investigate the claim. Sh. Ravi Mani Advocate/Investigator submitted its report dated 22.05.2019 and on the basis of his report and Post Mortem Report, the claim was repudiated vide letter dated 07.08.2019 with reason that the cause of death is due to alcohol i.e. deceased was under the influence of alcohol and the same is not covered under the policy. On merits, it is submitted that no application was filed by the complainant or her counsel for withdrawing the compliant on technical defect. No opportunity of being heard was granted to the answering opposite party to oppose that there exist no technical defect and hence no liberty be granted to file the fresh complaint on same cause of action. The time spent should not be excluded while computing the period of limitation of present complaint. It is settled law that "Without any application, the court cannot permit to withdraw the suit with liberty to file a fresh one on same cause of action." Further submitted that the deceased Jasmail Singh was first taken to Adesh Hospital, Bathinda, where the Doctor advised for admission, but the attendant left the hospital against the medical advice and then deceased Jasmail Singh was taken to Guru Gobind Singh Medical College, Faridkot. The answering opposite party immediately appointed the investigator who submitted its report on 22.05.2019 and the claim of the complainant was repudiated vide letter dated 07.08.2019. Remaining facts mentioned in the complaint are denied and a prayer for dismissal of the complaint is made.
4. In order to prove his case, complainant tendered in evidence his affidavit Ex.C1 alongwith copies of documents Ex.C2 to Ex.C11.
5. To rebut the evidence of complainant, Opposite Party No.2 tendered in evidence affidavit of Sh.R.N. Bansal, Senior Divisional Manager, United India Insurance Co. Ltd. Ex.OP2/1 alongwith copies of documents Ex.OP2/2 to Ex.OP2/4.
6. During the course of arguments, ld. counsel for both the parties have mainly reiterated the same facts as narrated in the complaint as well as written reply. The case of the complainant is that the son of complainant namely Jasmail/Jasmel Singh was also holding Card which was issued under Bhagat Puran Singh Sehat Sewa Yozna Vide Card bearing No. 9304 2000 2230 3396 5. Angrej Singh father of Jasmail Singh was died before the death of Jasmail Singh and the said Jasmail Singh left behind his mother now complainant, his sister Jaspreet Kaur who was married with Kuldeep Singh. Moreover, as per law only mother is entitled for the compensation of the death of Jasmail Singh. Further alleges that as per the aforesaid Bhagat Puran Singh Sehat Sewa Yozna, in case of the death of the head of the family or in case of the 100% disability of the head of the family a sum of Rs. 5,00,000/- is payable by the Opposite Parties as compensation to the family of the deceased which insured under the scheme. Unfortunately on 09.02.2019 Jasmail Singh now deceased son of complainant met with an accident when he was returning to his home on his motorcycle bearing no. PB04C-1182 and he died due to this accident. The DDR/GD/Rapat No.017 was got lodged in this regard with the Police of P.S.Baghapurana and postmortem of Jasmail Singh was conducted at GGS Medical College & Hospital at Faridkot on dated 10.02.2019. So, the complainant is entitled to Rs.5,00,000/- as insurance claim under Bhagat Puran Singh Sehat Sewa Yozna and she applied for the insurance claim regarding the accidental death of her son Jasmail Singh with the Opposite Parties vide file/registration no.1816 and after investigation officer of the Opposite Party No.3 also conducted the investigation regarding the accidental death of Jasmail Singh and collected all the documents from the complainant. Opposite parties even after conducting the investigation and collecting the necessary documents from the complainant flatly refused the genuine claim of the complainant. Ld. counsel for the Opposite Party No.3 has repelled the aforesaid contention of ld. counsel for the complainant on the ground that after receiving the claim regarding the death of Jasmail Singh, the Opposite Party no.3 immediately appointed Sh. Ravi Mani Advocate/Investigator to investigate the claim. Sh. Ravi Mani Advocate/Investigator submitted its report dated 22.05.2019 and on the basis of his report and Post Mortem Report, the claim was repudiated vide letter dated 07.08.2019 with reason that the cause of death is due to alcohol i.e. deceased was under the influence of alcohol and the same is not covered under the policy.
7. It is an admitted fact that the son of the complainant (decease life assured) was insured under Bhagat Puran Singh Scheme and was holder of card bearing no. 9304-2000-2230-3396-5. It has also not been denied that in case of accidental death, sum insured of Rs. 5 Lacs is admissible to the card holder/beneficiary under the said card. The deceased life assured/son of the complainant died in an accidental death, it is clear from the FIR on the record Ex.C5 and post mortem report ExC7. This fact has also not been denied by the Opposite Parties, but their objection is that as per investigator report dated 22.05.2019 Ex.OPs2/2 and as per post mortem report Ex.C7 and Ex.OPs2/4 death is due to alcohol, which is not covered under the policy. In this regard Our Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh in Appeal no.221 of 2018 titled Rajia Vs Reliance General Insurance Company Limited has held:-
“Complainant has already placed on the record the copy of the FIR, post mortem report, card issued under Bhagat Puran Singh Sehat Bima Yojna and Aadhar Card, which are necessary documents for settling the claim. They have not denied these documents but their objection is that complainant was not having the Driving Licence. It is not a motor accident claim under which the driving licence of the DLA was required, in fact it is health insurance policy under which the complainant is required to prove only the accidental death, which stands proved on the basis of FIR and post mortem report. Counsel for the Op has referred to policy exclusion clause No. 6, under which the claim is not payable arising or resulting from the insured person committing any breach of law with criminal intent but this clause is not applicable to the facts of the case because he did not die with an intention, it is just a matter of chance that accident took place and he died.”
The facts and circumstances of the instant case are fully attracted to Rajia Vs Reliance General Insurance Company Limited case (Supra).
8. In such a situation the repudiation made by Opposite Parties-Insurance Company regarding genuine claim of the complainant have been made without application of mind. It is usual with the insurance company to show all types of green pasters 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 seems 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.
9. In view of the above discussion, we hold that the Opposite Party No.2-Insurance Company have wrongly and illegally rejected the claim of the complainant.
10. In view of the aforesaid facts and circumstances of the complaint, we partly allow the complaint of the complainant and direct the Opposite Party no.2-Insurance Company to pay an amount of Rs.5,00,000/- (Rupees Five Lacs only) as sum assured with regard to the death of son of the complainant. The compliance of this order be made by the Opposite Parties within 60 days from the date of receipt of copy of this order, failing which the complainant shall be at liberty to get the order enforced through the indulgence of this District Consumer Commission. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room.
Announced in Open Commission.
