DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION FAZILKA.
Complaint No. CC/122/2023
Instituted On : 02.11.2023
Decided On : 27.08.2024
- Bimla Devi aged 34 years wife of late Jaswinder Singh (Mobile no.97803-45770).
- Maninder Singh aged about 8 years minor son of Jaswinder Singh.
- Sharanjeet Kaur aged about 7 years minor daughter of Jaswinder Singh both the minor children thrugh their next friend i.e. mother namely Bimla Devi wife of Jaswinder Singh; all residents of village Tarobari, Tehsil & District Fazilka, Pin 152123.
...Complainants
Versus
- M/s Corporation Bank, Branch Fazilka, Gaushala Road, Property no.594, Fazilka, Tehsil and District Fazilka, Pin 152123, through its Branch Manager.
- Oriental Insurance Company Limited, D No.18-36-M16-147, Balaiah Complex, First Floor, Beside KVB Bank, Near Anna Rao Circle, Tirupati-517507, Andhra Pradesh through its authorized signatory.
...Opposite Parties.
C.C. No.122 of 2023
Complaint under Section 35 of the Consumer Protection Act, 2019.
Quorum: Sh. Vishal Arora, President.
Sh. Raghbir Singh Sukhija, Member.
Smt. Tajinder Kaur, Member.
Present: Ms. Shilpa Wadhera, Counsel for Complainant.
Opposite Party no.1 Exparte.
Sh.Ashwani Dhingra, Counsel for opposite party no.2.
ORDER
(Vishal Arora, President):
Complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against opposite parties for seeking directions to settle the death claim of Jaswinder Singh and pay to the complainants death claim insurance amount of Rs.2,50,000/- alongwith interest @12% per annum besides Rs.2,00,000/- as compensation on account of mental agony & harassment and litigation expenses to the tune of Rs.22,000/-.
C.C. No.122 of 2023
- Briefly stated, the case of complainants is that the husband of complainant no.1 namely Jaswinder Singh S/o Jeet Singh was riding on a motor cycle and coming from village Gagan Ke after meeting his relative and when he reached near Dera Beas Radha Swami, suddenly his motor cycle was hit by a stray animal (cow) on the road and he fell down on the road, received grievous injuries and was taken to Civil Hospital, Fazilka in an ambulance. After giving first aid, the insured was referred to some specialized hospital for better treatment at Ludhiana and while on his way to Ludhiana in an Ambulance, the insured succumbed to injuries caused by stray animal. Rapat no.15 dated 23.07.2018 was entered at Police Station Sadar, Fazilka regarding the said accident. As per post mortem report, death of Jaswinder Singh was due to multiple injuries sustained by him from stray animal and reveals three injuries on the person. As per opinion of the doctor in the Post Mortem Report, the cause of death was due to injuries caused to vital organs i.e. brain. The insured husband of complainant no.1 died due to injuries caused by stray animal and he left behind his wife i.e. complainant no.1 and two minor children i.e. complainants no.2 and 3 who are living at the mercy of relatives and there is no other earning member in the family. And the present complaint has been filed by complainant no.1 as mother and natural guardian of
C.C. No.122 of 2023
complainants no.2 and 3. The insured husband of complainant no.1 was having an insurance policy bearing no.432700/48/2018/142 of opposite party no.2 through opposite party no.1 who were intimated regarding dealth of Jaswinder Singh but they paid no heed to the claim of complainants after receipt of required documents and lingered the claim on one pretext or the other. Legal notice was also issued but to no effect. Pleading deficiency in service and unfair trade practice on the part of opposite parties, the complainant has prayed for acceptance of the present complaint.
3. The Counsel for complainant was heard with regard to admission of the complaint and vide order dated 9.11.2023, complaint was admitted and notice was ordered to be issued to the opposite parties.
4. As per office report, notice issued to opposite party no.1, but despite service, nobody appeared on behalf of opposite party no.1 either in person or through counsel. Therefore, opposite party no.1 was proceeded against Ex-parte vide order dated 08.02.2024.
Upon notice, opposite party no.2 has appeared and filed written reply to the complaint raising certain preliminary objections interalia
C.C. No.122 of 2023
to the effect that the present complaint in the present form is not maintainable, the complainant has not come to the Commission with clean hands and concealed material and relevant facts from this Commission and the present complaint is barred by limitation. After receiving the claim of complainant, it was found that certain documents are required to be submitted for settling the claim but the same have not been supplied and opposite party no.2 vide letter dated 28.06.2019 demanded the following documents from opposite party no.1:-
1.The translated copy of the documents submitted does not convey any sense.
2. Police final report not submitted.
3. Driving license of the deceased not submitted as he is the “Tortfeasor”.
4. Post Mortem Report says injury to vital organ brain. It is silent about
R.T.A (Road Traffic Accident).
But no documents were supplied and finally the claim was closed for not providing the documents and intimation to this effect was sent to opposite party no.1 vide letter dated 15.07.2019. On merits, the preliminary objections have been reiterated and the other allegations of the complaint have been denied with a prayer for dismissal of the present complaint.
C.C. No.122 of 2023
5. The complainants along with the present complaint have placed on record Affidavit of complainant no.1 Bimla Devi Ex.C-1, Copies of, D.D.R. 15 dated 23.07.2018 Ex.C-2, Translated copy of D.D.R Ex.C-3, Order dated 12.04.2019 of S.D.M, Fazilka Ex.C-4, Death Certificate Ex.C-5, Post Mortem Report Ex.C-6, Policy schedule Ex.C-7, Letter dated 28.06.2019 Ex.C-8, Legal Notice Ex.C-9, Reply to legal notice Ex.C-10 and Postal receipt Ex.C-11. Per contra, counsel for opposite party no. 2 closed evidence after tendering Affidavit of Sh.Devinder Garg, Manager of Insurance company Ex.OP-2/1 and copy of letter dated 28.06.2019 Ex.OP-2/2.
6. We have heard the learned counsel for the parties and have also carefully gone through the record. The learned counsel for complainant and opposite party no.2 have argued on the same lines as per their respective pleadings.
7. The issuance of Insurance policy covering the accidental death GPA claim of Jaswinder Singh, deceased husband and father of complainants is not disputed by the insurance company. Counsel for the opposite party no.2 during the course of arguments only pressed upon the requirement of documents mentioned at Sr. no.1 to 4 of the letter Ex.O.P-2/2
C.C. No.122 of 2023
but failed to give any justification for demand of said documents. Perusal of the file reveals that documents mentioned at Sr. no.1 to 4 of the said letter have been wrongly demanded by the opposite party no.2 as detailed below which amounts to deficiency in service.
Plea of opposite party no.2 regarding translated copies of the documents submitted not conveying any sense and demand of the same is not reasonable and justified as complainant has duly placed on record copy of D.D.R No.15 dated 23.07.2018 in Punjabi Ex.C-2 along with its translated copy in English Ex.C-3 which fully conveys complete sense regarding the death of insured husband of complainant no.1 and father of complainants no.2 and 3 due to coming of stray animal on the road when he was traveling on his motorcycle on the road in front of Dera Beas Radha Swami on 22.07.2018 at about 09:30 PM as detailed above. It is further clear from the said documents that the accident was co-incidental in which no one was at fault.
As regard non submission of police final report demanded by insurance company, file regarding co-incidental death of deceased Jaswinder Singh S/o Jeet Singh, Resident of Village Tarobari under section 174 Cr.p.c. with respect to D.D.R No.15 dated 23.07.2018 was submitted
C.C. No.122 of 2023
before the court of S.D.M, Fazilka, who vide order dated 12.04.2019 issued final order under section 174 Cr.p.c on the basis of Police Report and statements of legal heirs of the deceased and the same has also been produced on record by complainants as Ex.C-4.
The plea of insurance company that post mortem report only says injury to vital organ brain but is silent about RTA (Road Traffic Accident) does not carry any weight as accident of insured occurred on 22.07.2018 at about 09:30 PM and as per information dated 22.07.2018 given by Navdeep of Civil Hospital, Fazilka to S.H.O Sadar, Fazilka at 10:18 PM duly certified and stamped by doctor of Civil Hospital, Fazilka, it is amply clear that said Navdeep of Civil Hospital, Fazilka had received the dead body of male patient Jaswinder Singh S/o Jeet Singh Resident of village Tarobari aged 25 years with history of road side accident (R.S.A) with some animal which was brought by 108 Ambulance. So, factum of road traffic accident/road side accident is duly mentioned and proved from the information letter dated 22.07.2018 as well as D.D.R No.15 dated 23.07.2018.
The demand of driving license of deceased/insured covered under group personal accidental insurance terming him as
C.C. No.122 of 2023
“Tortfeasor” is totally unjustified as Tortfeasor is a person who commits a wrongful act that causes another individual or business to suffer personal or financial loss but the deceased/insured cannot be termed as “Tortfeasor” as he has neither done any wrongful act or broken any rule nor is guilty of any negligence that attributed to the Commission of accident on road. Rather, the deceased/insured was not at fault and his death occurred co-incidentally due to coming of stray animal on the road when he was traveling on his motor cycle on the road in front of Dera Beas Radha Swami on 22.07.2018 at about 09:30 PM which is clearly apparent from D.D.R No.15 dated 23.07.2018 and order dated 12.04.2019 of S.D.M, Fazilka Ex.C-2 and Ex.C-4. Therefore, demand of driving license of deceased terming him as “Tortfeasor” is not at all justifiable and necessary for settling the claim of the complainants. Unfortunately, because of lukewarm and obstructive attitude of insurance company, genuine claim of widow and orphan children cannot be defeated for no fault of theirs and insurance company cannot insist on submission of driving license of deceased as the same is beyond the control of widow of deceased. The insurance company cannot hike its profit by rejecting genuine and honest insurance claims.
C.C. No.122 of 2023
Counsel for the complainant has placed reliance upon judgment of Hon’ble Supreme Court of India, reported in 2022 Live La (SC) 506 wherein it was held by the Hon’ble Supreme Court of India as under: -
“Insurance- Insurance Companies refusing claim on flimsy grounds and/or technical grounds–While settling the claims, the insurance company should not be too technical and ask for the documents, which the insured is not in a position to produce due to circumstances beyond his control. (Para 4.1)”.
As regard limitation in filing the present complaint, the complainants had earlier filed complaint bearing CC No.150/2020 transferred to this commission at Fazilka and registered as RBT/CC/15/2023 which was dismissed as withdrawn vide order dated 03.10.2023 with liberty to file fresh complaint on the same cause of action and the period spent in pursuing the remedy in the previous complaint was ordered to be excluded for the purpose of limitation. So, the present complaint is within limitation.
C.C. No.122 of 2023
8. From the aforesaid discussion, it transpires that the genuine claim of the complainant has been wrongly repudiated by the opposite party no.2. It is usual with the insurance companies to show green pastures to the consumers when they are to sell their policies. But however when it comes to the payment for claim, they invent all sort of excuses to deny the claim. Reliance in this connection can be placed on the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) which 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.
9. Therefore, closing the claim of complainant in such an event is not justified at all. Accordingly, the complainant is held entitled for a claim of Rs.2,50,000/- along with suitable interest and compensation.
C.C. No.122 of 2023
10. As regards interest, reliance can be placed on law laid down by Hon'ble National Commission in case titled as M/s. New Mark Knitwears Vs. Universal Sompo General Insurance Company Ltd. and others, Consumer Case No.2990 of 2017 decided on 25.04.2023.
11. In view of what has been discussed above, the present complaint is allowed against opposite party no.2 insurance company with Rs.15,000/- as consolidated compensation for deficiency in service, harassment, mental tension & agony suffered by the complainant and Rs.5000/- as litigation expenses. The opposite party no.2 is also directed to pay to the complainants a sum of Rs.2,50,000/-(Two Lakhs Fifty Thousand only) with interest @ 9% per annum from the date of death of insured i.e. 22.07.2018 till actual realization within a period of forty five days from the date of receipt of copy of this order. If the payment is not made within the stipulated period, opposite party no.2 shall be liable to pay the awarded amount with interest @ 12% per annum. The amount of award along with compensation and interest is to be shared by three complainants in equal share i.e. 1/3rd share each. Amount of share of minor claimants no.2 and 3 will be deposited by the insurance company in a Nationalized Bank in their names, in
C.C. No.122 of 2023
fixed deposit and same will be payable to them on attaining majority. However, interest accruing thereon will be payable to complainant no.1, mother/natural guardian of minors, for the purpose of their upbringing and education. The present complaint qua opposite party no.1 stands dismissed. Copy of order be issued to the parties free of costs. File be indexed and consigned to the record room.
ANNOUNCED IN THE OPEN COMMISSION:
27th Day of August, 2024
(Vishal Arora)
President
(Raghbir Singh Sukhija)
Member
(Tajinder Kaur )
Member
