BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM, JALANDHAR.

Complaint No.340 of 2015

Date of Instt. 13.08.2015

Date of Decision: 13.06.2017

Poonam Kumari widow of Shri Sandeep Kumar, resident of Radha Swami Mohalla, Mukerian, Tehsil Mukerian, District Hoshiarpur, Punjab also at House No.17, Mohalla No.31, Jalandhar Cantt.

..........Complainant Versus

1. M/s National Insurance Company Ltd., Through its Branch Manager, Branch Office Ghaziabad, 65, Navyug Market, Ghaziabad U.P. 201001.

2. M/s National Insurance Company Ltd., Through its Branch Manager, G.T. Road, Jalandhar.

….… Opposite parties

Complaint Under the Consumer Protection Act.

Before: Sh. Karnail Singh, (President)

Sh.Parminder Sharma (Member)

Present: Sh. Gulshan Arora, Adv Counsel for complainant.

Sh. Jaswant Singh, Adv Counsel for OP No.1 and 2.

Order

Karnail Singh (President)

1. The instant complaint filed by complainant, wherein alleged that complainant is the widow of Shri Sandeep Kumar, who had Insurance Policy issued to him vide Certificate of Insurance bearing No.2893752 in his name issued on 21.05.2012 from the OP No.1 which also has its office at Jalandhar. Therefore, the present complaint is being filed at Jalandhar as the OPs have their office at Jalandhar.

2. The husband of the complainant Shri Sandeep Kumar expired on 24.04.2013 in a road side accident. The complainant is the duly constituted nominee, whereby, she is authorized to all the benefits under the above policy. After death of Shri Sandeep Kumar, the complainant approached the OP with the request make payment against Insurance Policy. The complainant also sent representation duly supported with documents but the OP asked the complainant to submit the documents, which the complainant submitted through Jalandhar branch of the company which were further dispatched to OP vide dispatch No.950 dated 02.12.2013 duly received and acknowledged by office of the OP on 04.12.2013. The complainant was again asked to submit the documents, which she again sent, in this manner, the complainant has been repeatedly approaching the OP to disburse the amount of insurance policy as per terms and conditions of the Insurance Policy. All the ordinary means for redressal of the grievances of the complainant have proved abortive, the complainant has been left with no other alternative except to file the present complaint with the prayer that the OPs be directed to pay project value of the certificate to the complainant and further directed to pay compensation/damages for unfair trade practice and deficiency in service to the tune of Rs.1,00,000/- and also award the cost of present complaint.

3. Notice of the complaint was given to the opposite parties and accordingly OP No.1 and 2 filed their joint written reply and contested the complaint by taking preliminary objections that the complaint is time barred in view of the pleadings of the complainant and documents on record. The complainant has not supplied the required documents i.e. Claim Form, Post Mortem Report, FIR/Police Report, Panchnama, Death Certificate, ID Proof (Insured and Nominee), Succession Certificate, Bank Details of the insured and Cancelled Cheque, Payment Voucher duly discharged by the nominee. Despite letters dated 06.05.2013 and 25.06.2013. Thereafter, the OP finally requested the complainant again vide its letter dated 22.07.2013 to supply Claim Form, Post Mortem Report, FIR/Police Report, Panchnama, Death certificate, ID Proof, Succession Certificate, Bank details of the insured and Cancelled Cheque, Payment Voucher duly discharged by the nominee with specific mention in the said letter if the complainant will not comply with the requirements of letter dated 22.07.2013 within 7 days then it shall be presumed that the complainant is not interested in pursuing the claim and the claim file shall be filed as No claim will be closed. But despite various letters and letter dated 22.07.2013, the complainant did not respond as such the claim file of the complainant was closed as 'No Claim'. Thereafter, the complainant filed the present complaint on 13.08.2015 against the answering OPs but since the claim had become time barred under the terms and conditions of the insurance policy and the complainant was informed vide letter dated 22.07.2013 as such the present complaint is not maintainable against the answering OPs. It is further averred that the complainant is barred from her own acts and conducts to file the present complaint against the answering OP as such she cannot take benefits of her own wrongs. Since there is no negligence, deficiency, unfair trade practice, lack of service on the part of the OPs as such the OPs shall not be held liable for making the payment to the claimants as claimed by the complainant and further alleged that this Forum has no jurisdiction to try, entertain and decide the present complaint being time barred without any cause of action and without any negligence on the part of the OPs and has been filed just to extract money and a mere abuse of process of law and wastage of precious time of the Forum and as such this complaint deserves to be dismissed. On merits, the purchase of the insurance policy by Sandeep Kumar is not denied but the remaining allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merit and the same may be dismissed.

4. In order to prove the case of the complainant, complainant herself tendered into evidence duly sworn affidavit Ex.CW1/A alongwith documents Ex.C-1 to Ex.C-9 and closed the evidence.

5. Similarly, counsel for opposite parties tendered into evidence affidavit Ex.OPA alongwith documents Ex.OP-1 to Ex.OP3 and closed the evidence

6. We bestowed our thoughtful consideration to the submissions made by learned counsel for parties and also scanned the file very minutely.

7. After hearing the arguments, we came to conclusion that the factum in regard to purchase an insurance policy by the husband of the complainant namely Sandeep Kumar is established from the Insurance Certificate Ex.C-1 and it is also proved that the complainant Poonam Kumari is nominee of her husband as her name is very well described in the Certificate of Insurance Ex.C1. The Insurance Policy is for sum of Rs.3,20,000/- but the claim of the complainant has not been decided by the OP in either way rather the same was closed being No Claim for want of not producing the documents as demanded by the OP vide letter Ex.OP1 dated 06.05.2013, Ex.OP2 dated 25.06.2013 and Ex.OP3 dated 22.07.2013. In these letters, the complainant has first of all asked for submitting Claim Form but the complainant has already send a request Ex.C-5 to the Manager, National Insurance Company for making a payment of insurance claim. So, it means Ex.C5 is a Claim Form though it is not on a proper form but it can be considered as a Claim Form and furthermore, if there is no Claim Form submitted by the complainant then how and on what basis, the OP has demanded the documents from complainant vide letter Ex.OP1 to Ex.OP3 rather these letters itself show that the complainant has submitted a claim Form and thereafter the OP demanded the documents. Second document demanded by the OPs Post Mortem Report and if the complainant is able to produce on the file photostat copy of the Post Mortem Report on this file which is Ex.C4 then we cannot accept the version of the OP that the complainant has not send the copy of Post Mortem Report and similarly in regard to FIR which is available on the file Ex.C-3 and so for death certificate is concerned, the same is also placed on the file and in order to prove the ID Proof, the complainant has placed on file Ration Card and further complainant alleged that he has sent all the documents alongwith a letter Ex.C5 to the OP and photostat copy of postal receipt is available on the file Ex.C6. Further the OP has asked for production of succession certificate but we think that the succession certificate which is not required in this case because its insurance policy and complainant is the nominee and she herself alleged in the complaint that she is the only Legal Heir and entitled for the insurance policy being a nominee and further we cannot accept the version of the OP that cancelled cheque and payment voucher was not supplied by the complainant because as per version of the complainant, he has supplied all the documents and despite that the OP has failed to decide the insurance claim since from the date of apply i.e. 24.04.2013.

8. No doubt the OP has claimed that they have asked number of times for submitting some documents through letter Ex.OP1, Ex.OP2 and Ex.OP3 but the OP has miserably failed to establish on the file in what manner these letters were conveyed to the complainant whether through registered letter. If so then, where is the postal receipt if handed over by hand then signature of the complainant is required to be taken on the copy. So, with these observation, we are the opinion that the complainant never send these letters to the complainant rather retain in the office just to delaying the matter and since 2013, the insurance claim of the complainant has not decided i.e. till the date of filing complaint 13.08.2015, means kept pending for more than two years, whereas as per IRDA guide lines, the insurance claim is required to be decided within 30 days. So accordingly, we find un-necessary delay on the part of the complainant which is clear cut deficiency in service and we think that if only direction is given to decide the claim within specific period then the matter will again come in the Forum. So, accordingly it should be disposed finally in either way.

9. In view of the above detailed discussion, the complaint of the complainant is partly accepted and OPs are directed to pay the insurance claim to the complainant of deceased Sandeep Kumar with interest @ 9% per annum from the date of apply i.e. 24.04.2013 till realization and further OPs are directed to pay compensation to the complainant for mental harassment to the tune of Rs.10,000/- and litigation expenses of Rs.5000/-. The entire compliance of the order be made within 30 days from the date of receiving copy of order. Complaint could not be decided within stipulated time frame due to rush of work.

10. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

Dated Parminder Sharma Karnail Singh

13.06.2017 Member President