Haryana

Ambala

CC/56/2016

Balbir Kaur - Complainant(s)

Versus

M/s PACL Ltd. - Opp.Party(s)

Jasmer Chand

27 Dec 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AMBALA

 

                                                          Complaint case no.         :  56 of 2016.

                                                          Date of Institution          :  18.01.2016.

                                                          Date of decision             :  27.12.2017

 

          Balbir Kaur widow of Shri Ram s/o Shri Parkash Ram r/o village   Singhawala Tehsil & District Ambala.

……. Complainant.

 

1. M/s PACL Limited through its Manager, 172-C Rai Market, near PWD Rest House, Ambala Cantt.
2. Royal Sundaram Alliance Insurance Company Limited Rider House Plot No.136, Sector 44, Gurgaon, Haryana.

….…. opposite parties.

 

BEFORE:   SH. D.N. ARORA, PRESIDENT

                   SH. PUSHPENDER KUMAR, MEMBER                             

 

Present:       Sh.Jasmer Chand, Advocate for complainant.

                   OP No.1 exparte.

                   Sh.Mohinder Bindal, Advocate for OP No.2.

                  

ORDER

                   In nutshell, brief facts of the present complaint are that the complainant is nominee and one of the legal representatives of late Sh.Shri Ram who died in a roadside accident on 11.09.2013 within the area of police station Mulana, Ambala. Said Shri Ram serving as agent of OP No.1 and as its per policy he was insured for a sum of Rs.5 lac which was got done from OP No.2 through Op No.1. After the death of Shri Ram the complainant stepped into his shoes. It was the sole duty of OP No.1 to submit the claim of the complainant with OP No.2 as per its guidelines. The insurance premium of Rs.500/- was paid by insured and the period of insurance was from 06.12.2012 to midnight of 05.10.2013. The master policy number of the said insurance policy was PAWITAL001, Certificate No.PAWITAL-00026731 membership No.W008000219, under the Group Personal Accident Insurance Policy. At the time of death the policy was in operation.  The complainant had also submitted requisite papers of three other policies with OP No.1 and the payment qua the same has already been paid by the OP No.1 but the amount of Rs.5 lac has not been made despite depositing of requisite documents. The matter qua accidental death of Shri Ram was registered vide FIR No.208 dated 11.09.2013 and the post mortem on the dead body of deceased was conducted on 11.09.2013 at MMIMSR, Mulana. After the death of Shri Ram, papers were submitted to OP No.1 on 20.09.2013 for payment of sum assured by OP No.2. It was the duty of OP No.1 to submit the papers with OP No.2. The complainant received a letter dated 12.09.2014 from OP No.2 wherein it has been mentioned that the papers were submitted after 15 months and due to inordinate delay claim was rejected. The complainant had submitted the papers to OP No.1 in time  and it was to send the same to Op No.2 immediately after receiving the papers.  The OPs are liable to materialize the claim of the insurance policy but it has not been done despite making several requests by her. The act and conduct of the OPs clearly amounts to deficiency in service on their part.  In evidence, the complainant has tendered affidavit Annexure C/A and documents Annexure C2 to Annexure C15 and also examined Sh.Rajender Singh as CW1.

2.                Upon notice, OP No.1 did not appear and therefore, it was proceeded against exparte on 25.07.2016. Op No.2 appeared and filed its reply wherein it has been submitted that M/s Wital See Marketing Ltd. had taken a Group Personal Accidental Insurance Policy covering accidental death & disablement from the OP and said policy was issued subject to terms and conditions and Shri Ram was enrolled under this policy. The answering OP had received the death claim on 08.12.2014 wherein death has been mentioned on 11.09.2013 being road side accident and in the said letter it was intimated that nominee was unaware of the said policy.  As per policy conditions the claim was to be submitted within 30 days of said event but there is 15 months delay in intimating the claim.  The complainant has not submitted that claim directly to answering OP rather it has been routed through OP No.1 where the claim papers were submitted on 20.09.2013.  There is inordinate delay in lodging the claim. There is no deficiency in service on the part of answering OP. Other contentions made in the complaint have been controverted and prayer for dismissal of the claim has been made. In evidence the OP No.2 has tendered affidavit Annexure RX and documents Annexure R1 to Annexure R3.

4.                We have heard learned counsel for the complainant and learned counsel for the OP No.1 and have gone through the case file very carefully.

5.                It is established on the case file that husband of the complainant namely Shri Ram (since deceased) was agent of OP No.1 and was insured for a sum of Rs.5 lac vide master policy number of the said insurance policy was PAWITAL001, Certificate No.PAWITAL-00026731 membership No.W008000219 under the Group Personal Accident Insurance Policy (Annexure C-3) which was got done from OP No.2 through Op No.1. It is also established on the case file that Shri Ram had died in a road side accident and regarding this FIR under Sections 279/304-A IPC was registered at P.S.Mulana (Annexure C-11) and post mortem on his body was conducted vide post mortem report-Annexure C12.  It is also not disputed that Shri Ram had expired during the currency of the policy. 6.                       The sole ground of the Op No.2 is that as per policy conditions the claim was to be submitted within 30 days of said event but there is 15 months delay in intimating the claim. The complainant has not submitted that claim directly to OP No.2 rather it has been routed through OP No.1 where the claim papers were submitted on 20.09.2013 and there is inordinate delay in lodging the claim.

7.                          Perusal of the case file shows that there is nothing on the record to show that as to on which the OP No.2 had received intimation qua death claim. Though the OP No.2 had tendered affidavit of Sh.Aneesh Nair, Sr.Executive Legal and authorized signatory wherein he has reiterated the version of the reply but it is strange that no supportive evidence to authentic the plea made in the reply as well as affidavit Annexure RX has been led. Though the Op No.2 has tendered Annexure R2 i.e. document qua Intimation for death claim of Shri Ram but perusal of this document does not show the date of receiving the claim by the Op No.2 from Op No.1. In this document request for processing the claim has been mentioned. In the repudiation letter it has been mentioned that the Death claims warrants immediate investigation for ensuing that the evidence documents are verified immediately and in this case no chance has been given to investigate the case.  In the present case the police had investigated the matter and the documents such as FIR, Post Mortem report of Shri Ram and Death Certificate of Shri Ram are obtained/prepared during the investigation, therefore, it is not understandable as to which investigations the OP/insurance company were to be made.   It is strange that the OP No.2 in Annexure R2 has mentioned that This is added here that delay in intimation of claim caused due to nominee unaware about this policy but there is nothing on the file to show that as to who had asked/told and stated that the complainant was unaware about the policy in question. Moreover, it is admitted fact that except the policy in question the payment for other policies have been made by the insurance company and the complainant in para No.5 of the complaint has specifically mentioned that the claim for all the policies were submitted but the Op/insurance company has withheld the claim in question.  In para No.7 the complainant has specifically mentioned that the documents for the claim in question were submitted to the OP No.1 on 20.09.2013 alongwith another policy and receipt regarding this was issued by Sh.Rajinder, employee of Op No.1 who appeared in the witness box as CW1 and proved the receipt Annexure C1 regarding receiving of document of accidental claim of deceased Shri Ram on 20.09.2013. It was open for the insurance company to judge the case from every angle before repudiation of the claim but the insurance has failed to adduce any evidence to corroborate the version of alleged inordinate delay which the OP No.2/insurance company has made the basis for repudiating the claim in question. For the sake of arguments, if it is presumed that the claim has been lodged after 15 months even then it also does not affect the merits of the case and does not fatal to the case of complainant despite the fact that the death of Shri Ram insured in an accident is duly proved from the documents FIR and PMR (Annexure C11 and Annexure C12 respectively) and the insurance was for Group Personal Accident Insurance Policy and case of the complainant is covered under the above said scheme.  The insurance company cannot escape from the liability by rejecting the claim purely on technical grounds in a mechanical manner which results in loss of confidence of policy holders in insurance industry, therefore, OP No.2 is liable to indemnify the claim lodged qua death of Shri Ram. Hence, we have no hesitation to hold that the complainant is entitled for the benefit of insurance claim as per schedule. Accordingly, the repudiation letter Annexure C2/R3 is hereby quashed. Hence, the present complaint is allowed against Op No.2 only with costs which is assessed at Rs.10,000/- besides paying the benefits under the policy in question to the complainant to be paid by the Op No.2 to the tune of Rs.5 lac (Rs. Five Lac) alongwith interest @ 9 % per annum from the date of filing of the complaint till realization of the amount. The complaint against Op No.1 is dismissed. The compliance of the order be made within 30 days of receipt of the copy of this order. Copy of the order be sent to the parties concerned, free of costs, as per rules. File after due compliance be consigned to record room.

Announced on: 27.12.2017                                                                                                                                             

    

(PUSHPENDER KUMAR)                                  (D.N.ARORA)

          Member                                                             President                                                                                                District Consumer Disputes                                                                                 Redressal Forum, Ambala.