| Final Order / Judgement | DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BATHINDA C.C.No. 269 of 3-10-2019 Decided on :05-07-2023 Rajbhupinder Singh, aged 27 years, son of Jagsir Singh resident of village &PO Nahian wala, Tehsil and District Bathinda. ........Complainant Versus M/s SBI General Insurance Co. Ltd, Natraj, 301, Junction of Express Highway & Andheri, Kurla Road, Andheri (East) Mumbai-400 069 through its Managing Director/General Manager. M/s SBI General Insurance Co. Ltd„ 3rd & Fourth, Lotus IT Park, Road N.16, Plot No.B-18,19, Wagle Industrial Estate, Thane (W). Thane-400604 (M.R) through its Managing Director. .......Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986 QUORUM Sh. Lalit Mohan Dogra, President Sh. Shivdev Singh, Member Present : For the complainant : Sh. S.K Sharma, Advocate. For opposite parties : Sh. Vinod Garg, Advocate. ORDER Lalit Mohan Dogra, President The complainant Rajbhupinder Singh (here-in-after referred to as complainant) has filed this complaint U/s 12 of Consumer Protection Act, 1986, ( Now C.P. Act, 2019 here-in after referred to as 'Act') before this forum (Now Commission) against M/s SBI General Insurance Co. Ltd & another (here-in-after referred to as opposite parties). Briefly stated, the case of the complainant is that his father Jagsir Singh was insured with the opposite parties vide Policy No.175062-0000-00, Policy Type SBI-PA and the policy period was w.e.f. 9-5-2018 to 18.5.2019 (both days inclusive). The complainant is a nominee and therefore, is entitled to the insured amount. The other heirs of deceased Jagsir Singh are his wife-Kuivir kaur, Gurpreet kaur-unmarried daughter. It is alleged that Jagsir Singh-insured met with accident as his foot slipped suddenty while driving the tractor on 23.2.2019. He was taken to Sukhmani Nursing Home, Goniana Mandi and the doctor declared the insured as dead and discharge summary was prepared on 24.2.2019. M.C.Goniana Mandi was informed who issued death certificate. The complainant preferred claim vide No.669943 but the opposite parties repudiated the same on 31.7.2019 without assigning a cogent reason and on flimsy ground and has not disclosed as to which other documents were required. Due to said act of the opposite parties, the complainant has suffered mental tension, agony and frustration for which he claims compensation to the tune of Rs. 50,000/-. On this backdrop of facts, the complainant has prayed for directions to the opposite parties to make payment of insured amount of Rs.5,00,000/- with 18% p.a. interest from 24.2.2019 till payment and Rs.50,000/- and Rs.11,000/- as litigation expenses. Upon notice, opposite parties appeared through counsel and contested the complaint by filing written reply raising legal objections that the intricate questions of law and facts are involved in the present complaint which require voluminous documents and evidence for determination which is not possible in the summary procedure under the Act and appropriate remedy, if any, lies only in the Civil Court. The complainant has concealed material facts and documents from this Commission as well as the opposite parties. It has been pleaded that the complainant has concealed the fact that claim was lodged by complainant without submitting all the necessary documents which are required in order to establish an accidental death. The admissibility of claim is subject to fulfillment of conditions and submission of necessary documents with insurance company including FIR, PMR, death certificate, diagnostic reports etc. in order to establish that it was an accidental death. A certificate from Sukhmani Nursing Home was submitted confirming that insured was brought to the hospital without any visible injuries. The complainant has failed to submit the necessary documents along with claim to prove that cause of death was accidental. Even the complainant has also not disclosed the proper cause of death of insured of Jagsir Singh and also did not submit any document with replying opposite parties to prove the cause of death. The complainant has concealed the fact that proper reason has been mentioned in repudiation letter dated 31.07. 2019 regarding the said repudiation of claim. The claim of the complainant has rightly been repudiated by the opposite parties due to non-submission of required documents which are necessary to establish an accidental death. Earlier, the opposite parties sent various letters dated 16.3.2019 , 30.3.2019 , 31.3.2019 & 07.06.2019 to complainant to submit necessary documents required for decision of claim but to no effect. The opposite parties also got the matter investigated from M/s Detective Centre (India), Jalandhar who investigated the matter and submitted report dated 16.06.2019. Further legal objections are that there is no cause of action or locus standi against the opposite parties. The complainant is not consumer of the opposite parties qua the alleged cause of action. The complainant has not joined all the legal heirs of deceased Jagsir Singh hence the complaint is bad for non joinder of necessary parties. On merits, opposite parties have denied that they repudiated the claim without assigning a cogent reason or on flimsy ground or has not disclosed as to which other documents were required. Rather the opposite parties have rightly repudiated the claim of the complainant vide repudiation letter dated 31/07/2019 mentioning the reason that: "There is lack of documentary evidence like police reports or post mortem examination reports or diagnostic reports, which could prove the claimed cause of death. We have received on record certificate from Sukhmani nursing home confirming that insured was brought to hospital without any visible injuries. Death of insured due to accidental injuries could not be established from available documents." In further reply, the opposite parties have reiterated their version as pleaded in legal objections and detailed. In the end, the opposite parties prayed for dismissal of complaint. In support of his complaint, the complainant has tendered into evidence his affidavit dated 24.9.2019 (Ex. C-1) and documents (Ex.C-2 & Ex.C-3). In order to rebut the evidence of complainant, the opposite parties have tendered into evidence affidavit of Jatendra Dhabhai dated 29.11.2019 (Ex. OP-1/8) and documents (Ex.OP-1/1 to 1/7 & Ex.OP-1/9). The learned counsel for the complainant has argued that father of the complainant Jagsir Singh was insured with the opposite parties vide policy of Insurance w.e.f. 9-5-2018 to 18-5-2018 and complainant is nominee under the said insurance. It is further argued that Jagsir Singh, met with an accident on 23-2-2019 after having a sudden fall from tractor and was taken to Sukhmani Nursing Home, Goniana Mandi where he was declared brought dead by doctor as per discharge summary dated 24-2-2019. It is also argued that on claim being lodged, the opposite parties repudiated the claim of the complainant on 31-7-2019 without any reasonable cause which amounts to deficiency in service. The learned counsel for the complainant has also referred judgement of Hon'ble State Commission, Punjab, Chandigarh, in First Appeal No. 323 of 2017 decided on 9-8-2017 titled as National Insurance Co. Ltd., Vs. Jaswinder Kaur – wherein Hon'ble State Commission had relied upon the orders of Hon'ble National Commission in case TPD Gram Sewa Shahakari Samiti Ltd., Vs. Charnjit Kaur reported in 2011 (4) CPJ 390 and it was held that post mortem and police reports are not obligatory components before releasing insurance claim by insurance Company. On the other hand, learned counsel for the opposite parties has argued that complainant had lodged claim without submitting necessary documens to prove accidental death i.e. copy of FIR, copy of post mortem report, death certificate and diagnostic reports etc., to prove accidental death. It is further argued that even Sukhmani Nursing Home, has also confirmed that insured was brought to the hospital without any visible injuries. As such, by relying upon the terms and conditions of the policy of Insurance as detailed in Ex. OP-1/1, the claim was rightly repudiated by the opposite parties vide lette dated Ex. OP-1/2. In support of his submissions, learned counsel for the opposite parties has also relied upon judgements reported in 2019 AIR (Supreme Court) 2088; 2021(2) RCR (Civil) 618 (Supreme Court) ; 2019 (2) RCR (Civil) 18 (Punjab & Haryana High Court); 1995(1) ACJ 585 (Punjab & Haryana High Court). We have heard learned counsel for the parties and gone through the record and case law cited by learned counsel for the parties. It is admitted fact that father of the complainant had taken accidental cover to the tune of Rs. 5,00,000/-. The only question before this Commission is whether death of Jagsir Singh, Insured which took place on 23-2-2019 was accidental death or not. To prove his case, the complainant has placed on file his affidavit Ex. C-1, discharge summary of Sukhmani Nursing Home, Ex. C-2 and repudiation letter Ex. C-3. The contention of the learned counsel for the opposite parties is that the complainant has not placed on record or produced any diagnosic report, post mortem report or any police proceedings to prove this fact that Jagsir Singh died due to accident. However, we have gone through the record i.e. discharge summary as per which Jagsir Singh was brought to Sukhmani Nursing Home and it has been mentioned that he suffered head injury and was given pumping heart (chest), but he could not revive and was declared dead. We have also gone through report of Investigator Ex. OP-1/7 and documents attached with it. There is statement of Rajbhupinder Singh, Kulvir Kaur and Paramjit Singh recorded by Investigator and we find that all the documents have mentioned similar manner, date and time regarding occurence in which Jagsir Singh received injury and died. Even Sarpanch of village has given certificate in this respect. The Investigator of the opposite parties has given/obtained death certificate which is supported with extract of diary of Chowkidar whereby it is recorded that Jagsir Singh died due to fall from tractor. We have also gone through Daily Case Register of the Sukhmani Nursing Home, which shows that Jagsir Singh was promptly brought to the said hospital. The only reason for denial of claim by the opposite parties is that the doctor has certified that there was no external head injury and fact regarding head injury was written by doctor on being disclosed by relatives. However, this Commission is of the view that all the documents placed on record prove that sequence of events shows that Jagsir Singh died after receiving accidental injury due to fall from tractor and it is general practice especially in the villages that when the accidental death took place in the village, without any involvement of third person or event, such matters are not reported to the police and even procedure of post mortem is also not undergone. Therefore, it is duly proved on record through certificate of doctor that Jagsir Singh was brought to the hospital. It is not necessary that in all cases of head injury, the injured must have suffered external injury rather the injury can be internal. The opposite parties cannot deny rightful claim of the complainant only by taking excuse that accidental death is not proved as complainant has not produced copy of FIR/DDR/Post Mortem Report/Diagnostic Report. This Commission is of the view that copy of FIR/DDR/Post Mortem Report/Diagnostic Reports are not necessary to prove accidental death when there are other necessary records to prove said fact in the shape of register of Chowkidar, discharge summary of the hopsital, Certificate of Sarpach. Accordingly, this Commission is of the view that denial of claim by the opposite parties on frivolous grounds amounts to deficiency in service. As such, by relying upon the judgement of Hon'ble State Commission, Punjab, Chandigarh, in the case National Insurance Company Ltd., Vs. Jaswinder Singh, as fully detailed above, we hold that denial of claim for want of post mortem report, FIR and diagnostic reports, amounts to deficiency in service on the part of the opposite parties. However, so far as quantum of compensation to be paid to the complainant is concerned, the complainant has made prayer for claiming payment of Rs. 5,00,000/- as sum assured. As such, in the interest of justice, the complainant is held entitled to Rs.5,00,000/- which is amount as per prayer clause. Accordingly, present complaint is partly allowed and opposite parties are directed to pay an amount of Rs.5,00,000/- to complainant being nominee as per policy, alongwith interest @9% p.a. from the date of filing of complaint till realization. The complainant is also held entitled to Rs.5,000/- as compensation for mental tenion, agony and harassment and cost of litigation. The compliance of this order be made by the opposite parties jointly and severally within 45 days from the date of receipt of copy of this order. The complaint could not be decided within the statutory period due to heavy pendency of cases. Copy of order be sent to the parties concerned free of cost and file be consigned to the record room. Announced:- 05-07-2023 - (Lalit Mohan Dogra)
President (Shivdev Singh) Member
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