DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BARNALA, PUNJAB.
Complaint Case No: CC/107/2023
Date of Institution: 24.08.2023
Date of Decision: 13.11.2024
Harwinder Singh son of Dalwara Singh resident of Village Raisar, Tehsil & District Barnala, Punjab.
…Complainant
Versus
1. M/s Star Health & Allied Insurance Co. Ltd., 2nd Floor, Above Delhi Tractor and Combines, Opp. PNB Bank, College Road, Barnala through its Branch Manager.
2. M/s Star Health & Allied Insurance Co. Ltd., Regd. & Corporate Office No. 1, New Tank Street, Valluvar Kottam High Road, Nungambakkam, Chennai 600034 through its Chairman Cum Managing Director.
…Opposite Parties
Complaint Under Section 35 of the Consumer Protection Act, 2019.
Present: Sh. Varinder Kumar Goyal Adv counsel for complainant.
Sh. Rohit Jain Adv counsel for opposite parties.
Quorum.-
1. Sh. Ashish Kumar Grover: President
2. Smt. Urmila Kumari: Member
3. Sh. Navdeep Kumar Garg: Member
(ORDER BY ASHISH KUMAR GROVER PRESIDENT):
The complainant has filed the present complaint under Section 35 of the Consumer Protection Act 2019 against M/s Star Health & Allied Insurance Co. Ltd., 2nd Floor, Above Delhi Tractor and Combines, Opp. PNB Bank, College Road, Barnala through its Branch Manager & others (in short the opposite parties).
2. The facts leading to the present complaint are that father of the complainant named Dalwara Singh son of Sher Singh resident of Raisar, Distt. Barnala purchased one insurance policy named Accident Care Individual Insurance Policy for the period from 05.12.2022 to 04.12.2025 from the opposite parties vide Policy No.P/211229/02/2023/000290 for sum insured Rs. 25,00,000/- and paid the premium and nominated his son named Harwinder Singh, the complainant, in the said policy. It is further alleged that on 08.03.2023 father of the complainant while working in the fields was suddenly electrocuted and the complainant was informed about this by Mr. Shamber Singh and the complainant immediately reached the spot and took his father to Civil Hospital, Barnala in an ambulance. It is alleged that the doctors at Civil Hospital Barnala thoroughly checked father of the complainant and declared him dead due to electrocution. It is further alleged that the complainant lodged a DDR No. 016 at the police station Mehal Kalan under section 174 CRPC and Dr. Amoldeep Kaur of Civil Hospital Barnala conducted the post mortem of deceased Dalwara Singh and gave their opinion regarding cause of death "The cause of death in this case is electric shock which is sufficient to cause death in ordinary course of nature". It is alleged that the said accident caused death of the insured person within Twelve Calendar months from the date of accident. It is further alleged that on the direction of opposite parties the complainant submitted claim form, original insurance policy and other required documents for the settlement of said claim on dated 13.03.2023. It is further alleged that in case of unnatural/accidental death the complainant is entitled to get insured amount of Rs. 25,00,000/-. Thereafter, the complainant approached the opposite parties many a times for the settlement of the claim but the opposite parties avoided the complainant on one pretext or the other and ultimately 10.07.2023 flatly refused to settle the claim. As such, the act and conduct of the opposite parties comes within the definition of the unfair trade practice as well as deficiency in service. Hence, the present complaint is filed for seeking the following reliefs.-
- The opposite parties may be directed to pay a sum of Rs. 25,00,000/- alongwith interest @ 18% per annum from the date of death i.e. 8.3.2023 till realization.
- Any other relief which the Commission deems fit.
3. Upon notice of this complaint, the opposite parties appeared and filed written version by taking preliminary objections on the grounds that the complainant has no locus-standi to file the present complaint. The present complaint is not legally maintainable. The complainant has no cause of action to file the present complaint. The complainant has not come with clean hands etc.
4. On merits, it is admitted to the extent that the father of the complainant named Dalwara Singh son of Sher Singh resident of Village Raisar, Distt. Barnala purchased one insurance policy named Accident Care Individual Insurance policy for the period from 05.12.2022 to 04.12.2025 from the opposite parties vide policy No. P/211229/02/2023/000290 for the sum insured Rs. 25,00,000/- and paid the premium and nominated his son named Harwinder Singh, the complainant, in the said policy. It is further alleged that as per documents submitted on 08.03.2023 father of the complainant while working in the fields was suddenly electrocuted and the complainant was informed about this by Mr. Shamber Singh and the complainant immediately reached the spot and took his father to civil hospital, Barnala in an ambulance and the doctors at Civil Hospital Barnala thoroughly checked the father of the complainant and declared him dead due to electrocution. It is further alleged that after this the complainant lodged a DDR No. 016 at the police station Mehal Kalan under section 174 CRPC and Dr. Amoldeep Kaur of Civil Hospital Barnala conducted the post mortem of deceased Dalwara Singh and gave their opinion regarding cause of death "The cause of death in this case is electronic shock which is sufficient to cause death in ordinary course of nature”. It is further admitted to the extent that the complainant submitted claim form, and other required documents for the settlement of said claim and in case of unnatural/accidental death the complainant is entitled to get insured amount of Rs. 25,00,000/-. It is denied that claim form was submitted on 13.3.2023, rather the intimation regarding accident was given on 1.4.2023 and claim was submitted on 11.4.2023. It is further alleged that the complainant intimated on 1.04.2023 and submitted the claim form on 11.04.2023 alleging that on 08.03.2023 after about 3 o' clock his father S. Dalwara Singh went to the fields after eating bread from home, after that around 4:30 to 05:00 in the evening, Samber Singh (9417635864), neighbour of his farm, called and told him (the complainant) that his father Dalwara Singh was lying in a state of unconsciousness in the farm's kotha (room) and at that time the complainant was in another farm and went there after the phone call, after that the complaint arrange an ambulance and took his father Dalwara Singh to the Government Hospital Barnala, where the doctor checked up his father and declared him dead and on next day after conducting the post mortem, his funeral was done in the Village. It is further alleged that the cause of death in this case is electric shock which is sufficient to cause death in ordinary course of nature and the opposite parties have raised query vide letter dated 29.08.2023 to the insured/complainant and repudiation of the claim is conveyed to insured/complainant vide letter dated 13.09.2023 for non submission of Magistrate Order/ Final Report to process this claim. It is further alleged that claim is payable as per terms and conditions of the policy which were supplied to the insured along with policy. It is further alleged that the complainant never visited the opposite parties with necessary documents and information. It is further alleged that despite several reminders the complainant has failed to submit the police final report to the opposite parties. It is further alleged that the complainant may be directed to submit the documents sought by the opposite parties which will enable the opposite parties to process the claim as per policy terms and conditions. All other allegations are denied and prayed for the dismissal of complaint.
5. Ld. Counsel for the complainant on 4.12.2023 has suffered the statement that I do not want to file any rejoinder.
6. The complainant tendered into evidence affidavit of Harwinder Singh as Ex.C-1, copy of policy as Ex.C-2 (containing 9 pages), copy of post mortem report as Ex.C-3 (containing 6 pages), copy of death certificate as Ex.C-4, copy of DDR as Ex.C-5, copy of Adhaar Card of Dalwara Singh as Ex.C-6, copy of Adhaar Card of Harwinder Singh as Ex.C-7, copy of Repudiation letter dated 29.09.2023 as Ex.C-8, copy of statement of Account as Ex.C-9 and closed the evidence.
7. The opposite parties tendered into evidence affidavit of Sumit Kumar Sharma as Ex.OPs-1, copy of proposal form as Ex.OPs-2 (containing 4 pages), copy of policy as Ex.OPs-3 (containing 5 pages), copy of terms and conditions are Ex.OPs-4 (containing 8 pages), copy of claim form as Ex.OPs-5 (containing 4 pages), copy of death certificate as Ex.OPs-6, copy of General Diary as Ex.OPs-7, copy of PMR as Ex.OPs-8 (containing 6 pages), copies of letters are Ex.OPs-9 to OPs-12, copy of repudiation letter as Ex.OPs-13 (containing 3 pages), and closed the evidence.
8. We have heard the learned counsel for the parties and have gone through the record on the file.
9. It is admitted case of the opposite parties No. 1 & 2 that the father of the complainant named Dalwara Singh son of Sher Singh resident of Village Raisar, Distt. Barnala purchased one insurance policy named Accident Care Individual Insurance policy for the period from 05.12.2022 to 04.12.2025 from the opposite parties vide policy No. P/211229/02/2023/000290 for the sum insured Rs. 25,00,000/- and paid the premium and nominated his son named Harwinder Singh, the complainant, in the said policy (as per Ex.C-2 & Ex.O.Ps-2). It is further admitted case of the opposite parties that the complainant submitted claim form and other required documents for the settlement of said claim and in case of unnatural/accidental death the complainant is entitled to get insured amount of Rs. 25,00,000/-.
10. Ld. Counsel for the complainant argued that on 08.03.2023 father of the complainant while working in the fields was suddenly electrocuted and the complainant was informed about this by Mr. Shamber Singh and the complainant immediately reached the spot and took his father to Civil Hospital, Barnala in an ambulance. It is further argued that the doctors at Civil Hospital Barnala thoroughly checked father of the complainant and declared him dead due to electrocution. It is further argued that the complainant lodged a DDR No. 016 dated 9.3.2023 Ex.C-5 at the Police Station Mehal Kalan under section 174 CRPC and Dr. Amoldeep Kaur of Civil Hospital Barnala conducted the post mortem i.e. Ex.C-3 of deceased Dalwara Singh and gave their opinion regarding cause of death "The cause of death in this case is electric shock which is sufficient to cause death in ordinary course of nature". It is further argued that on the direction of opposite parties the complainant submitted claim form, original insurance policy and other required documents for the settlement of said claim on dated 13.03.2023. It is further argued that in case of unnatural/accidental death the complainant is entitled to get insured amount of Rs. 25,00,000/-, thereafter the complainant approached the opposite parties many a times for the settlement of the claim but the opposite parties avoided the complainant on one pretext or the other and ultimately 10.07.2023 flatly refused to settle the claim.
11. On the other hand, Ld. Counsel for the opposite parties argued that the complainant intimated on 1.04.2023 and submitted the claim form on 11.04.2023 alleging that on 08.03.2023 after about 3 o' clock his father S. Dalwara Singh went to the fields after eating bread from home, after that around 4:30 to 05:00 in the evening, Samber Singh (9417635864), neighbour of his farm, called and told him (the complainant) that his father Dalwara Singh was lying in a state of unconsciousness in the farm's kotha (room) and at that time the complainant was in another farm and went there after the phone call, after that the complaint arrange an ambulance and took his father Dalwara Singh to the Government Hospital Barnala, where the doctor checked up his father and declared him dead and on next day after conducting the post mortem, his funeral was done in the Village. It is further argued that the cause of death in this case is electric shock which is sufficient to cause death in ordinary course of nature and the opposite parties have raised query vide letter dated 29.08.2023 to the insured/complainant and repudiation of the claim is conveyed to insured/complainant vide letter dated 13.09.2023 for non submission of Magistrate Order/ Final Report to process this claim. It is further argued that claim is payable as per terms and conditions of the policy which were supplied to the insured along with policy. It is further argued that the complainant never visited the opposite parties with necessary documents and information. It is further argued that despite several reminders the complainant has failed to submit the police final report to the opposite parties, as such the claim of the complainant repudiated vide letter dated 29.9.2023 Ex.O.Ps-13.
12. We have gone through the facts and evidence produced by the parties. We have perused the repudiation letter dated 29.9.2023 Ex.O.Ps-13 vide which the opposite parties have repudiated the claim of the complainant. It is mentioned in the repudiation letter that “It is observed that despite our request, the insured patient family has not submitted the final report. In the absence of the documents, we are not able to further process your claim”. On the other hand, the complainant in order to prove his case has placed on record copy of Postmortem Examination Report of Dalwara Singh Ex.C-3 which was conducted by Dr. Amoldeep Kaur Medical Officer, Civil Hospital, Barnala on 9.3.2023 in which in the column of Opinion the cause of death mentioned as “the cause of death in this case is electric shock which is sufficient to cause death in ordinary course of nature probable time”. The complainant has also produced on record copy of DDR No. 016 dated 9.3.2023 Under Section 174 CRPC of Police Station Mehal Kalan, District Barnala which was registered on the statement of Harwinder Singh complainant son of Dalwara Singh vide which it is mentioned that on 08.03.2023 father of the complainant while working in the fields was suddenly electrocuted and the complainant was informed about this by Mr. Shamber Singh and the complainant immediately reached the spot and took his father to Civil Hospital, Barnala in an ambulance where the doctors at Civil Hospital Barnala thoroughly checked father of the complainant and declared him dead due to electrocution. Ld. Counsel for the complainant further argued that the complainant has submitted all the required documents with the opposite parties but the opposite parties have failed to settle the genuine claim of the complainant. After going through the above said documents produced by the complainant we are of the considered view that the complainant is successful in proving his case that his father was died due to accident and the complainant is entitled to the insured amount of Rs. 25,00,000/- as the deceased was insured for Accident Care Individual Insurance Policy and this fact is also admitted by the opposite parties, so at this stage opposite parties cannot escaped from their liabilities by taking these types of unreasonable and unjustified grounds. Ld. Counsel for the complainant relied upon the Judgment in New India Assurance Company Ltd., Vs Usha Yadav and others (2008) 151 PLR 313 Punjab and Haryana High Court, Chandigarh, vide which it is held that it seems that the insurance companies are only interested in earning the premiums, which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance Companies make the effected people to fight for getting their genuine claims.
13. From the above discussion, it is proved that the claim of the complainant was repudiated by the opposite parties on unreasonable and unjustified grounds and there is clear cut deficiency in service and unfair trade practice on the part of opposite parties.
14. In view of the above discussion, the present complaint is partly allowed and the opposite parties are directed to pay an amount of Rs. 25,00,000/- alongwith interest @ 7% per annum from the date of filing the present complaint till its actual realization to the complainant being nominee. The opposite parties are further directed to pay Rs. 10,000/- on account of compensation for causing mental torture, agony and harassment suffered by the complainant and Rs. 5,000/- as litigation expenses to the complainant. Compliance of this order be made within the period of 45 days from the date of the receipt of the copy of this order. Copy of the order be supplied to the parties free of costs. File be consigned to the records after its due compliance.
ANNOUNCED IN THE OPEN COMMISSION:
13th Day of November, 2024
(Ashish Kumar Grover)
President
(Urmila Kumari)
Member
(Navdeep Kumar Garg)
Member
