Present complaint under Section 12 of the Consumer Protection Act, 1986 as amended upto date has been filed by complainant Neelam Goyel wife of Late Sh.Vinod Kumar Goyel against opposite party i.e. National Insurance Company, Sultanpur Road, Kapurthala through its Branch Manager for claiming insurance amount of Rs.5 lacs under the insurance policy besides monetary compensation on account of deficiency in service on the part of opposite party.<br /> 2. Brief facts of the complaint are that husband of complainant Vinod Goyal took a private mediclaim policy No.401111/48/06/8500000255 for Rs.5,00,000/- with effect from 25/1/2007 to 24/1/2008 from the opposite party. It is further averred that on 16/9/07 her husband Vinod Kumar Goyel was coming back from Mata Chintpurni Ji to Kapurthala in the Santro car bearing R/C No. PB09-H-0509 owned by them and the said car met with an accident near Nangal Shama Chowk, Jalandhar with one Maruti Alto car bearing No.PB08-R-Temporary-4651 and to this effect DDR No. 7 dated 24/9/2007 was registered at Police Post Nangal Shama PS Sadar, District Jalandhar It is further averred that in the said accident Vinod Goyal suffered multiple injuries and he was taken to Johal hospital & Maternity Home, Rama Mandi, Jalandhar where number of surgery were done and he remained in the said hospital till 26/9/2007. After that he was shifted to Oxford hospital, Jalandhar on 26/0/2--9 where he remained admitted till 4/10/2007. Unfortunately Vinod Goyal succumbed to fatal injuries suffered by him in the accident and expired on 4/10/2007 and total amount of Rs.4,00,000/- was spent on his treatment in the said hospital. She is legally wedded wife/legal heir of Vinod Kumar Goyel and as such sent intimation about accident to the opposite party vide letter dated 25/2/2008 for claiming insurance amount of Rs.5 lacs under the policy . She received a letter dated 11/2/2008 from the opposite party asking her to submit certain documents for settlement of the claim and accordingly she submitted all documents demanded by the opposite party vide her letter dated 25/2/2008. That on 1/5/2008 complainant made her representation to the higher authorities of the opposite party requiring them to pay the claim at the earliest but opposite party failed to pay the claim of the complainant which amounts to deficiency in service on the part of opposite party against which she is entitled to the reliefs claimed.<br /> 3. Notice of the complaint was sent to te opposite party who appeared through counsel and filed written statement in which certain preliminary objections have been raised that complaint is not maintainable as the complainant has tried to take benefits of his own wrongs as it is obvious from the proceedings of the claim filed by the complainant with the opposite party that the complainant failed to submit original medical bills and record of the hospitals of her deceased husband Vinod Kumar and opposite party sent various letters on various dates to the complainant to submit the requisite original mdical bills and hospital record with the Company for settlement of the claim but the complainant failed to do so. As such there is no dficiency in servie on the part of opposite party.<br /> 4. In support of her version complainant has produced in evidence affidavit Ex.CA and documents Ex. C1 to C55.<br /> 5. On the other hand opposit party produced in evidence affidavit and documents Ex,.R1 to R4.<br /> 6. That after conclusion of evidence counse for the complainant argued that from the very beginning, intention of Insurance Company was doubtful as they wrote several letters on various dates to the complainant to submit one document after the other and ultimately complainant wrote letter Ex.C9 to the Chairman-cum- Managing Director, National Insurance Company, Calcutta and requested Insurance Company to pay her claim as the local office of the Insurance Company is not taking any interest to finalize the case of the complainant regarding payment of her claim. Even Johal hospital & Maternity Home wrote a letter Ex.C8 to the Insurance Company that deceased Vinod Goyal was not under the effect/influence of Alcohol at the time of accident and local Police was informed about the accident. X-ray report and file of the patient can be handed over to the Police or it can be submitted in the court as and when required but counsel for the opposite party argued vide Ex.C4 that they require some documents including X-ray films and medical reports . They also require history of Alcohol if taken at the time of accident . Insurance Company also demanded medical certificate or FIR lodged at th time of accident and complainant furnished all documents to the Insurance Company and even after that no claim was paid to the complainant on flimsy ground . One objection of the Insurance Company was that deceased Vinod Goyal can be treated as owner/driver and not an unknown passenger and as such claim cannot be given to the complainant.<br /> On 16/9/2007 at about 8.30 PM deceased Vinod Goyal was driving his Santro car bearing R/C No. PB09-H-0509 said car met with an accident with Alto car bearing No.PB08-R-Temporary-4651 . Both these vehicles were crushed due to accident beyond repair and driver and other passengers of both cars received multiple injuries. Injured passengers of both cars were admitted to Johal hospital and both parties do not want to take any legal action against each other , so it was due to this reason that DDR report was lodged and no FIR was lodged. Complainant placed on file the bills of payments made to the hospitals and receipts for the purchase of medicines from Ex.C13 to C55 and the total amount spent was estimated to be about Rs. 3,05,000/-.<br /> Ex.C1 is the copy of policy No.401111/48/06/8500000255 issued by National Insurance Company opposite party and the total sum assured by this policy was Rs.5,00,000/-. This policy was in force at the time of accident and the name of this policy was Privar medical policy and total premium of Rs.8168/- was paid by the complainant and deceased Vinod Goyal to the Insurance Company.. Ex.C3 is death certificate and Ex.C4 is letter from the Branch Manager of the opposite party vide which Branch Manager demanded some documents. <br /> That while filing written statement, opposite party admitted that Privar medical policy was issued to the complainant and only objection of the Insurance Company was that original medical bills and records of the different hospitals were not submitted with the claim. Opposite party also claimed that medical record and medical bills were very much essential for the just settlement of the claim. Opposite party has also objected to amounts spent on the treatment of Vinod Goyal. The fact of accident on 16/9/2007 is admitted by both the parties and the execution of Privar medical policy vide Ex.C4 is also admitted by both the parties. Vinod Goyal died on 4/10/2007. It is proved from Ex.C3 death certificate issued by Local Registrar of Birth and Death, Municipal Council, Jalandhar. Vinod Goyal remained admitted to Johal hospital and after that Vinod Goyal remained admitted to Oxford hospital, Jalandhar and Ex.C13 to C55 are medical bills of Vinod Goyal when he was admitted in the above mentioned hospitals in injured condition. All these documents clearly prove case of complainant . <br /> So we accept the complaint and direction opposite party Insurance Company to pay Rs.3,10,000/- alongwith interest @ 9% p.a. from 4/10/2007 the date on which Vinod Goyal succumbed to fatal injuries suffered by him in the road accident till realisation of the same.. This amount was spent on the treatment of Vinod Goyal which is proved by the receipts Ex.C13 to C55. We also direct opposite party to pay to the complainant Rs.20,000/- as damages for mental tension and harassment suffered by the complainant due to unfair methods adopted by opposite party and due to deficiency in service besides Rs.5000/- as cost of litigation payable within one month from the receipt of copy of this order.<br /> Let certified copies of judgment rendered be supplied/despatched to the parties without any unnecessary delay and thereafter file be consigned to record room.<br /> <br /> Announced :Gulshan Prashar Paramjit Singh<br /> 21.5.2009 Member President