Complaint No: 165 of 2019.

                                                              Date of Institution: 14.05.2019.

                                                                      Date of order: 02.11.2023.

Rajbir Kaur Widow of Sukhdev Singh Son of Balwinder Singh resident of VPO Pahra Tehsil and District Gurdaspur.

                                                                                                                                                       …....Complainant.                                                                                                                                                                                                                                                                                                                                                                                                   

                                                      VERSUS

1.       National Insurance Company Ltd. Regional office SCO, 332 - 334, Sector 34-A Chandigarh, through its Regional Manager. Pin – 160022.

2.       National Insurance Company Ltd. branch office G.T. Road Mandi Gurdaspur, through its Manager. 143521.

3.       United Bank of India, Branch Sangalpura Road Gurdaspur, through its Branch Manager. Pin – 143521

                                                                                                                                       ….Opposite parties.

                                              Complaint U/s 12 of the Consumer Protection Act.

Present: For the complainant: Sh.J.S.Randhawa, Advocate.

             For the opposite parties No.1 & 2: Sh.Ajay Dadhwal & Sh.Sumit Pathania, Advocate.  

              For the opposite party No.3: Sh.B.S.Aujla, Advocate.  

Quorum: Sh.Lalit Mohan Dogra, President, Sh.Bhagwan Singh Matharu, Member.

ORDER

Lalit Mohan Dogra, President.

          Rajbir Kaur, Complainant (here-in-after referred to as complainant) has filed this complaint under section 12 of the Consumer Protection Act (here-in-after referred to as 'Act') against National Insurance Co. Ltd. Etc. (here-in-after referred to as 'opposite parties).

2.       Briefly stated, the case of the complainant is that the husband of the complainant namely Sukhdev Singh Son of Balwinder Singh was having A/c No. 2098010023214 with the OP No. 3 bank. It is further pleaded that the complainant is nominee in the above mentioned account. It is further pleaded that the Govt. of India launched an Insurance Scheme under the name & Style of Pradhan Mantri Suraksha Bima Yojna (PMSBY) and Husband of the complainant on the asking of the bank officials of the OP No. 3 and being eligible to receive the benefits of the scheme opted to subscribe for the scheme. It is further pleaded that OP No. 3 is the nodal agency for the implementation of the scheme and date of birth of the husband of the complainant is 09.02.1982 and he was eligible for the benefit of above mentioned scheme. It is further pleaded that the OP No.3 debited installments from the account of the husband of complainant from time to time as per policy of the Govt. It is further submitted that on 17.07.2018 deceased Sukhdev Singh had gone to Kalanaur from Village Pahra on motor cycle bearing No.PB-02-DP-8962. It is further pleaded that at about 8 P.M. when the deceased was returning from Kalanaur to his village Pahra and reached near turn of village Kot Mohan Lal Tehsil and District Gurdaspur on Kalanaur - Gurdaspur Road, in the meantime he met with accident with an unidentified vehicle with the result deceased received multiple grievous injuries and fell down from his motor cycle. It is further pleaded that he was taken to Civil Hospital Gurdaspur from where he was referred to Abrol Hospital Gurdaspur after giving first aid and further to Chauhan Hospital Kotli (Pathankot), but unfortunately he succumbed to injuries in the way in area of Gurdaspur City on the same date, so dead body of the deceased was taken to his house. It is further pleaded that matter was reported to the police, but the police told that since the accident has occurred with an unidentified vehicle, so no post mortem etc. of the deceased is required to be conducted, so family members of the deceased cremated him. It is further pleaded that however later on, the police recorded Rapat No. 033 dated 24.08.2018 P.S. Sadar Gurdaspur instead of registering criminal case U/s 304-A/279 IPC against unknown vehicle and even the police did not got conducted post mortem of the deceased. It is further pleaded that after death of the husband of the complainant, the OP’s were approached for the grant of Rs.2 Lacs benefit of Pradhan Manti Suraksha Bima Yojna Scheme. It is further pleaded that complainant submitted her claim along with all the required documents. It is further pleaded that to the utter surprise of the complainant, the OP No.1 repudiated the claim of the complainant with the unsustainable observations i.e. Post mortem report and FIR are mandatory documents and in the absence of these documents, we are unable to settle the claim. It is further pleaded that this fact is totally wrong. It is further pleaded that infact, post mortem of the deceased was not conducted due to reasons fully mentioned above, and FIR was not registered by the police. It is further pleaded that the vehicle which caused accident is still untraced. It is further pleaded that observations raised by the OP No.1 are totally false, imaginary and not sustainable in the eyes of law. It is further pleaded that even otherwise, husband of the complainant was eligible for the benefit of PMSBY scheme and that is why the OP No.3 deducted premium amount from his above mentioned account. It is further pleaded that thereafter, the complainant approached the OP’s time and again and requested for the payment of amount of Rs.2 Lacs orally as well as in writing as per PMSBY Scheme on account of death of her husband in an accident, but the OP’s always put the matter with one or the other excuse. It is further pleaded that due to this illegal act and conduct of the opposite parties the complainant has suffered great loss and also suffered mental agony, Physical harassment and inconvenience. It is further pleaded that there is a clear cut deficiency in service on the part of the opposite parties.

          On this backdrop of facts, the complainant has alleged deficiency and unfair trade practice on the part of the opposite parties and prayed that necessary directions may kindly be issued to the opposite parties to make payment of Rs.2 Lacs to the complainant on account of death of her husband in an accident as per terms and conditions of PMSBY Scheme. It is further prayed that compensation to the tune of Rs.50,000/- may also be awarded to the complainant besides the amount in question on account mental agony, physical harassment and deficiency in service on the part of the opposite parties. Litigation expenses to the tune of Rs.5,000/- may also be awarded in favour of the complainant, in the interest of justice.

3.       Upon notice, the opposite parties No.1 and 2 appeared through counsel and contested the complaint and filing their written reply stating therein that the opposite party No. 1 had rightly repudiated the claim as per policy terms and conditions of PMSBY in which FIR and post mortem report is mandatory documents to settle any such claim. It is pleaded that it is wrong that the observations made by the opposite party No. 1 are totally false, imaginary or not sustainable. It is further pleaded that it is also wrong that the husband of the complainant was eligible for benefit of PMSBY Scheme.

          On merits, the opposite parties No.1 and 2 denied all the averments of the complaint and there is no deficiency in service on the part of the opposite parties. In the end, the opposite parties prayed for dismissal of complaint with costs. 

4.       Upon notice, the opposite party No.3 appeared through counsel and contested the complaint and filing their written reply stating therein that the opposite party No. 3 cannot tell regarding the accident took place of the deceased or not as the complainant has not produced the documents like post mortem report and FIR, so in the absence of these documents it cannot be ascertain whether the deceased succumbed to the injuries by accident. It is further pleaded that rapat was also written after 39 days from the date of death. It is pleaded that the complainant approached the opposite party No. 3, but it was not in time. It is further pleaded that complainant informed to the opposite party No. 3 on 12.10.2018 vide a written letter dated 12.10.2018 and the opposite party No. 3 informed the Insurance Company mentioned above regarding the information given by the complainant through the application dated 12.10.2018. It is further pleaded that the opposite party No. 3 repudiated the claim of the claimant on the grounds that the post mortem report and FIR mandatory documents and in the absence of these documents they are unable to settle the claim. It is further pleaded that it is upto the Insurance Company whether they have to settle the claim are not as per the rule and regulations of the company. It is further pleaded that the opposite party No. 3 is a Nodal agency of Insurance Company and they informed timely to the insurance company after information received from the complainant, but it was upto the Insurance Company regarding settlement of claim or not.

          On merits, the opposite party No.3 denied all the averments of the complaint and there is no deficiency in service on the part of the opposite party. In the end, the opposite party prayed for dismissal of complaint with costs. 

5.       Learned counsel for the complainant has filed an affidavit of Rajbir Kaur, (Complainant) alongwith other documents as Ex.C-1 to Ex.C-11.

6.       Learned counsel for the opposite parties No.1 and 2 has tendered into evidence affidavit of Sh. Sunil Tuli, (Divisional Manager, National Insurance Co. Ltd., Pathankot) as Ex.OP-1,2/A alongwith other documents as Ex.OP-1,2/1 to Ex.OP-1,2/2.

7.       Learned counsel for the opposite party No.3 has tendered into evidence affidavit of Sh. Pushkar Walia, (Divisional Manager, United Bank of India, Gurdaspur) as Ex.OP-3/1 alongwith reply.

8.       Rejoinder not filed by the complainant.

9.       Written arguments filed by both the opposite parties but not filed by the complainant.

10.     Ld. counsel for the complainant has argued that the husband of the complainant namely Sukhdev Singh Son of Balwinder Singh was insured under  Pradhan Mantri Suraksha Bima Yojna (PMSBY) and on 17.07.2018 deceased Sukhdev Singh had gone to Kalanaur from Village Pahra on motor cycle bearing No.PB-02-DP-8962 and met with accident with an unidentified vehicle with the result deceased received multiple grievous injuries and fell down from his motor cycle and  was taken to Civil Hospital Gurdaspur from where he was referred to Abrol Hospital Gurdaspur after giving first aid and further to Chauhan Hospital Kotli (Pathankot), but unfortunately he succumbed to injuries in the way in area of Gurdaspur City on the same date, so dead body of the deceased was taken to his house. It is further argued that  the police recorded Rapat No.033 dated 24.08.2018 at P.S. Sadar Gurdaspur instead of registering criminal case U/s 304-A/279 IPC against unknown vehicle and even the police did not got conducted post mortem of the deceased. It is further  argued that on claim being lodged the claim was repudiated by the opposite parties No. 1 and 2 for want of post mortem report and  FIR but it has been argued that the document Ex C5 is the OPD Slip issued by the civil Hospital Gurdaspur as per which it is clearly mentioned as RSA a case of road side accident and death certificate Ex C2 also proves that death has taken place on same day i.e 17-7-2018. More the legal heirs of the deceased have received claim from Motor accident Claims Tribunal Gurdaspur which itself proves the accidental death of the deceased.

11.     On the other hand counsel for opposite parties No.1 and 2 Mr. Ajay Dadwal has vehemently argued that the opposite parties No.1 and 2 had rightly repudiated the claim as per policy terms and conditions of PMSBY in which FIR and post mortem report is mandatory documents to settle any such claim and as such compliant is liable to be dismissed.

12.     Counsel for opposite party No.3 has argued that the complainant informed to the opposite party No. 3 on 12.10.2018 vide a written letter dated 12.10.2018 and the opposite party No. 3 informed the Insurance Company mentioned above regarding the information given by the complainant through the application dated 12.10.2018 and it is upto the Insurance Company whether they have to settle the claim are not as per the rule and regulations of the company. And as such complaint is laible to be dismissed.

13.     We have heard the Ld. counsels for the parties and gone through the record.

14.     It is admitted fact that the husband of the complainant namely Sukhdev Singh Son of Balwinder Singh was having A/c No.2098010023214 with the OP No. 3 bank as per statement of account Ex C1. It is further admitted fact that the complainant is nominee in the above mentioned account as per copy of passbook Ex C8 where nomination is shown as registered. It is further admitted fact that the Govt. of India launched insurance Scheme under the name & Style of Pradhan Mantri Suraksha Bima Yojna (PMSBY) and Husband of the complainant was insured under the said scheme for the benefit of above mentioned scheme. It is further admitted fact that the OP No.3 debited installments from the account of the husband of complainant from time to time as per policy of the Govt. which is further proved from statement of account Ex C1. It is further admitted fact that on 17.07.2018 Sukhdev Singh died which is also proved from the copy of death certificate Ex C2. It is further admitted fact that claim lodged by the complainant stands repudiated. The ground for repudiation of the claim by the opposite parties No.1 and 2 is condition No.4 of the claims procedure Ex.OP-1,2/2 as per which copy of post mortem report and FIR are required documents for settlement of the claim, but careful perusal of the said condition shows that post mortem report and FIR are not mandatory documents for the settlement of the claim. More over in the present case it can not be ignored that OPD Slip Ex C5 clearly shows that insured has met with an accident and death certificate proves his death on same day and by no means it can be suspected that death of the insured took place due to some other reasons. More over the complainant has placed on record copy of the award dated 25-5-2021 passed in the court of Smt. Ramesh Kumari MACT Gurdaspur as per which the claim petition filed by the legal heirs of the deceased Sukhdev Singh has been allowed by admitting the death to be accidental, copy of the said award is Ex C 12. Meaning there by it is proved on record that insured died due to the injuries sustained in the accident and act of the opposite parties No. 1 and 2 of having repudiated the claim for want of post mortem report and FIR is totally unjustified and amounts to deficiency in service.

15.     Accordingly present compliant is partly allowed and opposite parties No.1 and 2 are directed to pay sum assured  amount of Rs.2,00,000/- in respect of claim lodged by complainant being nominee alongwith interest @ 9% P.A. from the date of filing of present compliant till realization of the amount. Opposite parties No.1 and 2 are further directed to pay Rs.3,000/- to the complainant for mental tension, harassment, inconvenience and cost of litigation. Entire exercise shall be completed within 30 days from the receipt of copy of this order.         

16.     The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.

17.     Copy of the order be communicated to the parties free of charges. File be consigned.                                                                                                                                                               

            (Lalit Mohan Dogra)

                                                                                         President.  

Announced:                                                   (B.S.Matharu)

Nov. 02, 2023                                                       Member.

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