DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BARNALA.

                                                Complaint No.    231/14

                                                Instituted on:      03.11.2014

                                                Decided on:       11.05.2015

1.     Gagandeep Kaur aged 22 years widow of Gurbhej Singh, resident of Village Bakhatgarh, Tehsil and Distt. Barnala.

2.     Mohinder Kaur aged 62 years mother of deceased Gurbhej Singh, resident of village Bakhatgarh, Tehsil and Distt. Barnala.

                                                        …Complainants

                                Versus

1.     New India Assurance Building, 87, Mahatma Gandhi Road, Fort, Mumbai-400 001 through its authorised signatory/Director.

2.     The New India Assurance Company Limited, Branch Office, Near Street No.6, Kacha College Road, Barnala through its Branch Manager.

                                                        …Opposite parties

For the complainants   :       Shri Lokeshwar Sewak, Advocate.

For OPs                    :       Shri Varinder Goyal, Advocate.

Quorum:    Sukhpal Singh Gill, President

                Karnail Singh, Member

                Vandna Sidhu, Member

Order by : Sukhpal Singh Gill, President.

1.             Smt.Gagandeep Kaur and Smt. Mohinder Kaur, complainants (referred to as complainants in short) have preferred the present complaint against the opposite parties (referred to as OPs in short). Complainant number 1 is the widow of deceased Gurbhej Singh and complainant number 2 Mohinder Kaur is the mother of Shri Gurbhej Singh ( referred to as DLA in short). 

2.             The brief facts of the complaint are that the husband of the complainant number 1 was the member of the society i.e. Sanghera CASS Ltd. Sanghera and as such he purchased a personal accident policy bearing number 36130142130100000036  for Rs.10.00 Lacs from the OPs number 1 and 2. It is further stated that Shri Gurbhej Singh (DLA) on 22.11.2013 met with an accident with a tractor of Harpal Singh while going on the motorcycle with his brother Gursewak Singh and the DLA and Gursewak Singh both suffered multiple injuries on his body. It is further averred that the DLA was rushed to DMC Ludhiana for treatment and he remained admitted there from 22.11.2013 to 30.11.2013. It is further stated that since the compromise was effected between the parties, no FIR was got registered and only DDR regarding the accident on the basis of compromise was lodged on 25.11.2013. It is further stated that due to the said injuries which were received by the DLA on his head died at his house at Village Bakhatgarh. It is further stated that due to their non awareness, no post-mortem on the dead body of the DLA was conducted.  After the death of the DLA, the claim was lodged with the OPs and submitted all the required documents, but the OPs repudiated the claim of the complainant without any reasonable cause only on the ground that ‘there is no post mortem and FIR with the police. It is further averred that the DLA died after 17 days from discharge from DMC Ludhiana, so no evidence was produced for cause of death.’ Thus, alleging deficiency in service on the part of the OPs, the complainant has prayed that the Ops be directed to pay to the complainants an amount of Rs.10,00,000/- along with Rs.25,000/- on account of physical and mental agony and Rs.5500/- on account of litigation expenses.

3.             In reply, legal objections are taken up on the grounds that the complaint is not maintainable, that the complainant has no locus standi to file the present complaint and that this Forum has no jurisdiction to hear and try the present complaint. On merits, it has been denied that the complainant is the widow of deceased Gurbhej Singh. It has been denied that the complainants are the only legal heirs of the deceased.  It has been denied that the husband of the complainant number 1 Gurbhej Singh was the member of the society i.e. Sanghera CASS Ltd. It is further denied that he purchased a personal accident policy for Rs.10.00 Lacs from the Ops through the society and the OPs number 1 and 2 ever issued any policy and its insurance period was from 16.5.2013 to 15.5.2014.   It is further denied that the DLA suffered any multiple injuries and died due to that injuries. It is denied that the complainant submitted copy of DDR, death certificate etc. Lastly, the OPs have prayed for dismissal of the complaint with special costs.

4.             The learned counsel for the complainant has produced Ex.C-1 affidavit of Gagandeep Kaur, Ex.C-2 affidavit of Manjeet Singh, Ex.C-3 affidavit of Gursewak Singh, Ex.C-4 copy of order dated 10.9.2014, Ex.C-5 copy of ration card, Ex.C-6 copy of voter card, Ex.C-7 copy of Aadhar card, Ex.C-8 copy of letter dated 20.3.2014, Ex.C-9 copy of policy, Ex.C-10 copy of death certificate, Ex.C-11 copy of discharge summary of Gurbhej Singh, Ex.C-12 copy of DDR, Ex.C-13 copy of OPD card and closed evidence. On the other hand, the learned counsel for the OPs has produced  Ex.OP-1 affidavit  of M. Dhawal, Ex.OP-2 copy of policy along with terms and conditions and closed evidence.

5.             We have perused the pleadings, evidence of the parties and heard the arguments of the learned counsel for the parties.

6.             It is an admitted fact that the DLA Shri Gurbhej Singh was insured with the OPs for Rs.10,00,000/- under personal accident insurance  (Individual) policy for the period from 16.5.2013 to 15.5.2014, as is evident from the copy of insurance policy which is on record as Ex.OP-2.

7.             In the present case, it is on the record that Shri Gurbhej Singh (DLA) died on 17.12.2013 due to the accident which occurred on 22.11.2013 when the DLA met with an accident with a tractor of Harpal Singh while going on motorcycle alongwith his brother Gursewak Singh.  It is further on the record that after the accident, the DLA was got admitted in the DMC College and Hospital, Ludhiana as he suffered head injury and remained admitted in the hospital from 22.11.2013 to 30.11.2013.  It is further on record that the DLA died on 17.12.2013 at his house due to the injuries sustained by him during the accident on 22.11.2013. 

8.             The case of the complainant is that the OPs have repudiated the rightful claim of the complainant on the ground that the complainant has not produced any post-mortem report and FIR and the DLA died after a period of seventeen days from the date of discharge from the hospital.

9.             We have very carefully perused the case file and after hearing the arguments of the learned counsel for the parties, we find that the Ops have wrongly and intentionally repudiated the claim of the complainant.  It is an admitted fact that during the subsistence of the insurance policy on 22.11.2013, the DLA met with an accident and received multiple injuries and major injury on his head and for that he was immediately taken to DMC Ludhiana for treatment, where he remained admitted from 22.11.2013 to 30.11.2011 and ultimately died on 17.12.2013. 

10.            Now, the question arises for determination before us is whether the DLA died due to the alleged accident or due to a natural death.  Ex.C-8 is the copy of repudiation letter on record. We have perused the copy of discharge summary, Ex.C-11, which clearly proves that the DLA was taken to DMC Hospital, Ludhiana on 22.11.2013 as he had suffered multiple injuries due to the accident.  It further reveals that the DLA was admitted to DMC Ludhiana due to mental complaint and CT head was done.  In the history, it is also mentioned that the bike of the DLA was hit by truck.  Ex.C-12 is the copy of the register showing entry of DDR number 9 which clearly shows that the DLA met with an accident and suffered multiple injuries and for that he was got admitted in the DMC Ludhiana. It is worth mentioning here that in the DDR itself, it is written twice that the DLA met with an accident. On the other hand, the Ops have not produced any cogent, reliable and trustworthy evidence on record to support the contention of the Ops that the DLA did not die an accidental death.  The OPs have produced only a sworn affidavit of Shri M. Dhawal, Ex.OP-1 and copy of insurance policy Ex.OP2.   The accidental case of the DLA was also not got investigated from the investigator. Moreover, there is no explanation from the side of the Ops that why they did not get the matter regarding death of  the DLA investigated from the independent agency, as done by the OPs in a number of cases.  In the circumstances, we are of the considered opinion that the fact remains that the DLA died due to the head injury sustained by him during his accident with the tractor on 22.11.2013. 

11.            It is further worth mentioning here that the complainant has already lodged the DDR and the OPs have repudiated the claim for want of PMR.  Since the Ops have not produced on record any evidence in rebuttal that the DLA died due to accident, we feel that the rightful claim of the complainant cannot be denied.  Further reliance can also be placed on Darbara Singh and others versus The Taprian Amar Singh Cooperative Agriculture Services Society Limited and others 2013(4) CLT 192 (PB), wherein the insurance company repudiated the claim on the ground that no PMR was supplied by the complainant. On the other hand, the respondents have not rebutted or brought forth any evidence on record to prove that the deceased did not receive injuries in the accident or the death certificate produced is fabricated.  Merely non producing of the post-mortem report itself is not sufficient to throw away the case of the complainant.  It is further held that the post mortem could have been conducted, had the deceased died in the hospital, but in the absence of that, there is nothing to suggest that the deceased has not met with an accident or not died due to injuries received in the accident.  We feel that the case in hand fully falls under the above said citation of the Hon’ble Punjab State Commission as in the present case also, the DLA died at home after discharging from the hospital.  

12.            It is an admitted fact that the DLA is insured for Rs.10,00,000/- and the nominee under the policy is the complainant number 1, Smt. Gagandeep Kaur.  Since the complainant Gagandeep Kaur and Smt. Mohinder Kaur (mother of the DLA) have filed the joint complaint and it is clearly mentioned in the complaint that there is no other legal heirs, we feel that the ends of justice would be met if both the complainants are allowed to get 50% each of the insurance claim amount.

13.            The insurance companies are in the habit to take these type of projections to save themselves from paying the insurance claim. The insurance companies are only interested in earning the premiums and find ways and means to decline claims. The above said view was taken by the Hon’ble Justice Ranjit Singh of Punjab and Haryana High Court in case titled as New India Assurance Company Limited versus Smt. Usha Yadav and others 2008(3) R.C.R. 9 Civil) 111.

14.            In view of our above discussion, we allow the complaint and direct the Ops to pay to the complainants an amount of Rs.10,00,000/- on account of insurance claim and further to pay Rs.10,000/- on account of compensation for mental tension and litigation expense.   We further order the Ops to pay the above amount to the complainants in equal share. 

15.            This order of ours be complied with within a period of thirty days of its communication.   A copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                May 11, 2015.

                                                        (Sukhpal Singh Gill)

                                                           President

                                                                (Karnail Singh)

                                                                    Member

                                                                (Vandna Sidhu)

                                                                        Member