Haryana

Ambala

CC/107/2014

SAPNA - Complainant(s)

Versus

NIC CO. - Opp.Party(s)

N.S.Malhotra

12 Aug 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA.

                                     

           Complaint Case No.    :  107 of 2014

Date of Institution       :  16.04.2014

            Date of Decision         :   12.08.2016

 

1.         Sapna aged about 33 years wife of Vimal Kumar S/o Om Parkash,

2.         Shivani Vaid aged about 14 years D/o Vimal Kumar

3.         Ritik Vaid  aged about 12 years S/o Vimal Kumar

4.         Shiva Vaid aged about 10 years S/o Vimal Kumar

(complainants no. 2 to 4 minors through their mother & natural guardian Sapna –complainant  no.1), all residents of  village Simbla, Tehsil Barara, District Ambala.

 

……Complainants.

 

Versus

 

1.         National Insurance Company Limited through its registered office 3, Middleton Street, Post Box No.9229, Kolkata.

2.         National Insurance Company Limited, Second Floor, SCO 57, Sector 26-D Madhya Marg, Chandigarh.

3.         National Insurance Company Limited through its Divisional Manager, Second Floor, LiC Building, Ambala City.

4.         M.D. UHBVNL, Vidyut Sadan, Shakti Bhawan, Sector-6, Panchkula.

5.         Xen (Op.) Divn. UHBVNL, Ambala Cantt.

 

                                                ……Opposite Parties.

 

Complaint Under Section 12 of the Consumer Protection Act

 

CORAM:        SH. A.K. SARDANA, PRESIDENT.

                        SH. PUSHPENDER KUMAR, MEMBER.

                                               

Present:          Sh. N.S. Malhotra, Adv. counsel for complainant.

                        Sh. Mohinder Bindal, Adv. counsel for Ops No.1 to 3.

                        Sh. Sarvjeet Singh, Adv. counsel for Ops No.4 & 5.

 

ORDER.

 

                        Present complaint has been filed by complainant no.1 contending therein that  her husband Vimal Kumar  was employed as Line Man with UHBVNL (Ops No.4 & 5) and on 02.07.2012, her husband alongwith other employees Mohinder Singh, Sanjeev Kumar Vaid and Dhoom Singh was on duty at Rukri Feeder and was removing fault at about 9.00 P.M. at village Holi, he fell down from the poll of transformer due to sudden electric shock and suffered head injuries. He was shifted to M.M. Hospital and thereafter to PGI, Chandigarh for treatment but  despite the best treatment, Vimal Kumar expired on 12.07.2012.  It has been further contended by the complainants that all the employees of UHBVNL were insured for accidental death as well as permanent disability with National Insurance Company  Limited for the period from 17.07.2011 to 16.07.2012 under  group insurance policy purchased by the OP No.4 from OP – National Insurance Company for Rs.5.00 lac per employee at the premium of Rs.300/- per employee and thus the complainants supplied all the documents to OP-UHBVNL who lodged the claim with Op No.1  to 3 but the claim was not released despite lapse of about 2 years.  Hence, the present complaint seeking relief as per prayer clause has been preferred by the complainants before the Forum.

2.                     Upon notice, Ops No.1 to 3 appeared through counsel and filed written statement raising preliminary objections qua non-maintainability of complaint, no jurisdiction and suppression of material facts from the court.  On merits, it has been urged that M/s UHBVNL availed a group personal accident insurance policy from Op No.2  for its 11000 employees against any injury or death to them and it was made mandatory that such claim for injury or death of any such employee should be made only to the OP No.2 immediately or at the most within 30 days of the such loss and this time limit condition was made legally essential, mandatory and prominent for the entertainment of any such claim and thus a circular was even circulated by the insured i.e. UHBVNL, Panchkula to all its concerned offices vide letter dated 19.07.2012 whereby it was  also made clear that in case of rejection due to late submission of claim, the concerned office was held liable for all the liability. Since, the claim was submitted by Ops No.4 & 5 after  about 6 months qua the death of Vimal Kumar  and that too without any legal cause or reason for late submission, so the same  does not fall within the scope and purview of the insurance policy in question and was accordingly repudiated/rejected as per this specific & mandatory term and condition of the insurance policy. However, Ops No.1 to 3 has unnecessarily and without any cause or reason been made party to this case though they are not concerned in any manner. Hence,  a prayer for  dismissal of the complaint with costs has been made.

                        Ops No.4 & 5 filed their written statement separately raising preliminary objections qua non-maintainability of complaint against them since the answering OP have not rendered any kind of services or sold any goods to the complainants.  Hence,  the complainants are not consumers of answering Op and as such, the complaint is not maintainable.  On merits, purchase of the policy in question from OP insurance company  qua insurance of their employees has been admitted by the answering Ops and death of Vimal Kumar Lineman due to injuries suffered by him during the course of employment  has also been admitted. It has been further submitted that the claim for compensation on account of death of Vimal Kumar was lodged by them with OP insurance company as soon as the necessary documents viz. death certificate etc. were supplied by the complainants to the answering OP and thereafter it was bounden duty of the OP insurance company to proceed further with the claim & disburse payment of amount due under policy to the complainants and thus there is no delay or omission on their part. As such, a prayer for dismissal of complaint with costs has been made.

3.                     To prove her contention, complainant tendered her affidavit as Annexure CX alongwith documents as Annexures C-1  to C-11 and closed the evidence whereas on the other hand, the counsel  for Ops No.1 to 3 tendered in evidence affidavit of Sh. Vinay Kumar Sharma, authorized signatory as Annexure RX alongwith documents as Annexures R-1 to R-3 and closed the evidence.  Counsel for Ops No. 4 & 5 tendered in evidence affidavit of Sh. Vikas Bansal, SDO as Annexure RY alongwith documents as Annexures R4/1 to R4/6 and closed the evidence.

4.                     We have heard learned counsels for the parties and gone through the record minutely.  The main contention of the complainants is that Vimal Kumar  husband of complainant No.1 & father of complainants No.2 to 4 died on 12.07.2012 during the course of employment under Ops No.4 & 5 UHBVNL and he was insured under Group Insurance Scheme taken by Ops No.4 & 5 from OP insurance company by paying premium @ Rs.300/- per employee as clear from documents police report (Annexure C-1), PMR (Annexure C-2), Medical treatment record (Annexures C-3 & C-4) and Death Certificate (Annexure C-6) and this fact has been admitted by Op  Insurance company that deceased employee Vimal Kumar was insured with OP-insurance company through OP-UHBVNL vide policy (Annexure C-9) for the period effective from 17.07.2011 to 16.07.2012 and the UHBVNL has made payment  of premium to the OP insurance company as clear from their letter  dated 25.07.2011 (Annexure C-8) addressed to all XEN’s in UHBVNL.  

                        Counsel for the Ops No.1 to 3 has argued that as per the terms & conditions of the policy, in case of any injury or death, a claim should be submitted to them within one month of the occurrence but in this case the Ops-UHBVNL has submitted the claim with them after a lapse of 6 month of the death of employee Vimal Kumar. As such, they repudiated the claim of complainant. 

                        Counsel for Ops No.4 & 5 has argued that as soon as they received documents from complainants, they submitted the claim with OP insurance company, as such, there is no delay on their part whereas the OP insurance company is at fault in not releasing the claim to the complainants.

5.                     After going through the records placed on file, it is admitted fact on record that on the day of death of Vimal Kumar-insured employee i.e. 12.07.2012, he was duly insured with Ops-insurance company vide Group Personal Accident Insurance Policy purchased by Ops-UHBVNL from National Insurance Co. Ltd. Chandigarh i.e. Op No.2 covering risk of  accidental death as well as permanent disability to the extent of Rs.5.00 lac per employee but the main controversy involved in this case is that  as per OP Insurance Company, the OP-UHBVNL has lodged the death claim of insured Vimal Kumar beyond the period of 30 days which was mandatory period for lodging a claim as per terms & conditions of the policy and thus they are not liable to pay compensation to complainants whereas  Ops No.4 & 5 i.e. UHBVNL contention  is that they submitted  the claim of complainants to Op insurance company as soon as the complainants supplied death certificate of the deceased Vimal Kumar and thus they are not at fault and Op insurance  company is bound to release the claim  to the complainants.

6.         At the very outset, it is undisputed that Ops UHBVNL got insured their employees with Ops National Insurance Company by purchasing policy in question and the said policy was not handed over to each employee of Nigam rather all the XEN’s in UHBVNL were informed vide letter bearing memo no.CH-30/CAO/CAC/INS-EMP/2011-12 dated 25.07.2011 ( Annexure C-8) that “the insurance policy of employees has been purchased to cover risk of Accidental Death as well as Permanent Disability.  In the case of any mis-happening as stated above, necessary claim may be lodged with M/s National Insurance Company, SCO No.57, 2^nd Floor Madhya Marg, Sector 26-D, Chandigarh at once under intimation to this office as well as to GM/Admn. UHBVNL, Panchkula.

                        It has been observed by the insurance companies that field offices are not sending the claims intimation in time.  It is advised to send the claim intimation immediately within 15 days  as per policy clause. In case it is rejected due to non-intimation or delay in  intimation to the insurance company, the whole responsibility will lie with  the respective office.”

7.                     So, in view of the said instructions, it was the boundened duty of Ops No.4 & 5 i.e. UHBVNL to inform the OP insurance company at once or within the specified period as per policy clause or if there is any delay in informing the Op insurance Co. or in submitting the claim, then the same is due to lapse on the part of UHBVNL. Further the Ops No.4 & 5 in their reply have not raised any such objection qua late submitting the documents/death certificate of Vimal Kumar by the complainants. So the complainants are not at fault in any manner and the dispute, if any, qua not honouring the terms & conditions of the policy is inter-se between the OPs No.1  to 3  & Ops No.4 & 5 for which complainants are not liable to be penalized.

8.                     So, in view of the facts discussed above, we have come to the conclusion that there is no lapse on the part of complainants in any  manner rather Ops are deficient in providing proper services to complainants and they have committed unfair trade practice with them. As such, we have no option except to allow the present complaint.  Accordingly, the present complaint is allowed and all the Ops are held liable jointly & severally to pay the death claim of deceased Vimal Kumar-insured employee to the complainants and thus Ops are directed to comply with the following directions jointly & severally within thirty days from the communication of this order:-

1. To pay a sum of Rs.5,00,000/- to the complainants in equal shares alongwith simple interest @ 12% per annum to be accrued w.e.f. 12.09.2012 i.e. after 60 days from the date of death of Vimal Kumar-insured employee to till-realisation   
2. To pay Rs.10,000/- on account of compensation for harassment & mental agony etc. suffered by complainants.
3. To pay Rs.10,000/- as punitive damages for wrongly repudiating/rejecting the claim of complainants.

 

4. Also to pay Rs.10,000/- as costs for unwanted litigation including the advocate’s fee etc.

 

                   Further the award in question/directions issued above must be complied with by the OP within the stipulated period otherwise the  complainants shall be entitled to get the said order enforced under due provisions of the Consumer Protection Act.  However, it is made clear that the shares of minor complainants No.2 to 4 be deposited in any Nationalised Bank in the shape of fixed deposit receipts (FDRs) in their names till they attain majority. Copies of this order be sent to the parties concerned, free of costs. File be consigned to the record room after due compliance. 

 Announced:12.08.2016                                                                         Sd/-

                                                                                                  (A.K. SARDANA)

                                                                                                        PRESIDENT

                                                                                    

                                                                                      Sd/-                                                                                                                                                                               (PUSHPENDER KUMAR)

                                                                                                            MEMBER