DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
FATEHGARH SAHIB
Complaint No.CC 212 of 8.10.2013
Decided on:- 30.01.2015
Lakhwinder Singh S/oKulwinder Singh R/o H.No.481, Block A, Sector 20, Jasran Road, Kukkar Majra, Mandi Gobindgarh, Tehsil Amloh, District Fatehgarh Sahib.
……….Complainant
Versus
- The Oriental Insurance Company Ltd., Regd. and Head Office A 25/27,Araf Ali Road, New Delhi -110002 through its General Manager.
- The Oriental Insurance Company Ltd., Divisional Office No.14,80FIE, Partpar Ganj Industrial Area, Delhi-110092 through its Divisional Manager.
- Oriental Insurance Company Ltd.,Main Bazar, Mandi Gobindgarh (Code 233603),Distt.Fatehgarh Sahib through its Branch Manager.
- Gurtej Singh S/o Narranjan Singh R/o Village Dadheri, Tehsil Amloh,Distt. Fatehgarh Sahib (Mobile No.98551-50075)(Agent of Oriental Insurance Co.Ltd.Main Bazar, Mandi Gobindgarh)
………Opposite Parties.
Complaint under Section 12 of the
Consumer Protection Act.
QUORUM
Sh.Ajit Pal Singh Rajput, President
Smt.Veena Chahal, Member
Present: Sh.Ranjit Singh,Advocate for the complainant.
Sh.D.P.S.Anand,Advocate, for Ops no.1,2&3
Op no.4 exparte.
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BY SH.AJIT PAL SINGH RAJPUT,PRESIDENT
Complainant Lakhwinder Singh R/o Mandi Gobindgarh, Tehsil Amloh, District Fatehgarh Sahib has filed this complaint against the opposite parties (hereinafter referred to as the Ops) under Section 12 of the Consumer Protection Act. The brief facts of the complaint are as under:-
1. Kulwinder Singh father of the complainant was working as a driver in the Gobindgarh Public School and had insured himself with the Ops under the policy Nagrik Suraksha bearing No.271700/48/2011/1046 for the period from 17.8.2011 to 16.8.2011.Unfortunately on 31.1.2011 Kulwinder Singh had met with an accident at Mandi Gobindgarh and was admitted in Civil Hospital Mandi Gobindgarh from where he was shifted to DMC, Hospital,Ludhiana in a trauma and succumbed to the injuries on 1.2.2011.FIR No.22 dated 1.2.2011 to this effect was lodged with Police Station, Gobindgarh. Postmortem examination was conducted on the dead body of Kulwinder Singh, according to which the cause of death was shock and hemorrhage because of the injuries to the vital organs.
2. After the death of Kulwinder Singh, his son Lakhwinder Singh submitted the claim with the OPs alongwith relevant documents and requested the OPs to make the payment under the policy but the OPs without having gone through the facts repudiated the claim arbitrarily, malafide and without any reasonable cause .Thus there is deficiency of service on the part of the OPs. Hence this complaint for a direction to the OPs to pay Rs.5,00,000/- alongwith interest @18% per annum and Rs.50,000/- as compensation for the harassment and the mental agony suffered by the complainant.
3. Notice of the complaint was given to the OPs. OPs no.1,2&3 appeared and filed their joint written version while OP no.4 failed to come present to contest the case and was accordingly proceeded against exparte.
4. In the written version filed by OP no.1,2&3 , it is admitted that they had issued Nagrik Suraksha policy in favour of deceased Kulwinder Singh for the period from 17.8.2010 to 16.8.2011 for a sum of Rs.4lacs on accidental death and Rs.One lac on account of hospitalization treatment charges. It is denied that, Kulwinder Singh had died due to accident and any postmortem examination was conducted on his dead body. It is averred that vide letters dated 10.2.2011, 15.9.2011 and 16.6.2012, the complainant was requested to supply the relevant documents for settling the claim but the complainant failed to supply the relevant documents and accordingly the claim was repudiated on 16.02.2012 as per the terms and conditions of the policy. All other averments made in the complaint have also been denied and it is prayed to dismiss the complaint.
5. In order to prove his case, the complainant tendered in evidence his affidavit, Ex.C1, copy of FIR, Ex.C2, copy of Postmortem report, Ex.C3,copy of death certificate,Ex.C4,copy of repudiation letter dated 16.02.2012, Ex.C5, copy of certificate of insurance,Ex.C6 and closed the evidence.
6. On the other hand on behalf of OPs no.1,2&3, their counsel tendered in evidence Ex.OP1 affidavit of Sh.A.K.Sehgal, Sr.Divisional Manager. Oriental Insurance Company,Rajpura,Ex.OP2, copy of repudiation letter,Ex.OP3, copy of medical investigator, Ex.OP4, copy of ration card,Ex.OP5, copy of certificate,Ex.OP6 copy of certificate of insurance and closed the evidence.
7. The ld. counsel for the complainant has submitted that the OPs have repudiated the claim of the complainant in an arbitrarily manner. He stated that the reason mentioned in the repudiation letter i.e Ex-C5 the same is reproduced; “as per medical report the person died of Cardio respiratory Arrest which is a decease and not covered under the Policy.The post mortem of the deceased was not conducted which is must under accidental Policy.Why the same was not conducted.”
8. The ld. counsel stated that it is evident from the Post Mortem Report i.e Ex-C3 that the same was conducted on the body of the deceased on 01.02.2011 at 3:00 Pm. He pointed out that as per the opinion of the Doctor, deceased Kulwinder Singh died due to shock, hemorrhage and injuries to the vital organs and head injury. He pleaded that at the time of lodging the claim the complainant sent all the required documents including the Post Mortem Report i.e Ex-C3.The ld. counsel pointed out that the OPs in para no.4 of their written statement and in the evidence of Sh.A.K.Seghal, Sr.Manager has stated that on several dates letters were issued to complaint for supplying relevant documents has been proved to be a concocted version, as the OPs have failed to place on record any such letters/documents. The ld. counsel further argued that it is very well established that the OPs have repudiated the claim in an arbitrarily manner and thus have committed deficiency of service.
9. The ld. counsel for the OPs has pleaded that the claim of the complainant was rightly repudiated keeping in view the terms and conditions of the policy. He also pleaded that Dr.Vipin has stated in his evidence i.e Ex-OP7 that deceased was having adverse medical history and the claim cannot be admissible as per NSP/GPA policy terms and conditions. He submitted that several reminders were given to supply certain documents but the complainant failed to supply the same. Thus the claim was repudiated due to the reasons mentioned in the repudiation letter dated 16.01.2012.The ld. counsel stated that the present complaint deserves to be dismissed.
10. After hearing the Ld. Counsel for the parties and going through the pleadings, evidence produced by the parties and the oral arguments and written submissions, we are not persuaded to agree with the submissions made by the ld. counsel for the OPs. We are of the opinion that the OPs have failed to place on record any material documents which can prove that the complainant did not supply the relevant documents or the Post Mortem Report i.e Ex- C3 to the OPs. Even though the OPs have mentioned in their written statement and in evidence of Sh.A.K.Seghal, Sr.Manager i.e Ex-OP1 that several letters were written to the complainant and he failed to respond to their request but the OPs failed to place the same on record. It is very much evident from Ex-C3 i.e Post Mortem Report that the Post Mortem was conducted upon the body of deceased and as per the opinion of the Doctor who conducted the Post Mortem the cause of death was due to shock, hemorrhage, injuries to the vital organs and head injury. The complainant has claimed Hospitalization treatment charges but he has failed to place on record any bills of treatment or Hospital. Accordingly in view of our aforementioned discussion, we find that the OPs have in an arbitrary manner repudiated the claim filed by the complainant. Thus the OPs have acted in a negligent manner and committed deficiency of service. We direct the OPs No.1to3 to pay a sum of Rs.400000/-(Four lac) on account of accidental death alongwith 6% interest from the date of repudiation of the claim till its realization. We also direct the complainant to submit the Hospital bills with the OPs and claim the said expenses. The complainant is also held entitled to Rs.5000/- as litigation cost. The OPs are further directed to comply with the order within 45 days from the date of receipt of this order. The present complaint is partly accepted.
11. The arguments on the complaint were heard on 28.01.2015 and the order was reserved. Now the order be communicated to the parties. Copy of the order be sent to the parties free of cost and thereafter the file be consigned to the record room.
Pronounced
Dated:30.01.2015
(A.P.S.Rajput)
President
(Veena Chahal)
Member
