Haryana

Yamunanagar

CC/496/2011

Pushpa Devi W/o Sanjeev Kumar - Complainant(s)

Versus

OIC Ltd. - Opp.Party(s)

D.S.Kamboj

14 Feb 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

                                                                                    Complaint No.  496 of 2011.

                                                                                    Date of institution:17.05.2011.

                                                                                    Date of decision: 14.02.2017

Pushpa Devi aged about 30 years widow of late Sh. Sanjeev Kumar son of Sh. Om Parkash, resident of village Milak Jabhalia, Tehsil Bilaspur, District Yamuna Nagar. 

                                                                                                …Complainant.

                                    Versus

 

1. Divisional Manager, Oriental Insurance Company Ltd. Opp. Hindu Girls College, Court Road, Jagadhri, District Yamuna Nagar. 
2. Deputy General Manager, Oriental Insurance Company Ltd. Regional Office, LIC Building, Ambala Cantt.
3. The Manager Oriental Insurance Company Ltd. Head Office, A-25/27, Asaf Ali Road, New Delhi. 

 

                                                                                                 …Respondents.

 

BEFORE          SH. ASHOK KUMAR GARG, PRESIDENT

                         SH. S.C.SHARMA, MEMBER.

 

Present: Sh. D.S.Kamboj, Advocate, counsel for complainant.   

              Sh. Sushil Garg, Advocate, counsel for respondents.

 

ORDER

 

1.                     Complainant Pushpa filed the present complaint under section 12 of the Consumer Protection Act 1986 praying therein that respondents ( hereinafter respondents will be referred as OPs) be directed to pay the sum insured of Rs. 2,50,000/- (Rs. 2,00,000/- for personal accident plus Rs. 50,000/- for hospitalization) vide Nagrik Suraksha policy bearing No. 271700/48/2009/1142 dated 10.10.2008 and vide GPA policy bearing No. 271700/48/2009/1148 dated 10.10.2008 for Rs. 3,00,000/- alongwith compensation and litigation expenses etc. as mentioned in the complaint.

2.                     Brief facts as alleged by the complainant are that husband of the complainant obtained two insurance policies i.e. one under Nagrik Suraksha and 2^nd under GPA Insurance Policy from the OPs Insurance Company and paid the required premium as per instructions and guidance of the OPs Insurance Company. Sh. Sanjeev Kumar policy holder was electric mechanic and he was doing the work of repair at village Nizampur and when the husband of complainant was working on the tubewell of Rishi Pal son of Jyoti Ram Gujjar, resident of village Nizampur, unfortunately he got electrocuted alongwith other Mani Ram and both of them had died on 30.04.2009. The complainant has two minor sons namely Mohit and Rohit. Due to sudden death of Sanjeev Kumar, the matter was reported to the police of police station Sadhaura and a rapat No. 14 dated 30.04.2009 has been lodged in the police station and postmortem of the dead body was also conducted on 30.04.2009 in CHC Sadhaura. The complainant lodged a claim in respect of abovesaid policies with the OPs and submitted death certificate, postmortem report, copy of rapat roznamcha and affidavit of complainant but the complainant is running from pillar to post and visited the office of OPs so many times and requested the OPs to release the abovesaid amount of insurance but they did not take any action. The complainant has also served a legal notice dated 05.04.2011, which had been duly received by the OPs but they have not even replied the said notice but inspite of all above no claim amount was ever released by the OPs insurance company, which shows great deficiency in service on the part of OPs. Hence, this complaint.

3.                     Upon notice, OPs appeared and filed its written statement by taking some preliminary objections such as complaint is not maintainable; complainant has no cuase of action to file the present complaint; This Forum has no jurisdiction to entertain and decide the present complaint; the complainant has concealed the true and material facts and did not approach this forum with clean hands and on merit it has been specifically denied that Sanjeev Kumar insured got electrocuted alongwith other Mani Ram and both of them had died at the spot. It has been mentioned that the complainant submitted the documents including post mortem report containing there in that as per postmortem report dated 01.05.2009, the postmortem was conducted upon the body of insured shown as time as 11.40 A.M. on 30.04.2009 whereas the death shown as on 30.04.2009 at 2.30 PM which appears to be suspicious and accordingly the OPs Insurance Company repudiated the claim under the policies in question legally and bonafide. The OPs intimated the complainant with regard to the fate of her claim in due time, whereby the Ops repudiated the claim under the abovesaid policies.  Lastly, prayed for dismissal of complaint being false, frivolous and baseless.

4.                     To prove the case, complainant tendered into evidence her affidavit as Annexure CW/A and documents such as Photo copy of insurance policy amounting to Rs. 2,50,,000/- as Annexure C-1, Photo copy of insurance policy amounting to Rs. 3,00,000/- as Annexure C-2, Photo copy of DDR No. 14 dated 30.04.2009 as Annexure C-3, Photo copy of postmortem report of Sanjeev Kumar as Annexure C-4, Photo copy of death certificate of Sanjeev Kumar as Annexure C-5, Photo copy of Legal Notice dated 05.04.2011 as Annexure C-6,  Photo copies of postal receipt as Annexure C-7 to C-9, Photo copies of acknowledgement as Annexure C-10 to C-12, Photo copy of claim form as Annexure C-13, Photo copy of Postmortem report as Annexure C-14.

5.                     On the other hand, OPs failed to adduce any evidence, hence its evidence was closed by court order on dated 27.01.2017.             

6.                     We have heard the learned counsel for both the parties and have gone through the pleadings as well as documents placed on file very carefully and minutely.

7.                     The counsel for the complainant reiterated the averments mentioned in the complaint and prayed for its acceptance whereas the counsel for OPs reiterated the averments made in the reply and prayed for dismissal of complaint.

8.                     Learned counsel for the complainant hotly argued that the genuine claim lodged by the complainant on account of death of her husband has been illegally repudiated by the OPs Insurance Company on a false and baseless ground whereas the cause of death in respect of her husband has been specifically mentioned by the Medical Officer in the postmortem conducted on 01.05.2009 in which it has been clearly mentioned that Sanjeev Kumar son of Om Parkash had died due electric current. In the postmortem report in column No.5 it has been specifically mentioned that “burnt on left side”. Further, the death of the husband of complainant is also proved from the police papers as the police had recorded the statement of Chhatarpal Singh son of Kartar Singh during the investigation vide DDR No. 14 dated 30.04.2009. Lastly prayed for acceptance of complaint.

9.                     On the other hand, learned counsel for the OPs argued at length that as per postmortem report dated 01.05.2009, the postmortem was conducted upon the body of insured shown as time as 11.40 AM on 30.04.2009 whereas the death shown as on 30.04.2009 at 2.30 P.M. which appears to be suspicious and accordingly, the OPs Insurance Company has rightly repudiated the claim under the policies in question.  Learned counsel for the OPs further argued that there is a contradiction between the time of death and post mortem report.  So, the claim of the complainant was not payable and lastly prayed for dismissal of complaint. 

10.                   After going through the above noted arguments advanced by both the parties, we are of the considered view that it is not disputed that the husband of complainant purchased two insurance policies i.e. one under Nagrik Suraksha for a sum of Rs. 2,50,000/- (Rs. 2,00,000/- for personal accident plus Rs. 50,000/- for hospitalization) vide policy bearing No. 271700/48/2009/1142 dated 10.10.2008( Annexure C-1) and 2^nd under GPAS for Rs. 3,00,000/- vide policy bearing No. 271700/48/2009/1148 dated 10.10.2008 (Annexure C-2) and paid the required premium as per instructions and guidance of the OPs Insurance Company. It is also not disputed that husband of the complainant died on 30.04.2009 which is evident from death certificate (Annexure C-5) and copy of DDR No. 14 dated 30.04.2009.

 11.                  The only plea of the OPs Insurance Company is that Sanjeev Kumar died on 30.04.2009 at 2.30 P.M and postmortem was conducted on 30.04.2009 at 11.40 A.M. which appears to be suspicious. To rebut the foresaid contention of the OPs Insurance Company, counsel for the complainant draw our attention towards the DDR in which the date of death has been mentioned as 30.04.2009 at 2.30 PM which is duly evident from Annexure C-3 and further draw our attention towards the postmortem report dated 01.05.2009 in which the time of examination of body has been mentioned as 11.40 A.M. on 30.04.2009 and after cutting on the date,  the date has been mentioned as 01.05.2009 which is evident from Annexure C-14. The arguments advanced by the counsel for the OPs that Sanjeev Kumar died on 30.04.2009 at 2.30 P.M and postmortem was conducted on 30.04.2009 at 11.40 A.M. which appears to be suspicious is not tenable as the postmortem was conducted on 01.05.2009 which is evident from Postmortem report Annexure C-14 when the postmortem was conducted on 01.05.2009 then how it can be possible that the examination of body was conducted at 11.40 A.M. on 30.04.2009 which is only a clerical mistake as the date has been mentioned as 30.04.2009 instead of 01.05.2009. Further, insurance company has failed to file any investigation report or any cogent evidence to rebut the version of the complainant and further failed to convince this Forum that deceased Sanjeev i.e. husband of the complainant had  not died due electric current. Overall arguments advanced by the counsel for the OPs is not tenable whereas case of the complainant is duly proved from the documents filed by the complainant.

12.                   Further as a matter of fact in the reality, insurance companies in India are functioning arbitrarily with a view to escape and avoiding its legal and factual liabilities to make the payment of sum assured and doing fake acting in dramatically, opposite of the principle of fair play and decency and in that series it is not even caring that their wrong actions are causing wrongful losses to their customers.

13.                   Hence, after going through the above noted facts and circumstances of the case we are of the considered view that there is a deficiency in service on the part of OPs insurance company and OPs insurance company is liable to pay the insured amount to the complainant Pushpa widow of deceased Sanjeev Kumar and minor sons namely Mohit and Rohit  as the complainant has admitted in para No. 6 of complaint that the complainant has two minor sons namely Mohit and Rohit.  

14.                   Resultantly, we partly allow the complaint of complainant and direct the OPs Insurance Company to pay Rs. 2,00,000/- only under Nagrik Surkasha Policy for personal accident section i.e. 80% of total sum insured of Rs. 2,50,000/- vide policy bearing No. 271700/48/2009/1142 and Rs. 3,00,000/- on account of GPA policy bearing No. 271700/48/2009/1148 i.e. to pay total sum of Rs. 5,00,000/- ( Rs. 2,00,000/- +3,00,000/- ) five lacs within a period of 30 days failing which OPs will also be liable to pay interest at the rate of 6% per annum from the date of filing of complaint till its realization in equal share to (i) Smt. Pushpa wife of late Sh. Sanjeev Kumar, (ii) Baby Rohit and (iii) Mohit minor sons of late Sanjeev Kumar and further to pay Rs. 5000/- as compensation for mental agony, harassment as well as litigation expenses. Further, the share of the minors Rohit and Mohit will be deposited in the shape of FDR in the Nationalized Bank till attaining the age of majority. Order be complied within 30 days after preparation of copy of this order failing which complainant shall be entitled to invoke the jurisdiction of this Forum as per law. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced: 14.02.2017.

                                                                                    (ASHOK KUMAR GARG)

                                                                                     PRESIDENT

 

 

                                                                                    (S.C.SHARMA)

                                                                                     MEMBER