Haryana

Yamunanagar

CC/1220/2011

Rajwati W/o Dharam Singh - Complainant(s)

Versus

OIC Ltd. - Opp.Party(s)

Ravinder Kumar

09 Jul 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

 

                                                                                             Complaint No. 1220 of 2011.

                                                                                             Date of institution: 9.12.2011

                                                                                             Date of decision:9.7.2015.

Smt. Rajwati wife of Sh. Dharam Singh, resident of village Pipliwala, Tehsil Bilaspur, District Yamuna Nagar.   

                                                                                                                                                  …Complainant.

                                    Versus

 

1. The Divisional Manager, Oriental Insurance Company Ltd. Divisional Office, Opp. Madhu Hotel, Jagadhri Road, Yamuna Nagar. 
2. The Manager, Oriental Insurance Company Ltd. 80, First Floor, F.I.E. Patpar Ganj, Industrial Area, Delhi-110092.        

 

                                                                                                                                                  …Opposite parties.

 

CORAM:         SH. ASHOK KUMAR GARG, PRESIDENT.

                        SH. S.C.SHARMA, MEMBER.

 

Present:  Sh. Ravinder Kumar, Advocate, counsel for complainant.   

               Sh. Karnesh Sharma, Advocate, counsel for OPs.          

             

 

ORDER

 

1.                     Complainant Smt. Rajwati being nominee and natural guardian of her deceased son Sh. Gurdyal Singh has filed the present complaint under section 12 of the Consumer Protection Act. 1986 seeking direction to the respondents ( hereinafter referred as OPs) to pay Rs. 2,50,000/- and Rs. 3,00,000/- as insured amount alongwith interest at the rate of 18% per annum till the date of actual payment on account of death of her son in roadside accident.  

2.                     Brief facts as alleged by the complainant are that her son namely Gurdayal Singh was insured vide GPA policy bearing No. 271700/48/2009/365 & Nagrik Suraksha Policy bearing policy No. 271700/48/09/363 for a sum of Rs. 3,00,000/- & Rs. 2,50,000/-( Rs. 2,00,000/- for person accident section + Rs 50,000/- for hospitalization section) respectively valid w.e.f. 11.6.2008 to 10.6.2009 issued by the OP No.2. It has been further mentioned that her son namely Gurdayal Singh was unmarried who met with a road side accident on 18.1.2009 near village Chhachhruali, District Yamuna Nagar and expired on 19.1.2009 in Goyal Hospital, Jagadhri and in this regard a DDR bearing No.13 date 20.1.2009 was lodged in the police station Chhachhrauli, District Yamuna Nagar. His postmortem was conducted in Government Hospital, Jagadhri on dated 20.1.2009 vide PMR No. NKC/03/09 dated 20.1.2009. After the death of her son complainant lodged her claim under the above noted both the policies with the OPs and on intimation OPs deputed an investigator namely Sh. M.L.Vaish who visited the house of the complainant and collected the death certificate, PMR of her deceased son, copy of ration card and other requisite documents from the complainant. It has been further alleged that investigator assured the complainant that her claim is genuine and she will soon receive the claim amount of both the policies. Thereafter, the complainant repeatedly visited the office of the OPs to get the claim under the aforesaid policies for his deceased son but despite repeated visits and requests, the OPs failed to disburse the claim amount to the complainant and ultimately complainant got served a legal notice dated 24.10.2011. However, neither any reply of the legal notice was given by the OPs nor made the payment of both the policies to the complainant. It has been further stated that complainant is a poor widow lady and she has no source of income and further has lost his young son in this accident but the OPs have not left any chance to agonize her, rather the OPs have put salt on the wounds of the complainant by not disbursing her genuine claim on account of death of her young son. Lastly prayed that this act and conduct of the OPs constitute deficiency in service, hence OPs be directed to make the payment of Rs. 2,50,000/- and Rs. 3,00,000/- alongwith interest at the rate of 18% per annum and also be directed to pay Rs. 1,00,000/- on account of mental agony, harassment and economic loss and Rs. 5000/- as cost of litigation.

3.                     Upon notice, OPs appeared and filed its written statement by taking some preliminary objections such as territorial jurisdiction, locus standi, not maintainable, bad for non joinder and mis joinder and on merit, it has been mentioned that deceased Gurdayal Singh had purchased two insurance policies for an amount of Rs. 2,50,000/-( Rs. 2,00,000/- for person accident section + Rs 50,000/- for hospitalization section) and Rs. 3,00,000/- respectively in his name one under GPA policy which is enclosed Annexure R-4 and another Nagrik Suraksha Policy which is enclosed as Annexure R-5. It has been further mentioned that both the insurance policies contains terms and conditions which were agreed and accepted by Gurdayal Singh at the time of purchasing of insurance policies. It has been further stated that on receiving the intimation regarding the alleged death of Gurdayal Singh, the OPs immediately registered the claim and processed the same expeditiously but the complainant miserably failed to supply the copy of driving license of deceased Gurdayal Singh despite repeatedly letters and reminders to the complainant for supplying the copy of driving license of Gurdayal Singh on dated 29.7.2010, 25.10.2010 & 28.12.2010. It has been further stated that complainant has not filed any bill of hospital treatment, hence her claim regarding hospitalization is not covered and complainant is not entitled to get any amount on that account. Hence, the claim of the complainant was closed as ‘no claim’. Lastly prayed that complainant has filed the present complaint with malafide intention just to abstract the money from the insurance company and there was no deficiency in service on the part of OPs and prayed for its dismissal.

4.                     To prove the case, counsel for complainant tendered into evidence affidavit of complainant as Annexure CX and documents such as Photo copy of death Certificate as Annexure C-1, Photo copy of ration card as Annexure C-2, Photo copy of DDR as Annexure C-3, Attested copy of postmortem report as Annexure C-4, Photo copy of GPA policy amounting to Rs. 3,00,000/- as Annexure C-5, Photo copy of another insurance policy Nakrik Suraksha Policy as Annexure C-6, Postal receipt as Annexure C-7, Copy of Legal Notice as Annexure C-8, Photo copy of driving license of deceased Gurdayal Singh as Annexure C-9 and closed her evidence.

5.                     On the other hand, counsel for the OPs tendered into evidence affidavit of Sh. R.S.Kalra, Divisional Manager, Oriental Insurance Company Ltd. Yamuna Nagar as Annexure RX and documents such as Photo copies of letters dated 29.7.2010, 25.10.2010 & 28.12.2010 as Annexures R-1 to R-3 respectively Photo copy of GPA insurance policy as Annexure R-4, Photo copy of Nagrik Surksha Policy as Annexure R-5, Photo copies of dispatch register as Annexure R-6 to R-8 and closed the evidence on behalf of OPs.

6.                     We have heard the counsels of both the parties and have gone through the pleadings as well as documents placed on the file carefully and minutely. 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.

7.                      It is not disputed that son of the complainant Gurdayal Singh was insured vide policy bearing GPA No. 271700/48/2009/365 & Nagrik Suraksha Policy bearing policy No. 271700/48/09/363 for a sum of Rs. 3,00,000/- & Rs. 2,50,000/-     ( Rs. 2,00,000/- for person accident section + Rs 50,000/- for hospitalization section) respectively valid w.e.f. 11.6.2008 to 10.6.2009 issued by the OP No.2. It is further not disputed that son of the complainant had died during the substance of both the policies but inspite of lodging of the claim, completion of all the requisite formalities, submission of documents, opposite parties have not paid the claim amount. To support her contention, complainant has placed on record documentary evidence copy of DDR, PMR, Death Certificate, Ration Card, Copies of both the policies and copy of driving license of deceased Gurdayal Singh and also furnished her affidavit.

8.                     The only plea of the learned counsel for the OPs is that complainant failed to produce copy of driving license of deceased Gurdayal Singh despite repeated letters dated 29.7.2010, 25.10.2010 & 28.12.2010. Further learned counsel for the OPs argued that if the Hon’ble Forum comes to conclusion that complainant is entitled to get claim then complainant is entitled to get sum insured of Rs. 3,00,000/- vide policy GPA bearing No. 271700/48/2009/365 and sum insured of only Rs. 2,00,000/- out of Rs. 2,50,000/- under Nagrik Suraksha Policy bearing No. 271700/48/09/363 as per insurance policy because complainant has failed to file any documentary evidence regarding any hospitalization expenses of deceased Gurdayal Singh. Lastly prayed that as the complainant failed to provide required documents, hence the claim has been rightly repudiated as “ No Claim”.

9.                     But we are not convinced with the arguments advanced by the learned counsel for the OPs as Sh. Karnesh Sharma, Advocate, for the OPs failed to point out any violations of terms & conditions of the insurance policy in question, even no terms and conditions of the insurance policy has been placed on file by the OPs. Learned counsel for the OPs could not convince this Forum that on what ground OPs were demanded copy of driving license of deceased Gurdayal Singh whereas OPs have admitted in para No.4 of written statement on merit that, later on driving license was supplied. Inspite that OPs have not settled the claim of the complainant.

10.                   It is correct that complainant has neither produced any documentary evidence on account of hospitalization nor any details have been mentioned in her complaint. Hence, the complainant will not be entitled to get any claim on account of hospitalization charges and will be entitled to get the claim only of Rs. 2,00,000/- out of Rs. 2,50,000/- as per insurance policy.

11.                   The insurance companies in India with a view to escape and avoiding its legal and factual liabilities to make the payment of sum assured are fake acting in dramatically,  opposite of the principle of fairs play and decency and in that series it is not even caring that its wrongly actions are causing wrongful losses to their customers. In the present case instead of acting fairly, the insurance company is trying to avoid from its liability by making false pretext, which cannot be allowed to do so.

12.                   Consequently, keeping in view the above noted facts, this Forum is of the considered opinion that opposite parties have not paid the claim amount without any justification reason which amounts to deficiency in service on the part of the opposite parties. Hence we partly allow this complaint and direct the opposite parties to pay the claim amount of Rs. 3,00,000/- vide policy bearing GPA No. 271700/48/2009/365 & Rs. 2,00,000/- ( 80% of Rs. 2,50,000/- i.e. Rs. 2,00,000/- for person accident section except 20% of Rs. 2,50,000/- i.e Rs 50,000/- for hospitalization section) vide policy Nagrik Suraksha bearing No. 271700/48/09/363 to the complainant alongwith interest at the rate of 7% per annum from the date of filing of complaint till realization and further to pay a sum of Rs. 3,000/- as compensation for mental agony, harassment as well as Rs. 2000/- as litigation expenses. Order be complied within 30 days from the date of communication of this order. 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 in open court.

Dated: 9.7.2015.                 

                                                                                    (ASHOK KUMAR GARG )

                                                                                    PRESIDENT,

                                                                                     

 

                                                                                    (S.C.SHARMA )

                                                                                     MEMBER.