New Complaint No.189 of 2023.
Date of Institution:25.10.2023.
Old Complaint No: 19 of 2018.
Date of Institution: 08.01.2018.
Date of order:20.11.2023.
Sarabjit Kaur Wd/O Gurmej Singh, resident of Village Peeroshah Tehsil Batala District Gurdaspur. .
…...Complainant.
VERSUS
1. Oriental Insurance Company Limited, G.T. road Batala, Batala City Tehsil Batala District Gurdaspur.
2. H.D.F.C Bank Limited Tibri Road Gurdaspur, through its Manager / Representative.
3. Director General Punjab Police (Welfare department) Chandigarh, through its Representative.
….Opposite parties.
Complaint under section 12 of the Consumer Protection Act.
Present: For the Complainant: Sh.G.S.Pannu, Advocate.
For the Opposite Party No.1: Sh.S.J.S. Bajwa, Advocate.
None for the Opposite Party No.3.
Opposite Party No.2 exparte.
Quorum: Sh.Lalit Mohan Dogra, President, Sh.Bhagwan Singh Matharu, Member.
ORDER
Lalit Mohan Dogra, President.
Sarabjit Kaur, Complainant (here-in-after referred to as complainant) has filed this complaint under section 12 of the Consumer Protection Act (here-in-after referred to as 'Act') against Oriental Insurance Co. Ltd. Etc. (here-in-after referred to as 'opposite parties).
2. Briefly stated, the case of the complainant is that the husband of the complainant was serving in the Punjab Armed Police at Jalandhar and was having Salary Account in the Branch of the opposite party No. 2 at Jalandhar bearing A/c No.13391050086704. It is pleaded that there was an memorandum of agreement between the department of the husband of Complainant and the opposite party No.2 duly signed on dated 11.02.2016 as per which those Punjab Police employees who are having salary account in their bank will be given free accidental insurance cover upto Rs.10,00,000/- (Ten Lacs). It is further pleaded that the opposite party No. 2 in collaboration with the opposite party No. 1 had taken Insurance of their serving employees of the Punjab Armed Police from the opposite party No. 1 bearing Policy No.124591/48/2016/2 and it was in terms and conditions of the policy that the in case of natural death the legal heirs of the deceased will get Rs.2,50,000/- (Two Lacs Fifty Thousand) as claim and in case of accidental death the L.R’s will get Rs.10,00,000/-(Ten Lacs) as claim Hence, the complainant falls under the definition of the consumer. It is further pleaded that on 03.06.2016 the husband of the complainant namely Gurmej Singh who was serving in the Punjab Armed Forces was going on his motorcycle for attending his duty form his Village to Batala and when he reached near Village Malakpur at about 8.30 A.M. at that time one cow suddenly came in front of the motorcycle of the deceased and in order to save the cow the deceased lost control over the motorcycle and got slipped along with his motorcycle on the mettled road and accident took place and the deceased received multiple grievous injuries on his body including the injuries on the ribs and the other parts of the body and in the injured condition he was taken to Prabhjot Hospital Batala where the doctor examined the deceased and after getting him examined the doctor discharge him from the said hospital. It is further pleaded that the deceased was brought to his house after getting the first Aid from the hospital but the blood continued to get collected internally in the peritoneum Cavity due to the internal injuries sustained in the accident and ultimately the deceased succumbed to the injuries sustained in the accident on 05.06.2016. It is further pleaded that the Report regarding the said accident was logged on the statement of Faqir Singh bearing No. 0023 dated 05.06.2016 which may be read as part and parcel of this Complaint. It is further pleaded that thereafter the complainant through the opposite party No. 3 raised the accidental claim case of Gurmej Singh to the opposite party No. 1 Vide Claim No. 12000/48/2017/030165 which was rejected by the opposite party No. 1 vide repudiation letter dated 16.03.2017 on the ground that the injuries sustained and described in the post mortem report of the deceased could no corroborate with the manner of alleged accident and the consequent immediate medical examination plus line of treatment given. It is further pleaded that it cannot be established that the accident is the sole cause of death of deceased. It is further pleaded that the grounds taken by the opposite party No. 1 was vague and false and against the fact and circumstance of the case as it was clearly written in the post mortem report that the deceased received multiple grievous injuries sustained in the accident including the injuries sustained in the left chest below the nipple and on dissection there are fractures of the rib No. 7, 8 and subcutaneous tissue contains blood as per injuries No. 7 written in the Post Mortem Report. It is further pleaded that in the Post Mortem Report in the column of the Internal Examination Injuries there is Massive blood collection in the retro peritoneum mainly on the left side. It is further pleaded that it was clearly written in the opinion clause that cause of death is shock resulting from hemorrhage from the multiple injuries especially retroperitoneal hemorrhage and kidney and all the injuries are ante mortem in nature and sufficient to cause death in the ordinary course of nature and the all injuries was accidental. It is further pleaded that it was clearly established that the cause of death was accidental but to the utter surprise of the complainant, the claim of the claimant was rejected on the vague ground. It is further pleaded that there was a clear cut deficiency of service on the part of the opposite party. It is further pleaded that the opposite party No.1 had intimated regarding the rejection of the claim on the false and vague ground to the opposite party No. 2 who intimated the same to the opposite party No. 3. It is further pleaded that due to this illegal act and conduct of the opposite parties the complainant has suffered great loss and also suffered mental agony, Physical harassment and inconvenience. It is further pleaded that there is a clear cut deficiency in service on the part of the opposite parties.
On this backdrop of facts, the complainant has alleged deficiency and negligence in service and unfair trade practice on the part of the opposite parties and prayed that necessary directions may kindly be issued to the opposite parties to Pay the amount of Rs.10,00,000/- (Ten Lacs) alongwith interest may kindly be awarded to the complainant. It is further prayed that opposite parties pay Rs.50,000/- on account of mental pain and suffering harassment to the complainant, in the interest of justice.
3. Upon notice, the opposite party No.1 appeared through counsel and contested the complaint and filing their written, stating therein that the accident claim case of Gurmej Singh deceased husband of the complainant was legally and rightly repudiated by the competent authority vide letter dated 16.03.2017 on the ground that the injuries described in the post mortem report of late Gurmej Singh could not be corroborated with the manner of alleged accident and the consequent immediate medical examination plus line of treatment given. It is further pleaded that it cannot be established that the accident is the sole and direct cause of death of deceased. It is pleaded that claim case U/s 163-A of the Motor Vehicle Act filed by complainant for compensation on account of death of her husband Gurmej Singh in the alleged accident is pending in the court of Sh. Pushvinder Singh, Motor Accident Claims Tribunal, Gurdaspur. On merits, the opposite party No. 1 have reiterated their stand as taken in legal objections and denied all the averments of the complaint and there is no deficiency in service on the part of the opposite party. In the end, the opposite party prayed for dismissal of complaint with costs.
4. Opposite party No.2 did not appear despite the service of notice and was proceeded against exparte vide order date 26.02.2018.
5. Upon notice, the opposite party No.3 appeared through Sh.Rakesh Kumar, Constable and filing their written reply, stating therein that the husband of the complainant was serving in Punjab Police and having salary account with Branch of opposite party No. 2. It is pleaded that there is an agreement between the opposite Party No. 3 and the opposite party No. 2 dully signed on 11.02.2016. It is further pleaded that the those Punjab Police employees who are having salary account in their bank will be given free accidental insurance cover upto Rs.10 lac.
6. Learned counsel for the complainant has tendered into evidence affidavit of Sarabjit Kaur, (Complainant) as Ex.C-1 alongwith other documents as Ex.C-2 to Ex.C-12.
7. Learned counsel for the opposite party No.1 has tendered into evidence affidavit of Sh. Daulat Ram, (Incharge of Oriental Ins. Co. Ltd, Gurdaspur) as Ex.OP-1/1 alongwith other documents as Ex.OP-1/2 to Ex.OP-1/4.
8. Opposite party No.3 has filed an affidavit as Ex.OP-3/1 alongwith reply.
9. Written arguments not filed by the parties.
10. Counsel for the complainant has argued that the husband of the complainant was employed with Punjab Armed Police and having salary account with opposite party No.2. It is further argued that on account of agreement between the department and opposite party No.2, the employees of the department who were having account with opposite party No.2 were given free accidental insurance cover upto Rs.10 Lacs. It is further argued that on 03.06.2016 husband of the complainant met with an accident near village Malakpur and received multiple injuries and was taken to Prabhjot Hospital Batala and after examination husband of the complainant was discharged after first aid. However, on account of internal injuries the blood continued to got collected internally in the peritoneum cavaity and husband of the complainant died on 05.06.2016 due to the injuries received in the accident on 03.06.2016. Rapat No.0023 dated 05.06.2016 was lodged with the police. It is further argued that claim was lodged with the insurance company i.e. opposite party No.1 but the same was repudiated on the ground that the injuries described in the post mortem report could not corroborate with the manner of alleged accident and the consequent immediate medical examination plus line of treatment given. It is further argued that repudiation of the claim amounts of deficiency in service. Counsel for the complainant has placed on record copy of award passed in MACT Case No.24 of 2017 Ex.C11 wherein award passed by the tribunal has been complied with by the opposite party No.1 which amounts to admission of accidental death.
11. On the other counsel for the opposite party No.1 has argued that providing of accidental cover of Rs.10 Lacs is admitted. However, the claim lodged by the complainant was right repudiated by the insurance company as the injuries described in the post mortem report of late Sh.Gurmej Singh could not corroborate with the manner of alleged accident and the consequent immediate medical examination plus line of treatment given.
12. Opposite party No.2 remained exparte.
13. Case called several times but none has appeared on behalf of opposite party No.3 for arguments. However in written reply filed by opposite party No.3 it is pleaded that opposite party No.3 has no role to play in the matter and there is no deficiency in service on the part of department and as such complaint is liable to be dismissed.
14. We have heard the Ld. counsels for the complainant and opposite party No.1 and gone through the record.
15. It is admitted fact husband of the complainant was employed in Punjab Armed Police at Jalandhar and was having salary account with opposite party No.2. It is further admitted fact that as per agreement between the department and opposite party No.2 employees having account number with the opposite party No.2 were given free accidental insurance cover upto Rs.10 Lacs. It is further admitted fact that the insured i.e. husband of the complainant died on 05.06.2016 and the claimed lodged by the complainant has been repudiated by opposite party No.1 vide letter dated 16.03.2017. The only issue for adjudication before this Commission is whether the death of late Sh.Gurmej Singh took place due to the accidental injuries received on 03.06.2016 or due to some other reasons.
16. To prove her case complainant has placed on record affidavit of herself Ex.C1, copy of repudiation letter Ex.C2, copy of memorandum of understanding between opposite parties No.2 and 3 Ex.C3, copy of bank passbook Ex.C4, copy of post mortem report Ex.C5, copies of DDr Ex.C6 and Ex.C7, copy of driving licence Ex.C8, copy of R.C. of motorcycle Ex.C9, copy of intimation regarding rejection of claim Ex.C10, copy of award Ex.C11 and copy of identity card of Sh.Gurmej Singh Ex.C12 whereas opposite party No.1 has placed on record affidavit of Daulat Ram Incharge Ex.OP-1/1, copy of repudiation letter Ex.OP-1/2, copy of letter dated 03.02.2017 Ex.OP-1/3 and copy of opinion Ex.OP-1/4.
17. Perusal of file shows that the opposite party No.1 has repudiated the claim by relying upon the opinion given by Dr.C.H.Asrani Ex.OP-1/4 who has given opinion that the injuries described in the post mortem report of Gurmej Singh could not be corroborated with the nature of alleged accident and by relying upon the said opinion opposite party No.1 has repudiated the clam vide letter Ex.OP-1/2. However, perusal of file shows that opposite party No.1 has not made any effort to place on record affidavit of Dr.C.H.Asrani and as such the complainant was deprived off opportunity of cross-examination of said Dr.C.H.Asrani. Moreover, copy of award dated 25.04.2018 passed in MACT Case No.24 of 2017 passed in the court of Sh.Pushvinder Singh, MACT Gurdaspur shows that the said tribunal had passed award against opposite party No.1 whereby the tribunal admitted the death of Gurmej Singh as accidental and the said award has not been challenged by the opposite party No.1 and has reached finality, which clearly shows that accidental death is duly proved on record and counsel for the opposite party No.1 was unable to explain that why the accidental insurance cover of Rs.10 Lacs has been withheld upto now, when award of MACT has already been passed in the year 2018 and complied with. More over the accidental death is duly proved from the post mortem report on record. Accordingly, deficiency in service on the part of opposite party No.1 is fully proved and we have no hesitation in holding that complainant is entitled to receive Rs.10 Lacs i.e. accidental insurance cover on account of death of her husband Sh.Gurmej Singh.
18. Accordingly, present complaint is partly allowed and opposite party No.1 is directed to pay accidental insurance cover of Rs.10 Lacs to the complainant alongwith interest @ 9% P.A. from the date of this order till realization. Opposite party No.1 is also directed to pay Rs.10,000/- to the complainant as compensation on account of mental tension, harassment and cost of litigation. Entire exercise shall be completed within 30 days from the date of receipt of copy of this order.
19. The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.
20. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.
(Lalit Mohan Dogra)
President
Announced: (B.S.Matharu)
Nov. 20, 2023 Member
*YP*
