Before the District Consumer Disputes Redressal Commission, Room No. 208 2nd Floor, District Administrative Complex, Tarn Taran
Consumer Complaint No : 35 of 2019
Date of Institution : 27.05.2019
Date of Decision : 19.01.2023
- Smt. Simranjit Kaur widow of Gurvail Singh resident of village Poonian (Gharyala), Tehsil Patti, District Tarn Taran,
- Amandep Kaur minor aged 16 years daughter of Gurvail Singh son of Bishan Singh,
- Harmanpreet Singh minor aged about 14 years son of Gurvail Singh son of Bishan Singh through their real mother and natural guardian Smt. Simranjit Kaur widow of Gurvail Singh both residents of village Poonian (Gharyala) Tehsil Patti, District Tarn Taran.
......Complainants
Versus
- P.N.B. Met Life India Insurance Company Ltd. Unit No. 5-8 Eminent Mall Built on Property bearing No. 10, Keneddy Avenue, Mall Road Amritsar through its Branch Manager 143001
- P.N.B Met Life India Insurance Company Ltd. Unit No. 101, 1st Floor, TechniPlex-I Techniplex Complex, Off. Veer Swarkar Flyover, S.V. Road, Goregaon, West Mumbai, 400-062, Maharashtra
.....Opposite Parties
Complaint Under Section 12 and 13 of the Consumer Protection Act.
Quorum: Sh. Charanjit Singh, President
Ms. Nidhi Verma Member
Sh. Varinder Pal Singh Saini, Member
For Complainant Sh. Rajbir Singh Sandhu Advocate
For Opposite Parties Ms. Raj Gund Advocate
ORDERS:
Charanjit Singh, President
1 The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 12 and 13 against the opposite parties on the allegations that the complainant No. 1 is widow of Gurvail Singh son of Bishan Singh resident of village Poonia (Gharyala), Tehsil Patti, District Tarn Taran and the complainant No. 2 is the daughter (minor) and complainant No. 3 is the son (minor) of the deceased Gurvail Singh son of Bishan Singh and the present complaint has been filed by the complainant Nos. 2 and 3 through their real mother and natural guardian Smt. Simranjit Kaur complainant No. 1. The deceased Gurvail Singh was insured with Life Insurance Policy by the opposite parties vide insurance policy No. 22205589 and the deceased Gurvail Singh made his father Bishan Singh as his nominee of the above mentioned Insurance policy while availing this policy by paying Rs. 48,537.70 Paise as regular premium with Tax on 4.5.2017. The father of the deceased Gurvail Singh being nominee of the above mentioned policy had also died as such, the complainants are very much eligible for obtaining and receiving the insurance claim of the insured deceased Gurvail Singh. The Insurance premium was paid by the deceased to the opposite party No. 1 through a Negotiable Instrument dated 4.5.2017 amounting to Rs. 48,538/- issued by Punjab national Bank, Branch Gandiwind (Sarai Amanat Khan) tehsil and District Tarn Taran and as per terms and conditions of the policy, the opposite parties had given an Insurance cover of Rs. 10,20,000/- in case of the death of the insured to his nominee/ legal heirs. Unfortunately Gurvail Singh expired on 29.5.2017 at Khara Hospital, Valtoha Tarn Taran and after his death the complainant immediately approached the opposite parties and submitted all the relevant and required documents as per the request of the opposite parties which included copy of insurance policy, death certificate of deceased, particulars of the complainants etc. The opposite parties assured the complainants that the claim amount of Rs. 10,20,000/- will be released to them in a fort-night and as per the assurance of the opposite parties the complainants awaited the release of the claim. The complainants were very much harassed and embarrassed at the hands of the opposite parties as the opposite parties did not release the insurance claim inspite of several visits of the complainants with the opposite party No.1. The complainant has prayed that the present complaint may be allowed by granting the following relieves in favour of complainants.
- The opposite parties may kindly be directed to immediately release the insurance claim amount of Rs. 10,20,000/- to the complainants being legal heirs of deceased Gurvail Singh,
- The opposite parties may kindly be directed to pay compensation of Rs. 50,000/- alongwith expenses of Rs.30,000/- to the complainants
Alongwith the complaint, the complainant has placed on record affidavit of Simranjit Kaur complainant Ex. C-1, self attested copy of Insurance Policy Ex. C-2, Self attested copy of death certificate Ex. C-3, Self attested copy of Pan Card of deceased Ex. C-4, Self attested copy of Adhar Card of the deceased Ex. C-5, Self attested copy of legal notice dated 17.5.2019 and its receipt dated 17.5.2019 Ex. C-6 and C-7, Self attested copy of Adhar Card of complainant Ex. C-7.
2 Notice of this complaint was sent to the opposite parties and opposite parties appeared through counsel and filed written version by interalia pleadings that No claim under subject policy has been received till date from any person including complainants, hence insurance company was completely unaware of death of Life Assured (LA) prior to present complaint. Therefore, as no documents were received by insurance company, hence claim could not be processed. The complainants have approached this commission without approaching and filing the claim with requisite documents with the opposite parties No. 1 and 2, hence the present complaint is pre mature and liable to be dismissed. Insurance Company was never given any opportunity to assess and thereby process the claim under subject policy, hence the complainants be directed to submit requisite documents otherwise complainants ought to be put the strict proof of her contentions as to approach insurance company. As per settled principles of law, benefits under insurance policy are payable only to the nominee after completion of necessary formalities. Mr. Bishan Singh father of L.A. has been nominated under subject policy who has not been impleaded as party to the present complaint rather alleged to have been died. Consequently legal heir certificate is essential to process claim under subject policy. In the absence of claim as well as any documentary proof on record as to contentions of complainants, fact of present case are highly suspicious. Thereby contentions of complainants ought to be proved with documentary proof on record and further they ought to be directed to file claim with insurance company. As per mandatory requirement of Regulation and reiterated herein above, the nominee is under obligation to file necessary documents with opposite parties No. 1 and 2 to initiate the processing of claim, whereas in present case neither the nominee nor the complainants have filed the claim alongwith documents with opposite parties No. 1 and 2. The present complaint is pre mature and is liable to be dismissed on this ground alone. This commission may direct the complainants to register the death claim with opposite parties No. 1 and 2 alongwith all the necessary claim intimation documents as listed in the policy documents below in order to enable insurance company to decide on the claim processing which has been reiterated herein below
- The Original Policy document
- The claim forms as prescribed by us
- The discharge voucher as prescribed by us.
- Written intimation of death by the Beneficiary/ legal heir
- Official death certificate issued by a competent authority acceptable to the company
- Proof of title to policy like succession certificate, legal heirship certificate.
The complainants have categorically failed to submit claim under subject policy, opportunity to assess the claim has been denied to insurance company which is contrary to terms and conditions of subject policy and settled principles of law. Insurance company herein acted as per the mandate given to LA in proposal form and issued subject insurance policy and took all decision in conformity of insurance terms and conditions which is concluded contract between the insurance company and life assured. It is settled law that the insurance terms have to construe strictly and no relief which travels beyond the terms of the insurance policy can be granted. No case of deficiency in service is made out in this case as there is no breach on the part of the insurance company accordingly the present complaint is liable to be dismissed on this ground alone. LA was duly informed that in case he is not satisfied with the features or the terms and conditions of the policy he can withdraw/ cancel the policy under the “Free Look Period” provision which is within 15 days from the date of receipt of policy documents. LA retained the policy document and did not raise any objection towards the policy during the said “Free Look Period” with any grievance regarding the policy or its terms and conditions, policy terms, meaning thereby that the L.A agreed to the policy and its terms and conditions and the policy was to be agreement and satisfaction of the complainants. The complainants concealed and suppressed the material and relevant facts of case. The complainants have failed to set up a nexus between the damages claimed in the present complaint and the damage suffered by him. The damages claimed are arbitrary, without basis and is an abuse of process of law. The complainants have failed to make out a case of Deficiency of service as alleged or otherwise. The opposite parties have denied the other contents of the complaint and prayed for dismissal of the same. Alongwith the written version, the opposite parties have placed on record policy terms and conditions Ex. OP1,2/1, affidavit of Dapinder Singh Circle Manager Ex OP1,2/2.
3 The complainant has filed rejoinder to the written version filed by the opposite parties and denied all the pleas taken in the written version and reiterated the stand as taken in the complaint.
4 We have heard the Ld. counsel for parties and have also carefully gone through the documents on the file.
5 In the present case, there is no dispute that the deceased Gurvail Singh was insured with the opposite parties vide insurance policy No. 22205589. According to complainants they have submitted death claim alongwith all documents to the opposite parties but the opposite parties have not given the genuine claim to the complainant. But on the other hands, the stand of the opposite parties is that the present complaint is pre matured and in para No. 8 of the Preliminary objection of the written version, the opposite party has pleaded that “As per mandatory requirement of Regulation and reiterated herein above, the nominee is under obligation to file necessary documents with opposite parties No. 1 and 2 to initiate the processing of claim, whereas in present case neither the nominee nor the complainants have filed the claim alongwith documents with opposite parties No. 1 and 2. The present complaint is pre mature and is liable to be dismissed on this ground alone. This commission may direct the complainants to register the death claim with opposite parties No. 1 and 2 alongwith all the necessary claim intimation documents as listed in the policy documents below in order to enable insurance company to decide on the claim processing which has been reiterated herein below
- The Original Policy document
- The claim forms as prescribed by us
- The discharge voucher as prescribed by us.
- Written intimation of death by the Beneficiary/ legal heir
- Official death certificate issued by a competent authority acceptable to the company
- Proof of title to policy like succession certificate, legal heirship certificate.
However, at the time of arguments, Ld. counsel for the complainants contended that succession certificate cannot be submitted in this case because the same is a long expensive and tiresome route and in support of his version the Ld. counsel for the complainant has placed reliance on Shanti Devi Vs Bhojpur Rohtas Gramin Bank decided on 24, July, 2006 of National Consumer Disputes Redressal Commission and para No. 4 and 5 of the said citation is as follows:-
4 However, a solution-cum-justice oriented approach is need of the hour. One should not forget that it requires time, energy and money to obtain a succession certificate. Parties should not be forced to take such a long expensive and tiresome rout, when the problem can be solved otherwise protecting interest of all for satisfaction of their equitable rights.
5. Accordingly, if other heirs of the deceased give consent on an affidavit on due identification and have no objection, then the Bank should release the amount in favour of the complainant along with other heirs or should allow the complainant petitioner to withdraw 50% amount from the Bank account after taking an indemnity bond from her to safeguard the interest of the Bank, as well as other legal heirs. This view is essential to give a human face to our banking system as well as consumer to develop consumer friendly approach of consumer Fora to help the helpless widows facing disputes in the family. The respondent Bank is supposed to show this human face.
In view of above citation, the complainants cannot be forced to obtain succession certificate, however, in place of succession certificate, the complainants should file affidavits with regard to legal heirs of Gurvail Singh (deceased). The claim has not been decided so far and is still pending due to non providing of documents. In case Balu Waman Kadam vs. ICICI Lombard General Insurance Co. IV (2013) CPJ 16A (CN) (Mah.), the matter was similar, wherein the Insurance Company was asking the complainant to submit the documents again and again and the complainant was alleging that he had already submitted the requisite documents to the Insurance Company. In such circumstances, the Hon’ble State Consumer Disputes Redressal Commission Maharashtra disposed of the matter, by directing the Insurance Company to reconsider the claim of the complainant within one month on receipt of the required documents from the complainant.
6 While relying upon the above said authority, the Hon’ble State Commission, Punjab, Chandigarh passed the similar orders in case M/s Trends, through its Proprietor vs The Oriental Insurance Company Limited & Anr. Consumer Complaint No.245 of 2015 decided on 04.08.2017; and M/s Gurbir Rice Mills v. United India Insurance Company Ltd. & Ors. Consumer Complaint No.404 of 2016, decided on 09.10.2017, directing the Insurance Company to reconsider the claim of the complainant after submission of requisite documents by the complainant to it.
7 In view of our above discussion as well as keeping in view the ratio of above said judgments, we are of the opinion that the ends of justice would be met, if the Insurance Company be directed to decide the claim of the complainant, after the complainant submit all the requisite documents.
8 In view of the above discussion, the present complaint is disposed of with the direction to the complainant to submit the requisite documents demanded by the opposite parties-Insurance Company as follows
- The Original Policy document
- The claim forms as prescribed by us
- The discharge voucher as prescribed by us.
- Written intimation of death by the Beneficiary/ legal heir
- Official death certificate issued by a competent authority acceptable to the company
- Affidavit qua the legal heirs in place of succession certificate, legal heirship certifiate
to opposite parties for deciding the claim within a period of 30 days from the date of receipt of copy of order and on approaching the complaint for supplying the requisite documents, the opposite parties will issue proper receipt acknowledging the same. The opposite parties shall decide the claim of the complainants within a further period of two months therefrom and in case of failure on the part of the opposite parties the claim case of the complainant deemed to have been accepted. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Commission and due to COVID-19. Copies of the order be furnished to the parties as per rules. File is ordered to be consigned to the record room.
Announced in Open Commission.
19.1.2023
(Charanjit Singh)
President
(Nidhi Verma) (V.P.S. Saini)
Member Member
