BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL COMMISSION, JALANDHAR.

Complaint No.170 of 2021

      Date of Instt. 29.04.2021

      Date of Decision:19.05.2022

Ranjit Singh S/o Late Sh. Kuldeep Singh R/o Village Wariana, P.O. Nagra, Tehsil and District Jalandhar.

..........Complainant

Versus

1.       Punjab Gramin Bank, Village Wariana, District Jalandhar.

2.       The Branch Manager, Punjab Gramin Bank, Regional Office, PUDA Complex, District Jalandhar.

3.       Sr. Manager, Oriental Insurance Co. Ltd. Branch Office Mahavir       Marg, Kapurthala.

4.       The Chief Manager, Oriental Insurance Company Ltd. Oriental          House, A-25/27, Asaf Ali Road, New Delhi-110002.

….….. Opposite Parties

Complaint Under the Consumer Protection Act.

Before:        Dr. Harveen Bhardwaj             (President)

                   Smt. Jyotsna                            (Member)

                   Sh. Jaswant Singh Dhillon       (Member)   

Present:       Sh. Rajiv Kumar, Adv. Counsel for the Complainant.

                   Sh. Sandeep Kalia, Adv. Counsel for OPs No.1 and 2.

                   Sh. A. K. Arora, Adv. Counsel for OPs No.3 & 4.

Order

Dr. Harveen Bhardwaj (President)

1.                The instant complaint has been filed by the complainant, wherein it is alleged that the father of the complainant was having an insurance policy from Pradhan Mantri Sureksha Bima Yojna No.233106/48/2020/216 and same was issued by OP No.1 i.e. Punjab Gramin Bank, Village Wariana, District Jalandhar in collaboration with OP No.3 i.e. Oriental Insurance Company Ltd. Branch Office, Mahavir Marg, Kapurthala. The premium of Rs.12/- has been directly debited from the bank account bearing No.86560100034935 of the father of the complainant. The father of the complainant nominated his son Ranjit Singh in the above said insurance policy. On 04.01.2020 the father of the complainant namely Sh. Kuldeep Singh met with an accident at Raj Nagar, Jalandhar and he was admitted in Joshi Hospital, Jalandhar for treatment. Where on 08.01.2020 he died due to injuries suffered in accident. An FIR bearing No.0013 dated 22.01.2020 U/s 279, 427, 304-A, registered by P. S. Basti Bawa Khel, Jalandhar in this regard, but no post mortem was conducted. The complainant deposited the related documents regarding the death of his father to Punjab Gramin Bank, Wariana District Jalandhar i.e. OP No.1 on 27.01.2020. On 03.07.2020 a letter was received from OP No.3 i.e. Oriental Insurance Company Ltd Kapurthala vide which it was stated that Post Mortem report was not submitted with the claim. After the death of Kuldeep Singh, policy did not take the body in their custody for conducting the Post Mortem. Even the complainant was unaware about this fact that post mortem is mandatory for accidental death claim. A hard stand has been taken by OP No.3 in a rude and harsh manner and rejected the claim, vide letter dated 14.08.2020 by saying that Post Mortem Report is compulsory for settlement of Accidental Death Claim, which is not just and fair as no policy document and terms and conditions of the policy were provided to the father of the complainant. Even though the death summary was enclosed with other documents at the time of filing the claim and it clearly shows that the injuries suffered in the accident was the main cause of death. The complainant tried to understand the OPs that at the time of death of his father Kuldeep Singh, he was not aware about the fact that Post Mortem is mandatory in accidental death claim cases as neither Punjab Gramin Bank nor Oriental Insurance Company provided any document regarding the terms and conditions for lodging the claim in accidental death claim at the time of commencement of insurance policy or further at any point of time, but the OPs did not help the complainant and rejected his claim.  A legal notice was also served to the OPs on 05.03.2021 to settle the claim of the complainant. But no reply was received from the OPs No.1, 2 and 4. The OP No.3 sent reply to the legal notice through his counsel stating that “father of your client has got brain surgery 15 years ago. In this way deceased was an old man of 63 years of age and he was unable to ride on cycle on busy road.” The OP has utterly failed to perform the professional and contractual obligation as stated above which create great hardship, harassment, mental tension and physical pain and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to refund Rs.2,00,000/- with interest upto date as death claim, as per the insurance policy to the complainant and further OPs be directed to pay compensation of Rs.50,000/- and Rs.10,000/- as litigation expenses to the complainant.

2.                Notice of the complaint was given to the OPs and accordingly, OPs No.1 & 2 appeared through its counsel and filed joint written reply, whereby contested the complaint by taking preliminary objections that the present complaint is not maintainable under the law and deserves to be dismissed in limini. The complainant has not come to the Commission with clean hands and has suppressed the true and material facts from this Commission. The present complaint is totally based upon conjectures and presumptions drawn by the complainant and not based upon any cogent and valid document or opinion. The complaint, therefore, is totally frivolous and vexatious and ought to be dismissed under the provisions of Section 26 of the Consumer Protection Act, 1986 with exemplary costs. It is further averred that the factual events/facts regarding the present complaint has deliberately suppressed or twisted by the complainant in order to prejudice this Commission. The allegations made by the complainant are false, frivolous to his very knowledge that the complainant was well aware with the terms and conditions of the insurance policy and the claim of the respondent was rejected by the OPs No.3 & 4 for non supply of post mortem report of his father who died in an accident. The terms and conditions regarding the claim policy were also mentioned under claim form of the accidental death case is mentioned. The father of the complainant was having an insurance policy under Pradhan Mantri Sureksha Bima Yojana from the answering respondent under collaboration with OP No.3. Consent-cum-Declaration Form of deceased as nominee of his son i.e. complainant. On merits, the factum with regard to having an insurance policy from Pradhan Mantri Sureksha Bima Yojna, which was issued by the OP No.1 in collaboration with OP No.3, is admitted, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.

3.                OPs No.3 & 4 filed its separate joint written reply and contested the complaint by taking preliminary objections that there is no deficiency in service or unfair trade practice on the part of the answering OPs and that being so, the present complaint is liable to be dismissed. It is further averred that immediately on the receipt of information qua the death of Kuldeep Singh in the accident alleged to have occurred on 04.01.2020, claim was registered by the answering OP. Letter dated 03.07.2020 was written to the complainant to submit the Post Mortem Report of the deceased Kuldeep Singh, which was compulsory for the settlement of death claim as per terms and conditions of PMSBY policy. Since no Post Mortem on the dead body of the deceased Kuldeep Singh was conducted, which was necessary to establish the cause of death i.e. the death of Kuldeep Singh due to accident and as such, the claim of the complainant stands repudiated and the file of the said case was closed as ‘No Claim’.  It is further averred that the alleged accident has allegedly taken place on 04.01.2020, FIR in respect of the alleged accident was registered by the police on 22.01.2020 and there is delay of 15 days in the recording of FIR in question, thus the version detailed in the FIR appears to be after thought version got recorded with a motive to get the insurance claim qua the death of Kuldeep Singh in the alleged accident. The present FIR cannot be taken into consideration to establish the cause of death of Kuldeep Singh. On merits, it is admitted that the father of the complainant was met with an accident and was admitted in Joshi Hospital, Jalandhar for treatment, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.  

4.                Rejoinder to the written statement filed by the complainant, whereby reasserted the entire facts as narrated in the complaint and denied the allegations raised in the written statement. .

5.                In order to prove their respective versions, both the parties produced on the file their respective evidence.

6.                We have heard the learned counsel for the respective parties and have also gone through the case very minutely.

7.                It is not disputed that the father of the complainant was having an insurance policy from Pradhan Mantri Sureksha Bima Yojna issued by OP No.1 in collaboration with OP No.3. It is proved by the complainant that the father of the complainant met with an accident and was admitted in Joshi Hospital, where he could not sustain injuries and died due to injuries suffered in accident. He was admitted in Joshi Hospital. The copy of the death certificate has been proved as Ex.C-3 and copy of death summary of the deceased has been proved as Ex.C-8. An FIR regarding the accident was registered, which is Ex.C-4. The complainant has proved on record the bank account statement, which shows that the complainant was nominated by his father. Perusal of the FIR Ex.C-4 shows that the complainant gave statement to the police that one Bolero Vehicle No.PB08-CL-9194 Cream Colour hit very hard on the back side of his father’s cycle and his father fell on the ground. As per Ex.C-8, when he was taken to hospital, he was presented with injury to chest and pain in both hip, left leg and bilateral ribs with difficulty in breathing. He was diagnosed with Blunt trauma chest, fracture Ribs with pneumothorax right side, Fracture Acetabulum left side, Fracture shaft femur left side. This shows that he died because of the injury suffered due to accident and trauma and problem in breathing and suffered cardiac arrest.

8.                 He filed claim before the OP as per Ex.C-5/Ex.OP-2 on 27.01.2020. As per Ex.C-6, Post Mortem report was sought from the complainant by the OP in order to settle the death claim. In Ex.C-6/A, the complainant gave a reply that since the police did not take the custody of the dead body of his father for post-mortem nor took any action, therefore no post-mortem was conducted of the father of the complainant. The claim of the complainant was repudiated, vide Ex.C-7 on the ground that as per the terms and conditions, post-mortem is compulsory in accident death case, since no post-mortem was conducted, therefore the claim of the complainant was repudiated.

9.                The OPs have referred the terms and conditions of the PMSBY Policy Schedule Ex.OP3-4/1. As per this document in support of death due to accident may be any of the following. In Para No.1, three clauses have been written and as per the heading of this clause, any one of the following can be produced and considered in support of death. The complainant has provided the death certificate issued by Registrar of Birth and Death, Hospital Death Summary and FIR, but as per the complainant, the body was never taken by the Police, therefore no postmortem was conducted. It has been held by the Hon’ble National Commission, in Revision Petition No.1113 of 2008, titled as “New India Insurance Company Ltd. Vs. State of Haryana and Ors.”, wherein it is held as under:-

                   “Denial of the benefit under Government Scheme on      account of non-production of FIR and post-mortem report-         Treatment of deceased carried on in Government Medical           College and Hospital – No production of documents in support –     Insurer cannot discount and reject reports and statement of         Government Hospital authorities, Gram Panchayat and other      Government authorities, without evidence to contrary – Fraud,           misrepresentation of material facts with regard to death of      insured not establish – Repudiation of claim not proper –     Revision petition dismissed.”

                   It has further been held by the Hon’ble National Commission, in Revision Petition No.3329 of 2007, titled as “United India Insurance Company Ltd. Vs. Pallamreddy Aruna”, wherein it is held as under:-     

                   “Death due to snake bite - Post-mortem – Claim was     repudiated on the ground that proof of death by snake bite was          not established without conducting post-mortem- Contention cannot be accepted. Death was duly proved by certificate of    policy official, village Administrative officer and the doctor- In a small village, villagers cannot wait for post-mortem in cases of   snake bite – A doctor in such cases can certify that person       concerned had died because of poison due to snake bite – Order         passed by authorities below upheld.”

                   It has been held by the Hon’ble Uttarakhand State Commission, in First Appeal No.111 of 2011, date of decision 04.03.2014 titled as “The Oriental Insurance Company Limited Vs. Sabar Singh Kunwar and Ors.”, wherein it is held as under:-

                    “When the death certificate of the insured is on record, non-conduction of post-mortem is not material-District Forum        justified in allowing the consumer complaint.

                   So far as the post-mortem is concerned, when the death           certificate of the insured is on record and the factum regarding      his death during the validity of period of insurance has not been   disputed, non-conduction of post-mortem is immaterial in the given facts and circumstances of the case.”

                   It has been held by Hon’ble State Commission, Punjab, in First Appeal No.323 of 2017, date of decision 09.08.2017, titled as “National Insurance Company Ltd. Vs. Jaswinder Kaur and Ors.”, wherein it is held as under:-

                   “postmortem report and police report are not sine qua non requisites for claiming the insurance amount”.

10.              So as per the law laid down by the Hon’ble State Commission and Hon’ble National Commission, the post-mortem report is not required for the settlement of the claim. The death certificate of the father of the complainant has been proved on record. FIR has been proved on record to show that accident took place and even the diagnoses of the doctor showing that he suffered fractures on different parts of the body along with breathlessness shows that he died because of accident and cardiac arrest. No post-mortem was conducted. Post-mortem is not enough to prove the death. There is sufficient material to prove the reasons of the death of the father of the complainant. So, repudiation letter dated 14.08.2020 Ex.C-7 is held illegal and wrong and the same is herby set-aside and the complainant is entitled for the relief.

11.              In the light of above detailed discussion, the complaint of the complainant is partly allowed and OPs are directed to refund Rs.2,00,000/- with interest @ 9% per annum from the date of repudiating the claim i.e. 14.08.2020 till realization and further OPs are directed to pay Rs.10,000/- as compensation for causing mental tension and harassment to the complainant and Rs.5000/- as litigation expenses. The entire compliance be made within 45 days from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.

12.              Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

Dated          Jaswant Singh Dhillon    Jyotsna               Dr. Harveen Bhardwaj     

19.05.2022         Member                          Member              President