DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR
Complaint No. 67
Instituted on: 15.02.2019
Decided on: 05.04.2021
1. Kamaljit Kaur aged 35 years wd/o Late Avtar Singh S/o Hardev Singh 2. Amant Singh aged 17 years, 3. Harmanpreet Singh aged 12 years (both minor) sons of Avtar Singh under the guardianship of their mother Kamaljit Kaur widow of Late Avtar Singh, all residents of Village Arkwas, Tehsil Moonak, District Sangrur.
…Complainant
Versus
1. Punjab Health System Corporation, SIHFW Complex, Phase-6, Mohali through its Managing Director.
2. State of Punjab, through District Collector, Sangrur.
3. United India Insurance Company Ltd. Divisional Office, SCO 72, Phase IX, Mohali through its Divisional Manager.
..Opposite parties
For the complainant : Shri Amit Goyal, Adv.
For OP No.1&2 : Shri Vinay Jindal, Adv.
For OP No.3 : Shri G.S.Sibia, Adv.
Quorum: Shri Jasjit Singh Bhinder, President
Shri V.K.Gulati, Member
Order by : Shri Jasjit Singh Bhinder, President.
FACTS
1. Complainants have preferred the present complaint against the opposite parties on the ground that Shri Avtar Singh i.e husband of complainant number 1 and father of complainants number 2 and 3 was insured for Rs.50,000/- for health benefit and further Rs.5,00,000/- were payable in case of death as Shri Avtar Singh was covered under Bhagat Puran Singh Sehat Bima Yojna having number card 03053000090039911.
2. Further case of the complainant is that on 24.10.2018 Shri Avtar Singh went to Samana and was coming from Samana to Patran on his motorcycle bearing registration number PB-75-A-0152 and when he reached near Sarup White House village Retgarh then a truck coming from Patran side struck with the motorcycle of Avtar Singh, as such, he fell down on the road side and sustained serious injuries on his head and body, as such was taken to Civil Hospital Samana from where he was referred to Rajindra Hospital Patiala and further to PGI Chandigarh where he died on 3.11.2018 due to injuries sustained in the accident. Further case of the complainant is that FIR number 194 dated 3.11.2018 was lodged at PS City Samana against unknown person. Post-mortem on the dead body of the deceased was also conducted on 4.11.2018 at GMCH Sector 16, Chandigarh. Further case of the complainant is that thereafter the complainant lodged the claim on toll free number 104 of Ops and handed over all the documents such as FIR, post-mortem report, death certificate, RC of motorcycle and DL etc. and demanded the claim amount of Rs.5,00,000/-, but the same was not paid despite best efforts of the complainant. Thus, alleging deficiency in service on the part of the OPs, the complainant has prayed that the OPs be directed to pay to the complainant an amount of Rs.5,00,000/- along with interest and further claimed compensation and litigation expenses.
WRITTEN VERSION
3. No written reply has been filed by Ops number 1 and 2 and as such the right to file reply was closed by order of this Commission.
4. In reply filed by the OP number 3, legal objections are taken up on the grounds that the present complaint is not maintainable, that the complainant has concealed the material facts from this Commission, that the complainant has dragged the Ops into unwanted litigation and that the complainant has no locus standi and cause of action to file the present complaint. On merits, it is stated that the complainant has not lodged any claim with the Ops, that the complaint is wrong and that the complainants cannot take benefit of their own wrongs. Lastly, the OP has prayed that the complaint be dismissed with special costs.
EVIDENCE AND FINDINGS
5. The learned counsel for the parties produced their respective evidence.
6. The learned counsel for the complainant has argued that the complainants are the legal heirs of late Shri Avtar Singh and they have preferred the present complaint against the opposite parties on the ground that Shri Avtar Singh was insured for Rs.50,000/- for health benefit and further Rs.5,00,000/- were payable in case of accidental death as Shri Avtar Singh was covered under Bhagat Puran Singh Sehat Bima Yojna having number card 03053000090039911. The learned counsel for the complainant has further argued that on 24.10.2018 Shri Avtar Singh went to Samana and was coming from Samana to Patran on his motorcycle bearing registration number PB-75-A-0152 and when he reached near Sarup White House village Retgarh then a truck coming from Patran side struck with the motorcycle of Avtar Singh, as such, he fell down on the road side and sustained serious injuries on his head and body, as such was taken to Civil Hospital Samana from where he was referred to Rajindra Hospital Patiala and further to PGI Chandigarh where he died on 3.11.2018 due to injuries sustained in the accident. Further the learned counsel has argued that FIR number 194 dated 3.11.2018 was lodged at PS City Samana against unknown person. Post-mortem on the dead body of the deceased was also conducted on 4.11.2018 at GMCH Sector 16, Chandigarh. Thereafter the complainant lodged the claim on toll free number 104 of Ops and handed over all the documents such as FIR, post-mortem report, death certificate, RC of motorcycle and DL etc. and demanded the claim amount of Rs.5,00,000/-, but the same was not paid despite best efforts of the complainant. As such, the complainant has prayed for acceptance of the complaint.
7. On the other hand, the learned counsel for OPs has argued that the complainants have not lodged any claim with the Ops as such the complainant cannot take benefit of their own wrongs and as such the Ops have prayed that the complaint be dismissed with special costs.
8. To prove the case, Smt. Kamaljit Kaur has produced her affidavit Ex.C-1 and has deposed as per the complaint, Ex.C-2 is the card, Ex.C-3 is the copy of FIR dated 3.11.2018, wherein all the details of the accident have been mentioned, Ex.C-4 is the copy of post-mortem report conducted on the body of Avtar Singh on 4.11.2018, Ex.C-5 is the copy of registration certificate, Ex.C-6 is the copy of DL and Ex.C-7 is the copy of death certificate. Ex.C-8 is the legal notice sent to the OP for payment of the claim amount of Rs.5,00,000/-, Ex.C-9 is postal receipt, Ex.C-10 is the copy of aadhar card. On the other hand, the OP number 3 has produced affidavit Ex.OP3/1 of Shri Harmeet Singh Chahal and has deposed as per the written version of the OP number 3.
9. In the present case, as per the complainants version Shri Avtar Singh was insured with the OP number 3 vide card Ex.C-2. Shri Avtar Singh died on 3.11.2018 due to the accident suffered by him on 24.10.2018 and the post-mortem report is also on the file. So, it is clear that Shri Avtar Singh died on 3.11.2018 about two and half years ago. The OP i.e. the insurance company has argued that the complaint is premature as the complainant never lodged the claim with the Ops. The Op has further submitted that the complainant has not submitted the required documents. All the documents have been placed on the file by the complainant and this complaint was filed on 15.02.2019. The insurance company could have easily taken the documents and the OP had to settle the claim or to repudiate the same. The OP number 3 has produced Ex.OP3/2 regarding benefit coverage under the scheme which clearly shows that in case of accidental death, the claim amount of Rs.5 Lakhs would be paid to the dependents and the State Govt. has paid the entire premium to the insurance company. So, it is clear that this complaint is not premature as the insurance company is sitting on this file for the last two and half years. Since Avtar Singh was issued the health card under Bhagat Puran Singh Sehat Bima Yojna, as such he was insured for Rs.5,00,000/- in case of accidental death. Shri Avtar Singh died an accidental death on 3.11.2018 and Ex.C-4 post mortem report is also on the file. The complainants have filed this complaint stating that they are the legal heir and nominee of Avtar Singh. As such, we find it to be a clear cut case of deficiency in service on the part of the OP number 3 and the complaint deserves acceptance.
10. So, in view of our above discussion, we allow the complaint and direct OP number 3 to pay an amount of Rs.5,00,000/- along with interest @ 6% per annum from the date of filing of the present complaint i.e. 15.02.2019 till realisation to the complainants in equal share. If any legal heir is minor then the amount shall be kept in the shape of FDR till he/she attains majority. In the peculiar circumstances of the case, the parties are left to bear their own costs. This order be complied with within a period of sixty days of its communication. A copy of this order be issued to the parties free of cost. File be consigned to records.
Pronounced.
April 5, 2021.
(Vinod Kumar Gulati) (Jasjit Singh Bhinder)
Member President
