Punjab

Sangrur

CC/283/2018

Harjinder Kaur - Complainant(s)

Versus

Reliance General Insurance Co.Ltd. - Opp.Party(s)

Sh.Ramit Pathak

08 Jan 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR .

 

                                                                         Complaint No. 283

 Instituted on:   03.07.2018

                                                                         Decided on:     08.01.2024

 

Harjinder Kaur aged about 26 years wife of Late Sh. Dalbir Singh, resident of Village Bhindran, Tehsil and District Sangrur.

                                                         …. Complainant 

                                                 Versus

1.             Reliance General Insurance Company Limited, SCO No.147-148, 2^nd Floor, Sector 9-C, Madhya Marg, Chandigarh (UT) Chandigarh 160009 through its Manager (Legal).

2.             Punjab Health Systems Corporation, Civil Secretariat, Chandigarh, through its Managing Director.

3.             State of Punjab through Deputy Commissioner, Sangrur.

                                                        ..Opposite parties

 

 

For the complainant  :       Shri Ramit Pathak, Adv.

For the OP No.1        :       Shri Amit Goyal, Adv.

For the OP No.2&3   :       Shri Vinay Jindal, Adv.

 

Quorum                                          

Jot Naranjan Singh Gill, President

Sarita Garg, Member

                        Kanwaljeet Singh, Member

 

ORDER

SARITA GARG, MEMBER:

 

1.             Complainant  has preferred the present complaint against the opposite parties  on the ground that Dalvir Singh i.e. husband of the complainant was the member of Bhagat Puran Singh Sehat Bima Yojna which is being run by OP number 2 and 3 and they issued card bearing number 9305-3000-3120-3974-6 under which the beneficiary and his family can get the medical reimbursement for an amount of Rs.50,000/- and also entitled to get Rs.5,00,000/- on account of accidental death of card holder.  Further case of complainant is that on 5.8.2016, husband of the complainant was called by Gurpreet Kaur wife of Chamkaur Singh by stating that he is having some urgent work. Thereafter said Gurpreet Kaur alongwith her husband Chamkaur Singh gave severe beatings to the husband of the complainant and thereafter husband of the complainant came at the house and started vomiting, then he was taken to Civil Hospital Sangrur and thereafter was referred to Rajindra Hospital Patiala where he was stated to be brought dead.  Post-mortem on the dead body of the deceased was also conducted. Thereafter, FIR number 116 dated 6.8.2016 was got registered at P.S. Sadar Sangrur. It is stated further that the deceased died due to accidental death. Further case of complainant is that in the month of May, 2018, the complainant found the card and inquired about the same and came to know that husband of the complainant was insured under the said scheme and as such she lodged the claim at the customer care number 104 of the OPs about the death. Though the complainant approached the OPs so many times, but the claim was not paid. Thus, alleging deficiency in service on the part of the OPs, the complainant has prayed that OPs be directed to pay to the complainant an amount of Rs.5,00,000/- as death claim of the husband of the complainant along with interest from the date of death till its payment and further claimed compensation and litigation expenses.

2.             In reply filed by OP number 1, legal objections are taken up on the grounds that present complaint is not maintainable, that the complainant has not come to this Commission with clean hands and that Dalbir Singh, husband of the complainant was not enrolled by OP number 2. It is further averred that as per the records of the company neither claim was lodged, nor intimation was given by the complainant to OPs. The intimation regarding accident or accidental injury given by complainant is denied.  It is stated that the policy issued by the OPs under the scheme had expired on 31.10.2016. On merits, it is stated that in fact under the scheme only the card holder/head of the family enrolled under the BPSSBY scheme were insured for the amount of Rs.5,00,000/- in case of accidental death strictly to the terms and conditions of the policy and agreement. It is denied that the complainant ever lodged any claim with the OPs. It is stated further that the complainant is not entitled for any claim as the deceased was not enrolled as a member with the OPs.  It is stated that the policy had already expired on 31.10.2016. Lastly, OPs have prayed that the complaint be dismissed with special costs.

3.             In reply filed by OPs number 2 and 3, legal objections are taken up on the grounds that the complaint is not maintainable as the deceased Dalbir Singh died on 5.8.2016 whereas the policy was issued in November, 2016, that the complainant has no cause of action to file the present complaint and that the complainant has not come to this Commission with clean hands. It is stated that card number in question was issued in the name of Dalbir Singh in November, 2016 and the death of the deceased occurred on 5.8.2016, as such the claim is liable to be dismissed.  It is averred that the complainant himself alleged in that the death of the deceased was occurred due to sudden fight with Gurpreet Kaur and her husband Chamkaur Singh and an FIR number 116 dated 6.8.2018 was registered at PS Sadar Sangrur and it is stated that the death is not accidental one. Lastly, the OP number 2 and 3 has prayed for dismissal of complaint.

4.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-9 copies of documents and affidavit and closed evidence. On the other hand, the learned counsel for OP number 1 has produced Ex.OP1/1 to Ex.OP1/5 documents and affidavit and closed evidence. On the other hand, the learned counsel for OP number 2 and 3 has produced Ex.OP2&3/1 to Ex.OP2&3/5 copies of documents and affidavit and closed evidence.

5.             We have perused the complaint, version of the opposite parties and heard the arguments of the learned counsel for the parties.

6.             The learned counsel for the complainant has argued vehemently that Dalvir Singh,  husband of the complainant was the member of Bhagat Puran Singh Sehat Bima Yojna which is being run by OP number 2 and 3 and they issued card bearing number 9305-3000-3120-3974-6 under which the beneficiary and his family can get the medical reimbursement for an amount of Rs.50,000/- and also entitled to get Rs.5,00,000/- on account of accidental death of card holder.  The learned counsel for complainant has further argued that on 5.8.2016, husband of the complainant was called by Gurpreet Kaur wife of Chamkaur Singh by stating that he is having some urgent work. Thereafter said Gurpreet Kaur alongwith her husband Chamkaur Singh gave severe beatings to the husband of the complainant and thereafter husband of the complainant came at his house and started vomiting, then he was taken to Civil Hospital Sangrur and thereafter was referred to Rajindra Hospital Patiala where he was stated to be brought dead.  Post-mortem on the dead body of the deceased was also conducted. Thereafter, FIR number 116 dated 6.8.2016 was got registered at P.S. Sadar Sangrur. It is contended further that the deceased died due to accidental death. Further the learned counsel has argued that in the month of May, 2018, the complainant found the card and inquired about the same and came to know that husband of the complainant was insured under the said scheme and as such she lodged the claim at the customer care number 104 of the OPs about the death of Dalbir Singh. Though the complainant approached the OPs so many times, but the claim was not paid, as such has prayed for acceptance of the complaint.

7.             On the other hand, the learned counsel for the OPs has contended that Dalbir Singh, husband of the complainant was not enrolled by OP number 2. It is further contended that as per the records of the company neither claim was lodged, nor intimation was given by the complainant to OPs. The intimation regarding accident or accidental injury given by complainant has been denied. Further it is contended that in fact under the scheme only the card holder/head of the family enrolled under the BPSSBY scheme were insured for the amount of Rs.5,00,000/- in case of accidental death strictly to the terms and conditions of the policy and agreement, but in the present case the complainant has not produced any evidence to support the contention that the husband of complainant died an accidental death or he was ever enrolled as a member of the scheme. Lastly, the OPs have prayed for dismissal of the complaint with special costs.  It is further contended that the complainant herself has alleged that the death of the deceased was occurred due to sudden fight with Gurpreet Kaur and her husband Chamkaur Singh and an FIR number 116 dated 6.8.2018 was registered at PS Sadar Sangrur and it is stated that the death is not accidental one.

8.             After perusal of the whole record, we find that the complainant has failed to prove her case as first of all the complainant has failed to prove with whom the husband of the complainant was insured as  OP number 1 has clearly stated that card number 93053000412039746 was issued in the name of deceased Dalbir Singh in November, 2016 whereas the death of the deceased occurred on 5.8.2016.  Further a bare perusal of the FIR Ex.C-6 clearly reveals that the reason of death of Dalbir Singh was due to beatings given by Chamkaur Singh and Gurpreet Kaur, against whom FIR was also got registered. Further Ex.C-7 is the copy of post mortem report conducted on the dead body of Dalbir Singh deceased, which clearly reveals that as per information provided by police, alleged death is due to intake of poisonous substance and as per the hospital records it is stated that the deceased was brought  dead in emergency in RH Patiala.   Further Ex.OP2&3/1 affidavit of Dr. Parminder Kaur, Deputy Medical Commissioner, Civil Hospital, Sangrur clearly finds mention that the complainant is not entitled for any claim for accidental death as alleged in her claim petition. The definition of “accident is sudden, unforeseen and involuntary event caused by external visible and violent means.” As such, we find that the claim of the complainant does not fall in the definition of ‘accident’ also. The complainant herself alleged in complaint that death of the deceased occurred due to sudden fight with Gurpreet Kaur and her husband Chamkaur Singh and FIR number 116 dated 6.8.2018 was registered at P.S. Sadar Sangrur under section 304/34 of IPC. In this way the death of deceased Dalbir Singh is not an accident death.  In the circumstances, we find that the complainant has failed to prove her case by producing cogent, reliable and trustworthy evidence that it is an accidental death. Moreover, the complainant has also failed to prove that her husband was ever insured with the OPs under the said scheme. As such, we are of the considered opinion that the complainant is not entitled to any claim.

9.             In view of our above discussion, we dismiss the complaint of complainant, leaving the parties to bear their own costs.

10.           The complaint could not be decided within the statutory time period due to heavy pendency of cases.

11.           Copy of this order be supplied to the parties free of cost. File be consigned to the records after its due compliance.      

                            Pronounced.

                            January 8, 2024.