Punjab

Sangrur

CC/205/2018

Manjit Kaur - Complainant(s)

Versus

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

Sh.Udit Goyal

15 Mar 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

 

                                               

               

                                                Complaint No.    205

                                                Instituted on:      26.04.2018

                                                Decided on:       15.03.2019

 

1.    Manjit Kaur aged about 48 years wife of Late Sh. Jagsir Singh.

2.     Sehazpreet Kaur aged about 6 years.

3.     Agampreet Kaur aged about 3 years minor daughters of Late Sh. Jagsir Singh, both minors under the guardianship of their mother Manjit Kaur, all residents of Ward No.1-A, H.No.248, Janta Nagar, Dhuri, Tehsil Dhuri, District Sangrur.

                                                        …Complainants

                                Versus

1.             Reliance General Insurance Company Limited, SCO No.145-147, 2^nd Floor, Sector 9-C, Madhya Marg, Chandigarh through its Manager.

2.             Punjab Health Systems Corporation, State Institute of Health and Family Welfare Complex, Phase-VI, Near Civil Hospital, Sahibzada Ajit Singh Nagar, Roop Nagar, through its Managing Director.

3.             State of Punjab through Deputy Commissioner, Sangrur.

                                                        …Opposite parties

 

 

For the complainant    :               Shri Udit Goyal, Adv.

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

For OP NO.2and3      :               Shri Vinay Jindal, Adv. 

 

 

Quorum:    Vinod Kumar Gulati, Presiding Member

                 Manisha, Member

 

 

Order by : Vinod Kumar Gulati, Presiding Member.

 

1.             Smt. Manjit Kaur, complainant and others (referred to as complainant in short) have preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the husband of the complainant number 1 and father of the complainants number 2 and 3, namely, Jagsir Singh was the member of Bhagat Puran Singh Sehat Bima Yojna and the OPs issued card number 9305-3004-1748-0027-1 and under that scheme, Shri Jagsir Singh was insured for medical reimbursement for an amount of Rs.50,000/- and further was insured for Rs.5,00,000/- on account of accidental death as well as permanent disability.

 

2.             Further case of the complainant is that on 20.06.2016 the husband of the complainant number 1, namely, Jagsir Singh met with an accident and sustained head injuries, as such, was taken to Civil Hospital Sangrur, where on seeing the serious condition, he was referred to Rajindra Hospital, Patiala and further was  taken to PGI Chandigarh, however, he succumbed to the injuries on 24.6.2016.  Due to ignorance, mental shock and trauma, the post-mortem of the dead body of the deceased was not conducted, as such was cremated on the same day. Later on the complainant came to know about the insurance, as such the complainant lodged the claim with the Ops and submitted all the documents for releasing of the claim. The OP number 1 asked the complainant to submit the post-mortem report and the complainant number 1 specifically told that due to ignorance, mental shock and trauma the post-mortem of the deceased was not conducted and told that they can verify the genuineness of the claim from the police authorities as well as hospital authorities. As such, the OP number 1 appointed investigator, who investigated the claim and the OP number 1 assured that the claim would be released within one month, but no payment was made, despite the fact the complainant submitted all the documents. 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 the claim amount of Rs.5,00,000/- along with interest and further claimed compensation and litigation expenses.

 

3.             In reply filed by OP number 1, legal objections are taken up on the grounds that the complainant has not submitted the copy of PMR, copy of FIR, duly filled and signed claim form, that the complaint of the complainant is not maintainable, that the death of the deceased cannot be ascertained without FIR ad PMR, that the complainant has unnecessarily dragged the OPs into litigation and that the complainant has not come to the Forum with clean hands.  On merits, it is admitted that the husband of the complainant, Shri Jagsir Singh, was insured under the policy and card in question was issued. It is also admitted that the deceased assured died on 24.6.2016. It is stated further that since the complainant has failed to submit the copy of PMR, FIR etc. as such it is stated that no claim is payable.  The other allegations levelled in the complaint have been denied in toto.

 

4.             In reply filed by OPs number 2 and 3, legal objections are taken up on the grounds that the complaint is not maintainable, that the complainant has no cause of action to file the present complaint, that the complainant has not come to the Forum with clean hands and that this Forum has got no jurisdiction to hear and try the present complaint. On merits, it is admitted to the extent that husband of the complainant was the member of Bhagat Puran Singh Sehat Bima Yojna under the card in question, but the other allegations levelled in the complaint have been denied. It is stated that the claim has to be settled by OP number 1.

 

5.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-8 copies of documents and affidavit and closed evidence. On the other hand, the learned counsel for OP number 1 has produced OP1/1  to Ex.OP1/5 copies of documents and affidavit and closed evidence.  The learned counsel for OP number 2 and 3 has produced Ex.OP2&3/1 to Ex.OP2&3/4 copies of documents and closed evidence. 

 

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

 

                        7.          It is admitted fact between the parties that the complainant was issued the health card number 93053004174800271 by the Govt. of Punjab under Bhagat Puran Singh Sehat Bima Yojna. The card of the complainant was active when the alleged accident was happened. The complainant was insured vide policy number- 20043629140001068 issued by M/s. Reliance General Insurance Company Ltd, which was valid from 01-01-2016 to 31-10-2016. As per this policy death in personal accident of the insured is covered for Rs.5,00,000/- to the head of the family. Further that the husband of the complainant met with an accident on 20-06-2016 and succumbed to his injuries on 24-06-2016. As per the submission of the complainant in her complaint the post-mortem of the deceased could not be conducted and was cremated on the same day. FIR was also not lodged. The OP number 1 asked the complainant to submit the PMR and the complainant told that due to ignorance, mental shock and trauma, the PMR of the deceased was not conducted. OP number 1 through letters dated 06-05-2017 and 21-05-2017 requested the complainant to submit the pending documents to settle the claim, but the complainant did not submit the documents as demanded by the OP number 1. The complainant vide Ex.C-1 has submitted the copy of the admission register of Civil Hospital Sangrur, wherein no description of the injury received by the deceased has been mentioned. Further no discharge slip has been supplied from the above Hospital. None of the documents such as Ex.C-2, Ex.C-3, Ex.C-4, Ex.C-6, Ex.C-7 show that the deceased died due to injuries received in the accident. The complainant was required to prove that Jagsir Singh had died as a consequence of the accident. Further the complainants have failed to lead cogent evidence to proof their case. From the above it can be safely concluded that the story of the accidental death of the deceased was due to the accident is not true. Further the affidavit of Mr.Amrik Singh Kinth alias Kala, Municipal councillor, Janta Nagar Dhuri, District Sangrur has declared that the husband of the complainant met with an accident and sustained head injuries and was taken to Civil Hospital Sangrur, to Rajindera Hospital Patiala and further to PGI Chandigarh and Jagsir Singh succumbed to the injuries on 24-06-2016, but in his affidavit he has not mentioned where and how he sustained head injuries and which type of vehicle he was driving and his affidavit can not be relied upon and taken as the cogent proof of his death due to accident.  Further the complainant could prove not prove the death of her husband died due to accident by other evidence.  However, the learned counsel for the complainant has cited Rachpal Kaur versus State Bank of India, First Appeal No.480 of 2018 decided on 20.12.2018 and National Insurance Company Ltd. versus Jaswinder Kaur and others, First Appeal No.323 of 2017, decided on 20.09.2017 to support his case.  On the other hand the learned counsel for the OPs has cited Oriental Insurance company Ltd. versus Varinder Singh and others 2015(3) CLT 340 (NC), wherein it has been clearly stated that the complainant has to prove the death case by producing cogent and reliable evidence. But, in the present case, no such evidence has been produced on record to show that the deceased died due to accident. As such, the ratio of this case Oriental Insurance Co. Ltd versus Varinder Singh and others is straight-away applicable in the instant case.

 

8.             In view of our above discussion, we do not see any merit in the complaint and the complaint is dismissed. However, the parties are left to bear their own costs. 

 

9.              A copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                                March 15,  2019.

                                               

 

                                                 (Vinod Kumar Gulati)

                                                        Member

 

 

 

                                                          (Manisha)

                                                            Member