Punjab

Sangrur

CC/507/2017

Deso - Complainant(s)

Versus

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

SH.G.S.Chahal

08 Mar 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                             

                                                Complaint No.    507

                                                Instituted on:      03.10.2017

                                                Decided on:       08.03.2018

 

1. Deso aged about 48 years wife of Late Sh. Laddi Ram son of Nazar Ram.

2. Suman Rani aged about 24 years daughter of late Shri Laddi Ram.

3. Kuldeep Kumar aged about 20 years son of Late Shri Laddi Ram, all residents of Near Naudharani Phatak, Gandhi Nagar, Malerkotla, Tehsil Malerkotla, Distt. Sangrur.

                                                        …Complainants

                                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.

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 G.S.Chahal, Adv.

For Opp.Party No.1    :       Shri Amit Goyal, Adv.

For OP No.2&3         :       Ms.Amandeep Kaur, Adv..

 

 

Quorum:    Sukhpal Singh Gill, President

                Sarita Garg, Member

                Vinod Kumar Gulati, Member

               

 

Order by : Sukhpal Singh Gill, President.

 

1.             Smt. Deso, Suman Rani and Kuldeep Kumar being the legal heirs of Shri Laddi Ram, complainants (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 Shri Laddi Ram, husband of the complainant number 1 and father of the complainants number 2 and 3 was the member of Bhagat Puran Singh Sehat Bima Yojna, which is being run by the Ops number 2 and 3 and issued card number 0305-3001-8418-0027-0 and under the said scheme he was insured with the OP number 1 and the insured Laddi Ram and his family members were entitled to get the medical reimbursement for an amount of Rs.5,00,000/- and were further entitled to Rs.5,00,000/- in case of accidental death of the card holder.  The case of the complainant is that Shri Laddi Ram (referred to as DLA in short) on 6.9.2016 was going to his house from Phillaur on his motorcycle bearing registration number PB-12-E-4863 and at about 9.00 PM when he reached near Kup Kalan, Ahemdgarh, then in the meanwhile oil tanker bearing registration number PB-13-V-9739 which was standing in the middle of the road without any indication by its driver in a negligent manner and due to reflection of light of upcoming vehicle, the DLA could not see the oil tanker, as a result of which, the motorcycle in question struck with the backside of the tanker, resulting the DLA fell down on the road and sustained multiple injuries and died on the spot, of which FIR number 85 dated 7.9.2016 was recorded at PS Ahemdgarh.  Post mortem on the body of the DLA was also conducted at Civil Hospital, Malerkota.   Thereafter the complainant number 1 being the nominee under the policy lodged the claim with the Ops on their customer care number 104 on account of accidental death of her husband, but the claim was not paid despite submission of all the documents required by the Ops. 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 amount of Rs.5,00,000/- along with interest @ 18% per annum and further claimed compensation and litigation expenses.

 

2.             In reply filed by OP number 1, legal objections are taken up on the grounds that the complaint is not maintainable in the present form as the complainant has no cause of action to file the present complaint, that the complainant has filed a false and wrong complaint by concocting a false story. It is denied that the complainant ever lodged any claim with the Ops and further it is denied that the Ops appointed any surveyor. It is denied that the complainant ever lodged any claim at toll free number 104 or in writing to the OPs.  On merits, it is admitted that the deceased Laddi Ram was insured being the member of Bhagat Puran Singh Sehat Sewa Scheme under the card in question.  The other allegations levelled in the complaint including lodging of any claim with the Ops has been denied in toto.

 

3.             In reply filed by OP number 2 and 3, legal objections are taken up on the grounds that the complaint is premature, that the complaint is not maintainable and that the complainant has no cause of action to file the present complaint. On merits, it is admitted that the deceased Laddi Ram was the member of Bhagat Puran Singh Sehat Bima Yojna, but the remaining allegations of the complainant have been denied in toto.

 

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 the OP number 1 has produced Ex.OP1/1 to Ex.OP1/4 copies of documents and closed evidence. The learned counsel for OP number 2 and 3 has produced Ex.OP2&3/1 to Ex.OP2&3/6 copies of documents and affidavits and closed evidence.

 

5.             We have carefully perused the complaint, version of the opposite parties and evidence produced on the file and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits part acceptance, for these reasons.

 

6.             At the outset, it is an admitted fact of the complainant as well as the OPs that the husband of the complainant number 1, Shri Laddi Ram was insured under the policy in question with the Ops.  In the present case, the grievance of the complainant is that though the claim was lodged with the Ops on their toll free number 104 and further submitted all the required documents to the OPs, but despite that the claim was not paid/settled.  On the other hand, the stand of the Ops is that the complainant never lodged any claim with the Ops and as such the question of settling or not settling of the claim does not arise on the part of the Ops.  We have very carefully perused the whole case file, but failed to find out that the complainant ever lodged any claim with the Ops nor the complainant has produced any evidence on record to support her contention in this regard. In the circumstances, we feel that ends of justice would be met if the complainant is directed to first lodge the claim with the Ops about the death of DLA Laddi Ram and to submit the required documents.

 

7.             In view of our above discussion, we allow the complaint partly and direct the complainant to first lodge the claim along with all the documents to the OPs and thereafter the Ops shall decide the claim of the complainant within a period of 30 days of the receipt of documents from the complainant.  It is made clear that if the complainant still remains unsatisfied, then the complainant is free to file a fresh complaint. With these observations, we dispose of the complaint and the parties are left to bear their own costs. A copy of this order be issued to the parties free of cost. File be consigned to records.

                        Pronounced.

                        March 8, 2018.

 

                                                        (Sukhpal Singh Gill)

                                                                President

 

                                                                                               

                                                                (Sarita Garg)

                                                                    Member

 

 

                                                        (Vinod Kumar Gulati)

                                                                   Member