Punjab

Sangrur

CC/511/2017

Ranjit kaur - Complainant(s)

Versus

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

Sh..Lovepreet Walia

06 Mar 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

 

 

                                                               

                                                Complaint No.    511

                                                Instituted on:      03.10.2017

                                                Decided on:       06.03.2018

 

Ranjit Kaur aged about 38 years wife of Late Sh. Gurjant Singh son of Sh. Dalip Singh, resident of Village Khurani, Tehsil & 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 Lovepreet Walia, 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. Ranjit Kaur, complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that husband of the complainant, namely, Shri Gurjant Singh 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 0305-3000-09203975-7 and under the said scheme he was insured with the OP number 1 and the insured Gurjant Singh and his family members were entitled to get the medical reimbursement for an amount of Rs.50,000/- and were further entitled to Rs.5,00,000/- in case of accidental death of the card holder and the complainant was the nominee under the policy.  The case of the complainant is that the husband of the complainant was working in the fields on 6.10.2016 and he was bitten by the snake and as such, he was brought to Badrukhan for treatment and ultimately died on 7.10.2016. Thereafter post-mortem on the dead body of the deceased was conducted at Civil Hospital, Sunam and DDR number 13 dated 8.10.2016 was also got recorded.  Thereafter the complainant 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 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 Gurjant Singh 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 Gurjant Singh was the member of the 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-6 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, Shri Gurjant Singh was insured under the policy in question.  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 heer 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 Gurjant singh 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 6, 2018.

 

                                                        (Sukhpal Singh Gill)

                                                                President

 

                                                             

                                       

                                                                (Sarita Garg)

                                                                    Member

 

 

 

                                                        (Vinod Kumar Gulati)

                                                                   Member