DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION FAZILKA.
Complaint No. : CC/133/2023
Date of Institution : 05.12.2023
Date of Decision : 09.09.2024
Dakha Devi aged 55 years W/o Kahana Ram, R/o Street No.7, Diyal Nagri, Tehsil Abohar, District Fazilka.
...Complainant
Versus
The Manager, Reliance General Insurance Company Limited, SCO No.57-58-59, 4th Floor, Sector 17-A, Chandigarh.
...Opposite Party.
Complaint under Section 35 of the Consumer Protection Act, 2019.
Quorum: Sh. Vishal Arora, President.
Sh. Raghbir Singh Sukhija, Member.
Smt. TajinderKaur, Member.
Present: Sh. M.S.Chahal, counsel for complainant.
Sh. R.K. Sachdeva, counsel for opposite party.
ORDER
(Vishal Arora, President:)
Complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against opposite party for seeking directions to opposite party to pay Rs.5,00,000/- as death claim of deceased Ami Chand along with interest @12% per annum besides Rs.50,000/- as compensation for mental tension, agony and harassment and litigation expenses to the tune of Rs.11,000/-.
2. Briefly stated, the case of the complainant is that complainant is mother of Late Ami Chand. It has been pleaded that the Punjab Government launched Bhagat Puran Singh Sehat Bima Yojna for the welfare of the beneficiary of the said scheme. The son of complainant died in the vehicular accident and in this regard DDR No.019 dated 04.10.2016 was registered at Police Station, City 1, Abohar, District Fazilka. Ami Chand had availed one insurance policy under Bhagat Puran Singh Sehat Bima Yojna through smart card bearing no.9364-8009-2958-0021-4. The complainant number of times visited the office of opposite party with a request to settle the death claim of her son, submitted claim with all requisite documents to the opposite party but all in vain. Earlier, the present complaint was filed at District Consumer Commission, Ferozepur against United India Insurance Company and execution was also filed. But the execution was withdrawn with the permission to file fresh suit. Pleading deficiency in service and unfair trade practice on the part of opposite party, the complainant has prayed for acceptance of the present complaint. 3. The Counsel for complainant was heard with regard to admission of the complaint and vide order dated 08.01.2024, complaint was admitted and notice was ordered to be issued to the opposite party.
4. Upon notice, the opposite party has appeared and filed written reply to the complaint raising certain preliminary objections inter alia to the effect that the insurance is a bilateral contract and both the parties to the contract are bound by terms and conditions of contract viz-a-viz insurance policy. Upon intimation, the opposite party vide letters dated 29.12.2016, 23.01.2017 and 07.02.2017 requested Mr.Nand Lal, brother of deceased, Ami Chand to submit certain documents but he failed to submit the documents. Therefore, the claim was repudiated vide letter dated 22.02.2017. Even the complainant has not submitted requisite documents to enable the opposite party to process the claim. Opposite party issued multiple letters to the complainant but she failed to submit the documents.
The complainant has failed to implead all the legal heirs as a party to the case. Further, complainant has not even annexed legal heir certificate/NOC along with complaint. The deceased was not having a driving license as on the date of accident and this fact is admitted by the complainant in her statement. Driving without a license is a fundamental breach of policy terms & conditions. Further, the deceased was not even wearing a helmet at the time of accident and the said fact is even evident from the statement of the claimant. The present complaint is barred by limitation. On merits, the preliminary objections have been reiterated and other allegations of the complaint have been denied with a prayer for dismissal of the present complaint.
5. The complainant along with the present complaint has placed on record affidavit of complainant, Copies of, Post Mortem Report Ex C-2, Smart Card Ex C-3, death certificate Ex C-4, General Diary Details Ex C-5, Aadhaar card of complainant Ex C-6, Aadhaar Card of deceased Ami Chand Ex C-7, order dated 05.07.2023 Ex C-8 and letter dated 11.03.2022 received from United India Insurance Company Ltd. Ex C-9. Ld. counsel for opposite party has tendered into evidence, Copies of, statement of wife of deceased Ex O.P-1, claim form Ex O.P-2, letter dated 29.12.2016 Ex O.P-3, Letter dated 23.01.2017 Ex O.P-4, Letter dated 07.02.2017 Ex O.P-5, Letter dated 22.02.2017 Ex O.P-6 and affidavit of Suryadeep Singh Thakur, Authorized Signatory, Reliance GIC Ex O.P-7 and closed evidence.
6. We have heard the learned counsel for the parties and have also carefully gone through the record. The learned counsel for complainant and opposite party have argued on the same lines as per their respective pleadings.
7. The plea of the insurance company to the effect that the deceased was not having a driving license on the date of accident and was also not wearing a helmet at the time of accident is not tenable as nothing regarding the same has been mentioned in four letters Ex.OP-3 to Ex.OP-6 issued by insurance company making demand of documents.
8. As regard limitation in filing the present complaint, earlier the complainant had filed a complaint bearing C.C. No.364 of 2020 on 11.09.2020 which was allowed by The District Consumer Commission, Ferozepur vide order dated 07.09.2021 with a direction to the complainant to submit all the relevant documents with United India Insurance Company Ltd within 30 days from the date of receipt of copy of order and on receipt of required documents, the opposite parties will decide the claim of the complainant within 30 days. And in pursuance of the said order dated 07.09.2021, United India Insurance Company Ltd vide letter dated 11.03.2022 repudiated the claim of the complainant on the ground that as per documents provided by the complainant, date of death of deceased is 03.10.2016 which is not covered under the policy which is effective from 01.11.2016 to 31.03.2019. Accordingly, the complainant filed the present complaint impleading Reliance G.I.C as a party to the present complaint on 05.12.2023 which is within limitation from the date of repudiation of the claim by the United India Insurance Company. Even in all the four letters Ex.OP-3 to Ex.OP-6, only demand of documents has been made and claim of the complainant has never been repudiated by opposite party Reliance GIC Limited.
9. The plea put forward by the opposite party insurance company to the effect that letters dated 29.12.2016, 23.01.2017 and 07.02.2017 were issued to submit certain documents but the same were not submitted is correct but the plea to the effect that the claim was repudiated vide letter dated 22.02.2017 is wrong as perusal of said letter dated 22.02.2017 Ex.OP-6 reveals that after making demand of documents in the said letter, it has been mentioned that the complainant shall proceed with the claim assessment process only after the receipt of the above documents and the claim was not repudiated. However, the complainant has placed on record photocopies of the documents mentioned at serial number 1, 2, 4, 9 and 10 of letter dated 22.02.2017 Ex.OP-6 as Ex.C-5, Ex.C-2, Ex.C-7, Ex.C-4 and Ex.C-6 but has failed to produce on record any documentary evidence or postal receipt to prove that the said documents were sent to the insurance company along with claim form.
10. As regards documents mentioned at serial number 6, 7 and 11 of letter Ex.OP-6, the demand of the same is in genuine and have been wrongly demanded by the insurance company. The demand of said documents has been made with a request for submission of the said documents, if they exist. No documents can be demanded on the basis of “If’s and But’s” by the insurance company without conforming its existence. It has not been mentioned by the insurance company as to what is the requirement and relevance of said documents i.e. newspaper cutting, visra report and M.L.C when the accident duly stands established from Rapat no.19 dated 04.10.2016 of Police Station City Abohar Ex.C-5, P.M.R Ex.C-2 and death certificate Ex.C-4. Even the demand of L.R’s certificate in written statement and letter Ex. OP-6 at serial number 5 by the insurance company making demand of L.R’s certificate mentioning therein “In case nominee is not declared in the policy schedule” is wrong as insurance company itself has issued the policy and is in the possession of copy of policy and well in a position to see whether the nominee has been declared or not. So, the insurance company cannot demand documents mentioned at serial number 5, 6, 7 and 11 of the letters Ex.OP-4 to Ex.OP-6 as detailed above.
11. As regards the demand of documents at serial number 3 and 8 of the said letters, the same is legal and genuine and it is incumbent upon the complainant to submit the same to the insurance company.
12. In view of what has been discussed above, the present complaint is disposed off with a direction to the complainant to submit the original claim form, original cancelled cheque alongwith photocopies of the documents mentioned at serial number 1, 2, 4, 9 and 10 of letter Ex.OP-6 to the insurance company by registered post within a period of 30 days from the date of receipt of copy of this order. And opposite party insurance company will decide the admissibility of claim of the complainant within a further period of 45 days from the date of receipt of said documents. In case, the admissibility of claim is not decided within stipulated period of 45 days, then opposite party insurance company shall be liable to pay to the complainant a sum of Rs.300/- per day for the period of delay. If the complainant is dissatisfied with the decision taken by insurance company, then the complainant will be at liberty to file a fresh complaint on the same cause of action. The present complaint is disposed off accordingly. Copy of order be supplied to the parties free of costs under the rules. File be indexed and consigned to the record room.
ANNOUNCED IN THE OPEN COMMISSION:
09TH Day of September, 2024
(Vishal Arora)
President
(Raghbir Singh Sukhija)
Member
(TajinderKaur)
Member
