Punjab

Sangrur

CC/486/2015

Parveen Rani - Complainant(s)

Versus

Sangrur Central Co-op. Bank Ltd. - Opp.Party(s)

Shri Vikas Bansal

11 Feb 2016

ORDER

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR

                                                                    Complaint no. 486

Instituted on:   15.06.2015

                                                                   Decided on:     11.02.2016

1.    Parveen Rani aged about 33 years wd./o Sh. Happy Goyal      son of Sh. Hem Raj;
2.    Anjali Rani aged about 13 years d/o Sh. Happy Goyal;
3.    Naveen Goyal aged about 12 years son of Sh. Happy     Goyal;
4.    Shakashi Rani aged about 3 ½ years d/o  Sh. Happy Goyal;

( Minors through their mother and natural guardian Smt. Parveen Rani wd. /o sh. Happy Goyal.

All residents of village Satoj, Post office Dharmgarh, Tehsil Sunam, now residing at Indra Colony, Street No.03, Opp.District Library, Sangrur-148001 ( Pb.).

                                                          …. Complainants.          

                                         Versus

 

1.     The Sangrur Central Co-operative Bank Limited, Branch Cheema, District Sangrur through its Branch Manager.

2.     The Sangrur Central Co-operative Bank Limited, Head Office, Patiala Gate, Sangrur through its District Manager.  

3.     Bharti AXA General Insurance Company Limited, Pearl Plaza K-24, Plot No.ABCD & E, 2^nd Floor, Sector 18, Noida-201301 through its Managing Director.

4.     Bharti Axa General Insurance Company Limited, Mall Road, Near Bharat Nagar Chowk, Ludhiana through its Managing Director.                                                                                                           ….Opposite parties.

 

FOR THE COMPLAINANT:        Shri Vikas Bansal  Advocate                          

 

FOR OPP. PARTIES No.1&2 :    Exparte                    

 

FOR OPP. PARTIES No.3&4 :    Shri G.S.Shergill,  Advocate                    

 

FOR OPP. PARTY No.4     :       Shri G.S.Shergill, Advocate                     

 

 

Quorum

         

                   Sukhpal Singh Gill, President

K.C.Sharma, Member

Sarita Garg, Member

                 

 

 

ORDER:  

 

Sukhpal Singh Gill, President

 

1.             Parveen Rani, Anjali Rani, Naveen Goyal and Shakashi Rani, complainants have preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that being the being the account holder  of OPs No.1&2, husband of  complainant no.1 insured with OPs No.3&4 under cooperative Bank personal accident insurance scheme  for Rs.1,00,000/- . The husband of the  complainant died accidentally on 15.05.2013.  FIR No.41 dated 15.05.2013 was lodged at P.S.Cheema, District Sangrur and post mortem was conducted in Civil Hospital, Sangrur. The complainant being the beneficiary lodged the claim  and submitted all the relevant documents with OPs No.1&2 who further sent the same to Ops No.3&4. But the OPs No.3&4 repudiated the claim of the complainants on 18.02.2014 on the ground of delay in intimation and submission of documents late. The repudiation letter is wrong and illegal as  alleged condition  is not applicable  to the facts of the present case. Thus, alleging deficiency in service on the part of OPs, the complainants have sought following reliefs:- 

i)      OPs be directed to pay a sum of Rs.1,00,000/- along with interest @18% per annum from the date of death of insured till payment,  

ii)     OPs be directed to pay to the complainant a sum of Rs.50000/- as compensation   on account of mental agony, harassment and pay Rs.10000/- as litigation expenses.

2.             In reply filed by the OPs No.1&2, preliminary  objection on the ground of maintainability  has been taken up as deceased Happy Goyal was under the influence  of liquor at the time of alleged accident and the intimation was given after 104 days from the alleged death  and as such  there is violation of general policy  exclusion 8 (ii) as well as clause 11(a) of the policy.  On merits, it has been submitted that after getting the information the claim of the complainant was investigated  and during investigation as well as  from the post mortem report, it found that the deceased was under the influence of liquor  at the time of alleged accident. The complainant was  also asked to give reason for delay in intimation, but he failed to do so.

3.             In reply filed by OPs No.3&4, preliminary  objection on the ground of maintainability  has been taken up as deceased Happy Goyal was under the influence  of liquor at the time of alleged accident and the intimation was given after 104 days from the alleged death  and as such  there is violation of general policy  exclusion 8 (ii) as well as clause 11(a) of the policy. On merits, it has been submitted that after getting the information the claim of the complainant was investigated  and during investigation as well as  from the post mortem report, it found that the deceased was under the influence of liquor  at the time of alleged accident. The complainant was  also asked to give reason for delay in intimation, but he failed to provide the same and ultimately  the OP vide letter dated 18.02.2014  repudiated the claim of the complainant as per terms and conditions of the policy. Thus, there is no deficiency in service on the part of OPs No.3&4.

4.             The complainant has tendered documents Ex.C-1 to Ex.C-6 and closed evidence. On the other hand, OPs no.3&4 have tendered documents Ex.OPs3&4/1 to Ex.OPs3&4/6 and closed evidence.

5.             From the perusal of the file, we find that at the outset Shri Parveen Sharma, Advocate appeared on behalf of the OPs No.1&2 and filed written reply but thereafter neither he appeared nor produced any evidence on behalf of the OPs No.1&2 and ultimately on 11.01.2016, OPs No.1&2 were proceeded exparte.

6.             After hearing the arguments of learned counsel for the complainant and OPs No.3&4 and on perusal of the documents placed on record, we find that the husband of the complainant no.1 was insured for Rs.1,00,000/- under Cooperative Bank personal accident insurance scheme  with OPs No.3&4 as he was having a saving bank account with OPs No.1&2. The deceased policy holder died on 15.05.2013 due to an accident.  The complainants lodged the claim with OPs No.1 and 2 and the same was submitted to the OPs No.3&4 after processing the formalities and verifying the contents thereof but the OPs No.3&4 had repudiated the claim vide letter dated 18/02/2014 Ex.C-5 on the ground that the notice/ intimation was given after 104 days  of occurrence of loss which is more than one calendar month  and also Late Sh. Happy Goel  was under influence of alcohol, hence the claim is not admissible. Learned counsel for the OPs No.3&4 has vehemently argued that as per the terms and conditions of the policy the claimant should have submitted the claim within 30 days of the actual date of the accident.

7.             On carefully examining the terms and conditions of the policy, we find  that though the intimation was to be given in 30 days but then the company may condone the delay on merits of the claim subject to getting satisfied  that the delay in notification was due to reasons beyond the control of the insured/ insured person/ nominee”. In the present complaint, the insured died suddenly and the nominee had  submitted the claim and in such circumstances  it cannot be said that  the complainant/ nominee has submitted the claim with deliberate delay. Moreover, this condition does not even say that if the notice is not given within the stipulated period then the claim shall stand repudiated.  In support of his version learned counsel for the complainant has submitted the judgment of Hon’ble Tamilnadu  State Commission, Chennai delivered in case A.P. No.850/99 titled as  The Branch Manager, New India Assurance Company Limited Vs. Soosai, 2004(1) CLT 672, wherein it has been held that “ this condition does not say that if notice is not given within a month, the claim shall stand repudiated. On the other hand, it  would only require that  a notice to be given within a month after the event. It does not bar or state that failure to issue any notice within the prescribed period of one month would estop or eschew or prohibit anyone from making a claim. Even if there is such a condition, it cannot be upheld since it is unconscionable. The contract of insurance being one based upon honesty and good faith, such trivial technicalities cannot be allowed to sway the ultimate aim and goal of insurance. Therefore, we are unable to accept the contentions of the learned counsel for the  appellant and that the repudiation is justified on account of the proviso and the conditions”.

8.             The Ops have alleged that the complainant was under the influence of liquor  at the time of accident but they have not produced any cogent evidence to the effect that whether the complainant was heavy drunker  or he had taken some light healthy drink . In the absence of quantity of alcohol consumed by the complainant we are unable to  accept the version of the OPs that the accident occurred due to influence of liquor. Moreover the deceased was also not daily drunker, so we feel that it has no role in the cause of death.  

9.             So, in view of the above discussion made above, we find that the OPs No.3&4 are not only deficient in service but also indulged in unfair trade practice and has enforced the complainants to seek legal remedy in order to receive their rightful claim which has been supported by cogent evidence. The Hon’ble Punjab & Haryana High Court  in case tilted as New India Assurance Company Limited Vs. Smt. Usha Yadav and others 2008 (3) R.C.R. 9 ( civil) 111 has held that the insurance companies  are in the habit to take these type of projections to save themselves from paying the insurance claim. The Insurance companies are only interested in earning the premiums and find ways and means to decline claims.

10.           Further, the Hon’ble Supreme Court of India in Madras Port Trust Vs. Hymanshu International, (1979) 4 SCC 176 whereby, it deprecated the practice  often adopted by governmental and public authorities, of denying  just claims of citizens  on technical pleas, even though the claim lodged with them was otherwise well founded”. The relevant observations are extracted hereinbelow:-

“ ……2. We do not think that this is a fit case where we should  proceed to determine whether the claim of the respondent was  barred by Section 110 of the Madras Port Trust Act (II of 1905) . The plea  of limitation based on this Section is one which the court always looks upon with disfavour and it is unfortunate that a public authority like the Port Trust should, in all morality and justice, take up such  a plea to defeat  a just claim of the citizen.  It is high time that governments and public authorities adopt the practice of not relying upon technical  pleas for the purpose of defeating legitimate claims of citizens and do what  is fair and just to the citizens”. Here, it is obvious that the claim of the complainant was a just claim supported by the cogent and reliable evidence  of the complainant. Moreover, IRDA’s circular dated 20.09.2011, 14.4 clearly  says that genuine claims cannot be rejected on account of delay in intimation,  and that, the insurer’s decision to reject a claim must be based on “ sound logic” and “ valid grounds”. 

11.           In the light above facts, we allow the complaint against OPs No.3&4 and direct the OPs No.3&4 to pay a sum of Rs.100000/- being insured amount along with interest 9% per annum from the date of filing of complaint till realization. We further order the OPs No.3&4 to pay to the complainant a sum of Rs.10000/- on account of mental agony and harassment and also to pay a sum of Rs.5000/- as litigation expenses.

12.           This order of ours shall be complied with within 30 days from the receipt of copy of the order.  Copy of the order be supplied to the parties free of charge. File be consigned to records in due course.       

Announced

                February 11, 2016

 

 

 

( Sarita Garg)       ( K.C.Sharma)       (Sukhpal Singh Gill)                                                                                                                                     

             Member                Member               President

 

BBS/-