BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 163 of 2014
Date of Institution : 26.11.2014
Date of Decision : 16.8.2016
Smt.Karamjeet Kaur, aged about 27 years wife of late Sh.Sukhpal Singh, r/o village Phaggu, Tehsil and District Sirsa..
….Complainant.
Versus.
- SBI General Insurance Company Ltd., 101,201, 301, Natraj Junction of Western express Highway and Andheri Kurla Road, Andheri East, Mumbai-400069 through its Managing Director.
- State Bank of Patiala, Kalanwali, distt.Sirsa through its Branch Manager.
….Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SHRI S.B.LOHIA…………………PRESIDENT
SHRI RANBIR SINGH PANGHAL……MEMBER.
Present: Sh.T.M.Singh, Advocate for the complainant.
Sh.R.K.Mehta, Advocate for opposite party no.1
Sh.S.L.Sachdeva, Advocate for opposite party no.2
ORDER
Complainant case is that Sh.Sukhpal Singh, husband of complainant had taken a loan from Op bank and op bank had issued a insurance policy of Rs.4,00,000/- vide policy no. 137715-0000-00 to the husband of complainant on 29.7.2013 for a period of one year. On 26.2.2014, husband of the complainant met with an accident and ultimately died on the same day. He was taken to PHC Kalanwali from where he was referred to general hospital, Sirsa, but he was taken to Bombay Care Multi Speciality hospital, Sirsa where he died. FIR was not recorded because the doctor concerned of the hospital had not sent a ruqa to the police station. The fact of accident was well known to all and the same was also published in newspaper. Being nominee, complainant lodged her claim with the Os on16.2.2014, but Ops have not paid heed to the request of the complainant and further Ops are not ready to pay the insured amount. Hence, this complaint.
2. On notice, Ops appeared and contested the case by filing their written version that the deceased life assured got Master Accident Master Policy which was effective from 29.7.2013 to 28.7.2014 subject to terms and conditions of the policy. On receipt of information about the death of Sukhpal Singh, the complainant was informed to submit the relevant documents within 15 days from the date of receipt of letter, but she did not submit the same despite reminders issued by Ops. Since the complainant failed to submit the requisite documents including the death certificate of life assured alongwith scanning report of Sarsa Imaging Centre, Claim form, indoor case paper of hospitalization, FIR/Police report, MLC, Post Mortem report, therefore, the claim of complainant was closed.
3. By way of evidence the complainant has produced her affidavit Ex. CW1/A, legal notice Ex.C1, postal receipt Ex.C2, affidavit of one Jaspal Singh Ex.CW2/A, acknowledgement Ex.C3, copy of letter dt. 16.4.2014 Ex.C4, postal receipt Ex.C5, policy Ex.C6, prescription of doctor Ex.C7, copy of pass book Ex.C8, voter card Ex.C9, copy of newspaper Ex.C10, receipt dt. 26.2.2014 Ex.C11, NCCT Head report Ex.C12, Ex.C14, death certificate Ex.C13 and copy of PHC, Kalanwali register Ex.C15. Whereas the Ops produced affidavit of Branch Manager Ex. R1, affidavit on behalf of op no.2 Ex.R2, claim summary Ex.R3 and Ex.R4, letters dt. 9.4.2015 Ex.R5 to Ex.R10, policy Ex.R11 and Ex.R12, copy of legal notice Ex.R13 and reply Ex.R14.
4. We have gone through the record of the case carefully and have heard learned counsels for the parties.
5. The issuance of policy in question in favour of deceased Sukhpal Singh is an admitted fact. However, as per the version of Ops, relevant papers for settlement of the claim have not been submitted by the complainant despite of repeated reminders and her claim case was closed. There is no deficiency on the part of Ops. On the other hand, as per complainant’s case, initially deceased Sukhpal Singh was taken to PHC Kalanwali from where he was referred to GH, Sirsa and this fact is clear from Ex.C15 which is a photo copy of patient register maintained by PHC, Kalanwali. The FIR could not be recorded because the doctor of PHC Kalanwali or the doctor of Bombay Neuro Multi Speciality hospital have not sent ruqa to the police. As the condition of deceased Sukhpal Singh was very serious and he was having head injury besides the above injuries, he was taken to a pvt. Hospital for a better treatment instead of Govt. hospital, Sirsa. In the Pvt. Hospital, Sukhpal Singh died on the same day. The fact of accident is proved on record from the various treatment papers Ex.C7 and laboratory report Ex.C12. Further as per the version of the complainant, after death, body of the deceased was taken to village where he was criminated and no post mortem was got done. The fact of accident is well known to all and it was also published in a newspaper, copy of which is Ex.C10. After hearing both the sides, we are of the considered view that death of Sukhpal Singh has been clearly proved on the record through various documents. The fact of death in accident has also not been denied by the Ops. Ld. counsel for the complainant also cited case law 2014 ACJ 469 (Madras) titled Ambazhagan and others Vs. V.Shankar and another.
6. As a result of above discussion, we are of the considered view that Ops cannot deny the death claim of the complainant only for want of FIR and post Mortem report. Accordingly, we partly accept the present complaint and Ops are directed to settle the claim of the complainant on the basis of other documents of treatment, death certificate etc. and in the absence of FIR and Post Mortem report within a period of three months from today. Complainant is also directed to submit the relevant documents of treatment and other evidence regarding the accidental death of the deceased Sukhpal Singh alongwith duly filled in claim form and original policy to the Ops within 15 days from today. Copy of this order be supplied to the parties as per rules. File be consigned to record room after due compliance.
Announced in open Forum. President,
Dated: 16.8.2016 Member District Consumer Disputes
Redressal Forum, Sirsa.
