Charanjit Singh, President;

1        The complainants have filed the present complaint by invoking the provisions of Consumer Protection Act under Section 34, 35 and 36  of the Consumer Protection Act (herein after called   as 'the Act') against the opposite party by alleging that the complainant No. 1 is widow of deceased Ranjit Singh and complainant No.2  his mother and complainant Nos. 3 and 4 are daughter and son of Late Ranjit Singh who had availed SBI General’s Personal Accident Insurance policy of the opposite party with policy No. 24458422 and certificate No. 76711465 and which was valid from 29.9.2021 to 28.9.2022(wrongly written as 28.9.2021). The deceased Ranjit Singh had paid insurance premium of Rs. 500/- to the opposite party and the opposite party gave insurance cover of Rs. 10 Lakh qua the above mentioned policy to the deceased Ranjit Singh and he nominated Sulakhan Singh his father as nominee in the policy and Sulakhan Singh has already died. Unfortunately, Ranjit Singh died in a road side accident near his residence and his dead body was obtained by his family without getting post mortem of the body and also did not lodge any Rapat / FIR etc.  with the local police regarding the incident of road accident in which Ranjit Singh died due to lack of legal knowledge and consequences. After the death of Ranjit Singh, the complainants lodged an insurance claim with the opposite party to obtain the insurance cover of Rs. 10 Lakh from this party and also supplied death certificate of the deceased Ranjit Singh and also supplied the proofs of the complainants being legal heirs of the deceased and the opposite party assured the complainants that the insurance cover of Rs. 10 Lakh will be released to them in a fortnight.  Inspite of awaiting for more than a fortnight the complainant approached the opposite party through its local representative and inquired about the status of the claim case but this representative did not respond to the inquiry of the complainants and again told the complainants to wait for same more period for getting the claim, so they again awaited for a long time for the claim amount. The complainants have prayed the following relieves.

1. The opposite parties may kindly be directed to release the insurance claim amount of Rs. 10,00,000/- to the complainant.
2. The opposite parties may kindly be directed to pay compensation of Rs. 50,000/- alongwith litigation expenses of Rs. 50,000/- to the complainant.

Alongwith the complaint, the complainants have placed on record his affidavit Ex. C-1 alongwith documents i.e. self attested copy of death certificate Ex. C-2, Self attested copy of Adhar Card of the complainant No. 1 Ex. C-3, Self attested copy of Adhar Card of the complainant No. 2 Ex. C-4, Self attested copy of Adhar Card of the complainant No. 3 Ex. C-5, Self attested copy of Ahdar Card of the complainant No. 4 Ex. C-6. Self attested copy of Bank Statement Ex. C-7 and tendered in additional evidence document i.e. Insurance Policy Ex. C-8)

2        Notice of this complaint was sent to the opposite party and the opposite party appeared through counsel and filed written version by interalia pleadings that the present complaint is legally not maintainable and is liable to be dismissed, as the opposite party has not issued any policy bearing No. 24458422 or certificate No. 76711465 as alleged in Para No. 1 of the complaint nor any claim with respect to alleged policy has ever lodged by the complainants with the opposite party. As per record no policy bearing No. 24458422 has been found with the opposite party, therefore, the present complaint is liable to be dismissed.  The complainants have not filed the copy of policy alongwith  the complaint or any document has been supplied to trace out the policy, therefore, the opposite party reserves its right to amend the written statement as and when any copy of policy is provided or any correct number of the policy is provided. There is no deficiency of service or unfair trade practice on the part of Opposite Party invoking the jurisdiction of this Commission. Opposite Party processed the claim of the Complainants only after due perusal of all documents received and within the precincts of terms and conditions of the Policy. Hence the present complaint deserves to be dismissed in limine for want of cause of action. Keeping in view the facts, circumstances and law relating thereto the complainants have failed to produce any evidence or specific averments worth its salt to prove its claim admissible under the terms and conditions of the Insurance Policy. Therefore, the instant complaint is liable to be dismissed at the threshold. An insurance contract has following four essential ingredients, insofar as to claim indemnification there under:

i) Utmost good faith,

ii) Insurable interest,

iii) Valid consideration,

iv) Actual damages.

Unless all the above requirements are met with, insured cannot seek any indemnification from the Insurer. The complainants herein is guilty of violation of the sad ingredients and does not deserve any indulgence of this Commission. The instant complaint is a gross abuse of the process of law and the complainants have approached this Commission with unclean hands and has suppressed material facts and as such, this complaint is liable to be dismissed on this very ground. In view of aforementioned facts, it is submitted that the captioned complaint is frivolous, vague and vexatious in nature and there has been no ‘Unfair Trade Practice’ or ‘deficiency of service’ on the part of the opposite party. The captioned complaint has been made to injure the interest and reputation of the opposite party and therefore, the instant complaint is liable to be dismissed in liminie. The complainant has concealed the true and material facts from the knowledge of this commission, therefore, he is not entitled for any relief. The present complaint has been field without any cause of action against the opposite party, therefore the present complaint is liable to be dismissed.  The complainants are estopped by their own act and conduct from filing the present complaint. The complainants have no locus standi to file the present complaint.  The passbook pages attached with the complaint copy having no account details of the insured/ complainant. As submitted above o policy particulars or copy of policy has been provided by the complainants to the opposite party, moreover, the policy bearing No. 24458422 as mentioned in this claim has not been issued by the opposite party to the insured, therefore, present complaint being vague and false is liable to be dismissed. No date, place, title of alleged accident has been mentioned in the complaint, even nature of the accident has not been given, moreover,  (i) the complainants admit themselves that no PMR, no FIR, no DDR has been registered and the complainants have not filed even a single document to show that the death caused in alleged accident. In absence of documents, it cannot be said that alleged death caused in the alleged accident, therefore, the present complaint being vague and devoid of any merit is liable to be dismissed. The opposite party has denied the other contents of the complaint and prayed for dismissal of the same. Alongwith the written version, the opposite party has placed on record affidavit of Jitendra Dhabhai Manager Legal Ex. OP1, Self attested copy of authority letter Ex. OP-2

3        We have heard the Ld. counsel for the complainants and opposite party and have carefully gone through the record.

4        The case of the complainants is that Ranjit Singh predecessor in interest of complainants availed SBI General’s Personal accident insurance Policy of opposite party with policy No. 24458422 and policy is effective from 29.9.2021 to 28.9.2022 vide Ex. C-8 and during the period of insurance, Ranjit Singh has died in road side accident on 19.12.2021 vide death certificate Ex. C-2 and the complainants requested the opposite party for death claim of Ranjit Singh but the opposite party has not given the death claim to the complainants so far. On the other hands, the case of the opposite party is that the complainants have not filed the copy of policy alongwith the complaint nor any document has been supplied to trace out the policy. Perusal of file shows that neither the complainants nor the opposite party have placed on record repudiation letter in this case and the present case has not been decided so far by the insurance company.

5        From the perusal of the file, neither the complainants nor the opposite party has placed on record any document i.e. repudiation letter which reveals that the claim of the complainants have been decided on merits. Infact the claim has not been decided so far and the same is still pending.  In case Balu Waman Kadam vs. ICICI Lombard General Insurance Co. IV (2013) CPJ 16A (CN) (Mah.), the matter was similar, wherein the Insurance Company was asking the complainant to submit the documents again and again and the complainant was alleging that he had already submitted the requisite documents to the Insurance Company. In such circumstances, the Hon’ble State Consumer Disputes Redressal Commission Maharashtra disposed of the matter, by directing the Insurance Company to reconsider the claim of the complainant within one month on receipt of the required documents from the complainant. 

6        While relying upon the above said authority, the Hon’ble State Commission, Punjab, Chandigarh passed the similar orders in case M/s Trends, through its Proprietor vs The Oriental Insurance Company Limited & Anr. Consumer Complaint No.245 of 2015 decided on 04.08.2017; and M/s Gurbir Rice Mills v. United India Insurance Company Ltd. & Ors. Consumer Complaint No.404 of 2016, decided on 09.10.2017, directing the Insurance Company to reconsider the claim of the complainant after submission of requisite documents by the complainant to it. 

7        In view of our above discussion as well as keeping in view the ratio of above said judgments, we are of the opinion that the ends of justice would be met, if the Insurance Company be directed to decide the claim of the complainants, after the complainants submit all the requisite documents.  However, the opposite party has not mentioned in the written version that which documents are to be submitted by the complainants to the opposite party.

8        In view of the above discussion, the present complaint is disposed of with the following directions

(a)               The opposite party will submit the list of requisite documents to the complainants within 15 days from the date of receipt of copy of this order.

(b)               The complainants will submit the claim with requisite documents to the opposite party -Insurance Company for deciding the claim within a period of further one month and on approaching the complainants for supplying the requisite documents, the opposite party will issue proper receipt acknowledging the same.

(c)               The opposite party shall decide the claim of the complainants within a further period of two months therefrom

In case of failure on the part of the opposite party the claim case of the complainants deemed to have been accepted.  Copies of the order be furnished to the parties as per rules. File is ordered to be consigned to the record room.

Announced in Open Commission

22.11.2024