Haryana

Ambala

CC/73/2020

Sanjeev Kumar - Complainant(s)

Versus

SBI General Insurance Co ltd. - Opp.Party(s)

17 Nov 2021

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

 

                                                           Complaint case no.         :    73 of 2020

                                                           Date of Institution           :    09.03.2020

                                                           Date of decision              :    17.11.2021.

         

Sanjeev Kumar, aged about 35 years, son of Smt. Gita Rani, wife of Nand Lal, resident of # 354, Jogi Mandi, Ambala Cantt. (HR)

                                                                             ……. Complainant.

                                      Versus

1.       SBI General Insurance Co. Ltd., SBI Bank, Nicholson Road, Ambala Cantt., through its Branch Manager.

2.       SBI General Insurance Co. Ltd., 101, 201, 301 Natraj, Junction of Western-Express Highway & Andheri Kurla Road, Andheri East Mumbai-400069., through its Manager.

3.       Deputy Vice President, Claims Health SBI General Insurance Co. Ltd, 101, 201, 301, Natraj, Junction of Western-Express Highway & Andheri Kurla Road, Andheri East Mumbai 400069.

                                                                     ….…. Opposite Parties.

Before:        Smt. Neena Sandhu, President.

                   Smt. Ruby Sharma, Member,

Shri Vinod Kumar Sharma, Member.         

                            

Present:       Shri Ripanjit Singh, Advocate, counsel for the complainant.

Shri R.K.Vig, Advocate, counsel for the OPs.

 

Order:        Smt. Neena Sandhu, President

Complainant has filed this complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’) praying for issuance of following directions to them:-

1. To pay Rs.4,00,000/-, as compensation for the loss caused by the OPs.
2. To pay Rs.50,000/- as compensation for the mental agony and physical harassment suffered by the complainant.

OR

Any other relief which this Hon’ble Commission may deem fit.

 

2.       Brief facts of the case are that OPs are holding the work of General Insurance under SBI General Insurance Co. Ltd., having its head office at Mumbai and its branches throughout India including Ambala. Smt. Gita Rani w/o Nand Lal, mother of the complainant got insured with OPs, vide policy no. 143990 00001 and she appointed, complainant as her nominee in the said policy. Smt. Gita Rani suddenly expired on 05.05.2017 at Ambala Cantt and intimation to that effect was given to OPs. On 12.05.2017, OPs received the claim of the complainant and vide letter dated 14.06.2017,  asked the complainant to provide the following documents:-

1. Written intimation of claim.
2. Duly filled and signed claim form attested by authorized SBI Official.
3. Original certificate of insurance.
4. Copy of death certificate attested by issuing authorities.
5. Copy of FIR/MLC Copy/spot panchnama/inquest panchnama attested by issuing authorities.
6. Copy of Final Police Report attested by issuing authorities.
7. Copy of post mortem report attested by issuing authorities.
8. Affidavit from the legal heirs of the deceased (in case nomination has not been filed by deceased).
9. For NEFT payment please provide copy of cancelled cheque of nominee or copy of front page of bank passbook or letter from Bank confirming the account details of nominee with IFSC/MICR details.
10. Copy of photo ID & address proof of the nominee as per address mentioned in claim form. 

The above said documents were supplied to the OPs, for sanctioning the claim. Vide letter dated 18.07.2017, OPs demanded other documents mentioned below:-

1. Copy of FIR/MLC copy/spot Panchnama/inquest Panchnama attested by issuing authorities.
2. Copy of Final Police Report attested by issuing authorities.
3. Copy of post mortem report attested by issuing authorities.
4. Duly filled and signed central KYC Registry Form fill up by nominee as attached.
5. Aadhar Card and pan card copy of nominee. 

Complainant informed the OPs that death of Gita Rani was a sudden death, as such, no FIR was got registered and postmortem of dead body was not required to be conducted. As required by the OPs, complainant completed all the formalities.  After submission of requisite documents with the OPs, complainant contacted the OPs and enquired about his claim but they remained silent. He also served a legal notice dated 15.01.2018, upon the OPs, for settlement of his claim. However, OPs vide letter dated 31.07.2018, repudiated his claim. Complainant requested the OPs for reconsideration of his claim but they refused to do so. Due to unprofessional and dissatisfactory conduct of OPs, complainant suffered a lot of mental agony and physical harassment. Hence, the present complaint.

3.           Upon notice, OPs appeared and filed written version, raised preliminary objection with regard to maintainability etc. On merits, it is stated that the claim lodged by complainant on 12.05.2017, carefully perused and noted that Geeta Rani died due to illness and not due to accident, as such, it was a natural death. From the documents, death of the insured due to accidental injuries, could not be established and death due to medical illness is not covered under the policy, thus, the claim was rightly repudiated by answering OPs, vide letter dated 31.07.2018.  Rest of the averments of the complainant were denied by OPs and prayed for dismissal of the complaint with heavy costs.

4.           Complainant tendered his affidavit as Annexure CA alongwith documents Annexure C-1 to C-10 and closed the evidence.  On the other hand, learned counsel for the OPs tendered affidavit of Shri Jitendra Dhabhai, Authorized Signatory, # SBI General Insurance Company Limited, 101, Natraj Junction of Western Highway & Andheri, Kurla Road, Andheri East, Mumbai as Annexure OP-1/A along with documents Annexure OP-1/1 to OP-1/22 and closed the evidence on behalf of OPs.

5.           We have heard learned counsel for the parties and have also gone through the record very carefully.

6.           The learned counsel for the complainant submitted that the claim lodged by the complainant, being nominee was wrongly repudiated by the OPs, vide letter dated 31.07.2018, Annexure OP1/20. On the contrary, the learned counsel for the OPs submitted that the OPs have rightly repudiated the claim because the insured died due to illness/natural cause and not due to accidental injuries, as such, not covered under the policy.

7.           Admittedly, Smt. Geeta Rani was insured under the Group Personal Accident Insurance Policy, with the OPs, for the period of one year from 13.08.2015 and complainant was the nominee. From the death certificate Annexure C-4, it is evident that Smt. Gita Rani died on 05.05.2017 i.e. during the subsistence of the policy. In the medical certificate-to be filled by treating doctor, Annexure C-2, medical officer stated that as per record, patient Geeta Rani, Age 52/F, wife of Nand Lal was brought dead to the Civil Hospital, Ambala Cantt., at 2:50 PM, on 05.05.2017 and Sanjeev Kumar (son) and Saroj (daughter-in-law) of the deceased gave statement for not conducting the post-mortem. In the letter dated 11.08.2017, complainant stated that his mother Smt. Gita Rani died on 05.05.2017, due to fall from the motorcycle. Neither the FIR was got registered with the police nor post-mortem got conducted. His mother died naturally and not due to accident. No such document has been placed on record by the complainant to prove that his mother died due to accident. Taking all these facts and circumstances into consideration, we do not hesitate to conclude that the complainant has failed to prove his case and the complaint filed by him is liable to be dismissed.

              In view of the aforesaid discussion, we hereby dismiss the present complainant, being devoid of merits. The parties are left to bear their own costs. Certified copy of this order be supplied to the parties, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

          Announced on: 17.11.2021.

 

 

 

 

          (Vinod Kumar Sharma)        (Ruby Sharma)                   (Neena Sandhu)

              Member                             Member                            President