Haryana

Karnal

CC/396/2021

Raj Rani - Complainant(s)

Versus

SBI General Insurance Company Limited - Opp.Party(s)

Chander Mohan Sharma

06 Mar 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 396 of 2021

                                                        Date of instt.10.08.2021

                                                        Date of Decision:06.03.2023

 

1.     Raj Rani wife of Shri Roshan Lal.

2.     Rohan Bhaiwan son of Shri Roshan Lal.

3.     Muskan daughter of Shri Roshan Lal.

4.     Simran daughter of Shri Roshan Lal

        All residents  of village Ranwar, District Karnal.

 

                                               …….Complainants.

                                              Versus

 

1.     SBI General Insurance Company Limited, Branch Office, Sector-12, Karnal, through its Branch Manager.

2.     SBI General Insurance Company Limited 3^rd and 4^th floor, Lotus Park, Road no.16, plot no.B-8-19, Wagle Industries Estate, Thane (W) Thane-400604 through its Chairman/authorized signatory.

                                                                      …..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary……Member

          

 Argued by: Shri S.K. Buchkal, counsel for the complainants.

                    Shri Naveen Khetarpal, counsel for the OPs.

 

                    (Jaswant Singh President)

ORDER:   

                

                The complainants have filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that Shri Roshan Lal husband of complainant no.1 had purchased a General Insurance Master Policy no.1750650000, vide certificate no.49447384, which was valid for 20.06.2018 to 19.06.2019 for which the deceased paid a sum of Rs.500/- towards the annual premium and the terms of the policy was one year and he has appointed the complainant no.1 as nominee in the said policy. In this eventuality, the installment of the premium is to be paid in the month of June, 2020. On 10.05.2019, the policy holder Roshan Lal (now deceased) fell down from the stairs of his house on the pucca floor and he received the serious injuries on his head and skull and others parts of his body and he died due to these injuries. Immediately after the incident/accident Roshan Lal was taken to the Civil Dispensary Sector-6, Karnal, for the treatment. The doctor of the above hospital examined the patient Roshan Lal and started treatment but he could not be saved and he died on the same day. After examination the patient Roshan Lal, the doctor who examined the patient has categorically mentioned that there was a lacerated wound present at the skull with fresh bleeding/head injury. The medical officer of Civil Dispensary, Sector 6, Karnal also issued on Out Patient Health Care Card, vide CR no.6879 dated 10.05.2019. Unfortunately, his post mortem could not be conducted as the complainants did not know whether the PMR was necessary and his body was cremated. Complainant no.1 submitted a claim with insurance company i.e. OP on 16.07.2019 and the necessary documents i.e. claim form, Aadhar card, death certificate, out patient health care card dated 10.5.2019, certificate issued by the Medical Officer, Civil Dispensary, Karnal etc. in the office of the OP no.1. The officer of the OPs assured the complainants that the claim will be settled and a cheque/DD of the sum insured i.e. Rs.10 lacs will be sent at the address of the complainants but OPs did not settled the claim after repeated requests and visits. Lastly, complainants received a letter dated 30.06.2020 from the OPs, vide which the claim of the complainants has been repudiated by the OPs on the false and frivolous ground. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability and concealment of true and material facts. On merits, it is pleaded that on receipt of intimation regarding death of Shri Roshan Lal, OP deputed an independent investigator namely Elevate Detectives to investigate the matter and collect the documents, who after investigation, recording of statement of witnesses/complainants and collection of documents, submitted his report on 31.08.2019. By the facts, documents and investigation report it has come to know that death of insured Roshan Lal is claimed to be true to injuries sustained after fall from stairs at home.  However, there is lack of any documentary evidence like police reports, postmortem examination reports or diagnostic reports, which could prove the claim cause of death. Investigator submitted certificate from medical officer of Civil Dispensary establishing that there is no outpatient treatment record of insured available and earlier outpatient treatment certificate was issued only on request of relatives of insured. Statement of Anganwari persons and village Sarpanch were also recorded, which confirmed that Shri Roshan Lal died due to heart attack. Thus, it is clearly established that complainants have tried to defraud the company by submitting the fake documents for undue financial gains from OP, hence the claim of the complainants was rightly repudiated, vide letter dated 30.06.2020. There is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for complainants has tendered into evidence affidavit of complainant no.1 Ex.CW1/A, copy of Aadhar card of complainant Ex.C1, copy of Aadhar card of Rohan Ex.C2, copy of Aadhar card of Muskan Ex.C3, copy of Aadhar card of Simran Ex.C4, copy of payment acknowledgement slip Ex.C5, copy of out patient health care card Ex.C6, copy of certificate issued by Medical Officer, Civil Dispensary Sector-6, Karnal Ex.C7, original death certificate of Roshan Lal Ex.C8, copy of letter dated 30.06.2020 written by OPs Ex.C9 and closed the evidence on 31.05.2022 by suffering separate statement.

6.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Jitender Dhabhai, Deputy Manager Ex.RW1/A, copy of investigation report Ex.R1, copies of letter dated 16.02.2020 and 05.12.2019 by OPs to complainants Ex.R2 and Ex.R3, copy of repudiation letter dated 30.06.2020 Ex.R4, copy of claim form Ex.R5, copy of personal accident insurance cover confirmation Ex.R6 and closed the evidence on 05.08.2022 by suffering separate statement.

7.             We have heard the learned counsel of the parties and perused the case file carefully and have also gone through the evidence led by the parties.

8.             Learned counsel for complainants while reiterating the contents of complaint, has vehemently argued that Roshan Lal (since deceased) had purchased a General Insurance Master Policy during his life time. Roshan Lal fell down from the stairs of his house and received the serious injuries and he died due to these injuries. Complainants lodged the claim with the OPs but OPs repudiated the claim of the complainants, vide letter dated 30.06.2020 on the false and frivolous ground and lastly prayed for allowing the complaint.

9.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that as per the investigation report Roshan Lal died due to heart attack at his home not died as alleged by the complainants and prayed for dismissal of the complaint with heavy costs.

10.           We have duly considered the rival contentions of the parties.

11.           The onus to prove their case was relied upon the complainants but complainants have failed to prove their case by leading any cogent and convincing evidence. The case of the complainants is based upon the out patient health care card Ex.C6 and certificate Ex.C7. In certificate Ex.C7, relatives and attendants of the deceased were advised by the Medical Officer Civil Dispensary, Sector-6 Karnal for the postmortem at higher centre but they failed to get the postmortem upon the body of deceased to prove the exact cause of death. Rather, the case was investigated by the investigator of the OPs and during the investigation, the statement of Sarpanch and other Neighbourers were recorded and as per their statements, Roshan Lal insured died on 10.05.2019 due to heart attack at his home.

12.       In view of the above discussion, the present complaint is devoid of any merits and same deserves to be dismissed and same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:06.03.2023                                                                      

                                                                  President,

                                                       District Consumer Disputes

                                                       Redressal Commission, Karnal.

 

(Vineet Kaushik)           (Dr. Rekha Chaudhary)

                     Member                        Member