DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BARNALA, PUNJAB.

 

Complaint Case No : CC/203/2019

Date of Institution : 15.11.2019

Date of Decision : 10.08.2020

Avtar Singh aged about 35 years son of Late Gurdev Singh, resident of Patti Asha, Near Gurudwara Sahib, Village Jodhpur, District Barnala.                              …Complainant

Versus

1. SBI General Insurance Company Limited (Accident and Health Claims Team), Corporate and Registered Office: Natraj, 101, 201, 301, Junction of Western Express Highway and Andheri Kurla Road, Andheri (East), Mumbai-400069 through its Managing Director/Authorized Signatory. 

2. State Bank of India, Branch Cheema Jodhpur, Near Bus Stop and Government School, Village Cheema, District Barnala through its Branch Manager.  

…Opposite Parties

Complaint Under Consumer Protection Act.

Present: Sh. GP Singh counsel for complainant. 

Sh. AK Jindal counsel for opposite party No. 1.

Sh. Vinod Goel counsel for opposite party No. 2.

Quorum.-

1. Sh. Kuljit Singh : President

2. Sh. Tejinder Singh Bhangu : Member

(ORDER BY KULJIT SINGH, PRESIDENT):

    The complainant namely Avtar Singh has filed the present complaint under the Consumer Protection Act (as amended up to date)  against SBI General Life Insurance Company Limited, Mumbai and another. (in short the opposite parties). 

2. The facts leading to the present complaint as stated by the complainant are that the mother of the complainant namely Surjeet Kaur got opened one Bank Account No. 35870349857 in opposite party No. 2 branch. He further submitted that under the insurance scheme of opposite parties the amount of Rs. 500/- as premium was taken by the opposite party No. 2 on behalf of opposite party No. 1 from the deceased Surjeet Kaur for her insurance for the period from 1.7.2016 to 30.6.2017 for sum insured of Rs. 10,00,000/- under Group Personal Accident Master Policy No. 150420-0000-00 Certificate No. 44419782 issued by opposite party No. 1 having business concern with the opposite party No. 2.  

3. It is further alleged that on 26.10.2016 the wife of complainant namely Gagandeep Kaur and deceased were working in the house and at about 6.00 PM when deceased in order to cook tried to start the stove then suddenly a blow came out of stove due to which the upper part of the body of the deceased caught fire and she fell upon the stove. Then complainant and his wife arranged a vehicle and got admitted the deceased in Civil Hospital Barnala who referred her to Government Medical College and Hospital, Sector 32, Chandigarh but the deceased died on 6.11.2016 at the said hospital. The postmortem was conducted by Dr. Guarav Kumar vide postmortem report dated 7.11.2016. Further, regarding the said accident General Diary No. 22 dated 27.10.2016 was recorded at Police Station Barnala at the instance of complainant and proceedings under Section 174 Cr.PC were conducted by the police and report was finally sent to SDM Barnala which was allowed by SDM Barnala vide order dated 11.8.2017. 

4. It is further alleged that after the death of Surjeet Kaur the complainant being nominee moved the claim form with the opposite parties to take the insurance claim amount of Rs. 10,00,000/- regarding the death of deceased vide SBI General Claim No. 343094 under the said policy. The complainant also submitted attested copies of General Diary Details, Postmortem report, death certificate etc with the opposite parties but despite that insurance claim of the complainant was rejected by the opposite party No. 1 vide letter dated 27.10.2017 under the false pretext of non receipt of documents within the stipulated time period whereas claim cannot be denied on the basis of insurance policy, which amounts to deficiency in service and unfair trade practice on the part of the opposite parties. The complainant further submitted that he already filed a complaint before this Commission the then Forum which was disposed of by this Commission the then Forum vide order dated 19.8.2019 with the direction to the complainant to submit the necessary documents with the opposite party No. 1 and accordingly the complainant submitted the necessary documents with the opposite party No. 1 vide letter dated 28.8.2019 through registered post but the opposite party No. 1 has not settled the claim of the complainant within the stipulated period. Hence, the present complaint is filed seeking the following reliefs.-

1) The opposite parties may be directed to pay the insurance claim of Rs. 10,00,000/- alongwith up to date interest to the complainant on account of accidental death of Surjeet Kaur. 

2) To pay Rs. 30,000/- on account of compensation for mental and physical agony and harassment.             

3) To pay Rs. 10,000/- as litigation expenses.  

4) Any other relief which this Commission deem fit.  

5. Upon notice of this complaint, the opposite party No. 1 filed written version taking legal objections interalia on the grounds of that appropriate remedy of present complaint is civil court. Further, they objected the present claim on the ground of concealment of material facts as the complainant did not submit the requiring documents and did not provide information for processing of claim. The answering opposite party sent letters dated 13.2.2017, 28.2.2017 and 15.3.2017 calling upon the applicant to submit the copies of General Diary/FIR/MLC Copy/Spot Panchnama/ Inquest papers attested by some police authorities, copy of final investigation report, copy of postmortem report, copy of indoor case papers but he did not submit the said documents nor provided the information within the stipulated time period as per terms and conditions of policy so the claim was rejected vide letter dated 27.10.2017. The complainant also not supplied the said documents even after the decision of the earlier complaint and even not supplied the said documents in the Commission through counsel. Further, complainant is not the consumer of opposite party and no    cause of action and locus standi to file the present complaint and complaint also not maintainable.  

6. On merits, it is submitted that complaint regarding opening of account, deduction of premium and coverage under the scheme is matter of record. However, the said insurance is subject to terms and conditions of the policy. It is admitted that claim was lodged by the complainant. The opposite party sent many letters to the complainant to submit the documents and provide information so that claim could be decided as per terms and conditions of the policy but he failed to submit the same so his claim was rejected vide letter dated 27.10.2017. Rest of averments of the complaint are denied by the opposite party No. 1 and lastly prayed for submission of documents and claim may be decided as per terms and conditions of the policy. 

7. The opposite party No. 2 also filed written reply taking legal objections on the grounds that complaint is not maintainable against opposite party No. 2, estoppal and complaint filed by nominee and not by LRs.

8. On merits, it is admitted that deceased Surjeet Kaur was holder of account bearing No. 35870349857 with the opposite party No. 2 and on her request she got personal Accidental Insurance Master policy from the opposite party No. 1 and premium of the said policy was transferred to the opposite party No. 1 from her account. The opposite party No. 1 is not the sister concern of opposite party No. 2. It is also admitted that opposite party No. 1 issued certificate No. 44419782 regarding policy valid from 1.7.2016 to 30.6.2017 in favour of Surjeet Kaur deceased. Rest of the averments of the complaint are denied by the opposite party No. 2. No evidence regarding occurrence or burnt is filed by the complainant. Further, complainant has not filed any NOC from other LRs of Surjeet Kaur that they will not claim their share if claim is allowed in favour of complainant. Lastly, they prayed for the dismissal of the present complaint against the opposite party No. 2.

9. In support of his complaint, the complainant tendered into evidence his own affidavit Ex.C-1, copy of General Dairy Details No. 22 dated 6.11.2016 Ex.C-2, copy of General Dairy No. 21 dated 7.11.2016 Ex.C-3, copy of police report dated 11.11.2016 Ex.C-4, copy of police report dated 22.3.2017 Ex.C-5, copy of police report dated 15.4.2017 Ex.C-6, copy of order of SDM Barnala Ex.C-7, copy of death certificate of Surjeet Kaur Ex.C-8, copy of postmortem report Ex.C-9, copy of closure report dated 27.10.2017 Ex.C-10, copy of Aadhaar Card of complainant Ex.C-11, copy of claim form Ex.C-12, copy of order dated 19.8.2019 Ex.C-13, copy of letter dated 28.8.2019 Ex.C-14, copy of postal receipt Ex.C-15 and closed the  evidence.   

10. To rebut the case of the complainant, the opposite party No. 1  tendered into evidence copy of letter dated 29.10.2018 Ex.OP-1/1, copy of letter dated 13.2.2017 Ex.OP-1/2, copy of letter dated 28.2.2017 Ex.OP-1/3, copy of letter dated 15.3.2017 Ex.OP-1/4, copy of letter dated 27.10.2017  Ex.OP-1/5, copy of letter dated 3.9.2019 Ex.OP-1/6, copy of postal receipt  Ex.OP-1/7, affidavit of Jagdish Kumar Ex.OP-1/8 and closed the evidence.  The opposite party No. 2 tendered in evidence affidavit of Tej Narayan Sahu Ex.OP-2/1 and closed the evidence.

11. We have heard the learned counsel for the parties and have gone through the record.

12. It is admitted case of the complainant that Surjeet Kaur was having a bank account with the opposite party No. 2 and he purchased a Personal Accidental Insurance Master Policy from the opposite party No. 1, the premium of which was transferred to opposite party No. 1 through opposite party No. 2.  It is also admitted by the opposite party No. 2 that opposite party No. 1 issued Certificate No. 44419782 vide letter dated 29.10.2018 Ex.OP-1/1 to the deceased Surjeet Kaur in regard of Personal Accident Insurance Policy for a sum of Rs. 10,00,000/- for the period from 1.7.2016 to 30.6.2017 and nominee name in the policy is of the complainant Avtar Singh. It is not denied by the opposite parties that said deceased Surjeet Kaur died on 6.11.2016 during the validity of the insurance policy, which fact is also proved from copy of death certificate of Surjeet Kaur Ex.C-8. 

13. Further, the opposite party No. 1 also not specifically denied that deceased Surjeet Kaur died in an accident. From the copies of police authorities documents and order of SDM Barnala Ex.C-2 to Ex.C-7 and copy of Postmortem report Ex.C-9 it is proved on the file that deceased Surjeet Kaur on 26.10.2016 making food on the stove and suddenly caught fire due to high blow of fire from the stove due to which she was taken to Civil Hospital, Barnala where from she was referred to Rajindra Hospital, Patiala from where she was referred to GMCH, Sector 32, Chandigarh and during the course of treatment she died on 6.11.2016 within the validity period of the policy. So, it is proved on the file beyond any doubt that Surjeet Kaur deceased died due to personal accident of caught fire. 

14. It is admitted by the opposite party No. 1 that complainant lodged the claim with them but they repudiated the same vide letter dated 27.10.2017 Ex.C-10 due to non supply of required documents and information to process of the claim. It is also admitted by the opposite party No. 1 that complainant also filed a previous complaint before this Commission the then Forum in which complainant was directed to submit the documents but even then he did not submit the required documents and information with the opposite party No. 1 to process the claim. Even after the decision of that complaint opposite party No. 1 written a letter to the complainant dated 3.9.2019 Ex.OP-1/6 to submit some documents but complainant has failed to submit the required documents. On the other hand, the complainant submitted in his affidavit Ex.C-1 that after the decision of the earlier complaint on 19.8.2019 in which he was directed to submit the necessary documents with the opposite party No. 1 within the stipulated period, then in compliance of that order of this Commission the then Forum the complainant submitted the necessary documents with the opposite party No. 1 vide letter dated 28.8.2019 Ex.C-14 which were sent through registered post vide postal receipt Ex.C-15, so complainant claimed that he already sent all the necessary documents with the opposite party No. 1 but to harass him he rejected the claim of the complainant which belongs to the year 2016. 

15. We have carefully perused the last letter of opposite party No. 1 dated 3.9.2019 Ex.OP-1/6 written to the complainant to submit some documents i.e. copy of General Diary, Copy of Investigation Report and copy of postmortem report. The complainant already produced all these documents on the file as Ex.C-2 to Ex.C-7 and Ex.C-9, so in our view when the complainant produced all these documents on the file then there is no hitch for him to submit the same with the opposite party No. 1 but it is opposite party No. 1 who unnecessary denied the submission of documents only to delay the claim of the complainant and rejected the claim of the complainant on false ground. 

16. The Hon'ble Punjab and Haryana High Court at Chandigarh in case titled New India Assurance Company Limited Versus Smt. Usha Yadav and others 2008(3) RCR (Civil) Page-111 held as under.-

“It seems that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy. The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs. 5,000/- for luxury litigation being rich.”

This citation is also fully applicable to the facts of present case as in the present matter also the opposite party No. 1 earned premium of crores of rupees in Group Personal Accident Insurance Policy but at the time when complainant lodged insurance claim then opposite parties rejected the same on the baseless ground, which is clear cut deficiency in service and unfair trade practice on their part. 

17. As a result of our above discussion and citation of the Hon'ble Punjab and Haryana High Court at Chandigarh, the complaint of the complainant is allowed against the opposite party No. 1. Accordingly, the opposite party No. 1 is directed to pay Rs. 10,00,000/- (Ten Lacs Only) to the complainant on account of insurance claim of deceased Surjeet Kaur mother of the complainant being nominee in her insurance certificate Ex.OP-1/1. The opposite party No. 1 is also directed to pay Rs. 10,000/- to the complainant as consolidated amount of compensation on account of mental tension, harassment and litigation expenses. The opposite party No. 1 is also directed to deposit Rs. 10,000/- as costs in the Consumer Legal Aid Account maintained by this Commission. Compliance of the order be made within the period of 45 days from the date of the receipt of the copy of this order, failing which the opposite party No. 1 is directed to pay the above mentioned amount of Rs. 10,00,000/- (Ten Lacs Only) alongwith interest at the rate of 6% per annum from the date of order till actual realization. Copy of this order be supplied to the parties free of costs. The file be consigned to the records after its due compliance.  

ANNOUNCED IN THE OPEN COMMISSION:

        10th Day of August 2020

 

 

 

            (Kuljit Singh)

            President

              

(Tejinder Singh Bhangu)

Member