Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 327.
Instituted on : 28.07.2015
Decided on : 21.07.2017.
Smt. Raj Rani w/o Subhash Chander R/o Village-Kahni, Teh. & Distt. Rohtak.
………..Complainant.
Vs.
- S.B.I.General Insurance, 1st Floor, SCF-13, HUDA Commercial Complex Rohtak through its Branch Manager.
- S.B.I.General Insurance Co. Ltd. Regd. 201 to 203, Natraj Junction of Westren Express Highway Junction, Andheri(East) Mumbai through its Regional Manager.
- Manager, State Bank of India, New Grain Market, Rohtak.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.JOGINDER KUMAR JAKHAR, PRESIDENT.
MS. KOMAL KHANNA, MEMBER.
SH.VED PAL, MEMBER.
Present: Sh. Jai Karan, Advocate for the complainant.
Sh.Yogesh Sharma, Advocate for the opposite party No.1 & 2.
Ms. Loveleen N.Gupta, Advocate for opposite party No.3.
ORDER
SH. JOGINDER KUMAR JAKHAR, PRESIDENT :
1. The present complaint has been filed by the complainant with the averments that husband of complainant was having a saving bank account No.10192759870 with the opposite party No.3 and the officials of opposite party no.3 have told him to avail insurance policy after payment of Rs.100/-. Accordingly the husband of complainant had paid an amount of
Rs.100/- for one year and opposite parties had issued him insurance policy for a sum of Rs.400000/- w.e.f 05.10.2012. The complainant was nominated as nominee by her husband. It is averred that the husband of complainant accidently met with an accident on 31.03.2013 and he had expired on 02.04.2013. At that time the police asked the complainant to lodge FIR then the complainant refused to get register any FIR hence the police lodged a D.D.No.17 dated 31.03.2013. It is averred that complainant did not get conducted the post mortem of her husband as it was a clear cut case of accidental death due to roadside accident. It is averred that after the death of her husband the complainant intimated the opposite parties and submitted her claim file alongwith all the relevant documents but after passing a sufficient long period the opposite parties have not paid the insurance claim and are demanding the copy of FIR, PMR and other documents which is illegal and amounts to deficiency in service. As such it is prayed that opposite parties may kindly be directed to disburse the claim amount of Rs.400000/- along with interest, compensation and litigation expenses.
2. On notice opposite parties appeared and filed their separate written reply. Opposite party no.1 & 2 in their reply has submitted that complainant failed to provide necessary documents for the settlement of claim. It is averred that complainant has not till date provided the copy of police final report, copy of PMR, certificate from the treating doctor clarifying the reason for not considering the case as medico legal certification/FIR/post mortem copy of certificate by police authorities allowing the disposal of dead body without post mortem being done. It is averred that several reminders were sent to the complainant to complete the alleged formalities but the complainant failed to comply with the same and as such complainant is not entitled for any relief. It is prayed that complaint may kindly be dismissed with costs.
3. On the other hand, opposite party no.3 appeared and filed its written reply submitting therein that it is correct to the extent that the husband of complainant was having saving account with the opposite party No.3. But the answering opposite party has no concern with the issuance of insurance policy because the policy has been issued by opposite party no.1 & 2. It is averred that no FIR has been registered and post mortem was also not conducted and as such it cannot be said that the husband of the complainant had died in a road side accident. It is averred that the amount of premium Rs.100/- was transferred from the saving account of the husband of complainant and the policy was issued by opposite party No.1 & 2. It is averred that the answering opposite party is not concerned with payment of amount of claim. As such it is prayed that complaint may kindly be dismissed with cost against the answering opposite party.
4. Both the parties led evidence in support of their case.
5. Ld. Counsel for the complainant in his evidence has tendered affidavits Ex.CW1/A, and documents Ex.C1 to Ex.C11 and has closed her evidence. On the other hand, ld. Counsel for the opposite party No.1 & 2 has tendered affidavit Ex.RW1/A, documents Ex.R2 to Ex.R5 and closed his evidence. Ld. Counsel for opposite party no.3 has tendered affidavit Ex.RW3/A, document Ex.R3/1 and has closed his evidence.
5. We have heard ld. counsel for the parties and have gone through the material aspects of the case carefully.
6. In the present case it is not disputed that as per copy of pass book Ex.C8, husband of complainant was having saving bank account with the opposite party No.3 and an amount of Rs.100/- was debited from his account on 03.10.2012 on account of insurance premium. As per certificate of insurance Ex.C7, Sh. Subhash Chander husband of complainant was insured with the opposite party No.1 & 2 for a sum of Rs.400000/- under personal accident policy for a period of one year from 05.10.2012. It is also not disputed that as per copy of DDR Ex.C2, on 30.03.2013, the husband of complainant was travelling in an Auto No.HR-01K-0005 which was hit by the car in order to save Neel Cows and Subhash s/o Amirchand had suffered injuries who was admitted to PGIMS, Rohtak. As per death certificate Ex.C9, the husband of complainant had died on 02.04.2013 in PGIMS, Rohak. After the accident complainant had filed the claim with the opposite parties but the opposite party no.1 & 2 has not settled the claim on the ground that the complainant has not submitted the required documents to the opposite parties.
7. After going through the file and hearing the parties it is observed that the opposite party No.1 & 2 has not settled the claim of complainant on the ground that copy of FIR, PMR and final Police report has not been submitted by the complainant. In this regard it is observed that as per copy of DDR Ex.C2, on 30.03.2013 Subhash s/o Amirchand had suffered injuries in road side accident while he was travelling in an Auto No.HR-01K-0005. The alleged auto was hit by the car in order to save the Neel Cows coming on road. As per the alleged DDR, there was no fault of any party in committing the accident as the accident had solely occurred due to coming of Neel Cows on the road. Hence they did not lodge the FIR. As per copy of OPD Card Ex.C6, patient Subhash was admitted to PGIMS with history of Road Side Accident and as per statement made thereon, it was submitted and signed by the relative of patient Subhash that they had only want to treat the patient and did not want to do any police action. As per treatment record Ex.C3 of Subhash Chander at page No. 10, the cause of death was cardio respiratory arrest and multi fractures and the injuries occurred in a Road Side Accident on 30.03.2013. Hence from the alleged document placed on record it is proved that the cause of death of Subhash was due to injuries suffered in a road side accident. As there was no fault of any of the parties driving the vehicles and the accident had occurred due to saving the herd of Neel Cows so there was no need to lodge FIR. As such no FIR was lodged and no PMR was conducted. Hence the demand of alleged documents from the complainant by the opposite parties is illegal and amounts to deficiency in service and on this ground the complaint cannot be said to be pre-mature. In this regard we have placed reliance upon the law cited in 2015(2)CLT 504 titled as Geeta Devi Vs. United India Insurance Co. Ltd. whereby Hon’ble National Commission, New Delhi has held that: “Insurance Claim-Repudiation on the ground that police report, PMR not supplied to insurance company-Death caused by accidental fall-Held-In case of death caused by accidental fall the question of reporting to police and conducting a panchnama does not arise-The post-mortem was not done as the death of the insured was not construed to be a suspicious one-Repudiating the claim on the ground that the claimant had not sent the documents, which were not relevant to the nature of death, is totally unjustifiable., as per 2013(3)CLT 534 titled as Balwinder Kaur Vs. Kribhco & others, Hon’ble Punjab State Commission, Chandigarh has held that: “FIR & PMR- The complainant did not prove on record any FIR or the post mortem report for proving the fact that the death of insured was accidental-However, it is now well established that the accidental death can be proved by other evidence-The Foras under the act are not to insist that such a fact must be proved only by the production of the FIR and the post mortem report”, as per IV(2012)CPJ 759(NC) titled as United India Insurance col..Ltd. Vs. Giriraj Prasad Meena Hon’ble National Commission, New Delhi has held that: “Non-production of post-mortem report pales into insignificance-Deceased was taken to Govt. hospital wherein he died due to this accident-Consumer Court acts under benevolent legislation where claims of consumers are not to be brushed aside on frivolous grounds-Repudiation not justified”, as per 2014(1)CLT 567 titled Upper India Carriers Vs. M/s New India Assurance Co. Ltd. & Ors. whereby Hon’ble Chandigarh State Commission, Chandigarh has held that: “Despite submission of report by the Surveyor, the opposite parties have not taken decision for 1½ years, which by no stretch of imagination, can be said to be justified and the complaint, on this ground, cannot be said to be premature”, In view of the aforesaid law which are fully applicable on the facts and circumstances of the case, it is observed that repudiation of claim by the opposite parties is not justified and against the natural justice. As such the complainant is entitled for the claim amount as per policy.
9. In view of the facts and circumstances of the case, it is directed that opposite party No.1 & 2 shall pay the amount of Rs.400000/-(Rupees four lacs only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 28.07.2015 till its actual realization and shall also pay an amount of Rs.3500/-(Rupees three thousand five hundred only) as litigation expenses to the complainant maximum within one month from the date of decision failing which opposite party No.1 & 2 shall be liable to pay interest @ 12% p.a. on the awarded amount from the date of decision. Complaint is allowed accordingly.
10. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
21.07.2017.
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Joginder Kumar Jakhar, President
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Komal Khanna, Member.
……………………………….
Ved Pal, Member.
