BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 207 of 2018
Date of Institution : 02.08.2018
Date of Decision : 29.07.2019
Bhupinder Kaur widow of Shri Malkeet Singh son of Shri Ajeet Singh, resident of village Bhavdeen, Tehsil and District Sirsa (Haryana).
……Complainant.
Versus.
- Star Health and Allied Insurance Company Ltd., Branch Office: Ground Floor, Opp. Shakti Motors, Near IDBI Bank, Sirsa, Tehsil and District Sirsa through its Branch Manager.
- Star Health and Allied Insurance Company Ltd., Regd. office: 1, New Tank Street, Valluyer Kottam High Road, Nungambakkam, Chennai- 600 034, through its authorized signatory.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. R.L.AHUJA………………. ……PRESIDENT.
MRS. SUKHDEEP KAUR……………..MEMBER.
Present: Sh. JBL Garg, Advocate for the complainant.
Sh. M.K. Saini, Advocate for opposite parties.
ORDER
The case of the complainant, in brief, is that husband of complainant late Shri Malkeet Singh son of Sh. Ajeet Singh had purchased an accident care individual insurance policy from the opposite parties vide policy No.P/211121/02/2016/000054 for the period w.e.f. 21.3.2016 to 20.3.2017 for the sum assured of Rs.ten lacs and paid a sum of Rs.2004/- as insurance premium for the same. It is further submitted that on 2.12.2016, the husband of complainant while serving the she-buffaloes at the house suffered injury on his left leg with tethering hook/ stubble. The said injury got septic and he was firstly taken to Sanjivani Hospital on 5.12.2016 but due to his critical condition, he was shifted to Dayanand College & Hospital, Ludhiana on 6.12.2016, but he could not survive and died on 11.12.2016 due to said injury. That the complainant being the widow and legal heir of deceased lodged her claim with the op and submitted all the requisite documents for settlement of her claim and also observed the formalities as required from her, but till date the claim of complainant has not been decided by the ops. It is further submitted that complainant is legally entitled to get the amount of sum assured alongwith interest and all other consequential benefits. The complainant approached the ops on many occasions and requested for settlement of her claim, but the ops continued putting off the matter with one pretext or the other. Ultimately, the complainant got served a legal notice upon the ops on 19.1.2018 but of no use. Hence, this complaint.
2. On notice, opposite parties appeared and filed written statement taking certain preliminary objections regarding no locus standi, no cause of action, suppression of material facts, no consumer dispute, involvements of intricate question of law and facts and as such this Forum is not an appropriate Forum to adjudicate upon the subject matter and that registered and corporate office of the answering op is situated in Chennai and branch office at Hisar issued the policy in question, hence, this Forum has no jurisdiction to try and entertain and decide the present complaint and that complaint is time barred. It is submitted that complainant has reported the claim on 24.7.2017 i.e. after seven months about the demise of Mr. Malkeet Singh on 6.12.2016. On receipt of claim intimation, a letter dated 24.7.2017 was sent to the insured requesting to submit the documents i.e. claim form duly signed and filled by the beneficiary, death certificate, first information report to the police, post mortem report, coroner’s report/ police inquest report, original policy copy and reason for delay in intimation. That thereafter, despite repeated reminders dated 6.8.2017 and 5.9.2017, the insured has not submitted the above referred documents which are mandatory to process the claim. Hence, the claim was closed on the ground of non submission of required documents and the same was informed to the insured vide letter dated 5.10.2017. It is further submitted that unless and until the documents are not submitted, they are unable to process the claim. Hence, the insured has to submit the above referred documents to enable them to process the claim as per terms and conditions of the policy. It is further submitted that on receipt of the legal notice issued by the complainant, the claim was again reviewed and informed the complainant to submit the necessary claim documents vide their letter dated 2.2.2018. The complainant has not furnished the claim documents to process the claim and approached this Forum. Remaining contents of complaint are denied and prayer for dismissal made.
3. The parties then led their respective evidence.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. The complainant in order to prove his complaint has furnished her affidavit Ex.CW1/A in which she has reiterated all the averments made in the complaint. She has also placed on record copy of insurance policy Ex.C1, copies of treatment record Ex.C2 to Ex.C16, copy of claim form Ex.C17, copy of death certificate Ex.C18, copy of final bill Ex.C19, copies of letters Ex.C20, Ex.C21, copy of death form Ex.C22, copy of affidavit Ex.C23, copy of legal notice Ex.C24 and postal receipts Ex.C25, Ex.C26. On the other hand, the ops have furnished the affidavit of Sh. Rajiv Jain, Chief Manager Ex.RW1/A in which he has reiterated the averments made in the written statement. The ops have also placed on record copies of letters Ex.R1 to Ex.R4, copy of policy Ex.R5, copy of schedule Ex.R6, copy of letter dated 2.2.2018 Ex.R7, copy of legal notice Ex.R8 and copy of customer information sheet Ex.R9.
6. Admittedly, the husband of complainant namely Malkeet Singh had purchased an accident care individual insurance policy from the ops vide policy No.P/211121/02/2016/000054 for the period 21.3.2016 to 20.3.2017 for the sum assured of Rs.ten lacs. On 2.12.2016, said Malkeet Singh husband of complainant received injury and due to his critical condition he was shifted to Dayanand Medical & Hospital, Ludhiana but he could not survive and died on 11.12.2016. Due intimation was given to the ops and claim was lodged with the ops, but however, the claim file was closed due to non production of the required documents despite repeated reminders.
7. During the course of arguments, learned counsel for complainant has contended that complainant has already submitted the required documents to the ops, but however, she is still ready to submit the documents again. On the other hand, learned counsel for ops has contended that if complainant will submit the documents, the ops may consider the same as per terms and conditions of the insurance policy.
8. In view of above, present complaint is partly allowed and the complainant is directed to submit the documents as required by the ops i.e. claim form duly signed and filled by the beneficiary, death certificate, first information report to the police, post mortem report, coroner’s report/ police inquest report and original policy copy etc. within 15 days from the date of receipt of copy of this order and the ops are directed to re-open the claim file after receiving the documents from the complainant and to settle and pay the claim of the complainant within 45 days of the receipt of the documents, if same is payable under the terms and conditions of the policy. No order as to costs. A copy of this order be supplied to the parties free of costs. File be consigned to the record room.
Announced in open Forum. Member President,
Dated:29.07.2019. District Consumer Disputes
Redressal Forum, Sirsa.
