Punjab

Rupnagar

CC/15/71

Rajvir Singh - Complainant(s)

Versus

State Bank Of India - Opp.Party(s)

Sh. Rajiv Rana,Adv.

01 Apr 2016

ORDER

ORDER

                                      MRS. NEENA SANDHU, PRESIDENT

                   Sh. Rajvir Singh has filed this complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the Opposite Party (hereinafter referred to as ‘the O.Ps.’)  praying for issuance of the following directions to them:-

i)       To pay an of Rs.6,00,000/- i.e. Rs.4,00,000/- as per the

         policy and Rs.2,00,000/- as compensation,

 

ii)      To pay the litigation expenses,

 

iii)     To award any other relief, which this Forum may deem to compensate him on account mental agony, physical harassment and huge financial suffered by him.  

 

2.                In brief, the case of the complainant is that earlier, his father opened his Saving Account in the branch of O.P. No.1 vide No. 31194924407. The O.P. No.1 introduced an insurance policy to his father, at Anandpur Sahib, District Rupnagar and his father deposited the money for the same and the O.P. No.2 issued a policy bearing No.143990-0000-00 as well as certificate No.12247515 to his father for the sum insured of Rs.4,00,000/-. He was appointed as nominee by his father. On 3.3.2014, at about 3.30 PM, his father met with an accident, due to which, he expired at the spot and the post mortem was conducted by the Civil Hospital, Anandpur Sahib. Thereafter, he informed the O.Ps. regarding the death of his father, who demanded death certificate of his father and other documents. Accordingly, he submitted all the documents to the O.P. No.1 It is further stated that the O.P. No.1 carries on business within the territorial jurisdiction of this Forum and both the O.Ps. are severally and jointly bound to pay the compensation amount to him, but both the O.Ps. flatly refused to pay him the same, inspite of his repeated requests. Hence, this complaint.

 

 3.               Upon issuance of notice of the complaint, none having appeared on behalf of the O.P. No.1, it was proceeded against ex-parte vide order dated 02.09.2016.

 

4.                The O.P. No.2 filed written version on 24.09.2015. However, thereafter, it filed amended written version on 07.12.2015, after seeking permission of this Forum, taking preliminary objections that this Forum has no jurisdiction to entertain & try this complaint as there is no branch office of the answering O.P. situated within the jurisdiction of this Forum, as such, the complaint is liable to be dismissed on this score alone; that the complaint is not maintainable in the present form; that the complainant has not come to the court with clean hands and has suppressed the material facts from this Forum; that the answering O.P., vide letter dated 29.11.2014, has already repudiated the claim of the complainant, the death of the insured being due to the medical causes, which did not fall in the purview of policy terms & conditions; that there has been no deficiency in service on the part of the answering O.P., as such, the complaint is liable to be dismissed. On merits, it is stated that

after receipt of intimation from the complainant regarding the death of the insured, the answering O.P. wrote a letter to him on 16.9.2014, asking him to submit the following documents:-

                   i)       Translated copy of final Police Report attested by

issuing authorities.

 

ii)      Translated copy of FIR/MLC copy/spot

Panchnama/Inquest Panchnama attested by issuing

Authorities.

The complainant did not submit the above mentioned documents to the answering O.P., as such, the claim lodged by him was closed, which could have been reopened and processed, if the documents were received within 365 days from the incidence.  Thereafter, the answering O.P. vide letter dated 29.11.2014 has repudiated the claim of the complainant on the grounds that the cause of death of the insured i.e. Mr. Sulakhan Singh, as per the post mortem report, was due to cardiac failure due to myocardial infarction, there was no injury on the person of the insured, therefore, the death being due to the medical causes, the same did not fall in the purview of policy terms & conditions, as there was no coverage under the policy for death due to medical causes, as such, the claim has been rightly closed on the grounds mentioned above. Rest of the allegations made in the complaint have also been denied and a prayer has been made for dismissal thereof, with costs, the same being without any merit.

 

5.                On being called upon to do so, the complainant tendered his affidavit, Ex. CW1/A, photocopies of documents, Ex.C1 to Ex.C7 and his counsel closed the evidence on his behalf. On the other hand, the learned counsel for the contesting O.P. No.2 tendered affidavit of Sh. Jagdish Parshad, Motor TP Claims, SBI General Insurance Company, Ex.OP2/1, photocopies of documents, Ex.OP-2/2 to Ex.OP2/12 and closed the evidence.

 

6.                We have heard the learned counsel for the complainant and the O.P. No.2 and gone through the record of the file, carefully.

 

7.                At the outset, the learned counsel for the O.P. No. 2 raised the objection that the complaint is not maintainable and is liable to dismissed for want of territorial jurisdiction. To this effect, the learned counsel for the complainant submitted that the insured was maintaining a saving bank account with the O.P. No. 1 bank, at Anandpur Sahib, and it was the O.P. No.1, who had introduced the insurance policy in question to him and got issued the same in favour of the insured, from the O.P. No.2, at Anandpur Sahib. Since the policy was got issued at Anandpur Sahib, therefore, it is apparent the O.P. No. 2 is carrying on its business for gains at Anandpur Sahib i.e. within the territory of District Ropar, as such, this Forum has jurisdiction to adjudicate upon the instant complaint. We find force in the submission of the learned counsel for the complainant because the policy in question was got issued from Anandpur Sahib. Even the claim form, Ex. OP2/10, was also submitted before the SBI branch situated at Anandpur Sahib. Hence, the objection raised by the learned counsel is found to be without any force, hence, rejected.

 

8.                Now coming to the merits of the case, the learned counsel for the complainant submitted that the father of the complainant (now deceased) was duly insured with the O.P. No.2 under personal accident insurance policy, Ex. C1,  for a sum of Rs.4,00,000/-, for a period of one year from 23.01.2014. On 3.3.2014, the insured met with an accident and fell down from the motor cycle and his backbone, chest and head got injured, as such, he was taken to Civil Hospital, Sector 32, Chandigarh. The doctors concerned after giving treatment discharged him on 04.03.2014 and he was brought back home at Anandpur Sahib, but thereafter, on 5.3.2014, he suddenly felt pain in chest and was taken to Civil Hospital, Anandpur Sahib, but he was declared brought dead by the doctor concerned. Since the death of the insured was due to accident, the O.P. No. 2 was liable to pay the claim amount as per the terms & conditions of the policy, but it has repudiated the claim illegally.

 

9.                On the contrary, the learned counsel for the O.P. No. 2 submitted that the O.P. No. 2 has repudiated the claim on 29.11.2014 vide letter (Ex. OP2/3) on the ground that the death of the insured was not caused due to accident, but it was due to heart failure, as mentioned in the post mortem report, Ex. C5/Ex. OP2/12. He further submitted that the complainant has tried to distort the facts, as in para No. 4 of the complaint as well as in the supporting affidavit produced alongwith the same, it has categorically mentioned that his father (now deceased) met with an accident on 3.3.2014 and died at the spot, whereas in the affidavit tendered at the time of evidence as Ex. CW1/A, he has deposed that his father met with an accident on 3.3.2014  at 3.30 PM; that he was referred to Chandigarh and was discharged from the hospital and died due to accident and that his post mortem was conducted by the Civil Hospital, Anandpur Sahib. Even in the statement (Ex. C4) given by Sh. Kmalajit Singh son of Sulakhan Singh before the police station at the time of recording of DDR (Ex. C3) by the police, he had stated that his father met with an accident on 3.3.2014 at 3.30 PM and died on 5.03.2014. Thus, it stands proved that the complainant has distorted the facts with the purpose to  grab money from the insurance company, under the insurance policy in question, illegally, by showing that the death of the insured was due to accidental injuries. He further submitted that in the ‘Claim Summary’ Ex. OP2/2, under the head recommendations, it is categorically mentioned that as per post mortem report, cause of death was cardiac failure due to myocardial infarction and there were no injuries supporting the Panchnama in the post mortem. There were atherosclerotic changes in the blood vessels of the heart and coronary circulation. Paleness of myocardium as per the P.M., the death of the insured was due to natural causes i.e. to myocardial infarction. Death of the insured was due to natural causes. Hence, as per the terms and conditions of the insurance policy, the claim has been rightly repudiated by the O.P. No.2. He further submitted that in fact the claim was repudiated on 29.11.2014, but inadvertently, the date on the repudiation letter (Ex.OP2/3) has been mentioned as 29.11.2013 instead of 29.11.2014, as has been clarified to the complainant vide letter dated 18.11.2015 (Ex. OP2/4).

 

10.               The claim lodged by the complainant has been repudiated by the O.P. No. 2 vide letter Ex.OP2/2, on the ground that as per post mortem the cause of death of the insured was cardiac failure due to myocardial infarction. As the death was due to medical causes, the same does not fall in the purview of policy terms and conditions. As per the terms & conditions of the insurance policy in question, (Ex. OP2/5), the coverage under the same was limited to death of the insured on account of accident only. Thus, the sole question for consideration before us is—as to whether the cause of the death of the insured was due to accidental injuries, as alleged by the complainant, or due to cardiac failure due to myocardial infarction, as pleaded by the O.P. No. 2?

 

11.              It may be sated that the complainant has taken contradictory stand, as in para No. 4 of the complaint as well as in the supporting affidavit, he had stated that his father (now deceased) met with an accident on 3.3.2014 and died at the spot, whereas in the affidavit tendered at the time of evidence as Ex. CW1/A, he has deposed that his father met with an accident on 3.3.2014; he was referred to Chandigarh; he was discharged from the hospital and died due to the accident and that his post mortem was conducted by the Civil Hospital, Anandpur Sahib. He has not produced on record the hospital record, where the insured was initially taken for his treatment, although in the statement made by Sh. Kamaljit Singh son of insured since deceased i.e. Sulakhan Singh (Ex. C4) which was made before the police post concerned, it was stated that the deceased insured was referred to Civil Hospital, Anandpur Sahib and the concerned doctor after giving him first aid referred him to Sector 32, Chandigarh. The doctor concerned after giving the treatment discharged him yesterday i.e. on 4.3.2014 and he was brought to the house; that today his father again felt pain and he was taken to CH, APS, where he was declared dead. Had the complainant produced the record of the hospital, where the deceased was initially treated, the picture would have become clear from the history recorded by the said hospital that as to whether the deceased had received any injuries or as to whether the said injuries were so grievous in nature, to cause death of the insured. No doubt, in the post mortem report, Ex. C5/Ex.OP2/2, some injuries found on the body of the deceased have been mentioned, in the column meant for ‘INJURIES’ but none of the same appear to be grievous, so as to cause death of the said person. Even in the column meant for “OPINION” in the said post mortem report, it is clearly mentioned that the cause of death was cardiac failure due to myocardial infarction, which is sufficient to show death in ordinary course of nature. As such, even on the basis of the post mortem report, it cannot be concluded that actually, the cause of the death of the insured was due to accidental injuries. Taking all these facts & circumstances into consideration, we are of the view that the complainant has failed to prove that the death of the insured was due to accidental injuries, consequently, he is not entitled to any claim amount under the policy in question and the O.P. No. 2 has rightly repudiated the claim. Accordingly, the complaint filed against the O.P. No. 2 is liable to be dismissed. Even the complaint filed against the O.P. No. 1 is also liable to be dismissed because neither any specific allegation against it has been leveled by the complainant nor the same has been proved against it. 

 

12.              In view of the aforesaid discussion, the complaint is dismissed, leaving the parties to bear costs of their own.

 

                   The certified copies of this order be supplied to the parties forthwith, free of costs, as permissible under the rules and the file be indexed & consigned to the Record Room.

 

ANNOUNCED                                                                      (NEENA SANDHU)

Dated          01.04.2016                                                PRESIDENT

 

 

                                                (SHAVINDER KAUR)

                                                                     MEMBER.