BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM, JALANDHAR.
Complaint No.342 of 2016
Date of Instt. 09.08.2016
Date of Decision: 17.04.2018
Naranjan Singh age about 60 years S/o Sh. Tara Singh R/o VPO Ladhra, Block Bhogpur P.S. Kartarpur, Tehsil and District Jalandhar, Punjab.
..........Complainant
Versus
1. TATA-AIG, General Insurance Company Ltd., Registered Office, 15th Floor, Tower A, Peninsula Business Park, Ganpatrao Kadam Marg, Senapati Bhagat Marg, Lower Parelm Mumbai- 400013.
2. Axis Bank Ltd., G.T. Road Bhogpur, Tehsil and District Jalandhar through its Manager.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Sh. Karnail Singh (President)
Smt. Harvimal Dogra (Member)
Present: Sh. HS Kathar, Adv Counsel for the Complainant.
Sh. AK Arora, Adv Counsel for OP No.1.
Sh. Manmohan Sharma, Adv Counsel for OP No.2.
Order
Karnail Singh (President)
1. This complaint is presented by the complainant, wherein stated that the complainant is the husband of deceased Balwant Kaur, the said deceased Balwant Kaur has got insured from the OPs. The OP No.1 is the registered office and the OP No.2 is the branch of the said OP No.1, where from the deceased took the insurance policy.
2. That the deceased took insurance policy bearing No.0200296442 and clients ID 7850595, which commenced on 22.10.2013 to 21.10.2016. The complainant paid the lump sum installment of Rs.2647/- to the OP on behalf of the deceased. The OP told the complainant that they would pay Rs.10,00,000/- for any accidental death and any other claim during said period. Thus, under these circumstances, the complainant comes in the definition of 'Consumer' and they have right to knock the doors of this Forum. On 12.04.2014 at about 10:30 AM, the deceased was on the roof along with her grandson, who was playing there, while playing the said child reached near the stairs and deceased attempted to pick him, but she failed to do so and she lost her balance and fell down from the stairs and accordingly, got injury and died at the spot. The complainant brought the doctor, but she was declared died, due to said accident. The field officer of the OPs came at the spot and he investigated the case and recorded statements of the complainant, his family and Sarpanch of the village. He also took photographs of the stairs. The said field officer collected the medical report and other necessary documents for issuance the claim to the complainant. The said officer assured that the said claim would be released very soon. The complainant contacted a number of times with OPs and supply all required documents, but they failed to issue the said claim.
3. That again on 22.03.2016, the OPs received the papers from the complainant, but no reply was given. The OPs have indulged in unfair trade practice, as such, the complainant suffered great mental agony, harassment and financial loss. So, the complainant is entitled to claim damages from the OPs as under mental agony, financial loss and harassment caused due to unfair trade practice and negligence and deficiency in service on the part of the OPs and as such, the instant complaint filed with the prayer that the OPs may be directed to pay insurance policy claim to the complainant and further be directed to pay compensation to the tune of Rs.10,000/- for mental torture and financial loss caused to the complainant and OPs be also directed to pay litigation expenses, to the tune of Rs.15,000/-.
4. Notice of the complaint was given to the OPs and accordingly, OP No.1 appeared through his counsel and filed written reply and contested the complaint by taking preliminary objections that the claim of the complainant has rightly been repudiated by the answering OP as per the terms and conditions of policy of insurance. It was alleged by the complainant that the insured had met with an accident on 12.04.2014 while she was busy in the household activity and was coming down the stairs of her house, she suddenly fell down from the top most stairs and hurt back of the head and died at the spot. On the receipt of information qua the alleged death of the insured in the alleged accident, matter was investigated through an independent Investigator, M/s BIMA VIGIL, who have submitted their report dated 18.01.2016 with the answering OP. As per the Investigation report, there was no FIR/MLC, Postmortem Report confirming the accident and alleged death due to accident. No medical records confirming cause of death was submitted with the answering OP indicating alleged accidental injury and subsequent death as claimed by the complainant. It is further alleged that the alleged incident has occurred on 12.04.2014, whereas intimation of the claim was furnished to the OP after an inordinate delay of more than one year and eight months, this amounts to non-compliance with Uniform Provision No.10 of the policy of the Insurance and further alleged that no FIR was filed in relation to the accidental death of Ms. Balwant Kaur. There was no documentary evidence submitted with the answering OP confirming the death of Ms. Balwant Kaur resulted due to alleged accident during the policy period, thus, standing in violation of Uniform Provision No.12 of policy and further submitted that after receipt of Investigator report, a letter dated 02.02.2016 was written by the OP to the complainant calling him to give his reply within seven days from the date of receipt of the letter, failing which the answering OP may proceed with the closure of the case. However, no reply whatsoever was filed by the complainant to the said letter dated 02.02.2016 and as such, the case of the complainant was deemed to have been closed. It is further submitted that there is thorough application of mind applied by the answering OP prior to closing the case of the complainant and as such, there is no deficiency of service or unfair trade practice on the part to the answering OP. On merits, the factum in regard to purchase of property by the wife of the complainant is admitted and it is also admitted that the Investigator was appointed by the OP, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits and the same may be dismissed.
5. OP No.2 filed its separate reply and contested the complaint by taking preliminary objections that the OP No.2 is not in the business of Insurance and cannot carry on insurance business as its business is confined to what is listed out in Banking Regulation Act, 1949. OP No.2 is only an agent of Insurance Company i.e. OP No.1 and further admitted that the wife of the complainant purchased insurance policy from OP No.1 through OP No.2 and remaining allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits and the same may be dismissed.
6. In order to prove the case of the complainant, complainant himself tendered into evidence his own affidavit Ex.CW1 along with some documents Ex.C-1 to Ex.C-3 and further brought on the file affidavit of the Kulwant Singh, Lamberdar as Ex.CW2, Affidavit of Sukhwinder Singh, Ex. Member Panchayat as Ex.CW3, Affidavit of Mohabat Pal, Member Panchayat as Ex.CW4 and affidavit of Dr. Ranjit Singh as Ex.CW5/A alongwith document Ex.C-4 i.e. Treatment Report and then counsel for the complainant closed the evidence.
7. Similarly, counsel for OP No.1 tendered into evidence affidavit of Sh. Mohammad Azhar Wasi as Ex.OA, Affidavit of Sh. Anoop Bisht as Ex.OB alongwith documents Ex.O-1 to Ex.O-5 and closed the evidence and similarly, counsel for the OP No.2 tendered into evidence affidavit Ex.OP2/A and closed the evidence.
8. We bestowed our thoughtful consideration to the submissions made by learned counsel for the respective parties and also gone through the case file very minutely.
9. After considering the case of both sides, we find that the purchase of Insurance Policy from OP, by the wife of the complainant, is not in dispute, rather these factum are admitted one. It is also admitted that the insurance claim was filed by the complainant in regard to death of his wife insured Balwant Kaur, but the said claim was repudiated by the OP, vide letter dated 02.02.2016 Ex.O-4, on the ground that there is an inordinate delay of submitting of insurance claim, more than 1 year and 8 months and as per terms and conditions i.e. Provision No.10 of the policy, the claim is required to submit within maximum 30 days of actually accident or otherwise, it should be submitted immediately or within 7 days and further as per Provision No.12 of the Policy, the completed claim form and evidence i.e. along with written evidence must be furnished to the Insurance Company within 30 days after the date of such loss, failure to furnish such evidence within the time required shall not invalid date nor reduce any claim if you can satisfy the company that it was not reasonably possible for the complainant to give proof within such time, however, no proof will be accepted if furnished after than one year from the time of the loss occurred.
10. On the above grounds, the claim of the complainant have been repudiated by the OP and in support of above repudiation, the counsel for the OP made reliance upon a pronouncement of Hon'ble our State Commission, cited in 2012 (4) CLT 555, titled as “M/s Harbhagwan Subhash Chander Vs. Oriental Insurance Company Limited and Others”, further referred an other pronouncement of Hon'ble Uttarakhand State Consumer Disputes Redressal Commission, cited in 2010(2) UAD 177, titled as “National Insurance Company Limited Vs. Mayank Goel” and also referred an other pronouncement of Hon'ble National Commission, Revision Petition No.2397 of 2015, decided on 28.10.2015, titled as “Lalit Mohan Vs. Reliance General Insurance Co. Ltd.”
11. We have considered the plea taken by the OP for repudiation of the claim and find that the complainant alleged in the complaint that after the death of insured Balwant Kaur, intimation was furnished to the OP and then the OP appointed an Investigator, who visited the spot and recorded the statement of the complainant and submitted a report Ex.O-2, whereby categorically reported that there is no postmortem report or any other documentary evidence, showing that the deceased insured Balwant Kaur was died due to accident, but we find that the said Investigator also recorded the statement of doctor, who checked the insured Balwant Kaur and said statement is Ex.C-4, wherein the cause of death has been shown 'Head Injury' and this report has been proved by the doctor by placing on the file his affidavit Ex.CW5/A, wherein categorically deposed that he attended the deceased Balwant Kaur W/o Naranjan Singh, the said deceased was suffered from head injury due to fall and cause of death due to head injury and statement of the doctor is further corroborated by the complainant himself by producing on the file his affidavit Ex.CW1 and also examined Kulwant Singh, whose affidavit is Ex.CW2 and Sukhwinder Singh, whose affidavit is Ex.CW3 and Mohabat Pal, whose affidavit is Ex.CW4. So, from the above evidence, it is established that the death of the insured Balwant Kaur was caused due to falling from the stairs cases and it is apparently an accident and whenever, accident occurred, then insured is entitled for insurance amount.
12. We have also considered the report of the Investigator, who reported that there is no FIR, Police Report and Postmortem Report to prove the death of deceased Balwant Kaur due to accident, but we do not agree with the report of Investigator because if the death of deceased insured Balwant Kaur was caused inordinary and in natural way, then there is no requirement to lodge FIR or get Postmortem and moreover, the statement of the attending doctor is also recorded by the same Investigator and the said doctor in his affidavit Ex.CW5/A categorically deposed that the death of cause of the deceased Balwant Kaur was due to accident. So, from this angle, the observation given by the Investigator is not acceptable rather these are arbitrarily accepted by the OP just to deprive the complainant from eating the fruits of the claim of insurance policy.
13. Further more, we have also considered the main contention of the OP that there is a delay of 1 year and 8 months for giving intimation of the death of deceased Balwant Kaur to the OP. The complainant categorically stated in the complaint that after the incident, he reported the matter to the OP i.e. Insurance Company and then OP company appointed Investigator to this effect the matter is not disputed by the OP No.1 and it is also admitted that the Investigator was appointed by the OP and if Investigator was appointed by the OP, then duty casted upon the OP No.1 to bring on the file, when the said Investigator was appointed, the said letter, whereby the Investigator was appointed must be brought on the file to establish that after receipt of the intimation, the said Investigator was appointed and that date is very crucial in this case, but for the best known reason, the OP has not disclosed that date. Further the OP alleged the intimation was given after 1 year and 8 months and it is not described in the reply or in the affidavit or by way of any other document that in what mode, the said intimation was given whether by telephonically or by giving a letter or by filing an insurance claim, that document must required to bring on the file to establish the exact date of intimation, but for the best known reason, the said document again concealed by the OP. So, from all angle, we conclude that the OP No.1 is not able to establish that there was any delay of 1 year and 8 months on the part of the complainant rather we find that the delay for payment is only part of the OP, which is considered as deficiency in service and moreover, the judgments referred by the learned counsel for the OP are not attracted in this case because the facts of that judgment are not identical to the facts of the case in hand and as such, we reach to the conclusion that the OP No.1 has illegally, wrongly and arbitrarily repudiated the claim of the complainant, vide Letter Ex.O-4 and accordingly, the same is set-aside and further hold that the complainant is entitled for the relief claimed.
14. In the light of above detailed discussion, the complaint of the complainant is partly accepted and OP No.1 is directed to pay the insured amount of Rs.10,00,000/-, to the complainant with interest @ 9% per annum from the date of repudiation of the claim i.e. 02.02.2016, till realization and further OP No.1 is directed to pay compensation to the complainant for harassment, to the tune of Rs.30,000/- and OP No.1 is also directed to pay litigation expenses of Rs.10,000/-. The entire compliance be made within one month from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.
15. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Harvimal Dogra Karnail Singh
17.04.2018 Member President
