Order by:
Sh.Mohinder Singh Brar, Member
1. The complainant has filed the instant complaint under section 35 of the Consumer Protection Act, 2019 stating that the husband of the complainant namely Gurdev Singh alias Jodh Singh died in a road accident on 15.08.2016 and in this regard FIR No.132 dated 15.08.2016 was lodged with Police Station, Baghapurana District Moga upon the statement of Amarjeet Singh s/o Gurdev Singh r/o Baghapurana District Moga. The said Gurdev Singh was insured under Bhagat Puran Singh Sehat Bima Yojna having card no.9304 2003 0458 00201, in which the husband of the complainant was insured for Rs.5,00,000/- in case of death due to accident and card was also meant for free medical treatment of the whole family upto Rs.30,000/-. Alleged that the husband of the complainant was insured under the above said policy with United India Insurance Company Ltd and beneficiary card was also issued by it having their logo on the backside of above mentioned beneficiary card. After the death of her husband, the complainant in the month of September/October 2016 visited the Branch Office of United India Insurance Co. Ltd. at Moga and intimated about the death of her husband and requested them to settle the death claim of her husband. On the advice of Branch Manager of United India Ins. Co. Ltd. the complainant called on toll free helpline no.104 on which, she was asked to wait until investigator of their company visits to their place and to collects relevant documents for settling her husband's death claim. Alleged that in the month of March 2018, the complainant along with her son Amarjit Singh visited the office of United India Insurance Company Limited at Mohali who received required documents and told that they will soon appoint the Investigator and will settle the death claim of the husband of the complainant. Thereafter until January 2019 when no investigator visited the house of complainant, she again went to the office of Opposite Party No.1 and requested to give them her husband's file number and on the request of the complainant, they gave the file number 2130. Thereafter in mid March 2020, there was lockdown due to COVID-19 and complainant could not make efforts to get settle the death claim of her husband. Alleged further that later on 3rd February 2021, the complainant received one call from Investigator of the United India Insurance Co. Ltd. who came at the house of complainant and got obtained thumb impression of the complainant on claim form and also on all other documents and also recorded the statement of the complainant along with M.C of their ward namely Rinku Kumar and assured the complainant that her husband's claim will be settled after his final report. However, complainant received repudiation letter from United India Insurance Co. Ltd. on dated on 07.05.2021 with writing that "accident occurred on 15.08.2016, which is not covered under our policy period w.e.f 01.11.2016". Thereafter, complainant went to office of the Opposite Party No.1 who told that their claim did not lie with their company and should approach Reliance General Insurance for the settlement of their case. Then the complainant requested them to return her original documents submitted by her and to refer her case to Reliance General Insurance Co. Ld., but they flatly refused to do the same. Due to such illegal act and conduct of the opposite parties, the complainant has suffered mental tension, agony and harassment. Hence, this complaint. Vide instant complaint, the complainant has sought the following reliefs:-
a) Opposite parties may be directed to pay Rs.5,00,000/- as death of Gurdev Singh alias Jodh Singh i.e. husband of complainant alongwith interest @ 12% per annum till its realization.
b) To pay an amount of Rs.50,000/- as compensation.
c) To pay an amount of Rs.15,000/- as costs of the complaint.
d) Any other relief which this Commission may deem fit and proper also be granted.
2. Opposite Parties No.1 & 2 appeared through counsel and contested the complaint by filing written reply taking preliminary objections therein inter alia that the complaint of the complainant is not maintainable as per law; the complainant has got no locus standi to file the present complaint; the complainant has concealed the material facts from this Commission. Averred that the date of death of Gurdev Singh is 15.08.2016 and the period of policy had commenced w.e.f 01.11.2016, thus the claim is not covered under the policy. The present complaint of the complainant is time barred. The present complaint is filed in January, 2023 while date of death of Gurdev Singh is stated to be 15.08.2016. Moreover, death claim was reported vide PA file no.2130 while it was repudiated being Blue Card and date of accident was 15.08.2016 and the policy of answering parties for Blue Card Holders starts w.e.f 01.11.2016, hence the claim does not fall under the policy. However, the complainant has even not filed application for getting the delay condoned and is trying to mislead this Commission. On merits, all other allegations made in the complaint are denied and a prayer for dismissal of the complaint is made.
3. Opposite Party No.3 appeared through counsel and filed written reply taking certain preliminary objections therein inter alia that the complaint being time barred, false, frivolous, vexatious and baseless is not maintainable. The alleged complaint is based upon bald assertions and is a result of an afterthought, hence lacks credibility on the part of complainant; the complainant is stopped to file the present complaint by her own act and conduct. No alleged claim what so ever has been ever lodged or intimated to the answering Opposite Party. The complainant has got no cause of action against the answering Opposite Party. The complainant has not mentioned any alleged insurance policy details and particulars in the complaint with regard to make the answering Opposite Party insurance company responsible for any alleged claim. In the absence of said details Reliance General Insurance Company cannot be held liable for any claim and thus the name of the answering Opposite Party is entitled to be deleted from the array of the parties of the complaint. No deficient services have been render by the answering Opposite Party as alleged by the complainant. The answering insurance company has no concern with the alleged claim. The complainant or any body else has never intimated or submitted any claim document to the answering Opposite Party, hence the present being time barred is not maintainable against the answering Opposite Party and same is liable to he dismissed with compensatory costs. On merits, all other allegations made in the complaint are denied and a prayer for dismissal of the complaint is made.
4. In order to prove his case, the complainant has placed on record his affidavit Ex.C1 alongwith copies of documents Ex.C1 to Ex.C9.
5. On the other hand, Opposite Parties No.1 & 2 have tendered into evidence affidavit of Sh.R.N.Bansal, Senior Divisional Manager, United India Insurance Co. Ltd. Ex.OP1, 2/1 alongwith copies of documents Ex.OP1,2/2 & Ex.OP1,2/3. Whereas, Opposite Party No.3 has tendered into evidence affidavit of Sh.Suryadeep Singh Thakur Ex.OP3/1.
6. We have heard the ld. counsel for both the parties and also gone through the record.
7. It is proved on record that husband of the complainant namely Gurdev Singh (now deceased) was duly insured under Bhagat Puran Singh Sehat Bima Yojna, having Card No.9304 2003 0458 0020, copy of the card is Ex.C5. It is also proved on record, husband of the complainant died on 15.08.2016, copy of death certificate is Ex.C7 and it is also proved on record, insured died in a road accident on 15.08.2016 and in this regard FIR No.132 dated 15.08.2016 was lodged with Police Station, Baghapurana District Moga upon the statement of Amarjeet Singh s/o Gurdev Singh r/o Baghapurana District Moga, copy of the FIR is Ex.C2. After the death of her husband, the complainant lodged the claim with Opposite Parties No.1 & 2, which was declined by them stating that the said claim does not fall under the ambit/scope of the policy and repudiated the same stating the reason that accident occurred on 15.08.2016, which is not covered under the policy period w.e.f 01.11.2016 (Ex.C9). Now, we have to decide that whether repudiation of the claim of the complainant by Opposite Parties No.1 & 2 is genuine or not?
8. Perusal of the record reveals that the Opposite Parties No.1 & 2 have placed on record copy of agreement executed between the Department of Health & Family Welfare, Govt. of Punjab and United India Insurance Company (Ex.OP1,2/2), vide which, it is evident that agreement of the United India Insurance Company Ltd. starts w.e.f 01.11.2016 to 31.10.2017, whereas husband of the complainant was died on 15.08.2016, so it is evident that at the time of the accident husband of the complainant was not covered under the insurance policy of United India Insurance Co. Ltd. Hence, accident of husband of the complainant does not fall under the purview of the policy of United India Insurance Co. Ltd.
9. On the other hand, the stand of Opposite Party No.3 is that till date the complainant has not lodged the claim with them, so she is not entitled for any claim from it. The complainant has never intimated or submitted any claim document with it. We agree with the aforesaid contention of ld. counsel of Opposite Party No.3, there is no documents placed on record by the complainant revealing that she ever lodged any claim with them.
10. From the discussion above, the present complaint is hereby disposed of with a liberty to approach to Opposite Party No.3 i.e. Reliance General Insurance Company Ltd. and to lodge her claim with it. Keeping in view of the peculiar circumstances parties are left to bear their own costs. The pending application (s), if any also stands disposed of. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room.
Announced on Open Commission
