Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. : 557
Instituted on : 14.11.2018
Decided on : 29.04.2024.
1. Ravi s/o Late Baljeet Singh
2. Premo w/o Late Baljeet(wife of deceased)
3. Darshan w/oKashmir( Daughter of Baljeet)
4. Sunita w/o Sammy (Daughter of Beljeet)
All residence of H.No.757/13, Tej Colony, Rohtak.
..............Complainants.
Vs.
- The Federal Bank Ltd. Opp. ALL INDIA RADIO, 5, SUBHASH ROAD, BRANCH ROHTAK through its Manager.
- New India assurance Company Ltd. Resident of Divisional office:(353800) Rohtak, 313, Model Town, Delhi Road, Rohtak.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
DR. VIJENDER SINGH, MEMBER
Present: Sh.J.S.Saroha, Advocate for the complainant.
Sh.Gulshan Chawla, Advocate for the opposite party No.1.
Sh.SameerGambhir Advocate for opposite party No.2.
ORDER
NAGENDER SINGH, PRESIDENT:
1. Brief facts of the case as per complainant are thatfather of complainants no. 1, 3, and 4 namely Baljeet was account holder with opposite party no. 1 and he was having an account no. 16540100025987. The complainant no.1 is real son and complainant no. 2 is wife of deceased Baljeet, complainant no . 3 & 4 are daughters of deceased Baljeet. Complainant no. 1 is also nominee in the above said account. The father of complainant no. 1, 3 and 4 was insured with PRADHAN MANTRI BIMA YOJNA and in this regard announcement letter and Master policy nо.760400421501000000360 was issued by the opposite party no.1 and opposite party no.2 is insurance company which insured the father of complainant No 1, 3 & 4. Premium fee was deposited by deceased Baljeet.Father of complainant no. 1, 3& 4 had expired on 12.02.2016 in road accident and an FIR No.89 dated 16.02.2016, under section 201, 279, 304-A, PS RohtakSadar was registered. After that report under section 173 Cr.P.C had been submitted by the police in the court of Ms. Nidhi Solanki, JMIC, Rohtak. The complainants informed to the opposite party no.1 about death of his father and submitted all the relevant documents with opposite party no.1. The complainants lodged their claim with opposite party no.1 and a complete file in all respect was submitted by complainants in the office of opposite party no.1 but till today the claim has not been paid despite repeated requests and demands made by complainants. On 09.10.18 when complainants reached at the office of opposite party no.1, opposite party no.1 gave a letter to complainants and opposite party no.1 said that your claim was rejected by opposite party no.2.The rejectionof the claim of complainants is against the terms and condition of policyand opposite party no.1&2 are liable to pay an amount of Rs.120,000/- as claim amount under PRADHAN MANTRI BIMA YOJNA. The act of opposite parties is illegal and amounts to deficiency in service. Hence this complaint and it is prayed that opposite parties may kindly be directed to pay Rs.1,20,000/- for the death claim of Baljeet, to pay compensation of Rs.50000/- and counsel fee Rs.11000/- to the complainants.
2. After registration of complaint, noticeswere issued to the opposite parties. Opposite party No.1 in its reply has submitted that the contents regarding father of the complainant maintaining the account bearing no.16540100025987, with answering respondent is correct as per the record.The contents regarding father of the complainant having been insured under Pradhan MantriBimaYojna and issuance of the announcement letter and master policy no. 760400421501000000360 by insured/respondent no.2 is correct. It will be pertinent to mention here that the respondent is only the facilitator between the consumer and the insurance company i.e. New India Insurance Company. The premium amount collected from the insured was transferred to respondent no.2 i.e insurer for coverage of consumer under Pradhan MantriBimaYojna. It is further submitted that on the receipt of documents, the same were forwarded without any delay to the respondent no.2, being the insurer for settlement of the claim. It is wrong and denied that the opposite party has delayed the matter on any pretext, as alleged. It is the respondent no.2 who has to make the payment to the consumer/complainant being the insurer. The communication received from respondent no.2 i.e. New India Insurance Company as regard to denial of claim was forwarded to the complainant. The respondent is only the facilitator between the consumer and the insurance company and the claim amount was to be paid by the opposite party no.2 i.e. New India Assurance Company. All the other contents of the complaint were stated to be wrong and denied and opposite party No.1 prayed for dismissal of complaint with costs.
3. Opposite party No.2 in its reply has submitted that there is no conclusive evidence to establish that death of late Mr. Baljeet has occurred due to any accident and hence the Insurance Company has repudiated the claim of the complainant. The respondent insurance company duly informed vide mail dated 27-09-2018 to the Federal Bank regarding repudiation of claim. In absence of any conclusive evidence for accidental injuries resulting the demise of the insured member, the claim of the complainant is not admissible under PardhanMantri Suraksha BimaYojna. FIR and Police report does not confirm that death has occurred due to accident. So the claim is not payable. The complainant has not provided the FSL report as Post Mortem Report describes that chemical analysis for detection of stupefying agent and poison.PardhanMantri Suraksha BimaYojna is applicable in accidental death. The death is not an accidental and the claim does not comes under purview of Prime Minister Suraksha BimaYojna. Hence the claim of the complainant is not payable as per the terms and conditions of policy. Opposite party No.2 prayed for dismissal of complaint with costs.
4. Ld. counsel for the complainant in his evidence has tendered his affidavit Ex.CW1/A, documents Ex.C1 to Ex.C18and closed his evidence on dated 10.02.2022. Learned counsel for opposite party No.1has tendered affidavit Ex.RW1/A and closed his evidence on 03.06.2022.Learned counsel for opposite party No.2has tendered affidavit Ex.RW2/A, documents Ex.R2/1 to Ex.R2/14and thereafter failed to conclude its evidence despite availing sufficient opportunities and the evidence of opposite party No.2 was closed by the order dated 03.06.2022 of this Commission.
5. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
6. In the present case the main contention of the complainant is that life assured Baljeet Singh is having a bank account in Federal Bank i.e. respondentno.1 which was having insurance from New India Assurance company under Pradhan Mantri Suraksha BimaYojana. After the death of Baljeet Singh, LRs. of deceased filed the claim with the opposite parties but the same has been repudiated by the insurance company under Pradhan Mantri Suraksha BimaYojanaand the same is conveyed to the complainant by the opposite party No.1 on the ground that claim of the claimant was rejected on a report/email received by the bank from the New India Assurance Company Ltd. A copy of the mail is placed on record by the respondent as Ex.R2/2. After receiving this mail Federal Bank issued a ‘No claim’ letter dated 25.10.2018 which is placed on record as Ex.C17. The main contention of the rejection by the insurance company is as under:-“We refer to your trail mail in connection with the above PMSBY claim. We have gone through the Final Police Investigation Report and find that there is no conclusive evidence for alleged accident leading to the death of the insured member. In the absence of any conclusive evidence/records/documents for accidental injury resulting the demise of the insured member. We are unable to entertain the claim lodged under the scheme. You may kindly convey the decision to the claimants”. We have minutely perused the documents placed on record by both the parties. As per the documents the dead body of Baljit Singh was found on 12.02.2016 and post mortem was conducted by the police officials on 13.02.2016. In post mortem report 15 injuries marks were found on the body of deceased. After that a police complaint was got registered by the son of deceased namely Ravi with the police officials that deceased was died in a road side accident and FIR No.0089 dated 16.02.2018 was got registered in PS SadarRohtak u/s 201, 279 and 304A of IPC. As per post mortem report the cause of death is mentioned as under:- “In our opinion the cause of death in this case is injuries described and their complications. All injuries described are ante mortem in nature and sufficient to cause death in ordinary course of life. However, viscera have been preserved for chemical analysis for detection of stupefying agent and poison, if any.” Meaning thereby the deceased died due to injuries described in post mortem report and all the injuries are anti mortem in nature. As per the doctor these injuries are sufficient to cause death. The doctor has nowhere stated that deceased was died due to consumption of any poisonous substance. So as per our opinion the FSL report is no further required for the disposal of the claim of the complainants. It is also observed that report u/s 173 Cr.PC was also submitted by the police officials with the concerned Illaqua Magistrate placed on record as Ex.C8. In this report it has been specifically mentioned that in the alleged accident offending vehicle was not found and the case is quite old and no further investigation is required. Police also established that deceased Baljeet was died in road side accident. Hence the repudiation of the claim by the opposite party is illegal and amounts to deficiency in service and the opposite party no.2 is liable to pay the claim amount of Rs.120000/- to the LRs of deceased in equal share. As per amended titled filed by the complainant, there are 4 LRs of deceased.
7. In view of the facts and circumstances of the case we hereby allow the complaint and direct the opposite party No.2 to pay the amount of Rs.120000/-(Rupees one lac twenty thousand only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 14.11.2018 till its realisation and also to pay a sum of Rs.5000/-(Rupees five thousand only) as compensation on account of deficiency in service and Rs.5000/-(Rupees five thousand only) as litigation expensesto the complainants(L.Rs of deceased Baljeet) namely Ravi son of deceased, Premo wife of deceased, Darshan daughter of deceased and Sunita, daughter of deceased in equal share within one month from the date of decision.
8. 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:
29.04.2024.
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Nagender Singh Kadian, President
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TriptiPannu, Member.
……………………………….
Vijender Singh, Member
