Complainant Sudesh Kumari has filed the present amended complaint under section 12 of the Consumer Protection Act against the opposite parties and praying that Oriental Insurance Company Limited, who as per opposite party No.1, was the insurer, who is liable, may kindly be directed to pay her claim with 12% interest from the date of action till payment along with cost rupees one lac each on account of deficiency of services, and other reasons explained above. 

2.       The case of the complainant in brief is that his husband namely Narinder Kumar was having a saving bank account No.48 with opposite party No.1 and being the account holder he was the member of Sehkari Beema Yojna Scheme of opposite party No.1 and as such he was insured under Janta Personal Accident Insurance Policy up to one lac being the member of the said scheme and opposite party No.1 was deducting regular premium from his saving bank account maintained by him. It was pleaded that husband of complainant was met with an accident on 11.01.2004 and sustained serious injuries on various parts of the body and subsequently succumbed to his injuries on 18.01.2007 and accident was also recorded by the police under section 174 of Cr.P.C. It was further pleaded that death claim of the husband was lodged by the complainant with the opposite party No.1 which was not paid to her and complaint was filed by the complainant before this Forum/Commission against Bank and United India Insurance Company which was dismissed and an appeal was also filed by the complainant before the Hon'ble State Commission which was allowed vide orders dated 30.05.2013. It was also pleaded that United India Insurance Company who was the insurer at the time of accident in which Narinder Kumar was insured and the cause of action accrued, aggrieved by the decision of Hon'ble State Commission filed an appeal before the Hon'ble National Commission on the ground that United India was not the insurer and National Insurance Company was the insurer and a fine of Rs.25,000/- each was imposed by the Hon'ble National Commission to United India Insurance Company and The Gurdaspur Central Cooperative Bank for misleading the parties and was also directed the complainant to submit the DDR Report, Death Certificate, Handicaped Certificate and claim before opposite party No.1 within a period of one month from 17.12.2014 and bank will forward the same to National Insurance Company immediately and the Company will settle the matter within 90 days from the date of receipt of orders. It was next pleaded that as per direction of the Hon'ble National Commission all the documents were given to opposite party No.1 and United India Insurance Company and after receiving the same cost of Rs.25,000/- as imposed by the Hon'ble National Commission was paid by both of them but claim was not paid and then an application under section 27 of CPA for execution of the order of Hon'ble National Commission was filed by the complainant and after receiving the notice of the execution, National Insurance Company appeared through counsel and gave an undertaking on 23.12.2015 that the claim shall be settled within 90 days from the date of receipt of documents from United India Insurance Company Limited. Complainant alleged that on 18 April 2016 it was informed by the National Insurance Company that her husband was not insured with them as per their record at the time of accident and as such claim is not payable and also said that letter dated 18.04.2016 may kindly be treated as decision of National Insurance Company Limited in compliance of order dated 10.11.2014 passed by the Hon'ble National Commission in revision petition No.4746 of 2013 in United India Insurance Co. Ltd. Vs. Sudesh Kumari & others and compliance of undertaking dated 23.12.2015 given before this Forum/Commission in application under section 27 of CPA. Complainant further alleged that National Insurance Company Limited and Gurdaspur Central Cooperative Bank Sihowra Kalan made a mockery of the judicial process and willfull disobedience of the orders of Hon'ble National Commission and undertaking given on 23.12.2015. Complainant also alleged that it is clear cut deficiency of services on the part of opposite party No.1 who motivated the deceased Narinder Kumar husband of complainant for purchasing the policy and became member of Janta Group Insurance Policy and premium was also deducted by them from the account of the deceased and remitting the premium to some Insurance Company, it was for the bank manage and get the claim to the complainant. National Insurance Company equally deficient in providing service and misleading not only the complainant but also the judicial process and if it was discovered that Narinder Kumar was not insured with the company then the remedy with the company to approach the Hon'ble National Commission for revision but they choose to give an undertaking to settle the claim within 90 days from the date of receiving of documents from United India Insurance Company which also a contempt of Court. Complainant next alleged that opposite party No.1 i.e. Bank is liable to settle her claim because premium was deducted by them and record of insurer was also with them. An application was moved under Right to Information Act to know whether Narinder Kumar was insured under Janta Group Insurance Policy and if yes whcich was the Insurance Company but opposite party No.1 refused to give information on the plea that Bank is registered Cooperative Society and as such it is not public authority defined under RTI Act and withholding a normal information which shows their malafide intention. It is alleged that the cause of action has arisen in favour of the complainant and against the opposite parties when the complainant did not get her claim even after 13 years of the accident and 10 years of the death of the deceased Narinder Kumar husband of complainant. Complainant alleged that opposite parties are liable to pay cost to tune of Rs.one lac each for causing mental agony, harassment and for unnecessary litigation till Hon'ble National Commission thereby causing lot of expenses for no fault of her. It was informed by the opposite party at this stage that husband of complainant Narinder Kumar was insured with The Oriental Insurance Company Limited and Hon'ble National Commission has also held that this being a case of unique nature the delay factor will not make any effect, hence this complaint.

3.       Upon notice opposite party no.1 appeared through their counsel and filed written reply by taking the preliminary objections that complaint is not maintainable in the present form as the dispute is between the insurance company i.e. The Oriental Insurance Company with whom deceased was insured at the time of alleged accident and complainant, that the complaint is not maintainable in the Hon'ble Forum/Commission and as per terms and conditions of the insurance policy, the case of repudiation of the claim, the insured person was to file appeal before the Grievance Redressal Cell of the insurance company in the Divisional office of concerned Regional Office or the Grievance Cell of the Head Office of the company and if he not satisfied before the Grievance Cell he has to approach the Ombudsman of the insurance company established by the Central Govt. that complainant has no cause of action to file the present complaint against opposite party and that the husband of complainant was insured with the Oriental Insurance Company Ltd. At the time of alleged accident and opposite party just an agent to secure the insurance policy. On merits, it is stated that alleged accident took place in the year 2004 but as per the complainant death of her husband took place on 2007. It is for the complainant to prove the alleged accident and also to prove the death of her husband due to the injuries suffered in an alleged accident. And there is no relevant document and evidence which shows that the death was caused due to injuries in an accident. It is admitted that after purchase of insurance policy willfully by the deceased, the opposite party deducted premium from the account of deceased Narinder Kumar and it was for the bank to manage and get the claim to the complainant and if there is any claim, only the insurance company is liable for the same. All other averments of the complaint have been specifically denied and lastly prayed for dismissal of complaint.

4.       Sh.Harjit Singh Kahnuwania Advocate had appeared on behalf of opposite party no.2 after the service of notice on 18.05.2018 and filed memo of appearance but he failed to file his power of attorney and written reply of opposite party No.2 and as such defence of opposite party No.2 had been struck off vide order dated 16.07.2018.

5.       Opposite party No.3 appeared through their counsel after issuing the notice and filed written reply by taking  the preliminary objections that the complaint of the complainant is time barred as the claim is regarding accidental death of Narinder Kumar on 11.01.2004 and complaint against opposite party No.3 i.e. National Insurance Company was filed in April, 2017 after elapsed of 13 years, that present complaint is not maintainable and complainant is not entitled for any claim from  opposite party No.3 as the deceased Narinder Kumar was not insured with opposite party No.3 at the time of alleged accident. Opposite party No.3 traced the policy of its own and found that deceased Narinder Kumar son of Deewan Chand was covered under the Group Personal Accident Policy bearing number 401100/42/04/8200000041which was valid for the period 31.05.2004 to 30.05.2005 in the name of Gurdaspur Co-operative Bank Ltd. but as per the documents deceased Narinder Kumar was met with an accident on 11.01.2004 and died on 18.01.2007 per photocopies of DDR, claim form & death certificate and in the light of these documents, it was very much evident that Late Narinder Kumar was not covered at the time of accident i.e. 11.01.2004 and as such opposite party No.3 was not liable towards the legal heirs of deceased Narinder Kumar as he was not insured with the opposite party No.3 that complaint legally is not maintainable and that no cause of action has ever arisen in favour of the complainant. On merits, it is admitted that opposite party No.3 vide its letter dated 18.04.2016 complied with the orders of this Hon'ble Court and decided the claim of the complainant within 90 days of the submission of the documents by the United India Insurance Company and detailed information was also given to the complainant. All other averments made in the complaint have been denied and lastly prayed for dismissal of complaint with special costs under section 35-A C.P.C.

6.       In order to prove the case counsel for the complainant has tendered into evidence affidavit of complainant Ex.C1, copies of documents Ex.C2 to Ex.C12 and closed the evidence on behalf of complainant.  

7.       On the other hand counsel for the opposite party No.1 had failed to tender the evidence after availing many opportunities and imposing of costs and as such the same was closed by order on 18.06.2019.    

8.       Opposite party No.2 had also failed to tender their evidence as their defence had already been struck off vide order dated 16.07.2018.

9.       Counsel for the opposite party No.3 had tendered into evidence affidavit of Sh.Sunil Tuli Sr. Div. Manager Ex.OP-3/1 alongwith documents Ex.OP-3/2 to Ex.OP-3/4 and closed the evidence on behalf of opposite party No.3.

10.     Written arguments filed by the complainant and opposite party No.3 but not filed by opposite parties No.1 & 2.

11.     We have carefully examined all the documents/evidence produced on record for its contained statutory merit and have also judiciously considered and perused the arguments duly put forth by the learned counsels along with the incidental scope of adverse inference for some of the documents that have been somehow ignored to be produced by the contesting litigants against the back drop of the arguments as put forth by the learned counsels for their respective contestants.

12.     From the over all circumstances as enumerated in respective pleadings of the parties, it reveals that husband of the complainant was having bank account and member of Sehkari Beema Yojna Scheme with Opposite party no.1 and was insured under Janta Personal Accident Insurance Policy through opposite party No.1. Husband of the complainant met with an accident on 11.01.2004 and succumbed to injuries on 18.01.2007. Complaint was filed by the complainant before this Forum/Commission on 19.09.2007 against Bank and United India Insurance Company which was dismissed vide order dated 09.07.2008 as Ex.C6 and thereafter first appeal no.1112 of  2008 was filed by the complainant before the Hon'ble State Commission which was allowed vide order dated 30.05.2013 as Ex.C7. United India Insurance Company aggrieved by the order of Hon'ble State Commission and thereafter preferred revision petition no.4746 of 2013 before Hon’ble National Commission by taking the plea that it was not insurer at that time. It also came into light that National Insurance Company was the Insurer at the time of accident of Husband of complainant. The Hon’ble National Commission vide order dated 10.11.2014 as Ex.C8 directed that United India Insurance company was not involved in this case at all but due to wrong averments the parties misled and imposed fine of Rs.25,000/- on United India Insurance company and Rs.25,000/- on Opposite Party No.1 to pay to the complainant. The Hon’ble National Commission directed to the complainant to submit the requisite documents to the Opposite party no.1 and further OP no.1 forward the same to National insurance company to settle the claim within 90 days. After receiving the documents the National Insurance company Ltd. vide its letter no.401100/Legal/2016 dated 18.04.2016 as Ex.C9 repudiated the Insurance claim by stating that deceased was not insured with their Insurance company at that time. Thereafter as the complainant did not receive any claim, she filed a miscellaneous application before The Hon’ble National Commission for compliance of order dated 10.11.2014 but the same has been withdrawn on 20.01.2017 by the complainant to file an execution application before appreciate Forum. Thereafter complainant filed an application under Right to information act to OP.No.1 to disclose the name of Insurance Company who insured the husband of complainant at the time of accident, which was denied by OP No.1 as Ex.C12. Thereafter as it was not clear to the complainant from whom she may claim the insurance claim of death of her husband in execution application, as both the insurance companies tried to shift their liability upon each other. The Hon’ble National Commission vide its order dated 10-11-2014 had taken a view that in the peculiar circumstances of this case the question of delay will not arise. Hence the complainant preferred to file the present complaint and filed an application under order I rule 10 CPC to produce the insurance policy in question on file which was not intentionally disclosed by OP no.1 in earlier complaint. Thereafter OP no.1 disclosed the name of Insurance Company i.e. The Oriental Insurance Company Ltd.,

13.     The contention of OP no.1 is that policy has been issued by the OP. no.2 The Oriental Insurance Co. Ltd., where as The Oriental Insurance Co. Ltd., has alleged that Insurance Policy has not been issued by them, but policy itself speaks/shows that policy is issued by The Oriental Insurance Co. Ltd., and list of insured person is also annexed as submitted by OP no.1 i.e. placed on file. Both the opposite parties have tried to shift their liability upon each other.

14.     The fact is undisputed that the husband of the complainant was having a saving bank account No.48 with opposite party No.1 and being the account holder he was the member of Sehkari Beema Yojna Scheme of opposite party No.1 and as such he was insured under Janta Personal Accident Insurance Policy up to Rs.One Lac. However the name of the Insurance Company was disclosed by OP.No.1 on later stage. The said insurance policy was valid from the period 01.06.2003 to 31.05.2004 with opposite party No.2. After careful perusal of evidence and documents available in file it is clear that insured Narinder Kumar (since deceased) met with an accident on 11.01.2004 during existing of insurance policy and died on 18.01.2007 due to that accident. Therefore, complainant entitled to the claim under the said insurance policy.

15.     From the above details of the case and latest development came up during the proceeding of the case we see that the deceased was not insured with the opposite party No.3 i.e. National Insurance Co. Ltd. at the time of accident. Hence, opposite party No.3 cannot be considered liable for any claim in this case.        

16.     After hearing the arguments of both the parties and perusal of evidence in our opinion, opposite parties have committed deficiency in service not paying insured amount to the complainant and caused harassment to the complainant. 

17.     Therefore, as a sequel of the above discussion, this commission is of considered opinion that complainant has succeeded in proving her case and complaint in hand is hereby partly allowed and opposite party No.2  i.e. The Oriental Insurance Company Ltd., is directed to pay the insured amount i.e. Rs.One Lac alongwith interest @ 6% per annum from the date of filing of the present complaint i.e. 10.05.2017 to the complainant within 45 days from the date of receipt of copy of this order, failing which opposite party No.2 shall pay the amount alongwith interest @ 9% P.A. till its realization. In addition to this the Opposite party No.1 is directed to pay Rs.50,000/- on account of deficiency in service, mental agony and harassment and Rs.10,000/- in lump sum as litigation expenses to the complainant.

18.      The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.

19.     Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record room.  

                               (Kiranjit Kaur Arora)

                                                                         President

Announced:                                             (B.S.Matharu)

MARCH 01,2023                                         Member

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