DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
PATIALA.
Consumer Complaint No. 93 of 2.3.2016
Decided on: 21.6.2017
M/s S.S.Service Providers , Model Town, Patiala, through Sh.Darshan Kumar S/o Sh.Piara Lal, Power of attorney of its Prop.Mr.Ukesh Singla.
…………...Complainant
Versus
The IFFCO TOKIO General Insurance Co.Ltd., Ground Floor,Seetal Complex, 5-C/1, Near National Nursery Rajbaha Road, Patiala through its Manager.
…………Opposite Party
Complaint under Section 12 of the
Consumer Protection Act, 1986.
QUORUM
Smt. Neena Sandhu, President
Smt. Neelam Gupta, Member
ARGUED BY:
Sh.Rakesh Malhotra,Adv.counsel for complainant.
Sh.Amit Gupta,Adv.counsel for OP.
ORDER
SMT.NEENA SANDHU, PRESIDENT
Complainant M/s S.S.Service Providers, through Sh.Darshan Kumar, attorney of its Prop.Mr.Ukesh Singla, 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.P.).
2. In brief, the case of the complainant is that e complainant is providing private services/jobs to the unemployed needy persons/job seekers for earning his livelihood and got 882 persons/members registered with the firm, insured under Group Personal Accidental Policy, vide insurance policy No.51447666 w.e.f.5.8.2014 to 4.8.2015, with capital sum insured of Rs.1lac per employee by paying total premium of Rs.76,490/-. It is averred that Mr.Jasvir Singh, one of the insured person at Sr.No.259 amongst these 882 members.On 6.3.2015 said Sh.Jasvir Singh, met with a road side accident and succumbed to the injuries. FIR No.14 dated 7.3.2015 under Section 304-A/337/338 was lodged with P.S.Sadar Faridkot. Postmortem on the dead body of Jasvir Singh was conducted at Medical College, Faridkot vide PMR/GSC/34/15 dated 7.3.2015. Intimation regarding the occurrence and death of insured was given to the OP alongwith all relevant documents. Death claim was also lodged with the OP. The OP deputed its Investigator/Surveyor for investigation of death claim.Thereafter, the complainant made so many visits for early settlement of the claim of Jasvir Singh but the OP vide letter dated 2.11.2015 repudiated the claim stating that “the deceased person has not found to be covered under the Policy, so claim is not tenable and we are closing the case as No Claim”, which amounted to deficiency in service on the part of the OP. Hence this complaint with a prayer for a direction to the OP to pay Rs.one lac as capital sum insured amount of death compensation of Gurdeep Singh alongwith special inbuilt benefits under the policy in addition to capital sum insured as Rs.2500/-, in the event of death of insured outside his home for transportation cost of dead body, Rs.1000/-cost of clothing of deceased, Rs.1000/- ambulance charges,Rs.5000/-under education fund i.e. totaling Rs.1,09,500/- alongwith interest @18% per anum from the date of death till realization.The Op may also be directed to pay Rs.20,000/-as compensation for causing mental agony and physical harassment and Rs.15000/-as cost of litigation expenses.
3. On being put to notice, OP appeared and filed the written statement taking preliminary objection that the complainant has not come to the court with clean hands. On merits , it is admitted that one Group Personal Accidental Policy bearing No.51447666 , was purchased by M/s S.S.Service Providers, w.e.f.5.8.2014 to 4.8.2015 covering list of insured persons. It is stated that present complaint has been filed on account of accidental death of Jasvir Singh S/o Baljit Singh, who as per the complainant was covered at Sr.No.259 of the list of the insured persons whereas he was not covered under the policy. As such the complainant is not entitled for any claim.After denying all other averments made in the complaint, prayer has been made for dismissal of the complaint.
4. On being called to do so, the ld. counsel for the complainant has tendered in evidence, affidavit of Sh.Darshan Kumar,Ex.CA alongwith documents Exs.C1 to C9 and closed the evidence.
The ld. counsel for the OP tendered in evidence affidavit of Sh.Sanket Gupta,Ex.OPA alongwith documents Exs.OP1 to OP3 and relied upon Ex.C9 and closed the evidence.
5. We have heard the ld.counsel for the parties, gone through the written arguments filed by the ld.counsel for the complainant and have also gone through the record of the case,carefully.
6. The ld. counsel for the complainant has submitted that Mr.Ukesh Singla is running a business under the name and style of M/s S.S.Service Providers to earn his livelihood and is giving employment to the needy/job seekers persons as per their qualifications/experience. He got its 882 employees insured with the Iffco Tokio i.e. OP, for the period from 5.8.2014 to 4.8.2015 under Group Personal Accident Policy with capital sum insured of Rs. 1 lac per employee by paying total premium of Rs.67,490/-alongwith other special inbuilt benefits under the policy. Mr.Jasvir Singh, who was working as a conductor with it, was duly insured with the OP at Sr.No.259 under the said policy. On 6.3.2015, Jasvir Singh met with a road side accident and died. Accordingly being the employer complainant lodged the claim with the OP. OP deputed its surveyor and it provided all the requisite documents to the said surveyor. However, the OP vide letter dated 2.11.2015, repudiated the genuine claim on the ground that deceased person has not found to be covered under the policy. So claim is not tenable and we are closing the case as no claim. From the Non-Motor Cover note Ex.C2, it is evident that Iffco Tokio had issued a Group Personal accident Policy for sum assured capital S.I. Rs.1ac per employee to S.S.Service Providers i.e. complainant for the period from 5.8.2014 to 4.8.2015. On perusal of list of insured persons Ex.C5, it is found that name of late Jasvir Singh is mentioned at Sr.No.259. Once the name of late Jasvir Singh is duly mentioned in the list of insured persons, then the OP by repudiating the death claim of late Jasvir Singh on the ground that his name is not mentioned in the list of insured persons, has committed deficiency in service. From the cover note, it is abundantly clear that each employee of S.S.Service Providers, was duly insured for capital sum insured of Rs.one lac under Group Personal accident Insurance policy with the OP. As per Terms and conditions Ex.C4, the OP is liable to pay 100% of capital sum insured as death claim alongwith special inbuilt benefits.
7. In view of the aforesaid discussion, we allow the complaint and direct the OP in the following manner:
- To pay Rs.one lac i.e. 100% of the capital sum insured + special inbuilt benefits i.e. Rs.9,500/-, in total Rs.1,09,500/- alongwith interest @ 7% per annum from the date of repudiation i.e.2.11.2015 till its realization.
- To pay Rs.10,000/- as cost of litigation expenses.
The OP is directed to comply the order within a period of 30 days from the date of the receipt of the certified copy of this order. Certified copy of this order be sent to the parties free of cost under the Rules. Thereafter, file be indexed and consigned to the Record Room.
ANNOUNCED
DATED:21.6.2017
NEENA SANDHU
PRESIDENT
NEELAM GUPTA
MEMBER
