DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA
CC.No.516 of 20-10-2011
Decided on 05-03-2012
Paramjit Kaur, aged about 35 years, widow of Swaran Singh son of Sh. Bhanga Singh, Resident of village Har Rai
Pur, Tehsil & District Bathinda.
Lovepreet Singh, aged about 16 years,
Gurpreet Kaur, aged about 13 years,
Manpreet Kaur, aged about 10 years,
minor children of Swaran Singh son of Bhanga Singh, through their next friend and natural guardian Paramjit Kaur
(mother), Resident of village Har Rai Pur, Tehsil & District, Bathinda. .......Complainants
Versus
The Jandawala, Co-operative Agricultural Service Society Limited, VPO Jandawala, Sub Tehsil Nathana, District
Bathinda, through its President/Secretary.
United India Insurance Company Limited, Divisional Office, The Mall, Bathinda, through its Divisional Manager.
......Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986
QUORUM
Smt. Vikramjit Kaur Soni, President
Sh. Amarjeet Paul, Member
Smt. Sukhwinder Kaur, Member
Present:-
For the Complainant: Sh. Narinder Singla, counsel for the complainant
For Opposite parties: Sh. Harraj Singh, counsel for opposite party No.1
Sh. M.L.Bansal, counsel for opposite party No.2
ORDER
Vikramjit Kaur Soni, President:-
1. The present complaint has been filed by the complainant under Section 12 of the Consumer Protection Act, 1986 as amended up-to-date (Here-in-after referred to as an 'Act'). The brief facts of the complaint are that the opposite party No.1 had purchased Personal Accident and Medical Charges Policy for its employees from the opposite party No.2 vide Cover Note No.488239 effective from 29.05.2009 to 28.05.2010 for capital sum insured of Rs.5 Lacs plus Medical charges each and other benefits as per terms and conditions of the policy. Swaran Singh husband of the complainant No.1 was also insured under the aforesaid insurance policy. Swaran Singh-insured met with an accident on 12.02.2010 with truck bearing registration No.PB-03-Q-9745 while he was returning to his house at village on his motor cycle due to which Swaran Singh received multiple injuries, he was taken to Civil Hospital, Goniana and then was referred to Civil Hospital, Bathinda where the doctors declared him brought dead and the intimation was given to the Police Station, Nahianwala and FIR has been registered on 13.02.2010. The intimation in this regard was also given to the opposite parties and claim papers were duly submitted by the complainants to the opposite party No.2 through the opposite party No.1 within stipulated period. The opposite party No.2 only paid Rs.5 Lacs to the complainants in April, 2011 without any interest. The complainant has alleged that as per provisions of law, the opposite party No.2 was duty bound to settle the claim within 40 days, the complainants accepted the above said amount under protest and has given a protest note on the discharge voucher. The complainant has further alleged that according to the terms and conditions of the policy, the opposite party No.2 was duty bound to pay transportation charges of dead body of insured i.e. Rs.2,500/- and the said policy further provided that in the event of accidental death of insured, the opposite party No.2 shall also pay Rs.10,000/- as compensation towards education funds for dependent children who are below 23 years of age. The complainants have submitted the receipt of transportation charges of the death body for an amount of Rs.2,200/-. The opposite party No.2 has not paid Rs.10,000/- towards education funds despite of submission of school certificates of complainant Nos.2 to 4 and also not paid Rs.2,500/- on account of Transportation Charges despite of submission of receipt of transportation. Hence, the complainants have filed the present complaint for seeking directions of this Forum to the opposite parties to pay interest @ 18% p.a. on Rs.5 Lacs after 40 days from the date of accident till realization, Rs.10,000/- as education fund and Rs.2,500/- as transportation charges of dead body along with interest, cost and compensation or any other additional alternative relief.
2. Notice was issued to the opposite parties. The opposite parties after appearing before this Forum, have filed their separate written statements. The opposite party No.1 has pleaded that the complainant has never intimated the opposite party No.1 regarding any alleged accident. The opposite party No.1 has nothing to do with the honoring of the insurance claim in respect to death of Swaran Singh deceased rather the same is to be given by the opposite party No.2.
3. The opposite party No.2 has pleaded that it has already paid the entire insurance amount of Rs.5 Lacs to the complainants as admitted by the complainants themselves and no amount is pending that is to be payable to the complainants. The claim of Rs.12,500/- on account of education and transportation charges of the dead body was covered under the above said policy and the same is payable by the opposite party No.2 if documentary proof has been filed along with claim. The insured deceased, an employee of the opposite party No.1, was insured for Rs.5 Lacs only as per the terms and conditions of the policy. The amount of Rs.5 Lacs has already been paid by the opposite party No.2 to the complainants without any delay on completion of formalities and submission of requisite documents. The complainants have accepted the claim amount with their free consent and without any protest. As per terms and conditions of the policy, only insured amount was payable and the same has already been paid by the opposite party No.2 and now no extra benefit/claim is due or payable by the opposite party No.2. The complainant did not produce any vehicular documents for carrying the dead body. The complainant has herself failed to complete the formalities. Moreover, no such time frame is mentioned.
4. Parties have led their evidence in support of their respective pleadings.
5. Arguments heard. Record along with written submissions submitted by the parties perused.
6. Admittedly, the husband of the complainant No.1 was insured vide Cover Note No.488239 effective from 29.05.2009 to 28.05.2010 for capital sum insured of Rs.5 Lacs plus Medical charges and other benefits. The said policy was purchased by the opposite party No.1 for its employees from the opposite party No.2. The said policy was purchased by the opposite party No.1 for Swaran Singh being its employee. Swaran Singh-insured met with an accident on 12.02.2010 with truck bearing registration No.PB-03-Q-9745. The accidental benefit of Rs.5 Lacs has been paid to the complainant in April, 2011.
7. The complainant has submitted that she has taken the claim amount of Rs.5 Lacs under protest as, as per the terms and conditions of the policy, the opposite parties have to pay Rs.2,500/- as transportation charges for carrying the dead body of insured and Rs.10,000/- as compensation towards education funds for dependent children.
8. The complainants have produced the receipt of transportation charges for carrying the dead body for an amount of Rs.2,200/- and submitted school fee certificate of the children of the deceased but the opposite party No.2 has failed to pay Rs.2,200/- and Rs.10,000/- towards the transportation and the education fund.
9. The opposite party No.1 also wrote a letter dated 05.03.2011 to the opposite party No.2 in which the opposite party No.1 demanded Rs.5 Lacs on account of personal accident and Rs.10,000/- on account of education fund as per terms and conditions of the policy. The amount of Rs.5 Lacs has been paid but after lapse of long period whereas the opposite party No.2 was to pay Rs.5 Lacs within 40 days of death of the insured. The opposite party No.1 has only forwarded the claim of the complainants and has no role in honoring the claim in respect to the claim of deceased Swaran Singh, the claim is to be paid by the opposite party No.2.
10. The opposite party No.2 has submitted that it has paid the amount of Rs.5 Lacs to the complainants, the remaining amount which has been asked by the complainants as per terms and conditions of the policy, is not paid as the complainants have not submitted the documentary proof regarding the vehicle in which the body of the husband of the complainant No.1 was taken and Rs.10,000/- on account of education of Kids, was also not paid as no documentary proof has been submitted by the complainant No.1. If she would have submitted evidence of education of her children, the opposite party No.2 would have paid the claim of the claimants but the complainant herself had failed to furnish the requisite documents or to produce any evidence.
11. Ex.C-2 is bill-cum-receipt of the vehicle No.HP-12-6454 in which the dead body of Swaran Singh was taken. The opposite party No.1 has also written a letter dated 05.03.2011 Ex.C-3 for paying the amount of Rs.5,000/- + Rs.5,000/- = Rs.10,000/- for education of two children of the deceased Swaran Singh. The total claim of Rs.5,10,000/- was asked to pay to the complainant by the opposite party No.1.
12. Admitted facts of the parties that the amount of Rs.5 Lacs has been paid to the complainants. The documents related to bill-cum-receipt of the transportation for taking the dead body of the deceased insured Swaran Singh, is placed on file by the opposite parties as Ex.R-3 and has also placed on file fee cards of Gurpreet Kaur, Lovepreet Singh and Manpreet Kaur vide Ex.R-5 to Ex.R-7. As per the policy of the opposite parties, the amount is payable for two children of Rs.5,000/- each. All the documents which are required for processing the claim, have already been placed on file by the opposite parties themselves.
13. Moreover, Mithu Ram Sharma, Investigator, has submitted his report. The claim to the tune of Rs.5 Lacs has already paid which must have been paid after perusing of documents submitted by the complainants. There was no reason for the opposite parties to withhold the claim of Rs.2,500/- on account of transportation charges and Rs.10,000/- on account of education fund.
14. The opposite party No.2 has itself exhibit all the documents pertaining to transportation charges and regarding children studying in school. As per the above said Policy vide Ex.R-29:-
“(g) In the event of Death of the insured person due to accident as defined in the policy outside her/his residence the company shall reimburse expenses incurred for transportation of insured's dead body to the place of residence subject to a maximum of 2% of capital sum insured or Rs.2,500/- which ever is less.
(h) In he event of death of permanent total disablement of the insured due to accident as defined in the Tariff, the policy shall also provide compensation towards Education Fund for the dependent children as below:-
(i) If the insured person has one dependent child below the age of 23 years and amount equal to 10% of the CSI subject to a maximum of Rs.5,000/-.
(ii) If the insured person has more than one dependent child below the age of 23 years, and amount equal to 10% of CSI subject to a maximum of Rs.10,000/-.”
15. Therefore, in view of what has been discussed above, there is deficiency in service on the part of the opposite party No.2 for not paying the claim of the complainants within time and withholding the claim with regard to transportation charges and education fund of the children. Moreover, the amount of Rs.5 Lacs has been paid after much delay. As per the version of the complainant, the claim was payable in 40 days but no such evidence has been placed on file by the complainant as well as by the opposite parties. Hence, keeping in view the IRDA instruction, the processing time for claim, is 90 days. Thus deducting 90 days from the total period (i.e. 427 – 90 = 337 days) on which the amount of Rs.5 Lacs has been paid. Thus, the complainant is entitled for the interest on the amount of Rs.5 Lacs. Hence, this complaint is accepted with Rs.50,000/- as cost and compensation which includes interest on account of delayed payment of Rs.5 Lacs against the opposite party No.2 and dismissed qua opposite party No.1 and the opposite party No.2 is further directed to pay Rs.2,200/- on account of transportation charges and Rs.10,000/- on account of education fund to the complainant. Compliance of this order be done within 45 days from the date of receipt of copy of this order. In case of non-compliance, interest @ 9% P.A. will yield on the amount of Rs.12,200/- till realization.
A copy of this order be sent to the parties concerned free of cost and file be consigned for record. '
Pronounced in open Forum
05-03-2012
(Vikramjit Kaur Soni)
President
(Amarjeet Paul)
Member
(Sukhwinder Kaur)
Member
