DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                Complaint No.  645

                                                Instituted on:    03.11.2016

                                                Decided on:       21.04.2017

1.     Manpreet Kaur widow of Gurmit Singh;

2.     Yadwinder Singhs on of Gurmit Singh;

3.     Gurpreet Kaur D/o Gurmit Singh, resident of village Balian, Tehsil Dhuri, Distt. Sangrur.

                                                        …Complainants

                                Versus

1.             The New India Assurance Co. Ltd. 87, MG Road, Fort, Mumbai 400001 through its Regional Manager.

2.             The New India Assurance Co. Ltd. Divisional Office, Cinema Road, Nabha, Tehsil Nabha, Distt. Patiala through its Branch Manager.

3.             The Sangrur Central Cooperative Bank, Head Office, Patiala Gate, Sangrur through its  Manager.

4.             The Sangrur Central Cooperative Bank Limited, Branch office, Kanjla, Tehsil Dhuri, District Sangrur through its Branch Manager.

5.             The Balian M.P.C.A.S.S. Ltd. Tehsil Dhuri, Distt. Sangrur through its President.

                                                        ..Opposite parties

For the complainant  :       Shri S.P.Sharma, Adv.

For OPs No.1&2       :       Shri Amit Bhalla, Adv.

For OP No.3&4         :       Shri Amit Aggarwal, Adv.

For OP No.5             :       Exparte.

Quorum:   Sukhpal Singh Gill, President

                Sarita Garg, Member

                Vinod Kumar Gulati, Member

Order by : Sukhpal Singh Gill, President

1.             Smt. Manpreet Kaur and others, complainants (referred to as complainant in short) have preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that they are the legal heirs of Shri Gurmeet Singh (referred to as DLA in short) who was insured with the Ops number 1 and 2 through Ops number 3 and 4 vide Group Janta Personal Accident Insurance policy number 36150147152300000003, as he was having a saving bank account number 183734028000337 with the Op number 4 and also having Sehkari Kissan Credit card under account number 350 and passbook number 486.  It is further averred that under the scheme, the DLA was insured for Rs.1,00,000/- in case of accidental death of the person insured.

2.             Further case of the complainant is that the DLA met with an accident on 2.3.2016 and succumbed to the injuries. Post mortem on the dead body of the DLA was conducted on 2.3.2016 and DDR number 12 dated 2.3.2016 was also lodged at Chowki Ranike, PS Dhuri, Distt. Sangrur. Further case of the complainant is that after that the complainant submitted the required documents to the Ops number 2 and 3, but the claim was not settled, despite his repeated visits to the Ops.  Thus, alleging deficiency in service on the part of the Ops, the complainant has prayed that the Ops be directed to pay to the complainant the claim amount of Rs.1,00,000/- along with interest @ 18% per annum from the date of death of the insured i.e. 02.03.2016 till realisation and further claimed compensation and litigation expenses.

3.             In reply filed by Ops number 1 and 2, legal objections are taken up on the grounds that the complaint is not maintainable, that the complainant has unnecessarily dragged into unwanted litigation and that the complainant has no locus standi to file the present complaint. On merits, it is admitted that the DLA was insured under the policy and after receipt of the intimation, the OP appointed surveyor/investigator, namely, Shri Manjit Singh Kohli, who conducted thorough investigation and found that the DLA was under the influence of alcohol at the time of accident. This fact was also mentioned in the post-mortem report of Dr. Karamdeep Singh Kehla, Medical Officer, Civil Hospital, Sangrur, as such, it is stated that the claim was filed as no claim. However, any deficiency in service on the part of the OP has been denied.

4.             In reply filed by Ops number 3 and 4, it has been admitted that the DLA was insured with the Op number 1 for Rs.1,00,000/- in case of accidental death. It has been stated that the death claim of the DLA has been repudiated as no claim by the Ops number 1 and 2 by citing reasons that at the time of alleged accident, the DLA was under the influence of alcohol and the said fact of alcohol was duly mentioned in the post-mortem of the DLA. However, any deficiency in service on the part of the Ops has been denied.  

5.             In reply filed by OP number 5, it is admitted that the DLA was the member of the OP number at serial number 253 having khata number 350 and was insured with the Ops number 1 and 2 on 28.9.2015. The other allegations levelled in the complaint have been denied.

6.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-13 documents and affidavits and closed evidence. On the other hand, the learned counsel for OP number 1 and 2 has produced Ex.OP1&2/1 to Ex.OP1&2/5 documents and affidavit and closed evidence. The learned counsel for OP number 3 and 4 has produced Ex.OP3&4/1 affidavit, Ex.OP3&4/2 copy of intimation letter and closed evidence.

7.             We have carefully perused the complaint, version of the opposite parties, evidence produced on the file and written submissions and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.

8.             In the present case, the DLA, Shri Gurmit Singh was having a saving bank account with the OP number 4 as such he was insured with the OP number 1 and 2 under the Janta Personal Accident Policy for Rs.1,00,000/-. It is further case of the complainant that the DLA died an accidental death on 02.03.2016 of which DDR number 12 dated 2.3.2016 was recorded at Police Chowki Ranike, PS Dhuri, Distt. Sangrur, a copy of which on record is Ex.C-3 and the copy of post-mortem report on record is Ex.C-5. Thereafter the intimation of death was also given to the OPs number 1 and 2, but the grievance of the complainant is that the OP number 1 has wrongly repudiated the rightful claim of the complainant on the ground that at the time of death, the DLA was alcoholic.

9.             After hearing the arguments of the learned counsel for the parties and on the perusal of the documents placed on record, we find that the main point of controversy in the present complaint is with regard to that whether the DLA was alcoholic at the time of accident or not.  The learned counsel for the Ops number 1 and 2 has contended vehemently that it has been mentioned in the post-mortem report that on opening, smell of alcohol was present, mucosa inflamed.  But, on the other hand, the learned counsel for the complainant has contended vehemently that the DLA was not an alcoholic nor he was an alcoholic at the time of accident and has contended that the claim has been wrongly repudiated on the basis of post-mortem report.  The learned counsel for the complainant has further contended vehemently that there is nothing mentioned in the post-mortem report that how much quantity of alcohol had consumed by the DLA at the time of accident and further stated that the claim cannot be repudiated merely on the ground that there was smell of alcohol.  To support such a contention, the learned counsel for the complainant has cited National insurance Co. Ltd. Versus Soma Devi and others 2012(2) CPJ 50 (NC), wherein  the life insured died and in both the reports i.e. of post-mortem and investigators report, it was mentioned that the deceased had consumed alcohol with but giving any details about actual amount of alcohol consumed.  The Hon’ble National Commission held that the insurance company failed to produce credible evidence that it was intoxication which resulted in his death and the impugned order allowing the complaint by the Forum as well as the State Commission was upheld.  Similar is the position in the present case, as the OP has not produced any direct evidence to show that the DLA was alcoholic at the time of accident and further lacks about actual amount of alcohol consumed by the DLA.  As such, we are of the considered opinion that it is a fit case of deficiency in service on the part of the insurance company. Under the circumstances, we are of the considered opinion that ends of justice would be met if the OP number 1 and 2 are directed to pay to the complainant the claim amount of Rs.1,00,000/-.

10.           In the light of above discussion, we allow the complaint and direct OP number 1 and 2 to pay to the complainant an amount of Rs.1,00,000/- along with interest @ 9% per annum from the date of filing of the present complaint i.e. 03.11.2016 till realisation.  OP number 1 and 2 are further directed to pay to the complainant an amount of Rs.5,000/- in lieu of consolidated amount of compensation and litigation expenses.

11.           This order of ours be complied with within a period of thirty days of its communication. A  copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                April 21, 2017.

                                                        (Sukhpal Singh Gill)

                                                           President

                                                                (Sarita Garg)

                                                                    Member

                                                        (Vinod Kumar Gulati)

                                                                    Member