Punjab

Moga

CC/17/38

Gurbir Kaur - Complainant(s)

Versus

The New India Assurance Co. Ltd. - Opp.Party(s)

Sh. Jagroop Singh

23 Aug 2017

ORDER

THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA.

 

 

                                                                                      CC No. 38 of 2017

                                                                                      Instituted on: 11.04.2017

                                                                                      Decided on: 23.08.2017

 

1.       Gurbir Kaur wife of Late Sh.Surinder Singh age 35 years,

2.       Bhupinder Singh s/o Late Sh.Surinder Singh aged 13 years,

3.       Dilpreet Kaur daughter of Late Sh.Surinder Singh aged 11 years,

4.       Prabjot Singh son of Late Late Sh.Surinder Singh age 9 years,

Complainant nos.2 to 4 minor through their Mother Gurbir Kaur next friend and natural guardian of minor child, all residents of Village Rattian, Tehsil & District, Moga.

 

                                                                          ……… Complainant

 

Versus

1.       The New India Assurance Co. Branch G.T. Road, Moga Tehsil & District Moga.

 

2.       The New India Assurance Co. C-9, 2^nd Floor, Connaught House, Connaught Palace, New Delhi.

 

3.       Punjab and Sind Bank, Branch Railway Road, Moga, Tehsil & District Moga.

 

                                                                           ……….. Opposite Parties

 

 

Complaint U/s 12 of the Consumer Protection Act, 1986.

 

 

Quorum:    Sh. Ajit Aggarwal,  President

                   Smt. Vinod Bala, Member

                   Smt. Bhupinder Kaur, Member

 

Present:       Sh. Buta Singh, Advocate Cl. for complainant.

                   Sh. Jasvinder Singh, Advocate Cl. for opposite party nos.1 & 2.

                   Sh. Ajay Gulati, Advocate Cl. for opposite party no.3.

 

ORDER :

(Per Ajit Aggarwal,  President)

 

1.                Complainant has filed the instant complaint under Section 12 of the Consumer Protection Act, 1986 ( hereinafter referred to as the "Act") against The New India Assurance Co. Branch G.T. Road, Moga Tehsil & District Moga and others (hereinafter referred to as the opposite parties) directing them to pay Rs.2,00,000/- as insurance claim and Rs.50,000/- as compensation as well as Rs.15,000/- as litigation expenses to the complainant.

2.                Briefly stated the facts of the case are that complainant no.1 is widow of Sh.Surinder Singh son of Bikker Singh and complainant nos.2 to 4 are minor children of said Surinder Singh and the present complaint is also for the benefits of minor and there is no conflict of interest of minor with their natural mother. That the Government of India has launched the Scheme PMSBY (Pradhan Mantri Suraksha Bima Yojna) of Rs.2,00,000/- in case of death and the said scheme implemented through the Bank's where the person having saving account and banks further tie up with the insurance companies. The deceased Surinder Singh was having saving account no.00171000027964 with opposite party no.3. During his life time Surinder Singh had bought the abovesaid policy from the opposite party no.3. Surinder Singh had expired on 20.08.2015. Surinder Singh was a young and heart and healthy persons, but unfortunately on 20.08.2015 during the enforcement of abovesaid policy Surinder Singh who is the sole earning member of the family has been bitten by the snake in the fields while farming in the field at Village Rattian, Tehsil & District Moga, near the house of the complainants. Thereafter, the complainant arranged the vehicle and have brought Sh. Surinder Singh at DMC Ludhiana, where he was got admitted with the diagnosis of Snake Bite case and later he had been died. Thereafter performing her last rites and upon notice of abovesaid insurance policy the complainant had approached the opposite party no.3 and completed all the formalities for the death claim of her husband alongwith necessary formalities as described to her. Thereafter, the complainant visited the office of opposite party no.3 for status of his case time to time and the complainant no.1 was informed by opposite party no.3 that they have tie up the opposite party nos.1 & 2 and they have sent all the requisite documentations to opposite party nos.1 & 2 timely, but the fault is on the part of opposite party nos.1 & 2 who had not shown the interest towards the claim of the complainant. The complainant had also moved an application before the SDM Moga to get certificate about the death. On moving the said application SDM Moga had got the report through the officials concerned and upon getting the said report, complainants had also submitted the same to opposite parties, vide which death of Sh. Surinder Singh had been declared due to snake bite. The opposite parties had not paid any single penny to the complainants under the abovesaid insurance cover. Due to the acts of opposite parties, the complainant has suffered mental tension, agony and harassment. Hence this complaint.

3.                Upon notice, opposite party nos.1 & 2 appeared through counsel and filed written reply taking certain preliminary objections that the complaint is not maintainable; that the complainant is absolutely false and frivolous; that the complainants are not entitled to any claim or relief from this Forum, as they have concealed and mis-stated the facts before this Forum. As alleged by the complainant, the insured Surinder Singh son of Bikkar Singh died on 30.08.2015 while working in the fields, but no report was lodged with the Police Station or any Government Office. No Post Mortem was got conducted on the body of deceased Surinder Singh. The death was registered on 30.08.2015. No evidence of death due to snake bite was submitted. No FIR/DDR is lodged with the police for the death of the Insured Surinder Singh due to snake bite, the police did not conduct an independent inquiry. No one was present at the spot nor had been seen the snake biting the insured. The death of insured Surinder Singh due to snake bite is not confirmed for lack of evidence, as there is no Post Mortem Report, no police report, photographs of snake bite. The claim has been lodged only to extort money from the answering opposite party. The claim of the complainants is not maintainable as per terms and conditions of the insurance policy. From the above said facts, it is clear that the complainants have concocted a false story of detah of insured Surinder Singh due to snake bite only to lodge a false and frivolous claim against the answering opposite party. The complaint being false, frivolous is liable to be dismissed. On merits, it is submitted that it is the duty of the complainants to move an application before the DMC Hospital for conducting the post mortem on the body of the deceased Surinder Singh, but complainants did not move any application before DMC Hospital intentionally, wilfully because they knew that if the post mortem of the deceased Surinder Singh was conducted truth will come out. All other allegations made in the complaint have been denied and a prayer for dismissal of the complaint has been made.

4.                Opposite party no.3 filed written reply taking certain preliminary objections that the complaint is not maintainable against the answering opposite party bank; that the complainants have got no cause of action against the opposite party bank; that no deficient services have been rendered by the answering opposite party bank as alleged by the complainants. The claim was immediately lodged to the concerned Insurance Partner i.e. The New India Assurance Company Limited by the opposite party bank. The claim has to be settled by the said Insurance Partner under terms and conditions of the insurance policy in question and the bank has nothing to do with the same; that the complainants have impleaded the opposite party no.3 i.e. Punjab & Sind Bank unnecessarily, thus the complaint against the opposite party no.3 may be dismissed with compensatory costs. On merits, it is correct upto the extent that a saving account no.00171000027964 stands in the name of Surinder Singh. It is submitted that the mandatory formalities were completed at the time of loading the claim with insurance partner. Further submitted that the claim was lodged with the insurance partner but afterwards it is the said insurance company who has to settle the claim under the terms and conditions of the insurance policy in question and the answering opposite party has got no authority to decide the claim in question. All other allegations made in the complaint have been denied and a prayer for dismissal of the complaint with compensatory cost has been made.

5.                In order to prove the case, complainant tendered in evidence his duly sworn affidavit Ex. C-1 and copies of documents Ex. C-2 to Ex.C-8 and closed the evidence. 

6.                On the other hand, opposite party nos.1 & 2 tendered in evidence duly sworn affidavit of Sh. Pankaj Kumar Dua, Deputy Manager, New India Assurance Co. Ltd. Ex.OP-1, 2/1, copy of insurance policy Ex.OP-1, 2/2 and copy of rules Ex.OP-1, 2/3 and closed the evidence. Whereas, opposite party no.3 tendered in evidence affidavit of Sh. P.K. Verma, Chief Manager, Punjab & Sind Bank Ex.OP-3/1 and closed the evidence.

7.                We have heard the learned counsel for the parties and have very carefully gone through record placed on file.

8.                The case of the complainant is that the Government of India has launched the Scheme PMSBY (Pradhan Mantri Suraksha Bima Yojna) of Rs.2,00,000/- in case of death and the said scheme implemented through the Bank's where the person having saving account and banks further tie up with the insurance companies. Sh. Surinder Singh (the deceased) husband of the complainant no.1 was having saving account with opposite party no.3 and covered under the policy. Surinder Singh was a young, hearty and healthy person, unfortunately on 20.08.2015 he was bitten by the snake in the fields while farming. Thereafter, he was brought at DMC Ludhiana, where he was got admitted with the diagnosis of Snake Bite case and later on died. Thereafter, the complainant lodged the claim with opposite party no.3 and completed all the formalities for the death claim of her husband. Thereafter, the complainant visited the opposite party no.3 a number of times for the payment of death claim of her husband. But nothing was done by opposite parties. The complainant had also moved an application before the SDM Moga to get certificate about the death of her husband. On moving the said application SDM Moga had got the report through the officials concerned and upon getting the said report, complainants had also submitted the same to opposite parties, vide which death of Sh.Surinder Singh had been declared due to snake bite. But despite that the opposite parties had not paid any single penny to the complainants.

9.                In reply, opposite parties submitted that the mandatory formalities were completed at the time of lodging the claim with insurance partner. Further submitted that as alleged by the complainant, the insured Surinder Singh son of Bikkar Singh died on 20.08.2015 while working in the fields, but no report was lodged with the Police Station or any Government Office. No Post Mortem was got conducted on the body of deceased Surinder Singh. The death was registered on 30.08.2015. No evidence of death due to snake bite was submitted. No FIR/DDR is lodged with the police for the death of the Insured Surinder Singh due to snake bite, the police did not conduct an independent inquiry. No one was present at the spot nor had been seen the snake biting the insured. The death of insured Surinder Singh due to snake bite is not confirmed for lack of evidence, as there is no Post Mortem Report, no police report, photographs of snake bite. The claim has been lodged only to extort money from opposite parties. The claim of the complainants is not maintainable as per terms and conditions of the insurance policy. The complainants have concocted a false story of death of insured Surinder Singh due to snake bite. All other allegations made in the complaint have been denied and a prayer for dismissal of the complaint with compensatory cost has been made.

10.              The sole plea put forward by the opposite party Nos.1 & 2 for the repudiation is that in the absence of post mortem report it could not be confirmed that the death was on account of snake bite. The complainant has produced on record report of SDM, Moga as Ex.C-6 and Ex.C-7, whereby the investigation conducted by SDM, Moga, through police officials on the application of the complainant and in this investigation it was certified that the husband of the complainant (since deceased) died due to snake bite. Further the perusal of the treatment record of DMC and Hospital Ex.C-5 makes it apparently clear that Surinder Singh husband of the complainant died due to snake bite on 20.08.2015. It is an admitted fact that no post mortem examination was got conducted on the dead body of the insured. But merely on account of non-production of post mortem report, it cannot be concluded that the death of the insured was not as a result of due to snake bite. The non-production of documents like Post Mortem Report or medical evidence has drawn the attention of the Foras under the Act time and again. In 2005 (1) CPC 533 ( Life Insurance Corporation of India and others Vs. Smt. Nidhi Sahi) the case of the complainant was that the death of the insured occurred in the C.C.No. 296 of 2016 scooter accident and her claim was mainly challenged on the ground that no FIR was lodged nor any Post Mortem Examination had been performed on the body of the deceased. However, the factum of death was duly proved and was supported by statement of witness, who was pillion rider of the scooter at the time of accident. The complaint was allowed by the District Forum. In the appeal the same was upheld on the ground that the factum of death had been duly proved. It becomes very much clear from that judgment that even in the absence of the FIR or the Post Mortem Report, the factum of death in a particular way can be proved by producing other evidence. Similarly in 2006 (II) CPC 599 (National Insurance Company Limited Vs. Rita Devi It was held that non-production of the Post Mortem Examination report cannot be made a ground for repudiation of the claim. The facts were similar in 2009 (1) CLT 74 ( Parkash Kaur and others Vs. ICICI Lombard General Insurance Company Limited). In that case the insured had died due to snake bite and evidence was produced for proving that fact. However, there was no post mortem report or police report for proving that fact. It was held therein that the claim cannot be repudiated simply on the ground that the post mortem report or the police report was not produced especially when the death by snake bite is proved from other evidence. Ld. counsel for complainant further put reliance on citation  2006(1) CPJ 11 (Dharmisetty Srinivas Rao Vs New India Assurance Co. Ltd.) vide which our National Consumer Disputes Redressal Commission, New Delhi held that Insured had taken personal accident policy - He died due to snake bite - Claim not settled as post mortem was not conducted - Complainant was dismissed by State Commission giving rise to present appeal - Usually post mortem is not conducted in cases of snake bite - Certificate issued by Doctor is sufficient to prove the death of insured - Company directed to pay Rs. 5 lakh as per Insurance policy - Appeal allowed. Similar in 2007 (4) CPJ 389 (United India Insurance Company Ltd. Vs Pallamreddy Aruna) the case of the complainant was that Death due to snake bite. Post- mortem not conducted. Claim was repudiated on the ground that proof of death by snake bite was not established without conducting post mortem. Contention cannot be accepted. Death was duly proved by certificate of police official, village Administrative officer and the doctor. In a small village, villagers cannot wait for post-mortem in cases of snake bite. A doctor in such cases can certify that person concerned had died because of poison due to snake bite. Order passed by authorities below upheld. It has been further held that Ld. counsel for the petitioner further submitted that in terms of the policy, conduct of post-mortem is a must. In our view, in a small village, when a person dies because of snake bite, they would not wait for post-mortem or would not remove the dead body to the Civil Hospital which is far off. Hence, there is no substance in this version petition and it is dismissed. In view of the above, we are of the opinion that the case of the complainant stands proved on the record. The act and conduct of the opposite party Nos.1 & 2 amounts to sheer negligence as well as deficiency in service. The complainant is entitled to suitable compensation and costs of litigation. Since opposite party no.3 is the bank, who is only the interlocutory mediator, so complaint against opposite party no.3 is liable to be dismissed.

11.              In view of above discussion and law laid down by the higher courts cited above, the present complaint is hereby allowed against opposite party Nos.1 & 2 with the direction to pay to the complainant sum insured of Rs.2,00,000/- alongwith interest @9% per annum from the date of filing of present complaint i.e. 11.04.2017 till realization. The opposite party nos.1 & 2 are further directed to pay Rs.5,000/-(Five thousand only) for mental harassment and sufferings and Rs.3,000/-(Three thousand only) as litigation expenses. This order is directed to be complied with within a period of thirty days from the date of receipt of a copy of this order, failing which, the complainant shall be entitled to initiate proceedings under section 25 & 27 of the Consumer Protection Act. Complaint against opposite party no.3 stands dismissed. Copy of the order be supplied to the parties, free of cost. File be consigned to the record room.

Announced in Open Forum

Dated : 23.08.2017

 

                               (Bhupinder Kaur)                   (Vinod Bala)                     (Ajit Aggarwal)

                                     Member                                Member                             President