Punjab

Sangrur

CC/88/2015

Hardeep Kaur - Complainant(s)

Versus

The Sangrur Central Co-Op. Bank - Opp.Party(s)

Shri Swaran Singh Ratol

10 Aug 2015

ORDER

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR

                            

                                                                    Complaint no. 88

                                                                    Instituted on: 19.02.2015

                                                                   Decided on:    10.08.2015

 

1. Hardeep Kaur aged 45 years wife of Gurjant Singh,
2. Baljinder Singh son of Gurjant Singh,
3. Amandeep Kaur d/o Gurjant Singh son of Hardev Singh, all resident of village Balian, Tehsil & District Sangrur.

                                                          …. Complainants.                                                                    Versus

1.     The Sangrur Central Co-operative Bank Limited, Branch Bhindran, Tehsil & District Sangrur through  its District Manager.

2.     The Sangrur Central Co-operative Bank Limited,Head Office, Patiala Gate, Sangrur.

3.     Liberty Videocon General Insurance Company Limited, 10^th Floor Tower-A, Peninsula Business Park, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400 013.                                                                      ….Opposite parties.

 

 

FOR THE COMPLAINANT:    Shri S.S.Ratol, Advocate                          

 

FOR OPP. PARTIES No.1&2 : Shri Gagandeep Sibia, Advocate                    

 

FOR OPP. PARTY No.3     :    Shri Vinay Jindal, Advocate                     

 

Quorum

         

                   Sukhpal Singh Gill, President

K.C.Sharma, Member

Sarita Garg, Member

                 

ORDER:  

 

K.C.Sharma, Member

 

1.             Hardeep Kaur, Baljinder Singh and  Amandeep Kaur, complainants have preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that husband of the complainant no.1 was insured with the OP No.3 and premium of insurance was deducted from the account of the deceased by OP No.1. The husband of the complainant met with an accident and died  on 7.6.2014. DDR no. 19 dated 8.6.2014 was recorded in  P.S.City, Sangrur and post mortem was also conducted in Civil Hospital, Sangrur.   The complainants submitted the required documents with OP No.1 which were forwarded to OP No.2  and then to OP No.3 but the OP No.3 repudiated the claim of the complainants only on the ground that  intimation was  received on 29.11.2014, there is delay  in intimation and documents submission.  The non-payment of claim amount, amounts to deficiency in service on the part of OPs. Thus, alleging deficiency in service on the part of OPs, the complainant has sought following reliefs:- 

i)      OPs be directed to pay a sum of Rs.1,00,000/- along with interest from the date of death till realization,  

ii)     OPs be directed to pay to the complainant a sum of Rs.50000/- as compensation   on account of mental agony, harassment and Rs.11000/- as litigation expenses.

2.             In reply filed by the OPs No.1&2, preliminary  objections on the grounds of maintainability, cause of action and locus standi have been taken up. It is submitted that the complainants after the death of Gurjant Singh submitted  claim form  along with relevant documents with OPs No.1&2 which were immediately forwarded to the OP No.3. It is further submitted that the liability, if any, is of OP No.3 being the insurer for the release of claim amount to the complainants. Thus, there is no deficiency in service on the part of the OPs No.1&2.

3.             In reply filed by OP No.3, legal objections on the grounds of maintainability, concealment of material facts and cause of action have been taken up. On merits, it is submitted that the OP No.3 received the intimation from the office of OP No.1 on 29.11.2014 after a delay of almost five months.  In case the said policy with terms  and  conditions  was  not supplied by the OPs No.1 and 2  to the beneficiaries  and intimation was not given by the complainants or OPs No.1 and 2 to the OP No.3  as per terms and conditions of the policy, no claim  is payable to  by replying OP. It has been submitted that the complainants are claiming that sum assured under the policy is Rs.1,00,000/-  whereas actually  the sum assured under personal accident vide policy  valid from 29.09.2013 to 28.09.2014 was only for Rs.50,000/-. Thus, there is no deficiency in service on the part of OP No.3.

4.             The complainant has tendered documents Ex.C-1 to Ex.C-6 and closed evidence. On the other hand, OPs have tendered documents Ex.OPs1&2/1 to Ex.OPs1&2/4 and Ex.OP3/1 to Ex.OP3/7 and closed evidence.

5.             After hearing the arguments of learned counsel for the parties and on perusal of the documents placed on record, we find that the husband of the complainant was insured for Rs.50,000/- under the Group Personal Accident policy of OP No.3 as per document Ex.OP3/2. The deceased  policy holder died on 07.06.2014 due to an accident and  in support of her version the complainants have placed on record  police report and post mortem report which are Ex.C-1, Ex.C-2 and Ex.C-3.  The policy was obtained through OPs No.1 and 2 as the insured was having his account  with OPs No.1&2. The complainant lodged the claim with OPs No.1 and 2 and the claim document is dated 12.07.2014 and the same is placed on record as Ex.OP3/5. The OPs No.1 and 2 had submitted the same to OP No.3 on 26.08.2014 after processing and verifying the contents thereof  but OP No.3 had repudiated the claim vide document Ex.OP-3/6 on the ground that the claim papers  were received by them on 29.11.2014. the complainant has lodged the claim for a sum of Rs.1,00,000/-  but on the perusal of the document Ex.OP3/2, we find that the same is for Rs.50,000/- .

6.             Learned counsel for the OP No.3 has vehemently argued that as per the terms and conditions of the policy the claimant should have submitted the claim within 15 days of the actual date of the accident whereas the counsel for the OPs No.1&2 has argued that after receiving the  documents and  processing the same  they have submitted the claim to  OP No.3 on 26.08.2014.

7.             Learned counsel for the complainant has submitted that no terms and conditions were ever supplied to the insured either by OPs No.1&2 or by OP No.3 and no such evidence has been led by the OPs to prove that the terms and conditions were supplied to the deceased/ insured.

8.             In reply, the OP No.3 has admitted that the policy in question is for Rs.50,000/-  and had repudiated the claim as the same was submitted after  one month from the date of death and on carefully examining the terms and conditions of the policy contained in document Ex.OP3/3 under the head “ Notification of claim”  we find  that though the intimation was to be given in 15 days but then it has also been mentioned in this document that “ however, the company may condone the delay on merits of the claim subject to getting satisfied  that the delay in notification was due to reasons beyond the control of the insured/ insured person/ nominee”. In the present complaint, the insured died suddenly  on 7.6.2014 and the nominee had  submitted the claim on 12.07.2014 Ex.OP-3/5 and in such circumstances  it cannot be said that  the complainant/ nominee has submitted the claim with deliberate delay.  Moreover, this condition does not even say that if the notice is not given within 15 days then the claim shall stand repudiated. The received stamp on the document Ex.OP-3/5  is dated 27.11.2014  but in the repudiation letter which is Ex.OP3/6 the OP No.3 has mentioned the date  of receipt of the document  as 29.11.2014. It seems that the OP No.3 has not properly  processed the claim  as their own document  shows two different dates.  We have gone through some other  cases in which the OP No.3  is also a party and in all those cases the OP No.3 has mentioned the date of receipt as  29.11.2014 irrespective  of the date of delivery and places of the complainants are different. In support of his version learned counsel for the complainant has submitted the judgment of Hon’ble Tamilnadu  State Commission, Chennai delivered in case A.P. No.850/99 titled as  The Branch Manager, New India Assurance Company Limited Vs. Soosai, 2004(1) CLT 672, wherein it has been held that “ this condition does not say that if notice is not given within a month, the claim shall stand repudiated. On the other hand, it would only require that  a notice to be given within a month after the event. It does not bar or state that failure to issue any notice within the prescribed period of one month would estop or eschew or prohibit anyone from making a claim. Even if there is such a condition, it cannot be upheld since it is unconscionable. The contract of insurance being one based upon honesty and good faith, such trivial technicalities cannot be allowed to sway the ultimate aim and goal of insurance. Therefore, we are unable to accept the contentions of the learned counsel for the  appellant and that the repudiation is justified on account of the proviso and the conditions”.

9.             Learned counsel for the OPs No.1&2 has submitted that the claim has been submitted on 26.08.2014 and the same has not been delayed as alleged by the OP No.3 as on receiving  the documents it needs some time for processing of same.

10.           So, in view of the above discussion made above, we find that the OP No.3 is not only deficient in service but also indulged in unfair trade practice and has enforced the complainants to seek legal remedy in order to receive their rightful claim which has been supported by cogent evidence. The Hon’ble Punjab & Haryana High Court  in case tilted as New India Assurance Company Limited Vs. Smt. Usha Yadav and others 2008 (3) R.C.R. 9 ( civil) 111 has held that the insurance companies  are in the habit to take these type of projections to save themselves from paying the insurance claim. The Insurance companies are only interested in earning the premiums and find ways and means to decline claims.

11.           Further, the Hon’ble Supreme Court of India in Madras Port Trust Vs. Hymanshu International, (1979) 4 SCC 176 whereby, it deprecated the practice  often adopted by governmental and public authorities, of denying  just claims of citizens  on technical pleas, even though the claim lodged with them was otherwise well founded”. The relevant observations are extracted hereinbelow:-

“ ……2. We do not think that this is a fit case where we should  proceed to determine whether the claim of the respondent was  barred by Section 110 of the Madras Port Trust Act (II of 1905) . The plea of limitation based on this Section is one which the court always looks upon with disfavour and it is unfortunate that a public authority like the Port Trust should, in all morality and justice, take up such  a plea to defeat  a just claim of the citizen.  It is high time that governments and public authorities adopt the practice of not relying upon technical pleas for the purpose of defeating legitimate claims of citizens and do what is fair and just to the citizens”. Here, it is obvious that the claim of the complainant was a just claim supported by the cogent and reliable evidence  of the complainant. Moreover, IRDA’s circular dated 20.09.2011, 14.4 clearly  says that genuine claims cannot be rejected on account of delay in intimation,  and that, the insurer’s decision to reject a claim must be based on “ sound logic” and “ valid grounds”.  

12.           In the light above facts, we allow the complaint against OP No.3 and direct the OP No.3 to pay a sum of Rs.50,000/- being insured amount along with interest 9% per annum from the date of filing of complaint till realization. We further order the OP No.3 to pay to the complainant a sum of Rs.10000/- on account of mental agony and harassment and also to pay a sum of Rs.5000/- as litigation expenses.

13.           This order of ours shall be complied with within 30 days from the receipt of copy of the order.  Copy of the order be supplied to the parties free of charge. File be consigned to records in due course.       

Announced

                August 10, 2015

 

 

 

(SaritaGarg) (K.C.Sharma) ( Sukhpal Singh Gill)                                                                                                                                     

             Member                Member               President

 

BBS/-