Punjab

Sangrur

CC/81/2015

Jaspal Kaur - Complainant(s)

Versus

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

Shri Jaskaran Singh Aulakh

16 Jul 2015

ORDER

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR

                            

                                                                    Complaint no. 81

Instituted on: 16.02.2015

                                                                   Decided on:    16.07.2015

 

1. Jaspal Kaur aged 49 years widow of Late Bhagwant Singh,
2. Ramandeep Kaur aged 27 years son of Late Bhagwant Singh
3. Gurpreet Singh aged 24 years son of Late Bhagwant Singh

All residents of VPO Chaunda, Tehsil Malerkotla, District Sangrur.

                                                          …. Complainants.          

                                         Versus

 

1.     The Sangrur Central Co-operative Bank Limited, Patiala Gate, H.O. Sangrur 148001 ( Punjab) through its District Manager.

2.     The Sangrur Central Co-operative Bank Limited, Branch Manvi, Tehsil Malerkotla District Sangrur through its Branch Manager. 

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

 

 

FOR THE COMPLAINANT:    Shri J.S.Aulakh, Advocate                          

 

FOR OPP. PARTIES No.1&2 : Shri Amit Goyal,  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.             Jaspal Kaur, Ramandeep Kaur and Gurpreet Singh, complainants have preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that being the member of OPs No.1&2, husband of the complainant no.1 insured with OP No.3  as he was having saving bank account number 1894 with OP No.2. The husband of the complainant met with an accident and received  cervical spine injury and unfortunately he died on 12.05.2014.  After performing the last rites of Bhagwant Singh and Bhog Ceremony, the complainants submitted  the required documents with OPs No.1 and 2  . Thereafter  OPs No.1 and 2 vide letter number 3876-78 dated 25.06.2015  forwarded the claim of the complainant to the OP No.3 but the OP No.3 repudiated the claim of the complainants on the ground that  intimation along with documents received on 29.11.2014, there is significant delay  in intimation and documents submission.  The repudiation letter is wrong , illegal and  against the  principles of natural justice. 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/- as insurance claim of accidental death of insured Bhagwant Singh along with interest @18% per annum from the date of death till payment,  

ii)     OPs be directed to pay to the complainant a sum of Rs.30000/- as compensation   on account of mental agony, harassment and Rs.30,000/- on account of deficiency in service, iii)   OPs be directed to pay Rs.7700/- as litigation expenses.

2.             In reply filed by the OPs No.1&2, legal objections on the grounds of maintainability, cause of action, suppression of material facts and locus standi have been taken up. It is submitted that the complainants submitted  claim form along with documents which was forwarded to the OP No.3 well in time  vide letter number 3876-78 on 25.06.2014.  It is further stated that  there is no delay  on the part of OPs No.1&2 in submission of claim with OP No.3. 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 to the effect that  account holder Bhagwant Singh met with an accident on 26.04.2014  and succumbed to the injuries  on 12.05.2014, after more than six months from the date of alleged accident/ death.  It has been submitted in the reply that as per terms and conditions  of the policy, written notice had to be given within 15 days from the date of alleged accident  and claim with claim form & complete documents had to be lodged within 30 days  after the date of accident but the  terms and conditions number 10 and 11  of part 3 : General Exclusions of terms and conditions of the policy were violated which are mandatory and hence  no claim is payable to the complainant. So, the claim was repudiated vide letter dated 09.12.2014. 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.1,00,000/- under the Group Personal Accident policy of OP No.3 as he was a member of the OPs No.1 and 2 under Sehkari Bank Bima Yojna. The deceased  policy holder died on 12.05.2014 due to an accident.  The complainant lodged the claim with OPs No.1 and 2 and the same was submitted to the OP No.3 on 25.06.2014 after processing the formalities and verifying the contents thereof but the OP No.3 had repudiated the claim vide letter Ex.C-5 on the ground that the claim papers were received by them on 29.11.2014.

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 25.06.2014.

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.             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 and the nominee had  submitted the claim 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.  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 25.06.2014 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.1,00,000/- 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 60 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

                July 16, 2015

 

 

 

( Sarita Garg)       ( K.C.Sharma)       (Sukhpal Singh Gill)                                                                                                                                      

             Member                Member               President

 

BBS/-