Punjab

Sangrur

CC/257/2015

Rano Kaur - Complainant(s)

Versus

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

Shri G.S. Grewal

01 Oct 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR

                            

                                                                    Complaint no. 257

Instituted on:  04.05.2015

                                                                   Decided on:    01.10.2015

 

Rano Kaur aged about 42 years wife of Late Shri Babu Singh, resident of Village Lehal Kalan, Tehsil Lehra, District Sangrur.

                                                          …. Complainant      

                                         Versus

1.     The Sangrur Central Co-operative Bank Limited, Branch Office: Patiala Gate, Sangrur through its District Manager.

2.     The Lehal Kalan CASS Limited, Branch Lehal Kalan, Tehsil and District Sangrur through its Secretary;

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

 

FOR THE COMPLAINANT:   Shri G.S.Toor, Advocate                          

FOR OPP. PARTY No.1    :     Shri Amit Goyal,  Advocate                    

FOR OPP. PARTY No.2     :    Shri H.S.Sidhu, Advocate                    

FOR OPP. PARTY No.3     :    Shri Bhushan Garg, Advocate                    

 

 

Quorum

         

                   Sukhpal Singh Gill, President

K.C.Sharma, Member

Sarita Garg, Member

                 

ORDER:   

 

K.C.Sharma, Member.

 

1.             Smt. Rano Kaur, complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the husband of the complainant namely, Babu Singh (referred to as DLA in short) was having an account bearing number 601 with OP number 1 and being the member, the DLA was insured for Rs.50,000/- under Kissan Credit card with OP No.3 under policy number 4112-200501-13-5000002-00-000.  It has been further averred that on 11.8.2014, the husband of the complainant met with an accident within the revenue estate of Village Lehal Kalan, PS Moonak and sustained multiple injuries on his person and died after two days i.e. on 13.8.2014 in Amar Hospital, Patiala, of which FIR number 107 dated 16.8.2014 was also lodged at PS Moonak. It is further averred that after the death of the DLA, the complainant being the beneficiary lodged the claim with the Ops number 1 and 2 for getting the claim under the policy and submitted all the relevant documents with the Ops number 1 and 2 for releasing the claim amount, but it was told by them that the documents have been sent to OP number 3 for paying the claim. It is further stated that OP number 3 repudiated the claim of the complainant vide letter dated 9.12.2014 on false and vague grounds of delay in intimation and documents submission, which is totally illegal and wrong. Thus, alleging deficiency in service on the part of OPs, the complainant has prayed that the OPs be directed to pay to the complainant a sum of Rs.50,000/- as claim amount under the policy along with interest @ 18% per annum and further claimed an amount of Rs.55,500/- as compensation for mental agony, harassment and litigation expenses.

2.             In reply filed by the OP No.1, preliminary objections are taken up on the grounds of maintainability, that the complainant has no cause of action and locus standi to file the present complaint and that the complainant has not come to the Forum with clean hands.  On merits, it is admitted that Shri Babu Singh was insured for the sum of Rs.50,000/- in case of accidental death from OP number 3. It is further averred that the complainant submitted the claim documents with the Op and OP forwarded the claim to the OP number 3 i.e. insurance company vide letter number 8911 dated 22.9.2014 and further the claim of the complainant was repudiated vide letter dated 9.12.2014 by OP number 3.   Any deficiency in service on the part of the OP number 1 has been denied.

 

3.             In reply filed by OP No.2, legal objections are taken up on the grounds that the complainant has unnecessarily dragged the OP into uncalled litigation and that the complainant has got no locus standi to file the present complaint.  On merits, it has been stated that the Op number 2 has no liability to pay the claim and if there is any liability, then the same is of Ops number 1 and 3. Any deficiency in service on the part of OP number 2 has been denied.

 

4.             In reply filed by OP No.3, legal objections are taken up on the grounds that the policy in question was issued by the OP in favour of OP number 1 for the period from 29.09.2013 to 28.09.2014 thereby covering its KCC account holders subject to the terms and conditions under which the sum insured was Rs.50,000/-.   On merits, it is stated that the complainant has not explained the delay in lodging the FIR and even no information was given to the Ops before the cremation of Shri Babu Singh.  It has been denied that the complainant submitted all the relevant documents to the OP. It has been denied that the OP has repudiated the claim on false and vague grounds of delay in intimation and documents submission.  The claim was lodged on 29.11.2014 with the Ops after a delay of three months as accident took place on 11.8.2014. It is stated that the complainant is not entitled to get any claim from the OP and the claim has rightly been repudiated vide letter dated 09.12.2014.  Any deficiency in service on the part of the Ops has been denied.  

 

5.             The complainant has tendered documents Ex.C-1 affidavit of the complainant, Ex.C-2 copy of pass book, Ex.C-3 copy of repudiation letter dated 9.12.2014, Ex.C-4 copy of death certificate, Ex.C-5 copy of FIR, Ex.C-6 copy of PMR and closed evidence. On the other hand, the learned counsel for OP number 1 has tendered documents Ex. OP1/1 copy of claim forwarding letter, Ex.OP1/2 affidavit, Ex.OP1/3 copy of dispatch register, Ex.OP1/4 copy of postal receipt, Ex.OP1/5 copy of letter dated 1.11.2014 and closed evidence. The learned counsel for OP number 2 has produced Ex.OP2/1 affidavit, Ex.OP2/2 copy of member report, Ex.Op2/3 copy of resolution dated 3.6.2015 and closed evidence. The learned counsel for OP number 3 has produced Ex.OP3/1 affidavit, Ex.Op3/2 copy of policy, Ex.OP3/3 copy of terms and conditions, Ex.Op3/4 copy of claim form and closed evidence.

 

6.             After hearing the arguments of learned counsel for the parties and on perusal of the documents placed on record, we find that the DLA was insured for Rs.50,000/- under personal accident benefits with No.3 as he was having a Kissan Credit Card of OP No.2. The DLA died on 13.08.2014 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 after processing the formalities and verifying the contents thereof but the OP No.3 had repudiated the claim vide letter dated 09/12/2014, Ex.C-3 on the ground that the claim papers were received by them on 29.11.2014. 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.

 

7.             The OPs No.1 and 2 have admitted that the complainant has approached them and had lodged the claim and the same was forwarded to OP number 3 vide letter number 8911 on 22.9.2014 as per document Ex.OP1/1 and Ex.OP1/4.  From the postal receipt dated 22.09.2014, it is clearly evident that the documents were sent to OP number 3 by registered post which were received by them.

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.             In the present complaint, OP No.3 vide document dated 16.06.2014 has demanded driving license from the complainant but on the perusal of the documents placed on record we find that the document Ex.C-3 tendered by the complainant vide which the claim has been repudiated by OP number 3 is on the ground of delay in submission of the documents as the documents were received by the OP No.3 on 29.11.2014. There is no mention of requirement of driving license. It means that by this time the driving license  was with the OP no.3. The document Ex.OP1/5 dated 1.10.2014 clearly shows that there was no delay in submitting the claim as after the death of the beneficiary, it took some time to collect copies of FIR and other relevant documents and finally the OP number 1 who had paid the premium on behalf of the beneficiary policy holder also confirms that the documents were submitted to OP number 3 on 22.09.2014 through registered post and now if there is any delay is on the part of the OP number 3 to process the claim. So, in the light of above, we do not find that there is inordinate  delay  in the present complaint with regard to the submission of the claim papers by the complainant and in the light of above discussion we do not find any relevance of the ruling  titled as  Sasanka Mohapatra  Vs.  New India Assurance Company Limited,  2008 (3) CLT 149  cited by the OP No.3.        

 

10.            The learned counsel for OP number 3 has further placed on record the judgment of the Hon’ble National Commission, New Delhi, delivered in the First appeal number 470 of 2006, decided on 25.9.2012 in the case of New India Assurance Company Limited versus Shikha Bhatia and another, but as the facts of the present complaint are different to those of the case referred, so reliance can not be made of the cited judgment.   Further the learned counsel for OP number 3 has cited Vikram Greentech (I) Ltd. Versus New India Assurance Company Limited 2009(2) RCR (Civil) 817, wherein it has been held that the court while construing the terms of the policy is not expected to venture into extra liberalism that may result in re-writing the contract or substituting the terms which were not intended by the parties.  An insurance contract is a species of commercial transactions and must be construed like any other contract to its own terms and by itself, in a contract of insurance, there is requirement of uberimma fides.  In the present case, there are no such circumstances, as such, the ruling cited by the learned counsel for OP number 3 is not at all helpful to the case of the OP number 3.  It is worth mentioning here that in the present case the DLA died on 13.8.2014 and after the death of the DLA, the complainant first approached OP number 2 as the DLA was the member of OP number 2 and then after processing the case, OP number 2 forwarded the same to OP number 1 and OP number 1 further dispatched the same on 22.09.2014 to OP number 3.  So, from the facts mentioned above, it seems that the complainant approached OP number 2 well in time as per the policy document, which is on record as Ex.OP3/3 and in this document under the head ‘notification of claim it has been mentioned’.  However, nowhere it has been mentioned in the terms and conditions that the claim will be repudiated on the basis of delay.

 

11.            So, in view of the above discussion, 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.

 

12.            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”.  

 

13.            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.10,000/- on account of mental agony, harassment and also to pay a sum of Rs.5,000/- as litigation expenses.

 

14.            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.   

Pronounced.

 

                October 1, 2015.

 

 

 

                                                (Sukhpal Singh Gill)                                                                                                                                      

                                                                President

 

 

                                                             (K.C.Sharma)

                                                                 Member

 

 

                                                             (Sarita Garg)

                                                                  Member