Punjab

Sangrur

CC/96/2015

Sarbjeet Kaur - Complainant(s)

Versus

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

Shri Rajinder Goyal

13 Jul 2015

ORDER

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR

                            

                                                                    Complaint no. 96

                                                                    Instituted on:  02.03.2015

                                                                   Decided on:    13.07.2015

 

Sarbjeet Kaur w/o Late Baljinder Singh resident of Village Mander Kalan, Tehsil & District Sangrur.

                                                        …. Complainant.      

                                         Versus

 

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

2.     The Sangrur Central Coop Bank Limited, Patiala Gate Sangrur through its D.M.

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 authorized signatory.

                                                        ….Opposite parties.

 

FOR THE COMPLAINANT:    Shri Rajinder Goyal, Advocate                           

 

FOR OPP. PARTIES No.1&2 : Shri D.S.Dalee, 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.             Sarbjeet Kaur, complainant has 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 insured with OP No.3  as he was having Kisan Credit Card account number 2604 with OP No.1. The complainant was nominee under the policy. The husband of the complainant died on 13.06.2014  in fields due to electrocution. Post mortem was got done  and a DDR number 11 dated 14.06.2014 was also lodged.  After coming out of the shock and mental trauma, the complainant submitted the claim along with  all relevant documents to OP No.1 on 22.07.2014 vide receipt diary number 161 dated 22.07.2014.  The complainant was surprised to receive letter dated 10.12.2014  from OP No.3 through OP No.1 vide which OP No.3 has illegally repudiated the genuine claim of the complainant. It had been written  in the letter that  deceased life assured died on 13.06.2014 however intimation along with documents were received on 27.11.2014 and as there is significant delay in intimation and submission of documents, the claim is repudiated which is totally illegal and arbitrary. 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.50,000/- 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.40000/- as compensation   on account of mental agony, harassment and to pay Rs.5500/- as litigation expenses.

 

2.             In reply filed by the OPs No.1&2, it is submitted that claim was sent to the OP No.3 well in time  i.e. on 26.08.2014 which is very much clear from the letter number 6169 dated 26.08.2014.  It is further stated that  there is no role on our part i.e. OPs No.1 and 2 and whole responsibility lies with the OP No.3.  It has been alleged that the claim received by the insurance company on 27.11.2014 as from the above legal objection raised by OPs have documentary proof.

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 27.11.2014 i.e. after more than five 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 27.11.2014. 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-7 and closed evidence. On the other hand, OPs have tendered documents Ex.OPs1&2/1 to Ex.OPs1&2/3 and Ex.OP3/1 to Ex.OP3/6 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 he was a member of the Kissan Credit Card Scheme  of OPs No.1 and 2. The deceased  policy holder died on 13.06.2014 due to electrocution  and post mortem  on the body of the deceased was performed on 14.06.2014. The police report with the police station Longowal was also lodged on 14.06.2014 under DDR number 11. The complainant lodged the claim with OP No.1 on 22.07.2014 and the same was submitted to the OP No.3 on 26.08.2014 after processing the formalities and verifying the contents thereof but the OP No.3 had repudiated the claim vide letter Ex.C-7 on the ground that the claim papers were received by them on 27.11.2014.

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 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.             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 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 complainant to seek legal remedy in order to receive her 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.           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.

12.           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 13, 2015

 

 

 

( Sarita Garg)       ( K.C.Sharma)     (SukhpalSingh Gill)                                                                                                                                     

             Member                Member               President

 

BBS/-