Complainants Ms.Rupinder and others through the present complaint has sought the necessary directions to the opposite parties to release the insurance amount of late Sanjiv Kumar in their favour alongwith interest @ 12% per annum from the date of due till its realization and Rs.30,000/-as harassment and litigation expenses to them, in the interest of justice.

 2.       The case of the complainant in brief is that her husband was serving as constable/driver in CRPF department. On 17.2.2014 Sanjiv Kumar died in an accident at village Kot Santokh Rai, Tehsil and District Gurdaspur. Sanjiv Kumar was holding an account No.30296739834 in the Bank of opposite party no.1. The opposite party no.1 has collaborated with opposite party no.2, so opposite parties no.1 and 2 insured late Sanjiv Kumar vide accidental Silver policy vide a policy no.111134291400034 with Sanjiv Kumar’s personal accidental death insurance of Rs.3 lacs. After the death of Sanjiv Kumar, she being legal heirs of late Sanjiv Kumar registered claim to opposite party no.2 through opposite party no.1 on 13.8.2014 vide a claim no.2141106886. He sent so many representations through phone to opposite party no.2 for releasing the claim in their favour due to the accidental death of late Sanjiv Kumar, but till today opposite party no.2 have not released the amount of accidental insurance of Sanjiv Kumar. Hence this complaint.

3.           Notice of the complaint was issued to the opposite parties. Opposite party no.1 appeared through its counsel and filed its written reply by taking the preliminary objections that the complaint is not maintainable against the opposite party as the complainant is not consumer of the opposite party. The policy is issued by opposite party no.2; the opposite party is neither proper nor necessary party in the present case therefore the complaint is liable to be rejected against the opposite party; the role of opposite party is only as a corporate agent/facilitator and actual insurance is issued by opposite party no.1 and as such the complaint cannot be filed against the opposite party and is liable to be dismissed and it is the settled principal of aw u/s 230 of The Indian Contract Act that an agent can neither sue nor be sued except under the special circumstances. On merits, it was submitted that the opposite party has forwarded the case of the complainant to the opposite party no.2. Lastly, opposite party has prayed for the dismissal of the complaint.

4.      Opposite party no.2 appeared through its counsel and filed its written reply by taking the preliminary objections that the complainant has no cause of action to file the present complaint; there is no deficiency in service on the part of the opposite party. Actually the policy was issued as alleged in this complaint, but the liability of the insurance company is only as per terms and conditions of the policy. In the present case the date of death is 17.2.2014 and as per terms and conditions of the policy the claim is to be intimated within 90 days from the date of death. In the present case the claim has been intimated on 13.8.2015 i.e. after delay of 177 days which is breach of the terms and conditions of the policy. The insurance company lost its right to early investigate the matter and as such the claim has been repudiated vide letter dated 19 March, 2015. The letter of repudiation vide letter dated 19 March, 2015. The letter of repudiation has been duly sent to Koshalaya Devi mother of Sanjeev Kumar and the complainant has not come to the Forum with clean hands and concealed the material facts regarding the repudiation and not brought the true facts before this Ld.Forum as such the complaint is liable to be dismissed on this ground; the complaint of the complainant is not within limitation and this Ld. Forum has not territorial jurisdiction to try the present complaint. On merits, it was submitted that the policy was issued as alleged in this complaint but the liability of the insurance company is only as per terms and conditions of the policy. In the present case the date of death is 17.2.2014 and as per terms and conditions of the policy the claim is to be intimated within 90 days from the date of death. In the present case the claim has been intimated on 13.8.2015 i.e. after delay of 177 days which is breach of the terms and conditions of the policy. The insurance company lost its right to early investigate the matter and as such the claim has been repudiated vide letter dated 19 March, 2015. The letter of repudiation vide letter dated 19 March, 2015. The letter of repudiation has been duly sent to Koshalaya Devi mother of Sanjeev Kumar. All other averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.

5.       Counsel for the complainant has tendered into evidence affidavit of complainant Ex.C1, alongwith other documents Ex.C2 to Ex.C11 and closed the evidence.

6.       On the other hand, Sh.Amandeep Gupta Deputy Manager S.B.I. opposite party no.1 tendered into evidence his own affidavit and closed the evidence.

7.      Counsel for the opposite party no.2 tendered into evidence affidavit of Suryadeep Singh Thakur Authorized Signatory Ex.OP1 alongwith other documents Ex.OP-2/2 to Ex.OP-2/9 and closed the evidence.

8.      We have carefully examined the documents/evidence produced on record along with that ignored to be produced to support/prove their respective ‘claims’ as pleaded by the present litigants in the light of the arguments as put forth by the learned counsels, while adjudicating the present complaint. The present dispute has been the result of the impugned repudiation (on 19.03.2015) of the complainant-filed ‘death-claim’ by the OP2 insurers on account of the alleged ‘delay’ of 177 days in lodging of the same. Incidentally, the ‘delay’ has proved ‘fatal’ since it gets hit by the term # 6 (A) II (Ex.OP2/3) of the Claim process of ‘other terms and conditions’ of the related policy. The DLA died in a road-side ‘accident’ on 17.02.2014 whereas the claim has been allegedly filed/received by the OP2 insurers on 13.08.2014 i.e., after 177 days whereas it should have been filed within 90 days of the date of death. No doubt, the OP2 insurers have produced the applicable ‘terms and conditions’ here on the records of the proceedings but ‘have somehow failed to produce any cogent evidence to prove that these ‘terms and conditions’ were duly intimated to the DLA under his acknowledgement. The related ‘proposal-form’ of the applicable policy has been somehow ignored to be produced during the present complaint proceedings. Further, the OP2 insurers shall not be legally allowed to enforce/ implement the ‘undisclosed-terms’ of the policy that had somehow been ignored to be pre-intimated.

9.       Moreover, we are not convinced with the OP2 insurers’ pleading that the present ‘delay’ of 177 days has deprived them of an opportunity for an ‘early’ investigation. We find that ‘delay’ of course proves fatal in ‘theft-claim’ cases but in ‘death-claim’ case we are unable to appreciate its relevancy. It is quite understood that the DLA’s family member ‘complainants’ must have been in a state of shock and deep sorrow at the untimely road-accident death of the insured so as to have filed the present death-claim as per the terms that were never disclosed neither to the DLA during his life time nor to them. The complainants were also busy to collect the other terminal benefits of the DLA from his CRPF employers and the present impugned claim got delayed since it had to be forwarded to the OP2 insurers through the CRPF Employers and the OP1 Bank. Under the circumstances, we find that the OP2 insurers have wrongly and arbitrarily repudiated the otherwise a valid claim. Thus, we set aside the impugned ‘repudiation’ based upon the ‘delay’ in filing of the same.  The OP must realize that their administrative decisions in settling insurance claims are open to judicial reviews and thus need be taken with due application of mind and not arbitrarily and these should also be speaking in nature duly explaining the reason and logic of the decision as to how the same has been reached. The facts in issue need be appreciated while awarding sanctity to the current applicable law. However, the PMR (Post Mortem Report) confirms DLA’s death by road-accident that shall legally amount to be an ‘accidental-death’ unless, otherwise countered by some other ‘cogent’ evidence confirming suicide, murder etc. But, a mere ‘suspicion’ shall not take place of ‘evidence’.

10.     In the light of the all above, we set aside the OP insurer’s impugned repudiation of the complainant’s claims being arbitrary (contra to laws of natural justice) and amounting to ‘deficiency in service’ and thus, we ORDER the OP2 insurers to pay the impugned ‘insurance claim’ pertaining to the related Policy in question along with all the eligible benefits as applicable in case of ‘accidental-deaths’ etc if any, along with Rs.5,000/- as compensation for the undue harassment inflicted besides Rs.3,000/- as cost of litigation; within 30 days of receipt of the copy of these orders, otherwise the entire awarded amount shall attract interest @ 9 % PA form the date of filing of the complaint till actually paid.

11.     Copy of the order be communicated to the parties free of charges. File is ordered to be consigned to the record room. 

            (Naveen Puri)

                  President

ANNOUNCED:                                            (Jagdeep Kaur)

May13, 2016.                                                       Member

*MK*