Complainant Sulekha Rani has filed the present complaint U/s 12 of the Consumer Protection Act against the opposite parties and praying that the directions may kindly be issued to the opposite parties to pay the balance amount of Rs.3.00 Lacs on account of Group Personal Accident Insurance Policy of deceased constable Baldev Raj to her alongwith Rs.5,000/- as litigation expenses by accepting her complaint, in the interest of justice and fair play.

2.       The case of the complainant in brief is that she is widow of deceased Baldev Raj who was serving as constable in Punjab Home Guard No.2 Battalion B-Company Kotli Surat Malhi, Tehsil Batala, District Gurdaspur and retired from the service on 25.12.2013 on attaining age of 58 years. It was pleaded that deceased constable Sh.Baldev Raj was insured through opposite parties No.1 and 2 under "Group Personal Accident Insurance Policy" by opposite parties No.2 to 4 through their agent at Gurdaspur and the policy was valid from 19.12.2013 to 18.12.2014 and an amount of Rs.3100/- as premium/installment of said policy for the period from 19.12.2013 to 18.12.2014 was deducted from the salary of deceased Baldev Raj Constable who was died in an accident on 22.03.2014 after retirement during the validity of insurance policy, which was valid upto 18.12.2014. It was further pleaded that opposite parties had covered the risk of deceased Baldev Raj through "Group Personal Accident Insurance Policy" upto 18.12.2014 and received full amount of installment towards policy upto 18.12.2014 which has neither been cancelled in favour of deceased after retirement nor the balance installment amount received from the deceased was refunded to the complainant, whereas after the death of Baldev Raj, the complainant and other legal heirs namely Deepak (Son) and Deepika (Daughter) are legally entitled to receive the insurance policy amount of Rs.6,00,000/- which was covered under above said policy in question on account of death of her husband. It was also pleaded that complaint was filed by the complainant before this Forum/Commission for not paying the insured policy amount to her and the Ld. Consumer Forum/Commission vide order dated 17.08.2016 decided the complaint and had held that

          "In the light of above we find that the present complaint is premature since the opp. parties no.2 to 4 has not yet    finally decided the insurance claim. Thus we dispose of the complaint and direct the complainant to approach the opp. parties and submit the requisite relevant documents/information desired by them for settling the insurance claim within 15 days of the receipt of this order and further direct the opp. party insurance providers to decide the claim as per the terms and conditions of the policy within 15 days of the receipt of the document from the complainant. The opp. party further directed to decide the insurance claim duly filed by the complainant, duly verified as per the settled procedure lain down by the regulating agency IRDA".

and as per the above said order dated 17.08.2016 relevant information alongwith documents on the prescribed performa was submitted by the complainant to the opposite parties and also filed complaint under section 27 of the CPA for compliance of above said order. It was next pleaded that in compliance of order 17.08.2016 passed by this Ld. Forum/Commission, opposite parties paid only Rs.3.00 Lacs to the complainant on account of death of her husband Baldev Raj and had not paid the entire amount as per the terms and conditions of the policy and this order of opposite parties no.2 to 4 for not paying the entire insured amount to the complainant is illegal, null & void, against the law and terms and conditions of the policy and opposite parties intentionally withheld the remaining amount of insurance policy and this act of the opposite parties amount to deficiency in services and complainant had been mentally and physically harassed by the opposite parties, who is having no source of income. As such complainant is legally entitled for entire compensation amount on account of death of her husband as per terms conditions of the policy, hence this complaint.

3.       Upon notice opposite party No.1 appeared and filed their written reply by taking the preliminary objections that complaint is not maintainable in the present form and is under valued for the purpose of Court fee & jurisdiction; that no cause of action has arisen to the plaintiff to file the present suit and that the receipt of notice under 80 CPC is admitted but its legality & validity is challenged. On merits, it was submitted that husband of the complainant was enrolled as a volunteer as PHG organization on 23.03.2012 and was performing duty at P.S. Dera Baba Nanak and he was called off from duty on 24.12.2013 on completion of 58 years of age.  It is further pleaded that if deceased was insured at the time of his alleged death, it would be through opposite parties No.2 to 4. It is also pleaded that Rs.2,000/- and Rs.1100/- were deducted from wages on 03.11.2013 and 04.12.2013 respectively when the deceased was on duty but he was called off from duty on 24.12.2015 and decision of the claim of the policy was to be taken by opposite parties No.2 to 4 and not by opposite party No.1. It was next submitted that deductions were made on behalf of opposite parties No.2 to 4 when the volunteer/deceased Baldev Raj was on duty. It is further pleaded that a legal notice was served by the complainant which was replied by the State Head Quarter. All other averments made in the complaint have been denied and prayed for dismissal of the complaint with costs.

4.       Opposite parties No.2 to 4 also appeared through their counsel after the service of the notice and filed their written reply by taking the preliminary objections that complainant has no cause of action and locus standi to the file the present complaint; it is pleaded that previously complainant filed complaint titled as "Sulekha Rani Versus Commandant" for the death of her husband was decided by this Ld. Forum/Commission on 17.08.2016 and after that as per award the order had been duly complied by paying the insured amount of Rs.3,00,000/- to the complainant which was the sum inured under the policy and as per the policy sum insured for 13052 persons is 3,915,600,000/- and as such the sum insured for an individual amounts to Rs.3,00,000/- was received by the complainant as full and final payment; that the present complaint is barred by principle of res-judicata as the complaint on the same subject matter had already been decided and this Ld. Forum/Commission has no territorial jurisdiction to file the present complaint. On merits, it was submitted that the payment of Rs.3 Lacs as maximum coverage made to the complainant as per policy regarding the death of Baldev Raj and nothing is further due towards opposite parties No.2 to 4. All other averments made in the complaint have been denied and prayed for dismissal of the complaint.

5.       Complainant to prove her case had tendered into evidence her duly sworn affidavit Ex.C-1, copy of order dated 17.08.2016 Ex.C2, Copy of Post Mortem Report Ex.C3, Copy of cover note Ex.C4, copy of FIR Ex.C5 and closed her evidence. Counsel for the complainant had also tendered into additional evidence copy of letter dated 14.10.2013 Ex.C6 and closed the additional evidence on behalf of complainant.

6.       On the other hand Sh.Lakhbir Singh Platoon Commander had tendered into evidence affidavit of G.P.S.Dhillon Battalion Commander No.2 Battalion PHG Batala Ex.OP-1/1 and closed the evidence on behalf of opposite party No.1.

7.       Counsel for the opposite parties No.2 to 4 had tendered into evidence affidavit of Apurva Sharma authorized signatory Ex.OP-2,3,4/1 with copies of relevant documents Ex.OP-2,3,4/2 and Ex.OP-2,3,4/3 and closed the evidence on behalf of opposite parties No.2 to

8. Written arguments filed by the opposite party No.1 but not filed by complainant and opposite parties No.2 to 4.

9.       We have carefully examined all the documents/evidence produced on record for its contained statutory merit and have also judiciously considered and perused the arguments duly put forth by the learned counsels for the parties.

10.     Counsel for the complainant has argued that deceased Sh.Baldev Raj was insured under the "Group Personal Accident Insurance Policy" being employee with opposite party No.1. Policy was valid from 19.12.2013 to 18.12.2014 and during the continuation of the policy Sh.Baldev Raj died on 22.03.2014. It is further argued that earlier also complainant had filed complaint which was disposed off vide order dated 17.08.2016 and opposite parties were directed to settle the claim within 15 days after receipt of copy of order. It is further argued that the complainant is entitled to receive Rs.6 Lakh as the death of insured took place due to accident. However, opposite parties No.2 to 4 have made payment of Rs.3 Lakh only to the complainant which was payable only for natural death withholding of balance amount of Rs.3 Lakh amounts to deficiency in service.

11.     On the other hand opposite party No.1 has argued that the present complaint is not maintainable. However, employment and purchase of policy of insurance is admitted by opposite party No.1 and in the end has prayed for dismissal of complaint.

12.     Counsel for the opposite parties no.2 to 4 has argued that in compliance of order dated 17.08.2016 opposite parties No.2 to 4 have paid Rs.3 Lakh to the complainant which was the sum assured as per the policy of insurance. It is further argued that as per the policy of insurance the total sum assured was 3 Lakh and not 6 Lakh whether the death is accidental or natural.

13.     We have heard the Ld. counsels for the parties and gone through the record. To prove her case, complainant had placed on record her duly sworn affidavit, copy of order dated 17.08.2016 passed in complaint No.50 of 2016 Ex.C-2, copy of Post Mortem Report Ex.C-3, copy of policy Ex.C-4, copy of FIR Ex.C-5, copy of letter issued by opposite party No.1 Ex.C-6 whereas on the other hand opposite party No.2 to 4 have placed on record affidavit of Apurva Sharma, copy of Risk Assumption Letter Ex.OP-2,3,4/2 and copy of receipt Ex.OP-2,3,4/3. Counsel for the complainant has mainly relying upon letter Ex.C-6 dated 15.10.2013 as per which the legal heirs of deceased shall be entitled to Rs.6 Lakh on account of accidental death and Rs.3 Lakh in other case. However, policy schedule Ex.C-4 placed on record by the complainant herself clearly shows that maximum sum assured is Rs.3 Lakh as per the policy and in the column of condition in case of accidental death only 100% meaning thereby that the complainant was entitled to receive only Rs.3 Lakh from opposite parties No.2 to 4 which has already been paid by the opposite parties No.2 to 4 as per receipt Ex.OP-2,3,4/3 dated 01.06.2017.

14.     From the above discussion and evidence on record this Commission if of view that the complainant was entitled to receive only Rs.3 Lakh as compensation on account of death of her husband Sh.Baldev Raj. However, Sh.Baldev Raj died on 22.03.2014 but the opposite parties No.2 to 4 have made the payment to the complainant on 01.06.2017. Accordingly, the present complaint is partly allowed and opposite parties No.2 to 4 are directed to pay interest @ 9% P.A. on the amount of Rs.3 Lakh w.e.f. 22.03.2014 to 01.06.2017. Entire exercise shall be completed within 45 days from the date of receipt of copy of this order.

15.     The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.

16.     Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record room.  

                               (Lalit Mohan Dogra)

                                                                         President    

Announced:                                          (B.S.Matharu)

Aug. 01, 2023                                               Member

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