| Final Order / Judgement | DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BATHINDA C.C.No.75 of 26.02.2020 Decided on : 08-05-2024 Sarabjit Kaur aged about 32 years wd/o Satnam Singh @ Sattu S/o Tej Singh R/o Village Phulo Mithi, Tehsil & District Bathinda; Deepak Singh aged about 15 years (DOB: 16.10.2005) minor son of Satnam Singh; Parwinder Singh aged about 12 years (DOB: 20.6.2008) minor son of Satnam Singh; through their next friend and natural guardian/mother Sarabjit Kaur wd/o Satnam Singh @ Sattu R/o Village Phulo Mithi, Tehsil & District Bathinda. Mukhtiar Kaur aged about 54 years W/o Tej Singh (mother of deceased Satnam Singh @ Sattu); All residents of Village Phulo Mithi, Tehsil & District Bathinda.
........Complainants Versus United India Insurance Co. Ltd., Branch/Divisional Office: SCO No.72, Phase-9, Sahibzada Ajit Singh Nagar (Mohali), through its Branch/Divisional Manager. United India Insurance Co. Ltd., Divisional Office: 100 Ft. Road, Ist Floor, Natha Singh Tower, Bathinda, through its Divisional Manager, Punjab Health Systems Corp., (Bhagat Puran Singh Health Insurance Scheme), Phase-6 Near Civil Hospital, Sahibzada Ajit Singh Nagar (Mohali), through its Chairman-cum-Managing Director.
.......Opposite parties Complaint under Section 35 of the Consumer Protection Act, 2019 QUORUM Smt. Priti Malhotra, President Smt. Sharda Attri, Member Present : For the complainants : Sh. Ish Kumar, Advocate. For opposite parties : Sh.I.P Singh, Advocate for OP Nos.1 and 2. Opposite party No.3 ex-parte. ORDER Priti Malhotra, President The complainants Sarabjit Kaur and others (here-in-after referred to as complainants) have filed this complaint U/s 35 of Consumer Protection Act, 2019 (here-in after referred to as 'Act') before this Commission against United India Insurance Co. Ltd., and others (here-in-after referred to as opposite parties). Briefly stated, the case of the complainants is that Satnam Singh alias Sattu was husband of the complainant No.1, father of complainants No.2 and 3 and son of complainant No.4 and was insured under the scheme known as 'Bhagat Puran Singh Health Insurance Scheme' (Bhagat Puran Singh Sehat Bima Yojana) with opposite parties No.1 and 2 vide card No.9304-6000-2210-35817. This scheme/yojana has been introduced by Punjab Govt. (opposite party No.3) whereby Punjab Govt. has provided health insurance of Rs.30,000/- and accidental death insurance to the tune of Rs.5 lakhs to the members of the aforesaid scheme and claim, if any, arises regarding the member of the scheme, the same was/is payable by opposite party Nos.1 and 2. The husband of the complainant No.1 namely Satnam Singh alias Sattu was working as truck driver of truck bearing No.PB-03AP/9770 with M/s Talent Transport, 9/90 Near Gaushala, Raman, District Bathinda. It is alleged that in the mid of January 2019, husband of the complainant No.1 namely Satnam Singh alias Sattu alongwith cleaner/Khalasi Amanpreet S/o Jagseer Singh R/o Village Phulo Mithi, District Bathinda had gone to Jamnagar on the truck and on 15.1.2019, both of them were returning from Jamnagar to Punjab on the truck after loading 'Plastic Dana' and when the truck reached at Bikaner on 17.1.2019 and on 18.1.2019 at about 5-6 A.M, a telephonic message was received by the family members of Satnam Singh alias Sattu at Village Phulo Mithi from P.S. Loonkaransar, District Bikaner to the effect that the said truck met with an accident and in this accident, one of the occupant has died due to burn injuries whereas another is badly injured and he has been got admitted in the hospital. On the receipt of intimation, Sukhpal Singh S/o Kaka Singh R/o Village Phulo Mithi (cousin of Satnam Singh alias Sattu) alongwith Gursewak Singh, Manager of M/s Talent Transport, etc. reached at Loonkaransar. On visiting the site of accident, they saw that their truck bearing No.PB-03AP/9770 met with an accident with another truck bearing No.RJ-07GC/3520 and due to accident, both the truck caught fire and truck driven by Satnam Singh alias Sattu was totally burnt and became merely a scrap. Due to accident and fire, Satnam Singh alias Sattu could not come out from the truck and he died due to burn injuries whereas Amanpreet sustained multiple grievous injuries on his person and was got admitted in the hospital. On enquiry, it came to know that the accident has occurred due to rash and negligent driving of driver of another truck. The truck of Satnam Singh was totally burnt and his dead body was converted into small bones and ashes. It is further alleged that a case FIR No.0023 dated 18.1.2019 U/s 279/337/304-A IPC has also been registered on the statement of Sukhpal Singh S/o Kaka Singh R/o Village Phulo Mithi (cousin of deceased Satnam Singh) against the unknown driver of the truck and later on, one Puran Singh S/o Mohan Singh R/o Village Bisrasar, Pallu, Hanumangarh (Rajasthan) was named in the FIR and challan has already been presented by the police against Puran Singh before the Hon'ble Ilaqa Magistrate, Loonkaransar (Bikaner). In the accident, Satnam Singh has died due to burnt injuries and his dead body had converted into small white pieces of bones and ashes weighing about 300-400 gms. The officials of P.S. Loonkaransar has opined that since the entire dead body of Satnam Singh has already been converted into small white pieces of bones and ashes weighing about 300-400 gms, so there is no requirement of any postmortem nor opinion of M.O. is required to be taken and accordingly, the officials of P.S. Loonkaransar handed over the last remains of deceased Satnam Singh to his cousin Sukhpal Singh S/o Kaka Singh R/o Village Phulo Mithi vide memo (Fard) dated 19.1.2019. It is further alleged that thereafter Sukhpal Singh etc. returned to their village alongwith last remains of deceased Satnam Singh and after performing the last rites ceremonies, the complainant No.1 telephonically gave intimation in this regard with addressee No.3 at toll free No.104 on 24.1.2019 at about 12.20 noon and she was assured that within a period of 45 days, the claim regarding death of her husband shall be processed by the unsurance company, but no action was taken nor any official visited the complainant whereas complainant No.1 was assured that the official of the insurance company shall visit her to collect the requisite documents and to get the other formalities completed. Ultimately, the complainant No.1 approached opposite party No.2 and on its advise, she provided all the relevant documents to opposite party No.2. Opposite party No.2 assured the complainant No.1 that it shall forward the claim papers of the complainant No.1 to opposite party No.1 and her claim shall be settled very soon. It is further alleged that after few days, the complainant No.1 enquired about her claim from opposite party No.2, it conveyed that the claim papers regarding the death claim of her husband have already been forwarded by it to opposite party No.1, it has received the claim vide file No.1700. Although, the deceased Satnam Singh alias Sattu died due to personal accident and his death is an accidental death and there is sufficient documentary evidence in this regard, yet opposite party Nos.1 and 2 have repudiated the lawful claim of the complainant vide registered letter dated 19.6.2019 on flimsy grounds i.e. in the absence of documents i.e. postmortem report. It is also alleged that the police officials have clearly held that the postmortem of last remains of deceased Satnam Singh is not possible nor opinion of M.O. is required to be taken, so no postmortem could be got conducted and police officials have handed over the last remains of dead body of Satnam Singh to the family members of deceased for last rites ceremonies, but still opposite party Nos.1 and 2 have repudiated the lawful claim of the complainant No.1. On this backdrop of facts, the complainants have prayed for directions to the opposite parties to pay Rs.5 lakhs on account of sum assured alongwith interest @18% p.a. from the date of the death of insured/deceased till realization and Rs.1,50,000/- as compenstion and Rs.22,000/- as litigation expenses. Upon notice, opposite parties appeared through counsel and contested the complaint by filing written version raising legal objections that the intricate questions of law and facts are involved in the complaint. The complainant has levelled serious allegations of fraud and forgery. They require voluminous documents and evidence for determination. It is not possible in the summary procedure under 'Act' and appropriate remedy, if any, lies only in the civil court. The complainants have concealed the material facts and documents from this Forum and opposite parties. As such, they are not entitled to any relief. The complainants have concealed the fact that they did not provide required document i.e. postmortem report of deceased Satnam Singh @ Sattu for processing and decision of claim, although it was mandatory on the part of insured to provide all relevant documents for processing and decision of claim as per terms and conditions of the policy. As per Condition No.2 of the insurance policy schedule issued to opposite party Nos.1 and 2 whereby it is required to make a postmortem examination of the body of the insured person and a postmortem report copy shall be furnished alongwith other requirements as advised by opposite parties. In support of the claim and as per policy terms covers death due to an accident and in absence of postmortem report, it could not be confirmed that the death was on account of accident. As such, the claim was rightly repudiated vide letter dated 19.5.2019. The complainants have not disclosed the fact whether they filed any claim before the Motor Accident Claims Tribunal regarding the accident and also have not disclosed amount received from the Hon'ble Tribunal in the Motor Accident Claims that is necessary for just and proper decision of the complaint. The complaint is bad for non-joinder and mis-joinder of necessary parties as the claimants have not impleaded all the legal heirs of deceased Satnam Singh @ Sattu. The complainants have also not joined the driver, owner and insurer of truck No.RJ-07GC/3520 with whom the accident took-place, who are also necessary parties. The complainants are not 'consumer' of opposite parties and they have no locus-standi or cause-of-action to file the complaint. The complaint is not maintainable in its present form. As such, the complaint is liable to be dismissed. On merits, opposite parties have reiterated their version as taken in the legal objection as detailed above and controverted all other averments of the complainants and prayed for dismissal of complaint. Upon notice, none appeared on behalf of opposite party No.3. As such, ex-parte proceedings were taken against it. In support of their complaint, the complainants have tendered into evidence affidavit of Sarabjit Kaur dated 18.2.2020, (Ex.C1) and documents, (Ex.C2 to Ex.C8). In order to rebut the evidence of complainant, opposite parties have tendered into evidence affidavit of Baldev Singh dated 14.10.2020, (Ex.OP1/1) and document, (Ex.OP1/2). We have heard learned counsel for the parties and gone through the file carefully. Learned counsel for parties have reiterated their stand as taken in their respective pleadings as detailed above. We have given careful consideration to these submissions. Case of the complainants is that Satnam Singh alias Sattu was insured under 'Bhagat Puran Singh Health Insurance Scheme' also known as 'Bhagat Puran Singh Sehat Bima Yojana' with opposite party Nos.1 and 2 vide card No.9304-6000-2210-35817, (Ex.C2). In this scheme, accidental death insurance to the tune of Rs.5 lakhs to the members was covered. While coming from Jamnagar, the truck of insured deceased Satnam Singh alias Sattu at Loonkaransar, District Bikaner met with an accident, which caught fire and in this accident, the husband of the complainant No.1 Satnam Singh alias Sattu died due to burn injuries sustained and his dead body got converted into small bones and ashes. Evidently, in this regard, FIR No.0023 dated 18.1.2019 U/s 279/337/304-A IPC was registered. FIR, (Ex.C3) proves this fact. It is also proved on record that after the death of Satnam Singh @ Satuu, the complainant No.1 lodged the claim with opposite party Nos.1 and 2, but they have repudiated the claim of the complainants vide letter dated 19.6.2019, (Ex.C8) on the ground of absence of postmortem report. Perusal of FIR, (Ex.C3) proves that the body of insured i.e. Satnam Singh @ Satuu was got converted into ashes when the truck which he was plying caught fire and got completely burnt due to the impact of the accident in question. The reason for rejection of the claim in question is highly absurd and it has also been observed that opposite parties adopted too technical approach to reject the genuine claim of the complainants, which is not sustainable in the eyes of law. We are of the considered view that it is fact of common knowledge that it is not possible to do postmortem of ashes of any dead body. As such, the ground of rejection of claim by opposite parties on the ground of absence of postmortem report is not justified. It amount to deficiency in services and unfair trade practice on the part of opposite parties. In view of what has been discussed above, present complaint is partly allowed with Rs.25,000/- as cost and compensation against opposite parties. Opposite parties are directed to pay the accidental death insurance claim amount of Rs.5 lakhs to the complainants in equal share in their respective accounts. The compliance of this order be made within 45 days from the date of receipt of copy of this order. In case of non-compliance of the order within the stipulated period, thereafter opposite parties will be liable to pay additional cost of Rs.35,000/- to the complainants. The complaint could not be decided within the statutory period due to heavy pendency of cases. Copy of order be sent to the parties concerned free of cost and file be consigned to the record room. Announced 08-05-2024 - (Priti Malhotra)
President (Sharda Attri) Member
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