Ritu Vohra complainant through the present complaint filed under Section 12 of the Consumer Protection Act, 1986 (for short, ‘the Act’) has prayed that a direction be issued to the opposite party to pay Rs.10,00000/- alongwith interest @ 18% P.A. from the date of filing the claim with the opposite party. Opposite party is further directed to pay Rs.2,00,000/- for pain suffering in the hands of the opposite party including Rs.20,000/- as litigation expenses.
The case of complainant in brief is that her husband Sh.Vanit Kumar was the owner of the car bearing registration No.PB-58-A-2172 which was fully insured with the opposite party vide cover note No.862697 for a period of one year from 30.12.2002 to 29.12.2003. The above mentioned policy cover was the accident benefit to the tune of Rs.2,00,000/-. It was pleaded that the two PA policy (Personal Accident Policy) No.427093 and 427094 dated 17.2.2003 were also purchased by the husband of the complainant to the tune of Rs.8,00,000/- in which hospitalization was also covered. It was pleaded that husband of complainant suffered head injuries as well as fracture in backbone along with other injuries on 20.6.2003 in the area of P.S. Sarhand and got admitted in P.G.I. Chandigarh where he remained under treatment upto 16.10.2003 and during the treatment he was in coma and thereafter died on 20.11.2003 due to accidental injuries. Regarding this accident DDR No.18 dated 22.6.2003 was also recorded in P.S. Sarhand. It was further pleaded that complainant on the treatment of her husband spent more than Rs.5,00,000/- and for getting the claim from the opposite party she submitted all the requisite documents in their office on 21.5.2004 but after that opposite party failed to pay the claim to the complainant. Opposite party did not inform the complainant regarding the progress of the claim till the laps of long time. It was pleaded that complainant is a housewife and was not acquainted about the law regarding the claim and approached the Advocate for legal assistance for her claim against the claim in the above mentioned policies and as per the guideline of her Advocate she filed a claim petition for getting the claim which was dismissed by the Court of Sh.Harpal Singh MACT, Gurdaspur vide order dated 8.9.2010 on the ground that the deceased Vanit Kumar was not third party but held that claimant is entitled for personal accidents benefits under the motor vehicle policy. Complainant again as per the guidelines of the Advocate filed the appeal before the Hon'ble High Court which was also dismissed vide order dated as per the statement of the Advocate. It was pleaded that complainant is an illiterate lady and did not know the technicalities of the claim. Even an ordinary prudent person cannot know the technicalities of the laws and she was also under the depression due to untimely and unnatural death of her husband. It was next pleaded that opposite party conducted in the inquiry regarding the claim of the complainant for contesting the claim an found that the same was genuine and they required documents from her for processing the claim and as such she was entitled for the claim falls under personal accident policies which were obtained by her husband from the opposite party for benefits of his family in case of anything happened with him but the opposite party had not done anything for the payment of claim within the mandatory period of 3 months which amounts to deficiency in service on their part. Complainant also issued two letters dated 7.4.2014 to the opposite party for the payment of the both the claims but the opposite party did not inform the complainant regarding the position of the claim. It was pleaded that complainant is the wife as well as nominee of the deceased and her husband got the personal accidental insurance for his benefits as well as for the benefit of his family but the opposite party with the malafide intention failed to pay the claim to the complainant, hence this complaint.
3. Notice of the complaint was issued to the opposite party who appeared through their counsel and filed the written reply by taking the preliminary objections that complaint is not maintainable as there was a delay of more than 11 years and the same deserves to be dismissed on this ground alone. It was stated that complaint was in contravention with the terms and condition of the insurance policy. It was stated that after receiving the claim form opposite party intimated the complainant through letter dated 08.11.2005 about the requisite documents for forwarding the claim like Post Mortem Report etc. but the same had not been supplied by the complainant till date. It was further stated that without Post Mortem Report the reason of death of death cannot be ascertained and without knowing the cause of death the company cannot pass the claim as per the terms and conditions of the insurance policy. Complainant is not entitled for any compensation and complaint may kindly be dismissed with cost as it file on false and concocted ground. On merits, It was stated that a letter dated 8.11.2005 was served upon the complainant for supplying of required documents but she failed to supply to same due to which claim of complainant could not be settled. All other averments made in the complaint have denied and lastly the complaint has been prayed to be dismissed with costs.
4. Counsel for the complainant tendered into evidence affidavit of the complainant Ex.C1 alongwith other documents Ex.C2 to Ex.C182 and closed the evidence.
5. Counsel for the opposite party tendered into evidence affidavit of Pardeep Singh Branch Manager Ex.OPW1/A alongwith other documents Ex.OP-1 to Ex.OP-9 and closed the evidence on behalf of opposite party.
6. We have carefully examined the available evidence on the record file so as to interpret the meaning and purpose of each document determined against the backdrop of the respective arguments of the learned counsels of the litigants. We observe that the prime dispute prompted from the impugned repudiation of the accidental death claim as filed by the widow complainant. The OP insurer’s plea/objection of ‘delay’ in filing the present complaint was duly ‘set-aside’ by the forum’s Orders dated 04.05.2014 allowing the complainant’s application for ‘condonation’ of delay. The OP insurers have also admitted the date of car-accident as: 20.06.2003 along with the validity of the Car Comprehensive Insurance Policy bearing cover note # 862697 (Ex.C4) up to 29.12.2003 and that of the personal Accident Insurance Policies with cover note nos.427093 & 42709 (Ex.C5 & Ex.C6) up to 16.02.2004. The personal owner accident-death insurance cover for Rs 2.0 Lac in the car insurance is not in dispute, either. The accident was intimated on 30.06.2003 (Ex.C16) as acknowledged on 03.07.2003 by the OP insurers on intimation letter, itself. The respective insurance claims for the above Policies stand filed vide Ex.C7 & Ex.C8 and further, the documents requisitioned by the OP insurers for settlement of the death-claim(s) vide letters of 30.12.2003 (Ex.OP1), of 23.02.2004 (Ex.OP2), of 27.04.2014 (Ex.OP3) and of 18.05.2004 (Ex.OP4) stand submitted/supplied on 21.05.2014 vide Ex.C17 (as duly acknowledged thereon, itself); but for the medical-report of the Post Mortem since it could not be conducted as the DLA (Deceased Life Assured) breathed his last at his home at Dhariwal where he was brought back from the PGI, Chandigarh to avoid the financial burden of medical-treatment. However, the OP insurers repudiated the insurance claim on 08.11.2005 exclusively on account of the complainant’s inability to produce/submit the non-existent PMR (Post Mortem Report) as is evident from the Ex.OP5 & Ex.OP6. At this, the complainant (acting upon the inadvertently procured legal advice) filed her claim petition (on 02.01.2006) before the Motor Accident Claims Tribunal, Gurdaspur; who dismissed the same (on 08.09.2010) as ‘not-maintainable’ under Section 163-A of the Motor Vehicle Act, 1988 but somehow had duly adjudicated the issue of ‘cause of death’ (as Issue No. 1) in his orders (Ex.C18) at page ‘8’ to be the ‘car accident’ occurring on 20.06.2003 as per the DDR No.18 (Ex.C3) of 22.06.2003. Moreover, the OP insurers have also not been able to establish the cause of death to be some other than the car-accident of 20.06.2003.
7. From the pleadings and evidence on record we find that the opposite party vide letter Ex.OP5 and Ex.OP6 dated 8.11.2005 has not yet finally decided the insurance claim of the claimant and closed the file of the complainant as NO CLAIM on 8.11.2005 and have rather sought certain documents/information from the complainant which the complainant is bound to supply except Post mortem Report as the MACT, Gurdaspur has already adjudicated the issue of ‘cause of death’ (as Issue No.1) in his orders (Ex.C18) at page ‘8’ to be the ‘car accident’ occurring on 20.06.2003 as per the DDR No 18 (Ex.C3) of 22.06.2003. Thus we dispose of the complaint and direct the complainant to approach the opposite party and submit the requisite documents/information desired by them except PMR for settling the insurance claim within 15 days of the receipt of these orders and further direct the opposite party insurance providers to decide the claim as per the terms and conditions of the policy within 15 days of the receipt of documents from the complainant.
8. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned.
(Naveen Puri)
President.
ANNOUNCED: (Jagdeep Kaur)
NOV. 26, 2015 Member.
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