Punjab

Faridkot

CC/19/106

Rajveer Kaur - Complainant(s)

Versus

United India Insurance co. Ltd - Opp.Party(s)

Kailash Kumar Goyal

18 Mar 2020

ORDER

  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FARIDKOT

 

Complaint No. :        106  of 2019

Date of Institution:      18.04.2019

Date of Decision:        18.03.2020

 

Rajveer Kaur widow of Harjinder Singh son of Gurcharan Singh r/o Village Marar, Near Gurdwara Jand Sahib Marar, Tehsil Sadiq District Faridkot.

...Complainant

Versus

1. United India Insurance Company Ltd., SCO 72, Phase IX, Mohali, Division Office, Mohali through its Branch Manager/Authorized Signatory.
2. State of Punjab through Deputy Commissioner, Faridkot.
3. MD India Health Insurance TPA Private Limited Max Pro Info Park, D-38, Phase – I, Industrial Area, Mohali, Punjab 160055.
4. Director, Bhagat Puran Singh Sehat Beema Yojna, c/o Directorate of Health and Family Welfare Punjab, Parivar Kalyan Bhawan, Sector 34-A, Chandigarh through its Authorized Signatory.

cc no. - 106 of 2019

5. Senior Medical Commissioner, (Designated Bhagat Puran Singh Sehat Beema Yojna) Office of Civil Surgeon, Faridkot.

.....Opposite Parties

Complaint under Section 12 of the

Consumer Protection Act, 1986.

 

Quorum: Sh. Ajit Aggarwal, President,

               Smt Param Pal Kaur, Member.

 

Present: Sh Kailash Goyal, Ld Counsel for complainant,

              Sh Atul Gupta, Ld Counsel for OP-1,

              Sh Aseem Dhir, Ld Counsel for OP-2, 4 and 5,

   OP-3 and Ex-parte.

ORDER

(Ajit Aggarwal, President)

                                        Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against OPs seeking directions to OPs to make payment of Rs.5 lacs on account of death of her husband against insurance policy and for further directing OPs to pay Rs.1,00,000/- as compensation for harassment, inconvenience, mental agony besides litigation expenses of Rs.15,000/.

cc no. - 106 of 2019

2                                     Briefly stated, the case of the complainant is that Harjinder Singh husband of complainant was insured under Bhagat Puran Singh Health Insurance Scheme and he paid Rs.30/-to OPs. He was issued card no.0304 5000 0850 3550, 7 valid for the period from 1.11.2016 to 31.05.2019 and as per insurance policy in the event of death of head of family, family is entitled for sum of Rs. 5 lacs. It is further submitted that during the subsistence of policy in question, husband of complainant died in a motor vehicle accident on 07.12.2018 in respect of which, FIR No.85 dated 08.12.2018 was got registered in Police Station Sadiq, Tehsil Sadiq and District Faridkot and his post mortem was conducted at Guru Gobind Singh Medical College and Hospital, Faridkot on 08.12.2018. Thereafter, complainant contacted OPs on their toll free number regarding death of her husband and also furnished all documents required for processing the death claim to the Investigator of OPs, but they did not pay even a single penny on account of insurance claim for the death of her husband. Complainant made several requests to OPs to make payment of genuine insurance claim, but all in vain, which amounts to deficiency

cc no. - 106 of 2019

in service. They have caused unnecessary harassment to her by not paying the genuine  claim on account of death of her husband and this act of OPs amounts to trade mal practice and deficiency in service and it has caused harassment and mental agony to complainant for which she has prayed for directions to OP to pay Rs.1,00,000/-as compensation alongwith Rs.15,000/-as cost of litigation besides the main relief. Hence, the present complaint.

3                           The counsel for complainant was heard with regard to admission of the complaint and vide order dated 23.04.2019, complaint was admitted and notice was ordered to be issued to the opposite parties.

4                            Notice issued to OP-3 through registered cover did not receive back undelivered. Acknowledgment might have been lost in transit. Summons were deemed to be served, but despite repeated calls, no body appeared on behalf of OP-3 either in person or through counsel on date fixed. Statutory period expired and therefore, vide order dated 18.06.2019, OP-3 was proceeded against exparte.

 

cc no. - 106 of 2019

5                         On receipt of the notice, OP-1 filed written statement taking preliminary objections that complainant is not their consumer and there is no relationship of consumer or service provider between complainant and answering OP. No cause of action arises against answering OP. Moreover, no immediate information regarding death of Harjinder Singh insured was given to them thereby preventing them to gather first hand information, which is a violation of terms and conditions of the policy in question and therefore, present complaint is liable to be dismissed. It is averred that complaint involves complex questions of law and facts, which require voluminous evidence and it can not be decided by this Forum having limited jurisdiction and limited time span and therefore, it is liable to be referred to competent Civil Court.  No proper particulars of insurance have been produced on record either by complainant or by other OPs. It is averred that answering OP has numerous regional offices, divisional and branch officers and it is not possible for them to locate the insurance particulars without supplying the said documents and therefore

cc no. - 106 of 2019

insurance of alleged deceased is denied. Even as per law and provisions of scheme, complaint filed by complainant is time barred. However, on merits, OP-1 has denied all the allegations of complainant regarding accident, death or post mortem of her husband being wrong and incorrect and it is reiterated that there is no deficiency in service on their part and made prayer for dismissal of complaint with costs.

6                             Ld Counsel for OP-2, 4 and 5 also filed reply taking preliminary objections that Bhagat Puran Singh Sehat Bima Yozna has been closed by the Punjab Government with effect from 19.04.2019 and therefore, present complaint is liable to be dismissed. It is averred that complainant is not their consumer and there is no relationship of consumer or service provider between them. However, on merits, OP-5 admitted before the Forum that said scheme was launched by Punjab Government and answering Ops were running the same. It is also admitted that premium amount of Rs.30/-was paid by deceased Harjinder Singh and he was duly issued a Smart Card by them. It is further averred that matter regarding claim of Rs.5,00,000/- as sought by complainant, is between complainant and Insurance Party

cc no. - 106 of 2019

No. 3 and they have no role to play in making payment of insurance claim. It is asserted that neither complainant informed them about death of Harjinder Singh nor she is entitled to claim any compensation for death of her husband. Moreover, claim is payable only by Insurance Party no.3 and not by them. All the other allegations are denied being wrong and incorrect and it is further averred that there is no deficiency in service on the part of answering OPs. Prayer for dismissal of complaint with costs is made.

7                         Parties were given proper opportunities to prove their respective case. Ld Counsel for complainant tendered in evidence affidavit of complainant as Ex.CW-1/A and documents Ex C-1 to Ex C-7 and then, closed the evidence.

8                            In order to rebut the evidence of the complainant, ld counsel for OP-1 tendered in evidence, affidavit of R N Bansal as Ex OP-1/1 and then, closed the same on behalf of OP-1.  Ld Counsel for OP-2, 4 and 5 suffered statement before the Forum that reply filed by him be read as evidence in present case.

 

cc no. - 106 of 2019

9                          We have heard the learned counsel for the parties and have very carefully gone through the affidavits and documents on the file.

10                        Ld Counsel for complainant has vehementally argued that being a member of Bhagat Puran Singh Sehat Bima Yojna having card no.0304 5000 0850 3550 7 against policy in question, Harjinder Singh husband of complainant was insured under this scheme. It was valid from 1.11.2016 to 31.05.2019 and during the subsistence of policy in question, husband of  complainant died in a vehicular accident on 07.12.2018 regarding which FIR No.85 dated 08.12.2018 has been registered in Police Station City, Sadiq, Faridkot and due intimation regarding death of her husband was given by complainant to OPs. Complainant also furnished all documents required for processing the claim to Investigator appointed by Ops and also completed all required formalities, but till now, OPs have not cleared the genuine claim of complainant, which amounts to deficiency in service and trade mal practice on the part of OPs. She has prayed for accepting the

 

cc no. - 106 of 2019

present complaint alongwith compensation and litigation expenses besides main relief. She has stressed on document Ex C-1 to 7.

11                     To controvert the allegations of complainant, ld counsel for OP-1 argued that complainant is not their consumer and therefore, present complaint is liable to be dismissed. It is averred that complainant has no locus standi to file the present complaint and have denied all the allegations of complainant being wrong and incorrect and asserted that there is no deficiency in service on their part. It is further argued that no information regarding death of insured was given to them thereby preventing them to gather first hand information, which is a violation of terms and conditions of the policy. Moreover, neither complainant nor other OPs have produced on record particulars in respect of insurance of deceased. It is averred that OP-1 has numerous regional, divisional and branch officers and it is not possible for them to locate the insurance particulars of deceased husband of complainant without supplying the same and therefore insurance of alleged deceased is denied.  Moreover, no Post Mortem Report proving the death of said Harjinder Singh is furnished by complainant to them

cc no. - 106 of 2019

It is further argued that all the allegations of complainant are incorrect and wrong and made prayer for dismissal of complaint with costs.

12                          Ld Counsel for OP-2, 4 and 5 argued that Bhagat Puran Singh Sehat Bima Yozna has been closed by the Punjab Government with effect from 19.04.2019 and even complainant is not their consumer and there is no relationship of consumer or service provider between them. As per their counsel, said scheme was launched by Punjab Government and they were running the same. It is also admitted that premium amount of Rs.30/-was paid by Harjinder Singh deceased husband of complainant and they issued a Smart Card to deceased. It is argued that all the benefits  and matter regarding insurance claim of Rs.5,00,000/-, is between complainant and Insurance Company and they have no role in making payment of insurance claim. There is no deficiency in service on the part of OP-5 and prayer for dismissal of complaint with costs is made.

13                   After careful perusal of the record available on file and going through the evidence led by parties, it is observed that case of

cc no. - 106 of 2019

the complainant is that her husband was insured under Bhagat Puran Singh Health Insurance Scheme and was duly allotted card for availing the policy. During the subsistence of policy in question, her husband died in an accident and after his death, complainant gave due intimation regarding death of her husband to OPs and completed all requisite formalities and requested Ops to pay insurance claim on account of death of her husband. Grievance of complainant is that despite repeated requests OPs did not make payment of insurance claim under the policy in question. On the other hand plea  taken by OP-1 is that complainant is not their consumer and even husband of complainant was not insured with them as no intimation regarding death of Harjinder Singh and documents in respect of his insurance were ever provided by complainant or other OPs.  As per OP-1 they have several regional, divisional, branch and micro offices set by them and it is difficult for them to locate detail regarding insurance of  husband of complainant. OP-1 took plea that deceased was not the head of family and all documents regarding legal heirs of deceased Harjinder Singh have not been mentioned. It is also denied that any

cc no. - 106 of 2019

accident dated 7.12.2018 was ever occurred and deceased sustained injuries in said accident. it is averred that FIR No.85 dt 08.12.2018 has nothing to do with present complaint and said Harjinder Singh did not die at the spot and moreover, no intimation regarding accident, treatment or death was ever supplied to them. As per OP-1 vide letter dated 02.07.2019, they asked complainant to furnish post-mortem report regarding death of Harjinder Singh, but complainant failed to provide the same to them. On the contrary OP-2, 4 and 5 admitted before the Forum in their written reply as well in arguments that Harjinder Singh deceased husband of complainant paid Rs.30/-to them and he was insured with them and it is also admitted that smart card in question was issued to her husband by them, but they have denied the payment of insurance claim and asserted that payment in respect of insurance claim is to be made by Insurance Company and they have nothing to do in this regard. There is no deficiency in service on the part of OP-5.

14                        To prove her pleadings, complainant has stressed on document Ex C-3 copy of card issued under Bhagat Puran Singh

cc no. - 106 of 2019

Health Insurance Scheme that clearly depicts that policy in question was issued in the name of deceased Harjinder Singh. It contains information about Bhagat Puran Singh Health Insurance Scheme and clears the point that in case of death of head of family member of insured, family is entitled for Rs.5 lacs as insurance claim. Moreover, card of deceased issued under Bhagat Puran Singh Sehat Bima Yojna is valid for the period from 1.11.2016 to 31.05.2019. Ex C-1 affidavit of complainant further proves the pleadings of complainant that despite repeated requests, OPs have not made a single penny to clear the claim on account of death of her husband. Ex C-1 is copy of adahar card of Harjinder Singh and Ex C-2 is adhar card of  complainant which proves the fact that she was the wife of deceased Harjinder Singh. Ex C-5 is copy of Post Mortem Examination Report that reveals the fact that Harjinder Singh died on 07.12.2018 in accident and Ex C-4 copy of FIR No.85 dated 08.12.2018 also proves the pleadings of complainant. Ex C-6 is copy of Death Certificate issued by Government of Punjab Health and Family Welfare Department. As per salient features of Bhagat Puran Singh Health Insurance Scheme, in the

cc no. - 106 of 2019

event of accidental death or disability of two parts, sum of Rs.5 lacs would be given to the family of deceased or to the beneficiaries and validity of policy was commencing from 1.11.2016 to 31.05.2019. Ex C-7 is copy of letter issued by Insurance Company to complainant vide which they asked complainant to provide post mortem report of deceased Harjinder Singh though same has already been supplied by complainant to them. There is no doubt that complainant was aggrieved by the act of OPs in not making payment of insurance claim to her. Card issued to deceased under Bhagat Puran Singh Sehat Bima Yojna is beyond any doubt.  Death certificate sought by OP-1 is also placed on record. Plea taken by OP-1 that complainant did not provide them requisite documents i.e Post Mortem Report of deceased Harjinder Singh,  has no legs to stand upon in the light of Ex C-7. Complainant has placed on record sufficient and cogent evidence to prove her pleadings. There is no reason to doubt that complainant has suffered huge harassment and mental agony by action of Insurance Company in not making payment of insurance claim on account of death of her husband.

cc no. - 106 of 2019

15                                  From the above discussion and in the light of evidence produced by the respective parties, we are of considered opinion that complainant has succeeded in proving her case and therefore, present complaint is hereby accepted against OP-1 and OP-3. OP-1 and OP-3 are directed to pay Rs.5 lacs to complainant on account of insurance claim for death of husband who was insured with OPs alongwith interest at the rate of 9 % per anum from the date of filing the present complaint till final realization. OP- 1 and OP-3 are further directed to pay Rs.5,000/-to complainant as compensation for harassment and mental agony suffered by her as well as for litigation expenses. Compliance of this order be made within one month of the receipt of the copy of the order, failing which complainant shall be entitled to proceed under Section 25 and 27 of Consumer Protection Act. Complaint against OP-2, OP-4 and OP-5 stands hereby dismissed. Copy of the order be supplied to parties free of cost as per law. File be consigned to record room.

Announced in Open Forum

Dated : 18.03.2020                     (Param Pal Kaur)            (Ajit Aggarwal)         

               Member                               President