Punjab

Moga

CC/16/128

Paramjit Kaur - Complainant(s)

Versus

United India Insurance Co. - Opp.Party(s)

Sh. Navdeep Singh Gill

21 Dec 2016

ORDER

THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA.

 

 

                                                                                      CC No. 128 of 2016

                                                                                      Instituted on: 28.07.2016

                                                                                      Decided on: 21.12.2016

 

Paramjit Kaur aged about 52 years wife of Late Amarjit Singh son of Mehar Singh, resident of VPO Bughipura, Tehsil and District Moga.

                                                                                ……… Complainant

 

Versus

1.       United India Insurance Co. Ltd. 24 Whites Road, Chennai, through Concerned Officer.

 

2.       United India Insurance Co. Ltd. Mall Road, Ferozepur City, through its Branch Manager.

 

3.       Cooperative Bank, Branch Dala, Tehsil and District Moga, through its Branch Manager. 

 

                                                                           ……….. Opposite Parties

 

 

Complaint U/s 12 of the Consumer Protection Act, 1986.

 

 

Quorum:    Sh. Ajit Aggarwal,  President

                   Smt. Vinod Bala, Member

                   Smt. Bhupinder Kaur, Member

 

Present:       Sh. Navdeep Singh Gill, Advocate Cl. for complainant.

                   Sh. Pawan Kumar Sharma, Advocate Cl. for opposite party nos.1 & 2.

                   Sh. Dilraj Singh Gill, Advocate Cl. for opposite party no.3.

 

ORDER :

(Per Ajit Aggarwal,  President)

 

1.                Complainant has filed the instant complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as the "Act") against United India Insurance Co. Ltd. 24 Whites Road, Chennai, through Concerned Officer and others (hereinafter referred to as the opposite parties) directing them to release Rs.5,00,000/- on account of claim of policy no.2001024215P103080080. Further opposite parties may be directed to pay Rs.80,000/- on account of damages and Rs.20,000/- on account of litigation expenses to the complainant or any other relief which this Forum may fit and proper be granted. 

2.                Briefly stated the facts of the case are that Sh. Amarjit Singh, deceased husband of the complainant was having Bank account bearing no.121834036100014 with opposite party no.3. The opposite party no.3 introduced a policy of opposite party nos.1 & 2 and opposite party no.3 also told to Amarjit Singh that only a mere amount will be deducted from his account on account of premium of policy and in case any mishapenning occurred with said Amarjit Singh, then opposite parties will pay Rs.5,00,000/- to the person to whom Amarjit Singh will appoint as nominee. As per instructions and directions of opposite party no.3 said Amarjit Singh purchased a policy of opposite party nos.1 & 2 and in this regard premium of his policy was deducted by the opposite party no.3 from his account time to time. During the period of said policy husband of the complainant died in road accident in Dubai on 17.06.2015. After completing all formalities the Government of Dubai had sent the dead body of Amarjit Singh to India. Thereafter, the cremation ceremony of Amarjit Singh was peformed at his native village Bughipura. After that the complainant sent all the requisite documents to the opposite parties and filed claim regarding death of Amarjit Singh. But vide letter dated 11.05.2016, opposite party no.3 informed the complainant that her claim regarding death of Amarjit Singh has been rejected by opposite party nos.1 & 2 by raising objection that post mortem report of deceased Amarjit Singh has not been provided by the complainant and opposite party no.3 had also provided a photocopy of letter issued by opposite party nos.1 & 2. After getting the said copies, the complainant visited the office of opposite party no.2 many a times and requested them release her claim. But opposite party no.2 flatly refused to release the claim by raising objection that post-mortem report is very essential to know the cause of death, only then her claim can be released. The complainant requested them that in all the documents sent by Government of Dubai, it is clearly mentioned that cause of death 'as a result of traffic accident. Due to non payment of the claim amount, the complainant had suffered a lot. From the act of the opposite parties deficiencies in services on the part of opposite parties is fully proved. Hence this complaint.

3.                Upon notice, opposite party nos.1 to 3 appeared through their counsels and filed their separate written replies.

                   Opposite party nos.1 & 2 filed written reply taking certain preliminary objections that the complaint is not maintainable; that the complainant is estopped by his own act and conduct; that the complainant has not complied with the terms and conditions of insurance policy; that there is no deficiency in service on the part of answering opposite parties; that the complainant has not come to the Forum with clean hand. She has concealed, suppressed and misstated the material facts from this Forum. The true facts are that Smt. Paramjit Kaur has concealed the cause of death of the deceased Amarjit Singh and did not supply the post-mortem report of deceased Amarjit Singh and without the post-mortem report the claim is not maintainable. The post mortem report is the most important document for the answering opposite parties to verify the cause of death. Further submitted that the body of the deceased Amarjit Singh was cremated in India in his native village without post mortem. Therefore, there is no deficiency in service on the part of opposite parties and the claim was repudiated after thorough investigation as claim is not maintainable without post mortem report of the deceased. Therefore, the complainant is not entitled to any claim. On merits, it is submitted that Amarjit Singh (deceased) was insured under Group Personal Accident Tailor made Policy for the period 01.06.2015 to 31.05.2016. All other allegations made in the complaint has been denied and a prayer for dismissal of the complaint has been made.

4.                Opposite party no.3 filed written reply taking certain preliminary objections that the complaint is not maintainable in the present form; that the complaint is bad for non-joinder and mis-joinder of the necessary parties; that all the legal heirs of deceased Amarjit Singh are not made party, so complaint deserves dismissal. On merits, it is admitted correct to the extent that deceased Amarjit Singh was having saving bank account in the bank of answering opposite party. It is further admitted correct to the extent that Amarjit Singh husband of the complainant had died and the opposite party no.3 informed the complainant regarding the rejection of claim of complainant due to the reason non providing of post mortem report of deceased Amarjit Singh. Moreover, all the documents related with death of deceased Amarjit Singh were forwarded to opposite party nos.1 & 2, so the opposite party no.3 has no fault at all. All other allegations made in the complaint has been denied and a prayer for dismissal of the complaint has been made.

5.                In order to prove the case, complainant tendered in evidence his duly sworn affidavit Ex. C-1 alongwith copies of documents Ex. C-2 to Ex.C-26 and closed the evidence. 

6.                On the other hand, opposite party nos.1 & 2 tendered in evidence duly sworn affidavit of Sh. Baldev Singh, Divisional Manager Ex.OP-1, 2/1 and copies of documents Ex.OP-1, 2/2 & Ex.OP-1, 2/3 and closed the evidence. Whereas, opposite party no.3 tendered in evidence duly sworn affidavit of Sh. Sohan Singh, Branch Manager, The Central Co-operative Bank Ltd. Ex.OP-3/1 and closed the evidence.

7.                We have heard the ld. Counsel for the parties and have very carefully gone through record placed on file.

8.                Ld. Counsel for complainant has argued that the husband of the complainant namely Sh. Amarjit Singh (deceased) was having Bank account with opposite party no.3. On the allurement of opposite party no.3 complainant purchased the insurance policy of opposite party nos.1 & 2. Opposite party no.3 also told that in case any mis-happening occurred with deceased, then opposite parties will pay Rs.5,00,000/- to the person to whom Amarjit Singh will appoint as nominee. The complainant was appointed as nominee in the said policy. During the period of said policy husband of the complainant died in road accident in Dubai on 17.06.2015. After completing all formalities the Government of Dubai had sent the dead body of Amarjit Singh to India and cremation ceremony of Amarjit Singh was performed at his native village Bughipura. After that the complainant submitted claim alongwith all the requisite documents to the opposite parties. However, vide letter dated 11.05.2016, opposite parties rejected the claim of the complainant on the ground that post mortem report of deceased Amarjit Singh has not been provided by the complainant. The complainant approached opposite parties many times and requested them that in all the documents sent by Government of Dubai, it is clearly mentioned that cause of death 'as a result of traffic accident. The opposite parties illegally and wrongly rejected the claim of the complainant.

9.                To controvert the arguments of complainant, ld. Counsel for opposite party nos.1 & 2 argued that Smt. Paramjit Kaur has concealed the cause of death of the deceased Amarjit Singh and did not supply the post-mortem report of deceased Amarjit Singh and without the post-mortem report the claim is not maintainable. The post mortem report is the most important document for the answering opposite parties to verify the cause of death. Further argued that the body of the deceased Amarjit Singh was cremated in India in his native village without post mortem. Therefore, there is no deficiency in service on the part of opposite parties and the claim was repudiated after thorough investigation and claim is not maintainable without post mortem report of the deceased and the complainant is not entitled to any claim. Whereas, ld. Counsel for opposite party no.3 argued that it is admitted that deceased Amarjit Singh was having saving bank account in the bank of answering opposite party. It is further admitted that Amarjit Singh husband of the complainant had died and the opposite party no.3 informed the complainant regarding the rejection of claim of complainant due to the reason non providing of post mortem report of deceased Amarjit Singh. Moreover, all the documents related with death of deceased Amarjit Singh were forwarded to opposite party nos.1 & 2, so the opposite party no.3 has no fault at all.

10.              We have thoroughly gone through the file, evidence and arguments lead by ld. counsel for the parties. It is admitted case of the parties that husband of the complainant namely Amarjit Singh insured with opposite party nos.1 & 2, through opposite party no.3 and complainant was appointed as nominee in that insurance policy. It is further admitted that during the policy period, on 17.06.2015, the husband of the complainant died in a road accident in Dubai and his dead body was brought to India and cremated in his native village. It is further admitted that the complainant lodged the claim regarding the death of his husband with opposite party nos.1 & 2 and submitted all the required documents and completed all the formalities. But the opposite party nos.1 & 2 repudiated the claim of the complainant vide their letter dated 05.05.2016, copy of which is Ex.C-3 and Ex.OP-1,2/2 on the reason that the complainant has not submitted copy of post-mortem report. Ld. counsel for opposite party nos.1 & 2 argued that the complainant did not supplied post-mortem report and without post mortem report the claim is not maintainable. The post-mortem report is the most import document for the insurance company to verify the cause of death and without the same the complainant is not entitled for the compensation and opposite party nos.1 & 2 rightly repudiated the claim of the complainant, after thorough investigation. Now, the case of opposite party nos.1 & 2 is that post-mortem is essential to ascertain the cause of death of deceased and without the post mortem report they cannot verify the cause of death and cannot pay the insurance claim. On the other hand, the complainant produced documents to prove that her husband died in a road accident. To prove this fact, complainant produced copy of police report lodged by police at Saudi Arabia as Ex.C-8 stating the particular of the accident, the translation of the same is Ex.C-7, which is duly verified by Consulate General of India at Jeddah. Death notification issued by Ministry of Health at Saudi Arabia is Ex.C-10 and its translation is Ex.C-9, copy of death certificate issued by Ministry of Interior, Civil Affairs of Saudi Arabia is Ex.C-12 and its translation is Ex.C-11. Death notification issued by Ministry of Health at Saudi Arabia duly signed and verified by Director of the Hospital, where the deceased husband of the complainant brought for treatment and also signed by treating doctor as Ex.C-14 and its translation as Ex.C-13. Medical report of Deceased issued by treating doctor at Saudi Arabia is Ex.C-16 and its translation is Ex.C-15. In all these documents it is categorically mentioned that the husband of the complainant died as a result of traffic accident and cause of death under the Heading Cause of Death it is mentioned that Disease or conditions directly leading to death: Basal skull fracture and severe nervous shock. From all these documents it is clearly proved that the husband of the complainant died in Saudi Arabia in a road accident and cause of death and injuries are clearly mentioned in these documents, which are duly verified and counter signed by Consulate General of India at Jeddah. Merely on account of non-production of post mortem report, it cannot be concluded that the death of insured was not as a result of due to road accident. The non-production of documents like Post Mortem Report or medical evidence has drawn the attention of the Foras under the Act time and again. In 2005 (1) CPC 533 (Life Insurance Corporation of India and others Vs. Smt. Nidhi Sahi) the case of the complainant was that the death of the insured occurred in the scooter accident and her claim was mainly challenged on the ground that no FIR was lodged nor any Post Mortem Examination had been performed on the body of the deceased. However, the factum of death was duly proved and was supported by statement of witness, who was pillion rider of the scooter at the time of accident. The complaint was allowed by the District Forum. In the appeal the same was upheld on the ground that the factum of death had been duly proved. It becomes very much clear from that judgment that even in the absence of the FIR or the Post Mortem Report, the factum of death in a particular way can be proved by producing other evidence. Similarly in 2006 (II) CPC 599 (National Insurance Company Limited Vs Rita Devi), it was held that non-production of the Post Mortem Examination report cannot be made a ground for repudiation of the claim. The facts were similar in 2009 (1) CLT 74 (Parkash Kaur and others Vs ICICI Lombard General Insurance Company Limited). In that case the insured had died due to snake bite and evidence was produced for proving that fact. However, there was no post mortem report or police report for proving that fact. It was held therein that the claim cannot be repudiated simply on the ground that the post mortem report of the police report was not produced especially when the death by snake bite is proved from other evidence.

11.              From the above discussion, it is clearly proved that husband of the complainant died in Saudi Arabia due to road accident and this fact is clearly proves from the document issued by Government of Saudi Arabia. Now, the insurance company cannot denied the claim of the complainant only on the ground that she has not submitted the copy of Post Mortem report, whereas the death notification Ex.C-14 and medical report Ex.C-16 and its translation Ex.C-13 and C-15 respectively, which are duly signed by treating doctor stating the cause of death as amounts to Post Mortem report. Moreover as per case law discussed above if the death proved even by support of statement of witness and other evidence, the claim cannot be rejected on the ground of non production of post mortem report or FIR. So, in these circumstances, the company wrongly repudiated the claim of the complainant on false grounds, which amounts to deficiency in service on the part of opposite parties. Hence the present complaint in hand is hereby allowed against opposite party nos. 1 & 2. They are directed to pay insurance claim regarding the death of Amarjit Singh husband of the complainant alongwith interest @ 9% per annum from 05.05.2016, when they repudiated the claim of the complainant till final realization. Further the opposite party nos.1 & 2 is directed to pay Rs. 3000/-(Three thousand only) as litigation expenses to the complainant. The present complaint against opposite party no.3 stands dismissed. Compliance of the order be made within 30 days from the receipt of copy of this order, failing which, the complainant shall be entitled to initiate proceedings under section 25 & 27 of the Consumer Protection Act. Copy of the order be supplied to the parties, free of costs. File be consigned to record room.

Announced in Open Forum.

Dated: 21.12.2016.

 

                               (Bhupinder Kaur)                 (Vinod Bala)         (Ajit Aggarwal)

                                            Member                            Member                President