Punjab

Sangrur

CC/604/2019

Charanjit Kaur - Complainant(s)

Versus

United India Insurance Comany Limited - Opp.Party(s)

Sh. Lovepreet Singh Walia

03 Oct 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR .

 

                                                                        Complaint No. 604

 Instituted on:   25.11.2019

                                                                        Decided on:     03.10.2023

 

Charanjit Kaur aged about 41 years wife of Late Sh. Baljit Singh, resident of village Nagra-148026, Tehsil Bhawanigarh, District Sangrur.

                                                         …. Complainant 

                                                 Versus

1.             United India Insurance Company Limited, Railway Station Road, Sangrur 148001 through its Divisional Manager.

2.             Punjab Health Systems Corporation, Phase VI, SAS Nagar, Mohali 160055 through its Managing Director. (Notice to OP number 2 not issued).

3.             State of Punjab through Deputy Commissioner, Sangrur 148001. (Notice to OP number 3 not issued)

                                                        ..Opposite parties.

 

For the complainant    :       Shri L.S. Walia, Adv.

For OP No.1              :       Shri Ashish Kumar, Adv.

 

Quorum                                           

Jot Naranjan Singh Gill, President

Sarita Garg, Member

                        Kanwaljeet Singh, Member

 

ORDER

JOT NARANJAN SINGH GILL, PRESIDENT

 

1.             Complainant  has preferred the present complaint against the opposite parties on the ground that the husband of the complainant, Shri Baljit Singh was the member of Bhagat Puran Singh Sehat Bima Yojna against which the OPs number 2 and 3 issued card bearing number 0305-3000-9230-3973-8 to Shri Baljit Singh. It is further averred that under the said scheme  Shri Baljit Singh was insured for medical reimbursement for an amount of Rs.50,000/- for medical treatment and further was insured for Rs.5,00,000/- on account of accidental death of the card holder and except that no terms and conditions of the policy were issued by the OP number 1.

2.             Further case of the complainant is that unfortunately on 2.2.2019 husband of the complainant, namely, Shri Baljit Singh took poisonous liquid under the impression of medicine and after sometime he felt uneasiness and was taken to Civil Hospital, Sangrur, but he died on the way to the hospital, of which DDR number 20 dated 3.2.2019 was lodged at PS Bhawanigarh and post-mortem on the dead body of the husband of the complainant was also conducted on the same date.  Further it is averred that after the death of the husband of the complainant she remained under mental shock and trauma and in the month of June, 2019, while the complainant was searching something in the almirah, then she found the said card and she immediately approached OP number 1 for lodging the claim. Thereafter the surveyor of the OP number 1 visited the house of the complainant and took all the relevant documents and got signed on blank papers, but the claim was not released.  Further in the month of October, 2019 the OP number 1 sent the letter whereby repudiated the claim of the complainant. Thus, alleging deficiency in service on the part of the Ops, the complainant has prayed that the Ops be directed to pay to the complainant the claim amount of Rs.5,00,000/- along with interest and further claimed compensation and litigation expenses.

3.             In reply filed by the OP number 1,  legal objections are taken up on the grounds that OP number 1 has been dragged into unwanted litigation, that the complainant is not a consumer and that the complaint is not maintainable. On merits, it is stated that on the request of State Govt. of Punjab, Department of Health and Family Welfare, Punjab, the Mohali office of OP number 1 issued a policy namely Bhagat Puran Singh Sehat Bima Yojna. The sum insured was Rs.5,00,000/- per main member only regarding accidental death and permanent total disability.  It is stated further that after receiving intimation regarding death of Baljit Singh in an accident on 2.2.2019, an approved investigator was appointed, who personally investigated the matter in question and submitted his report dated 19.7.2019 subject to terms and conditions of the policy and as per report, no cause of death is mentioned in the post-mortem report.  After examining the file carefully the OP policy issuing office repudiated the claim as Baljit Singh died due to illness which is not covered under the policy. As per post-mortem report, the cause of death is not opined by the doctor who conducted the post-mortem, as such it is stated that the said office has rightly repudiated the claim. The other allegations levelled in the complaint have been denied in toto. Lastly, the Ops prayed for dismissal of the complaint.

4.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-15 copies of documents and affidavit and closed evidence. On the other hand, the learned counsel for OP number 1 has produced Ex.OP1/1 to Ex.OP1/6 copies of documents and affidavit and closed evidence. 

5.             We have gone through the pleadings put in by  the parties along with their supporting documents with their valuable assistance. 

 

6.             At the outset, it is an admitted fact between the complainant and OP number 1 that  husband of complainant, Shri Baljit Singh was insured with the OP number 1 for Rs.5,00,000/- in case of accidental death. It is also not in dispute that Shri Baljit Singh died on 2.2.2019, as is evident from the copy of death certificate, which is on record as Ex.C-8,  DDR number 20 dated 3.2.2019 regarding the death of the insured was also recorded, a copy of which on record is Ex.C-9 wherein it has been clearly mentioned that Shri Baljit Singh died due to mistakenly consuming of poisonous medicine.  The disputed fact is only that the OP number 1 says that Shri Baljit Singh died due to natural death and not an accidental death as he was ill.  

7.             To support the contention, the complainant has produced ExC-1 her sworn affidavit,  Ex.C-9 copy of DDR, Ex.C-10 copy of post-mortem report conducted on the dead body of Shri Baljit Singh on 3.2.2019, wherein it has been stated by the doctor that “in my opinion the cause of death in this case will be given after chemical examination report”.  The case of the complainant is further supported by the declaration of Shri Narinder Pal Singh, Ex.C-11, wherein he has clearly mentioned that Shri Baljit Singh died on 2.2.2019 due to mistakenly consuming of poisonous substance.  The Gram Panchayat Village Nagra also issued certificate Ex.C-12 duly signed and stamped by Sarpanch, Smt. Paramjeet Kaur, wherein it has been mentioned that Shri Baljit Singh died on 2.2.2019 due to mistakenly consuming of poisonous substance. Ex.C-13 is also certificate issued by Numberdar Darshan Singh stating the same story.  Ex.C-14 is the newspaper clipping dated 4.2.2019 wherein it has been again clearly mentioned that one Baljit Singh, field labourer consumed poisonous substance erroneously and died. Ex.C-15 is the repudiation letter dated 26.9.2019, wherein it has been stated that Shri Baljit Singh died due to illness and as such the claim is not payable.

8.             On the other hand, we have perused the investigation report submitted by one Nirmal Singh, Ex.OP/1 and bare perusal of it nowhere shows that Shri Baljit Singh died due to illness and in the same it is clearly mentioned that as per the post-mortem report the cause of death of the deceased will be given after Chemical Examination Report. It is worth mentioning here that chemical examination report was never received by the OP number 1, as is evident from Ex.OP1/3, the letter dated 30.1.2021 sent by Manjit Singh Kohli, Mechanical Engineer to the OP number 1, wherein it has been clearly mentioned that as per the remarks given by Dr. Guntass Kaur, she has not received the Chemical Examination Report/visra report of deceased/Baljit Singh. Since it is a clear cut case of the complainant that Baljit Singh died due to mistakenly consuming of poisonous substance, which fact  is supported by the self declaration of the complainant herself and with declaration of Narinder Pal  Singh, Gram Panchayat certificate and also certificate issued by Nambardar.  More over, the OP number 1 has not produced any chemical examination report on record.  If the OP number 1 has not received the chemical examination report, then the complainant cannot be made to suffer on that account and claim cannot be repudiated.

9.             Further to support the contention of complainant, the learned counsel for the complainant has cited New India Assurance Co. Ltd. versus Lakhwinder Kaur RP No.1523 of 2005, decided on 20.7.2005, wherein the Hon’ble National Consumer Commission found that the insured consumed pesticides by mistake and died, death was not caused by external violence and visible means and it was held that death was accidental and not suicide and the revision petition of the insurance company was dismissed. Again the Hon’ble National Commission in case R.P. No.1405 of 2016 Life Insurance Corporation of India versus Dr.A.B.Singh, the claim of the complainant was repudiated on the ground that deceased committed suicide and the complaint was allowed, as the OP failed to prove that it was a suicide and the repudiation was found unjustified. The same view was also taken by the Hon’ble National Commission in IDBI Federal Life Insurance Co. Ltd. versus Anua Ghosal and another RP No.1786 of 2014 decided on 5.1.2015.  In the circumstances of the case, in the present case, the OP number 1 has miserably failed to prove on record that the death of Baljit Singh occurred due to illness as averred in the written reply by the OP number 1. Further there is no explanation from the side of the OP number 1 that why they  repudiated the genuine claim to the complainant.  Further in the circumstances of the case, it is fully proved on record that the said Baljit Singh was insured for Rs.5,00,000/- as is evident from the copy of Bhagat Puran Singh Sehat Bima Yojna, Ex.OP1/7 for an accidental death and further his death covers under the insurance policy. As such, we are of the considered opinion that the deficiency in service on the part of the OP number 1 is writ large, as the OP number 1 has wrongly and wilfully repudiated the rightful claim of the complainant.

10.            In view of our above discussion, we allow the complaint and direct OP number 1 to pay to the complainant an amount of Rs.5,00,000/- along with interest @ 7% per annum from the date of filing of the present complaint i.e. 25.11.2019 till realisation in full. We further direct OP number 1 to pay to the complainant an amount of Rs.5,000/- in lieu of compensation for mental tension, agony and harassment as well as an amount of Rs.5,000/- on account of  litigation expenses. This order shall be complied with by OP number 1 within a period of thirty days of receipt of copy of this order.

11.            The complaint could not be decided within the statutory time period due to heavy pendency of cases.

12.            Copy of this order be supplied to the parties free of cost. File be consigned to the records after its due compliance. 

 

                             Pronounced.

                            October 3, 2023.