DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.
Complaint No. 42
Instituted on: 02.02.2018
Decided on: 08.08.2018
Baljit Kaur aged about 50 years widow of Gurbax Singh son of Diya Singh, resident of Village Kamalpur, Tehsil Dirba, District Sangrur.
…Complainant
Versus
1. United India Insurance Company Limited, SCO No.2, Phase-9, Mohali through its Manager.
2. Punjab Health Systems Corporation, Civil Secretariat Chandigarh, through its Managing Director.
3. State of Punjab through Deputy Commissioner, Sangrur.
…Opposite parties
For the complainant : Shri Anil Aggarwal, Adv.
For OP No.1 : Shri Bhushan Garg, Adv.
For OP NO.2&3 : None.
Quorum: Sarita Garg, Presiding Member
Vinod Kumar Gulati, Member
Order by : Sarita Garg, Presiding Member.
1. Smt. Baljit Kaur, complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the husband of the complainant, Shri Gurbax Singh was the member of Bhagat Puran Singh Sehat Bima Yojna and under that scheme, Shri Gurbax 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 the said Gurbax Singh was issued card bearing number 9305-3000-0240-3981-9 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 on 29.01.2017 the husband of the complainant, namely, Gurbax Singh died due to accidental injuries caused by Gurpreet Singh son of Joginder Singh while travelling on motorcycle number PB-13-AV-0595, of which DDR number 43 dated 9.2.2017 was lodged at PS Dirba. Further case of the complainant is that thereafter being the beneficiary under the policy, she lodged the claim with the OPs on account of death of her husband on their toll free number 104 and they apprised that the claim will be paid, but the Ops failed to pay the claim. It is further averred that the post-mortem on the dead body of the deceased was not conducted due to illiteracy and family sentiments. It is further averred that when the claim of the complainant was not settled, the complainant got served a legal notice upon the OPs, but nothing happened. 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 OP number 1, preliminary objections are taken up on the grounds that the complaint of the complainant is false, frivolous and vexatious in nature, that there is neither any negligence nor deficiency in service on the part of the OP, that the complainant has not approached this Forum with clean hands, that the complainant has got no cause of action to file the present complaint. On merits, it is denied that the husband of the complainant, namely, Gurbax Singh died due to accidental injuries while travelling on motorcycle and the DDR was lodged after a period of 11 days. It is stated further that the Ops appointed Shri Nirmal Singh as investigator who submitted his report dated 14.3.2017, who reported that in the absence of post-mortem report, the cause of death is not clear, as such, it is stated that the OPs are not liable to pay the claim. The other allegations levelled in the complaint have been denied in toto.
4. In reply filed by OPs number 2 and 3, it is stated that the complaint is premature as the Govt. Of Punjab vide notification dated 21.9.2016, the complainant should approach the District Level Grievance Committee for redressal of his grievance, that the complaint is not maintainable and that the complainant has no cause of action to file the present complaint. On merits, it is admitted to the extent that husband of the complainant was the member of Bhagat Puran Singh Sehat Bima Yojna vide card number 9305-3000-0240-3981-9, but the other allegations levelled in the complaint have been denied.
5. The learned counsel for the complainant has produced Ex.C-1 to Ex.C-11 copies of documents and affidavit and closed evidence. On the other hand, the learned counsel for OP number 1 has produced OP1/1 to Ex.OP1/5 copies of documents and affidavit and closed evidence. The learned counsel for OP number 2 and 3 has not produced any evidence on record.
6. We have carefully perused the complaint, version of the opposite parties and heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.
7. At the outset, the learned counsel for the complainant has contended vehemently that the husband of the complainant, namely, Gurbax Singh was insured with the OP number 1 through OPs number 2 and 3 as per the insurance policy for Rs.5,00,000/- (in case of accidental death) and has contended that the Op number 1 has wrongly and intentionally withheld the rightful claim of the complainant to the tune of Rs.5,00,000/-, whereas the case of the OP number 1 is that the said Gurbax Singh (referred to as DLA in short) did not die at all on 29.11.2017 due to accidental injuries while travelling on the motorcycle. But, it is worth mentioning here that the OP number 2 and 3 has clearly mentioned in the written reply that the said DLA was the member of Bhagat Puran Singh Sehat Bima Yojna and the card bearing number 9305-3000-0240-3981-9 was issued to the DLA. Further the learned counsel for the complainant has contended vehemently that the above said card was in activation at the time of death of the DLA, meaning thereby the death of the DLA falls within the insurance period as the death took place on 29.01.2017. Ex.C-1 is the copy of insurance card in question showing the insurance of Gurbax Singh. Ex.C-2 is the copy of general diary details, which clearly reveals that the DLA suffered accidental injuries and died due to that injuries. Further Ex.C-3 is the copy of legal notice served upon the Ops, which clearly supports the case of the complainant. Further we have also perused the investigation report of Shri Nirmal Singh, a copy of which on record is Ex.C-10, which clearly reveals that the DLA suffered accidental injuries, but it is stated that the cause of death is not clear, but we feel that since the DLA suffered accidental injuries and succumbed to that injuries at the spot. The OPs have produced nothing on record to support their contention that the DLA did not die due to the accidental injuries. There is no explanation from the side of the Op number 1 that why it had withheld the genuine claim to the complainant. In the circumstances of the case, it is fully proved on record that the said DLA was insured for Rs.5,00,000/- 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 at writ large and is liable to pay the due insurance claim to the complainant.
8. 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 @ 9% per annum from the date of filing of the present complaint i.e. 02.02.2018 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 litigation expenses. This order of ours shall be complied with by OP within a period of thirty days of receipt of copy of this order.
9. A copy of this order be issued to the parties free of cost. File be consigned to records.
Pronounced.
August 8, 2018.
(Sarita Garg)
Presiding Member
(Vinod Kumar Gulati)
Member
