Punjab

Sangrur

CC/389/2020

Kamaljit Kaur - Complainant(s)

Versus

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

Sh. Sandip Kumar Goyal

25 Sep 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR .

                                                                        Complaint No. 389

 Instituted on:   14.10.2020

                                                                         Decided on:     25.09.2024

 

Kamaljit Kaur wife of late Darshan Singh son of Baru Ram, resident of Ward No.10, Moonak, Tehsil Moonak, District Sangrur.

                                                         …. Complainant 

                                                 Versus

1.             United India Insurance Company Limited, Railway Chownk, Sangrur through its Branch Manager.

2.             State of Punjab through Deputy Commissioner, Sangrur.

3.             Punjab Health Systems Corporation, SIHFW Complex, Phase-6, Mohali through its Managing Director.

 

                                                        ..Opposite parties.

 

 

For the complainants   :       Shri S.K.Goyal, Adv.

For OP No.1                :       Shri G.S.Sibia, Adv.

For OP No.2&3           :       Shri Vinay Kumar Jindal, 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 late husband of complainant, namely, Darshan Singh was the member of Bhagat Puran Singh Sehat Bima Yojna, against which the OPs issued card bearing number 73053180027900159 under which a benefit of Rs.5,00,000/- was available in case of accidental death of card holder as per the scheme of the Punjab Govt.  Further case of complainant is that on 21.10.2018 unfortunately Darshan Singh son of Baru Ram died due to an accident suffered with the car while he was on the motorcycle. Further case of complainant is that the complainant being the legal heir as well as nominee of Darshan Singh lodged the claim on the toll free number of the OP and the OP promised that employee of the OP i.e. United India Insurance Company will collect the documents from the complainant, but no one came to collect the relevant documents. It is further averred that the OPs issued the complainant file number 2044.  Though the complainant got served the legal notice dated 23.11.2019 upon the OPs for release of the claim amount of Rs.5,00,000/- but nothing was paid till filing of the complaint.  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 of Rs.10,000/- on account of mental tension, agony, pain  and further an amount of Rs.10,000/- was claimed as litigation expenses.

2.             In reply filed by OP number 1,  preliminary objections are taken up on the grounds that the complaint is not maintainable, that the complainant has filed the present complaint by concealing the true and material facts from this Commission, that the complainant has unnecessarily dragged the OPs into uncalled litigation, that the complainant has no locus standi to file the present complaint and that the complainant has not come to this Court with clean hands. On merits, the allegations levelled in the complaint have been denied for want of knowledge. However, it is admitted that the complainant called on helpline number and investigator was appointed by the OPs, but the complainant failed to deposit the requisite documents with the company or with the investigator, which are necessary for settlement of the claim. Though the OPs demanded number of documents from the complainant for the settlement of the claim, but the complainant failed to supply the same to the OPs, as such, the complaint is said to be premature and the complainant was advised to send all the original documents to the OPs so that final decision may be taken in a proper and effective manner. Lastly, prayed for dismissal of the complaint with special costs.

3.             Record shows that vide order dated 24.05.2022, defence of OPs number 2 and 3 was struck off.

4.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-8 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.OP1/2 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 Darshan 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 Darshan Singh died on 21.10.2018 due to an accident, as is evident from the copy of FIR dated 23.10.2018 u/s 279, 337, 427 of IPC ExC-6 and copy of post-mortem report Ex.C-4, wherein it has been clearly mentioned at page number 5 in the column of opinion that the cause of death in this case is due to injuries sufficient due to road side accident which is antimortem  in nature and sufficient to cause death. Ex.C-2 is the copy of legal notice and Ex.C-3 is the copy of postal receipt. Ex.C-5 is the copy of card of Bhagat Puran Singh Sehat Bima Yojna of Darshan Singh. Ex.C-8 is the copy of judgment dated 11.12.2019 of MACT Tribunal, Sangrur. On the other hand, the stand of the OP number 1 is that the complainant did not submit the required documents for the settlement of the claim.   The disputed fact is only that the complainant did not submit the requisite documents to the OP number 1 for settlement of the claim and the OP number 1 has also contended that the complaint is premature as such the same should be dismissed. It is worth mentioning here that the objection raised by the OP number 1 that the complainant did not supply the requisite documents  seems to be vague and without any basis, as a bare perusal of the file reveals that the complainant has already produced on record the copy of police report Ex.C-6 as well as copy of post-mortem report Ex.C-4, which clearly proves/shows the accidental death of Shri Darshan Singh. All the relevant documents have been placed on the file by the complainant and this complaint was filed on 14.10.2020. The OP number 1 could have easily taken the documents and settled the claim or to repudiate the same.  It is worth mentioning here that as per the document Ex.Op1/2  clause 5.3 provides that in case of accidental death, the payment towards the claim shall be made to the spouse of the deceased HoF beneficiary. Accordingly, we are of the considered opinion that the insurance amount of Rs.5,00,000/- is payable  to the complainant being the spouse of Darshan Singh insured. As such, we find that in the present case, the complainant has sufficiently proved her case by producing cogent, reliable and trustworthy evidence on record and withholding of the amount of Rs.5,00,000/- by the OP number 1 is a case of clear cut deficiency in service on the part of OP number 1.

7.             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 complaint i.e. 14.10.2020 till realisation in full. We further direct OP number 1 to pay to the complainant an amount of Rs.10,000/- in lieu of compensation for mental tension, agony and harassment as well as litigation expenses.

8.             This order shall be complied with by OP number 1 within a period of sixty days of receipt of copy of this order.

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

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

                        Pronounced.

 

                      September 25, 2024.