Punjab

Sangrur

CC/205/2020

Kamla Devi - Complainant(s)

Versus

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

Sh. Sanjeev Goyal

22 Oct 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR .

                                                                         Complaint No. 205

  Instituted on:   28.07.2020

                                                                          Decided on:     22.10.2024

 

Kamla Devi aged about 45 years wife of Late Sh. Lala Ram, resident of #778, Ghumiar Basti, Ward No.1, Hareri Road, Sangrur.

                                                         …. Complainant 

                                                 Versus

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

2.             Punjab Health System Corporation, Phase VI, SAS Nagar, Mohali 160055 through its Managing Director.

3.             State of Punjab through Deputy Commissioner, Sangrur.

 

                                                        ..Opposite parties.

 

For the complainant  :       Shri Udit 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.             The complainant has filed this complaint against the OPs on the ground that husband of the complainant Shri Lala Ram was the member of Bhagat Puran Singh Sehat Bima Yojna, against which the OPs number 2 and 3 issued smart card bearing number 0305-3005-4548-0027-3 under which a benefit of Rs.5,00,000/- was available in case of accidental death of card holder as per the scheme of opposite parties number 2 and 3.  Further case of complainant is  that on 20.10.2018 the deceased was working as labourer with Shri Gurjit Singh Masson for doing the construction work and all of sudden he slipped from shuttering and received multiple grievous injuries on his head and other parts of the body, as such he was immediately taken to Civil Hospital, Sangrur from where he was referred to Rajindra Hospital, Patiala and from where he was taken to Amar Hospital, Patiala. Further case of complainant is that there from the deceased Lala Ram was taken to PGI Chandigarh for better treatment. The doctors on 28.10.2018 declared that there are no chances of survival of the deceased Lala Ram due to severe head injury and was advised to take him at home for taking care in the last days and he ultimately succumbed to injuries on 09.11.2018.  The deceased was cremated on the same day without conducting the post-mortem due to ignorance on the advice of relatives. However, DDR No.41 dated 20.10.2018 was got lodged at P.S. City-1 Sangrur.  Further case of complainant is that the complainant being the nominee and beneficiary, lodged the claim on the toll free number 104 of the OPs for releasing of the claim amount. Further case of complainant is that the executive of the OPs told the complainant that they will send their representative to collect the documents. As such representative of the OP number 1 came to the house of the complainant and took all the documents from the complainant and got the thumb impressions of the complainant on blank printed performa. Thereafter the complainant approached the OPs so many times to get the claim amount from the OP number 1,  but nothing was done.   It is further averred that the OPs sent a letter dated 15.10.2019, whereby the OPs repudiated the claim of the complainant on the ground of absence of documents i.e. FIR and post-mortem. Further it is averred that the claim of the complainant has been wrongly repudiated as from the medical documents as well as  DDR, the case of the complainant is proved that the deceased died an accidental death. 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.5,70,000/- (Rs.5,00,000/- claim amount plus Rs.70,000/- spent on the treatment) along with interest and further claimed compensation of Rs.1,00,000/- on account of mental tension, agony, pain  and further an amount of Rs.22,000/- 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 OP into uncalled litigation, that the complainant has no locus standi and cause of action to file the present complaint. On merits, the allegations levelled in the complaint have been denied. It is stated that the complainant never lodged the claim with the OP, as such visiting of the representative of the OP in the house of the complainant does not arise at all. It is stated that the complainant did not submit any document to the OP, such as, FIR and post-mortem report despite demanded by the OP. As such the claim of the complainant has rightly been repudiated.  Any deficiency in service on the part of the OP has been denied. Lastly, the OP has prayed for dismissal of the complaint with costs.

3.             Record shows that vide order dated 30.05.2022, 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-10 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.OP1/4 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.             It is an admitted fact between the complainant and OP number 1 that Late Lala Ram was insured with the OP number 1  for Rs.5,00,000/- in case of accidental death. It is also not in dispute that Lala Ram died/succumbed to the injuries on 09.11.2018 due to an accident, as is evident from the copy of General Diary Details  Number 041 dated 20.10.2018 Ex.C-3, whereas Ex.C-4 is the copy of discharge summary issued by Department of Neurosurgery, PGIMER, Chandigarh wherein it has clearly been mentioned in the column Final Diagnosis: severe head injury with bifrontal contusion with ASDH along FALX with Diffuse Brain Edema and further in the column of Brief History and clinical findings, it has been mentioned that 50/M with No known Comorbidities, was admitted with A/H/O Fall from height. Ex.C-2 is the copy of card of Bhagat Puran Singh Sehat Bima Yojna of Shri Lala Ram. Ex.C-5 is the copy of medical bills. Ex.C-6 is the inpatient bill of deceased Lala Ram issued by Amar Hospital, Patiala. Ex.C-8 is the copy of death certificate of deceased Lala Ram, whereas Ex.C-7 is the certificate issued by Shri Nachhattar Singh, Municipal Councillor, Municipal Council, Sangrur stating that Shri Lala Ram son of Leelu Ram died due to an accidental injuries suffered by him on 20.10.2018, when he was working as labourer and fell from the shuttering and was cremated without conducting postmortem. Ex.C-10 is the copy of repudiation letter dated 15.10.2019 issued by the OP number 1 for want of FIR and post-mortem report. All this evidence is duly supported by the affidavit of complainant Ex.C-1.

7.             On the other hand, the stand of the OP number 1 is that the complaint of the complainant deserves dismissal as the complainant never lodged the claim with the OP number 1 or on its toll free  number 104 nor the complainant has produced copy of FIR and post-mortem report on record.  But in the present case, the fact remains that the deceased Lala Ram died an accidental death  as is evident from the copy of General Diary Report Ex.C-3 and  copy of discharge summary issued by the PGIMER, Chandigarh, which is on record as Ex.C-4 from where the complainant has sufficiently produced on record that the deceased Lala Ram died an accidental death. Moreover, OP number 1 has placed on file Ex.OP1/3, wherein it has been mentioned that he (deceased) died due to falling from pad of wall.  Further, Lala Ram was insured for Rs.5,00,000/- for an accidental death under Bhagat Puran Singh Sehat Bima Yojna and he died an accidental death as discussed above. The OP number 1 did not pay the rightful claim to the complainant. It is worth mentioning here that stand of the OP number 1 that the complainant did not produce the copy of FIR and post-mortem report, as such the claim has rightly been repudiated, but we are unable to accept such a contention, whereas otherwise the complainant has established on record that the deceased Lala Ram died an accidental death. It is worth mentioning here that as per the document Ex.OP1/4 clause 5.3 (ii) in case of accidental death, the payment towards the claim shall be made to the spouse of the deceased HOF beneficiary.  In the circumstances of the case, we find that the complainant is entitled to get the insurance claim amount of Rs.5,00,000/- from the OP number 1 and by not settling the claim of the complainant, the OP number 1 is deficient in rendering service towards her.

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 @ 7% per annum from the date of filing of the complaint i.e. 28.07.2020 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.

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

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

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

                           Pronounced.

                           October 22, 2024.

 

           (Kanwaljeet Singh)  (Sarita Garg) (Jot Naranjan Singh Gill)

                  Member                       Member                  President