DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                Complaint No.  659

                                                Instituted on:    12.12.2017

                                                Decided on:       26.07.2018

Nachattar Kaur wife of Late Sh. Malkit, resident of Village Punnawal, Tehsil Dhuri, District Sangrur.

                                                        …Complainant

                                Versus

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

2.             United India Insurance Company Limited, Registered Divisional Office: SCO 72, Phase IX, Mohali, through its Manager.

3.             Punjab Health Systems Corporation, Civil Secretariat, Chandigarh through its Managing Director.

4.             State of Punjab through Deputy Commissioner, Sangrur.

                                                        ..Opposite parties.

For the complainant  :       Shri Ramandeep Singh, Adv.

For Opp.Party No.1&2:     Shri G.S.Sibia, Adv.

For OP No.3             :       Shri Vinay Jindal, Adv.

Quorum:   Sukhpal Singh Gill, President

                Sarita Garg, Member

                Vinod Kumar Gulati, Member

Order by : Sukhpal Singh Gill, President.

1.             Smt. Nachattar 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 husband of the complainant, namely, Shri Malkit was the member of Bhagat Puran Singh Sehat Bima Yojna, which is being run by the Ops number 3 and 4 and issued card number 3000-0860-3962-6 and under the said scheme he was insured with the OP number 1 and the insured Malkit and his family members were entitled to get the medical reimbursement for an amount of Rs.50,000/- in case of medical treatment and were further entitled to Rs.5,00,000/- in case of accidental death of the card holder.  The case of the complainant is that Shri Malkit met with an accident on 3.3.2017 near KRBL factory, Bhasaur and sustained multiple grievous injuries on his person, and as such he was brought to Civil Hospital, Dhuri and thereafter he was referred to PGI Chandigarh on 4.3.2017 and remained under treatment upto 17.3.2017 and ultimately succumbed to the injuries at PGI Chandigarh. FIR number 27 dated 4.3.2017 was also lodged and the post-mortem on the dead body of Shri Malkit was conducted at Civil Hospital, Dhuri.  Thereafter the complainant lodged the claim with the OPs being the nominee under the policy, but the claim amount was not released to the complainant despite her best efforts. 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 amount of Rs.5,00,000/- along with interest @ 18% per annum and further claimed compensation and litigation expenses.

2.             In reply filed by OP number 1 and 2, preliminary objections are taken up on the grounds that the complaint is premature and deserves dismissal as the Ops have not repudiated the claim, that the complainant has dragged the Ops into unwanted litigation, that the complainant has got no locus standi and cause of action to file the present complaint and that the complainant has not come to the Forum with clean hands. It is denied that the complainant ever lodged any claim at toll free number 104 or in writing to the OPs.  On merits, the existence of the card number in question has been denied in toto. It is further stated that the complainant never lodged any claim with the Ops nor submitted any of the documents to the OPs, as such the question of paying any claim does not arise at all. The other allegations levelled in the complaint including lodging of any claim with the Ops has been denied in toto.

3.             In reply filed by OP number 3 and 4, legal objections are taken up on the grounds that the complaint is premature, 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 that the deceased Malkit was the member of Bhagat Puran Singh Sehat Bima Yojna, but the remaining allegations of the complainant have been denied in toto.

4.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-7 copies of documents and affidavit and closed evidence. On the other hand, the learned counsel for the OP number 1 and 2 has produced Ex.OP1&2/1  affidavit and closed evidence. The learned counsel for OP number 3 and 4 has produced Ex.OP3&4/1 to Ex.OP3&4/4 copies of documents and affidavits and closed evidence.

5.             We have carefully perused the complaint, version of the opposite parties and evidence produced on the file and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits part acceptance, for these reasons.

6.             At the outset, it is an admitted fact of the complainant as well as the OPs that the husband of the complainant, Shri Malkit, was insured under the policy in question with the Ops.  In the present case, the grievance of the complainant is that though the claim was lodged with the Ops and further submitted all the required documents to the OPs, but despite that the claim was not settled and paid to the complainant.  On the other hand, the stand of the Ops is that the complainant never lodged any claim with the Ops and as such the question of settling or not settling of the claim does not arise on the part of the Ops.  We have very carefully perused the whole case file, but failed to find out that the complainant ever lodged any claim with the Ops nor the complainant has produced any evidence on record to support her contention in this regard. In the circumstances, we feel that ends of justice would be met if the complainant is directed to first lodge the claim with the Ops about the death of deceased Malkit and to submit the required documents to the Ops for settlement of the claim.

7.             In view of our above discussion, we allow the complaint partly and direct the complainant to first lodge the claim along with all the documents to the OPs and thereafter the Ops shall decide the claim of the complainant within a period of 30 days of the receipt of documents from the complainant and intimate the complainant about their decision by registered.  It is made clear that, if the complainant still remains unsatisfied, then the complainant is free to file a fresh complaint if she so desired. With these observations, we dispose of the complaint and the parties are left to bear their own costs. A copy of this order be issued to the parties free of cost. File be consigned to records.

                        Pronounced.

                        July  26, 2018.

                                                        (Sukhpal Singh Gill)

                                                                President

                                                                (Sarita Garg)

                                                                    Member

                                                        (Vinod Kumar Gulati)

                                                                   Member