Punjab

Sangrur

CC/309/2019

Raj Bala Devi - Complainant(s)

Versus

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

Sh.Harinder Pal

14 Mar 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR .

                                                                        Complaint No. 309

 Instituted on:   04.07.2019

                                                                         Decided on:     14.03.2024

 

Raj Bala Devi W/o Late Ramdia Singh, resident of Village Karoda, Tehsil Moonak, District Sangrur.

                                                         …. Complainant 

                                                 Versus

1.             United India Insurance Company Limited, Railway Chowk, Sangrur through its Branch Manager 148001.

2.             United India Insurance Company Limited, Divisional Office, Mohali SCO No.72, Phase-9, SAS Nagar, Mohali through its Divisional Officer 160062.

3.             State of Punjab through Deputy Commissioner, Sangrur 148001.

4.             Punjab Health Systems Corporation, SIHFW Complex, Phase-6, Mohali through its Managing Director 160055.

                                                        ..Opposite parties.

 

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

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

For OP No.3&4         :       Shri Vinay Jindal, Adv.

 

Quorum                                           

Jot Naranjan Singh Gill, President

Sarita Garg, Member

                             Kanwaljeet Singh, Member

 

ORDER

SARITA GARG, MEMBER

 

1.             Complainant  has preferred the present complaint against the opposite parties on the ground that husband of the complainant, Shri Ramdia Singh was the member of Bhagat Puran Singh Sehat Bima Yojna against which the OPs issued card bearing number 73053103996200108 under which a benefit of Rs.5,00,000/- was available in case of accidental death of family head as per the scheme of the Punjab Govt.  It is further averred that on 6.11.2017, unfortunately Shri Ramdia Singh died due to accident at police Chowki Tharua, PS Patran, District Patiala, whereas the accident took place on 17.10.2017 and firstly deceased was admitted to Arora Hospital at Tohana and from where he was referred to the CMC Hissar, where he succumbed to the injuries on 6.11.2017. It is further averred that the complainant is the legal heir as well as the nominee of Ramdia Singh and after his death, complainant being legal heir of Ramdia Singh called at the toll free number mentioned on the card i.e. 104 and lodged the claim. Thereafter the  employee of the OPs number 1 and 2 came to the complainant at her residential address and gave the claim form to the complainant and the complainant duly filled the claim form and submitted copy of police report, copy of addhar card, copy of death certificate and copy of smart card. Further case of complainant is that the OPs repudiated the claim of the complainant on 18.3.2019 due to not providing the post-mortem report. 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/- and an amount of Rs.10,000/- was claimed as litigation expenses.

2.             In reply filed by OP number 1 and 2,  legal objections are taken up on the grounds that present complaint is not maintainable, that the complainant has filed the present complaint by concealing the true and material facts, that the complainant has unnecessarily dragged the OPs into uncalled litigation, that the complainant has got no locus standi to file the present complaint and that the complainant has not come to this Commission with clean hands. On merits, it is admitted that the complainant lodged the claim with the OPs and the OPs demanded several documents from the complainant and sent letters to the complainant, but despite receipt of said letters, the complainant failed to submit the post-mortem report of her deceased husband, as such the OPs repudiated the claim of the complainant vide their office letter dated 18.3.2019 as per terms and conditions of the policy. The other allegations levelled in the complaint have been denied in toto. Lastly, OPs number 1 and 2 have prayed that the complaint is liable to be dismissed.

3.             Record shows that vide order dated 12.11.2021, it was observed that OPs number 3 and 4 are not interested to submit their written response as such their defence was struck off.

4.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-12 copies of documents and affidavit and closed evidence. On the other hand, the learned counsel for OPs number 1 and 2 has produced Ex.OP1&2/1 to Ex.OP1&2/4 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.             At the outset, it is an admitted fact between the complainant and OP number 1 and 2 that  husband of complainant, Shri Ramdia Singh was insured with the OPs number 1 and 2 for Rs.5,00,000/- in case of accidental death. It is also not in dispute that Shri Ramdia Singh died on 06.11.2017, as is evident from the copy of death certificate, which is on record as Ex.C-4,  DDR number 16 dated 17.10.2017 regarding the death of the insured was also recorded, a copy of which on record is Ex.C-3 wherein it has been clearly mentioned that Shri Ramdia Singh died due to accident which took place on 16.10.2017 when he alongwith his  nephew Sajjan Kumar were going on the tractor and the tractor in question fell in the Bhakhra river and due to this his grand son Harbilas and servant Mukesh Kumar drown in the Bhakhra river.  Ex.C-4 is the copy of death certificate of Ramdia Singh, Ex.C-5 is the copy of prescription slip of CMC Delhi Road, Hisar, wherein it has been mentioned that patient Ramdia Singh was admitted on 01.11.2017 and expired on 06.11.2017. Ex.C-7 is the copy of DDR number 15 dated 18.10.2017. Ex.C-12 is the certificate issued by Gram Panchayat Karoda, Tehsil Moonak wherein it has been mentioned that Ramdia Singh died due to accident and all this is supported by the affidavit of complainant Ex.C-1.  On the other hand, the stand of the OPs number 1 and 2 is that the complainant did not submit the post mortem report despite calling the same vide letter dated 18.3.2019 Ex.OP1&2/3, which is very much necessary for the settlement of the claim.   The disputed fact is only that the OP number 1 and 2 objected that the complainant has not produced on record the copy of post-mortem report, which is very much necessary for just decision of the case.  It is no doubt true that the complainant has not produced any post-mortem report on record, but we may mention that the complainant has produced sufficient evidence i.e. report of doctor where the deceased Ramdia Singh was immediately admitted in the hospital after the accident. This report cannot be ignored which is very much helpful to the case of the complainant.  Reliance can be placed on the judgment pronounced by the Hon’ble Punjab State Commission in Manager, Health Administrator Team, Bajaj Allianz General Insurance Co. Ltd. versus Ravinder Kaur 2010(3) CLT 509 (Punjab State Commission), wherein it was held that police report and post-mortem report are not essential documents in themselves, when the death by accident or by inhaling of insecticides is clearly proved by other means the repudiation of insurance claim cannot be sustained. Death of assured held to be accidental death.  Similarly, the Punjab State Commission in Darbara Singh and others versus The Taprian Amar Singh Cooperative Agriculture Services Society Limited another 2013(4) CLT 192, wherein it has been held that merely non producing of the post-mortem report itself is not sufficient to throw away the case of the appellants. The post-mortem could have been conducted, had the deceased died in the hospital, but in the absence of that, there is nothing to suggest that the deceased has not met with an accident or not died due to injuries received in the accident. Respondent No.3 repudiated the claim, just on the ground of non production of the post-mortem report, which has nothing to do with the death and the cause of death was very clear from the other documents produced.  As such, we find that in the present case, the complainant has sufficient proved her case by producing cogent, reliable and trustworthy evidence to show the accidental death of Shri Ramdia Singh. More over, the Ops have not produced any evidence to the contrary. As such, we are of the considered opinion that the deficiency in service on the part of the OPs number 1 and 2 is writ large, as the OPs number 1 and 2 have wrongly and wilfully repudiated the rightful claim of the complainant.

7.             In view of our above discussion, we allow the complaint and direct OPs number 1 and 2 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. 04.07.2019 till realisation in full. We further direct them to pay to the complainant an amount of Rs.5000/- in lieu of compensation for mental tension, agony and harassment as well as an amount of Rs.5000/- on account of  litigation expenses. This order shall be complied with by OPs number 1 and 2 within a period of sixty days of receipt of copy of this order.

 

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

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

                        Pronounced.

                        March 14, 2024.

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