Punjab

Sangrur

CC/356/2020

Sahida - 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. 356

 Instituted on:   12.10.2020

                                                                         Decided on:     22.10.2024

 

Sahida aged about 38 years wife of Late Dhanna, resident of Ram Nagar Basti, 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 Dhanna was the member of Bhagat Puran Singh Sehat Bima Yojna, against which the OPs issued card bearing number 0305-3000-6138-0027-3 under which a benefit of Rs.5,00,000/- was available in case of accidental death of card holder as per the scheme of the Ops.  Further case of complainant is  that on 06.10.2018 unfortunately said Dhanna died in an accidental death when he alongwith his father-in-law Siraj was going to Hareri Road from Barnala Kanchian by foot to purchase milk and at about 8.30 PM when they reached near Sant Attar Singh Dairy, Hareri Road, Sangrur, a motorcycle bearing registration number PB-13-AM-8979 which was coming from backside being driven by its driver with one pillion rider in a rash and negligent manner struck his motorcycle on the backside of the deceased, as a result of which, deceased and both the occupants of the motorcycle fell on the road. The deceased sustained head injuries and other injuries on his person and was immediately  taken to Civil Hospital, Sangrur, where the doctors of Civil Hospital Sangrur declared him brought dead. Accordingly, FIR number 81 dated 7.10.2018 under section 279/304-A was registered at P.S. City Sangrur against the driver of the motorcycle. Post-mortem on the dead body of the deceased was conducted at Civil Hospital, Sangrur.  Further case of complainant is that the complainant being the legal heir as well as nominee 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 signatures of the complainant on blank performa. Thereafter the complainant approached the OPs so many times to get the claim amount from the OP number 1,  but nothing was done.   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.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 well as on the helpline number 104 of the OP, as such visiting of the representative of the OP in the house of the complainant and getting signatures on the performa does not arise at all. It is stated that the complainant did not submit any document to the OP, as such the complaint is premature.  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 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-5 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.             It is an admitted fact between the complainant and OP number 1 that Late Dhanna was insured with the OP number 1  for Rs.5,00,000/- in case of accidental death. It is also not in dispute that Dhanna died on 06.10.2018 due to an accident, as is evident from the copy of FIR Number 0081 dated 07.10.2018 Ex.C-3, whereas Ex.C-4 is the copy of post-mortem report, wherein it has been clearly mentioned in the column of opinion as to the cause of death “In my opinion the cause of death in this case is Shock due to head injury i.e. injury to vital organ brain which is sufficient to cause death in ordinary course of nature. Ex.C-2 is the copy of card of Bhagat Puran Singh Sehat Bima Yojna of Shri Dhana. Ex.C-5 is  the copy of aadhar card of the complainant showing that she is the wife of Dhana deceased. All this evidence is duly supported by the affidavit of complainant Ex.C-1. On the other hand, the stand of the OP number 1 is that the complaint is premature as the complainant never lodged the claim with the OP number 1 or on its toll free  number 104.  But in the present case, the fact remains that the deceased Dhanna died an accidental death  as is evident from the copy of FIR Ex.C-3 and  copy of post-mortem report Ex.C-4. The complainant has sufficiently produced on record that the deceased Dhanna died an accidental death. Further, Dhanna was insured for Rs.5,00,000/- for an accidental death under Bhagat Puran Singh Sehat Bima Yojna and he died an accidental death. 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 never lodged the claim with the OPs and the complaint is premature is not at all tenable because the OP number 1 even did not choose to register the claim since the present complaint has already been filed on 12.10.2020 and the OP number 1 was waiting for getting the claim registered and all the relevant documents have been placed on the file by the complainant. The Opposite party No.1 could have easily taken the documents and settled the claim or to repudiate the same. Even the stand of the complainant is that the complainant has lodged the claim on toll free number 104 and submitted all the relevant documents to the representative of the OP. It is worth mentioning here that as per the documents Ex. Op.1/2 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.

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. 12.10.2020 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.

 

                        October 22, 2024.

 

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

                  Member               Member                   President