DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR                                              

                                                Complaint No.    30

                                                Instituted on:      25.01.2019

                                                Decided on:       05.04.2021

Satnam Singh son of Joginder Singh, resident of near Rao Dharamsala, Ward No.9, Moonak, Tehsil Moonak, District Sangrur.

                                                        …Complainant

                                Versus

1.             United India Insurance Company Ltd. Registered and Head Office, 24, Whites Road, Madras-600014 through its MD/GM.

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 complainant    :               Shri S.K.Goyal, Adv.

For OP No.1              :               Shri Bhushan Garg, Adv.

For OP NO.2&3         :               Shri Vinay Jindal, Adv.

Quorum:    Shri Jasjit Singh Bhinder, President

                Shri V.K.Gulati, Member

Order by : Shri Jasjit Singh Bhinder, President.

FACTS

1.             Shri Satnam Singh, complainant  has preferred the present complaint against the opposite parties  on the ground that mother of the complainant i.e. Balbir Kaur wife of Joginder Singh was issued a health card by OP number 2 under Bhagat Puran Singh Sehat Bima Yojna having number 03053000650800279 and under this card accidental benefit of Rs.5,00,000/- was available in case of accidental death.  Further case of the complainant is that on 18.9.2018 at about 5.15 AM unfortunately Balbir Kaur died due to hit of train while going to Chhajli from Jakhal to sell the toys.  Further the complainant is legal heir as well as nominee of Balbir Kaur and after the death of Balbir Kaur, the  complainant being her legal heir intimated the OP and thereafter filled the claim form and supplied all the documents for settlement of the claim.  The complainant also sent legal notice dated 26.12.2018 to the OP for paying the claim amount of Rs.5,00,000/- but nothing was paid. 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 an amount of Rs.5,00,000/- along with interest and further claimed compensation and litigation expenses.

WRITTEN VERSION

2.             In reply filed by the OP number 1, legal objections are taken up on the grounds that the present complaint is pre mature and the claim is still pending as the complainant has not submitted the documents such as FIR, PMR etc, that the complainant has no cause of action, that there is no deficiency in service, that the complainant has filed this false, baseless complaint and should be dismissed with special costs.  On merits, it is admitted that under the scheme the State Govt. paid all the premiums to the OP, but the complainant has not paid any amount to  the OP.  It is stated further that as per the terms and conditions of the policy, all the documents required in the event of claim are required to be submitted within 180 days after the date of accident, but the complainant failed to provide the same,  so the complaint is premature and the same is liable to be dismissed. 

3.             No reply has been filed by Ops number 2 and 3 and their right to file written version was struck off vide order dated 6.9.2019.

EVIDENCE AND FINDINGS

4.             The learned counsel for the parties produced their respective evidence.

5.             The learned counsel for the complainant has argued that Balbir Kaur wife of Joginder Singh was issued a health card by OP number 2 under Bhagat Puran Singh Sehat Bima Yojna. The learned counsel for the complainant has further argued that on 18.9.2018 at about 5.15 AM unfortunately Balbir Kaur died due to hit of train while going to Chhajli from Jakhal to sell the toys.  The learned counsel for the complainant has further argued that the complainant is the nominee and legal heir of Balbir Kaur, but despite that the insurance claim has not been paid. As such, the complainant has prayed that the complaint be allowed.

6.             On the other hand, the learned counsel for the Op has argued that the Op number 1 never repudiated the claim of the complainant and the claim is still pending and has prayed that the complaint be dismissed.

7.             To prove this case, Satnam Singh complainant has tendered affidavit Ex.C-1 and has deposed as per the complaint. Ex.C-2 is  legal notice sent to the opposite parties, Ex.C-3 is the postal receipt, Ex.C-4 is post-mortem report, Ex.C-5 is card of Bhagat Puran Singh Sehat Bima Yojna, Ex.C-6 is application written to the police, Ex.C-7 is copy of death certificate. Ex.C-8 is aadhar card of satnam and Ex.C-9 is aadhar card of Balbir Kaur.

8.             On the other hand on behalf of the OP number 1 Smt. Hemlata Panwar, Deputy Manager has filed affidavit Ex.OP1/1 and has deposed as per the written version, Ex.OP1/2 is the agreement, Ex.Op1/3 is the repudiation letter sent to the complainant.

9.             In the present case, as per the complainant’s version Smt. Balbir Kaur was insured with the OP number 1 vide card Ex.C-5.  Smt. Balbir Kaur died on 18.09.2018 at 5.15 AM and the post-mortem report is also on the file.  So, it is clear that Smt. Balbir Kaur died  on 18.9.2018 about two and half years ago.  The OP i.e. the insurance company has tendered written arguments and has stated that the complaint is premature and the OP has never repudiated the claim and the claim is still pending. The Op has further submitted that the complainant has not submitted the required documents.  All the documents have been placed on the file by the  complainant and this complaint was filed on 25.01.2019.  The insurance company could have easily taken the documents and the OP had to settle the claim or to repudiate the same.  In the written arguments, it is stated in para number 3 that Punjab Govt. launched Bhagat Puran Singh Sehat Bima Yojna and in case of accidental death, the claim of Rs.5 Lakhs would be paid to the dependents and the State Govt. has paid the entire premium to the insurance company. So, it is clear that this complaint is not premature as the insurance company is sitting on this file for the last two and half years.  Since Balbir Kaur was issued the health card under  Bhagat Puran Singh Sehat Bima Yojna, as such she was insured for Rs.5,00,000/- in case of accidental death.  Smt. Balbir Kaur died an accidental death on 18.09.2018 and Ex.C-6 post mortem report is also on the file.  Shri Satnam Singh complainant has filed this complaint stating that he is the legal heir and nominee of Balbir Kaur, but the complainant has not mentioned entire legal heirs. As such, the complainant shall submit the list of all the living legal heirs to the OP number 1.

10.            So, in view of our above discussion, we allow the complaint and direct OP number 1 to pay an amount of Rs.5,00,000/- along with interest @ 6% per annum from the date of filing of the present complaint i.e. 25.01.2019 till realisation to the legal heirs of the complainant in equal share.  If any legal heir is minor then the amount shall be kept in the shape of FDR till he/she attains majority.  We further direct OP number 1 to pay to the complainant an amount of Rs.5,000/- on account of compensation for mental tension, agony and harassment and further an amount of Rs.5,000/- on account of litigation expenses. This order be complied with within a period of sixty days of its communication. A copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                April 5, 2021.

        (Vinod Kumar Gulati)      (Jasjit Singh Bhinder)

                 Member                            President