Punjab

Sangrur

CC/213/2018

Shinder Kaur - Complainant(s)

Versus

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

Sh.Lovepreet Walia

05 Dec 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                               

               

                                                Complaint No.    213

                                                Instituted on:      01.05.2018

                                                Decided on:       05.12.2018

 

 

Shinder Kaur wife of Late Sh. Karamjit Singh, resident of Village Tolawal, Tehsil Sunam, District Sangrur.

                                                        …Complainant

                                Versus

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

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

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

                                                        …Opposite parties

 

For the complainant    :               Shri Lovepreet Walia, Adv.

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

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

 

 

Quorum:    Inderjeet Kaur, Presiding Member

                Vinod Kumar Gulati, Member

 

Order by : Inderjeet Kaur/Vinod Kumar Gulati, Members.

1.             Smt. Shinder 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 the husband of the complainant, Shri Karamjit Singh was the member of Bhagat Puran Singh Sehat Bima Yojna and under that scheme, Shri Karamjit Singh was insured for medical reimbursement for an amount of Rs.50,000/- for medical treatment and further was insured for Rs.5,00,000/- on account of accidental death of the card holder and the said Karamjit Singh was issued card bearing number 9305-3000-1650-3986-6 and except that no terms and conditions of the policy were issued by the OP number 1.

 

2.             Further case of the complainant is that on 07.12.2017, the husband of the complainant, namely, Karamjit Singh died accidentally while doing labour work within the jurisdiction of P.S. Cheema, District Sangrur. Thereafter on the statement of Gurpreet Singh, DDR number 3 dated 7.12.2017 was lodged at P.S. Cheema and post-mortem on the dead body of the deceased was conducted at Civil Hospital, Sunam.  Further case of the complainant is that the complainant being the nominee and beneficiary lodged online claim with the OPs on their customer care number 104 and assured that surveyor will visit to the complainant.  On 20.2.2018, the surveyor of the OP number 1 visited the house of the complainant and took all relevant documents from the complainant for the settlement of the claim, but till date the OPs failed to release the payment despite serving a legal notice dated 31.3.2018 upon the OPs. 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 and litigation expenses.

 

3.             In reply filed by OP number 1, it is stated that on the request of OP number 2, OP number 1 issued a policy namely Bhagat Puran Singh Sehat Bima Yojana in its favour which was for the benefit of blue card holders, farmers, traders and construction workers.  It is stated further that after receipt of intimation regarding death of Karamjit Singh, OP number 1 appointed Sh. Nirmal Singh investigator for investigation, who visited personally and investigated the matter in question and submitted his report dated 24.1.2018.  After examining the entire file carefully, the OP number 1 sent a letter dated 27.2.2018 to the complainant to provide death certificate in original with government logo and IFSC code of State Bank of India within 10 days of receipt of the letter, otherwise the OPs will close the file as ‘no claim’, when no response was received from the complainant, OP  number 1 closed the file. The other allegations levelled in the complaint have been denied in toto.

 

4.             In reply filed by OPs number 2 and 3, legal objections are taken up on the grounds that the complaint is not maintainable, that the complainant has no locus standi and cause of action to file the complaint, that the complainant has not come to the Forum with clean hands and has suppressed the material facts and this Forum has got no jurisdiction to hear and decide the present complaint. On merits, it is admitted that the card in question was issued to the husband of the complainant under the scheme and the card was active and the deceased was insured under the policy which was valid for the period from 1.11.2016 to 31.10.2017.  It is also admitted that the deceased was insured for Rs.5,00,000/- being the head of the family, but the other allegations levelled in the complaint have been denied.

 

5.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-16 copies of documents and affidavit and closed evidence. On the other hand, the learned counsel for OP number 1 has produced OP1/1 to Ex.OP1/4 copies of documents and affidavit and closed evidence.  The learned counsel for OP number 2 and 3 has produced documents Ex.OP2&3/1 to Ex.OP2&3/4 and closed evidence.

 

6.             We have carefully perused the complaint, version of the opposite parties and heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.

 

 

7.             It is admitted fact that the husband of the complainant was the member of the Bhagat Puran Singh Sehat Bhima Yojna, which was run by PHSC and the card was issued to the husband of the complainant and under this scheme, medical reimbursement of Rs.50,000/- was entitled for and Rs.5,00,000/- on account of accidental death of the card holder.  The husband of the complainant died on 7.12.2017 in accident and DDR number 3 dated 7.12.2017 was lodged at PS Cheema and the post-mortem on the dead body of the husband of the complainant was conducted at Civil Hospital, Sunam.  The complainant being the nominee and the beneficiary lodged online claim with the OPs and the OP number 1 appointed surveyor and on 20.2.2018 visited the house of the complainant and to call the relevant record for the settlement of the claim.  Further OP number 1 repudiated the claim of the complainant on the ground that she did not submit the death certificate in original with Govt. logo and IFSC code of SBI within ten days of the receipt of the letter dated 27.2.2018. On the perusal of the record submitted by OP number 1, it has been observed that OP number 1 could not place on record any document showing they had sent the letter dated 27.2.2018 to the complainant to furnish the above said documents. Also the legal notice sent by the complainant was not replied though the complainant has submitted enough proof of sending the legal notice to the OPs.  Also the OP 1 did not place on record the copy of the  report submitted by the surveyor to show that the above two number documents have not been submitted by the complainant during his visit.  It is pertinent to mention here that the death certificate of the deceased was issued by the competent authority on 29.12.2017 and the bank account of the complainant was being operated by her since 11.6.2013. We failed to understand the contention of the OP number 1 for not supplying the above said two number documents despite its possession by the complainant before the visit of the surveyor and demanded by OP number 1 vide letter dated 27.2.2018. Keeping above in view, the claim repudiated by OP number 1 on the above grounds is not justified.

 

 

8.             As such, the complaint of the complainant is allowed and the OP number 1 is directed to pay to the complainant an amount of Rs.5,00,000/- along with interest @ 9% per annum from the date of filing of the present complaint till realisation.  OP number 1 is also directed to pay to the complainant an amount of Rs.5000/- on account of compensation and an amount of Rs.5000/- on account of litigation expenses. This order of ours be complied with within a period of thirty days from the date of receipt of copy of this order. A copy of this order be issued to the parties free of cost. File be consigned to records.

 

9.              A copy of this order be issued to the parties free of cost. File be consigned to records.

                                Pronounced.                             

                                December 5, 2018.

 

 

                                                            (Inderjeet Kaur)

                                                          Presiding   Member

 

 

                                                        (Vinod Kumar Gulati)

                                                                     Member