Punjab

Sangrur

CC/312/2018

Gurmail Kaur - Complainant(s)

Versus

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

Sh.Sandip Kumar Goyal

01 Feb 2021

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR                                              

               

                                                Complaint No.    312

                                                Instituted on:      20.07.2018

                                                Decided on:       01.02.2021

 

Gurmail Kaur w/o Late Kaka Singh S/o Bhana Singh, resident of Village Hambalwas Jakhepal, Tehsil Sunam, District Sangrur.

                                                        …Complainant

                                Versus

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

2.             State of Punjab through Deputy Commissioner, Sangrur.

3.             Punjab Health System 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 G.S.Sibia, Adv.

For OP NO.2&3         :               Shri N.S.Sahni, Adv.

 

Quorum:    Shri Jasjit Singh Bhinder, President

                Shri V.K.Gulati, Member

Order by : Shri Jasjit Singh Bhinder, President.

 

1.             Smt. Gurmail Kaur, complainant  has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that husband of the complainant i.e. Kaka Singh was issued a health card by the Govt. of Punjab under Bhagat Puran Singh Sehat Bima Yojna having smart card number 03053000008039861  and under the card benefit of Rs.5,00,000/- was available in  case of accidental death of family head.  Further case of the complainant is that on 29.03.2018 the husband of the complainant namely Kaka Singh died due to hit of unknown vehicle while he was returning from Mansa to his village which is near village Dhaipi. The complainant is the legal heir as well as the nominee of Kaka Singh deceased.  After the death of Kaka Singh, complainant being the legal heir of  Kaka Singh called at the toll free number regarding the death.  After that the employees of the insurance company came to and gave the claim form to the complainant.  Further after that the complainant filled the claim form and submitted the copy of police report, copy of voter card, copy of death certificate and other necessary documents to the Ops.  The grievance of the complainant is that the Ops neither allowed the claim nor repudiated the claim.  As such, 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 from the date of death till its actual payment and further claimed compensation and litigation expenses.

2.             In reply filed by the OP number 1, preliminary objections are taken up on the grounds that the present complaint is not maintainable , that the present complaint is premature as the complainant has not submitted all the relevant documents with the Ops, so without the documents it is not possible to settle the claim, that the complainant is not the consumer of the OP, that the complainant has got no locus standi to file the present complaint and the complainant has not come to the Court with clean hands.  On merits, it is stated that the OP demanded several documents from the complainant i.e. report under section 174 of Cr.P.C. and post-mortem report from the complainant for the settlement of the claim but the complainant failed to provide the same to the OP and further it is averred that the claim could not be settled due to non providing of the relevant documents.  It is stated further that the complainant is not entitled to get any relief from this Forum, as such the OP has prayed for dismissal of the complaint with special costs.

3.             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 got no cause of action, that the complainant has not come to the Forum with clean hands and that this Forum has got no jurisdiction to hear and try the present complaint.  On merits, it is admitted that health card in question was issued to the husband of the complainant under the said scheme by Govt. of Punjab i.e. Bhagat Puran Singh Sehat Bima Yojna. The above said card was active when the alleged accident was happened.  As per record of state Nodal Agency, Kala Singh was insured vide policy number 11210048161800000106 issued by United India Insurance Co. ltd. which was valid from 1.11.2016 to 31.10.2017. It is stated further that as per this policy death in personal accident of any insured was covered for Rs.5,00,000/- to the head of the family if insured died in an accident.    Lastly, the Ops have prayed for dismissal of the complaint with special costs.

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

5.             We have perused the complaint, version of the opposite parties and heard the arguments of the learned counsel for the parties.

6.             The learned counsel for the complainant has argued that husband of the complainant, namely, Kaka Singh son of Bhana Singh was issued a health card by the Govt. of Punjab under Bhagat Puran Singh Sehat Bima Yojna having smart card number 03053000008039861  and under the card benefit of Rs.5,00,000/- was available in  case of accidental death of family head. The learned counsel for the complainant further argued that on the intervening night of 29.03.2018 at about 7.30/8.00 PM, the husband of the complainant, namely, Kaka Singh died due to hit of unknown vehicle while he was returning from Mansa to his village which is near village Dhaipi. The learned counsel for the complainant has  further argued that the complainant is the legal heir as well as the nominee of Kaka Singh deceased. Further the learned counsel for the complainant has argued that the OP has dishonestly repudiation the rightful claim of the complainant. The learned counsel for the complainant has cited Manager, Health Administration Team, Bajaj Allianz General Insurance Co. Limited versus Ravinder Kaur and others 2010(3) CLT 509 (Punjab State Commission): Insurance claim-personal accident cover- Accident. Accused while spraying insecticides in his sugarcane fields inhaled insecticides and died. Claim repudiated on the ground that the police report and post-mortem report not produced which could prove that death of assured has taken place by accident. Held that, these were not essential documents in themselves, the non-production of which leads to automatic repudiation of insurance claim. If 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-  Appeal liable to be dismissed. Order directing appellants to pay insurance claim of Rs.50,000/- with interest upheld. The learned counsel for the complainant also cited Darbara Singh and others versus The Taprian Amar Singh Cooperative Agriculture Services Society Limited another 2013(4) CLT 192 (Punjab State Commission) Consumer Protection Act,1986 Section 2(1)(g) Insurance claim. Repudiation -Respondents have not rebutted or brought forth any evidence on record to prove that deceased did not receive injuries in the accident or the death certificate produced is fabricated. 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. Order passed by the District Forum is against the evidence on the file and is not sustainable.  Respondent no.3 is directed to pay Rs.1,00,000/- along with interest @ 7.5% per annum to the appellants from the date of filing of the complaint till realisation Rs.10,000/- are awarded as litigation expenses in favour of the appellants.

 

7.             On the other hand, the learned counsel for the OPs has argued that the date of death of the deceased is not clear whether he died on 28.3.2018 or 29.03.2018.  The learned counsel for the Ops further argued that the complainant has not produced any post-mortem report on the record.  The learned counsel for the Ops further argued that there is contradiction between the date of death and the date of accident and as such has prayed for dismissal of the complaint.

8.             To prove the case, the complainant has produced her own affidavit Ex.C-1 and has deposed as per the complaint.  Ex.C-2 is the statement of Gurmail Kaur wherein she has deposed that the deceased Kaka Singh has died an accidental death, Ex.C-3 is the  copy of card, Ex.C-4 is the copy of DDR which was recorded on 29.3.2018 at 2.00 AM and DDR number is 18, wherein it is mentioned that at about 4.00 PM police party went to Bathinda Hospital where Kaka Singh was admitted and he injured in the accident and died.  Death certificate of Kaka Singh is Ex.C-5 and he died on 29.3.2018.  Ex.C-6 is the prescription slip of Rajan Hospital Bathinda where he was put on ventilator.  Ex.C-7 is the report of Pioneer Imaging and Diagnosis showing that :

-Fracture petrous part of right temporal bone with bleed in right mastoid air cells.

-Fracture squamous part of right temporal bone with cover lying soft tissue swelling.

-SAH seen in bilateral sylvain fissure, bilateral temporal frontal and parietal sulci.

-Multiple hemorrhagic contusions seen in bilateral temporal lobe largest measuring 14x13 mm in size.

-This SDH seen in left temporal convexity.

-Effacement of the basal cisterns, bilateral sylvain fissure and bilateral cortical sulci s/o significant diffuse brain edema.

 -Bleed in posterior IHF and over tentorium on right side.

-Rest of the brain parenchyma appears normal

-Ventricular system appears normal

-Brain stem & Cerebellum unremarkable.

 

Ex.C-8 is also report of  Pioneer Imaging and Diagnosis regarding the injuries of Kaka Singh showing that:

 

-Fracture of 2^nd to 9^th ribs on right side.

-Fracture of right clavicle bone.

-Evidence of mild hemothorax on right side.

-Evidence of mild pneumothorax on right side.

-Small lung contusion seen on right side

-Trachea, carina, main and lobar bronchi: are normal in position, calibre and wall thickness. There is no obvious intraluminal mass lesion.

-No mediastinal lymphadenopathy noted.

-Mediastinal vascular structures are normal.

 

 

9.             So it is clear from the above said reports that Kaka Singh died due to serious accidental injuries.  Ex.C-9 and Ex.C-10 are the copies of report and Ex.C-11 is the copy of Aadhar card of the complainant. Ex.C-12 is the copy of passbook of the complainant.

 

10.            On behalf of the OP number 1, Ex.OP1/1 affidavit of Shri Harmeet Singh Chahal, Senior Divisional Manager has been filed  wherein he has stated that the complainant failed to produce the post-mortem report, as such the claim could not be settled.  In affidavit, this witness has not challenged the date of death of the deceased Kaka Singh.  Ex.OP1/2 is the copy of letter written to the complainant to produce the copy of post-mortem report. Ex.OP1/3 is the document  of policy.  Dr. Parminder Kaur, District  Medical Commission, Civil Hospital, Sangrur has tendered affidavit Ex.OP2&3/1 and stated that health card number 03053000008039861 was issued to the husband of the complainant  under the scheme of Govt. of Punjab under Bhagat Puran Singh Sehat Bima Yojna. The above said card was active, when the alleged accident occurred.  She has further stated that as per this policy death in personal accident of any insured  is covered for Rs.5,00,000/- to the head of the family if insured died in accident.  The Ops have also produced Ex.OP2&3/2 in which the Ops number 2 & 3 have mentioned about the accident.

11.            The main dispute in this case was that the post-mortem report of deceased Kaka Singh is not on the file and post-mortem was not conducted. In the case Manager, Health Administration Team, Bajaj Allianz General Insurance Co. Limited versus Ravinder Kaur (Supra) , the Hon’ble Punjab State Commission has held that where death is proved and post-mortem report was not produced, post-mortem report is not a necessary document and claim has been allowed. Similarly, same facts were also found in Darbara Singh and others versus  The Taprian Amar Singh Cooperative Society Limited and another (supra), wherein post-mortem was not conducted but the claim was allowed.  So there are concurrent judgments of the Hon’ble Punjab State Commission that post-mortem report is not necessary to pay the claim.  Death in this case by accident is proved beyond any reasonable doubts.  DDR Ex.C-4, referral certificate of Rajan Hospital Ex.C-6, diagnostic reports Ex.C-7 and Ex.C-8 are on the file, which shows that there were serious injuries on the body of Kaka Singh and Kaka Singh died an accidental death. 

12.            The learned counsel for the OP number 1 pointed out that there are discrepancies regarding the date of death whether death of Kaka Singh occurred on 28.3.2018 or 29.3.2018.  While the death in this case is proved, so such discrepancy in date has no effect on the case of the complainant.  Ops number 2 and 3 have admitted that Kaka Singh was insured and the beneficiary under the policy is entitled to get an amount of Rs.5,00,000/-.

 13.           So, in view of our above discussion, we allow the complaint and direct the OP number 1 to pay compensation of Rs.5,00,000/- to all the legal heirs of the complainant in equal share.  If some legal heir is minor then his share be kept in the bank in the shape of FDR till he attains the maturity.  OP number 1 shall also pay 6% interest on the above said amount from the date of filing of the complaint i.e. 20.7.2018 till realisation. However, 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.

                February 1 , 2021.

 

 

        (Vinod Kumar Gulati)      (Jasjit Singh Bhinder)

                 Member                            President