Santosh Kumari widow of late Subash Chander Saini(mother of deceased Sarabjit Singh Saini), resident of H.No.1353, Street no.8, Behind Merodo Colony, near G.N.E. College, Ludhiana.

…..Complainant.

Versus

1- Standard Chartered Bank India Bank Card Centre, 3rd Floor & 4th Floor, Raheja Point, Magarath Road, Bangalore-560 h its Managing Director having its branch office at Ludhiana.

2- Standard Chartered Bank, Feroze Gandhi Market, Ludhiana through its Manager.

3- The Oriental Insurance Company Limited, Divisional Office No.4, 2nd Floor, Anand Bhawan, S.C. Road, Jaipur-302001(Rajasthan) through its Divisional Manager having its Regional Office at Chandigarh.

4- The Oriental Insurance Company Limited, Regional Office, Sector-17, Chandigarh through its Regional Manager. ….Opposite parties.

O R D E R

1- Sh. Sarabjit Singh son of the complainant, was holder of credit card no.5543 7470 8056 1508 issued by Standard Chartered Bank, opposite parties no.1 & 2. By virtue of the holder of credit card, son of the complainant was got covered by opposite parties no.1 & 2 against personal accident policy, obtained by opposite parties no.1 & 2 from insurance company opposite parties no.3 & 4. Sh. Sarabjit Singh expired on 14.6.2005 due to rail accident and death was communicated to opposite party vide letter dated 9.7.2005, supported with necessary documents including death certificate, credit card statement, post mortem report, certificate issued by the railway police, death certificate issued by Municipal Corporation, Ludhiana. Complainant requested for settlement of insurance claim which was registered by opposite parties no.3 & 4 as case no.95097. As per requirement of opposite parties no.3 & 4, claim form was duly filled by the complainant and also signed discharge voucher which were given to opposite party vide letter dated 8.8.2005. After making necessary verification through investigator Sh. Rakesh Sharma, complainant again supplied necessary documents to opposite party and also furnished affidavit, indemnity bond, surety bond, consent of all legal heirs to opposite parties no.3 & 4. But despite it, opposite party failed to settle the claim.

Further claimed that deceased Sarabjit Singh was also holder of credit card of HSBC bank, with whom death claim was lodged and insurance company of HSBC bank, had settled the claim for a sum of Rs.1,50,000/- as per terms of credit card. But opposite party have not settled the claim. So, such act on part of opposite parties claimed amounting to deficiency in service. Hence, claimed in this complaint under section 12 of the Consumer Protection Act, 1986, that entitled for insurance amount under the policy alongwith compensation and costs.

2- Opposite parties no.1 & 2 in their reply, have admitted obtaining of credit card by son of the complainant and that by virtue of holder of credit card, was insured against personal accident policy. On receipt of death claim, the complainant was intimated vide letter dated 2.8.2005, to contact Oriental Insurance Company Limited, with regard to her claim. Because the claim was not to be settled by the bank. Complainant was also intimated that her claim was pending with Insurance Company, for want of documents which she failed to make available to opposite parties no.3 & 4, despite their repeated letters. They have prayed for dismissal of the complaint.

3- Opposite parties no.3 & 4 Insurance Company in reply, have admitted that claim was lodged by the complainant at Jaipur. It was processed at Jaipur and the claim was repudiated by Oriental Insurance Company Ltd. Jaipur, vide letter dated 19.12.2006. So, claimed that this Fora has no jurisdiction, to decide the complaint. Further pleaded that immediately on receipt of claim, complainant was called vide letters dated 3.2.2006, 13.3.2006, 11.8.2006 and 22.11.2006, to furnish documents detailed in letter dated 3.2.2006, which were required to process the claim.

But complainant failed to supply the documents and as such, claim file due to non cooperation by the complainant, was closed as “no claim”, vide letter dated 19.12.2006. So, there is no deficiency in service on their part. Further claimed that complainant is estopped by own act and conduct to file the complaint, as she failed to furnish the requisite documents. Further averred that if claim is admissible, then liability of the company would be restricted to Rs.50,000/- only.

They further took plea that on receipt of the claim, Sh. Rakesh Sharma was appointed investigator, to investigate the claim and he had submitted his report dated 8.8.2005. It was reported that the death of the insured occurred due to his own gross negligence, while crossing unmanned railway track as pedestrian. So, complaint is not maintainable. They have admitted that the deceased was a credit card holder from opposite parties no.1 & 2 and was covered under personal accident policy issued by opposite party no.3.

4- To prove their respective cases, parties adduced evidence by way of affidavits and documents.

5- We have heard ld. counsel for the parties and have also scanned the documents and other material placed on file carefully.

6- Undoubtedly, son of the complainant was holder of Standard Chartered Classic Card (Ex.C1) from opposite parties no.1 & 2. Being holder of credit card, son of the complainant, automatically got accident insurance covered under insurance policy Ex.R18, in view of the arrangement between opposite parties no.1 & 2 with Oriental Insurance Company Ltd., opposite parties no.3 & 4. Be it stated that death of son of the complainant, being credit card holder of opposite parties no.1 & 2, in a railway accident, is established. But proved from report Ex.R33 of Sh. Rakesh Sharma investigator qua which he has filed his affidavit Ex.RW2/A that son of the complainant, while crossing unmanned railway track, met with an accident. Ex.R38 police report, English translation of which is Ex.R39, also proves that Sh. Sarabjit Singh died while crossing railway line KM No.4/7-8, Ludhiana. Death of Sh. Sarabjit Singh in that accident, is fortified from postmortem report Ex.R40.

7- So, it is established in this complaint that Sh. Sarabjit Singh, being holder of credit card from the bank opposite party no.1 & 2, was automatically covered under accidental insurance issued by opposite parties no.3 & 4, vide policy Ex.R18. Now question is whether opposite parties no.3 & 4 were justified in closing the file, due to non cooperation by the complainant and not furnishing desired documents as sought by them.

8- Opposite parties no.3 & 4 closed the claim of the complainant under letter dated 19.12.2006, copy of which is Ex.R19. But this letter is addressed to one Ms Sarla Arora of New Delhi, qua her claim no.96097, pertaining to death of Sh. Sarabjit Singh Saini. The claim in the accident case, was never lodged by Ms Sarla Arora of New Delhi, regarding accidental death of Sh. Sarabjit Singh Saini.

But it was lodged by his mother Smt. Santosh Kumari, complainant. If the claim was filed as “no claim”, under letter Ex.R19, dispatched to Ms Sarla Arora by opposite parties no.3 & 4, under dispatch entry Ex.R22, it would be of no consequence qua claim of the complainant. Because such communication was not addressed and delivered to the complainant, but to one Ms Sarla Arora of New Delhi. Whereas, complainant Smt. Santosh Kumari is resident of Ludhiana. In these circumstances, we have no hesitation, to rely on affidavit Ex.CW1/A of the complainant that despite meeting all requirements of opposite parties, furnishing all desired documents, the claim till now, has not been settled. Opposite party filed claim of somebody else, as “no claim” and not of the complainant, nor have intimated her qua closing her claim.

9- Complainant has placed on record, application dated 9.7.2005, given to insurance company qua death of her son Sh. Sarabjit Singh and furnished them with statement of accounts of the master card (Ex.C4) alongwith post mortem report Ex.C5. Insurance Company vide communication Ex.C8 dated 18.7.2005, acknowledged receipt of claim, assuring the complainant, to settle the same at the earliest. Complainant vide communication Ex.C9 through registered letter, made available to the insurance company, claim form, discharge voucher alongwith death certificate, police report, post mortem report etc.(Copies of which are Ex.C10 and Ex.C11). Again vide letter Ex.C12 dated 4.10.2005, she made available death certificate translated to vernacular language alongwith original account statements of Standard Chartered Bank to the Insurance Company (Ex.C13 to Ex.C15).

10- Thereafter, Sh. Rakesh Sharma investigator engaged by the insurance company, vide communication Ex.C16 dated 27.7.2005, required complainant, to provide certain documents to him and regarding it, reminder Ex.C17 dated 11.11.2007 was sent by the Insurance Company to the complainant. Complainant vide communication dated 20.12.2005 Ex.C8, made available affidavit, indemnity bond, surety bond, consent letter (Ex.C19 to Ex.C22).

11- Next allegations of the complainant that accident claim of the use of the card of HSBC Bank, was settled by the National Insurance Company Ltd., is authenticated from communication Ex.C24 dated 29.11.2005, copy of cheque Ex.C25 dated, letter Ex.C26 and cheque Ex.C27. So, it means such plea of the complainant is correct that claim of accidental death of her son, was settled by insurance company of HSBC Bank, but not by opposite parties no.3 & 4.Then, she served legal notice Ex.C28 dated 20.2.2006 to all the opposite parties, which was replied by insurance company vide reply Ex.C29 dated 24.2.2006. Vide that reply, they sought succession certificate and vide communication Ex.C30, demanded certain documents. Standard Chartered Bank answered the notice vide reply Ex.C31 dated 202.3.2006, refuting the claim.

12- It is in backdrop of aforesaid material, to be seen whether information or documents, as sought by opposite party from the complainant, were made available to them or not. In this behalf, most relevant document is Ex.R33 report of investigator engaged by insurance company.

In that report, the investigator never alleged that complainant failed to cooperate in the investigation and did not make available the desired documents. Rather, he after giving entire case history of the claim, in last concluded para, reported that accidental death of insured in rail accident, is correct and fit to settle the claim as per subject to terms and conditions of the insurer. Therefore, stressing at this stage that documents as sought from the complainant by the insurance company vide letter Ex.R7, Ex.R8 and Ex.R10, were not made available, appears to be an excuse, to deny or delay the claim, because the documents mentioned therein, were already made available by the complainant, as discussed in earlier part of the order.

13- In these circumstances, we are of the clear view that opposite parties no.3 & 4 are certainly guilty of deficiency in service, by not settling insurance claim, as lodged by the complainant, on account of accidental death of her son. They have been deferring the matter on one pretext or the other and took false plea of filing it, due to non cooperation by the complainant, vide letter Ex.R19, which in fact, is addressed to somebody else and not the complainant. Under the insurance policy Ex.R18, opposite party was liable to pay for the accidental death of son of the complainant, but failed to settle the same.

14- Consequently, question is to what amount, complainant for accidental death of her son, would be entitled. Policy schedule appended with policy Ex.R18 goes to show that for accidental death of a pedestrian/motorcycle, as per operative clause of the policy, classic credit card holder, liability of the company would be Rs.50,000/-. Son of the complainant was holder of classic credit card. If the death occurred as pedestrian, then liability of the company would be restricted to Rs.50,000/-.

We have already referred earlier that as per report of the investigator and the police report, son of the complainant died while crossing railway line. It means he on foot, was crossing the railway line, when met with an accident and consequently, died. Therefore, liability of the insurance company under the policy would restrict to Rs.50,000/- only.

15- In view of aforesaid discussion, we allow this complaint and direct opposite parties no.3 & 4, to pay under policy Ex.R18, insurance amount of Rs.50,000/-(Rupees Fifty Thousand only) to the complainant with 9% interest from the date of complaint till payment. For causing harassment and not settling the claim despite submission of all documents and proof qua accidental death, opposite parties no.3 & 4 ordered to pay compensation of Rs.8000/- and litigation costs of Rs.2000/-.