DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,

ROPAR

               Jagmail Singh S/o Karnail Singh R/o Village & PostOffice Jandi, Tehsil Jagraon, Ludhiana, Punjab.

                                                                                  …..Complainant

                                        Versus

1. The New India Assurance Company Limited, Regional Office, 4th Floor, Surya Tower, 108, The Mall, Ludhiana through its Regional Manager.
2. M/S Cosmic Power Engineers, 2nd floor, Ajay Gandhi Complex, Near Sarabha Nagar Pully Traffic Lights, Pakhowal Road, Green Field, Ludhiana through its Manager 

                                                                              ….Opposite Parties

Consumer Complaint under Section 12 of the Consumer Protection Act, 1986 (old)

QUORUM:

        Mr. S.K. Aggarwal, President

        Mr. Ramesh Kumar Gupta, Member

PRESENT:

        For the complainant : In Person

        For the OPs               : Sh. R. K. Chand Adv.

ORDER

This complaint has been filed by the complainant against the opposite parties (herein referred to as “OPs”) under Section 12 of the Consumer Protection Act, 1986 (old) with the averments that Sh. Ranbir Singh now deceased  was working with OP No.2 i.e. M/s Cosmic Power Engineers, 2nd Floor, Ajay Gandhi Complex, Near Sarabha Nagar, Pully Traffic Lights, Pakhowal Road, Green Field, Ludhiana. Complainant Jagmail Singh is the father of and legal heir of the deceased Sh. Ranbir Singh and Ranbir Singh has died unmarried. The complainant is fully dependent upon the income of deceased Ranbir Singh and OP No.2 had obtained Group Personal Accidental Insurance policy, for the benefits of its employees in order to cover the risk of 24 hours for a year including deceased Ranbir Singh from New India Assurance Co. Ltd., vide Policy No.36040042160100000067.  In the said policy deceased Ranbir Singh was insured for the sum of Rs.5,00,000/- for the period from 1.5.2016 to 30.4.2017. On 22.06.2016 Ranbir Singh was on his duty with OP No.2.  Ranbir Singh along with other employees of the company of OP No.2 had gone to Field Ganj, Shahpur Road on the order of AJE Pritpal Singh, While repairing electricity Ranbir Singh got electric shock which resulted into his accidental death on 22.06.2016. The complainants being the legal heirs of deceased Ranbir Singh had approached OP No.2 for compensation on account of death of Ranbir Singh, in Group Accidental Personal Accidental Policy. Then OP No.2 lodged the claim with OP No.1 with regard to Ranbir Singh after receipt of necessary documents from the complainants. Recently the complainants came to know that OP No.1 deputed some investigation officer to investigate the matter. The alleged report is prepared by said Investigation Officer at the instance of OP No.1 so that they cannot pay the claimed amount to the complainants. The alleged report is totally false and concocted one. Sh. Ranbir Singh had not violated any terms and conditions of the insurance policy. The complainants also came to know that OP No.2 has violated the terms and conditions of Agreement/Contract arrived at between OP No.2 with the PSPCL, so on the basis of that OP No.1 refused to settle the claim of the complainants on the recommendation of the said investigation report of the investigator. The post mortem of Sh. Ranbir Singh was conducted at Civil Hospital, Ludhiana and DDR was also lodged. The complainants many time requested the OPs to pay the insured amount but they failed to settle the claim of the complainants. Alleging deficiency in service on the part of the OPs filed the present complaint for issuance of following directions to them:-

1. To pay Rs.5,00,000/- along with interest @ 24% per annum from the date of accident till realization of the entire amount; 
2. To pay Rs.1,00,000/-, as compensation, on account of mental tension, harassment, pain and suffering; and   
3. To pay Rs. 22,000/-, as litigation charges to complainants.
2.      Upon notice, OP No.1 has appeared and took preliminary objections to the effect that this Commission has got no jurisdiction to try and decide the present complaint since there is no deficiency in service or negligence on the part of the answering OP as alleged. OP No.1 received intimation on 21.7.2016 regarding the death claim of Sh. Ranbir Singh and immediately on receipt of claim, it was duly entertained and registered. M/s Krish Associates, Investigators were deputed on 21.7.2016 for investigation of the case. M/s Krish Associates through its representatives duly investigated the matter, collected documents, recorded statements of the witnesses and they submitted their investigation report dated 05.1.2017 along with documents with the answering OP No.1. M/s Krish Associates also submitted addendum report dated 24.3.2017 with the answering OP.  After receipt of the investigation report along with documents and addendum report, the claim file was duly scrutinized by the officials of the answering OP and it was found that the claim of the complainants was not payable as per the terms and conditions of the policy and there was also violation of the terms and conditions of work order-cum-contract agreement dated 07.06.2016. The claim of the complainants was not payable and the same has been repudiated, vide letter dated 05.04.2017.  On merits, it is admitted that Sh. Ranbir Singh was working with OP No.2 i.e.  M/s Cosmic Power Engineers. It is submitted that investigator M/s Krish Associates thoroughly investigated the matter without bias to any of the parties and has rightly recommended for repudiation of the claim. It is further submitted that claim of the complainants is not payable on the grounds mentioned in para no.1 to 21 of the repudiation letter dated 05.04.2017.  Denying all other averments made against OP No.1 a prayer for dismissal of the complaint has been made.
3.      OP No.2 has filed written reply taking preliminary objections to the effect that the present complaint is legally not maintainable. The deceased Sh. Ranbir Singh was working with the answering respondent as Electrician. The answering OP2 is working as Contractor to attend the calls of PSPCL. The answering OP2 has obtained Personal Accident Insurance Policy (group unnamed) policy No.3604004216010000067 for the period from 01.05.2016 to 30.04.2017 for the benefit of its employees in the sum of Rs.5.00 lakhs, each.  The contract dated 30.06.2016 is not part of policy as the policy was enforceable in full in above mentioned period. Policy was not limited to office hours and covered all types of accidental death and injuries. During the subsistence of policy, the deceased         Sh. Ranbir Singh was working with the answering OP2 as Electrician and he was on duty when he met with an accident and died due to electric current as per post mortem report conducted by the doctors of Civil Hospital, Ludhiana, vide PRR/RG/15/16. FIR No. 491 dated   23-06-2016, U/S 304-A, 34 IPC with P.S. Division No.l Ludhiana was registered regarding the occurrence. There is no negligence on the part of answering OP2 and officials of PSPCL.  After the incident, the answering OP2 collected and arranged all the documents and lodged the claim with OP No.1 to pay the sum assured to the LRs of Sh Ranbir Singh. But OP No.2 deputed Sh. R.P. Kalhotra, Investigator of M/s Krish Associates to investigate the claim.  As per documents provided under RTI Act, 2005, he was not an insurance expert, who has submitted his false reports dated 05.01.2017 and 24.3.2017 to OP No.1 and mentioned that insured has violated contract between OP No.2 and PSPCL. There is no endorsement of the said contract on the policy. The officials of OP No.1 failed to understand this aspect.  It shows non-application of mind on the part of OP No.1. OP No.1 illegally repudiated the claim of the complainants, vide letter dated 05.04.2017.  OP No.2 has recruited trained and qualified staff on regular basis. The answering OP No.2 has already supplied the computerized salary record of June 2016, FIR, PM and other documents for payment of claim of the deceased Sh. Ranbir Singh. The answering OP2 has been wrongly impleaded as party in the complaint. In fact, answering OP is obtaining the policy for the benefit of its employees. Except the policy, the answering OP has no privity of contract with the deceased to pay any type of amount. The complainants are claiming under the policy from OP No.1.  The answering OP has not violated any terms and conditions of the policy and complainants are entitled to claim from OP No.1. There is no deficiency in service on the part of answering OP.  The complainants are entitled to the claim under the policy from OP No.1. The present complaint is maintainable against OP No.1 only and not against answering OP No.2.  A prayer for dismissal of complaint against OP2 has been made.
4.      In support of his case, ld. counsel for the complainant has tendered in evidence affidavit Ex-CA of Sh. Jagmail Singh along with various documents Ex.C-1, to Ex-C-6.
5.      In rebuttal, ld. counsel for the OP1 has tendered in evidence affidavit Ex-RA of Sh. Jaswant Singh Dhaap, Manager The New India Assurance Company Limited, Regional Office, The Mall, Ludhiana, affidavit Ex-RA of Sh. R. P. Kalotra  M/s Krish Associates, Investigators, Detectives, tracers Ludhiana, claim repudiated letter Ex-R1 along with documents Ex.R2 to Ex.R49. The learned counsel for OP NO.2 has tendered in evidence affidavit Ex-RA2/2  along with various documents Ex.R1/2 to Ex-R12/2.
6.      We have heard the complainant in person as none appeared on behalf of OP Nos.1 and 2.   We have also gone through the record of the case carefully.  
7.      Admittedly, OP No.2-M/s Cosmic Power Engineers was working as Contractor to attend the calls of P.S.P.C.L. and the deceased Sh Ranbir Singh was working with OP No.2 as an Electrician, which is also clear from the Payment of Salary/Wages Register for the month of June, 2016 (Ex.C-5).  OP No.2 had obtained Personal Accident Insurance Policy (group unnamed), vide policy No.3604004216010000067 for the period from 01.05.2016 to 30.04.2017 from OP No.1-Insurance Company for the benefit of its employees with the sum assured of Rs. 5.00 lakhs each (Ex.C-6). On 22.06.2016 while repairing electricity, above named Sh Ranbir Singh got electric shock and died due to said electric shock during his treatment on 22.6.2016.  The death certificate of deceased Sh. Ranbir Singh Ex.C-2 and FIR No. 0049 dated 23.06.2016 Ex.C-3 has been proved regarding electric shock suffered by the deceased Sh. Ranbir Singh.  A copy of post mortem examination report of deceased Sh. Ranbir Singh dated 23.6.2016 is proved as Ex.C-4 in which Doctors opined that the cause of death was cardio respiratory due to electric shock.  It is, thus, held that deceased Sh. Ranbir Singh was duly covered under the insurance policy (Ex.C-6) and he died due to accident as a result of electric shock during the subsistence of the insurance policy. The complainant lodged the insurance claim with OP No.1-Insurance Company through OP No.2-employer of deceased Sh Ranbir Singh by submitting all the requisite documents.  OP No.1-Insurance Company got the claim examined through its investigators but ultimately the insurance claim lodged by the complainants was repudiated by OP No.1-Insurance Company, vide letter dated 05.04.2017 (Ex.C1/Ex.R1) on account of certain violations mentioned in this said letter. 
8.      We have examined the repudiation letter dated 05.04.2017, Ex.C1/Ex.R1 and other documents placed on record.  We have also perused the violations mentioned in the said repudiation letter.  We are of the firm view that OP No.1-Insurance Company has rejected the claim purely on technical grounds without any justification and has not placed any document on record to prove the same. Further the claim of the complainants cannot be rejected on the allegation based on the statement of accompanying employee that the deceased did not observe the proper precautions while repairing the fault in the electric supply or in performing his duty. The same is not corroborated by any other cogent evidence and there may be a number of reasons for suffering the alleged statement by the other employees during the investigation of the insurance claim. Further the reply of OP No.1-Insurance Company is vague and there is no specific and reasoned denial of the assertion of the complainants by it.  It is, thus, held that there is deficiency in service on the part of OP No.1-Insurance Company in repudiating the genuine insurance claim of the complainants on account of death of deceased Shri Sh Ranbir Singh, vide repudiation letter dated 05.04.2017 due to which the complainant, who is the father of the deceased Sh Ranbir Singh, must have suffered mental tension and harassment. 
9. .     In the light of our aforesaid discussion, the complaint of the

complainant is allowed partly and OP No.1-Insurance Company is directed to pay the insurance amount of Rs.5,00,000/- to the complainants along with interest @ 9% per annum from the date of repudiation of claim i.e. 05.04.2017, within a period of 30 days from the date of receipt of free certified copy of this order, failing which the aforesaid amount will carry interest @ 12% per annum till actual payment.  OP No.1-Insurance Company is also directed to pay a sum of Rs.40,000/-, as compensation, on account of mental agony, physical harassment and monetary loss and to pay a sum of Rs.21,000/-, as litigation expenses.

10. .   The complaint could not be decided within the statutory period due to pandemic of Covid-19 and paucity of staff.  Free certified copies of this order be sent to the parties, as per rules. File be indexed and concerned clerk is directed that file be returned back to District Consumer Disputes Redressal Commission, Ludhiana, for proper consignment.

Pronounced on : 27.12.2023.

                              (Ramesh Kumar Gupta)                                                                       (S.K. Aggarwal)

                                                      Member                                                                             President