Punjab

Sangrur

CC/565/2019

Bharbhur Kaur - Complainant(s)

Versus

Punjab Health System Corporation - Opp.Party(s)

Sh.Amit Goyal

05 Sep 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR .

                                                                        Complaint No. 565

 Instituted on:   04.11.2019

                                                                        Decided on:     05.09.2023

 

Bharbhur Kaur wife of Late Thakur Dev Singh R/O Ward No.13, Khanauri, Tehsil Moonak, District Sangrur.

                                                         …. Complainant 

                                                 Versus

1.             Punjab Health Systems Corporation, SIHFW Complex, Phase-6, Mohali through its Managing Director 160055.

2.             State of Punjab through District Collector, Sangrur 148001.

3.             United India Insurance Company Limited, Divisional Office, Railway Road, Sangrur through its Divisional Manager.

4.             United India Insurance Company Limited, Divisional Office, SCO 72, Phase IX, Mohali through its Divisional Manager 160062.

                                                        ..Opposite parties.

 

For the complainant    :       Shri Amit Goyal, Adv.

For OP No.1&2         :       Shri Vinay Jindal, Adv.

For OP NO.3&4         :       Shri N.S.Sahni, Adv.

 

Quorum                                           

Jot Naranjan Singh Gill, President

Sarita Garg, Member

                        Kanwaljeet Singh, Member

 

 

ORDER

JOT NARANJAN SINGH GILL, PRESIDENT

 

1.             Complainant  has preferred the present complaint against the opposite parties on the ground that husband of the complainant, Thakur Dev Singh was the member of Bhagat Puran Singh Sehat Bima Yojna against which the OPs number 3 and 4 issued card bearing number 9305-3000-0428-0028-0 to Thakur Dev Singh during his life time. It is further averred that under the said scheme  Shri Thakur Dev  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 except that no terms and conditions of the policy were issued by the OPs.

2.             Further case of the complainant is that unfortunately on 22.11.2018 husband of the complainant, namely, Thakur Dev Singh met with an accident near Pipal Chowk, Khanauri and as such was taken to AP Trauma Centre, Patiala from where he was further referred to PGI Chandigarh, but he died on 26.11.2018 due to injuries sustained in the said accident. FIR number 127 dated 26/11/2018 was also got lodged at P.S. Khanauri against unknown persons and the vehicle which caused accident could not be traced.  Post mortem examination on the dead body of the deceased was conducted on 27.11.2018 at PGI Chandigarh. Further it is averred that after the death of the husband of the complainant she lodged the claim on toll free number 104 of OPs and further handed over all the documents i.e. copy of FIR, post-mortem report, death certificate, copy of BPPSSBY card and copy of bank passbook etc. to the representative of the OPs for payment of the claim amount of Rs.5,00,000/-, but the OPs miserably failed to pay the claim to the complainant despite sending of the application dated 25.9.2019 to the OP number 3 at Sangrur. It is further averred that the Ops neither gave any reply to the complainant nor settled the claim, which is said to be deficiency in service on the part of the OPs. Thus, 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.             Record shows that OPs number 1 and 2 did not file any written reply despite granting of so many opportunities, as such defence of OPs number 1 and 2 was struck off by this Commission vide its orders dated 20.09.2021. 

4.             In reply filed by the OP number 3 and 4,  legal objections are taken up on the grounds that the complaint is premature as the claim of the complainant has not been repudiated so far and the complaint is liable to be dismissed, that the complaint is bad for necessary parties, that the complainant has got no cause of action and that the complaint is not maintainable.  On merits, the story mentioned in the complaint is said to be wrong and false. It is stated further that the complainant has neither disclosed the names of all legal heirs of deceased nor has impleaded as a party to the complaint. The complainant has not provided all the requisite documents to the OPs for settlement of the claim. It is stated that the complaint of the complainant is premature as the Ops have not repudiated the claim till then. It is further stated that no such accident took place on 22.11.2018.  Further it is stated that perusal of the FIR shows that it was got registered later on after consultation with the lawyer or some other expert with a view to claim amount from OPs. Lastly, it is prayed that the complaint be dismissed with special costs. The other allegations levelled in the complaint have been denied in toto.

5.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-9 copies of documents and affidavit and closed evidence. On the other hand, the learned counsel for OP number 3 and 4 has produced Ex.OP3&4/1 affidavit and closed evidence. 

6.             We have gone through the pleadings put in by  the parties along with their supporting documents with their valuable assistance. 

 

7.             At the outset, it is an admitted fact between the complainant and OP number 3 and 4 that  husband of complainant, Thakur Dev Singh was insured with them for Rs.5,00,000/- in case of accidental death. It is also not in dispute that Thakur Dev Singh died on 26.11.2018 as is evident from the copy of death certificate, which is on record as Ex.C-7. Further FIR number 0127 dated 26.11.2018 regarding the accident of Thakur Dev Singh was recorded, a copy of which on record is Ex.C-3 wherein it has been clearly mentioned that Thakur Dev Singh when going to his motorcycle suffered accidental injuries when an unknown person coming on motorcycle struck with the motor cycle of Thakur Dev Singh and as such, he suffered injuries on 22.11.2018. But the OP number 3 and 4 wrongly did not settle the claim despite lapse of sufficient period and submission of the required documents for settlement of the claim.  Whereas the stand of OP number 3 and 4 is that the complaint is premature one as they have not repudiated the claim as such. 

8.             To support the contention, the complainant has produced ExC-1 her sworn affidavit,  Ex.C-2 copy of card, Ex.C-3 copy of FIR, Ex.C-4 copy of post-mortem examination report of the deceased conducted at PGI Chandigarh on 27.11.2018 and further it reveals that the cause of death of the deceased is Cerebral damage consequent to blunt trauma to head meaning thereby the insured died due to blunt head injuries.  Further Ex.C-8 is the copy of legal notice dated 25.9.2019 served upon the OP number 3 for settlement of the claim but all in vain.

9.                On the other hand, the OP number 3 and 4 have produced only Ex.OP3&4/1 affidavit of one Manmohan Singh, Deputy Manager to support the contention of the OPs number 3 and 4. A bare perusal of it nowhere reveals that why they did not settle the claim of the complainant nor there is any mention about the fact that why the claim was not settled for such a long time. We may mention that the OPs number 1 and 2 did not even filed written reply despite granting of opportunities nor the OPs number 3 and 4 have produced any cogent, reliable and trustworthy evidence to support their contention except affidavit of one Manmohan Singh, Deputy Manager.  In the circumstances, we find it to be a clear cut case of deficiency in service on the part of the OP number 3 and 4 in not settling the rightful claim of the complainant, whereas the complainant has produced sufficient evidence on record to settle the claim of the complainant. As such, we are of the considered opinion that the deficiency in service on the part of the OP number 3 and 4 is writ large, as they  wrongly and wilfully did not settle the rightful claim of the complainant for such a long time and even during the present proceedings OPs number 3 and 4 did not choose to settle the claim nor they cited any reason for the same nor they demanded any documents from the complainant for settlement of the claim during the present proceedings .

 

10.            In view of our above discussion, we allow the complaint and direct OP number 3 and 4 to pay to the complainant and all the other legal heirs of the deceased Late Thakur Dev Singh in equal share an amount of Rs.5,00,000/- along with interest @ 7% per annum from the date of filing of the present complaint i.e. 04.11.2019 till realisation in full. If any legal heir is minor then the amount shall be kept in the shape of FDR in a nationalised bank till he/she attains majority. We further direct them to pay an amount of Rs.5000/- in lieu of compensation for mental tension, agony and harassment as well as an amount of Rs.5,000/- on account of  litigation expenses. This order shall be complied with by OPs  number 3 and 4 within a period of thirty days of receipt of copy of this order.

11.            The complaint could not be decided within the statutory time period due to heavy pendency of cases.

12.            Copy of this order be supplied to the parties free of cost. File be consigned to the records after its due compliance. 

                        Pronounced.

 

                        September 5, 2023.