DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BARNALA, PUNJAB.

 

Complaint Case No : CC/37/2018

Date of Institution : 04.04.2018

Date of Decision : 19.08.2019

Avtar Singh aged about 34 years son of Late Gurdev Singh resident of Patti Asha, Near Gurudwara Sahib, Village Jodhpur, District Barnala. 

…Complainant

Versus

1. SBI General Insurance Company Ltd., (Accident and Health Claims Team), Corporate and Registered Office “Natraj” 101, 201, 301, Junction of Western Express Highway and Andheri Kurla Road, Andheri (East) Mumbai-400069 through its Managing Director/ Authorized Signatory. 

2. State Bank of India, Branch Cheema Jodhpur, Near Bus Stop and Government School, Village Cheema, District Barnala through its Branch Manager.

…Opposite Parties

Complaint Under Section 12 of Consumer Protection Act, 1986.

Present: Sh. GP Singh counsel for complainant.

Sh. AK Jindal counsel for opposite party No. 1.

Sh. Vinod Kumar Goyal counsel for opposite party No. 2.    

Quorum.-

1. Sh. Kuljit Singh : President

2. Sh. Tejinder Singh Bhangu : Member

3. Smt. Manisha : Member

(ORDER BY KULJIT SINGH, PRESIDENT):

1.    The complainant namely Avtar Singh son of Late Gurdev Singh has filed the present complaint under Consumer Protection Act (In short the Act) against SBI General Insurance Company Limited, Mumbai and another. (hereinafter referred as opposite parties). 

2. The facts leading to the present complaint as stated by the complainant in his complaint are that the mother of the complainant namely Surjeet Kaur got opened one bank Account bearing No. 35870349857 with opposite party No. 2. It is further submitted that under the insurance scheme of the opposite parties an amount of Rs. 500/- as premium was deducted by the opposite party No. 2 on behalf of opposite party No. 1 from the deceased and she was insured from 1.7.2016 yo 30.6.2017 for sum assured of Rs. 10,00,000/- under Group Personal Accident Master Policy No. 150420-0000-00 Certificate No. 44419782 issued by opposite party No. 1, in the event of death caused in an accident.

3. It is further alleged that on 26.10.2016 wife of the complainant Gagandeep Kaur and deceased were working in the house and at about 6.00 PM when deceased in order to cook food tried to start the stove then suddenly a blow came out of the stove due to which the upper part of the body of the deceased caught fire and she fell upon the stove. The complainant and his wife arranged a vehicle and got admitted the deceased in Civil Hospital, Barnala from where she was referred to Government Medical College and Hospital, Chandigarh but deceased died on 6.11.2016. Postmortem of the deceased was conducted by Dr. Gaurav Kumar Demonstrator Department of Forensic Medicine, GMCH, Chandigarh vide postmortem report dated 7.11.2016. Further, regarding the said accident General Diary No. 22 dated 27.10.2016 was recorded at Police Station, Barnala at the instace of the complainant and proceedings under Section 174 Cr.PC were conducted by the police, report of which was sent to SDM, Barnala through proper channel which was allowed by SDM, Barnala vide order dated 11.8.2017. 

4. After the death of Surjeet Kaur complainant being her nominee moved the claim form with the opposite parties for taking the insurance claim amount of Rs. 10,00,000/- regarding the death of deceased vide SBI General Claim No. 343094 under the said insurance policy. The complainant also furnished the attested copies of General Diary Details, Postmortem Report, Death Certificate etc about the deceased as required by the opposite parties but despite submission of all these documents the opposite parties rejected the claim of the deceased vide letter dated 27.10.2017 under the false pretext of non receipt of documents within the stipulated time period, whereas the said claim cannot be denied on the basis of insurance policy which amounts to deficiency in service and unfair trade practice on their part. Hence, the present complaint is filed seeking the following reliefs.-

1) The opposite parties be directed to pay the insurance claim of  Rs. 10,00,000/- alongwith interest on account of death of Surjeet Kaur.   

2) To pay Rs. 30,000/- as compensation for harassment and mental agony. 

3) To pay Rs. 10,000/- as litigation expenses.  

4) Any other relief which this Forum deems fit and proper. 

4. Upon notice of this complaint, the opposite party No. 1 filed written version taking legal objections interalia on the grounds  that intricate questions of law and facts are involved in the present complaint so the appropriate remedy is only civil court. Further, complainant has concealed material facts from this Forum so he is not entitled to any relief. He concealed that complainant did not submit the required documents and also not provided information for processing of claim. The answering opposite party sent letters dated 13.2.2017, 28.2.2017 and 15.3.2017 for submission of copies of general diary/ FIR/MLC copy/Spot Panchnama/Inquest papers attested by same issuing policy authorities, copy of diary closure report/final police investigation report attested by same issuing policy authorities, copy of postmortem report duly attested, copy of indoor case papers with admission notes, investigation reports and transfer notes for all hospitalization after accident duly attested but the complainant did not submit the said documents nor provided the information within the stipulated time period as per terms and conditions of the policy. The conclusion regarding the eligibility of coverage/admissibility of amount could only be arrived on receipt complete set of said documents as per policy terms and conditions. So, the claim was rejected vide letter dated 27.10.2017. Further, complainant is not a consumer and he has no locus standi or cause of action to file the present complaint. 

5. On merits, it is submitted that the insurance and coverage of deceased is subject to terms and conditions of the policy and admissibility of claim which only be decided on perusal of required documents as per terms and conditions of the policy. It is admitted that claim was lodged by the complainant. The opposite party sent letters dated 13.2.2017, 28.2.2017 and 15.3.2017 to the complainant for submission of some documents but he failed to submit the same so the claim was rejected vide letter dated 27.10.2017. Rest of the averments of the complaint are denied by the opposite party No. 1 and prayed for the dismissal of the present complaint with costs. 

6. The opposite party No. 2 filed written version taking legal objections on the grounds of maintainability and estoppal.   

7. On merits, it is admitted that deceased Surjeet Kaur was account holder of the answering opposite party and also got personal accidental insurance from the opposite party No. 1, premium of which was transferred by opposite party No. 2 to the opposite party No. 1. it is also admitted that opposite party No. 1 issued card/certificate No. 44419782 valid from 1.7.2016 to 30.6.2017 to Surjeet Kaur deceased.  Rest of averments of the complaint are denied by the opposite party No. 2 and it is submitted that Surjeet Kaur may have other LRs but no NOC is attached who may entitle for share in said claim. A letter from other co-sharer that they have no objection if claim is allowed and paid to complainant is filed with the complaint. Due to this fact complaint is defective. Further, no succession certificate is attached by the complainant with this complaint. So, there is no deficiency in service on their part and prayed for the dismissal of the present complaint qua the opposite party No. 2 with costs. 

8. In support of his case, complainant tendered into evidence his own affidavit as Ex.C-1, copy of General Dairy Details as Ex.C-2 and Ex.C-3, copy of report dated 11.11.2016 as Ex.C-4, copy of report dated 22.3.2017 as Ex.C-5, copy of report dated 15.4.2017 as Ex.C-6,  copy of report dated 11.8.2017 as Ex.C-7, copy of death certificate as Ex.C-8, copy of postmortem report as Ex.C-9, copy of letter dated 27.10.2017 as Ex.C-10, copy of Aadhaar Card as Ex.C-11, copy of claim form as Ex.C-12 and closed the evidence. 

9. To rebut the case of the complainant, the opposite party No. 1 tendered into evidence copy of letter dated 13.2.2017 as   Ex.O.P-1/1, copy of letter dated 28.2.2017 as Ex.O.P-1/2, copy of letter dated 15.3.2017 as Ex.O.P-1/3, copy of letter dated 27.10.2017 as Ex.O.P-1/4, copy of letter dated 29.10.2018 as Ex.OP-1/5, affidavit of Jitendra Dhabhai as Ex.OP-1/6, copy of insurance policy as Ex.OP-1/7 and closed the evidence. The opposite party No. 2 tendered in evidence affidavit of Rajinder Singh Branch Manager Ex.OP-2/1 and closed the evidence. 

10. We have heard the learned counsel for the parties and have gone through the record. Written arguments filed by the parties have also been gone through.

11. It is admitted fact between the parties that Surjeet Kaur was account holder with the opposite party No. 2 and insured with the opposite party No. 1 and opposite party No. 1 deducted the premium of the policy from the account of said Surjeet Kaur and transferred the same to the opposite party No. 1. It is also admitted by the opposite party No. 2 that opposite party No. 1 issued card/certificate No. 44419782 to the deceased Surjeet Kaur which was valid from 1.7.2016 to 30.6.2017. It is proved by the complainant on the file vide General Diary Details Ex.C-2 and Ex.C-3, reports Ex.C-4 to Ex.C-7, copy of death certificate Ex.C-8 and copy of postmortem report Ex.C-9 that deceased Surjeet Kaur died on 6.11.2016 in an accident taken place on 26.10.2016 when said Surjeet kaur tried to start the stove and suddenly a blow came out of stove due to which the upper part of the body of deceased Surjeet Kaur caught fire and she fell down on the stove. It is admitted by the opposite party No. 1 that the claim was lodged by the complainant but they rejected the claim of the complainant vide letter dated 27.10.2017 Ex.C-10 on the ground that the complainant failed to submit the documents as demanded by the opposite party No. 1 vide letters dated 13.2.2017, 28.2.2017 and 15.3.2017 respectively Ex.OP-1/1 to Ex.OP-1/3. 

12.    We have perused the letters dated 13.2.2017, 28.2.2017 and 15.3.2017 Ex.OP-1/1 to Ex.OP-1/3 respectively in which the opposite party No. 1 demanded the documents Copy of General Diary, Copy of investigation report, copy of postmortem report and copy of indoor case papers. Out of which the complainant has placed on file copy of General Diary Details Ex.C-2 and Ex.C-3, copy of investigation reports Ex.C-4 to Ex.C-7 and copy of postmortem report Ex.C-9. So, complainant is directed to submit the same with the opposite party No. 1 by self attesting the same or by taking certified copies of these documents from this Forum as in our view there is no need to attest the same as he filed these documents in this Forum and exhibited the same. Further, in our view there is no need of indoor case papers when the postmortem report is available in which it is specifically mentioned that cause of death is septicaemia due to intected burn injuries over 40 percentage of the total surface area. 

13. Further, the opposite party No. 1 cannot repudiate the claim of the complainant on the ground of non submission of documents he must be given more opportunity to the complainant to submit the documents as they have earned premium from the deceased Surjeet Kaur who only purchased the insurance policy to support her family after her death. 

14. As a result of the above discussion, present complaint is disposed of with a direction to the complainant to submit the necessary documents to the opposite party No. 1 as mentioned in para No. 12 of this order within 15 days from the date of the receipt of the copy of this order. The opposite party No. 1 is also directed to consider the documents of the complainant and settled his claim within the period of 30 days from the date of the receipt of documents from the complainant as mentioned above. However, if the complainant will not satisfy with the outcome of the settlement of the insurance claim by the opposite party No. 1 then he is at liberty to file a fresh complaint on the same cause of action before this Forum, if he desires so. Copy of the order be supplied to the parties free of costs. File be consigned to the records after its due compliance.

  ANNOUNCED IN THE OPEN FORUM:

19th Day of August 2019

 

 

            (Kuljit Singh)

           President

 

           (Tejinder Singh Bhangu)                Member

 

(Manisha)

Member