Order by:
Sh.Amrinder Singh Sidhu, President
1. The complainant has filed the instant complaint under section 35 of the Consumer Protection Act, 2019 on the allegations that the husband of the complainant namely Harjeet Singh died in a road accident on dated 13.03.2016 and in this regard an FIR No. 41 dated 14.03.2016 U/s 304A/279 of IPC was registered at Police Station Dharamkot upon the statement of Gurpal Singh son of Bakhtaur Singh, resident of Village Karyal Tehsil and District Moga. That the above said Jaspal Singh was insured under Bhagat Puran Singh Sehat Bima Yojna having Card No. 7304 2103 4105 0003 9 in which the husband of the complainant was insured for Rs. 5,00,000/- on the death due to accident and card was meant for free medical treatment of the whole family up to Rs. 30,000/-. The husband of the complainant had been insured under the above said policy of Bhagat Puran Singh Sehat Bima Yojna through United India Insurance Company Limited and the beneficiary card was also issued by the United India Insurance Company Limited having their Logo on the backside of above mentioned beneficiary card. The card was issued to the deceased by the Punjab Mandi Board having insurance tie-up with United India Insurance Company Limited. After the death of husband of the complainant, the complainant visited the office of the opposite party no. 1 and intimated to opposite party no. 1 about the death of her husband and requested to settle the death claim of her husband. The opposite party no.1 told the complainant to call upon 104 Toll Free number and the complainant immediately called upon the said number and the complainant was told by the person on the said number that the Investigator of the company will visit the spot and will inquire the matter about the death claim. The complainant was ensured by the said helpline no. 104 that she has to wait until investigator of the company visits her place to collect the required documents for settling the claim of the death of her husband. In the Month of November 2016 and thereafter in the month of January 2017, the complainant with her brother visited the office of opposite party no.1 and told them about the matter of death claim of her husband Harjeet Singh and requested to settle the death claim of her husband. But opposite party no. 1 did not bother about the requests of the complainant and told to the complainant that she will have to visit the Head Office of company at Mohali i.e. opposite party no. 2. In the month of April, 2017 the complainant visited the office of the opposite party no. 2 who received her required documents and they told the complainant whether if they have reported about the death to Punjab Mandi Board i.e. opposite party no. 4 which is also necessary and same be also intimated so that the death claim can be settled as soon as possible. After returning from the office of opposite party no. 2, the complainant reported the death vide requisite documents at the office of opposite party no. 4. Thereafter the complainant several times called at Helpline number who asked to wait and thereafter in March 2020 there was lockdown due to COVID-19 and the complainant could not visit any office. On 05-04-2021, the complainant again visited the Head Office at Mohali i.e. opposite party no. 2 who flatly refused to give any claim regarding death of husband of the complainant as she was told that United India Insurance Company Limited came into agreement with Bhagat Puran Singh Sehat Bima Yojna on dated 01.11.2016 as the claim regarding death of her husband does not lie with their company and you should approach Reliance General Insurance Co. Ltd. i.e. the opposite party no. 3. The complainant had shown the beneficiary card bearing the Logo of United India Insurance Company Limited at the back of the card. But they did not bother about any requests of the complainant. Due to the illegal act and conduct of the opposite party No. 1 and No. 2, the complainant is suffering from mental tension, agony and harassment since last four years. The opposite parties no. 1 and 2 did not explain to the complainant how the Reliance General Insurance Company Limited is liable to pay the claim of the death of husband of the complainant and why they demanded the relevant and required documents from the complainant. Complainant also got served the registered legal notice upon the opposite parties on 20-05-2021 with the request to settle the death claim of her husband namely. But despite the service of notice, the opposite parties have failed to settle the death claim of the husband of the complainant and the opposite parties did not pay any heed towards the requests of the complainant. In this way there is a clear cut deficiency in the service of the opposite parties. Hence this complaint. Further alleges that the Supreme Court vide application No. 665/2021 in SMW (C) No. 3/2020 has directed that the period of the limitation is extended till further order which is in the continuation of the order dated 23-03-2020 which was earlier till 08-03-2021 has been extended till further order. So the present complaint of the complainant is well within limitation. Vide instant complaint complainant has sought the following reliefs:-
a) Opposite parties may be directed to pay Rs.5,00,000/- as death claim of her husband alongwith interest @ 12% per annum till its realization.
b) To pay Rs.50,000/- as compensation on account of mental tension, agony and harassment suffered by the complainant.
c) To pay Rs.11,000/- as litigation charges.
d) And any other relief which this Commission deem fit and proper in the interest of justice and equity.
2. Opposite parties no.1 & 2 appeared through counsel and contested the complaint taking preliminary objections therein inter alia that the complaint is not maintainable. The complainant has got no locus standi to file the present complaint against the answering opposite parties. No cause of action arose to the complainant against the answering opposite parties. The complainant has not complied with the terms and conditions of the Insurance Policy. The complaint is barred by the law of limitation. Hence the complaint may kindly be dismissed on this score. There is no deficiency of service on the part of the answering opposite parties. Thus the complaint may kindly be dismissed on this score. The answering opposite parties denies regarding providing insurance cover to the husband of the complainant as no insurance policy was furnished before the Commission by the complainant, however the answering opposite parties reserves its right to file amended written statement as and when insurance policy was filed before this Commission by the complainant or any new facts came to the knowledge of the answering opposite parties. Further alleges that the date of accident was 13.03.2016 as alleged in the complaint whereas the answering opposite parties issued Bhagat Puran Singh Sehat Bima Yojna within State of Punjab w.e.f 01.11.2016 to 31.10.2017, hence accident does not fall under the purview of the policy of the answering opposite parties. Thus the answering opposite parties are not liable to pay any amount to the complainant. The Commission has got no jurisdiction to try the complaint as voluminous evidence is required to decide the complaint. The complaint is bad for non joinder and misjoinder of necessary parties. The complaint has been filed to harass the answering opposite parties with malafide intention to cause harm to them. Hence the complaint may kindly be dismissed. Remaining facts mentioned in the complaint are also denied and a prayer for dismissal of the complaint has been made.
3. Upon notice, none has come present on behalf of opposite party no.3, despite service, hence opposite party no.3 was proceeded against exparte. Upon notice, opposite party no.4 appeared through counsel and filed written reply, thereafter till date none has come present on behalf of opposite party no.4.
4. Opposite party no.4 filed the written reply taking preliminary objection therein inter alia that the complaint is not maintainable. The complainant has got no locus-standi. No deficiency in service has been attributed to the opposite party. The complaint is absolutely false and frivolous. Complicated questions of law and facts are involved in the present complaint. Moreover lengthy examination-in-chief and cross examination of the parties/witnesses are required in the complaint. So the complaint is required to be decided by the civil court and this Forum has got no jurisdiction to entertain, try and dispose off the complaint. Therefore, the complaint as such deserves dismissal. The complainant has not approached the Forum with clean hands rather he has willfully concealed the material and patent facts from this Forum while filing the present complaint which ipso-facto disentitles the complainant to seek any relief against the opposite party. Complaint is false, frivolous, baseless, vague, malicious and unmeritorious, therefore, in the event of dismissal of the complaint the opposite party is entitled to special costs as provided under C.P. Act. The opposite party has been dragged into litigation unnecessarily and opposite party is not liable to pay any amount as a matter of fact opposite party collected the data of framers from the Commission agent as per instruction of higher authorities and issued the card to the concerned persons. The opposite party is not liable to pay any amount as alleged in complaint. Only Insurance company is liable. Remaining facts mentioned in the complaint are also denied and prayer of dismissal of the complaint has been made.
5. Complainant has filed the replication to the written reply of opposite parties no.1 & 2 stating that on 05.04.2021, when the complainant visited the Head Office at Mohali, who flatly refused to give any claim regarding death of husband of the complainant as she was told that United India Insurance Company Limited came into agreement with Bhagat Puran Singh Sehat Bima Yojna on 01.11.2016 so the claim regarding death of her husband lies with Reliance General Insurance Company Limited i.e. opposite party no.3. Neither the opposite party no.1 nor Opposite Party 2 conveyed about the same nor directed the complainant properly. As in the proceedings of the pre-bid meeting, it was held on 21.12.2015 regarding personal accident policy cover of Rs.5,00,000/- under Bhagat Puran Singh Sehat Bima Yojna where it was clarified that a policy will commence from 01.01.2016 (Reliance General Insurance Company Limited) and will be co-terminus with the main Health Insurance Policy i.e. with United India Insurance Company Limited, so the beneficiary card i.e. Bhagat Puran Singh Sehat Bima Yojna card also has the logo of the United India Insurance Company Limited at the backside of the card, so the above said company is also liable to pay the death claim alongwith interest as both the opposite parties no.2 & 3 are co-terminus with the above said health policy and accident death claim. All other objections raised by the opposite parties are also denied.
6. In order to prove her case, complainant tendered in evidence her affidavit Ex.C1 along with copies of documents Ex.C2 to Ex.C4, Ex.C4A, Ex.C4B, Ex.C4C, Ex.C4D and Ex.C5 to Ex.C8.
7. On the other hand, to rebut the evidence of complainant, ld. counsel for the opposite parties no.1 & 2 tendered in evidence affidavit of Sh.R.N.Bansal, Divisional Manager Ex.OPs1 alongwith copy of document Ex.OPs2.
8. During the course of arguments, both the ld. counsel for the complainant as well as opposite parties have mainly reiterated the facts as narrated in the complaint as well as written reply respectively. We have perused the rival contentions of ld. counsel for the parties and gone through the record. The contention of ld. counsel for the complainant is that husband of the complainant namely Harjeet Singh died in a road accident on dated 13.03.2016. Complainant was insured under Bhagat Puran Singh Sehat Bima Yojna having Card No. 7304 2103 4105 0003 9 in which the husband of the complainant was insured for Rs. 5,00,000/- on the death due to accident. The husband of the complainant had been insured under the above said policy through United India Insurance Company Limited and the beneficiary card was also issued by the United India Insurance Company Limited having their Logo on the backside of above mentioned beneficiary card. After the death of husband of the complainant, the complainant intimated to opposite party no.1 & 2 about the death of her husband and requested to settle the death claim of her husband. But they did not bother about the requests of the complainant. On 05.04.2021 the complainant again visited the Head Office at Mohali i.e. opposite party no. 2 who flatly refused to give any claim as she was told that United India Insurance Company Limited came into agreement with Bhagat Puran Singh Sehat Bima Yojna on dated 01.11.2016 as the claim regarding death of her husband does not lie with their company and she should approach Reliance General Insurance Co. Ltd. i.e. the opposite party no. 3. The complainant had shown the beneficiary card bearing the Logo of United India Insurance Company Limited at the back of the card. But they did not bother about any requests of the complainant. On the other hand, ld. counsel for the opposite parties no.1 & 2 contended that the date of accident was 13.03.2016 as alleged in the complaint whereas the opposite parties issued Bhagat Puran Singh Sehat Bima Yojna within State of Punjab w.e.f. 01.11.2016 to 31.10.2017, hence accident does not fall under the purview of the policy of the answering opposite parties. Whereas, opposite party no.4 contended that they have been dragged into litigation unnecessarily and opposite party is not liable to pay any amount as a matter of fact opposite party collected the data of framers from the Commission agent as per instruction of higher authorities and issued the card to the concerned persons, so they are not liable to pay any amount as alleged in complaint.
8. We have perused the rival contentions of ld. counsel for the parties have also gone through the record. The main question for deciding the matter before us is that which insurance company is liable to pay the claim of the complainant either United India Insurance Company or Reliance General Insurance Co. Ltd. Perusal of the record shows that opposite party no.1 & 2 placed on record Ex.OPs2 in which against the Column heading Bhagat Puran Singh Sehat Bima Yojana Policy, it is mentioned that “means the insurance policy of Bhagat Puran Singh Sehat Bima Yojana a scheme instituted by the GoP for the provision of health insurance cover and personal accident and disability cover by an insurer to the Bhagat Puran Singh Sehat Bima Yojana. Beneficiary Family Unites, within in the State of Punjab, which shall commence on 1st November, 2016 and shall end on 31st October 2017.” In support of this contention ld. counsel for the opposite party no.1 & 2 has placed on record affidavit of Sh.R.N. Bansal, Divisional Manager, United India Insurance Company Ex.OPs1. From the above it is evident that Bhagat Puran Singh Sehat Bima Yojana issued within the State of Punjab w.e.f 01.11.2016 to 31.10.2017. On the other hand, opposite party no.3 i.e. Reliance General Insurance Co. Ltd. did not opt to appear and contest the proceedings. In this way, the opposite party no.3 has impliedly admitted the correctness of the allegations made in the complaint. It also shows that opposite parties have no defence to offer or defend the complaint. In this regard Hon’ble State Consumer Disputes Redressal Commission, Punjab at Chandigarh in First Appeal No.221 of 2018 titled as Rajia Vs. Reliance General Insurance Company Limited, decided on 23.07.2018 has observed as below:-
“The DLA died in an accidental death, it is so clear from the FIR on the record Ex. C-3 and post mortem report Ex. C-4. This fact has also not been denied by the Ops but their objection is that accident took place because of the negligence of the DLA as he was not holding any driving licence to drive the vehicle. In the agreement between Op No. 2 & Op No. 1 (Ex. Op-1/5) according to the beneficiary coverage Clause 3.4, in case of accidental death benefit amount is Rs. 5 Lacs and for the claim settlement, the complainant was required to submit the claim form, death certificate, copy of FIR, copy of post mortem report, smart card and the bank account details. Complainant has already placed on the record the copy of the FIR, post mortem report, card issued under Bhagat Puran Singh Sehat Bima Yojna and Aadhar Card, which are necessary documents for settling the claim. They have not denied these documents but their objection is that complainant was not having the Driving Licence. It is not a motor accident claim under which the driving licence of the DLA was required, in fact it is health insurance policy under which the complainant is required to prove only the accidental death, which stands proved on the basis of FIR and post mortem report. Counsel for the Op has referred to policy exclusion clause No. 6, under which the claim is not payable arising or resulting from the insured person committing any breach of law with criminal intent but this clause is not applicable to the facts of the case because he did not die with an intention, it is just a matter of chance that accident took place and he died. However, counsel for the Op was unable to get how the driving licence is relevant for the settlement of the claim under the health insurance policy, therefore, the Op as well as the District Forum has taken a wrong plea to dismiss the complaint of the complainant, therefore, the order passed by the District Forum is not legally sustainable and is liable to be set-aside.”
In view of the aforesaid facts and circumstances of the complaint, Hon’ble State Consumer Disputes Redressal Commission, Punjab allowed the complaint and it directed the Opposite Party No.3 i.e. Reliance General Insurance Company Limited to pay a sum of Rs.5 Lacs to the complainant alongwith interest and compensation and litigation costs.
9. In view of the aforesaid facts and circumstances and taking into account the Order of Hon’ble State Consumer Disputes Redressal Commission, Punjab titled as Rajia Vs. Reliance General Insurance Company Limited Supra, we partly allow the present complaint. Opposite Party No.3 i.e. Reliance General Insurance Company Limited is directed to pay Rs.Five Lacs alongwith interest @ 8% per annum from the date of filing the present complaint i.e. 28.06.2021 till its actual realization to consumer namely Jasveer Kaur for the death of deceased Harjeet Singh who was her husband. The compliance of the order be made by Opposite Party No.3 i.e. Reliance General Insurance Company Limited within 60 days from the date of receipt of copy of this order, failing which the complainant shall be at liberty to get the order enforced through the indulgence of this Commission. Copies of the order be furnished to the parties free of costs. File be consigned to record room.
Announced in Open Commission.
