Punjab

Sangrur

CC/139/2019

Kulwinder Kaur - Complainant(s)

Versus

The Rajomajra MP CASS Ltd. - Opp.Party(s)

Sh. Kamalpreet Singh

20 Jun 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR .

          

                                                   Complaint No. 139

                                                   Instituted on:   02.04.2019 

                                                   Decided on:   20.06.2024

Kulwinder Kaur W/o Late Shinder Pal  Singh alias Shinder Singh Alias Surinder Singh, resident of village Rajomajra, Tehsil Dhuri, District Sangrur.      

                                                          ..Complainant.                                            Versus

1.       The Rajomajra MP CASS limited, Rajomajra, Tehsil Dhuri, District Sangrur, through its Secretary.

2.       The Sangrur Central Cooperative Bank limited, Branch Office: Patiala Gate, Sangrur through its District Manager.

 3.      The Sangrur Central Cooperative Bank Limited, Branch Office: Dhuri, Tehsil Dhuri, District Sangrur, through its Branch Manager.

4.       Bharti AXA General Insurance Company Limited, Unit No.S.F-2, 261, Lajpat Kund, Guru Nanak Mission Chowk, Jalandhar, through its Manager.

                                            ….Opposite parties 

 

QUORUM                                         

JOT NARANJAN SINGH GILL: PRESIDENT

SARITA GARG                             : MEMEBR

KANWALJEET SINGH             : MEMBER

 

 

 For the complainant :ShriKamlpreetSingh  

                                  Advocate              

For the OP.No.1.       : Exparte

        

For the Op.No.2&3    :  Shri Appolojit Singh  Advocate

For the Op.No.4     : Shri Sanjeev Goyal &Shri Udit  

                               Goyal Advocate

 

ORDER

 

KANWALJEET SINGH, MEMBER

1. The complainant has alleged in this complaint that the husband of complainant is the member of Op.1 and obtained the services from Op.no.2 & 3 by opening a Saving Bank Account no. 50758. The husband of complainant was insured under the cooperative bank personal accident group insurance scheme for One Lakh, which was issued by Op.no.4. The complainant is legal heir of deceased Surinder Singh. The complainant was the nominee under the above said policy. On 15.11.2014, when the husband of the complainant gone to fields and trying to on the switch, then husband of the complainant got severe electric shock and was immediately taken to civil hospital, Dhuri. On the way Surinder Singh died. Postmortem was conducted at civil hospital, Dhuri on 15.11.2014. DDR no. 22 dated 15.11.2014 was lodged at police station sadar, Dhuri. The concerned Doctor stated that the opinion regarding the cause of death will be given after the receipt of chemical examination and pathologist report. Complainant lodged the claim with the Op.1 to 3 and submitted the required documents. Op.1 to 3 stated that they will start the further process after receiving the chemical examination report and pathological report .In the month of Feb,2016 the complainant received the copy of report from the concerned department. Thereafter, complainant approached to Op.1 to 3 and submitted the report. Then op.1 to 3 told that they will send all the claim documents to Op.4 for release the claim amount. The complainant approached the Ops number of times, but the Ops failed to release the claim. Op.4 letter dated 06.5.2017, repudiated the claim of the complainant. The complainant is a widow lady and has no source of income to maintain her family. The Ops committed deficiency in service and unfair trade practice qua the complainant and lastly prayed the Ops may kindly be directed to pay the claim amount of Rs. 1,00,000/- along with interest @ 18% p.a. from the date of death till realization and to pay Rs. 50,000/- on account of mental agony and Rs. 22,000/- as litigation expenses.
2. Upon notice, despite of service of notice, the Op.1 has not appeared and proceeded exparte vide separate order dated 10.6.2019. The remaining Ops filed reply separately. In reply of Op.2 & 3 taking legal objection that the complaint is not maintainable. The complainant has no cause of action and locus-standi to file the complaint and complainant not come to the court with clean hands. On merits, the complaint is correct to the extent that the complainant has obtained the services from Op. 2 &3 by opening the Saving Bank Account no. 50758 and under the account of the husband of the complainant was insured for personal accident of Rs. 1,00,000/- which was issued by Op.4. The Bank has a tie up with the insurance company of Op.4. The complainant approached the Bank for claim in September, 2016 before this no intimation has been given to the bank. After receiving the intimation the bank immediately has forwarded the claim of the complainant to Op.4 on 26.09.2016. The matter remains between the members of the policy and Op.4. The complaint is correct to the extent that the Op.4 repudiated the claim on 06.5.2017 of the complainant. The remaining allegations are denied by the Op. 2 & 3 and lastly prayed that the complaint may kindly be dismissed with special costs.
3. Reply of Op.4 taking preliminary objections that the compliant is not maintainable as no premium was paid before the issuance of policy i.e. 01.06.2014. It is confirmed that the premium was paid on 07.10.2014 after issuance of the policy in question. Therefore, there is a violation of section 64VB of insurance act 1938. The policy was valid from 01.06.2014 to 31.05.2015. At the time of the issuance of the policy, no premium was paid by the Surinder Pal Singh. So the claim of the complainant is not admissible. The complainant is not a consumer qua the op.4. No service of any kind was ever taken by the complainant from Op.4. Without admitting the insurance, it is submitted that the intimation regarding the alleged occurrence was received on 04.10.2016 with a delay of 686 days and there is violation of clause 11 (a) of the policy. The written notice must be given within one month of such loss of sight or amputation. Insured person does not comply with the previsions of this clause of the policy. So, all the benefits under the policy shall be forfeited at the option of the company. On merits, the husband of the complainant not insured under the policy. The Op.2 took group personal accidental insurance policy bearing no. 1637787 for its 69433 unnamed saving account holder having sum assured of Rs. 1,00,000/- each. The policy was valid for the period from 01.06.2014 to 31.05.2015. The premium was deducted from the account of deceased on 07.10.2014 after the issuance of the policy. On 04.10.2016, the op.4 received the intimation with regard to the death of Surinder Singh who allegedly died on 15.11.2014. Therefore, there was a delay of 686 days. The Op.4 wrote a letter to Op.2 for explaining the reason for delay in intimation of 686 days. The Op.4 appointed investigator to investigate the claim of the complainant. The investigator visited the house of complainant and recorded the statement and collected the documents. It is confirmed that the premium from the account of deceased was deducted on 07.10.2014, whereas the policy was already issued on 01.6.2014. Therefore, the claim of the complainant was found not admissible under the policy and lastly prayed that the complaint is liable to be dismissed with  costs.
4. In support to prove her case the complainant tendered into evidence her self attested affidavit Ex.C-1 and some other documents which are Ex.C-2 to Ex. C-10 and closed evidence.
5. On the other hand, to rebut the case of the complainant, the Op.no.2 & 3 have produced in their evidence some documents i.e  Ex.Op2&3/1 affidavit and some documents Ex.Op2&3/2 to Ex.Op.2&3/6 and closed the evidence.
6. Similiarly, the Op.4 tendered into evidence Ex.Op.4/1 affidavit and some documents Ex.Op.4/2 to Ex.Op.4 /7 and closed the evidence.
7. We have heard the learned counsel for parties and gone through the record file carefully with the valuable assistance of the learned counsel for the parties. During arguments, the contentions of both the parties are similar to their respective pleadings, so there is no need to reiterate the same to avoid repetition.
8. Now, come to major controversy, whether the complainant is liable for relief as claimed by her in her prayer or not?
9. Admittedly, Op.2 & 3 pleaded in para no. 3(a) reply on merits, Op.2 & 3 having saving bank account number 50758. It is also admitted by Op. 2 & 3 that the complainant was insured under group personal accident insurance for Rs. 1,00,000/- which was issued by Op.4. Op. 2 & 3 have a tie –up of the insurance policy in question with Op.4. The complainant approached with the Op. 2 & 3 for claim in the month of September 2016. Before this no intimation has been given to the bank. After receiving the intimation the bank immediately has forwarded the claim of the complainant to Op.4 on 26.09.2016. It is not disputed that the policy in question was valid since 1.6.2014 to 31.5.2015. From the perusal of pleadings of Op.4 pleaded that the complainant was not paid the premium. The premium  of the policy was received on 31.5.2015. As per the confirmation was given by Op.1 & 2. Whereas, the premium was deducted from the account of deceased on 07.10.2014 after the issuance of the policy. While the policy was already issued on 01.6.2014. As far as concerned the evidence produced by the complainant Ex.C-2 is the Police intimation has been given by Nirmal Singh brother of deceased on 15.11.2014. It transpires from the perusal of Ex.C-3 the postmortem examination report dated 15.11.2014 in which the concerned doctor specifically mentioned that “ the opinion regarding the cause of death will be given after the receipt of chemical examination and pathologist’s report. In this context, the concerned medical officer namely Dr. Amanpreet Kaur put her signature on the bottom of the report on 15.11.2014. The senior medical officer Civil Hospital, Dhuri also put the signature and embosses the official stamp on the same.
10. To trace out the veracity of truth, this Commission has examined the utmost important document which is Ex.C-9 report of Chemical examiner to Govt. of Punjab. On the face of the record, it is prima facie made out that the sealed parcel referred on 15.11.2014 and received on 12.12.2014 by the  concerned officials and report prepared on 02.02.2016. It transpire from the perusal of Ex.Op.2&3/4 letter dated 17.11.2016 issued by Op.2 to Op.4 regarding the requisite documents of Shinder Pal Singh(Now Deceased) husband of complainant has already sent to the regional office, Jalandhar vide claim no. C1107286 and letter no. 8242 dated 26.9.2016. Op.2 also requested to Op.4 to process the claim at the earliest and obliged. Further, as per Ex.Op.2&3/6 account statement of complainant’s husband for the period of 1.4.2014 to 31.05.2014. It has shown in the vital document that on 26.5.2014 premium paid Rs. 40/- . From the perusal of Ex.Op.4/2 registered letter dated 12.5.2017 issued by the Op.4 to Op.2 regarding death claim closer letter under group personal accident insurance of complainant’s husband vide claim no. C1116319 under policy no. 11637787. In this letter Op.4 mentioned that husband of the complainant died on 15.11.2014. The premium was deposited on 07.10.2014 After issuance of the subjected policy.  The policy period was valid since 01.06.2014 to 31.05.2015. As per section 64VB of insurance act, 1938 which says “no risk to be assured unless premium is received in advance”. It is further mentioned in the letter that premium was paid after the issuance of the policy, therefore claim is not admissible as per the terms and conditions of the policy. Op.4 stated in the letter (supra) the intimation received on 04.10.2016 which is after 686 days. Intimation is the violation of the condition 11(a) of the terms and conditions of the policy. So, prima facie claim is not admissible on account of above mentioned condition. Op.4 closed the claim as no claim. As per Ex.Op.4/4 personal accident insurance claim form complainant put her signature in Punjabi language on page no. 3. Ops miserably failed to prove the factum with regard to on which specific date the claim form lodged by the complainant. We feel there is no specific date mentioned on the claim form. It transpire from the perusal of Ex. Op.4/6 policy terms and conditions clause 11 is reproduced as under :-

11) Duty of the insured/ insured person on occurrence of the loss on the occurrence of loss within the scope of cover under the policy the insured/insured person shall :

a) Give written notice with full  particulars to the company immediately. In case of death, written notice of the death must, unless reasonable cause is shown, be so given before internment/cremation and in any case within one calendar month after the death.

   It is incumbent upon the Op no.4 since 01.06.2014from the date of issuance of the policy to till date of occurrence i.e. 15.11.2014 issue a letter to the insured to deposit the premium if not paid. Unfortunately, the husband of the complainant expired due to electric shock. In this situation Ops why not issued official letter/Email/SMS qua the complainant to deposited the due premium of the policy in question. Moreover, ops did not cancel the policy till the date of death of the insured due to lack of premium. In this juncture, the “principle of estoppel” is fully applicable qua the Op.4. It is writ large on the file the insured died on 15.11.2014. We feel during 07.10.2014 to 15.11.2014(during one month and eight days) op.4 did not refund the premium of the insured on the ground of section 64VB of the insurance Act. From this angle, later on repudiation of  the claim of the insured by Op.4 is not justified in the parameter of insurance contract. The Act of Op.4 is unjust, in proper, unfair, arbitrary, inoperative before the eye of law.

Moreover, complainant produced on record document Ex.C-6 which has shown the reason for delay. This very fact regarding the cover of delay reasons specifically mentioned in the affidavit of the complainant which Ex.C-1.In the affidavit (supra) complainant solemnly affirm  and declared on oath in para no. 4 of the affidavit which is Ex.C1. Complainant pleaded that the claim lodged with Op.1 to Op.3 alongwith requisite documents for release the accidental claim amount of Rs.1,00,000/-. Op.1 to Op.3 stated that they will start the further process after receiving of chemical examination report as well as pathological report. Complainant obtained the copy of report from the concerned department. Thereafter, the complainant approached to Op.1 to Op.3 and submitted the report. Then op.1 to op.3 told to the complainant that they will send all the documents to Op.4. Op. 4 will release the claim within 2 to 3 months. Complainant visited the office of Ops number of times but all in vain. Ultimately, op.4 repudiated the claim of the complainant on 05.06.2017. This commission has the considered opinion that the complainant’s brother lodged the police intimation on the same day i.e. 15.11.2014 of occurrence of death of complainant’s husband. We feel that the delay if any occurred due to awaiting the report of chemical examiner which was prepared by the chemical examiner on 02.02.2016 which was received by the office of SHO, Sangrur on 12.02.2016. SHO, Police Station, Dhuri moved an application dated 11.05.2016 for taking the opinion of Concerned doctor. Then the concerned doctor has given his opinion on 31.05.2016 regarding the cause of death occurred due to electric shock. “ A man can lie, but document can’t”.

11.   On the basis of pleadings of both the parties as well as documentary evidence led by the them, this Commission has no hesitation to hold that on the part of complainant has no delay to lodged the claim with the Ops. We feel that the insurance company received huge amount by way of premium and issue  the insurance policy to the innocent consumers frequently. On the other hand, Civil Society Phenomenon is toward the insurance  Companies  are avoiding by one pretext  or another  to pay the liability of insurance claim to the aggrieved consumers, we feel that  an insurance contract is known as a contract of “ uberrima fides” based  on “ utmost good faith” which is fully applicable in the present complaint. The Consumer Commissions are duty bound to provide justice to the deserving consumers. The Consumer Commission redresses the grievances through  justice to the innocent consumers, but the justice seems to be. We feel that the complainant is liable for relief. This is a fit case to redress the grievances of the complainant.

12.   Resultantly, keeping in view of the  facts and the peculiar circumstances of the case   in hand  and with  careful  analysis  of the evidence available on record. We partly allow the complaint of the complainant and directed the Op.4 to pay the insured amount of Rs. 1,00,000/- to the complainant alongwith interest @7% from the date of filing of the complaint till realization. Further, Op.4 to pay a consolidated sum of Rs. 10,000/- as compensation and litigation expenses.  This order of ours shall be complied within 45 days from the receipt of copy of the order.

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

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

 

                            Announced.                                      

                            June 20, 2024

 

( Kanwaljeet Singh)     (Sarita Garg)         (Jot Naranjan Singh Gill)    

Member             Member                     President