Punjab

Sangrur

CC/548/2019

Gindero Devi W/o Late Amrik Singh R/o near Dehlan Road, Ward No.3 Tehsil Moonak District Sangrur. - Complainant(s)

Versus

United India Insurance Company - Opp.Party(s)

Sh. L.S.Walia

05 Oct 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR .

 

                                                                        Complaint No. 548

 Instituted on:   22.10.2019

                                                                         Decided on:     05.10.2023

 

 

Gindero Devi wife of Late Amrik Singh, resident of Dehlan Road, Ward No.3, Tehsil Moonak, District Sangrur.

                                                         …. Complainant 

                                                 Versus

1.             United India Insurance Company Limited, SCO No.72, Phase-9, Mohali through its Manager 160062.

2.             Punjab Health Systems Corporation, Phase VI, SAS Nagar, Mohali 160056 through its Managing Director.

3.             State of Punjab through Deputy Commissioner, Sangrur 148001.

                                                        ..Opposite parties.

 

For the complainant  :       Shri L.S. Walia, Adv.

For OP No.1             :       Shri Bhushan Garg, Adv.

For OP No.2&3         :       Shri Vinay Jindal, 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, Shri Amrik Singh was the member of Bhagat Puran Singh Sehat Bima Yojna against which the OPs issued card bearing number 9305-3000-0778-0027-9 to Shri Amrik Singh. It is further averred that under the said scheme  Shri Amrik 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 27.2.2019 at about 6.30 PM husband of the complainant, namely, Shri Amrik Singh met with an accident and was immediately taken to Civil Hospital Moonak from where he was referred to higher centre for better treatment  and he died on the way. Thereafter on the statement of one Bagga Ram son of Garib Dass, GDR number 49 dated 28.2.2019 was lodged at PS Moonak. Further it is averred that after the death of the husband of the complainant she lodged the claim with the OPs at customer care  number 104 on 29.5.2019 from mobile number 99142-44692 and the OPs assured that the claim will be released shortly.  Further on 15.6.2019 the surveyor of OP number 1 namely Nirmal Singh visited the house of complainant and took signatures of complainant on printed performa for release of the claim amount. But thereafter the complainant received a letter from OP number 1 whereby it was stated that post mortem report be submitted, but since no post mortem was conducted at the dead body of the deceased, the complainant could not submit the same. It is further stated that the complainant though provided the certificate of doctor showing road side accident (RSA) of the assured, but the OPs did not accept such a contention of the complainant and failed to release the rightful claim of the complainant. Thus, alleging deficiency in service on the part of the Ops, 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 of Rs.1,00,000/- and an amount of Rs.22,000/- was claimed as litigation expenses.

3.             In reply filed by OP number 1,  legal objections are taken up on the grounds that OP number 1 has no privitiy of contract with the complainant or deceased Amrik Singh, that the complainant has no cause of action and locus standi to file the present complaint, that there is no deficiency in service on the part of the OPs and that the complainant is not a consumer. On merits, it is stated that Punjab Govt. launched Bhagat Puran Singh Sehat Bima Yojna as per which, the claim of Rs.5,00,000/- was payable to the defendants in case of accidental death.  It has been denied that husband of the complainant died in an accidental death and it is also denied that he was taken to Civil Hospital Moonak and thereafter he died on the way when was taken to higher centre for treatment. It is stated that post-mortem report is a necessary document for just settlement of the claim. It is stated further that the investigator also intimated in his report dated 20.6.2019 that no post-mortem has been conducted on the dead body of the deceased Amrik Singh. The other allegations levelled in the complaint have been denied in toto. Lastly, OPs have prayed that the complaint is liable to be dismissed.

4.             Record shows that  OPs number 2 and 3 did not file written response, as such their defence was struck off vide order of this Commission dated 29.10.2021.

5.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-16 copies of documents and affidavit and closed evidence. On the other hand, the learned counsel for OP number 1 has produced Ex.OP1/1 to Ex.OP1/5 copies of documents and affidavit and closed evidence. The OPs number 2 and 3 did not produce any 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 1 that  husband of complainant, Shri Amrik Singh was insured with the OP number 1 for Rs.5,00,000/- in case of accidental death. It is also not in dispute that Shri Amrik Singh died on 27.2.2019, as is evident from the copy of death certificate, which is on record as Ex.C-8,  GDR number 49 dated 28.2.2019 regarding the death of the insured was also recorded, a copy of which on record is Ex.C-10 wherein it has been clearly mentioned that Shri Amrik Singh died due to accident which took place at Moonak.  The disputed fact is only that the OP number 1 objected that the complainant has not produced on record the copy of post-mortem report, which is very much necessary for just decision of the case. 

8.             To support the contention, the complainant has produced ExC-1 her sworn affidavit,  Ex.C-10 copy of GDR, Ex.C-9 is the copy of certificate issued by Member Nagar Panchayat Moonak wherein it has been clearly stated that Shri Amrik Singh died due to accident on 27.2.2019. Further we have perused copy of OPD Slip Ex.C-14 issued by Medical Officer Sub Divisional Hospital Moonak, wherein it has been clearly mentioned that Amrik Singh had visited to Emergency on 27.2.2019 at 6.40 PM with the history of road side accident and after giving him first aid the patient was referred to higher centre for further management. Further Ex.C-15 is the copy of again prescription slip (OPD slip) dated 27.2.2019 and attested by Medical Officer where the word RSA (Road Side Accident) has been clearly mentioned on the document. The complainant has alleged that all this clearly shows that the husband of the complainant died due to road side accidental injuries. 

9.             On the other hand, the learned counsel for the OPs have drawn our attention towards various letters written to the complainant Gindero Devi demanding copy of post-mortem certificate of deceased Amrik Singh vide letters Ex.OP1/2 to Ex.OP1/5. Ex.OP1/6 is the copy of agreement. It is no doubt true that the complainant has not produced any post-mortem report on record, but we may mention that the complainant has produced sufficient evidence i.e. report of doctor where the deceased Amrik Singh was immediately admitted in the hospital after the accident. This report cannot be ignored which is very much helpful to the case of the complainant.  Reliance can be placed on the judgment pronounced by the Hon’ble Punjab State Commission in Manager, Health Administrator Team, Bajaj Allianz General Insurance Co. Ltd. versus Ravinder Kaur 2010(3) CLT 509 (Punjab State Commission), wherein it was held that police report and post-mortem report are not essential documents in themselves, when the death by accident or by inhaling of insecticides is clearly proved by other means the repudiation of insurance claim cannot be sustained. Death of assured held to be accidental death.  Similarly, the Punjab State Commission in Darbara Singh and others versus The Taprian Amar Singh Cooperative Agriculture Services Society Limited another 2013(4) CLT 192, wherein it has been held that merely non producing of the post-mortem report itself is not sufficient to throw away the case of the appellants. The post-mortem could have been conducted, had the deceased died in the hospital, but in the absence of that, there is nothing to suggest that the deceased has not met with an accident or not died due to injuries received in the accident. Respondent No.3 repudiated the claim, just on the ground of non production of the post-mortem report, which has nothing to do with the death and the cause of death was very clear from the other documents produced. 

As such, we find that in the present case, the complainant has sufficient proved her case by producing cogent, reliable and trustworthy evidence to show the accidental death of Shri Amrik Singh. More over, the Ops have not produced any evidence to the contrary. As such, we are of the considered opinion that the deficiency in service on the part of the OP number 1 is writ large, as the OP number 1 has wrongly and wilfully repudiated the rightful claim of the complainant.

10.           In view of our above discussion, we allow the complaint and direct OP number 1 to pay to the complainant an amount of Rs.5,00,000/- along with interest @ 7% per annum from the date of filing of the present complaint i.e. 22.10.2019 till realisation in full. We further direct OP number 1 to pay to the complainant an amount of Rs.5000/- in lieu of compensation for mental tension, agony and harassment as well as an amount of Rs.5000/- on account of  litigation expenses. This order shall be complied with by OP number 1 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.

 

                       October 5, 2023.

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