State Consumer Disputes Redressal Commission
Reliance Life Insurance Company Ltd. vs Surjeet Singh on 20 September, 2017
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH.
First Appeal No.71 of 2017
Date of institution : 02.02.2017
Date of decision : 20.09.2017
Reliance Life Insurance Company Limited, 2nd Floor, opposite
Municipal Council, The Mall, Ferozepur City, through its
Authorized Signatory. Mr. Muniesh Khosla, Senior Territory
Manager, Reliance Life insurance, available at SCO 147-148, First
Floor, Sector 9-C, Madhya Marg, Chandigarh.
....Appellant/Opposite Party
Versus
Surjeet Singh, aged about 37 years, S/o Sh. Jarnail Singh, Village
Basti Mohmohd Shah, P.O. Doad, near Railway Phatak, Tehsil &
District Ferozepur.
....Respondent/Complainant
First Appeal against the order dated
15.12.2016 of the District Consumer
Disputes Redressal Forum, Ferozepur.
Quorum:-
Hon'ble Mr. Justice Paramjeet Singh Dhaliwal, President
Mrs. Kiran Sibal, Member
Present:-
For the appellant : Sh. Inderjit Singh, Advocate For the respondent : Sh. G.S. Bhandari, Advocate. JUSTICE PARAMJEET SINGH DHALIWAL, PRESIDENT The instant appeal has been filed by the appellant/opposite party against the order dated 15.12.2016 passed by District Consumer Disputes Redressal Forum, Ferozepur (in short, "the District Forum"), whereby the complaint First Appeal No.71 of 2017 2 filed by the respondent/complainant, under Section 12 of the Consumer Protection Act, 1986, was allowed and the opposite party was directed to pay the remaining insurance claim of ₹2,50,000/-, due to accidental death of Sh. Jarnail Singh, along with interest at the rate of 9% per annum from 31.03.2016, when it paid lesser amount of ₹2,50,000/- out of the claim amount, till realization. It was further directed to pay ₹3,000/-, as consolidated compensation for mental agony, pain and harassment as well as litigation expenses.
2. It would be apposite to mention that hereinafter the parties will be referred, as have been arrayed before the District Forum.
Facts of the Complaint
3. Brief facts, as averred in the complaint, are that the complainant is the nominee of his father Jarnail Singh, insured (now deceased), who was holder of policy ID No.89342869 issued by the opposite parties, for the sum assured of ₹2,50,000/-, under which total death benefit on account of accident was provided to the tune of ₹5,00,000/-. Under that policy, annual premium of Rs.15,000/- was payable for 15 years. During his life time, Sh. Jarnail Singh had been paying the instalments regularly. He died an accidental death on 06.03.2016 at 10.00 P.M. due to electric current at his tubewell while irrigating his crops. His death certificate, Panchayatnama, copy of police Rapat No.16 and verification conducted by SHO Mamdot are attached with the First Appeal No.71 of 2017 3 complaint. It was further averred that the complainant is entitled to ₹5,00,000/-, whereas the opposite party paid only ₹2,50,000/- to him. He approached and requested to opposite party to pay the remaining amount of ₹2,50,000/-, but to no effect. The aforesaid act and conduct of the opposite party amounted to deficiency in service and unfair trade practice. Hence, the complainant approached the District Forum, seeking directions to the opposite parties to pay ₹2,50,000/- as remaining insurance claim amount; ₹50,000/-, as compensation for mental agony, pain and harassment; and ₹5500/-, as costs of litigation. Defence of the Opposite Parties
4. Upon notice, the opposite party appeared before the District Forum and filed reply to the complaint, raising preliminary objections that the complaint is not maintainable, as it had already settled the death claim of insured and paid the amount of ₹2,50,000/-, as per terms and conditions of the policy and nothing remained due against the opposite party. The complainant did not approach the District Forum with clean hands and suppressed the material facts. In fact, the insured died on 06.03.2016 and the claim was lodged on 21.03.2016 and there was a delay of 15 days in intimating the opposite party. Thereafter, the opposite party released the claim amount on 31.03.2016. After receipt of claim amount, the complainant, in connivance with the police, got lodged the DDR No.16 dated 24.04.2016 with the Police Station Mamdot, District Ferozepur. The complainant violated the terms and First Appeal No.71 of 2017 4 conditions of the policy, as he failed to produce Post Mortem report or any other document to substantiate the accidental death of life assured. The cheque of the said amount of ₹2,50,000/- was duly encashed by the complainant, without lodging any protest. On merits, the pleas, as taken in preliminary objections, were reiterated and it was pleaded that the complainant ceased to be the consumer, after encashment of the aforesaid cheque. He is not entitled to any other amount. All other allegations of the complainant were also denied and dismissal of the complaint was prayed.
Finding of the District Forum
5. Both the sides produced evidence in support of their respective averments before the District Forum, which after going through the same and hearing learned counsel on their behalf, allowed the complaint, vide impugned order. Hence, this appeal. Contentions of the Parties
6. We have heard learned counsel for the parties and have carefully gone through the records of the case.
7. Learned counsel for the appellant/opposite party vehemently contended that the deceased life assured (in short, "the DLA") died on 06.03.2016 and the claim was lodged on 21.03.2016 i.e. after the delay of 15 days. After receipt of claim amount, the complainant in connivance with the police, got lodged the DDR No.16 dated 24.04.2016 with the Police Station Mamdot, District Ferozepur. The complainant violated the terms and First Appeal No.71 of 2017 5 conditions of the policy, as he failed to produce any medical document. No post-mortem was got conducted, which was mandatory, as per the policy conditions and insurance rules and norms. It was further contended that the death claim of deceased life insured (in short, "DLA") has already been settled and paid the amount of ₹2,50,000/- on 31.03.2016, as per terms and conditions of the policy. The complainant duly got encashed the cheque of the said amount issued by the opposite parties and nothing is due against the opposite party. It was, thus, contended that the appeal may be allowed and the impugned order may be set aside.
8. Per contra, learned counsel for the respondent/ complainant vehemently contended that his father died on 06.03.2016 due to electric shock in the fields, while irrigating the crops. Under the policy, in question, the total death benefit on account of accident was ₹5,00,000/-. The complainant lodged a DDR regarding the accident with the Police Station, Mamdot, who conducted investigation, in which it was found that the DLA died due to electric shock. However, out of the total compensation of ₹5,00,000/-, the opposite party had paid only ₹2,50,000/-. The District Forum passed the impugned order, after properly appreciating the entire evidence on record. It was, thus, contended that the appeal may be dismissed.
Consideration of Contentions
9. We have given thoughtful consideration to the contentions raised by the learned counsel for the parties. First Appeal No.71 of 2017 6
10. Admittedly, Sh. Jarnail Singh (now deceased), father of the complainant, was insured with the opposite party, vide policy documents Ex.C-2 and Ex.C-3; under which the total death benefit on account of accident was provided to the tune of ₹5,00,000/-. The DLA died on 06.03.2016 due to electric current in the fields, while irrigating the crops. Panchayatnama, Ex.C-5, issued by the Gram Panchayat of Village Basti Mohammad Shah duly prove this fact. The complainant lodged DDR, Ex.C-6, with P.S. Mamdot, District Ferozepur. On the basis of that DDR, an investigation was conducted by Sh. Manjit Singh, S.H.O., who submitted his report dated 24.04.2016, authenticating the death of the DLA due to electric current in the fields while irrigating his fields. The complainant lodged the claim with the opposite parties, who vide letter dated 31.03.2016, Ex.OP-2, settled the claim to the tune of ₹2,50,000/- and sent the cheque of that amount to the complainant in full and final settlement. It is not disclosed in that letter, as to how and in what circumstances, the claim was settled to the tune of ₹2,50,000/- only.
11. The plea of the opposite party that the complainant intimated it about the death of the DLA after 15 days of the accident, is not tenable, because no such ground was taken by the opposite party in its letter Ex.OP-2. In fact, the opposite party had not repudiated the claim, rather the claim was settled by it, vide that letter. Even otherwise, the family of the DLA must have remained in grief, after his sudden death. It is a matter of common First Appeal No.71 of 2017 7 knowledge that after the sudden death of an insured person in a family, the family members are not supposed to go first to the Insurance Company to inform it about the death. The family member usually remain busy in performing last rites of the deceased for some days and due to that reason, some delay is likely to be happened. In such circumstances, it cannot be said that the delay was intentionally caused by the complainant in intimating the Insurance Company.
12. So far as the plea of the opposite party that the complainant violated the terms and conditions of the insurance policy, as no Postmortem Examination of the DLA was conducted after his death is concerned, it was held by this Commission in "Parkash Kaur & others v. ICICI Lombard General Insurance Company & another" 2009(1) CLT 74, which was a case of death due to snake bite, that the claim cannot be repudiated simply on the ground that the post mortem report or police report is not proved despite the fact that the snake bite or accident is proved by other evidence. Similarly, this Commission in "Manager, Health Administrator Team, Bajaj Allianz General Insurance Co. Limited v. Ravinder Kaur & Ors." 2012 (1) CPC 100 held that where the insured died due to inhaling of insecticide the claim cannot be repudiated on the ground that the FIR was not filed and that the post mortem examination was not conducted.
13. The District Forum also rightly relied upon the judgment of this Commission reported as Life Insurance First Appeal No.71 of 2017 8 Corporation of India v. Smt. Nidhi Sahi 2005 (1) CPC 533, in which it was held that in the absence of FIR or Postmortem report, the factum of death in a particular way can be proved by producing other evidence. Similarly, in National Insurance Company Limited v. Rita Devi 2006 (II) CPC 599 (Haryana), it was held that non-production of Postmortem report cannot be made a ground for repudiation of the claim.
14. In view of the law laid down in above noted judgments, we hold that the non-production of Postmortem report or FIR cannot be made basis for repudiation/denial of the insurance claim.
15. The sum and substance of above discussion leads us to the conclusion that the opposite parties withheld the remaining amount of claim i.e. ₹2,50,000/- in an illegal and wrongful manner. The complainant being nominee of the DLA under the policy, in question, is entitled to the remaining claim amount of ₹2,50,000/-. The District Forum, after properly and minutely going through the entire evidence on the file, correctly passed the impugned order and the appeal merits dismissal.
16. Accordingly, the appeal is dismissed and the impugned order is upheld.
17. The appellant had deposited a sum of ₹25,000/- at the time of filing of the appeal. It deposited another sum of ₹2,77,375/- , vide receipt dated 06.06.2017, in compliance of the directions of this Commission. Both these amounts, along with interest which First Appeal No.71 of 2017 9 has accrued thereon, if any, shall be remitted by the registry to the District Forum, after the expiry of 45 days of the sending of certified copy of the order to them. The respondent/complainant may approach the District Forum for the release of the above amount and the District Forum may pass the appropriate order in this regard, in accordance with law.
18. The appeal could not be decided within the statutory period due to heavy pendency of court cases.
(JUSTICE PARAMJEET SINGH DHALIWAL) PRESIDENT (MRS. KIRAN SIBAL) MEMBER September 20, 2017.
(Gurmeet S)