State Consumer Disputes Redressal Commission
Simarjeet Kaur vs National Insurance Company Ltd. on 9 September, 2013
2nd Additional Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
First Appeal No. 576 of 2012
Date of institution: 9.5.2012
Date of Decision : 9.9.2013
Simarjeet Kaur @ Simranjeet Kaur aged about 36 years widow of
Jaswinder Singh, resident of # 49, Village Kangar, Tehsil Phul, District
Bathinda.
.....Appellant/Complainant
Versus
1. National Insurance Company Ltd., Divisional Office, The Mall,
Bathinda, through its Divisional Manager.
2. National Insurance Company Ltd., Division III, 1 Shakespeare
Sarani, 6th Floor, Kolkatta, Now Division No. III, 8, India
Exchange Place, Kolkatta 700001, through its Divisional
Manager.
3. Golden Trust Financial Services (G.T.F.S.) S.B. Mansion 16, R.N.
Mukherjee Road, Kolkatta 700001, Through its
owner/M.D./Manager.
4. Golden Multi Service Club of Golden Trust Financial Services
(G.T.F.S.), S.B. Mansion 16, R.N. Mukherjee Road, Kolkatta
700001, Through its owner/M.D./Manager.
.....Respondent/Opposite Parties
Argued By:-
For the appellant : Sh. Navneevan Gupta, Advocate for
Sh. Mukand Gupta, Advocate
For respondents No.1&2 : Sh. Rajesh Verma, Advocate
For respondents No.3&4 : None.
First Appeal against the order dated 19.3.2012
passed by the District Consumer Disputes
Redressal Forum, Bathinda.
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member
Shri Piare Lal Garg, Member Gurcharan Singh Saran, Presiding Judicial Member The appellant/complainant (hereinafter called 'the complainant') has filed the present appeal against the order dated FIRST APPEAL NO. 576 OF 2012 2 19.3.2012 passed by the District Consumer Disputes Redressal Forum, Bathinda (hereinafter called "the District Forum") in consumer complaint No. 436 of 29.8.2011.
2. The complainant-Simarjeet Kaur has filed the complaint under Section 12 of the Consumer Protection Act, 1986 (in short 'the Act') against the opposite parties on the allegations that Jaswinder Singh deceased had purchased personal accidental insurance policy from opposite parties Nos. 1 & 2 through OP Nos. 3 & 4 for a sum of Rs. 5,00,000/- for the period of 8.4.2004 to 7.4.2019 and opposite party had issued insurance certificate through OP Nos. 3 & 4 and no policy alongwith terms and conditions was ever issued in this regard. If the terms and conditions have been explained to the insured at the time of issuance of insurance cover, these could have been given to them at the same time or at least these could have been got signed from them, therefore, these were not brought to the notice of the complainant. The complainant is nominee and Class-I heir of the deceased. The signatures of deceased Jaswinder Singh were taken on the blank proposal form at the time of said insurance. According to the policy, the accidental death is covered for a sum of Rs. 5 lacs.. Jaswinder Singh died on 20.7.2010 due to electric shock in the fields and his post mortem is conducted at Civil Hospital, Rampura Phul. The brother of the deceased immediately lodged the claim under P.A. with opposite party and also submitted all the required documents. Opposite parties appointed one Investigator Mr. R.K. Sharma, who visited the complainant and recorded her statement and Sukhmander Singh brother of the deceased on 15.1.2011 also. He also verified the FIRST APPEAL NO. 576 OF 2012 3 post mortem report, DDR and final police report from P.S. Dialpura. However, to the utter surprise of the complainant, she received a letter dated 28.2.2011 from opposite party No. 2 in which they demanded Employer Salary Certificate/ copy of Form No. 16 of IT Return for the year 2004-05 whereas the deceased was only an agriculturist and no income tax is levied on agricultural income, therefore, he did not file any return with the Income Tax Officer and he lodged the protest to the opposite parties and moreover, the claim of the complainant cannot be repudiated due to non-producing the documents, which are not in their possession. The Investigator appointed is under the thumb of opposite parties and cannot afford to disoblige their master and he made the report under the instructions of the opposite party. The opposite parties are service oriented company and in case of any loss and damage they are supposed to provide services and settle the claim within two months from the date of intimation to the customers. The opposite parties has not paid the claim of the complainant for which he has suffered great mental agony and pains for which the complaint was filed with the direction to the opposite parties to make the total loss amount of Rs. 5 lacs alongwith damages to the extent of Rs. 1 lac and litigation cost of Rs. 50,000/-.
3. The complaint was contested by the opposite parties. Opposite parties No. 1 & 2 in their reply have taken legal objections that the complaint has been filed to injure the goodwill and reputation of the opposite party; complicated questions of law and facts are involved which required elaborate evidence and the matter be FIRST APPEAL NO. 576 OF 2012 4 relegated to the Civil Court; the complainant has concealed the material facts; the complainant was called upon to submit income tax return for the year 2004-05 at the time of taking the policy of the insured vide letter dated 28.2.2011 but the complainant did not submit the document which was essential for settlement of the claim, therefore, the complaint is premature and liable to be dismissed. The insurance policy is contract between the parties and both the parties are bound by the terms and conditions; the complainant has no cause of action and locus-standi to file the complaint, the complainant has not impleaded all the legal heirs of Jaswinder Singh. On merits, it was denied that only the insurance certificate was issued to the complainant but the terms and conditions were printed/ mentioned on the said insurance certificate but the complainant has produced only the front page of the same. It is correct that there was coverage of Rs. 5 lacs in case of accidental death. It was further submitted that deceased Jaswinder Singh was himself thoroughly negligent and he started refitting the motor in the bore without waiting for electrician and without confirming from the Power Grid regarding the supply of electricity and that he did not take proper care and was entangled with the electric cut/wires. It has been further stated that on 28.2.2011 letter was sent to the complainant to submit Income Tax Return for the year 2004-05 to decide the claim and eligibility as per the terms and conditions of the policy. It has been denied that no income tax return is filed by the agriculturist; due to this reason, the claim of the complainant could not be adjudicated, therefore, the complaint is premature. Accordingly, it has been stated that there is no deficiency FIRST APPEAL NO. 576 OF 2012 5 in services on the part of the opposite parties and the same be dismissed.
4. OP Nos. 3 & 4 has filed reply that deceased Jaswinder Singh had obtained Janta Personal Accident Insurance Coverage under Group Insurance Policy from National Insurance Co. Ltd. through policy No. 100300/47/01/9600022/04/96/30017 for the period of 8.4.2004 to 7.4.2019. OP Nos. 3 & 4 are just agent, therefore, there is no liability with them and they are also not jointly and severally liable to pay the claim. Jaswinder Singh had died accidental death due to electric shock in his fields while refitting his motor and after that the complainant was requested to submit her claim documents and after he received the same from the complainant; were sent to opposite parties and it was for the insurance company to settle the claim. Ultimately, it was submitted that the complaint qua them be dismissed.
5. The parties were allowed by the learned District Forum to lead their evidence.
6. In support of his allegations, the complainant had tendered into evidence affidavit of Simarjeet Kaur Ex. C-1, affidavit of Vipan Kumar Ex. C-2, insurance cover Ex. C-3, copy of DDR, Post Mortem, Jamabandi Ex. C-4 to C-6, certificate Ex. C-7, letters Ex. C-8 to 12, memorandum of understanding Ex. C-13, claim form Ex. C-14 and other documents Ex. C-15 to C-24. On the other hand, opposite parties No. 3 & 4 had tendered into evidence affidavit of Shantau Saha Ex. R-1 and opposite parties No. 1 & 2 tendered into evidence affidavit of Pawan Chaudhary, DM Ex. R-2, affidavit of R.K. Sharma, FIRST APPEAL NO. 576 OF 2012 6 investigator Ex. R-3, photocopies of schedule of premium, cover note and investigation report and proposal form Ex. R-4 to R-7.
7. After going through the submissions in the complaint, written statements, evidence and documents on the record, the learned District Forum in its impugned order observed that Jaswinder Singh died in accident for which he was insured with OP Nos. 1 & 2 and in the terms and conditions there is no requirement to furnish Income Tax Return as demanded by OP No. 1. With regard to impleading the legal heirs of the deceased Jaswinder Singh, the nominee is authorised to receive the payment and in case other legal heirs of the deceased had dispute then they can settle their dispute with the complainant but the opposite party cannot deny the claim of the complainant. Accordingly, the complaint was allowed with the direction to opposite parties No. 1 & 2 to pay the sum insured amount of Rs. 5 lacs and compensation to the extent of Rs. 25,000/-.
8. Aggrieved with the order passed by the learned District Forum, the appellant/complainant has filed the present appeal.
9. In the grounds of appeal, it has been contended by the counsel for the appellant that just Rs. 25,000/- has been given as compensation. In case the interest would have been calculated atleast @ 9% per annum from the date of death of the husband of the complainant then certainly, it would have been more than Rs. 25,000/- and accordingly, as per I.R.D.A. instructions, the insurance company is liable to pay 2% interest above the bank rate prevailing at the beginning of the financial year, therefore, the amount of compensation be increased.
FIRST APPEAL NO. 576 OF 2012 7
10. We have heard the learned counsel for the appellant Sh. Navjeevan Gupta, Advocate for Sh. Mukand Gupta, Advocate and learned counsel for respondents No. 1 & 2 Sh. Rajesh Verma, Advocate.
11. As per the version of the appellant/complainant, it has been contended that according to IRDA Rule 9(6), it has been provided as under:-
(6) Upon acceptance of an offer of settlement as stated in sub-
regulation (5) by the insured, the payment of the amount due shall be made within 7 days from the date of acceptance of the offer by the insured. In the cases of delay in the payment, the insurer shall be liable to pay interest at a rate which is 2% above the bank rate prevalent at the beginning of the financial year in which the claim is reviewed by it."
12. Whereas after accepting the claim of the complainant, the learned District Forum has awarded a compensation just of Rs. 25,000/- and interest has been given from 29.8.2011 whereas the husband of the complainant died on 20.7.2010, therefore, she was entitled to interest from that date and in case the interest has not been awarded then the compensation should have been given accordingly. Whereas, it has been argued by the counsel for respondents No. 1 & 2 that the compensation is just discretion of the learned District Forum and it cannot be claimed as a matter of right.
13. We have considered the contentions raised by the counsel for the parties. No doubt the compensation is discretion of the District Forum but there should be some basis for granting the compensation and it should not be given arbitrarily. In case we go through IRDA Rule 9(6) then the interest should have been 2% over FIRST APPEAL NO. 576 OF 2012 8 and above the prevalent rate of interest and from the date the husband of the complainant had died but it was given from the date of the complaint. In case the claim was wrongly repudiated, the interest should have been awarded from three months after the death of the husband of the complainant i.e. 20.10.2010 as this time is required to process the claim, on the sum of Rs. 5 lacs @ 9% per annum, therefore, we are of the opinion that the interest should have been awarded from after three months from the date of death of the husband of the complainant i.e. 20.10.2010 and not from the date of filing of the complaint.
14. In view of the above discussion, the appeal filed by the appellant is partly allowed with no order as to costs and the order dated 19.3.2012 of the learned District Forum is modified to the extent that the appellant/complainant will be entitled to interest on the sum of Rs. 5 lacs after three months from the date of death of the husband of the complainant i.e. 20.10.2010.
15. The arguments in this appeal were heard on 3.9.2013 and the order was reserved. Now the order be communicated to the parties as per rules.
16. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
(Gurcharan Singh Saran)
Presiding Judicial Member
September 9, 2013. (Piare Lal Garg)
as Member
FIRST APPEAL NO. 576 OF 2012 9