State Consumer Disputes Redressal Commission
National Insurance Co. Ltd vs Sh. Rahul on 19 February, 2026
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH.
First Appeal No.194 of 2025
Date of institution : 05.03.2025
Reserved on : 09.02.2026
Date of Decision : 19.02.2026
The Regional Manager, Regional Office, National Insurance Co. Ltd.,
Regional Office PMSBY Claim Hub, SCO 332-334, Sector 34-A,
Chandigarh (UT).
....Appellant/Opposite Party No.1.
Versus
1. Rahul @ Rahil s/o Sarwan Singh r/o VPO Adamwal, Tehsil &
District Hoshiarpur (Punjab) 146001.
.......Respondent No.1/Complainant.
2. Manager, State Bank of India, Kanak Mandi Branch, Hoshiarpur
146001.
.......Respondent No.2/Opposite Party No.2.
First Appeal under Section 41 of the
Consumer Protection Act, 2019
against the order dated 10.12.2024
passed by the District Consumer
Disputes Redressal Commission,
Hoshiarpur in CC No.463 of 2022.
Quorum:-
Hon'ble Mrs. Justice Daya Chaudhary, President
Ms. Simarjot Kaur, Member
1) Whether Reporters of the Newspapers may be allowed to see the Judgment? Yes/No
2) To be referred to the Reporters or not? Yes/No
3) Whether judgment should be reported in the Digest?
Yes/No Present:-
For the appellant : Sh.G.S.Ahluwalia, Advocate For respondent No.1 : Sh.Kartik Gupta, Advocate For respondent No.2 : None FA No.194 of 2025 2 SIMARJOT KAUR, MEMBER :
The Appellant/Opposite Party No.1 has filed the present Appeal to challenge the impugned order dated 10.12.2024 passed by the District Consumer Disputes Redressal Commission, Hoshiarpur (in short, "the District Commission"), whereby the Complaint filed by the Complainant had been partly allowed.
2. It would be apposite to mention here that hereinafter the parties will be referred, as were arrayed before the District Commission.
3. Briefly, the facts of the case as made out by the Complainant in the Complaint filed before the District Commission are that Smt.Sukhwinder Kaur, late mother of the Complainant had her Savings Bank Account with the OP No.2 Bank. OP No.2 had issued her the PMSBY Policy with sum insured @ Rs.2.0 Lac by deducting an annual premium of Rs.12/- from her account. The Complainant was the nominee in the said PMSBY. On 11.10.2021, late Smt.Sukhwinder Kaur, the insured had accidentally consumed an expired medicine at her home and breathed her last on the same day. The incident was reported to the Police Station Sadar. The proceeding u/s 174 Cr.P.C. was initiated. The statements of the various relatives of the deceased as well as of Lambardar Satvir Singh were recorded. The Post-Mortem was conducted at the local Govt. Hospital. In due course of time, Complainant being nominee of Late Sukhwinder Kaur had filed death claim along with all the requisite documents with OP No.1- Insurer. The Complainant had FA No.194 of 2025 3 followed-up with OP No.1 on regular basis vide telephonic calls/ personal visits. The Complainant had served a legal notice upon OPs to make the payment of the maturity amount of Rs.2,00,000/-, as per the Policy along with interest and compensation. The said notice was replied by OP No.1 through email by giving false reason that the final opinion/chemical examination report of the deceased had not been received from OP No.2. In the absence of any report regarding exact cause of death, they were unable to process the case further. Hence, the Complaint was filed by the Complainant with the prayer to issue directions to the OPs to pay an amount of Rs.2,00,000/- as maturity amount of the policy in dispute along with Rs.50,000/- as compensation on account of mental tension, agony and harassment and to pay an amount of Rs.20,000/- as cost of litigation.
4. Upon issuance of notice of the Complaint, the OP No.1 had appeared and filed the written version by raising certain preliminary objections. It was alleged that Smt.Sukhwinder Kaur @ Satwinder Kaur had died by consuming poisonous substance which amounts to suicide. Thus, no claim was payable on account of her coverage under Pradhan Mantri Suraksha Bima Yojna (PMSBY). The death by way of suicide was not covered under the said scheme. Therefore, the claim was rightly repudiated. On merits, it was denied that the deceased had consumed any expired medicine. The medical record of the deceased had established that the mother of the Complainant had consumed poisonous substance which amounts to suicide. Thus, no claim was payable to late Smt. Sukhwinder Kaur/her nominee. It was admitted that the OPs had rightly sought FA No.194 of 2025 4 chemical examination report of the deceased to know exact cause of death. As per information provided by the Police in Post-Mortem Report, the deceased had expired due to suspected poisoning. The doctor in the PMR had reserved his opinion regarding cause of death and had mentioned that opinion would be given after receipt of Chemical Examiner Report of Viscera. The Insurance Company-OP No.1 had asked SBI-OP No.2 also to supply final opinion of the doctor/Chemical Examination Report to know the cause of death. OP No.1 had sent emails on 19.03.2021, 02.04.2021 and 03.05.2021 with final reminder dated 18.06.2021. However, no reply was ever received. Thus, the Insurance Company-OP No.1 vide its email dated 27.07.2021 had reported the case as 'No Claim'. The OP No.1 had stated that there was no 'deficiency in service' on their part as the Complainant had failed to provide chemical examination report of the deceased. All other averments made in the complaint were denied and OP No.1 had prayed for dismissal of the Complaint.
5. Upon issuance of notice of the Complaint, OP No.2 had appeared and filed its written version by mentioning that OP No.2 had sent the claim papers of the deceased linked to her Bank account for taking decision in the matter. The relevant documents were also sent with the claim papers. It was stated that OP No.2 had received a legal notice and the same was replied by the concerned parties stating therein that the chemical report of the case was yet to be received. The case would be decided thereafter. It was also mentioned in the hospital report wherein it had categorically stated that the death of the deceased had occurred due to suspected FA No.194 of 2025 5 poisoning. Now, the suspected poisoning was to be decided as per law/instructions of the Insurance Company. It was further stated that there is no 'deficiency in service' as OP No.2 has forwarded the case to the Insurance Company without any delay and final decision of the case was pending with the OP No.1. OP No.2 prayed for dismissal of the Complaint.
6. By considering the averments made in the Complaint, the Complaint filed by the Complainant was partly allowed vide order dated 10.12.2024 passed by the District Commission. The relevant part of said order is reproduced as under:-
"18. Thus, partly allow this Complaint and order the OP1 insurers to pay the impugned death-claim at the full S.I. sum insured of the related policy @ Rs.2.0 Lac with interest @9% PA with effect from its date of maturity till realization, with all its accrued benefits, if any, besides to pay him a sum of Rs.20,000/- in lump sum, as compensation cum cost of litigation within 45 days of receipt oof the copy of these orders, otherwise the entire awarded amont shall attract additional interest @3% PA from the date of the orders till realization, in entirety."
7. The Appellant/OP No.1 has filed the present Appeal being aggrieved by the order dated 10.12.2024 passed by the District Commission by raising a number of arguments.
8. Mr.G.S.Ahluwalia, Advocate learned Counsel for the Appellant/OP No.1 has argued on the similar lines as mentioned in the written reply. Learned Counsel has submitted that the Consumer Complaint was filed by Legal Heir of Sukhwinder Kaur, who had a FA No.194 of 2025 6 Saving Bank Account with SBI, Hoshiarpur. Mother of Complainant had availed an Insurance Policy under Pradhan Mantri Sureksha Bima Yogna (PMSBY) from NICL, wherein premium of Rs. 12/- was automatically deducted from her Bank account. Total sum insured under the policy was Rs.2.00 Lakhs. The Complainant was the nominee in the Bank Account of the deceased. Smt.Sukhwinder Kaur had allegedly died on 11.10.2020, due to consumption of some expired medicine by mistake. The learned Counsel has stated that the claim of the Complainant was repudiated by the Appellant/OP No.1 on the ground that the insured had died due to poisoning as per PMR. The doctor had reserved his final opinion regarding cause of death, on account of awaited Chemical Examination Report of Viscera.
9. It was further stated that PMSBY Scheme covers accidental death. Whereas, the death of deceased had occurred due to suicide. Therefore, the claim was not payable. Complainant had failed to produce on record Chemical Examination Report. There was no evidence that deceased had consumed expired medicine in the presence of any witness. Even otherwise, the consumption of expired medicine could be ineffective, but could not cause death.
10. It was also alleged that the District Commission had erroneously allowed the Complaint by ignoring the pleas of the OP No.1 that Post Mortem Report (PMR) was not conclusive. It was issued while the Chemical Examination Report of Viscera was awaited. It was averred that the Complainant had failed to produce FA No.194 of 2025 7 Report of Chemical Examination of Viscera, with a view to cover-up suicide.
11. The District Commission had not considered that the Complainants had not mentioned the name of alleged expired medicine along with Batch Number, date of Manufacture, date of expiry, name of Manufacturer, etc.
12. It was also alleged that the Complainant had concocted a false story, with the intent to unduly encash Insurance Policy. It has been observed by the District Commission that the insurer did not supply terms and conditions of policy to the insured, which is irrelevant. Whereas raising of claim itself proves that the terms and conditions of the policy were duly served upon insured. It was prayed that there was no 'deficiency in service' on the part of insurer. The claim was rightly repudiated since death was not accidental. Learned counsel for the Appellant had prayed for setting aside of order dated 10.12.2024 and for consequent dismissal of Consumer Complaint No.463 of 2022.
13. Mr.Kartik Gupta, Advocate, learned Counsel for the Respondent No.1/Complainant has reiterated the facts of the Complaint. Learned counsel for the respondent No.1/Complainant has submitted that District Commission had rightly allowed the Complaint. It had concluded that there was nothing on record to show that as to why the OPs had repudiated the claim of the Complainant. There was nothing on record to prove that deceased had allegedly died due to suicide and it was not a accidental death. FA No.194 of 2025 8 He has relied upon the judgements "IDBI Federal Life Insurance Company Ltd. Versus Anuva Ghosal and another", 2015 (14) RCR (Civil) 37 (NCDRC), "SBI Life Insurance Company Ltd. Vs. Sudesh Khanduja and another" decided by NCDRC in RP No.471 & 472 of 2012, "United India Insurance Company Ltd. Vs. Renuka Anandrao Jogdana", 2012 (54) RCR (Civil) 374 (NCDRC), "Bank Manager, HDFC Standard Life Insurance Co. Ltd. Vs. Pradosh Mandal & Anr. (NCDRC), Mohan Lal Vs. The Branch Manager, Life Insurance Corporation of India (PB.SCDRC), Cholamandlam Ms General Ins. Co. Ltd. Vs. Rameshbhai Ramjibhai Kakdiya (Gujarat SCDRC), "Bharti and others Vs. National Insurance Company & Anr." , Maharashtra SCDRC, "The Branch Manager M/s United India Insurance Company Limited Vs. E.Bhakthavastsala Reddy and others" (Andhra Pradesh SCDRC). Learned counsel for the Respondent No.1/Complainant has prayed that the present appeal be dismissed with costs and order dated 10.12.2021 and the claim of the Complainant be upheld and the same be released in favour of the Complainant.
14. None has appeared on behalf of the Respondent No.2- OP No.2 at the time of final arguments.
15. We have heard the oral arguments raised by learned Counsel for the Appellants as well as Respondent No.1. None has appeared on behalf of Respondent No.2 despite service. We have also perused the order dated 10.12.2024 as well as all the relevant documents available on the file.
FA No.194 of 2025 9
16. Facts relating to the filing of the Complaint by the Complainant before the District Commission, issuance of notice, raising of oral arguments by learned Counsel for the parties and passing of impugned order dated 10.12.2024 by the District Commission, thereafter filing of present Appeal before this Commission by the Appellant/OP No.1 is not in dispute.
17. The issue for adjudication before us as to whether the OPs had rightly repudiated the claim of the deceased insured or not ?
18. To deal with the aforesaid issue, we have thoroughly gone through Ex.OP No.1 i.e. Post-Mortem Examination Report wherein under the caption of 'Information supplied by the Police/or Hospital Record', it has been reported that Smt.Sukhwinder Kaur the wife of Sarwan Singh "ALLGED TO HAVE DIED DUE TO SUSPECTED POISNUOUS". The Post-Mortem Report dated 12.10.2020 has been concluded with the following remarks :-
"IN MY OPINION CAUSE OF DEATH IN THIS CASE WILL BE GIVEN AFTER THE RECEIPT OF THE CHEMICAL EXAMINER REPORT OF VISCERA."
19. Thereafter, as per Ex.OP-2 the Appellant had asked to SBI for Chemical Examination Report. It was also mentioned in the said communication that in absence of Chemical Examination Report and final opinion of the Doctor regarding exact cause of death, the Appellant was unable to proceed further.
20. On perusal of Ex.OP 3 i.e. FAQs on PRADHAN MANTRI SURAKSHA BIMA YOJNA (PMSBY), it has transpired that as per the said scheme, the beneficiaries covered under it were insured for a FA No.194 of 2025 10 sum of Rs.2.00 lac with a premium of Rs.12/- per annum per Member. It has categorically been mentioned in question 13 as under :-
13. Does the PMSBY cover death/disability resulting from natural calamities such as earthquake, flood and other convulsions of nature? What about coverage of suicide/murder?
Natural calamities being in the nature of accidents, any death/disability (as defined under PMSBY) resulting from such natural calamities is also covered under PMSBY. While death due to suicide is not covered, that from murder is covered.
Further in Q.22 it has been mentioned as under :-
Q.22. If the insured is missing and death is not confirmed, will be legal heirs get benefit of insurance?
PMSBY covers deaths confirmed by documentary evidence, to have been caused by accident.
21. A perusal of the above FAQs of PMSBY shows that the Appellants repudiated the claim of the mother of the Complainant on ground of suicide as the same was not covered under the said scheme. Besides, the Complainant/Respondent had not tendered the Chemical Examination Report as sought by it from him as well as SBI (Ex.OP-2).
22. On perusal of the contents of the Complaint, wherein it has been mentioned that Smt.Sukhwinder Kaur had died due to some expired medicine lying in the house by mistake. However, in the Post-Mortem Report, it has categorically been reported that the deceased had died due to consumption of poisonous substance and the report could not be concluded as the report of the chemical examiner (Viscera) was awaited. Besides, the Complainant has not FA No.194 of 2025 11 disclosed any details of the expired medicine that was consumed by Smt.Sukhwinder Kaur i.e. name, date of manufacture, date of expiry etc. In absence of such material evidence/details, it is difficult to reach any conclusion with regard to the main issue involved in the Complaint/Appeal in hand i.e. whether Smt.Sukhwinder Kaur had died due to accidental death or suicide. In addition to it, it is pertinent to observe that the Complainant did not produce the report of the chemical examiner at any stage of proceedings of the Complaint before the District Commission or this Commission. In light of the above observations, it is pertinent to observe that there are disputed questions of law involved in the case in hand which requires elaborate evidence/cross-examination of witnesses to adjudicate on the main issue. The same cannot be decided in a summary trial before this Commission.
23. We have also gone through the impugned order wherein District Commission has not addressed on the issue of exact cause of death of the deceased - Smt.Sukhwinder Kaur. Hence, in view of the discussions in foregoing paragraphs, evidence tendered by the Appellant, absence of chemical examination report (Viscera) and absence of details with regard to the expired medicine which the mother of the Complainant had consumed, we deem it appropriate to set-aside the impugned order dated 10.12.2024 passed by the District Commission. However, a liberty is granted to the Respondent-Complainant to approach appropriate Forum/Court of Law for redressal of his grievances.
FA No.194 of 2025 12
24. In foresaid terms, the present Appeal is allowed and the order passed by the District Commission is set-aside.
25. The Appellant had deposited an amount of Rs.1,11,134/- at the time of filing the Appeal with this Commission. Said amount, along with interest, which has accrued on the amount deposited by the Appellant, if any, shall be remitted by the Registry to the Appellant through crossed cheque/demand draft after the expiry of period of limitation in accordance with law.
26. Since the main case has been disposed off, so all the pending miscellaneous applications, if any, are accordingly, disposed off.
27. The Appeal could not be decided within the statutory period due to heavy pendency of court cases.
(JUSTICE DAYA CHAUDHARY) PRESIDENT (SIMARJOT KAUR) MEMBER February 19, 2026 Lb/-