Haryana

Charkhi Dadri

cc/41/2019

Smt. Rekha - Complainant(s)

Versus

Cholamandalam MS General Insurance Company Ltd - Opp.Party(s)

Sh. Prem Singh

07 Jun 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL

COMMISSION, CHARKHI DADRI. 

 

                Complaint No.      : 44 of 2019.                    Date of Institution: 18.02.2019

                RBT Case No.       : 41 of 02.09.2019

                Date of order:     :  07.06.2024

Smt. Rekha aged 32 years widow of Sh. Parveen Kumar, resident of village Imlota, Tehsil & Distt. Charkhi Dadri

..Complainant.

                    VERSUS

1. Cholamandlam MS General Insurance Company Ltd., 2^nd Floor, Dare House, 2NSC Boss Road, Chennai-600001.
2. M/s Indusind Bank Ltd. Upstair Axis Bank, Loharu    Road, Charkhi Dadri, Tehsil & Distt. Charkhi Dadri.

                                ..Opposite party.

    COMPLAINT UNDER THE CONSUMER PROTECTION ACT,

 

Before- Hon,ble Manjit Singh Naryal, President.

Hon’ble Dharam Pal Rauhilla, Member

 

Argued by:Shri Prem Singh Yadav, Adv. for the complainant.

        Shri Satender Ghanghas, Adv. for the OP no.1.

         Shri Rajender Verma, Advocate for OP no.2.

 

O R D E R

 

1.     Smt. Rekha (hereinafter referred to as “the complainant”) has filed the present complaint against the opposite parties (hereinafter referred to as “the OPs”) originally against Cholamandlam MS General Insurance Company Ltd., Chennai-600001 (OP No.1), Cholamandlam Investment and Finance Company Ltd. having its office at Loharu Road, Charkhi Dadri (OP no.2) and M/s Indusind Bank Ltd. Charkhi Dadri(OP no.3) which subsequently amended to as Cholamandlam MS General Insurance Company Ltd., Chennai-600001 (OP No.1) and M/s Indusind Bank Ltd., Charkhi Dadri, (OP no.2) as mentioned in the title of this  order. The averments  of the complainant are that her husband namely Parveen Kumar insured with the OPs vide insurance policy no.2841/00182086/000/00 from 26.04.2016 to 25.04.2020  for a  sum of Rs. 15,00,000/-. On 29.05.2018 husband of the applicant viz. Shri Parveen Kumar went to his field for giving water in fields when snake had bitten him and he died. Dead body was cremated. The complainant and her family members were not knowing about the post mortem after death of Sh. Parveen Kumar and as such post mortem was not conducted. As the husband of the complainant had died due to snake bite and in this regard an evidence was adduced in resolution passed by the Gram Panchayat, Village Imlota by passing a resolution dated 10.08.2018 (ex.C3) stating that death of Parveen husband of Mrs. Rekha had died due to snake bitting and recommended for financial assistance under Rajiv Gandhi Insurance Scheme duly signed by all Panchayat Members. Thereafter, the complainant submitted her claim alongwith documents to the OP no.1 the insurance company. The claim of the complainant was repudiated by the OP vide letter dated 02.11.2018 stating inter- alia, as under:-

 “As you are aware that the policy covers only death arising out of an accident, in the instant case there are no documentary evidence to confirm the exact nature and cause of death & particularly, whether the death was due to an accident. In the absence of any documentary evidence confirming the death of the insured was due to an accident, the insurance company conveyed their inability to consider the claim being inadmissible as per the terms and conditions of the policy.”

The repudiation of the claim of the complainant is illegal and unjustified. Whereas as per Resolution of Gram Panchayat it was clearly proved the death of Parveen Kumar was due to snake bite and as such OPs are liable to pay the insured amount. Hence, this complaint.

2.     Upon notice, the OP no.1 appeared and filed its reply/written statement and contested the complaint on the grounds that on 29.05.2018 Parveen (since deceased) went to his fields for irrigating where he was bitten by snake. Due to snake bite he became restless and fell down and died. Neither post mortem examination nor panchnama nor FIR was got registered, which were essential documents to establish the cause of death. It is a matter of record that the policy obtained by the deceased covers only the death arising out of accident and in the instant case there is no documentary evidence to confirm the exact nature and cause of death and particularly, whether the death was due to an accident. In the absence of any documentary evidence confirming that the death of the insured was due to an accident, the death claim of the insured could not be considered and it is found inadmissible as per the terms and conditions of the insurance policy. The intimation was given by the complainant on 15.10.2018 after a period of 139 days of the death of Parveen when the claim was lodged. After receiving the intimation from the complainant, the OP no.1 wrote a letter dated 02.11.2018 mentioning the grounds of repudiation and stating that the complainant is not entitled to receive the claimed amount as prayed for in the complaint. The OP no.1 denied other allegations of the complaint and took preliminary objections regarding locus-standi and the complainant has not come before this Forum with clean hands and suppressed the true & material facts.
3.     On appearance, the Indusind Bank (OP no.2) had filed written statement stating that the borrower Mr. Parveen Kumar son of Hari Kishan approchased answering OP with a request to sanction a loan for purchase LPT-2515/LPT-2515 load body. Answering OP had sanctioned the loan of Rs. 18,36,057/- and this amount was to be paid in 42 installments. The agreement value of this loan account was Rs.23,27,524/-. At the request of borrower, personal accident policy was taken by the answering OP no.2 from OP no.1 for the account of the borrower Parveen Kumar. It was reported by the family members of the deceased that he had died due to snake bite. Intimation in this regard was given to the OP no.1. The petitioner is required to submit claim form to claim the insurance amount. The OP no.1 is duty bound to process the claim and make the claim amount in the loan account of deceased Parveen Kumar and to adjust said amount in the outstanding of loan account. After the death of the borrower Parveen Kumar, installment of loan amount was not paid by the legal heirs. There is no deficiency in service on the part of answering OP and complaint of the complainant is liable to be dismissed with costs against the answering OP and prayed to direct OP no.1 to release compensation amount in any in favour of OP no.2 and  pass such order as deemed fit by the Forum.

4.       In order to her case, the complainant has filed her sworn affidavits Ex.CW1/A, Ex.CW2/A, Ex.CW3/A, Ex.CW4/A, Ex.CW5/A and further produced following documents on record:-

    Ex.C-1   -   Copy of repudiation letter.

    Ex.C-2   -   Copy of certificate of insurance

    Ex.C-3   -   Copy of resolution dated 10.08.2018                     by the Gram Panchayat, Imlota.

    Ex.C-4   -   Copy of death certificate.

    Ex.C-5   -   Copy of Driving Licence.

    Ex.C-6   -   Copy of Nakal Jamabandi

and evidence of the complainant was closed.

5.     On the other hand, learned counsel for the OP no.2 has tendered affidavit Ex.R1 and document Annexure R1 & Annexure R2 and closed the evidence on 12.01.2021.
6.     The learned counsel for the OP no.1 has filed sworn affidavit of Shri Kuber Dett Sharma, Dy. Manager of the company as Ex.RW1/A and further produced the following documents on record:-

Ex.R-3   -   Copy of Personal Accident-claim note

Ex.R-4   -   Copy of Personal Accident-claim Form

Ex.R5    -   Copy of Repudiation Letter

Ex.R6    -   Copy of Personal Accident Claim-Form

Ex.R7    -   Copy of Certificate of Insurance

Ex.R8    -   Copy of terms and conditions of                 Cholamandlam General Insur. Co. Ltd.

and evidence of the OP no.1 was closed on 13.09.2021

7.     We have heard the arguments advanced by learned counsel for the parties and gone through the material on record thoroughly and carefully.
8.     Ld. Counsel for the complainant has reiterated the contents of the complaint.  He contended that OPs have wrongly repudiated the claim of the complainant on the false grounds.  He further contended that the complainant has not violated any condition of the policy.  He further contended that there is deficiency in service on the part of the OPs and prayed for acceptance of complaint with costs.
9.     On the other hand, ld. counsel for OP no.1 reiterated the contents of the written statement. He contended that while examining the claim documents and investigation report, OP no.1 have observed that the complainant has violated the policy conditions and thus repudiated the claim vide letter dated 02.11.2018.  He further contended that there is no deficiency in service on the part of OP no.1 and the complaint of the complainant is liable to be dismissed.
10.     On the other hand, learned counsel for the OP no.2 reiterated the contents of the written statement. He further contended that OP no.1 is duty bound to process the claim and make the claim amount in the loan account of deceased Parveen Kumar and to pay the same to OP no.2 being bank from whom loan was taken by the deceased/insured and to adjust said amount in the outstanding of loan account. After the death of the borrower Parveen Kumar, installment of loan amount was not paid by the legal heirs. There is no deficiency in service  on the part of answering OP no.2 and complaint of the complainant is liable to be dismissed against OP no.2 and payment of insurance claim amount  be made to OP no.2
11.     After hearing the learned counsel for the parties and having gone through the material/facts and documents available on the records, we are of the considered view that complaint in hand deserves acceptance, because there is deficiency in service on the part of OPs.  It is admitted by the OPs in their written statement that the deceased Parveen was insured with the OP no.1.  It is also mentioned by the OP no.1 in their written statement that intimation about the death of the insured was given to OP no.1 after 139 days of the death. It is also averred by the OP no.1 in their written statement and repudiation letter Ex.R5 as under:

 “The dead body was not subjected to post mortem report nor any panchnama. FIR was not filed with police or inquest was not conducted and GD was not filed, which are essential document to establish the cause of death as accident.”

 We find that OP no.1 has not taken ground of delay in filing the claim in repudiation letter. It established that in a claim made by the insured before a Consumer Commission an insurance company cannot take a defense which did not form the basis of repudiation of the claim. Hence, in this case additional ground of delay by 139 days in filing claim is not tenable.

12.   The complainant has placed as many as 5 duly sworn affidavits including himself as well as Ajit, Member Panchayat of village Imlota Ex.CW-2/A , Rambilas, Secretary of village Imlota as Ex.CW-3/A, Sushila Devi, Sarpanch  of village Imlota as Ex. CW-4/A,  Baljeet son of Girwar, resident of village Imlota as Ex. CW-5/A in support of claim of the claimant. In all the affidavits inter alia, it has been solemnly affirmed and declared that

 “On dated 29.05.2018 said Parveen Kumar son of Krishan went to his field for watering to his field at that time snake has bitten Sh. Parveen Kumar and died due to snake bite. Thereafter dead body of Parveen Kumar was cremated. The fact regarding death of Parveen Kumar by snake biting was verified by me and Gram panchayat Imlota and it was found that Parveen Kumar had died due to snake biting.”

13.     As evident from statement of account of Indusind Bank (Annexure R2) which shows Zero balance outstanding, meaning thereby that the loan account has already been settled.
14.     The complainant placed on record a resolution of Gram Panchayat (Ex.C3) which also corroborates that death was due to snake bite. The said resolution was signed by Sarpanch, Gram Panchayat, Imlota, Ram Bilash, Gram Sachiv, Imlota, Charkhi Dadri and other members.  The  Hon’ble National Consumer Disputes Redressal Commission in judgment titled  United India insurance Company Limited Vs. Parllamreddy Aruna, Revision petition no .3329 of 2007, decided on 22.10.2007, was held that

“Proof of death by snake bite was not established without conducting post-mortem- contention cannot be accepted – Death was duly proved by certificate of police official, village Administrative officer and the doctor – in a small village, villagers cannot wait for post-mortem in cases of snake bite.”.

 The facts of the case law produce by ld. counsel for the complainant is applicable to the facts of the present case.  Thus, there is clear cut deficiency in service and unfair trade practice on the part of the OP no.1, as they have failed in redressal of grievance of the complainant.

        Ld. counsel for the OP-1 has placed his reliance upon Smt. Roshni Devi Vs. National Insurance Co. Ltd, Case no. GIC/18/NIC/11/06, Chandigarh Ombudsman Centre, but the same is not applicable to the facts and circumstances of the case in hand.

15.     Moreover, the OP no.1 has deliberately does not settle the claim of the complainant and harassed her without any valid reason.  So, in our view, the complaint of the complainant deserves acceptance and also she is entitled for compensation on account of mental, physical harassment and deficiency in service on the part of the OP no.1. Therefore, in view of facts and circumstances mentioned above, complaint of the complainant is allowed.  The OP no.1 is directed:-
    1. To pay the insured amount i.e. Rs. 15,00,000/- alongwith interest @ 9% per annum from the date of repudiation of claim i.e. 02.11.2018, subject to furnishing No Dues Certificate from the OP no.2 viz. Indusind Bank Ltd.
    2. To pay Rs.10,000/- (ten thousand only) as compensation on account of mental agony, physical harassment & hardship, due to deficiency in service & mal trade practice on the part of OP no.1 and punitive damages.
    3. To pay Rs.5000/- (Five thousand only) as the litigation charges.

All the above amount shall be disbursed in all first class legal heirs in equal share and in case of minor legal heir in that situation his/her amount shall be deposited in  Nationalized Bank in the shape of FD and withdraw after attaining the age of maturity.

16.     The compliance of the order shall be made within 45 days from the date of the order.  In case of default, the OP no.1 shall be liable to pay interest @ 12% p.a. on total amount as directed above vide clause No. i from the date of default i.e. after 45 days from the date of this order.  Certified copies of the order be supplied to the parties free of costs.  File be consigned to the record room, after due compliance.