| Final Order / Judgement | DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BATHINDA C.C. No. 46 of 9-02-2018 Decided on : 15-12-2021 Renu Bala, aged about 52 years widow of Sh. Bhushan Kumar, R/o H. No. 11298, Gali Panditan Wali, Backside Khalsa School, W. No. 35, Bathinda. .......Complainant Versus Cholamandalam MS General Insurance Company Limited, 2nd Floor, Dare House, 2 NSC Bose Road, Chennai 600001 through its Managing Director Cholamandalam MS General Insurance Company Limited, Branch Office at Bathinda, through its Branch Manager Indusind Bank Limited, G.T. Road, Near Bus Stand, Bathinda, through its Branch Manager
.......Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986 QUORUM Kanwar Sandeep Singh, President Smt. Paramjeet Kaur, Member Present For the complainant : Sh. Rakesh Mangla, Advocate For opposite parties : Sh. Vinod Garg, Advocate, for OPs No. 1 & 2. Sh. K K Vinocha, Advocate for OP No. 3. ORDER Kanwar Sandeep Singh, President The complainant Renu Bala (here-in-after referred to as complainant) has filed this complaint U/s 12 of Consumer Protection Act, 1986 (Now C.P. Act, 2019, here-in after referred to as 'Act') before this Forum (Now Commission) against Cholamandalam M S General Insurance Co. Ltd., and others (here-in-after referred to as opposite parties). Briefly stated, the case of the complainant is that the husband of the complainant namely Sh. Bhushan Kumar was covered under the Group Personal Accident Master Policy No. 2841/0015466/002/00 of the opposite parties No.1&2 issued in the name of the opposite party No. 3 for the period from 12-08-2015 to11-08-2019 for a sum of Rs.4,70,000/- and Rs, 30,000/- for which the husband of the complainant deposited the requisite premium with the opposite parties. It is alleged that unfortunately Bhushan Kumar husband of the complainant was caught hold by electric shock on 17-07-2017 at home and died due to the electrocution. Due to the untimely death of Bhushan Kumar due to the electrocution, the entire family of the complainant i.e. the complainant herself and her children were in the state of shock and no postmortem of the deceased Bhushan Kumar could be got conducted. Even no FIR or DDR was got lodged as the complainant and her family members are simpleton persons and were not aware of the intricacies of law. After a few days of the death of Bhushan Kumar, the complainant was recovered from the shock and became normal and while checking the documents of Bhushan Kumar, the complainant got the copy of the aforesaid certificate of insurance issued by the opposite parties No.1 &2. Thereafter complainant along with her son Yugdutt Kumar approached the officials of the opposite parties No. 2 & 3 and informed them about the death of Bhushan Kumar due to the electrocution. The complainant, being the only dependent of the deceased Bhushan Kumar being his widow, applied for the insurance claim with the opposite parties and furnished the requisite documents. The opposite parties started demanding the postmortem report of the deceased Bhushan Kumar and FIR. The complainant requested the opposite parties that due to untimely death of Bhushan Kumar, the entire family of the complainant was in the state of shock and as such the postmortem of the dead body of Bhushan Kumar could not be got conducted and no FIR/DDR was got lodged with the police. However, the complainant obtained the certificate from Ram Dass, MC Bathinda regarding death of Bhushan Kumar, due to electrocution and furnished the same to the opposite parties along with death certificate of Bhushan Kumar, but the opposite parties kept on putting the matter off and on, on one or the other false pretext and have failed to pay any amount of insurance claim to the complainant. Ultimately, the opposite parties have refused to pay any amount of insurance claim to the complainant. The complainant has further alleged that the husband of the complainant died due to electrocution and is covered under the policy issued by the opposite parties No.1 & 2 and therefore, they cannot wriggle out of their liability to pay the insurance claim only on the ground that the postmortem of the deceased was not got conducted and FIR/DDR was not got lodged although the same is neither intentional nor willful and as such the complainant, being the widow and only dependent of deceased Bhushan Kumar, is entitled to the insurance claim of the deceased Bhushan Kumar from the opposite parties. Due to said illegal and arbitrary act of the opposite parties, the complainant is suffering from great mental tension, agony botheration, harassment and also suffered financial losses and as such the complainant is entitled to the compensation. On this backdrop of facts, the complainant has prayed for directions to the opposite parties to pay the insurance claim of Rs. 5,00,000/- in addition to compensation to the tune of Rs.50,000/- besides litigation expenses of Rs. Rs,5500/-. Hence, the present complaint. Upon notice, the opposite parties appeared through their respective counsel and contested the complainant by filing reply. Opposite parties No.1 & 2 filed their joint written reply raising legal objections that the intricate questions of law and facts are involved in the present complaint which require voluminous documents and evidence for determination which is not possible in the summary procedure under the Act and appropriate remedy, if any, lies only in the Civil Court; that the complainant has concealed material facts and documents from this Commission as well as from the opposite parties therefore, the complainant is not entitled to any relief. It is pleaded that the complainant has concealed the fact that on perusal of the claim documents, it was found that it was alleged by complainant that on 17.07.2017 when Mr. Bhushan kumar was going to Bathroom, he came in contact with electric wire due to which he received electric shock and died on the spot. The dead body was not subjected to any postmortem, nor any panchanama. FIR was filed with police or inquest was conducted, which are essential documents to establish the cause of death as accident. 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 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 opposite parties are unable to consider the claim and the same is inadmissible as per terms and conditions of the policy Accordingly letter dated 23.11.17 was issued to the complainant in this respect. Further legal objections are that the complainant has not impleaded all the legal heirs of deceased Bhushan Kumar who are necessary parties; that the complainant is not consumer; that the complainant has no standi or cause of action to file the present complaint against opposite parties and that the complaint is not maintainable in the present form. On merits, the opposite parties No.1 & 2 have denied that deceased Bhushan Kumar was caught/ held by electric shock on 17.07.2017 at home or died due to electrocution. It is pleaded that the complainant did not get any postmortem conducted on the body of deceased and no FIR or DDR was lodged, in the absence of which the complainant cannot allege or prove any accidental death, which is mandatory for a claim under the policy. It is denied that the complainant furnished any documents regarding the postmortem of dead body, FIR or DDR recorded with the police or any other document to prove that the death of Bhushan Kumar deceased is occurred due to receipt of electric shock or it is accidental. The opposite parties have also pleaded that they are within their rights to demand said documents as per terms and conditions of the policy in order to decide as to whether the deceased died due to any accident and thus to decide the claim as per terms and conditions of the policy. It is denied that the husband of complainant died due to electrocution or is covered under the policy. After denying all other averments of the complainant, the opposite parties No. 1 & 2 prayed for dismissal of complaint. Opposite party No. 3 filed separate written reply raising legal objections that the complainant has got no locus-standi and cause of action to file the complaint as opposite party No. 3 is not at fault in any manner whatsoever, if insurance claim with regard to the death of deceased Bhushan Kumar (husband of complainant) has been repudiated by opposite party No. 1 for violating the Insurance Policy and its terms and conditions. It has been pleaded that the complainant herself was in process and has been dealing with opposite parties No. 1 & 2 regarding insurance-claim of her husband Late Bhushan Kumar. Neither complainant nor any other legal heir of deceased Bhushan Kumar has given any information with regard to the cause of death or otherwise about death of Bhushan Kumar. So, complainant is not entitled to any relief against opposite party No. 3 as it is not at fault in any manner whatsoever. It has been pleaded that the complainant has not come to this Commission with clean hands and has suppressed true facts. The true facts are that Bhushan Kumar now deceased during his life time at his choice and voluntarily purchased a group Insurance Policy (concerning borrower of replying opposite party) from opposite No. 1 as at that time he intended to obtain loan from opposite party. He as a borrower and one of his friend Gurmit Singh as Co-borrower obtained loan/finance of Rs. 5,50,000/- against Force Tempo Traveller Megha Bus 13 STR + D BS-III bearing Registration No. PB-01A-1896 and agreed to repay Rs. 7,32,668/- i.e. inclusive of finance charges etc; in 42 monthly installments, vide Loan Agreement No. PJB00277L Dated 17.8.2015, which he and his co-executants executed & signed the same after admitting its terms and conditions to be correct and true and agreed to abide by the same. On 22.3.2018 a sum of Rs. 1163.72 on account of over-due charges and Rs. 1,75,000/- on account of future due plus other charges, as is clear from loan account statement dated 22.3.2018, is outstanding in aforesaid loan account. The opposite party No. 3 has his legal right to recover the balance outstanding amount from complainant & others in terms of loan Agreement. Now giving threats by complainant under the garb of present complaint that she would not pay the remaining amount is totally against law, facts, terms and conditions of loan Agreement. However, in the event of accepting any insurance claim and granting any monetary benefit by this Commission, the same may please be ordered to be paid to opposite party No. 3, because opposite party No. 3 is nominee to receive the claim amount and purpose of getting insurance was that due amount of loan is to be paid by insurer in the event of the death of the insured accidentally and further to protect the legal heir from suffering any liability if such an event is happened accidentally. It is further pleaded that in the event of paying claim amount to opposite party No. 3, then any over and above sum after adjusting payable sum, opposite party No. 3 shall refund the excess amount, if any to the complainant. Further legal objections are that the complaint is bad for non-joinder and mis-joinder of necessary parties; that the rights and obligations regarding loan in question between the parties to it, are duly incorporated in Loan Agreement, which deceased Bhushan Kumar as borrower and his co-executants; has duly executed and signed the same after reading and understanding its terms and conditions to be correct and true and agreed to abide by the same. Since, insurance claim has been repudiated by concerned Insurance Company and in absence of repayment of loan/finance outstanding against borrowers and others, neither parties concerned can be left free nor loan amount can be waived as is clear from terms and conditions of the Loan Agreement. On merits, the opposite party No. 3 has pleaded that the opposite party No. 3 is neither aware of the death of Bhushan Kumar nor about the cause of his death, as neither complainant nor any other heir/person informed the replying opposite party about it. In fact, passing or non-passing/repudiating the claim is independent act of opposite parties No. 1 & 2 as per its requirement in terms of policy. So, opposite party No. 3 cannot be faulted nor can be held to be deficient. The opposite party No. 3 has just financed the vehicle and has nothing to do with the insurance policy taken by deceased. This fact is also clear from repudiation letter of insurance claim, which addressed to complainant herself. After denying all other averments of the complainant, opposite party No. 3 prayed for the dismissal of the complaint. In support of his complaint, the complainant has tendered into evidence affidavit of Renu Bala dated 26-04-2018 (Ex.C-1) photocopy of certificate of Insurance (Ex.C-2), photo copy of letter dated 23-11-2017 ( Ex.C-3), photo copy of death certificate (Ex.C-4) and closed evidence. In order to rebut the evidence of complainant, opposite parties No. 1 & 2 have tendered into evidence affidavit of Satyabratta Dass dated 27-07-2018 (Ex.OP-1/1), photocopy of Insurance policy along with terms and conditions containing pages 1 to 12 (Ex.OP-1/2) photocopy of certificate of Insurance containing pages 1 to 2 (Ex.OP-1/3) photocopy of repudiation letter dated 23-11-2017 (Ex.OP-1/4) and closed evidence. Opposite party No.3 also tendered into evidence affidavit of Robin Arora dated 06-04-2018 (Ex.OP-3/1), photocopy of account statement (Ex.OP3/2), photocopy of loan agreement containing 14 pages (Ex.OP3/3) and closed evidence. We have heard learned counsel for the parties and gone through the record. In the case in hand, there is no dispute that Bhushan Kumar husband of the complainant was insured with opposite parties No. 1 & 2 vide Insurance policy Group Personal Accident Master issued to Indusind Bank Ltd. (opposite party No. 3) from 12-8-2015 to 11-8-2019 (Ex. C-2). Bhushan Kumar died on 17-7-2017 and his dead body was not subjected to postmortem nor any panchnama, FIR was filed with police or inquest was conducted. The complainant filed claim under insurance in question with opposite parties No. 1 & 2 and they repudiated the claim vide letter dated 23-11-2017 (Ex. C-3). The plea of the complainant is that the cause of death of her husband is electrocution and since she (complainant) and her whole family was under shock due to sudden death of Bhushan Kumar, she could not get the postmortem conducted of the dead body of Bhushan Kumar nor any panchnama, FIR was filed with police or inquest was conducted. She has also taken plea that complainant and her family members are simpleton persons and were not aware of the intricacies of law. A perusal of repudiation letter Ex. C-3 reveals that opposite parties No. 1 & 2 repudiated the claim filed by complainant on the ground that since the policy covers only death arising out of an accident but in this case dead body was not subjected to any postmortem, nor any panchanama, FIR was filed with police or inquest was conducted, which were essential document to establish the cause of death as accident. A perusal of file reveals that complainant herself produced on file Insurance Policy in question as Ex. C-2. Under Clause 'Claim procedure' of the policy, it is clearly mentioned that claim Police FIR, Post Mortem Report, Doctor's Certificate and relevant medical papers, any other proof of accidental death and Inquest Report, are the essential documents which were required for processing the claim. The complainant has admitted in her complaint that she has not obtained any document, as detailed above, and only certificate obtained from Ram Dass M.C. regarding death of her husband, was furnished to opposite parties. She has not placed on file even a single document out of the aforesaid documents to establish that cause of death of her husband is electrocution/accidental. The plea taken by complainant that she being simpleton person was not aware of the intricacies of law is not tenable as a perusal of complaint and affidavit (C-1) of complainant reveals that she has signed the said document in English meaning thereby that she is a literate lady. In such circumstances, it cannot be said she does not know about the loan borrowed by her husband and Insurance and also terms and conditions of the policy. The opposite party No. 3 in para No. 2 of written reply on merits has pleaded that opposite party No. 3 is neither aware of death of Bhushan Kumar nor about the cause of his death. Thus, the reply of opposite party No. 3 is also silent on this aspect. The complainant has not placed on file even a single document to establish that cause of death of her husband was electrocution/accidental. Mere allegations cannot take shape of proof unless and until supported by cogent and convincing evidence. In such circumstances, opposite parties are not liable to pay the claim as the policy in question covers only accidental death of insured person. Thus, there is no deficiency in service on the part of opposite parties No. 1 & 2 in repudiating the claim of the complainant. Resultantly, this complaint fails and is hereby dismissed with no order as to costs. The complaint could not be decided within the statutory period due to heavy pendency of cases. Copy of order be sent to the parties concerned free of cost and file be consigned to the record. Announced : 15-12-2021 (Kanwar Sandeep Singh) President (Paramjeet Kaur) Member
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