| Final Order / Judgement | DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BATHINDA C.C. No. 166 of 25-6-2018. Decided on : 31-01-2022 Jaswinder Kaur, aged about 43 years Wd/o Jagmohan Singh R/o Village Kotha Guru, Teh. Rampura Phul, District Bathinda. ........Complainant Versus HDFC ERGO General Insurance Company Limited, 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (East) Mumbai 400 059. .......Opposite party.
Complaint under Section 12 of the Consumer Protection Act, 1986 QUORUM Kanwar Sandeep Singh, President Sh. Shivdev Singh, Member. Smt. Paramjeet Kaur, Member Present For the complainant : Sh. Naresh Garg, Advocate For opposite party : Sh. Varun Gupta, Advocate. ORDER Kanwar Sandeep Singh, President The complainant Jaswinder Kaur (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 H.D.F.C ERGO General Insurance Company Limited (here-in-after referred to as opposite party). Briefly stated, the case of the complainant is that Jagmohan Singh, husband of the complainant, purchased individual Personal Accidental Policy No. 33171001168082000 from the opposite party valid for the period from 16-5-2016 to 15-5-2017 for Sum Assured Rs. 10,00,000/-. Jagmohan Singh nominated complainant in the said policy. It is alleged that on 16-5-2016, Jagmohan Singh alongwith Bhupinder Singh, Dharamvir Singh @ Raju, had gone to D.C. Office at Bathinda in Scorpio Vehicle No. DL-8CJ/7891 in cconnection with making Arms Licence of Dharamvir Singh for all India. The said Dharamvir Singh alongwith him took his Arms Licence and 32 Bore Revolver. When they returned from Bathinda and about 12.30 p.m, they were on bridge of drain in between Village Ghania and Village Maluka, they stopped the vehicle in order to urinate. Jagmohan Singh took the revolver of Dharamvir Singh and went to urinate by the side of bridge. He started moving revolver in filmy style and suddenly a shot fired from the revolver which hit in the head of Jagmohan Singh and he died on the spot. Jaskaran Singh, son of complainant made statement to the police at Police Station Dayalpura, District Bathinda and Rapat No. 15 dated 16-5-2016 was lodged in Daily Diary Register. It is further alleged that Post Mortem Report examination on dead body of Jagmohan Singh was conducted by Dr. Deep Shikh, Medical Officer, Civil Hospital, Rampura on 16-5-2016 vide PMR No. DS/PMR/014/2016. It is also alleged that complainant lodged claim with the opposite party for payment of sum assured and submitted all the relevant documents. The complainant also got issued legal notice dated 1-9-2016 to the opposite party requesting to make payment of claim amount. In response to said legal notice, opposite party wrote letter dated 9-9-2016 to Jaskaran Singh, son of complainant stating therein that some documents have not been received by them so far for finalizing the claim. Thereafter, on 6-10-2016, complainant submitted reply to said letter stating that she has already lodged claim with the opposite party and submitted all the relevant documents and claim of the complainant is mentioned as C331716000125 on letter dated 9-9-2016. The complainant alleged that she intimated the opposite party that she is ready to furnish fresh documents as required by opposite party for finalizing the claim and making payment of claim amount of insurance, but till date the complainant never received any claim form nor any official contacted the complainant so far. It is alleged that complainant filed complaint before this Commission on the same cause of action on 15-11-2016 which was decided on 28-3-2018, vide which direction was given to the opposite party to decide the claim as per documents submitted by complainant. This Commission also held that opposite party is deficient in service as it unnecessarily delayed to settle the claim and improsed cost and compensation to the tune of Rs. 10,000/-. The complainant further alleged that opposite party rejected the legal claim of the complainant on 25-5-2018 on flimsy ground that Suicide, attempted suicide or self-inflicted injury or illness” and the losses claimed are not covered under the policy. No policy or its terms and conditions were ever supplied by the opposite party to the deceased or to the complainant. The opposite party issued no claim letter against law and against facts whereas the police/Govt. Agency already declared that the same is accidental death and not suicidal. It is further alleged that due to non-payment of claim amount of Rs. 10,00,000/-, the complainant suffered mental agony and pain for which she claims compensation to the tune of Rs. 2,00,000/-. On this backdrop of facts, the complainant has prayed for direction to the opposite party to pay claim amount of Rs.10,00,000/- with interest @18% p.a. w.e.f date of death alongwith damages to the extent of Rs. 2,00,000/- in addition to Rs. 1,00,000/- as litigation expenses. Upon notice, the opposite party put an appearnace through counsel and contested the complaint by filing written reply. In written reply, the opposite party raised legal objections that in order to prove its case, opposite party would have to lead evidence and examine number of witnesses, which includes examination of an expert and the proceedings before this Commission are summary in nature and adjudication of issues which involve disputed factual questions cannnot be decided in summary proceedings. That all the contentions raised in the reply are independent and without prejudice to each other and the same are on the basis of document and records as available with the opposite party. Thereafter, the opposite party submitted preliminary submissions that claim of the complainant was already decided by opposite party as per terms and conditions of the policy and as per decision of the opposite party, the deceased insured had died due to voluntary act amounting to self inflicted injury/suicide which categorically falls under the exclusion of the insurance policy terms and conditions. It is pleaded that the policy in question was issued alongwith policy wording containing its terms and conditions which were duly handed over to the insured deceased. The complainant has created a false story in complaint to mislead this Commission by false and frivolous facts and circumstances. That post lodging of claim, the opposite party got conducted investigation by appointing independent investigator and have also appointed forensic consultant to know the exact nature of injuries and its causes. Upon investigation conducted by the agency namely Affinity Multiservices Pvt. Ltd., it got well established that the deceased insured had shot himself and committed suicide. The insurance policy was purchased by visting HDFC Bank, Bhakta Branch in the morning around 10.17 a.m. and on the same day around 12.30 p.m. deceased insured shot himself after taking number of insurance policies. It is also pleaded that the claim was referred to Rajdeep Consultants which is a forensic analyst. The report submitted by Rajdeep Consultants has categorically analysed the injury marks, its dimension, wound pattern as appeared in the Post Mortem Report and FIR and have concluded that deceased Jagmohan Singh shot by holding pistol in right hand, pressing against right temporal side near right eye while standing. It further concluded that he voluntarily shot himself from point blank range and the bullet entered into deep brain in cranial cavity which caused internal bleeding through left ear. The forensic consultant after detailed pictoral analysis has presented the actual nature of accident leading to the death of the insured. In further preliminary submissions, the opposite party stated that in the light to investigation report and forensic report, it becomes clear that death was not due to any accident but on account of voluntary act; that there are ample evidence to show that deceased insured had voluntarily purchased number of insurance policies from various insurers including individual Personal Accident Policy from this opposite party and have committed suicide immediately after purchasing the policy; that the FIR or the Daily Diary Report is recorded on the basis of version stated by the son of deceased insured just to make out a case to get benefit under multiple insurance policies; that complainant is estopped from filing the present complaint by her own acts, conduct, omissions and acquiescence; that the complaint is not maintainable and that the complainant has failed to disclose any legal and valid cause of action against the opposite party to file the present complaint. On merits, the opposite party admitted issuance of policy in question but stated that policy was issued subject to its terms and conditions which were duly supplied to the complainant and was never disputed. The claim was lodged claiming benefits under 'Accidental Death' of the policy. The policy was obtained by concealing the material facts, which amount to fraudulent practices and thus no benefits of the policy can be extended to the beneficiary. The opposite party got a report of Forensic Expert which clearly finds mentioned that injury received by the insured is not possible in accident way rather the deceased life assured committed suicide in the given facts. It is pleaded that after going through the entire facts of the death of the deceased as showed by the complainant clearly showed that the deceased insured must committed suicide, attempted suicide or self inflicted injury because in the given facts it is not possible to receive such type of gunshot as described by her, so the complainant concocted the story. The entire version stated before the police authority just on the ground of sympathetic basis and never dislosed to the police authority clear motive of the occurrence. There has been a deliberate attempt to defraud the opposite party of a huge sum for which opposite party is contemplating to launch appropriate criminal proceedings against the complainant and other involved in the fraud in order to wrongfully obtain the claim amount in the subject policy from the opposite party. The insurance claim payouts are made from the pool of funds of many consumers of the services of an insurance company. Hence, to honour an illegitimate claim, would mean doing injustice to other genuine policy holders. Hence, even entertaining the said case would be against the principals of natural justice and this would not be in the interest of consumers of services of an insurance company. A proper service has been provided by the opposite party to the every policy holder, so there is no deficiency in service on the part of the opposite party. It is further pleaded that complainant has failed to make out a prima facie case against the opposite party. Hence, for the reasons stated above, the relief sought for by the complainant in his complaint are denied as false, unsustainable and without any merits. After controverting all other averments of complainant, the opposite party prayed for dismissal of complaint. In support of her complaint, the complainant has tendered into evidence her affidavit dated 25-6-2018 (Ex. C-1), photocopy of Insurance policy (Ex. C-2), photocopy of DDR (Ex. C-3), photocopy of death certificate (Ex. C-4), photocopy of Post Mortem Report (Ex. C-5), photocopy of legal notice & postal receipt (Ex. C-6 & Ex. C-7), photocopy of order dated 28-3-2018 (Ex. C-8), photocopy of repudiation letter (Ex. C-9) and closed the evidence. In order to rebut the evidence of complainant, the opposite party tendered into evidence affidavit dated 21-8-2018 of Pankaj Kumar (Ex. OP-1/1), photocopy of policy (Ex. OP-1/2), photocopy of terms and conditions (Ex. OP-1/3), photocopy of investigation report (Ex. OP-1/4), photocopy of forensic report (Ex. OP-1/5), photocopy of repudiation letter (Ex. OP-1/6), photocopy of cheque (Ex. OP-1/7), photocopy of letter (Ex. OP-1/8) and closed the evidence. The opposite party also tendered in additional evidence affidavit dated 18-9-2018 of Suresh Kumar (Ex. OP-1/9) and affidavit dated 20-9-2018 of Sandip (Ex. OP-1/10). The learned counsel for the parties reiterated their stand as taken in their respective pleadings. We have heard learned counsel for the parties and gone through the record carefully. In the case in hand, there is no dispute between the parties that Jaskaran Singh, husband of the complainant obtained insurance policy under which he was insured for the sum assured of Rs. 10.00 Lacs in case of accidental death. Jagmohan Singh died on 16-5-2016. The complainant, being nominee, filed claim with the opposite party claiming sum assured, but her claim was repudiated by the opposite party vide letter dated 25-5-2018. A perusal of repudiation letter (Ex. C-9) reveals that ground taken by the opposite party for repudiation of claim is that the insured expired due to self inflicted injury and death was not due to any accident. In this regard, the opposite party has mentioned policy wording which depicts “No indemnity is available hereunder and no payment will be made by the Company for any claim directly or indirectly caused by, based on, arising out of or howsoever attributable to any of the following : - “Suicide attempted suicide or self-inflicted injury or illness”. In written reply, the opposite party has pleaded that claim was referred to Rajdeep Consultants which is forensic analyst. The report submitted by Rajdeep Consultants has categorically analysed the injury marks, its dimension, wound patten as appeared in the Post Mortem Report and FIR and have concluded that the deceased Jagmohan Singh shot by holding pistol in right hand, pressing against right temporal side near right eye while standing. The report of said expert concluded that insured voluntarily shot himself from point blank range and the bullet entered into deep brain in cranial cavity which caused internal bleeding through left ear. The pictoral analysis has presented the actual nature of incident leading to the death of insured. Ex. OP-1/5 is the report of Rajdeep Consultants dated 9-7-2017. No doubt this consultant in his final opinion has mentioned that it is an voluntary act but this report is based on pictorial analysis whereas perusal of file reveals that before deputing these consultants, the opposite party got the matter investigated through Affinity Multiservices Pvt. Ltd., The report of this Investigating Agency is on the file as Ex. OP-1/4. This report was issued on 22-6-2017 whereas report of Rajdeep Consultants (Ex. OP-1/5) is dated 9-7-2017. The report of Affinity Multiservices Pvt. Ltd., shows that this Investigator has attached with his report copy of Investigation of 174 CrPC Challan Register. Under column “Report” it is mentioned :- “ This investigation is done on the statement of Jaskaran Singh who is working as a Salesman. His father Jagmohan Singh alias Neendi, Baljinder Singh, Dharamvir alias Raju has gone to renew the Gun Licence and were coming back after that. Near Malika Canal have stopped to do the nature call. There Dharamvir alias Raju (name wrongly mentioned infact Jagmohan Singh) has started revolving the gun and all of a sudden a gun shot hit his head and due to this he died on the spot. This incident occured all of a sudden due to gun shot and for investigation the information is given and the report is registered.” The opposite party firstly appointed Investigating Agency Affinity Multiservices Pvt. Ltd., which investigated the matter after obtaining information under RTI even from police authorities, which revealed whole incidence, and submitted their report on 22-6-2017 but for the best reasons known to the opposite party, thereafter opposite party appointed Rajdeep Consultants for further investigations who submitted their report on 9-7-2017. No reasoning has been given by the opposite parties for appointment of second consultant. Rajdeep Consultants, Forensic Expert had not joined any of the persons named as eyewitness and moreover in this case, matter was brought to the notice of police. After investigation police conducted proceedings U/s 174 CrPC as it was an accidental case. Once information was given to the police regarding occurence, then concerned police officer must have conducted further investigation if he would have found commission of any offence. Moreover, place of occurence is not disputed in this case which is also far away from the place of owner of fire arm. The revolver involved in the incidence was not of the deceased rather it was registered in the name of some Dharamvir Singh. It is not acceptable that a person would borrow a fire arm from another person for committing suicide. Seat of injury is not material rather it is to be seen that whether it is accidental or suicidal. Post Mortem Report Ex. C-5 also finds mentioned that “information furnished by police – accidental gunshot (self). The opposite party has not placed on file any statement/affidavit of witness to prove that death of insured was not accidental. Thus, keeping in view the facts, circumstances and the evidence placed on file by the parties, this Commission is of the view that, as detailed above, police has investigated the matter and Investigation carried out by the police shall prevail upon any other investigation report of paid private Investigation agency and there remains no doubt that death of Jagmohan Singh was accidental. Hence, repudiation of genuine claim of complainant is without any basis and on flimsy grounds amounts to deficiency in service on the part of the opposite party. The complainant also filed complaint before this Commission vide CC No. 548 of 15-11-2016 seeking directions to opposite party to make payment of claim, but the stand/pleading of opposite party in that case was the complainant has not submitted complete documents. This Commission vide order dated 28-3-2018 held that claim can be settled on the basis of documents already submitted and holding opposite party deficient, directions were given to settle the claim within 45 days and pay Rs. 10,000/- as cost and compensation. Thereafter opposite party vide letter dated 25-5-2018, repudiated the claim of the complainant on the basis of Investigation Report of Forensic Export dated 9-7-2017, which was already in the custody of opposite party (at the time of first complaint). Hence, this act of the opposite party itself proved that the contention of the opposite party was just to repudiate the claim. Ex. OP-1/2 is the policy in question which shows that sum assured in case of accidental death for Jagmohan Singh was Rs. 10,00,000/-. The complainant has pleaded that she is nominee in the said policy being wife of insured and this fact is not specifically denied by the opposite party. Hence, complainant is entitled to the sum assured alongwith interest and compensation for harassment which she is suffering since from the year 2016 at the hands of opposite party. In view of what has been discussed above, this complaint is partly allowed with Rs. 5,000/- as cost and compensation. The opposite party is directed to pay Rs. 10,00,000/- (Rupees Ten Lacs) being sum assured of Jagmohan Singh, deceased, to complainant with interest @9% p.a. w.e.f. 15-5-2018 i.e. 45 days after order dated 28-3-2018 (Ex. C-8) till realization. The compliance of this order be made by the opposite party within 45 days from the date of receipt of copy of this order. 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 : 31-1-2022 (Kanwar Sandeep Singh) President (Shivdev Singh) Member (Paramjeet Kaur) Member
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