Haryana

Ambala

CC/270/2020

Balveer Kaur - Complainant(s)

Versus

ICICI Lombard Motor Insurance Co. - Opp.Party(s)

G.S. Ahluwalia

09 May 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	270 of 2020
Date of Institution	:	06.11.2020
Date of decision	:	09.05.2023

1. Balveer Kaur widow of Shri Dalveer Singh,
2. Manpreet Singh son of Late Shri Dalveer Singh, both residents of Village Isharheri, PO Massingan, District Patiala (Pb).

          ……. Complainants

                                                Versus

1. ICICI Lombard General Insurance Ltd., ICICI Bank Tower, Bandra Kulra Complex, Bandra (East), Mumbai- 400051, through its authorized Signatory.
2. S Goel & Goel, O-Max, The Mall, Patiala (Pb), through its authorized Signatory. (Phone No.01752214716).

                                                                                                    ….…. Opposite Parties.

Before:        Smt. Neena Sandhu, President.

                             Smt. Ruby Sharma, Member,

          Shri Vinod Kumar Sharma, Member.           

 

Present:       Shri Gurmit Ahluwalia, Advocate, counsel for the complainants.

                     Shri Rajesh Kumar, Advocate, counsel for the OP No.1.

                     Shri R.K. Bharat, Advocate, counsel for the OP No.2.

Order:        Smt. Neena Sandhu, President.

1.                Complainants have filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’) praying for issuance of following directions to them:-

a) To release/pay compensation of Rs.15 lacs along with interest @ 18% per annum from the date of death of the deceased policy holder namely Sh. Dalveer Singh till its actual payment against PA cover claim.

b) To pay Rs.50,000/-, on account of unnecessary harassment caused to the complainants.

c) To pay Rs.22,000/-, as litigation expenses.

or

Grant any other relief or order which this Hon’ble Commission may deems fit.

 

2.             Brief facts of the case are the husband of  complainant no.1 and father of the complainant no.2 namely Sh. Dalveer Singh (since deceased) had purchased a Motor Cycle make Hero II Deluxe bearing Engine No.HSIIENJ9J20603, Chassis No.NDLIAR206J9J12655 on 31.01.2019 which was hypothecated with IDB Financial SER Limited. The said vehicle was got insured with OP No.1 vide insurance certificate bearing certificate No.3005/43601425/10003/000 valid from 31.01.2019 to 30.01.2024. At  the time of receiving premium from the husband/father of the complainants the premium regarding PA cover was also received by the OP No.1 as is evident from the insurance certificate issued by the OPs and it was told by the OP No.1  that the vehicle including PA cover has been insured for a period of five years as per the new policies of the insurance company and accordingly the deceased husband/father of the complainants remained under impression that his vehicle including PA cover has been insured for a period of five years. Unfortunately on 15.06.2020 at about 1.30 p.m. the husband/father of the complainants namely Sh. Dalveer Singh met with an accident within the area of village Bhanokheri, P.S. Sadar Ambala, Tehsil and District Ambala while driving the motorcycle in question on its correct left side and at a moderate speed and suffered serious injuries in the said accident. He was got admitted in Sant Hospital, Ambala City for his treatment but he succumbed to those injuries during his treatment on 25.06.2020 and post mortem of his dead body was conducted on 26.06.2020. DDR No.26 dated 25.06.2020 was also registered. The family members of the insured had also verbally informed OP No.1 regarding the above said accident as well as the death of the deceased policy holder and they were advised to lodge a claim in writing with the office of OP No.1. Complainant no.2 is the nominee and son of the deceased and he accordingly lodged a death claim in the office of OP No.1  with a request to release the amount of compensation i.e. Rs.15 lacs against PA cover claim in his favour and he also deposited all the requisite documents as required/demanded by OP No.1 but till now OP No.1  has failed to release the legal claim regarding the death of insured namely Sh. Dalveer Singh. When needful was not done by OP No.1 the complainants served with a legal notice dated 22.07.2020, which was duly received and acknowledged by the OP No.1 but to no avail. The complainant no.2 also moved an application dated 28.08.2020 in the office of OP No.1 but to no avail.  Hence, the present complaint.
3.           Upon notice, the OP No.1 appeared and filed written version raising preliminary objection to the effect that the instant complaint is a gross abuse of process of law and has been filed by the complainant with the sole purpose of harassing and pressuring OP No.1;  the present complaint is also misuse of process of law; the complaint is not maintainable, as it is ex-facia, misconceived, vexatious, untenable and devoid of any merits; the complainant has not come to the court with clean hands; complex question of law and facts are involved, hence, same is to be relegated to the civil court;  the complaint is bad for mis-joinder and non-joinder of necessary parties and estoppel etc. On merits, it has been stated that the insured had taken policy from OP No.1 valid for the period from 31.01.2019 to 31.01.2020 for damage to own vehicle, whereas from 31.01.2020 to 31.01.2024 third party policy was taken by the owner of the vehicle. As per the contention of the complainants, the insured Dalveer Singh met with an accident 15.06.2020, whereas the insured was not covered under the policy at that time as the comprehensive cover was upto 31.01.2020 and was having the third party insurance from 31.01.2020 to 31.01.2024. Because the insured was not covered under the policy on 15.06.2020, as such the complaint is liable to be dismissed on this score alone. Rest of the averments of the complainants were denied by the OPs and prayed for dismissal of the present complaint with special costs.
4.           Upon notice, the OP No.2 appeared and filed written version and raised preliminary objection with regard to maintainability, no territorial jurisdiction, no cause of action, jurisdiction and not come with clean hands and concealed the true and material facts etc. On merits, while admitting the factual matrix of the case  to the extent that Sh. Dalveer Singh (since deceased) and his son i.e, complainant No.2 had purchased a motorcycle from the branch office of OP No.2 situated at Devigarh and got hypothecated the same with HDB Financial Service Ltd.. Rather, the motorcycle was purchased at Patiala and the same was got insured with OP No.1 i.e. ICICI Lombard Motor Insurance Company, TF1-5, Third floor, 88, The Mall, Ludhiana, Punjab, 141001. As far as the period of insurance policy is concerned, it is submitted that the policy is OD Policy for one year covering the period from 31.01.2019 to 30.01.2020 for which damage to vehicle and owner of vehicle was covered and thereafter, it is a third party policy as availed by Sh. Dalveer Singh and his son covering the period from 31.01.2020 to 30.01.2024 which is also evident from the cover note. This fact has been intentionally suppressed by the complainants in order to fetch easy money. The insured was were well aware of the factum of nature of policy and the insurance term i.e. 1+4 i.e. 1 year for OD policy and remaining period for third party insurance and he had obtained this policy after paying due premium. There is no such condition of giving verbal intimation about any incident to answering OP. Rather, OP No.2 is only the retailer/dealer of the Hero Motorcycles and after sale of the motorcycle, it has nothing to do with the same. Moreover, the complainant No.2 and his father had opted and availed the insurance policy themselves and if they have any grievance, the same only stands against the OP No.1 and not against OP No.2. Rest of the averments of the complainants were denied by the OP No.2 and prayed for dismissal of the present complaint with costs.
5.           Complainant No.1 tendered his affidavit as Annexure CW1/A alongwith documents as Annexure C-1 to C-28 and closed the evidence of the complainant No.1. On the other hand, learned counsel for the OP No.1 tendered affidavit of Divyam Suri, Authorized officer/Manager Legal, ICICI Lombard General Insurance Co. Ltd. as Annexure OP-1/A alongwith document as Annexure R-1 and closed evidence on behalf of the OP No.1. Learned counsel for the OP No.2 tendered affidavit of Rohit Goel, Authorized Signatory of the OP No.2-company- M/s Goel & Goel, Patiala as Annexure OP-2/A alongwith documents as Annexure OP-2/1 to OP-2/3 and closed evidence on behalf of the OP No.2.
6.           We have heard the learned counsel for the parties and have also carefully gone through the case file.
7.           Learned counsel for the complainants submitted that since not making payment of the amount of Rs.15 lacs, after the death of insured, during subsistence of the policy in question, the OPs are deficient in providing service and adopted unfair trade practice. 
8.           On the contrary, learned counsel for the OPs submitted that the motorcycle in question was insured alongwith CPA (Personal accident) cover of Rs.15 lacs for the period from 31.01.2019 to 31.01.2020 and also for damage to own vehicle, whereas from 31.01.2020 to 31.01.2024 insurance was covered only for the third party. He further submitted that since the insured died on 15.06.2020 i.e. during the period when he was not covered under the policy in question, as such, the complainants are not entitled to get any claim out of the policy in question.  
9.           Since neither the issuance of policy in question in favour of the insured i.e. husband of the complainant no.1 and father of complainant no.2 nor the death of the insured in the accident in question are in dispute, as such, the moot question which falls for consideration is, as to whether, the complainants are entitled to get any insurance claim out of the policy in question, being legal heirs of the insured- deceased Sh. Dalveer against PA cover or not. For coming to any conclusion, in the matter,  it has to find out, as to whether,  on the day of accident, the insured was covered under the insurance policy in question or not.  It may be stated here that though the complainants have contended with vehemence that the policy in question was valid for the period of 5 years under which the insured was also covered for personal accident, yet, when we peruse terms and conditions of the policy in question, Annexure OP-2/1 it is clearly found mentioned therein that the motorcycle in question was insured alongwith CPA (Personal accident) cover of Rs.15 lacs for the period from 31.01.2019 to 31.01.2020 and also for damage to own vehicle, whereas from 31.01.2019 to 30.01.2024 the insured was not covered and only the third party was covered under the same for the said period. In our considered opinion, since the accident of the insured occurred on 15.06.2020 at about 1.30 p.m. and he ultimately died during treatment on 25.06.2020 i.e. after about 5 months of expiry of policy for damage to own vehicle and Personal Accident cover i.e. 30.01.2020, as such, the complainants are not entitled to get any claim amount for the period, which was covered only for the third party and not the insured.  It is significant to mention here that the insurance policy between the insurer and the insured represents a contract between the parties and the insured cannot claim anything more than what is covered by the insurance policy. Our this view is supported by the ratio of law laid down by the Hon’ble Supreme Court of India in Oriental Insurance Co. Ltd Vs Sony Cherian (II 1999 CPJ 13 SC) wherein it was held that- ― “..The insurance policy between the insurer and the insured represents a contract between the parties. Since the insurer undertakes to compensate the loss suffered by the insured on account of risks covered by the insurance policy, the terms of the agreement have to be strictly construed to determine the extent of liability of the insurer. The insured cannot claim anything more than what is covered by the insurance policy. That being so, the insured has also to act strictly in accordance with the statutory limitations or terms of the policy expressly set out therein…”.
10.           In view of peculiar facts and circumstances of this case, it is held that because the complainants have failed to prove their case, therefore, no relief can be given to her. Resultantly, this complaint stands dismissed with no order as to cost. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.           

Announced:- 09.05.2023.

 

(Vinod Kumar Sharma)	(Ruby Sharma)	(Neena Sandhu)
Member	Member	President