Haryana

Ambala

CC/210/2020

Rahul Kumar - Complainant(s)

Versus

Shri Ram Gen Inss Co Ltd - Opp.Party(s)

B.S. Behgel

01 May 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	210 of 2020
Date of Institution	:	01.10.2020
Date of decision	:	01.05.2023

 

Rahul Kumar son of late Shri Jaswant Singh, resident of village Khera, PO Gokalgarh, Tehsil Barara, District Ambala.                                                 

……. Complainant.

Versus

1. SHRI RAM General Insurance Company Ltd. E-8, EPIP, RIICO, Tonk Road, Sitapura, Industrial Area, Sitapura, Jaipur, Rajasthan-302022 through its Divisional Manager/ Authorized Person.
2. Shriram General Insurance Company Ltd., # 2075-76, Shingari Complex, Baldev Nagar, Ambala City Through its Branch Manager.

 ….…. Opposite Parties

Before:        Smt. Neena Sandhu, President.

                             Smt. Ruby Sharma, Member,

          Shri Vinod Kumar Sharma, Member.           

 

Present:       Shri B.S. Behgal, Advocate, counsel for the complainant.

                              Shri Mohinder Bindal, Advocate, counsel for the OPs.           

Order:        Smt. Neena Sandhu, President.

1.           Complainant has 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:-
   1. To release the claim in favour of the complainant amounting to Rs.15,00,000/- along with interest and future interest.
   2. To pay Rs 5,00,000/- as compensation on account of mental agony and harassment.
   3. Cost of the litigation.
382.  

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

 

2.             Brief facts of the case are that the complainant is real son of Late Shri Jaswant Singh, who was the owner and driver of the vehicle/ motor cycle bearing Regn. No.HR-54E-5374 Marka Bajaj Platina-100 C, which was insured with the OPs vide policy No.10015/31/20/004424 for the period from 01.09.2019 to 31.08.2020 midnight along with PA cover under section III for owner-Driver for Rs.15,00,000/-. Premium of Rs.1741/- had been paid by the father of the complainant at the time of insurance of the above said vehicle. The father of the complainant was a mason (Raj Mistri) and on 11.09.2019 he was returning to his village from village Uplana on his motor cycle bearing Regn. No. HR-54E-5374 and when at about 7.30 PM reached near village Khera on Jharumajra road, suddenly one wheel cart (buggi jhota) appeared in front of the motor cycle of father of the complainant. Due to dark night, he could not judge the said wheel cart and the motor cycle got unbalanced from him and he along with the motor cycle fell on the road and suffered multiple & grievous injuries. On receiving the information of accident, the complainant along with other persons reached at the spot and took his father at Monga Hospital, Ambala where after giving first aid, the doctor referred father of the complainant to GMCH, Sector-32, Chandigarh and died on 20.09.2019. The complainant also reported the matter to the police that the accident took all of sudden and nobody is responsible for the same. Police got registered DDR No.033/20.09.2020. Post Mortem on the body of father of the complainant was conducted by the doctors of GMCH, Sector-32 Chandigarh on 20.09.2019. The father of the complainant having a valid driving licence at the time of incident and he had made the complainant as nominee in the policy. The complainant moved application, being son and nominee before the OPs for payment of compensation of Rs.15,00,000/- on account of death of his father due to use of the above mentioned motor cycle. Thereafter, the OPs demanded certain documents from the complainant vide letter dated 22.02.2020, which were submitted by him but they failed to pay the claim amount to the complainant, inspite of his repeated requests. When his requests were not acceded, the complainant got served a Regd. Ad Legal Notice dated 19.08.2020 posted on 19.08.2020 upon the OPs but to no avail.   Hence this complaint.
3.           Upon notice, the OPs appeared and filed written version and raised preliminary objections with regard to maintainability, not come with clean hands and suppressed the material facts and cause of action. On merits, it has been stated that the claim of the complainant against the death of his father namely Sh. Jaswant Singh allegedly in a roadside accident was duly entertained in due course and the complainant was immediately asked to comply certain formalities and was asked to submit the necessary requisite and mandatory documents like police report, PMR and death detail report issued by the concerned treating hospital, and all other papers showing the involvement of the insured vehicle in question since the complainant had been claiming the benefits under a motor insurance policy no. 10015/31/20/0040024 issued against motorcycle bearing registration no. HR-54E-5374 meant against the death of the insured person while driving the insured vehicle himself only. The complainant was asked to give some cogent proof to prove the death of his father while driving the insured motorcycle in question since the report of DDR no. 33 dated 20.09.2019 seems to be manipulated one, being lodged after an inordinate delay of 9 days of the alleged occurrence and was even totally silent about the exact vehicle involved in the alleged incident which the deceased was alleged to be driving at the time of alleged incident. Moreover, the complainant was also asked to comment upon the reason of death as mentioned in the death certificate issued by the hospital GMCH, Sector 32, Chandigarh where the death has been mentioned due to cardiac arrest but he failed to respond. The OPs are still ready to entertain the present claim if the complainant provides the required information and proof with regard to the involvement of the alleged motorcycle besides the alleged DDR no. 33 dated 20.09.2019 which is silent upon the details of the motorcycle allegedly involved in this alleged accident alongwith the explanation as to why in the death certificate issued by the GMCH, sector 32, Chandigarh dated 20.09.2019 the cause of death has been shown as cardiac arrest. The insured as well as all the beneficiaries under the said policy are legally bound to abide and follow the terms and conditions thereof. Rest of the averments of the complainant were denied by the OPs and prayed for dismissal of the present complaint with special costs.
4.           Learned counsel for the complainant tendered affidavit of the complainant as Annexure CA alongwith documents as Annexure C-1 and C-11 and closed the evidence on behalf of the complainant. Learned counsel for the OPs tendered affidavit of Santosh Sharma, Authorized Signatory, Shriram General Insurance Co. Ltd., Registered Office, Jaipur as Annexure OP-A alongwith documents Annexure OP-1 to OP-5 and closed the evidence on behalf of OPs.
5.           We have heard the learned counsel for the parties and have also carefully gone through the case file.
6.           Learned counsel for the complainant submitted that despite the fact that the insured died due to the accident while he was driving the insured motorcycle, who was also insured under Section III for owner-Driver for Rs.15 lacs, yet, by not paying the claim amount to the complainant, being nominee and beneficiary of the insured-deceased, the OPs are deficient in providing service and adopted unfair trade practice.
7.           On the other hand, learned counsel for the OPs submitted that complainant failed to prove that the insured died because of accident while driving the motorcycle in question. As per the medical certificate of cause of death dated 20.09.2019, Annexure OP-1 having been issued by the Government Medical  College & Hospital, Sector 32, Chandigarh, the immediate cause of death of the insured has been mentioned as cardiac arrest”, as such, the claim of the complainant is not payable.
8.           Since the issuance of policy in favour of the deceased-insured and also that the complainant was his nominee/beneficiary are not in dispute, as such, the only main question which falls for consideration is, as to whether,  the OPs were right in not entertaining the claim of the complainant or not?
9.           The first plea of the OPs is that in the DDR, number of the motorcycle has not been mentioned and as such it is not proved that the insured died in accident on the said motorcycle, it may be stated here that we have gone through the contents of said DDR and statements filed alongwith the same and found that it has been clearly mentioned therein that the complainant has clearly intimated the police concerned that the insured-Jaswant Singh met with an accident which took place on 11.09.2019 with one wheel cart, while he was on his motorcycle, which ultimately resulted in his death in the Government Hospital, Sector 32, Chandigarh. In our considered opinion, if the police concerned did not mention the number of the motorcycle in the DDR or any other document, then the insured or the complainant cannot be faulted because he has no control over the police. On the other hand, had there been any doubt with the OPs to the effect that the incident was tried to be shown as a case of accident with a wheel cart and the DDR no. 33 dated 20.09.2019 seems to be manipulated one, they could have deputed the surveyor to confirm the above fact by inspecting the motorcycle in question and other facts, yet, they miserably failed to do so and on the other hand, adopted shortcut method by not considering the claim of the complainant. As such, this plea of the OPs is not merit acceptance, hence rejected.
10.           Second plea of the OPs is that as per the medical  certificate of cause of death dated 20.09.2019, Annexure OP-1 having been issued by the Government Medical  Hospital, Sector 32, Chandigarh, the immediate cause of death has been mentioned as cardiac arrest, as such, it was a natural death, it may be stated here that we have gone through the document Annexure OP-1 and found that though it has been mentioned therein that the immediate cause of death of the insured is cardiac arrest, yet, at the same time, it has also been mentioned in Annexure OP-1 that the significant condition contributing the death, not related to the disease or condition causing it is “BLUNT TRAUMA ABDOMEN”. Significantly, when we go through the postmortem report which is of 8 pages, Annexure C-6 of the insured, it is found that it has been clearly mentioned by the doctor concerned that the patient had an alleged history of roadside accident on 11.09.2019, referred from Monga Hospital, Ambala and he had multiple comorbidities. It has also been mentioned in Annexure C-6 that stapled laparotomy wound measuring 30 cms over anterior abdominal wall in the midline; 5 cm below the xiphisternum and End ileostomy wound present over the left side of front of abdomen 6 cm to the left of midline and 8 cm above left anterior superior iliac spine were also found. It is very significant to mention here that the cause of death of the patient has been mentioned as “BLUNT TRAUMA ABDOMEN AND ITS COMPLICATIONS CONSEQUENT UPON BLUNT FORCE/SURFACE IMPACT OVER THE ABDOMEN”. Thus, this report Annexure C-6 leaves no doubt with this Commission to hold that the patient though had died with cardiac arrest, yet, the significant condition contributing the death was “BLUNT TRAUMA ABDOMEN” which has definitely occurred due to the said accident.  Since, from the documents, referred to above, it is proved beyond any doubt that the ultimate cause of death of the insured was accident, therefore, we are of the considered opinion that by not considering the claim of the complainant, the OPs have committed deficiency in providing service and are thus liable to pay the claim amount to the complainant.
11.           From the perusal of certificate cum policy schedule Annexure C-1, it is evident that the Deceased Life Assured (DLA) under the personal accident cover was insured for a sum of Rs.15,00,000/-. DLA appointed Rahul Kumar as nominee. Since, it has been proved on record that the ultimate cause of death of the insured was accident, therefore, complainant being the nominee is entitled to get the amount of Rs.15,00,000/-, alongwith interest. Complainant is also entitled to get compensation for the mental agony and physical harassment suffered by him alongwith litigation expenses.  
12.           In view of the aforesaid discussion, we hereby allow the present complaint and direct the OPs, in the following manner:-
    1. To pay the claim amount of Rs.15,00,000/-, to the complainant.
    2. To pay Rs.3,000/- as compensation for the mental agony and physical harassment suffered by the complainant.
    3. To pay Rs.2,000/- as litigation expenses.  

The OPs are further directed to comply with the aforesaid directions within the period of 45 days, from the date of receipt of the certified copy of the order, failing which the OPs shall pay interest @ 6% per annum on the awarded amount, from 01.05.2023 i.e the date of order, till realization. However, complainant is directed to assist the OPs in processing his claim by way of filing claim form if not yet submitted with them. 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:- 01.05.2023

 

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