Delhi

StateCommission

CC/11/187

RUDRA PARTAP NARYAN SINGH HUF - Complainant(s)

Versus

ANSAL HOUSING & CONSTRUCTION LTD & ANR. - Opp.Party(s)

21 Aug 2018

ORDER

IN THE STATE COMMISSION : DELHI

(Constituted under Section 9 of the Consumer Protection Act, 1986)

Date of Arguments : 21.08.2018

Date of Decision : 04.09.2018

FIRST APPEAL NO.187/2011

 

Smt. Neelam Sharma,

W/o. Late Shri Praveen Sharma,

Presently R/o. 133, 2^nd Floor,

Pratap Nagar, Jail Road,  New Delhi.                                                    …..Appellant

 

Versus

1. Manager,

National Insurance Company,

1/3 Azadpur Commercial Centre,

2.  

 

2. Divisional Manger,

National Insurance Company,

E-2/9, Jhandewalan Extn. New Delhi.               .....Respondent No.2

 

CORAM

Hon’ble Sh. O. P. Gupta, Member (Judicial)

Hon’ble Sh. Anil Srivastava, Member

1.     Whether reporters of local newspaper be allowed to see the judgment?                                                               Yes/No

2.      To be referred to the reporter or not?                                                                                                        Yes/No

Shri O.P. Gupta, Member (Judicial)

JUDGEMENT

 

1. Aggrieved by order dated 28.03.11 the complainant is in appeal before this Commission. The complaint was dismissed simply  on the ground that complainant did not submit the claim with respondent/ Insurance Company.

 

2. Facts giving rise to the filing of complaint were that husband of the appellant took two insurance policies from respondent. One was Personal Accident Policy and the other was Medi-claim Policy. Value of each of the policy was Rs.2 lakhs. On 25.09.05 husband of the appellant fell down from the balcony of the house at Rani Bagh, Shakur Basti, Delhi and expired on 31.03.06 due to injuries incurred after the  accident, he was taken to Bhagwan Mahavir Hospital  and he was shifted to Indian Spinal Injuries Centre, Sector-C, Vasant Kunj, New Delhi where he remained admitted from 25.09.05 to 21.10.05. The said hospital raised bill of Rs.96,379.99 out  of  which insurance paid Rs.89,171/- through Family Health Plan.

 

3. Condition of the husband of the appellant did not improve, he was having badsores and again admitted in Indian Spinal Injuries Centre on 14.11.05 where he remained till 18.11.05. Hospital sent medi-claim to the Insurance Company, respondent did not respond. The appellant paid Rs.16,086.99 towards remaining amount. Subsequently also husband of the appellant was admitted in the hospital from time to time and appellant spent Rs.79,745.43, Rs.10,000/-, Rs.75,493/-, Rs.69,143/-, Rs.20,000/- and Rs.5,866/- towards medicine charges in Indian Spinal Injuries Centre and charges to G.M. Modi Hospital. The sum total of these sums alongwith Rs.89,171/- already reimbursed by the respondent exceed Rs.2 lakhs which was the sum insured under Medi-claim Policy. Thus complainant claimed Rs.1,10,829/-  only on account of the Medi-claim Policy. She also claimed Rs.2 lakhs as compensation towards mental agony, harassment and cost of litigation.

 

4. The complainant claimed Rs.2 lakhs on account of Personal Accident Policy for the fell down of her husband from balcony. The OP resisted both the claims on the plea that complainant had not filed the claim under either policy. The competent authorities examined the matter and found that complainant had not filed the claim. Thus there was no occasion to process the claim and to honour them.

 

5. District Forum found that complainant did not file rejoinder inspite of opportunity. However she filed her own affidavit in evidence and documents Exbit C/1 to C/11 which were Death Certificate, copies of policy, copies of treatment of Bhagwan Mahavir Hospital, Copy of Medi-claim Policy, copy of letter of the complaint and legal notice.
6. Per contra the respondent filed affidavit of Shri Harish Pandey.

 

7. The District Forum held that complainant had not place any document or acknowledgement of the Insurance Policy to show that Insurance Company received any of the two claims. The contention of complainant was that he personally submitted letter 10.11.08 copy of which was Exbit C/10, postal record was Exbit C/11. The said letter and legal notice were no replied by the Insurance Company. It has not been established by relevant documents that appellant filed claim.

 

8. We have gone through the material on record and heard the arguments. First of all we would like to mention that the Insurance Company did not send reply of letter dated 10.11.08 or legal notice. It is settled law that silence is half consent. If the Insurance Company felt that complainant had not filed any claim it should have replied the notice. None reply of notice amounts to admission. In this regard reliance can be placed on decisions of our own Hon’ble High Court in 1980 Rajdhani Law Reporter noted G4,1988 RLR 520, 1992 RLR 380 & 98(2002) DLT 573 DB.

 

9. The counsel for the appellant further submitted that even if it is presumed for a moment that no claim was submitted, still the subsequent conduct of the respondent is such which reflects adamency of the respondent not to pay the claim. He filed copy of covering letter dated 17.11.16 filed by the appellant with the respondent company, in pursuance of  order dated 01.10.16 passed by Lok Adalat, during the pendency of the appeal. The said letter  contains endorsement of receipt by Insurance Company alongwith its rubber seal. He further submitted copy of letter dated 30.06.17 from Insurance Company to the appellant which recites that maximum balance payable amount under policy no.360804/48/05/8500000/76 which could be paid against documents/ bills submitted before Lok Adalat was Rs.1,10,829/-. The appellant was requested to send her consent to receive the amount as full and final settlement of the claim and provide her bank account details  (cancelled cheque/ copy of passbook) for initiating payment. The appellant submitted required details vide her letter dated 08.03.18 which contains endorsement of receipt of the said letter under its rubber seal. Despite that the appellant has not released the payment till now.

 

10. The counsel for respondent tried to escape the consequence of letter dated 30.06.17 sent by respondent by submitting that it simply mentioned that maximum balance amount  payable was Rs.1,10,829/-. According to her it did not amount admission on the part of the respondent of its liability to pay the amount.

 

11. We have given anxious consideration to the arguments of respondent and find the same to be not tenable. If the respondent did not intend to pay the amount, it would not have called for the bank account details (cancelled cheque/ copy of pass book) for initiating payment.

 

12. Not only this the counsel for appellant draw our attention to proceeding dated 02.02.18 vide which the appellant was directed to provide bank account details alongwith the copy of cancelled cheque, as desired by respondent for the purpose for transfer of the amount. On 27.04.18 it came that the appellant supplied the same and filed copy of letter delivered to the respondent. Another copy thereof was supplied to the respondent on that date before this Commission. Appellant was directed to produce another copy of cancelled cheque. Appellant filed copy of cancelled cheque on 08.05.18 and supplied yet another copy to the respondent. The respondent was directed to bring the payment of admitted amount on 31.05.18. The respondent did not do the needful. Rather it again took the plea that appellant did not supply copy of cancelled cheque. That was rejected by observing that said submission was against recorded. Still appellant handed over photocopy of the blank cheque on 31.05.18 before this Commission. The respondent was directed to bring payment of the amount on 31.08.18. The same had no effect on the respondent. The responsible Officer of the respondent who was directed to appear vide order dated 08.05.18 and 31.05.18 did not appear. All this shows nothing but adamency of the respondent not be pay the admitted claim even.

 

13. The counsel for the respondent submitted that appellant can claim only one out of the two claims. It was directed to cite the case law on 27.04.18 but it failed to do so. The two policies were for different purposes, one was Accident Policy, falling down from roof is covered under this policy. Other was Medi-claim Policy  which was for treatment. The other claim fell under this policy. The root cause of the two claims may be same but coverage under the two policies do not overlap.

 

14. Counsel for appellant submitted that technicalities like non filing of claim should not be allowed to stand in way  of substantial justice as per decision of  Hon’ble Supreme Court in Om Prakash vs. Reliance General Insurance IV (2017) CPJ 10. No prudent person would follow the case from 2009 to 2018 without lodging a claim. Had the complainant not lodged the claim she would have quickly withdrawn the complaint with liberty to lodge the claim. Again at the cost of repetition it may be observed that subsequent contact of the respondent in not honouring its liability to pay balance amount shows that it did not intend to pay and defence of non filing of claim was only an excuse.  NO adverse inference could be drawn for non filing of rejoinder as [er decision of our own Hon’ble High Court in 1994 (4) Delhi Lawyers 71.

 

15. For the foregoing  reasons the appeal is accepted. Impugned order is set aside. The respondent is directed to pay balance amount of Rs.1,10,829/- against Medi-claim Policy and Rs.2 lakhs against Personal Accident Policy. However on the facts and circumstances of the case we are not inclined to allow interest or compensation.

 

16. The respondent will comply with the order within 45 days from receipt of copy of this order. In the event of failure to do so it will pay the interest also @9% per annum from the date of this order till the date of payment.

 

 

17. Copy of the order be sent to both the parties free of cost.

 

18. One copy of the order be sent to District Forum for information.

 

19. File be consigned to record room.

 

 

 

(ANIL SRIVASTAVA)                                           (O.P. GUPTA)                                    

MEMBER                                               MEMBER (JUDICIAL)

 

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