Punjab

StateCommission

FA/56/2014

Ruldu Ram - Complainant(s)

Versus

Bajaj Allianz General Insurance Comapny - Opp.Party(s)

Rahul Sharma

13 Mar 2015

ORDER

2^nd Additional Bench

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB

DAKSHIN MARG, SECTOR 37-A, CHANDIGARH

 

First Appeal No. 56 of 2014

 

                                                                       Date of institution:  20.1.2014  

                             Date of Decision:  13.3.2015

 

Ruldu Ram @ Ruldu Singh aged about 48 years son of Charanji Ram, Resident of VPO Dhudian, Tehsil Moonak, District Sangrur.

…..Appellant/Complainant

 

                                      Versus

 

1. Bajaj Allianz General Insurance Company Ltd., registered office : GE Plaza, Airport Road, Yerwada, Pune-411006, through its General Manager.
2. Bajaj Allianz General Insurance Company Ltd., SCF 12-13, 2^nd Floor, Gurudwara Dukhniwaran Sahib Market, Patiala, through its Branch Manager.

…..Respondents/OPs

 

First Appeal against the order dated 6.11.2013 passed by the District Consumer Disputes Redressal Forum, Sangrur.

 

Quorum:-

 

              Shri Gurcharan Singh Saran, Presiding Judicial Member

              Shri Jasbir Singh Gill, Member

    Shri Harcharan Singh Guram, Member

 

Present:-

 

          For the appellant             :         None.

          For the respondents        :         Sh. R.S. Dhull, Advocate

 

 

 

 

Gurcharan Singh Saran, Presiding Judicial Member

ORDER

The appellant/complainant(hereinafter referred as “the complainant”) has filed the present appeal against the order dated 6.11.2013 passed by the District Consumer Disputes Redressal Forum, Sangrur (hereinafter referred as “the District Forum”) in consumer complaint No.89 dated 22.2.2012 vide which the complaint filed by the complainant was dismissed.  

2.                The complaint was filed by the complainant under the Consumer Protection Act, 1986 (in short ‘the Act’) against the respondents/opposite parties (hereinafter called ‘the Ops’) on the allegations that the wife of the complainant, namely, Darshana Devi had obtained the services of the Ops by getting Safeguard Personal Accident Policy bearing No. OG-10-1214-6401-00000282 for a sum of Rs. 5,00,000/- w.e.f. 15.7.2009 to 14.7.2012. It was further alleged that on 6.10.2009, the wife of the complainant alongwith her son Gagandeep and brother-in-law Tarsem Chand had gone to Village Ghorenab to see their relatives. At about 3.00 p.m. when they had reached the Bus Stand suddenly a stray cattle hit Darshna Devi as a result of which she sustained multiple injuries on her head and other parts of the body. She was immediately taken to Civil Hospital, Moonak but on the way, she succumbed to the injuries. She was cremated without conducting any post mortem. DDR No. 7 dated 21.12.2009 was recorded in P.S. Lehra. The complainant could not lodge the claim under the policy with the OP as his policy was misplaced and as and when he found the policy, he approached the Op for claim after submitting the relevant documents vide notice dated 12.1.2011. However, the Ops sent a letter dated 10.2.2011 to the complainant through Investigator and demanded certain documents to settle the claim. The complainant vide letter dated 10.3.2011 had submitted the documents to Op No. 2, but the claim was not settled, which amounts to deficiency in services on the part of the Ops. Hence, the complaint with a direction to the Ops to pay the insurance amount of Rs. 5 lacs alongwith compensation of Rs. 50,000/- and litigation expenses of Rs. 11,000/-.

3.                The complaint was contested by the Ops, who filed written reply taking legal objections that there was no deficiency in services or unfair trade practice on the part of the Ops. Complainant had not come to the Forum with clean hands and had suppressed the material facts; the complainant had unnecessarily dragged the Ops in unnecessary litigation, therefore, the complaint was liable to be dismissed with special costs of Rs. 20,000/- and that the Hon’ble Forum had got no jurisdiction to entertain the complaint. On merits, it was admitted that the complainant was assigning under the policy issued in the name of Darshana Devi for the period 15.7.2009 to 14.7.2012 with sum insured of Rs. 5 lacs. However, it was denied that Darshana Devi was hit by a stray cattle and died on account of that. DDR No. 7 dated 21.12.2009 is an afterthought story. The claim was lodged with the OPs on 12.1.2011 after a gap of 1 year 4 months and it was not attached with any post mortem report or the FIR. Therefore, the story put forth by the complainant that Darshana Devi died an accidental death was concocted one. Otherwise as per the terms and conditions of the policy, in case of accidental death, the legal heirs of the insured were required to give the intimation immediately to the insurance company and send the copy of the post mortem report within 30 days, therefore, the complainant had also violated the terms and conditions of the policy and accordingly, the claim was rightly repudiated by the Op. No merit in the complaint and it be dismissed.

4.                The parties were allowed by the learned District Forum to lead their evidence.

5.                In support of his allegations, the complainant had tendered into evidence legal notice Ex. C-1, postal receipt Ex. C-2, claim form Ex. C-3, policy Ex. C-4, DDR Ex. C-5, death certificate Ex. C-6, letter Ex. C-7, reply Ex. C-8, postal receipt Ex. C-9, translated DDR Ex. C-10, translated copy of death certificate Ex. C-11, panchayat certificate Exs. C-12 & 13, Statement of Gagandeep Singh Ex. C-14, Tarsem Chand Ex. C-15, letter Ex. C-16, postal receipt Ex. C-17, Sarpanch Certificate Ex. C-18, Gram Panchayat certificate Ex. C-19, affidavits Exs. C-20 to 23. On the other hand, the opposite party had tendered into evidence affidavit Ex. R-1, policy with terms and conditions Exs. R-2 & 3, statement Ex. R-4, investigation report Ex. R-5, repudiation letter Ex. R-6, claim form Ex. R-7.

6.                After going through the allegations in the complaint, written reply filed by the OPs, evidence and documents brought on the record, the complaint filed by the complainant was dismissed on the ground that evidence with regard to the factum how Darshana Devi died is contradictory. It is not supported by any post mortem report that it was accidental death and according to the terms and conditions of the policy, information was required to be given within a period of 30 days whereas intimation in this case was given after one year 4 months and accordingly, the learned District Forum held that repudiation was justified.

7.                None was present on behalf of the appellant, therefore, we had gone through the grounds of appeal with the help of Sh. R.S. Dhull, Advocate for the respondents.

8.                In the grounds of appeal, it was pleaded that the dismissal of the complaint only on the ground of late intimation was not justified. However, under the policy, there is no provision that in case the intimation was given beyond the period of 30 days then the claim will be repudiated. The reason for that was that he got mis-placed his policy, therefore, he could not give the intimation to the Ops within the said period. Therefore, the order so passed by the learned District Forum is liable to be set-aside and the complaint so filed by the complainant be accepted.

9.                There is no dispute with regard to the policy taken by the deceased wife of the complainant from the Ops. The death of the deceased is also within the insured period. However, there is dispute with regard to the nature of the death and that the intimation was not given within the limitation period. According to Clause 2(a) of the terms and conditions, it has been provided as under:-

“a)     You or someone claiming on your behalf must inform us in writing immediately and in any event within 30 days.”

Then in Clause 2(f), it has been provided as under:-

“f)      In case of your Death, someone claiming on your behalf must inform us in writing immediately and send us a copy of the post mortem report within 30 days.”

10.              In view of these terms and conditions of the policy, in case there is accidental death then intimation was required to be given to the OPs within a period of 30 days and that to be supported by Post Mortem Report. Here in this case, the incident took place on 6.10.2009. Even DDR was got recorded on 21.12.2009 and intimation to the Ops was given on 12.1.2011, after a gap of one year four months, therefore, the complainant has not complied with the terms and conditions of the policy. Even Post-mortem Report is not there to prove what was the cause of death. Mere certificate given by the Sarpanch is not sufficient to say that it was an accidental death. Where the complainant had violated the terms and conditions of the policy, then the claim of the complainant is liable to be rejected. Therefore, we are of the opinion that the Ops had rightly repudiated the claim and consequently, the complaint was rightly dismissed by the District Forum.

11.              In view of the above discussion, we do not see any merit in the appeal and the same is dismissed with no order as to costs.

12.              The arguments in this appeal were heard on 9.3.2015 and the order was reserved. Now the order be communicated to the parties as per rules.

 

13.              The appeal could not be decided within the statutory period due to heavy pendency of Court cases.

 

 

 (Gurcharan Singh Saran)

Presiding Judicial Member

 

 

                                                                            (Jasbir Singh Gill)

                                                                                                    Member

 

 

March 13, 2015.                                                      (Harcharan Singh Guram)

as                                                                                                Member