Haryana

Karnal

CC/313/2019

Kiran - Complainant(s)

Versus

Cholamandalam MS General Insurance Company Limited - Opp.Party(s)

Y.P. Arora

04 Mar 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                       Complaint No. 313 of 2019

                                                        Date of instt.30.05.2019

                                                        Date of Decision:04.03.2022

 

Kiran wife of late Shri Bakhsi aged 36 years resident of village Budha Khera, Tehsil and District Karnal.

 

                                               …….Complainant.

                                              Versus

 

1.     Cholamandalam MS General Insurance Co. Ltd. through its Manager, office at Sector-12, Karnal.

2.     Indusind Bank Pvt. Ltd. through its Manager, office at sector-12, Karnal.

                                                                      …..Opposite Parties.

 

Complaint Under Section 12 of the Consumer Protection Act, 1986 and after amendment Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

                   

 Argued by: Shri Y.P. Arora, counsel for complainant.

Shri Vineet Rathore, counsel for OP no.1.

Shri Suraj Kanwar, counsel for OP no.2.

 

                    (Jaswant Singh President)

ORDER:   

                

                   The complainant has filed the present complaint Under Section 12 of the Consumer Protection Act, 1986 as after amendment under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that the husband of complainant namely Bakshi Ram (since deceased) was a registered owner of motorcycle bearing registration no.HR-05-AP-0801. The husband of complainant was insured with OP no.1, vide policy no.2860/00146454/000/00. The husband of complainant was covered under the Group Personal Accident Master Policy issued to M/s Indusind Bank customers. On 25.05.2018 the husband of complainant went from his residence on the abovesaid motorcycle but he did not return to his house, due to which his family members went on for searching him and on next day i.e. 26.05.2018, dead body of insured/Mr. Bakshi Ram was found in the Canal Water. The matter was reported to police post Bohli, P.S. Matlauda, District Panipat. The police recorded DDE no.25 dated 26.05.2018 and investigated the matter. The post mortem of the dead body was also conducted by Civil Hospital, Panipat. Intimation in this regard was also sent to OP no.1 and also lodged the claim, vide claim no.2860000497, under Group Personal Accident Insurance Policy. All the relevant documents were also submitted with the claim form in the office of OP no.1. Thereafter, complainant visited the office of OP no.1 so many times and requested for settlement of the claim but OP no.1 always postponed the matter on one pretext or the other and lastly repudiated the claim of the complainant, vide letter dated 02.01.2019, on the false and frivolous ground. In this way there was deficiency in service and unfair trade practice on the part of the OPs. Hence, complainant filed the present complaint seeking direction to the OP no.1/insurance company to pay the claim amount of Rs.2,00,000/- alongwith interest @ 18% per annum and also to pay a sum of Rs.50,000/- as compensation for mental agony and Rs.15,000/- as litigation costs.

2.             On notice, OP no.1 appeared and filed its written version raising preliminary objections with regard to maintainability and concealment of true and material facts. On merits, it is pleaded that as per complainant on 25.05.2018 insured Bakshi Ram went from his house on motorcycle no.HR-05-AP0801 being driven by himself and when he did not come back after the late night then they searched for him. They found the body of insured floating in the water in the canal near iron bridge, near refinery Bohli, District Panipat. After receiving the claim intimation under the policy, OP no.1 without any delay starting collecting facts and documents so as to process the claim as per the terms of policy. On investigation of the case, scrutiny of claim papers submitted in support of claim, insured Bakshi Ram went from his house on motorcycle in question being driven by himself, PMR was conducted by Medical Officer Government Hospital, Panipat.  According to PMR, the cause of death in this case is asphyxion due to drowning which is sufficient to cause death in ordinary course of nature. With the final outcome of investigations it was safely concluded that it is a suicide case, because in PMR, no accidental injuries or other injuries received by the deceased. It is also noted that deceased has left his house in late night and the reasons is not clear as to why he has gone to the canal at night. Further, police also did not convert the DDR into FIR, since no accidental/incidental injuries were found. It is further pleaded that there is no document which could confirm the death was due to an accidental one. Death has happened due to drowning but not accidental one. The circumstances suggest suicidal death as deceased left his motorcycle and his motorcycle was found near Karnal, but no information regarding damages to the motorcycle. Therefore, presumption of death is suicide. As such by dint of Repudiation letter dated 02.01.2019, it was intimated to complainant that the claim is not admissible due to violation of policy terms and conditions- Exclusion no.1 “The policy does not provide benefits for any death disability, expense or loss incurred in result of any injury attribute directly or indirectly to the following:-

 “Intentionally self-inflicted injury, suicide or any attempt threat while sane or insane. Since, the claim falls under the abovementioned exclusion clause, no claim can be processed under the above mentioned policy condition”.

There is no deficiency in service on the part of the OP no.1 while repudiating the claim of the complainant. The other allegations made in the complaint have been denied by the OP no.1 and prayed for dismissal of the complaint.

3.             OP no.2 appeared and filed its separate written version raising preliminary objections with regard to maintainability; limitation; jurisdiction and cause of action. On merits, it is pleaded that there is no contract and any type of consideration has taken place between the OP no.2 and has not charged any kind of premium of insurance policy from the complainant. All the risks and liabilities are covered by the OP no.1 only who had issued the policy to the complainant. OP no.2 provides the banking services to the people for deposit and withdrawal of the money. It is further pleaded that OP no.2 bank is only a facilitator whereas the insurance policy issued by OP no.1 and as such complaint be filed against the OP no.2 is liable to be dismissed.

4.             Parties then led their respective evidence.

5.             Complainant tendered into evidence her affidavit Ex.CW1/A, copy of insurance certificate Ex.C1, copy of claim form Ex.C2, repudiation letter dated 02.01.2019 Ex.C3, copy of DDR/DDE dated 26.05.2018 Ex.C4, copy of post mortem report of deceased Bakshi Ram Ex.C5, copy of Aadhar card of complainant Ex.C6, copy of driving licence of Bakshi Ram/deceased Ex.C7 and closed the evidence on 06.12.2019 by suffering separate statement.

6.             On the other hand, OP no.1 tendered into evidence affidavit of Mr. Sujeet Kumar Sahu Ex.OP1/A, affidavit of Sanjay Jain Advocate/investigator Ex.OP2/A, personal accident claim form Ex.OP1, repudiation letter dated 02.01.2019 Ex.OP2, personal accident claim note Ex.OP3, copy of DDR Ex.OP4, statement of Kiran Ex.OP5, statement of Karam Chand Ex.OP6, post mortem report Ex.OP7, investigation report Ex.OP8 and closed the evidence on 28.09.2021 by suffering separate statement.

7.             OP no.2 tendered into evidence affidavit of Kulveer Singh Panwar, Deputy Manager Ex.RW1/A, statement of account Ex.R1 and Ex.R2 and closed the evidence on 27.10.2021 by suffering separate statement

8.             We have heard the learned counsel of the parties and perused the case file carefully and have also gone through the evidence led by the parties.

9.             Learned counsel for complainant, while reiterating the contents of complaint, has vehemently argued that husband of complainant namely Bakshi Ram (since deceased) was a registered owner of motorcycle bearing registration no.HR-05-AP-0801 and was insured with OP no.1, under the Group Personal Accident Insurance Policy. On 25/26.05.2018 the husband of complainant was expired. Intimation in this regard was sent to OP no.1 and also lodged the claim under the abovesaid Policy. All the relevant documents were also submitted with the claim form in the office of OP no.1. Thereafter, complainant visited the office of so many times and requested for settlement of the claim but OPs always postponed the matter on one pretext or the other and lastly repudiated the claim of the complainant, vide letter dated 02.01.2019 on the false and frivolous ground. Hence, prayed for allowing the complaint.

10.           Per contra, learned counsel for OP no.1, while reiterating the averments made in the written version, has vehemently argued that it is a suicide case, because in PMR, no accidental injuries or other injuries received by the deceased. Death has happened due to drowning but not accidental one. Therefore, the claim of the complainant has rightly been repudiated, vide letter dated 02.01.2019. Hence, prayed for dismissal of the complaint.

11.           Learned counsel for OP no.2 argued that OP no.2 bank is only a facilitator. All the risks and liabilities are covered by the OP no.1 only, who had issued the policy to the insured. Hence, prayed for dismissal of the complaint against OP no.2.

12.           Admittedly, the husband of complainant had expired during the subsistence of the insurance policy. The claim of the complainant has been repudiated by the OP no.1, vide letter Ex.C3/Ex.OP2 dated 02.01.2019 on the grounds which reproduced as under:-

“on perusal of the claim documents, independent service provider’s report, it is observed that on 26.05.2018 Mr. Bakshi Ram went from his residence by bike bearing registration no.HR-05-AP-0801, but he did not return to his residence due to which his family members searching for him. After that on 26.05.2018 found the dead body of insured in canal water.

As per independent service providers report and the circumstantial evidence that insured had committed suicide.

Since above mentioned document/information indicate that the insured has committed suicide. We regret to inform that the claim is not admissible due to violation of policy terms and conditions-Exclusion no.1 which is reproduced hereunder:-

“The policy does not provide benefits for any death disability, expense or loss incurred in result of any injury attribute directly or indirectly to the following:-

“Intentionally self-inflicted injury, suicide or any attempt threat while sane or insane. Since, the claim falls under the abovementioned exclusion clause, no claim can be processed under the above mentioned policy condition”.

 

13.           The claim of the complainant has been repudiated by the OP no.1 on the ground that husband of complainant has committed suicide and as per the exclusion clause 1 of the Group Personal Accident Insurance Policy, the complainant is not entitled for any compensation.

14.           The onus to prove her case was lies upon the complainant but complainant miserably failed to prove her case by leading any cogent and convincing evidence. Rather, it is evident from post mortem report Ex.C5/OP7, no injury found on the body of the deceased.  The motorcycle in question was also found in standing condition and without any damaged, at the place of incident. It is also evident from the DDR Ex.C4/OP4, the incident took place coincidence. If the deceased met with an accident he might have received multiple injuries and motorcycle also became damaged.  It is not case of the complainant that she has filed the MACT case and received the compensation, if the deceased died in the accident then the complainant should have filed the MACT case.

It is also admitted facts that police has not converted the said DDR in the accident case. It has been proved from the record, that the insured had committed suicide. Thus, complainant is not entitled for claim under Group Personal Accident Insurance Policy.

15.           Thus, as a sequel to abovesaid discussion, we found no merits in the present complaint and same is hereby dismissed. No order as to costs. The parties concerned be communicated the order accordingly, and the file be consigned to the record room, after due compliance.

Dated:04.03.2022

                                                                       

                                                                  President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal.

 

(Vineet Kaushik)       

                           Member