Haryana

Yamunanagar

CC/270/2011

Kamlesh W/o Labh singh - Complainant(s)

Versus

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

Vijaydeep Singh

09 Nov 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

 

                                                                                           Complaint No. 270 of 2011.

                                                                                           Date of institution: 29.03.2011 

                                                                                           Date of decision: 09.11.2016

Smt. Kamlesh aged about 43 years widow of Shri Labh Singh, resident of village Sarawin, PS Azizpur, Tehsil Bilaspur, District Yamuna Nagar.

                                              …Complainant.

                                                           Versus     

Cholamandalam MS General Insurance Company Ltd. Regional Office: SCO 236, 2^nd Floor, Sector 12, Karnal through its branch Manager, Regd. and Head Office: “ Dare House” 2^nd Floor, NSC Bose Road, Chennai Tamilnadu through its MD/GM.

                                                             

                                                                                                                                                ...Respondent.

           

BEFORE:         SH. ASHOK KUMAR GARG…………….. PRESIDENT.

                        SH. S.C.SHARMA………………………….MEMBER.

 

Present:           Sh. Vijay Deep Singh, Advocate, for complainant.      

                        Sh. Rajiv Gupta, Advocate for respondent.

 

ORDER

 

1                      The present complaint has been filed under section 12 of the Consumer Protection Act, 1986 praying therein that respondent (hereinafter referred as OP) be directed to make payment of Rs.2,00,000/-  on account of personal accident claim and also to pay compensation as well as litigation expenses.

2.                     Brief facts of the present complaint, as alleged by the complainant, are that husband of the complainant Shri Labh Singh purchased a motor cycle, Hero Honda bearing Registration No.HR71-6014 (Annexure C-2) which was got insured with the OP Insurance company vide policy bearing No.APG-00004180-000-00 valid from 11.02.2009 to 10.02.2010 (Annexure C-1) vide this policy, the complainant was also insured for personal accident of Rs.2,00,000/-. Unfortunately, husband of the complainant Shri Labh Singh died on 08.01.2010 in road side accident, when he was coming to his village from Bilaspur while he was himself driving the motor cycle in question. An FIR bearing No.5 dated 08.01.2010 (Annexure C-3) was got registered in the police station Bilaspur and postmortem (Annexure C-5) was also conducted. As per terms and conditions of the Insurance policy, husband of complainant is insured for Rs.2,00,000/- in case of death while driving the motor cycle in question. Accordingly, complainant applied for insurance claim but the OP Insurance Company kept on delaying the matter on one pretext or the other. The complainant also served a registered legal notice dated 18.09.2010, which was duly received by the OP Insurance Company but neither any reply has been given nor the OP Insurance company  paid the claim amount. Hence, there is deficiency in service on the part of the OP Insurance Company. Hence, this complaint.  

3.                     Upon notice, OP Insurance Company appeared and filed its written statement by taking some preliminary objections such as complaint is not maintainable; there is no negligence or deficiency in service; the insurance policy along with its terms and conditions stands already supplied to the husband of the complainant. In this case complainant has alleged that accident took place on 08.01.2010 while her husband was driving the motor cycle  bearing Registration No.HR71-6014 but the OP Insurance Company was never intimated nor any claim was lodged with it. Had the complainant lodged any claim with the insurance company, a specific claim number would have been assigned to the complainant. Even, the police was also not informed immediately. As such there was violation of the terms and conditions of the Insurance Policy wherein it has been so recorded that “Notice shall be given in writing to the company immediately upon the occurrence of any accidental loss or damage and in the event of any claim and thereafter the insured shall give all such information and assistance as the company shall require. Furthermore,  as per terms and conditions of the insurance policy, the personal accident benefit under the insurance policy is available  only if the owner driver is the registered owner and he holds a valid and effective driving license at the time of accident while himself driving the insured vehicle. However, in the present case as there was violation of condition No.1 of the Insurance policy, hence there is no deficiency in service or unfair trade practice on the part of OP Insurance Company and on merit controverted the contents of the complaint and reiterated the stand taken in the preliminary objection. Lastly, prayed for dismissal of complaint.

4.                     In support of his case counsel for the complainant tendered into evidence affidavit of complainant as Annexure CW/A and photocopy of documents i.e. Insurance Policy  as Annexure C1, photocopy of RC bearing No.HR71-6014, which is stands in the name of Labh Singh as Annexure C-2, photocopy of FIR bearing No.5 dated 08.01.2010 as Annexure C-3 , photocopy of report under Section 173 Cr.P.C. as Annexure C4, photocopy of postmortem report as Annexure C5,  photocopy of death certificate as Annexure C6, photocopy of Driving Licence bearing No.16384/GNR issued on 08.08.2003  and valid upto 10.08.2013 with effect from 11.08.2008 as Annexure C-7, copy of legal notice dated 18.9.2010 as Annexure C8, postal receipt as Annexure C9, acknowledgement as Annexure C10, photocopy of Ration Card as Annexure C11, photocopy of letter issued by Indusind Bank as Annexure C12 and closed the evidence on behalf of complainant.

5.                     On the other hand, ld. counsel for the OP Insurance Company tendered into evidence affidavit of Shri Abhilash Chander as RW/A, terms and conditions of the Insurance policy  as Annexure R1 and closed the evidence on behalf of OP Insurance Company.

6.                     We have heard the learned counsels of both the parties and have gone through the pleadings as well as documents placed on the file very carefully and minutely.

7.                     It is not disputed that husband of the complainant Sh. Labh Singh was the registered owner of the motor cycle, Hero Honda, Splendor plus bearing registration No.HR71-6014, which is also evident that from the copy of Registration Certificate (Annexure C2). It is also not disputed that motor cycle in question was not insured with the OP Insurance Company w.e.f. 11.02.2009 to 10.02.2010 and owner-cum-driver was insured for a sum of Rs.2,00,000/- on account of personal accident, which is  also evident from Insurance Policy (Annexure C1). It is also not disputed that when the husband of the complainant was going on motor cycle bearing Registration  No.HR71-6014, met with an accident on 08.01.2010, which is evident from the copy of FIR bearing No.5 dated 08.01.2010 (Annexure C3) and from the copy of final report under Section 173 Cr.P.C. Annexure C4.             It is also not disputed that husband of the complainant succumbed to the injury on the same day on 08.01.2010, which is duly evident from the copy of postmortem report (PMR) (Annexure C5) and death certificate (Annexure C6).

8.                     The only version of the OP Insurance Company is that the complainant never lodged any claim with the OP Insurance company whereas as per terms and conditions of the Insurance Policy i.e. condition No.1, complainant was supposed to immediately inform to the OP Insurance Company. Hence, the claim of the complainant is not payable and is liable to be dismissed.

9.                     On the other hand, learned counsel for the complainant argued at length that the genuine claim of the complainant  has been wrongly withheld by the OP Insurance company whereas from the perusal of copy of FIR Annexure C3, copy of challan  under Section 173 Cr.P.C.  Annexure C4 and copy of postmortem report Annexure C5, it is duly evident that husband of the complainant succumbed to the injuries in road side accident. Learned counsel for complainant further argued that the husband of the complainant was registered owner of the motor cycle bearing Registration No.HR71-6014 and was also having valid driving licence at the time of the alleged accident and he was driving the motor cycle in question, meaning thereby  that there was no violation of terms and conditions of the Insurance Policy issued on the part of deceased Labh Singh. Learned counsel for the complainant referred the case law titled as “Reliance General Insurance Company Limited Versus Sri Avvn Ganesh 2012(1) CPC Page No.681” wherein it has been held that

“Consumer Protection Act, 1986- Section 21 (b) & 2 (1) (g) – Insurance Policy- Repudiation of claim-Limitation-Claim was repudiated on death of insured on the ground that intimation of death was given after four months instead of one month-Complaint dismissed  by District Forum but appeal was allowed by the State Commission-Hence this revision petition – Delay in intimation of death of insured due to injuries in accident cannot be held to be erroneous to insurance claim when fact of death was duly proved on the basis of medical record- Delay in intimation cannot be prejudicial because in such cases delay was not any cause of preventing insurance company from carrying out an investigation in the facts of the case-No infirmity found in the order of the State Commission accepting claim of Rs.5 lacs with cost of Rs.2,000/- Revision Petition Dismissed. 

10.                   After hearing the parties at length we are of the considered view that claim of the complainant has been wrongly withheld by the OP Insurance Company whereas from the perusal of copy of FIR bearing No.5 dated 08.01.2010 Annexure C3 and copy of report under Section 173 Cr.P.C. Annexure C4 and copy of postmortem report bearing No.2/10 dated 09.01.2010 (Annexure C-5), it is duly evident that husband of the complainant died in motor vehicular accident when he was driving the motor cycle in question and coming back to his village from Bilaspur. We have also perused the copy of driving licence bearing No.16384/GNR dated 08.08.2003 Annexure C7 which was duly valid at the time of alleged accident and further we have also perused the copy of Registration Certificate of the motor cycle in question Annexure C2 and from the perusal of this Registration Certificate it is also evident that motor cycle in question was registered in the name of husband of complainant Labh Singh meaning thereby  that husband of the complainant who was registered owner of the motor cycle in question and was having valid driving licence at the time of alleged accident, died when he was driving the motor cycle in question. Hence, as per terms and conditions of the Insurance policy he was fulfilling all the conditions of the policy in question for getting the claim on account of personal accident. The only plea of the OP Insurance Company that complainant has not informed the Insurance Company immediately is not tenable as the present complaint is pending since 29^th March, 2011 before this Forum and all the necessary documents are attached with this complaint from the very beginning and despite that OP Insurance Company has not taken any step to settle the genuine claim of the complainant. Moreover, it is settled law that the OP Insurance Company cannot deny claim of the complainant on the technical ground. The facts of the case law titled as “Reliance General Insurance Company Limited Versus Sri Avvn Ganesh 2012(1) CPC Page No.681” are applicable to the fact of the present case.      

11.                   In the circumstances noted above, the present complaint of the complainant is hereby partly allowed and the OP Insurance Company is directed to pay a sum of Rs.2,00,000/- on account of death of husband of the complainant  along with interest @ 7% per annum from the date of filing the complaint till its realization and OP Insurance Company is further directed  to pay Rs. 5000/- as litigation expenses. From the perusal of the copy of Ration Card Annexure C11, it is evident that Labh Singh was also having one daughter namely Renu Devi, so, claim amount be paid in equal share to each Smt. Kamlesh and her daughter Ms. Renu Devi. The share of the minor Renu Devi will be kept in FDR till the age of majority. Order be complied within a period of 30 days after preparation of copy of this order, failing which complainant shall be entitled to initiate action as per law. Copies of this order be supplied to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Pronounced in open court:

Dated: 09.11.2016

                                                                                          (ASHOK KUMAR GARG)

                                                                                           PRESIDENT

                                                                                           DCDRF Yamuna Nagar

 

 

                                                                                          (S.C.SHARMA)

                                                                                           MEMBER