Haryana

Ambala

CC/82/2022

Pushpa Devi - Complainant(s)

Versus

Dhruv Automobiles - Opp.Party(s)

G.S.Ahluwalia

11 Oct 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	82 of 2022
Date of Institution	:	08.03.2022
Date of decision	:	11.10.2024

Pushpa Devi wife of Late Shri Amar Dutt, resident of House No.16-A, New Laxmi Nagar, Jandli, Ambala City.

……. Complainant

Vs.

 

1. Dhruv Automobiles, through its authorized signatory, plot No.2028, Abadi Kirpa Nagar, Chandigarh Highway Baldev Nagar (opposite Passport Office), Ambala City.
2. ICICI Lombard General Insurance Company Limited, through its authorized signatory (Motor Claim Manager), Tower-D, 12^th Floor, Global Business Park, Mehroli, Gurugram.  

 

….…. Opposite Parties

Before:        Smt. Neena Sandhu, President.

                       Smt. Ruby Sharma, Member,

          Shri Vinod Kumar Sharma, Member.           

 

Present:      Shri G.S. Ahluwalia, Advocate, counsel for the complainant.

                    OP No.1 already ex parte.

                    Shri Mohinder Bindal, Advocate, counsel for the OP No.2.

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:-

(i)      To pay the death claim as per the policy.

(ii)     To pay Rs.15,00,000/- as per policy to the complainant and Rs.4,00,000/-, as compensation for the mental agony and          physical harassment suffered by the complainant.

(iii)    To pay Rs.50,000/- as litigation expenses.  

                                      OR

 Grant any other relief which this Commission may deems fit.

2.             In this complaint, it is stated that the complainant earlier filed a complaint before this Hon’ble Commission and due to technical defect, he had withdrawn the same, which was dismissed as withdrawn by this Hon’ble Commission vide its order dated ­­­­17.01.2022, with the permission to file a fresh complaint. Brief facts of the case are that the husband of the complainant purchased a motor cycle bearing No.HR01-AJ-4878 from the OP No. 1 and got it insured from Hero Insurance Broker Dealer i.e. OP No. 2 on 08.07.2020 vide Comprehensive Policy Certificate No.3005/48418423/11580/00 at the office of Dhruv Automobiles i.e. OP No.1, which was valid from 08.07.2020 till midnight of 07.07.2021. At the time of taking the insurance policy, It was assured that in the event of any miss-happening including owner as well as driver or third party, the insurance company shall be liable to indemnify the registered owner. It was also assured that in case of death or fatal injury of registered owner, the nominee-Pushpa Devi, being the legally wedded wife would be compensated by the OP No. 2. On 25.10.2020, the husband of the complainant was returning to his house from his office on his motor cycle bearing No.HR01-AJ-4878 at a moderate speed and on the correct side of the road. At about 6.45 p.m., when he reached near Kali Paltan bridge, near GRP office, Ambala Cantt, he met with an accident and suffered multiple grievous injuries and was taken to Civil Hospital, Ambala City, where the doctors declared him as dead. A DDR No.12 dated 26.10.2020 was registered at PS Parao regarding this accident. Post Mortem of the dead body of the husband of the complainant was conducted on 26.10.2020 in Civil Hospital, Ambala City. After the death of husband of the complainant, Amar Dutt, she being the nominee, is fully entitled to get the claim from the OPs. The complainant visited the OPs various times to get the death claim ultimately they told that her claim has been declined. Thereafter, the complainant served a legal notice dated 27.11.2020 upon the OPs, but the OPs did not bother and thereafter, the complainant again sent reminder dated 22.01.2021, but the OPs failed to do the needful. By not paying the genuine claim, the OPs have committed deficiency in providing service and also indulged in unfair trade practice. Hence, the present complaint.
3.           Upon notice, none appeared on behalf of the OP No.1 before this Commission, therefore, it was proceeded against ex-parte vide order dated 29.04.2022.
4.           OP No.2 appeared and filed written version and raised preliminary objection with regard to not come with clean hands and suppressed the material facts, cause of action etc. On merits, it has been stated that the insurance policy was issued subject to certain terms and conditions with a limited scope, as mentioned in detail in the insurance policy. The deceased husband of the complainant availed the said insurance policy after going through the each and every aspect and limited scope of the insurance policy and accordingly insurance policy was issued by charging the premium for the period from 08.07.2020 to 07.07.2021 only with regard to third party loss and own damage clause without any coverage or benefit of personal accident claim. The deceased husband of the complainant accepted the policy agreeing and being fully aware of its specific coverage and scope. It is further stated that upon issuance of an insurance policy, the insurer undertakes to indemnify the loss suffered by the insured on account of risks covered under the policy. It is a matter of contract and in terms of the contract, the relation of the parties shall abide and it is presumed that when the parties have entered into a contract of insurance, they have to rely upon the terms of the contract. It is further stated that the answering OP is liable to indemnify the insured or his nominee against the losses covered under the policy as per its scope and purview only according to the coverage availed by the insured and premium paid by him. Since the complainant has never reported/lodged any claim against the death of her husband thus there was no question to deal or deny any such claim as alleged. It is further stated that the answering OP has to work under certain framework and as per IRDA guidelines without any discrimination. Rest of the averments of the complainant were denied by the answering OP and prayed for dismissal of the present complaint with costs.
5.           Learned counsel for the complainant tendered affidavit of complainant as Annexure C-W1/A alongwith documents as Annexure C-1 to C-10 and closed the evidence on behalf of complainant. On the other hand, learned counsel for the OP No.2 tendered affidavit of Divyam Suri, Authorized Signatory/Legal Manager of the OP No.2-Company-ICICI Lombard General Insurance Co. Ltd., Regional Office, Chandigarh as Annexure OP-2/A  alongwith document as Annexure OP-2/1 and closed evidence on behalf of the OP No.2.
6.           We have heard the learned counsel for complainant and learned counsel for OP No.2 and have also carefully gone through the case file.
7.           Learned counsel for the complainant submitted that by not making payment of death claim amount as per the policy in question, after the death of insured, who died during subsistence of the policy in question, OP No.1 is deficient in providing service, negligent and adopted of unfair trade practice. 
8.           On the contrary, learned counsel for the OP No.2 submitted that the vehicle in question was not insured for Personal accident, under the policy in question, as such, the complainant is not entitled to get any claim out of the policy in question, after the death of the insured.  
9.           Since neither the issuance of policy in question in favour of the insured nor the death of the insured in the accident in question are in dispute, as such, the moot question which falls for consideration is, as to whether, the complainant is entitled to get any insurance claim out of the policy in question, being nominee of the insured- deceased (Sh.Amar Dutt) against PA cover or not. For coming to any conclusion, in the matter,  this Commission has to find out, as to whether,  on the day of accident, the insured was covered under the insurance policy in question for PA cover or not.  It may be stated here that we have gone through the contents of insurance cover note, Annexure OP-2/1 and found that under the Column-B- Liability Premium Computation (Section II), the insured had not paid any amount of premium towards PA Cover (Owner Driver), as the same has been mentioned as Zero “0”. However, the insured had availed the coverage for his vehicle,  with regard to third party loss and own damage only and had not availed the benefit of personal accident claim. In our considered view if the insured had not paid even a single penny to claim benefit of personal accidental cover-(Owner-Driver), his legal heirs cannot claim any amount against the same. It is significant to mention here that the insurance policy between the insurer and the insured represents a contract between the parties and the insured or his legal heirs cannot claim anything more than what is covered by the insurance policy. Our this view is supported by the ratio of law laid down by the Hon’ble Supreme Court of India in Oriental Insurance Co. Ltd Vs Sony Cherian (II 1999 CPJ 13 SC) wherein it was held that- ― “..The insurance policy between the insurer and the insured represents a contract between the parties. Since the insurer undertakes to compensate the loss suffered by the insured on account of risks covered by the insurance policy, the terms of the agreement have to be strictly construed to determine the extent of liability of the insurer. The insured cannot claim anything more than what is covered by the insurance policy. That being so, the insured has also to act strictly in accordance with the statutory limitations or terms of the policy expressly set out therein…”.
10.           In view of peculiar facts and circumstances of this case, it is held that because the complainant has failed to prove her case, therefore, no relief can be given to her. Resultantly, this complaint stands dismissed with no order as to cost. 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 on: 11.10.2024.

 

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