| Final Order / Judgement | DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BATHINDA C.C. No. 156 of 7-6-2018 Decided on : 11-04-2022 Munish Kumar aged about 34 years S/o Mohinder Kumar Tanvish Garg aged about 10 years Asmiti Garg aged about 11 years - Both minor children through natual guardian Sh. Munish Kumar Garg - All R/o H. No. 23656, Street No. 1, Harbans Nagar, Dabwali Road, Bathinda.
........Complainants
Versus Dolphin Travel Marketing Private Limited, A-212 C/304, Tirupati Plaza, Street No. 1, Shakarpur, Delhi Insurance Company through its CMD/MD/GM/President/Director/Chairman/DivisionalManager/ Branch Manager/Authorized Signatory National Insurance Company Limited, Registered Office 3, Middleton Street, Post Box No. 9229, Kolkata 700071 through its CMD/MD/GM/President/Director/Chairman National Insurance Company Limited, 65 Hapur Road, Navyug Market, Ghaziabad, Uttar Pradesh through its Divisional Manager/Branch Head National Insurance Company Limited, The Mall, Bathinda, through its Divisional Manager/Branch Manager Shiv Raj Singh S/o Jagtar Singh R/o H. No. 25771, Gali No. 2, Amarpura Basti, Bathinda (Deleted vide order dated 14-6-2018)
.......Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986 QUORUM Sh. Kanwar Sandeep Singh, President Sh. Shivdev Singh, Member Smt. Paramjeet Kaur, Member Present For the complainant : Sh. Ashok Gupta, Advocate For opposite parties : Sh. Lalit Garg, Advocate, for OP No. 1. Sh. R K Mangla, Advocate, for OPs No. 2 to 4. OPs No. 5 deleted. ORDER Kanwar Sandeep Singh, President The complainant Munish Kumar and others (here-in-after referred to as complainants) have filed this complaint U/s 12 of Consumer Protection Act, 1986 (Now C.P. Act, 2019, here-in after referred to as 'Act') before this Forum (Now Commission) against M/s. Dolphin Travel Marketing Private Limited and others (here-in-after referred to as opposite parties). Briefly stated the case of the complainants is that complainants No. 2 & 3 are the minor sons of Niti wife of complainant No. 1 and mother of complainant No. 2 & 3 and this complaint has been filed on behalf of minors through their natural guardian. It is alleged that the wife of complainant No. 1 purchased accident policy as well as health policy from opposite party No. 1 through opposite party No. 5 who further purchased the insurance policy from opposite party No. 2 to 4. The opposite parties got all types of information and verification regarding family of the complainants and issued policy No. 361201/42/16/8200000272 for Rs 4,00,000/- out of which Rs 3,20,000/- was covered for the accidental death and upto Rs 80,000/- for Hospital. The said policy was issued in the name of Niti wife of complainant No. 1 and mother of complainants No. 2 & 3 for the period from 31-1-2017 to 30-1-2018. The complainant No.1 was nominee of the policy holder. It is also alleged that on dated 5-8-2017 at 5:30 pm Niti was going to market while driving her scooter. When she reached opposite Gali No. 4 of Harbans Nagar, all of a sudden, she struck with stray animal and fell down on the road and died on the spot. The people gathered there and they called the husband of Niti i.e. complainant No. 1. The complainant No. 1 reached at the spot and took dead body of Niti to his house and performed her last rites early in the morning on next day. Information was given to the police who recorded D.D.R on 15-8-2017. The complainants alleged that the claim was lodged with opposite party No. 1 who further sent claim No. 361201/42/17/82/90000110 to opposite parties No. 2 to 4. It is also also alleged that thereafter on 17-11-2017, complainants got a letter from opposite party No. 3 vide which they demanded some documents which the complainants duly sent except post-mortem report as the post-mortem could not be done on Niti as there was confusion due to the death of Niti in her prime youth. It is further alleged that opposite party No. 3 repudiated the claim by writing letter to opposite part No. 1 on dated 9-3-2018 by making false excuse that complainants have not sent the required documents even after 3 reminders, so the claim file is closed. The complainants alleged that repudiation letter of 9-3-2018 is totally illegal, false, incorrect and manipulated. The complainants have sent all the required documents i.e. D.D.R report, Insurance certificate, Adhaar cards of complainant No. 1 and both children, Death certificate and affidavit. It was requested to the opposite parties that no post-mortem report is available as it could not be done due to confusion/perplexed condition of the complainants as the deceased was of early age. The complainants alleged that the opposite parties are intentionally and purposely not paying the insurance amount of Rs 3,20,000/- of death case and are harassing unnecessarily only to swallow the claim of the complainants despite the fact that all the formalities and required documents have already been sent. All the documents as demanded by the opposite parties were handed over to opposite party No. 5 for sending it to the other opposite parties. The complainants also alleged that they are suffering mental tension and loss of physical health due to the blatent negligence on the part of opposite parties who are not making the death claim to the complainants rather creating hinderance without any logic, for which complainants claim compensation to the tune of Rs. 1,00,000/-. On this backdrop of facts, the complainants have prayed for directions to the opposite parties to make death claim payment of Rs 3,20,000/- to complainants with interest @ 18% p.a. w.e.f. 5-8-2017 till payment and also pay Rs. 1,00,000/- as compensation and any other additional or alternative relief. On the statement of learned counsel for complainants, name of opposite party No. 5 was deleted from the array of the parties. Upon notice, opposite parties appeared through counsel and filed written reply. The opposite party No. 1 filed separate written reply and raised preliminary objections that the complaint is not maintainable as this Commission has no territorial jurisdiction to try and entertain the present complaint. No cause of action has arisen within the territorial jurisdiction of this Commission. The complainants themselves have placed on record copy of the Insurance Policy which clearly shows that the same has been issued by the office of the Insurance Company situated at Ghaziabad and not from Bathinda. That neither the complainants nor the wife of the complainant No. 1 was ever consumer of opposite party No. 1. The opposite party has not charged even a single penny from the wife of complainant No.1. That the complainants have not come to this Commission with clean hands and has suppressed the material facts. The complainants have deliberately and wrongly stated in the complaint that the wife of the complainant No. 1 had purchased the Insurance Policy from opposite party No.1. The opposite party No.1 had gifted the Insurance Policy to the wife of the complainant No.1 on complementary basis only and no consideration towards the insurance Policy had been charged by opposite party No.1 from the wife of complainant No. 1. That the complaint is bad for mis joinder of parties. The opposite party No.1 is neither competent nor authorized to decide the dispute and also not liable to make the payment of the insurance amount as claimed by the complainants. On merits, it has been pleaded that opposite party No.1 had sold a product package to the wife of complainant No.1 and at that time, had given the Insurance Policy as a gift . The opposite party has not charged even a single penny from the wife of the complainant No.1 towards the Insurance Policy. At the time of gifting the Insurance policy, a list of formalities required to be completed by the relatives of the deceased persons were provided wherein it was specifically stated as to what are the documents required for processing the insurance claim and in such documents one of the document is Post Mortem report of the deceased person is mandatory. In the present case, despite the request of the Insurance Company the complainants have not sent copy of Post Mortem Report of the deceased Ms. Niti, hence, complainants cannot claim any benefit in the absence of the required documents. The opposite party No. 1 is not in any manner responsible either for making the death claim to the complainants or for rejecting the death claim. The Insurance policy was gifted by opposite party No.1 free of cost and no premium for the same was paid by the wife of the complainant No.1. The opposite parties No. 2 to 4 filed their joint written reply by raising legal objections that the complaint has been filed by the complainants only to injure the goodwill and reputation of the opposite parties. Even otherwise, the complaint is false, frivolous and vexatious. That the intricate questions of law and facts are involved in the complaint which requires voluminous documents and evidence for determination which is not possible in the summary procedure under the 'Act'. That this Commission has got no territorial jurisdiction to try and entertain the present complaint. The proposal form was allegedly submitted with opposite party No.1 at Delhi, policy was issued by National Insurance Company, Ghaziabad Branch, claim was also lodged with National Insurance Company, Ghaziabad Branch, and that Branch has processed the claim and ultimately repudiated the claim of the complainants for want of requisite documents meaning thereby no part of cause of action has arisen to the complainants within the territorial jurisdiction of this Commission. That the complainants have concealed material facts and documents from this Commission. It has been pleaded that true facts are that as per information collected from National Insurance Company, Ghaziabad Branch, the complainants lodged the claim with them on 15.8.2017 whereas deceased insured has allegedly died on 5.8.2017. The matter regarding the alleged accidental death of insured was reported to the police on 15.8.2017. In this way, the intimation to the police as well as Insurance company has been given after unexplained delay of 10 days i.e. after deliberations and consultations whereas as per terms and conditions of the policy, the complainants were supposed to inform the police and Insurance company immediately after the alleged accident/incident. However, on receipt of claim, National Insurane Company, Ghaziabad Branch sought some information and documents and they repeatedly vide their letters dated 14.9.2017, 17.11.2017 and 13.1.2018 requested the complainants to submit the following documents, which are required for the settlement of the claim of the complainants:- i) Postmortem report. ii) Attested/certified copy of police report. iii) Identity card of insured. iv) Affidavit for nominee. v) Copy of welcome letter sent by opposite party no.1 to the insured. But, the complainant No.1 only provided copy of his voter ID card, PAN card and passport, and has failed to submit the aforesaid requisite documents nor he applied for the extension of time for providing the requisite documents, so the National Insurance Company, Ghaziabad Branch, has rightly closed the claim of the complainants with the remarks 'No response even after three reminders (14.9.2017, 17.11.2017 and 13.1.2018) vide letter dated 9.3.2018 and an intimation regarding the same was given to the complainant. It has been pleaded that after the closure of the claim, the complainant No.1 sent only certified copy of police report in "Punjabi". As per terms and conditions of the policy, in case of accidental death of insured, postmortem report is essential for the settlement of the claim as cause of death could be ascertained by postmortem report only. Further legal objections are that the complainants are estopped by their own act, conduct & acquiescence from filing the present complaint and that the complainants have no locus standi or cause of action to file the present complaint. On merits, the opposite parties No. 2 to 4 admitted that opposite party no.1 purchased the policy from National Insurance Company, Ghaziabad Branch in the name of deceased insured namely Ms. Niti. It has been pleaded that complainant No. 1 lodged the claim with National Insurance Company, Ghaziabad Branch on 15.8.2017, but he failed to provide the requisite information and documents sought from the complainants despite three reminders. After controverting all other averments, the opposite parties No. 2 to 4 prayed for dismissal of complaint. In support of their complaint, the complainants have tendered into evidence affidavit dated 29-5-18 of complainant No.1 (Ex. C-1), photocopy of letters (Ex. C-2 & Ex. C-3), photocopy of DDR No. 9 (Ex. C-4), photocopy of certificate of Insurance (Ex. C-5), photocopy of letter (Ex. C-6), photocopy of Adhar Cards (Ex. C-7 & Ex. C-8), photocopy of DL (Ex. C-9), photocopy of postal receipt (Ex. C-9), photocopy of Death Certificate (Ex. C-10), photocopy of Adhar Card (Ex. C-12) and affidavit dated 14-6-18 of complainant No.1 (Ex. C-13). In order to rebut the evidence of complainant, opposite party No. 1 tendered into evidence affidavit dated 7-7-18 of Parveen Jain (Ex. OP-1/1), photocopy of welcome letter (Ex. OP-1/2) and photocopy of brochure (Ex. OP-1/3 & Ex. OP-1/4). The opposite parties No. 2 to 4 tendered into evidence affidavit dated 24-7-18 (Ex. OP-2/1), photocopy of Insurance policy (Ex. OP-2/2). Photocopy of terms and conditions (Ex. OP-2/3), photocopy of DDR (Ex. OP-2/4), photocopy of translation of DDR (Ex. OP-2/5), photocopy of claim intimation (Ex. OP-2/6 & Ex. OP-2/7), photocopy of postal envelope ( Ex..OP-2/8), photocopy of letter dated 14.9.2017 and 17.11.2017 (Ex..OP-2/9 & 2/10), photocopy of postal envelop (Ex..OP-2/11), photocopy of medical certificate (Ex.OP-2/12), photocopy of postal envelop (Ex.OP-2/13), photocopy of letter dated 13.1.2018 (Ex.OP-2/14), photocopy of repudiation letter dated 9.3.2018 (Ex.OP-2/15) and copy of detailed e-mail ( Ex. OP-2/16). The learned counsel for the parties reiterated their stand as taken in their respective pleadings and detailed above. We have heard learned counsel for the parties and gone through the record. In the case in hand, the allegation of the complainants is that Niti wife of complainant No. 1 and mother of complainants No. 2 & 3 was insured vide 361201/42/16/8200000272 for Rs 4,00,000/- out of which Rs 3,20,000/- was covered for the accidental death and upto Rs 80,000/- for Hospital expenses. On 5-8-2017, Niti was going to market while driving her scooter and all of sudden, she struck with stray animal. She fell down on the road and died on the spot. Complainant No. 1 filed claim with the opposite parties and submitted documents except post mortem report. The opposite parties vide letter dated 9-3-2018 repudiated the claim of the complainants. Ex. C-2 is the repudiation letter dated 9-3-2018 which shows that claim of complainants stands closed due to not filing/submitting the required documents despite three reminders which includes post mortem report. The opposite parties have pleaded in written reply that in case of accidental death of insured, postmortem report is essential for settlement of claim as cause of death could be ascertained by post mortem report only. The submission of learned counsel for the complainants is that the opposite parties have illegally repudiated the claim of the complainant due to non-submission of post mortem report. Since complainant No. 1 was under shock and got confused due to sudden demise of his wife due to which late intimation was given to the Insurance Company and police and also post mortem of dead body of Niti could not be conducted. The learned counsel for complainants further submitted that moreover, when other evidence is on the file, post mortem report is not necessary. In support of his submissions, learned counsel for the complainants relied upon : (i) 2017(3) CLT 378 case titled Narinder Kaur Vs. Bajaj Allianz General Insurance Co. Ltd., & others (ii) 2017(3) 758 case titled Om Prakash Vs. Reliance General Insurance & Anr., (iii) 2012(1) CPC 100 case titled Manager, Health Administrator Team, Bjaj Allianz Gneral Insurance Co. Ltd., Vs. Ravinder Kaur & Ors. The complainants, to prove their version that Niti, insured wife of complainant No. 1, died due to accidental death, placed on file copy of DDR dated 15-8-17 (Ex.C-4/Ex. OP-2/4). A perusal of affidavit (Ex. C-13) and DDR (Ex. C-4) reveals that version of complainant No. 1 in both these documents is self contradictory. A perusal of DDR reveals that incident took place on 5-8-17 whereas DDR was got recorded on 15-8-17 i.e. after 10 days. The DDR was recorded on the statement of complainant No. 1. In the DDR, complainant No. 1 has stated that on 5-8-17, while going to market, scooter of his wife Niti struck with stray animal due to which she fell down and died at the spot. He has futher got recorded that his family members reched at the spot but uptill that time, his wife was already expired. Nearby persons also gathered at spot and with the help of family member of complainant No. 1 dead body of Niti was brought home. Further statement of complainant No. 1 is that he was informed telephonically about accident and he immediately came home from job. It was odd time at night, so in the early morning under preplex, dead body of Niti was cremated. In the affidavit Ex. C-13, complainant No. 1 has deposed that while going to market on scooter all of sudden, his wife Niti struck with stray animal and due to this, she fell down on the road and died on the spot. People gathered there and they called husband of Niti (complainant No.1) and thereafter complainant No. 1 reached the spot and took dead body to his house and performed the last rites of Niti on next day early in the morning. Thus, contradictory version of complainant No. 1 creats doubt regarding accidental death of Niti, wife of complainant No. 1. DDR was got recorded after 10 days of incident. DDR without any corroborative evidence cannot be treated as substantial piece of evidence or conclusive proof of accident. Even intimation to the Insurance Company was also given very late. The complainant has not placed on file any document to prove accidental death of Niti. No post mortem/medical certificate declaring death of Niti is brought on file. Eyewitness of said accident are not examined to prove accident. No photograph of said accident or even of damaged scooter has been brought on file by the complainant. In such circumstances, it cannot be said that death of Niti, insured wife of complainant took place due to accident. Thus, it cannot be said that opposite parties are deficient in demanding post mortem report of Niti from complainants to confirm accidental death. Hence, there is no deficiency in service on the part of the opposite parties in closing the claim file of the complainants. With utmost regard and humility to the aforesaid authorities cited by the learned counsel for the complainants, they are distinguishable on facts. In view of what has been discussed above, this complaint fails and is hereby dismissed with no order as to costs. The complaint could not be decided within the statutory period due to heavy pendency of cases.
Copy of order be sent to the parties concerned free of cost and file be consigned to the record. Announced : 11-4-2022 (Kanwar Sandeep Singh) President (Shivdev Singh) Member (Paramjeet Kaur) Member
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