Punjab

Faridkot

CC/19/119

Smt Baljit Kaur - Complainant(s)

Versus

HDFC EGRO General Insurance co. Ltd. - Opp.Party(s)

Vinod kumar Monga

16 May 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, FARIDKOT

 

Complaint No. :     119 of 2019

Date of Institution:  01.05.2019

Date of Decision :   16.05.2023

 

1. Smt Baljit Kaur aged 40 years,  widow of late Head Constable Gursewak Singh No.971/GRP resident of Village Sahoke, Tehsil Moga.
2. Talwinder Singh aged about 22 years son of late Head Constable Gursewak Singh No.971/GRP resident of Village Sahoke, Tehsil Moga.

                                                                                        ...Complainant

Versus

 

1. HDFC Ergo General Insurance Company Ltd (Formally HDFC General Insurance Company Ltd), Registered and Corporate Office, Floor, HDFC House 165-166, Backbay Reclamation, HT Parikh Marg, Church Gate, Mumbai-400020.
2. HDFC Ergo General Insurance Company Ltd (Formally HDFC General Insurance Company Ltd), through its Branch Manager, Near Bus Stand, Faridkot.

                                                                              .......Ops

Complaint under Section 12 of the

Consumer Protection Act, 1986.

                        CC-119 of  2019

 

 

Quorum:    Smt Priti Malhotra, President,

Smt Param Pal Kaur, Member.

 

Present:       Sh Vinod Monga, Ld Counsel for complainant,

                   Sh Atul Gupta, Ld Counsel for OPs.

* * * * * * *

ORDER

(Priti Malhotra, President)

                                          Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against OPs seeking directions to OPs to make payment of insurance claim pertaining to mediclaim insurance policy bearing no.299920790009100000 and for further directing OPs to pay Rs.1,00,000/- as compensation for harassment, inconvenience, mental agony and litigation expenses of Rs.25,000/-.

2                                        Briefly stated, the case of the complainant is that Gursewak Singh deceased husband of complainant was insured with OPs under policy in question. On 132.09.2017, when he was going from Kotkapura to Sahoke on his motorcycle bearing no.PB69-A-3348 at a reasonable speed, a stray animal suddenly came out of

CC-119 of  2019

fields and struck against his motorcycle. Gursewak Singh fell from motorcycle and struck against the road and got head injury. Entire accident was witnessed by Talwinder Singh and Mandeep Singh, who were following him on another motorcycle. They immediately made call to their village members, but in the meantime, Highway Petrol Police reached on spot and carried him to Civil Hospital, Kotkapura. From Kotkapura, he was referred to Bathinda and then to DMC, Ludhiana, where he died on 16.09.2017 due to accidental injuries. DDR to this effect was also got recorded in Police Station Bajakhana and Police also conducted proceedings under Section 174 of Cr. P. C. Thereafter, complainant no. 1 lodged claim with OPs and also furnished all documents required by OPs, but OPs repudiated  the claim of complainant on the ground that deceased Gursewak Singh was under the influence of alcohol at the time of said accident. Complainant made several requests to OPs to clear the point that Gursewak Singh never consumed liquor in his life time, but all in vain. Even legal notice issued by complainant through her counsel, served no purpose. Despite repeated requests, OPs did not do anything needful to clear the insurance claim. All this amounts to

CC-119 of  2019

deficiency in service and trade mal practice on the part of OPs and has caused harassment and mental agony to him. He has prayed for directions to Ops to pay the insurance claim and Rs.1,00,000/- as compensation besides Rs.25,000/- as cost of litigation. Hence, the present complaint.

3                                             The counsel for complainant was heard with regard to admission of the complaint and vide order dated 07.05.2019, complaint was admitted and notice was ordered to be issued to the opposite parties.

4                                            On receipt of the notice, OPs filed reply taking preliminary objections that complaint is not maintainable in the present form as complicated questions of law and facts are involved in it and it can not be decided in summary proceedings. Complainant has not come to the Forum with clean hands and has concealed the material fact. However, it is admitted that complainant was insured with them under policy in question and asserted that they have rightly repudiated the claim of complainant as per terms and conditions of the policy because son of deceased insured disclosed before them that at the time of said  accident, Gursewak Singh was

CC-119 of  2019

driving the vehicle under the influence of liquor and therefore, as per terms and conditions of the policy in question, OPs are not liable to make payment of insurance claim.  OPs alleged that as per admission notes of DMC, Ludhiana, deceased insured had a 20 years history of alcohol and son of deceased also confirmed this fact. All the other allegations are denied being wrong and incorrect and prayed for dismissal of complaint with costs.

5                                    Parties were given proper opportunities to prove their respective case. The complainant tendered in evidence his affidavit Ex.C-1 and documents Ex C-2 to C-9 and then, closed his evidence.

6                                    In order to rebut the evidence of the complainant, the opposite party tendered in evidence, affidavit of Shweta Pokhriyal as Ex OP-1, documents Ex OP-2 to 5 and then closed the same on behalf of OPs.

7                                  We have heard the arguments addressed by all the parties and have also gone through the evidence and documents led by the parties.

CC-119 of  2019

8                                From the careful perusal of record and going through the affidavits, evidence and pleadings of the parties, it is observed that grievance of complainant is that her husband was insured under the policy in question and during the validity of insurance period, he met with an accident. Due to head injuries in accident, he died and after his death, complainant no. 1 submitted claim alongwith bills and documents to OPs, but they repudiated the insurance claim on false ground of liquor consumption. In reply, Ops admitted that complainant was insured with OPs under the policy in question and it also not denied that he died due to said accident. OPs stresses mainly on the point that deceased insured was under the influence of liquor at the time of accident and therefore, they have rightly repudiated the claim as per terms and conditions of the policy, claiming there is no deficiency in service on their part.

9                                 After having gone through the record and considering the arguments of the parties, it is clear enough that complainants are duly entitled for the insurance claim as the OPs have failed to produce on record any authentic document justifying the repudiation of the genuine claim of the complainants. In the

CC-119 of  2019

absence of any authentic proof of taking alcohol, plea taken by Ops that deceased was under the influence of alcohol, has no legs to stand upon. It is observed that in the  absence of any cogent proof of alcohol consumption, it is hard to believe that the insured (now deceased) was under the influence of alcohol at the time of accident and also the accident occurred only due to the negligence of the deceased /insured. Nowhere from the post-mortem report, it is proved that while driving, deceased insured was under the influence of liquor. Even there is no record from the Civil Hospital, Kotkapura where the insured ( now deceased) was first taken after the accident that he was under the influence of liquor. By repudiating the claim of complainants on false ground of alcohol consumption by deceased, OPs cannot escape from their liability of making payment of genuine insurance claim to the complainants. On the other hand, complainants have placed on record sufficient and cogent evidence to prove their pleadings and all documents placed on record by them are authentic and are beyond any doubt. Therefore,complaint filed by complainants stands hereby allowed with direction to OPs to pay the death claim as per terms and conditions of the policy to complainants. Ops are

CC-119 of  2019

further directed to pay Rs.20,000/-to complainants as consolidated compensation for harassment and mental agony suffered by them and for litigation expenses incurred on present complaint. Compliance of this order be made within one month of receipt of the copy of the order, failing which complainants shall be entitled to proceed as per Consumer Protection Act. Copy of order be given to parties free of cost. File be consigned to record room.

Announced in Commission

Dated : 16.05.2023                 

 

                   Member                                    President

                  (Param Pal Kaur)             (Priti Malhotra)