BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SIRSA.
Consumer Complaint no. 40 of 2020
Date of Institution : 22.01.2020.
Date of Decision : 04.09.2024.
Sukhwinder Singh son of Shri Purshottam son of Pal Singh, resident of village Khewoli,Tehsil and District Sirsa.
……Complainant.
Versus.
1. HDFC Ergo General Insurance Company Ltd., Branch Office at HDFC Bank Ltd., Sangwan Chowk, Sirsa, District Sirsa through its Branch Manager.
2. HDFC Ergo General Insurance Company Ltd. Regd. & Corporate Office : 1st Floor, HDFC House, 165/166, Backbay Reclamation, H.T. Parekh Marg, Mumbai- 400 020, through its Manager.
...…Opposite parties.
3. Smt. Manjeet Kaur – Widow,4. Shimla Devi- daughter, 5. Soma Rani- daughter, 6. Simran- daughter of Shri Purshottam son of Pal Singh, resident of village Khewoli, Tehsil and District Sirsa.
…. Proforma opposite parties.
Complaint under Section 12 of the Consumer Protection Act, 1986.
Before: SH. PADAM SINGH THAKUR …………PRESIDENT
MRS.SUKHDEEP KAUR………………MEMBER.
SH. OM PARKASH TUTEJA…………..MEMBER
Present: Sh. M.L. Pinder, Advocate for complainant.
Sh. H.S. Raghav, Advocate for opposite parties no.1 and 2.
Sh. M.S. Gill, Advocate for proforma opposite parties no.3 to 6.
ORDER
The present complaint has been filed by complainant under Section 12 of the Consumer Protection Act, 1986 (after amendment u/s 35 of the Consumer Protection Act, 2019) against the opposite parties (hereinafter referred as OPs).
2. In brief, the case of the complainant is that father of complainant, proforma ops no. 4 to 6 and husband of proforma op no.3 late Shri Purshottam had purchased a second hand motor cycle bearing registration No. HR-24AB/6273 on 09.08.2019 from its previous owner Shri Satpal Singh son of Shri Kanda Singh, resident of village Kheowali, Tehsil and District Sirsa. The said motor cycle was insured with United India Insurance Company vide insurance policy No. 1119033119P102760994 for the period 28.05.2019 to 27.05.2024. That father of complainant also owned and possessed a car bearing registration No. HR-24Z/5325 which was insured with ops no.1 and 2 vide insurance policy no. 2311 1004 7133 8800 000 for the period 31.07.2019 to 30.07.2020 and in this policy the insured Shri Purshottam had paid premium for compulsory personal accident. It is further averred that late Shri Purshottam had purchased the above said motor cycle on 09.08.2019 but its ownership could not be transferred by him in his name, however on 16.08.2019 father of complainant while driving the afore said motor cycle met with an accident as a stray animal came in front of the motor cycle. In this accident, Shri Purshottam suffered serious and grievous injuries and he ultimately died on 23.08.2019 at Sarvodya Hospital. It is further averred that as per clause 4 of the Circular Ref: IRDAI/ NC/CIR/MOTP/158/09/2018 dated 20th September, 2018 and Circular Ref: IRDA/NL/CIR/MOTP/170/10/2018 dated 9th October, 2018 issued by the Insurance Regulatory and Development Authority of India, in case any person owns multiple vehicle, then the insured has to pay the premium for CPA for only vehicle and not on every vehicle. That complainant being one of the legal heirs of late Shri Purshottam lodged his claim with the ops and supplied all the required documents and information to the ops as required but till date the ops have not settled the claim of complainant. It is further averred that complainant has already taken up the said matter with the ops on number of occasions and requested for settlement of his claim but the ops continued putting off the matter with one pretext or the other and ultimately complainant got served a legal notice upon ops on 11.12.2019 but of no use. That as per above circulars, the ops no.1 and 2 are under legal and factual obligation to settle and pay the claim amount of Rs. 15 lacs to the complainant and since same has been withheld intentionally and deliberately, therefore, complainant is entitled to recover the same alongwith interest @12% per annum from the date of death of insured till realization of the same. It is further averred that ops no.1 and 2 by their such act and conduct have caused unnecessary harassment and mental tension to the complainant for which he is entitled to compensation from them and now two days ago they have refused to admit the claim of complainant. Hence, this complaint.
3. On notice, ops no.1 and 2 appeared and filed written version and also amended written version taking certain preliminary objections that complaint is premature, misconceived, false, incorrect and malafide and is nothing but an abuse of the process of law and it is an attempt to waste the precious time of this Commission as the same is filed by complainant only to avail undue advantage; that instant complaint is not maintainable in its present form in facts and law as per provisions of the Consumer Protection Act, 2019; that deceased policy holder was not holding a valid driving licence for driving the insured vehicle; that complainant has no cause of action for filing the instant case against the ops’ company and instant case and prayer is barred by law of limitation and that complainant has suppressed the material facts. It is further submitted that complainant has not provided all the requisite documents to the answering ops’ company despite repeated reminders whereas it has been specifically mentioned in the notices served upon him that sought documents/ information are necessary for claim review. The complainant has been served notice dated 26.02.2020 and 04.03.2020 and claim denial letter dated 13.03.2020 and complainant was provided ample opportunity and time by ops’ company but ops received no cooperation and response from the complainant due to his ulterior motives and malafide intentions, hence this complaint is not maintainable and deserves to be dismissed with heavy cost. The claim has been rejected due to pendency of the documents i.e. Post Mortem/ Coroner’s report, indemnity bond, legal heir/ succession certificate, address, ID, one photo and bank details of the legal heir, completely filled and signed claim form, DL of the deceased policy holder, RC of the insured vehicle and FIR copy of the alleged accident. The ops have been writing letters to complainant to provide relevant details to enable it to consider her claim, however, complainant had not submitted the required details as mentioned in the letters dated 26.02.2020, 04.03.2020 and deliberately not provided related details which has compelled answering ops to reject the claim of complainant vide letter dated 13.03.2020, therefore, prima facie the present complaint being frivolous and based on incorrect facts is liable to be dismissed with exemplary costs. It is further submitted that complainant has mentioned that Sh. Purshottam purchased one bike with registration No. HR-24AB-6273 from Sh. Satpal Singh and the same is insured with United India Insurance Company. The ownership of Bike has not been transferred by Sh. Purshottam into his name from Sh. Satpal Singh and said Satpal Singh is the owner of bike with which Purshottam met with an accident. That in the policy No. 2311100471338800000 which is for Mahindra KUV 100 Car bearing registration No. HR-24-Z-5325 in Section III- Personal Accident Cover for Owner-Driver, it is specifically mentioned that company undertakes to pay compensation as per the scale for bodily injury/ death sustained by the owner-driver of the vehicle, in direct connection with the vehicle insured or whilst driving or mounting into/ dismounting from the vehicle insured or whilst traveling in it as a co-driver. From the same it is clear that claim under personal accident cover for owner driver is payable only if the owner-driver sustains the fatal injury while using the insured vehicle only and in the complaint in hand, admittedly Sh. Purshottam met with an accident while driving a Bike with registration No. HR-24AB-6273 which is neither insured by ops’ company nor he was registered owner of the same. It is further submitted that complainant has wrongly quoted an IRDA Circular in the complaint and in the said circular, IRDAI has specifically mentioned in Clause 4 (v) that coverage under stand-alone CPA (Compulsory Personal Accident) will be extent to all vehicles owned by the owner-driver and shall be payable only if the owner driver drives any vehicle he/ she owns. However, Sh. Purshottam met with an accident while driving a Bike with registration No. HR-24AB-6273 and as admitted by complainant, Sh. Purshottam is not the registered owner of said Bike and as such complainant is not at all entitled to any benefit under the policy and complaint is liable to be dismissed. It is further submitted that insurance policy is also a contract between insurer and the insured. This contract is as well governed by the principles of Indian contract law as such is equally binding over the parties to contract.
4. On merits, while reiterating the pleas of preliminary objections it is submitted that complainant has not attached the RC of the bike with registration No. HR-24AB-6273 with which it is alleged that Sh. Purshotam met with an accident while driving. It is admitted by complainant that Sh. Purshotam has purchased one Bike with registration No. HR-24AB-6273 from Sh. Satpal Singh and same is insured with United India Insurance Company. It is further submitted that it is admitted by complainant that ownership of said Bike has not been got transferred by Sh. Purshotam into his name from Sh. Satpal Singh and Sh. Satpal Singh is owner of said bike with which Sh. Purshotam met with an accident. That complaint is liable to be dismissed as being pre-mature as all documents including the basic document like claim form is not submitted by the complainant, however, even otherwise the claim is not payable as claim under Personal Accident Cover for owner-driver is payable only if the owner-driver sustains the fatal injury while using the insured vehicle only and in the complaint in hand, admittedly Sh. Purshotam met with an accident while driving above said Bike which is neither insured by ops’ company nor Sh. Purshotam is the registered owner of said bike. Remaining contents of complaint are also denied to be wrong and prayer for dismissal of complaint made.
5. Proforma ops no.3 to 6 filed reply and admitted the contents of the complaint and prayed for acceptance of the complaint.
6. The complainant in evidence has tendered his affidavit Ex. CW1/A, affidavit of Sh. Satpal Singh son of Shri Khanda Singh as Ex. CW2/A and documents Ex.C1 to Ex.C20.
7. On the other hand, ops no.1 and 2 have tendered affidavit of Sh. Vivek Yadav, Senior Manager as Ex.R1 and documents Ex.R2 to Ex.R10.
8. We have heard learned counsel for the parties and have gone through the case file.
9. From the proposal form cum transcript letter for private car package policy Ex.C13, it is evident that Sh. Prashotam, now deceased father of complainant and proforma ops no. 4 to 6 and husband of proforma op no.3 during his life time got insured his Car bearing registration No. HR-24-Z-5325 with ops no.1 and 2 for the period 31.07.2019 to 30.07.2020. It is the case of complainant that his father also purchased a second hand motor cycle bearing registration No.HR-24AB/6273 on 09.08.2019 from its previous owner Shri Satpal Singh son of Shri Khanda Singh but just within a week before transfer of its ownership in his name, the father of complainant while driving the aforesaid motor cycle met with an accident as a stray animal came in front of the said motor cycle and he sustained serious and grievous injuries and ultimately died on 23.08.2019 at Sarvodya Hospital, Sirsa. Though father of complainant met with an accident while driving the motor cycle which was purchased by him from its previous owner as per affidavits Ex.C4 and Ex.C5 but since the additional premium of Rs.325/- was paid by said Purshottam Singh for personal accident cover for owner driver at the time of insurance of his car in question as is evident from Ex.C13, therefore, complainant has claimed insurance claim amount of Rs.15,00,000/- for the death of his father from the insurer of the Car in question as per circulars issued by Regulatory and Development Authority of India and averred that as per clause 4 of the Circular dated 20.09.2018 and Circular dated 09.10.2018, in case any person owns multiple vehicle, then the insured has to pay the premium for CPA for only vehicle and not on every vehicle. The ops no.1 and 2 have also relied upon sub clause (v) of Clause 4 of the Circular dated 11.12.2018 of IRDAI which stipulates that Coverage under the stand-alone CPA will extend to all the vehicles owned by the owner-driver under the same policy. In other words, the cover under the stand-alone CPA policy would be valid when the owner-driver drives any of the vehicles he/she owns. The complainant has asserted that before the said motor cycle could be registered in the name of his father Shri Purshotam, unfortunately his father just within seven days of the purchase of motor cycle met with an accident and ultimately died on 23.08.2019 and he could not get the vehicle registered in his name and as such his father stepped into the shoe of previous owner of the motor cycle. However, in order to claim coverage under personal accident cover for owner driver, it is one of the condition of the insurance policy that the owner driver holds an effective driving licence. But in the present case the complainant has failed to prove on record that his father now deceased was having a valid and effective driving licence and he has failed to provide copy of driving licence of his father since deceased besides other relevant documents and even no copy of driving licence is placed on file by complainant. Since the complainant has failed to provide copy of valid driving licence of his father since deceased besides other relevant documents as per requirement of the policy and as per requirement of the ops no.1 and 2 vide their several letters, therefore, complainant is estopped from claiming any personal accident coverage claim from ops due to his own act and conduct and therefore, he is not entitled to any claim from ops no.1 and 2.
10. In view of our above discussion, we do not find any merit in the present complaint and same is hereby dismissed but with no order as to costs. A copy of this order be supplied to the parties as per rules. File be consigned to the record room.
Announced: Member Member President,
Dated: 04.09.2024. District Consumer Disputes
Redressal Commission, Sirsa.
