Punjab

Sangrur

CC/315/2015

Lakhwinder Singh - Complainant(s)

Versus

HDFC ERGO Gen. Inc.Co. - Opp.Party(s)

Shri Sumir Fatta

15 Oct 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                               

 

                                                Complaint No.    315

                                                Instituted on:      18.05.2015

                                                Decided on:       15.10.2015

 

Lakhwinder Singh son of Late Shri Dharam Pal, resident of Village Kamalpur, Tehsil Sunam, District Sangrur.

                                                        ..Complainant

                                        Versus

HDFC Ergo General Insurance Company Ltd. 6^th Floor, Leela Business Park, Andheri Kurla Road, Andheri,  Mumbai  through its Authorised Signatory.

                                                        ..Opposite party

 

For the complainant    :       Shri Sumir Fatta, Adv.

For OP                      :       Shri G.S.Shergill, Adv.

 

 

Quorum:    Sukhpal Singh Gill, President

                K.C.Sharma, Member

                Sarita Garg, Member

 

 

Order by : Sukhpal Singh Gill, President.

 

1.             Shri Lakhwinder Singh,  complainant (referred to as complainant in short) has preferred the present complaint against the opposite party (referred to as OP in short) on the ground that the father of the complainant, namely, Shri Dharam Pal (referred to as DLA in short) obtained two insurance policies i.e. Sarv Suraksha bearing number 40770328 dated 18.01.2011 for Rs.2,00,000/- and number 2950200209095 dated 22.2.2012 for a sum of Rs.4,00,000/- from the agent of the OP at Sunam, under which the DLA was insured for the above said sums in case of accidental death. 

 

2.             The case of the complainant is that on 2.10.2013, when the DLA was spraying on paddy in his fields, he suddenly started to feel dizziness and slept and after 3 and 4 hours, his condition started to deteriorate and when the complainant and his brother called a medicine shop owner from Kamalpur village, then he advised to shift the DLA in the hospital and on the way to the hospital, he died.  The information of death of the DLA was given to the PS Dirba, where DDR number 35 dated 3.10.2013 was recorded. It is further stated that the post-mortem on the dead body of the DLA was not conducted due to religious believes and his dead body was donated to Saraswati Institute of Medical Sciences with the inspiration of Hazur Maharaj Sant Gurmeet Ram Rahim Singh Ji Insan.  Thereafter the complainant lodged the claim and submitted the documents to the OPs, but the OPs did not pay the claim, and ultimately on 9.2.2015, the OPs repudiated the claim of the complainant on false and vague grounds. Thus, alleging deficiency in service on the part of the Ops, the complainant has prayed that the Ops be directed to pay to the complainant the claim amount of Rs.6,00,000/- along wtih interest @ 18% per annum and further claimed compensation and litigation expenses.

 

3.             In reply filed by the OP, preliminary objections are taken up on the grounds that the complaint is false, frivolous, vague and vexatious in nature and the same has been filed only to injure the reputation of the OP. As per the terms and conditions of the policy, in case of accidental death the insured was required to provide post mortem report, FIR along with medical cause of death, in the absence of which it clearly proves that the DLA did not die accidentally as alleged.  It is further stated that after intimation of the loss, the claim was lodged and documents supporting the accidental nature of death was asked from the complainant and sent so many letters to the complainant.  It is stated further that the DLA died due to inhalation of pesticides while spraying pesticide in the paddy field. That the Op appointed an investigator namely, De-Escorts Medical Services, who submitted its report on 16.9.2014.  Any deficiency in service on the part of the Op has been denied. On merits, it is denied that the DLA died on 2.10.2013 due to accidental death due to spraying on paddy as the complainant did not provide any medical document to prove the accidental death of the DLA.   It is stated further that the complainant did not provide the copy of FIR, post-mortem report and medical documents, as such it is stated that the claim has rightly been repudiated. 

 

4.             The learned counsel for the complainant has produced Ex.C-1 copy of claim form regarding policy number 40770328, Ex.C-2 and Ex.C-3 copies of letters, Ex.C-4 copy of postal receipt, Ex.C-5 copy of letter, Ex.C-6 copy of postal receipt, Ex.C-7 copy of letter, Ex.C-8 copy of postal receipt, Ex.C-9 and Ex.C-10 copies of letters, Ex.C-11 copy of repudiation letter, Ex.C-12 copy of claim regarding policy number 2950200209095, Ex.C-13 and Ex.C-14 copies of letters, Ex.C-15 copy of postal receipt, Ex.C-16 copy of letter, Ex.C-17 copy of postal receipt, Ex.C-18 to Ex.C-20 copies of letters, Ex.C-21 copy of death certificate, Ex.C-22 copy of DDR number 35, Ex.C-23 copy of certificate of village Gram Panchayat, Ex.C-24 certificate dated 4.10.2013, Ex.C-25 affidavit of the complainant and closed evidence.  On the other hand, the learned counsel for the Ops has produced Ex.OP-1 to Ex.OP-6 copies of letters, Ex.OP-7 coy of investigation report, Ex.OP-8 copy of policy, Ex.OP-9 copy of certificate dated 4.10.2013, Ex.OP-10 copy of terms and conditions, Ex.OP-11 affidavit of Pankaj Kumar and closed evidence.

 

5.             We have very carefully perused the pleadings of the parties and heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.

 

6.             It is an admitted fact that the DLA was insured with the OPs under two policies bearing number 40770328 dated 18.1.2011 and policy number 2950200209095 dated 22.2.2012 for assured sum of Rs.2,00,000/- and Rs.4,00,000/-, respectively, in case of accidental death of the DLA.     But, the grievance of the complainant is that the Ops have illegally repudiated the rightful claim of the complainant on the ground that the death is not accidental one, as such it is averred that the claim is not payable by the OP.  In the present case, the question, which arises for determination before us is whether the DLA died an accidental death or that the claim is payable or not.

 

7.             Ex.C-22 is the copy of DDR showing that the DLA has died and the dead body of the DLA was given to the complainant without conducting any post-mortem on the body of the DLA and Ex.C-23 is the certificate dated 12.10.2013 issued by Gram panchayat, Village Kamapur, wherein it has been clearly stated that the DLA died on 2.10.2013 due to inhalation of spray while spraying the pesticides in his fields.  It is also mentioned in the certificate that when the DLA was being taken to Civil Hospital, he died on the way.  Ex.C-24 is the copy of certificate issued by Saraswathi Institute of Medical Sciences, Hapur, which clearly shows that the body of DLA was donated to the said institute for medical study and research purposes.   Ex.C-25 is the affidavit of complainant to support the allegations levelled in the complaint.  On the other hand, the stand of the OP is that the complainant has not produced sufficient evidence on record to corroborate the contention that the DLA died in an accidental death, such as, FIR copy, self description of incidence, cause of death from hospital etc.  but the OP has not produced any conclusive evidence to show that the DLA did not die an accidental death due to pesticides.  We have also perused the investigation report dated 16.10.2014 submitted by De-Escorts Medical Services, but it nowhere concluded that the DLA did not die due to inhalation of pesticides, rather its conclusion is that ‘Since final medical cause of death is not confirmed in this case and also no homicidal, suicidal, self inflicted mode of taking pesticides noted no PM was also conducted, no medical treatment was also done, we recommend this case repudiated in absence of any supporting evidence from insured side to prove this case as accidental death.”.  But, we are unable to accept the contention of the OP that the DLA did not die an accidental death in the absence of any cogent, reliable and trustworthy evidence on record.  Further it is worth mentioning here that if any one dies an accidental death, it is not mandatory to get the post-mortem conducted, more so when, in the present case, the body of the DLA has been donated to Saraswathi Institute of Medical Sciences, Hapur, for medical study and research purposes. 

 

8.             The learned counsel for the OP has contended that no claim is payable to the complainant since he has failed to produce on record the reliable evidence to corroborate his contention about the death of the DLA. He has also cited Mrs. Madhumit Bose versus The Manager, HDFC Ergo General Insurance company Limited, First Appeal No.64 of 2014, decided on 2.2.2015 (NC), wherein it has been held in para number 12 that before the claim could be admitted by the insurance company, it was incumbent upon on the part of the complainant to provide proof to establish that the death was accidental. No doubt, as per the allegation, which has not been disputed, the insured person fell from the bus which obviously would constitute an accident, but as rightly held by the State Commission, it could not be established that the cause of the death of the insured was the injury caused by the accident. The aspect is required to be established by clear evidence and the plea taken by the appellant to the effect that settlement Commissioner of the State Government had sanctioned  payment of Rs.25,000/- on death of the insured by the accident, cannot provide necessary proof to establish the fact that the death of the insured person could actually be attributed to the accident and the injury caused in that accident, since there was a gap of 11 days between the accident and the death.  But, in the present case, no such circumstances are there as in this case, the death of the DLA occurred on the same day i.e. the day of accident, when the DLA was being taken to the hospital for treatment.  

 

9.             The learned counsel for the complainant has cited The Sangrur Central Cooperative Bank Branch Dirba through its District Manager, Sangrur, District Sangrur versus Jasbir Kaur etc. First Appeal No.955 of 2011, decided on 3.7.2014, wherein it has been held by the Hon’ble Punjab State Commission that merely on account of non lodging of the FIR or non conducting of the post mortem examination on the dead body of the deceased, it cannot be concluded that his death was not as a result of snake bite.  In 2005(1) CPC 533 (Life Insurance Corporation of India and others vs. Smt. Nidhi Sahi) the case of the complainant was that the death of the insured occurred in the scooter accident and her claim was mainly challenged on the ground that no FIR was lodged nor any post-mortem examination had been performed on the body of the deceased. However, the factum of death was duly proved and was supported by statement of witnesses, who was pillion rider of the scooter at the time of accident. The complaint was allowed by the District Forum. In the appeal the same was upheld on the ground that the factum of death had been duly proved. It becomes very much clear from the judgment that even in the absence of the FIR or the post-mortem report, the factum of death in a party way can be proved by producing other evidence.   Similarly, in 2006(II) CPC 599 (National Insurance Company Limited versus Rita Devi), it was held that non production of the post-mortem examination report cannot be made a ground for repudiation of the claim. 

 

10.            Further can it be said that the death as a result of sudden inhalation of pesticides while spraying in the fields is to be termed as accidental death? The word ‘accidental’ has been defined in Oxford Advanced Learner’s Dictionary, “happening by chance; not planned”.  It is always an unpleasant event that happened unexpectedly.  We have no hesitation in concluding that the death as a result of sudden inhalation of pesticides while spraying in the fields can be termed as accidental death, as the death was accidental one not planned.  

                       

11.            In the present case, we are of the considered opinion that the Op has wrongly and illegally repudiated the rightful claim of the complainant and hold that the Op is deficient in rendering service to the complainant.

 

12.            In view of our above discussion, we allow the complaint and direct the OP to pay to the complainant the claim amount under both the policies to the tune of Rs.6,00,000/- along with interest @ 9% per annum from the date of repudiation of the claim i.e. 09.02.2015 till realisation. The OP is also directed to pay to the complainant an amount of Rs.11,000/- on account of compensation for mental tension, agony and harassment and Rs.5500/- on account of litigation expenses.

 

13.            This order of ours shall be complied with within a period of thirty days of its communication. A copy of this order be supplied to the parties free of cost. File be consigned to records.

                Pronounced.

                October 15, 2015.

                                                        (Sukhpal Singh Gill)

                                                           President

 

 

                                                              (K.C.Sharma)

                                                                Member

 

 

                                                                (Sarita Garg)

                                                                   Member