DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BARNALA, PUNJAB.

Complaint Case No : CC/174/2020

Date of Institution : 20.08.2020

Date of Decision : 08.02.2022

Chamkaur Singh S/o Late Sh. Gurdeep Singh resident of Paka Darwaja, Village Pharwahi, District Barnala-148101 (Punjab) through Authorized Agent Sh. Gurwinder Singh (Real Brother of complainant) S/o Late Sh. Gurdeep Singh resident of Paka Darwaja, Village Pharwahi, District Barnala-148101 (Punjab).                      …Complainant

Versus

1. The General Manager, HDFC Ergo General Insurance Co. Ltd., 5th Floor, Tower No. 1, Stellar IT Park, C-25, Sector 62, NOIDA-201301. 

2. Manager, HDFC Ergo General Insurance Company Ltd., SCO No. 124-125, Madhya Marg, Sector 8-C, Chandigarh-160008. 

                …Opposite Parties

Complaint under Section 35 of the Consumer Protection Act 2019

Present: Sh. Jatin Goyal Adv counsel for complainant.

Sh. Anuj Mohan Adv counsel for opposite parties.

Quorum.-

1. Sh. Ashish Kumar Grover : President

2. Smt. Urmila Kumari : Member

3. Sh. Navdeep Kumar Garg : Member

(ORDER BY ASHISH KUMAR GROVER PRESIDENT):

    The complainant Chamkaur Singh through his Authorized Agent Gurwinder Singh filed the present complaint under Consumer Protection Act 2019 against The General Manager, HDFC Ergo General Insurance Company Limited, Noida and another. (in short the opposite parties). 

2. The facts leading to the present complaint as stated by the complainant are that Gurdeep Singh father of the complainant had purchased three policies vide policy No. 2952201385265900000 which was a combo policy, second policy No. 2950201340604800000 and third policy No. 2952201385265901000. The first combo policy was for sum insured for Health Suraksha Policy amounting to Rs. 3,00,000/- and Sarv Suraksha Personal Accident amounting to Rs. 10,00,000/-. In the second policy sum insured for accidental death, permanent total disability and permanent partial disability was Rs. 10,00,000/- and in the third policy sum insured for accidental death, permanent total disability and permanent partial disability also was Rs. 10,00,000/-. 

3. It is further alleged that on 3.1.2019 Gurdeep Singh father of the complainant died in the motor vehicle accident while driving Motor Car No. PB-03Y-7984 which was registered in his name. Complainant was nominee in all the policies. The complainant lodged the claim and submitted all the requisite documents. It is further alleged that the accident was sudden and nobody was responsible so there was no need to inform the police. No postmortem was conducted as per religious beliefs. The complainant is entitled to the claim amounts of accidental death in all the policies. The opposite parties sent letter dated 5.6.2019 and demanded certain documents. The complainant replied the said letter vide letter dated 28.6.2019 and sent the available documents. The opposite parties have not settled the claim and as per law the insurance company is to decide the claim within two months. The complainant visited the opposite party No. 2 many times and requested to pay the claim but in vain. Even, he sent legal notice through his counsel but with no response. Hence, the present complaint is filed seeking the following reliefs.-

1) The opposite parties may be directed to pay sum assured of Rs. 30,00,000/- alongwith interest at the rate of 12% per annum from 3.1.2019 to 2.8.2020 amounting to Rs. 5,84,000/-. 

2) To pay Rs. 50,000/- on account of compensation for mental agony and harassment and Rs. 10,000/- as litigation expenses. 

3) Any other fit relief may also be given. 

The complainant is also entitled to recover interest at the rate of 12% per annum from 3.8.2020 till actual realization. 

4. Upon notice of this complaint, opposite parties filed written version taking preliminary submission that Gurdeep Singh obtained multiple policies from the opposite party as mentioned in the complaint out of which two policies were valid from 30.4.2018 to 29.4.2020 whereas one policy was valid from 3.3.2016 to 2.3.2019. All these policies were issued to the insured subject to terms and conditions of the policy. The insured died in accident on 3.1.2019 and complainant lodged claims with the opposite party seeking personal accidental death benefit. It is further submitted that the opposite parties issued letter dated 15.3.2019 and demanded some documents and claim was put under investigation. During investigation it was revealed that as per record of Anganwadi the insured had died because of heart attack. Since the complainant misrepresented the cause of death of the insured, the claim is not admissible under the policy and same was communicated vide letter dated 23.4.2019. It is further submitted that as per terms and conditions of the policy under credit shield insurance the respondent is liable to pay balance outstanding loan amount up to the maximum sum insured in the event of accidental death or permanent total disability. Under other policy the respondent demanded some documents vide different letters but failed to submit the same, so the claim was closed vide letter dated 1.7.2019.

5. The opposite parties have also taken preliminary objections that the complaint is bad for non joinder and mis joinder of necessary parties. Further, the complaint has not been filed by a competent person. The said policies were purchased by deceased Gurdeep Singh and Chamkaur Singh was the nominee in the said policies. However, the present complaint has been filed by one Gurwinder Singh alleged authorized agent of said Chamkaur Singh so the complaint is liable to be dismissed on this score alone. Further, Civil court is the appropriate Forum to decide the present complaint and present complaint does not fall within the consumer dispute.  

6. On merits, it is submitted that Gurdeep Singh deceased multiple polices from the opposite parties. Further, Gurdeep Singh expired due to ailment and no FIR was lodged in any police station regarding his accident nor any postmortem report or MLR was conducted. The opposite parties demanded various documents to process the claim from the complaint but he has not provided the requisite documents so the claim was closed on the ground of non submission of documents vide letters dated 29.6.2019 and 1.7.2019. Rest of the contents of the complaint are denied by the opposite parties and lastly prayed for the dismissal of the present complaint with costs. 

7. In support of his complaint, the complainant tendered into evidence affidavit of Gurwinder Singh Ex.C-1, copy of policy No. 2952201385265900 Ex.C-2, copy of policy No. 2950201340604800000 Ex.C-3, copy of policy No. 2952201385265901000 Ex.C-4, copy of application dated 22.4.2019 Ex.C-5, copy of legal notice Ex.C-6, copy of postal receipt Ex.C-7, copy of affidavit of Chamkaur Singh Ex.C-8, copy of reminder dated 5.6.2019 Ex.C-9, copy of letter dated 28.6.2019 Ex.C-10, postal receipt Ex.C-11, copy of death certificate of Gurdeep Singh Ex.C-12, copy of power of attorney of Chamkaur Singh Ex.C-13, affidavit of Gurwinder Singh Ex.C-14, affidavit of Pargat Singh Ex.C-15 and closed the evidence. Rejoinder to the reply filed by the complainant.

8. To rebut the case of the complainant the opposite parties tendered in evidence affidavit of Shweta Pokhriyal Ex.OPs-1, copy of welcome letter dated 3.3.2016 alongwith copy of policy Ex.OPs-2, copy of welcome letter dated 30.4.2016 alongwith policy Ex.OPs-3, copy of claim form Ex.OPs-4, copy of claim document check list Ex.OPs-5, copy of claim reminder letters dated 14.3.2019, 15.3.2019 and 28.3.2019 Ex.OPs-6 to Ex.OPs-8, copy of claim form dated 5.3.2019 Ex.OPs-9, copy of Anganwadi register and its translation Ex.OPs-10 and Ex.OPs-11, copy of questionnaire for the claimant Ex.OPs-12, copy of statement of account Ex.OPs-13, copy of claim repudiation letter dated 23.4.2019 Ex.OPs-14, copies of reminders dated 9.4.2019, 5.6.2019, 18.6.2019, 29.6.2019 and 1.7.2019 Ex.OPs-15 to Ex.OPs-19 and closed the evidence. 

9. We have heard the learned counsel for the parties and have gone through the record on the file. Written arguments also filed by both the parties. 

10. It is admitted case of the opposite parties that the complainant's father Gurdeep Singh purchased the said policy No. 2952201385265900000, second policy No. 2950201340604800000 and third policy No. 2952201385265901000. All the above said policies covered accidental death. The case of the complainant as per complaint is that the father of complainant namely Gurdeep Singh (insured) died due to motor vehicle accident while driving Motor Car No. PB-03Y-7984. The complainant was nominee in all the policies. It is further alleged in the complaint by the complainant that the accident was sudden and nobody was responsible and there was no need to inform the police. No postmortem was conducted as per religious beliefs. The claim was lodged with the opposite parties and also submitted the documents to the opposite parties. 

11. The opposite parties filed written version and denied that the deceased Gurdeep Singh was died in accident. It is further alleged that the insured Gurdeep Singh was expired due to ailment, as such no FIR was lodged in any police station regarding his alleged accident nor any postmortem report or MLR was conducted. The complainant himself admitted in his complaint that no FIR was lodged and no postmortem was conducted of deceased Gurdeep Singh. The complainant alleged in the complaint that the accident was sudden and nobody was responsible. But the complainant has produced the affidavit Ex.C-15 of Pargat Singh. He deposed in the said affidavit that one Truck was coming from other side and due to that lights of said Truck were put in the eyes of Gurdeep Singh car driver, who was only present in the car and his car turned in our fields because the fields were very deep and his vehicle was damaged and car driver Gurdeep Singh got insured. He further alleged that he took him out of the vehicle on the spot. He further alleged in the said affidavit that he took him to Aastha Hospital, Barnala, where the staff has checked him and declared dead. The complainant has not produced any record of Aastha Hospital, regarding the treatment or admission of deceased Gurdeep Singh. The complainant to prove the accidental death has produced Ex.C-12 i.e. Book of Chaukidar in which cause of death of Gurdeep Singh is mentioned accident. On the perusal of the said certificate it found that the initially cause of death was mentioned as “Heart Attack” and later on there was cutting of word “Heart Attack” and inserted “Accident”. Neither the cutting was signed by any authority nor stamped. 

12. On the other hand, the opposite parties have tendered certain documents vide which they demanded several documents from the complainant. But the complainant failed to produce the said documents. The opposite parties have also produced Ex.O.P-10 i.e. copy of Register of Anganwadi in which the cause of death of Gurdeep Singh has mentioned as “Heart Attack” and the translated copy of Anaganwadi Register was also produced by the opposite parties i.e. Ex.O.P-11. The stand of complainant is contradictory as the affidavit of Pargat Singh Ex.C-15 and the pleadings of complaint are different from each other. The complainant has failed to produce any evidence regarding the accidental death of deceased Gurdeep Singh. Therefore, the claim of the complainant was declared as no claim by the opposite parties. 

13. The Ld. Counsel for opposite parties has produced judgment of the Hon'ble National Consumer Disputes Redressal Commission, New Delhi, 2020(2) R.C.R. (Civil) 718, vide which the Hon'ble National Commission, held that Personal accident policies will be attracted only when death or permanent disability has been caused due to accident. Accident not proved. Insurance claim under the policies not payable. The Hon'ble National Commission, further held that no proof filed bythe complainant to establish the factum of an accident, rather there was certain facts which prove that the complainant has not come with clean hands to file the present complaint. No record of treatment at Kathamandu, Nepal has been filed so that the real initial position could not be known. 

14. Ld. Counsel for opposite parties also submitted the judgment of Hon'ble National Consumer Disputes Redressal Commission, New Delhi 2012(2)C.P.J. 290, in which the Hon'ble National Commission dismissed the complaint of the complainant on the ground that accidental death not proved. Natural death not covered under the policy. The Hon'ble National Commission, further held that the petitioner has failed to produce the copy of FIR or the postmortem report of deceased despite repeated requests and reminders by the respondent. The aforesaid documents were mandatory required to support the claim. In the absence of postmortem report, the exact cause of death of the deceased is not established. The insurance company was liable to compensate the insured only if the death or permanent total disablement or loss of limb, loss of eyes, etc. has occurred solely due to accident by external, visible and violent means. In the absence of such evidence, it cannot be held that the insured died due to accident. 

15. In view of the above discussion and law laid down by the Hon'ble National Commission, New Delhi, there is no merit in the present complaint and same is accordingly dismissed. However, no order as to costs or compensation. Copy of the order be supplied to the parties free of costs. File be consigned to the records after its due compliance.

ANNOUNCED IN THE OPEN COMMISSION:

        8th Day of February, 2022

 

 

            (Ashish Kumar Grover)

            President

              

(Urmila Kumari)

Member

 

(Navdeep Kumar Garg)

Member