Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 627.
Instituted on : 06.11.2017.
Decided on : 04.04.2019.
1. Bhupander, age 32 years, son of Sh. Mahabir.
2. Upashna (Minor through her father as next friend and natural guardian), daughter of Sh. Bhupander son of Sh. Mahabir.
Both residing at Village Kahni 12- Tehsil and District Rohtak.
………..Complainant.
Vs.
1. HDFC ERGO General Insurance Company Limited, 3rd Floor, Central Market, Phase-1, Ashok Vihar, Delhi.
2. Reliance Trends, Near Medical Mor, Delhi Road, Rohtak, through its Manager.
3. Strategic Manpower Solutions Limited, Reg. Office: 3rd Floor, Court House, Lokmanya Tilk Marg, Dhobi Talao, Mumbai-400002.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
SH. VED PAL, MEMBER.
DR. RENU CHAUDHARY, MEMBER.
Present: Sh. Sanjay Kaktan, Advocate for complainants.
Sh. Gulshan Chawla, Advocate for opposite party No. 1.
Sh. Yogender Dalal, Advocate for opposite parties No. 2 & 3.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that the wife of the complainant No. 1 and mother of the complainant No. 2 namely Rekha Deswal was serving as Tr. C.S.A. and was posted in Reliance Trends, Rohtak since 25.11.2013. That on 14.03.2015, the wife of the complainant No. 1 had expired left behind the complainants as class one legal heirs and complainants are legally entitled to receive all the service benefit and claims. That the complainant had filed an application before the Permanent Lok Adalat, Rohtak against the opposite party No. 2 and others for the service benefit of deceased Rekha Deswal. The said application filed was dismissed as withdrawn on 20.09.2017 with liberty to move before the appropriate Court or Forum for redressal of his grievances, if he so desires. That the opposite parties No. 2 and 3 did not pay the amount of Group Personal Accident Insurance Policy to the complainant. The opposite party No. 2 sent the claim of deceased Rekha Deswal to opposite party No. 1 vide claim No. C299917007750 and policy No. 2999200606374801004, but the opposite party illegally and in collusion with opposite parties No. 2 and 3 did not make the payment of the said policy to the complainants on the false reason. That the act of opposite parties is illegal and there is deficiency in service on the part of opposite parties. As such, it is prayed that opposite parties may kindly be directed to make the payment of Group Personal Accident Insurance Policy i.e. Rs.5,00,000/- alongwith interest @ 18% per annum from the date of death of deceased Rekha Deswal till its realization and also to pay Rs.50,000/- as compensation and Rs.11,000/- as litigation expenses as explained in relief clause.
2. After registration of complaint, notice was issued to the opposite parties. Opposite party No. 1 in its reply has submitted that the claim was lodged by the Reliance Retail Limited against the death of one of the insured under the policy named as Rekha Deswal. That after scrutinizing the documents submitted on behalf of the insured/deceased, it was found that the documents submitted were insufficient to settle the claim amount. As from the perusal of the documents it was prima facie evident that the death of deceased happened due to consumption of poison which amounts to suicide and which is exclusion under the policy terms and conditions. Therefore, in order to ascertain the actual facts the documents were sought. The required documents were:
i) FIR
ii) Final Investigation Report
iii) Duly filled claim form mentioning incidence detail/brief about the accident.
It is pertinent to mention here that the documents requested were important for the process of claim and settled of the claim. But the complainant failed to submit the alleged documents. All the other contents of the complaint were stated to be wrong and denied and opposite party No. 1 prayed for dismissal of complaint with cost qua the opposite party No. 1.
3. Opposite parties No. 2 and 3 in their reply has submitted that Smt. Rekha Deswal was employed by opposite party No. 3 vide offer letter dated 22.11.2013 and she died on 14.03.2015. It is pertinent to mention here that the complainants have knowingly, deliberately and intentionally not put forwarded true and correct facts with regard to the reason of death of Smt. Rekha Deswal. That wife of the complainant No. 1 died due to consuming of Aluminum Phosphide poisoning and as per Group Personal Accident Insurance Policy wherein “Suicide” case is not covered under the same. Hence, she was not entitled to the benefits under guidelines of IRDA. It is prayed that complaint may kindly be dismissed with costs qua the opposite parties No. 2 and 3.
4. Ld. counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C14 and has closed his evidence on dated 06.08.2018. Ld. counsel for the opposite party No. 1 has tendered affidavit Ex.RW1/A and documents Ex.R1/1 to Ex.R1/4 and closed his evidence on dated 17.12.2018. Learned counsel for the opposite parties No. 2 and 3 in his evidence has tendered affidavit as Ex.RW2/A and has closed his evidence on dated 26.11.2018.
5. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
6. After going through the file and hearing the parties it is observed that as per copy of documents placed on record by the complainant i.e. Post Mortem report Ex.C7, Forensic Science Laboratory, Madhuban, Karnal Haryana Ex.C8, and Ex.C10, the cause of death of deceased Rekha is due to consumption of poisonous substance and as such the claim was repudiated by the opposite parties as per terms and conditions of the policy. We have also perused the terms and conditions enclosed with Ex.RW1/1 and as per Section 5 (clause 3) of the General Exclusions, it is submitted that : “Bodily injury or sickness due to willful or deliberate exposure to danger, (except in an attempt to save human life), intentional self-inflicted injury, suicide or attempt threat, or arising out of non-adherence to Medical Advice”.
6. In view of the aforesaid facts it is observed that the claim of the complainant is not covered under the policy and as such OPs have rightly repudiated the claim. However, the authorities cited by ld. counsel for the complainant AIR 2006 Madhya Pradesh 195, LIC Vs. Ku. Ankita and Anr., II(2014)CPJ 699(NC) titled as Life Insurance Corporation of India Vs. Shyama Kumwar & Ors. and IV(2015)CPJ307(NC) titled as UIIC Vs Saraswattbai Balabhau Bharti & Ors., the same are not fully applicable on the facts and circumstances of the case as the same are related to life insurance and the present complaint pertains to Group personal accident Insurance policy having different terms and conditions. As such there is no deficiency in service on the part of opposite parties. Accordingly the present complaint stands dismissed with no order as to costs.
8. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
04.04.2019.
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Nagender Singh Kadian, President
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Ved Pal Hooda, Member.
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Renu Chaudhary, Member.
