DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

BATHINDA (PUNJAB)

CC No. 378 of 23-08-2010

Decided on : 31-03-2011

1. Balwinder Kaur aged about 56 years Wd/o Sukhdev Singh

2. Jaspreet Kaur aged about 45 years D/o Sukhdev Singh

3. Jasdeep Singh aged about 30 years S/o Sukhdev Singh

4. Simerpreet Singh aged about 22 years S/o Sukhdev Singh

   All R/o H. No. 21583, St. No. 10/3, Power House Road, Bathinda

   Now R/o H. No. 1449, Model Town, Phase 3, Bathinda.

.... Complainants

Versus

1. ICICI Lombard General Insurance Co. Ltd., Sharma Complex, Corner Power House Road, Guru Kanshi Marg, Bathinda, through its Branch Manager

2. Dayanand Medical College & Hospital, Ludhiana through its Medical Superintendent (Deleted vide order dated 28-1-2011)

    

.... Opposite parties

Complaint under Section 12 of the Consumer Protection

Act, 1986.

 

QUORUM

Ms. Vikramjit Kaur Soni, President

Dr. Phulinder Preet, Member

Sh. Amarjeet Paul, Member

For the Complainant : Sh. Naresh Garg, counsel for the complainant

For the Opposite parties : Sh. Jai Gopal Goyal, counsel for opposite party No. 1

Opposite party No. 2 deleted.

O R D E R

VIKRAMJIT KAUR SONI, PRESIDENT

1. This complaint has been filed by the complainant under Section 12 of the Consumer Protection Act, 1986 as amended upto date (here-in-after referred to as 'Act'). The brief facts of the complaint are that Maruti Zen Car bearing registration No. PB-11-P-1190 was comprehensively insured with opposite party No. 1 vide Insurance Cover Note/Certificate No. 3001/53290112/00/000 w.e.f. 27-12-2009 to 25-12-2008. The opposite party No. 1 issued the said Insurance certificate only and never issued any policy in this regard. In the above said Insurance cover note, the opposite party No. 1 also charged Rs. 100/- under Compulsory Insurance as per GR-36 of Indian Motor Tariff of Rs. 2.00 Lac as Personal Accident Insurance of Owner-Driver. Sukhdev Singh, owner of the above said car met with an accident on 25-11-2008 with one Tractor Trolley No. PB-03-F-6825 while he was driving the car and in this accident, he received multiple fatal injuries and ultimately, he died on 8-1-2009 due to said injuries. In this accident, the car was totally damaged and the claimants filed the claim with opposite party No. 1 regarding loss to the car and regarding the death of Sukhdev Singh under Compulsory P.A. of Owner Cum Driver Sukhdev Singh. The opposite party No. 1 paid the loss of the car as total loss to complainant No. 1 as legal heir of the deceased Sukhdev Singh, but they did not pay the claim of Sukhdev Singh to the tune of Rs. 2,00,000/- till date. After the accident, Sukhdev Singh was immediately admitted at Adesh Hospital, Bhucho, Bathinda, but due to his serious condition, the complainants shifted him with opposite party No. 2 on 26-11-2009. Sukhdev Singh was admitted with opposite party No. 2 under CR No. 2008-131161 from 26-11-2008 to 7-1-2009 upto 11.59 p.m. when the last final bill was paid by the complainant. Sukhdev was admitted with opposite party No. 2 and right from beginning, he was was on ventilator. He was in the state of coma and the claimants spent about Rs. 10,00,000/- on his treatment. The complainants got discharged Sukhdev Singh from opposite party No. 2 on 7-1-2009 at 11.59 p.m., but ultimately Sukhdev Singh succmbed to the injuries on 08-01-2009 at his house due to said accident. The opposite party No. 1 paid the loss of the car to the complainant No. 1 being legal heir of deceased Sukhdev Singh after taking no objection from the other complainants Nos. 2 to 4 i.e. Children of deceased. Thereafter, the opposite party No. 1 is sitting on the claim and demanded unnecessary documents i.e. Indemnity Bond, Affidavits, Doctor Certificate (DMC Ludhiana) on Claim Form etc., including the English version of DDR and death certificate. The complainants supplied all the demanded documents to the opposite parties although these documents were already submitted at the time of settling the car loss. The complainants alleged that Sukhdev Singh till his death was in coma from 25-11-2008 to 8-1-2009 and he died on the next day after discharge from opposite party No. 2 on 7-1-2009 and there was nothing on record that he was died due to some other reason except the injuries sustain in the above said accident. Due to non-payment of claim by opposite party No. 1, the complainants have suffered mental agony and pains, hence this complaint.

2. The opposite party No. 1 filed its written reply and pleaded that there is no nexus between the alleged accident and death of deceased Sukhdev Singh owner of the said car and the alleged recording of DDR No. 17 dated 26-11-2008 with PP Bhucho Mandi is self serving report effected to grab the present claim from opposite party No. 1. It has been submitted that the claim of owner-driver is not payable as the complainants did not supply the necessary documents i.e. attested copy of PMR, NOC from all legal heirs, Idemnity Bond and English translation of the FIR etc., The Post Mortem Report is necessary for adjudication of the claim submitted by complainants which has not been submitted by the complainants till today.

3. The opposite party No. 2 filed its separate written reply and submitted that when on 26-11-2008, the husband of complainant No. 1 got admitted, he was suffering from head injury with multiple ribs fracture and septicemia. Sukhdev Singh remained under treatment with opposite party No. 2 w.e.f. 26-11-2009 to 7-1-2009 and on 7-1-2009, the complainants left the hospital of opposite party No. 2 with patient Sukhdev Singh against medical advice. A treatment bill of Rs. 3,19,377/- only was paid by the complainants on account of treatment of Sukhdev Singh. After declaring LAMA on 7-1-2009, the claim form of Reliance Insurance Company was submitted by Jasdeep Singh was duly filled and attested by the concerned doctor and the same was handed over to the son of patient Sukhdev Singh i.e. complainant No. 3. Thereafter, the complainant No. 1 submitted another claim form of ICICI Lombard General Insurance Company which was again filled, attested and handed over to complainant No. 1. It has been pleaded that for the first time on 16-08-2010 i.e. after about one and half year, the complainant No. 1 sent request through speed post for supply of the copy of treatment file and it was intimated to complainant No. 1 that as her husband was admitted as a case of road side accident and it is a Medico Legal case, the demanded record cannot be issued to any person except the police authorities. However, the copies of investigation reports can be issued to her for which she may visit in person on any working day between 9.00 a.m. to 4.30 p.m. The opposite party No. 2 pleaded that it rendered the treatment to Sukhdev Singh as per Standard Protocol of Medical Science. He was taken away by the complainants on their own risk and responsibility against the medical advice of doctors of opposite party No. 2.

4. Parties have led their evidence in support of their respective pleadings.

5. Arguments heard and written submissions submitted by the parties perused.

6. The learned counsel for the complainants submitted that Sukhdev Singh owner of the car met with an accident on 25-11-2008 with Tractor trolly when he was driving the car. In this accident, he received multiple fatal injuries and ultimately he died on 8-1-2009. The complainants filed the claim with the opposite parties for loss to the vehicle as well as for accidental death of Sukhdev Singh under Personal Accident. The claim lodged against the loss to the car was paid by opposite party No. 1 as total loss to the legal heir of Sukhdev Singh whereas the claim under Personal Accident was not paid by the opposite parties.

7. On the other hand, the learned counsel for opposite party No. 1 submitted that claim of the owner-driver is not payable as the complainant did not supply the necessary documents i.e. attested copy of PMR, NOC from all legal heirs Indemnity Bond and English translation of FIR etc., He argued that even otherwise also, the claim is not payable being there is no direct nexus between accident and death of owner Sukhdev Singh. The deceased Sukhdev Singh was not subjected to Post Mortem and in the absence of post mortem report, the claim cannot be paid.

8. These are undisputed facts between the parties that car of Sukhdev Singh was comprehensively insured with opposite party No. 1; the said car met with an accident and Sukhdev owner of the car suffered multiple injuries and ultimately he succumbed to the injuries; the loss on account of vehicle loss was paid by opposite party No. 1 as total loss to the legal heir of deceased Sukhdev Singh and the claim against Personal Accident Insurance of Sukhdev Singh has not been paid by the opposite party No. 1.

9. The opposite party No. 1 has not settled the claim of complainants on three grounds :

   i) Non-submission of certain documents

   ii) No postmortem report was supplied

   iii) No nexus between the accident and death of Sukhdev Singh

    

10. The opposite party No. 1 vide letters Ex. C-17 & Ex. C-18 has demanded PA claim Form, original policy. English translated version of FIR duly attested, original post mortem report/death certificate, attested RC copy of vehicle and driving licence, NOC of all legal heirs, Indemnity cum declaration undertaking, original passport size photo of claimant. Current address proof of claimant, ID proof of claimant and proof of relationship. The opposite party No. 1 has stated that claim against the vehicle in question has been paid. Thus, the payment of claim on total loss basis by the opposite party No. 1 itself proves that complainants have submitted all the required documents that is why claim against vehicle loss has been paid to the legal heirs of Sukhdev Singh. However, the complainants have also produced in their evidence copy of Insurance policy, photocopy of RC of vehicle, death certificate, copy of DDR, English version of DDR, case summary duly signed by opposite party No. 1, LAMA summary duly signed by opposite party No. 2, claim form, Indemnity cum declaration undertaking, photocopy of telephone bill and voter card as proof of address and photocopy of driving licence Ex. C-5 to Ex. C-16 respectively. As far as post mortem report is concerned, when the record itself speaks that deceased Sukhdev Singh suffered injuries due to road accident and remained under coma and ultimately succumbed to the injuries, post mortem is not necessary. For this, we get support from the observations of the Hon'ble State Commission, Punjab, Chandigarh, in the cases :

    First Appeal No. 171 of 2010 decided on 12-03-2010 in case titled Manager, Health Administrator Team, Bajaj Allianz General Insurance Co. Vs. Ravinder Kaur held :

    “This submission has been considered. When a man dies the family is caught of by crisis and it is not always, it happens many times that the family members forget to report the matter to the police about this unnatural death and the dead body is also not subjected to post mortem examination. Moreover the reports to the police as well as the post mortem report are the only documents which proves that the death of assured has taken place by accident. These were not essential documents in themselves, the non-production of such leads to automatic repudiation of the insurance claim.”

    First Appeal No. 1595 of 2010, Date of decision : 18-10-2010 titled LIC Vs. Harjinder Kaur wherein it has been observed :-

    “In these circumstances even if the respondent has failed to prove a copy of the FIR or a copy of the post mortem report she has led sufficient evidence on the file for reaching the conclusion that Nasib Singh insured had died by an accident. Once it is proved that Nasib Singh insured had died by an accident nothwithstanding the condition of formalities, the respondent is entitled to the insurance claim under the double accident benefit. To that extent, therefore, the findings of the learned District Forum are upheld.”

11. After the accident, the deceased Sukhdev Singh was admitted with opposite party No. 1 and thereafter he was shifted to opposite party No. 2. During the admission, Sukhdev Singh remained under coma and ultimately, the complainants got him discharged against LAMA on 7-1-2009 and Sukhdev Singh died on 8-1-2009. The DMC & Hospital, Ludhiana was made a party as opposite party No. 2 to the complaint by the complainant but later on after filing the written reply by opposite party No. 2, the complainant got it deleted. The opposite party No. 2 has stated in written reply that complainant No. 1 requested for supply of treatment file and in reply to her request, the opposite party No. 2 intimated to complainant No. 1 that as her husband was admitted as a case of road side accident and it is a Medical Legal case, the demanded record cannot be issued to any person except the Police authorities. Sukhdev Singh, was admitted on 26-11-2008 when he was suffering from head injury with multiple ribs fracture and septicemia. He remained under treatment with the opposite party No. 2 w.e.f. 26-11-2008 to 7-1-2009 and on 7-1-2009, the complainants left the hospital of opposite party No. 2 with patient Sukhdev Singh against Medical Advice. Thus, the reply of opposite party No. 2 makes the position crystal clear that Sukhdev Singh was admitted in the hospital as a case of road accident. A perusal of Claim Form B – Medical Attendant Certificate Ex. R-5 also reveals that against Sr. No. 8 “Direct cause/s of illness” : RSA meaning thereby Road Side Accident.

12. The complainants spent huge amount on the treatment of Sukhdev Singh, but his condition was not improved and through out the admission, he remained under coma and was on ventilator. Ultimately, the complainants got discharged him from opposite party No. 2 on 7-1-2009 Against Medical Advice and he succumbed to the injuries on 8-1-2009, suffered by him due to accident. Hence, under these circumstances, it cannot be said that there was no nexus between the accident and the death of Sukhdev Singh.

13. Keeping in view the record produced by the parties, facts and circumstances of the case, this Forum is of the considered view that there is deficiency in service on the part of the opposite parties in not paying the claim to the complainants on account of death of Sukhdev Singh. Hence, this complaint accepted with Rs. 5,000/- as cost and Rs. 10,000/- as compensation. The opposite party is directed to pay an amount of Rs. 2,00,000/- being the sum assured of deceased Sukhdev Singh as per Insurance Cover Note Ex. C-5, to complainant No. 1 on behalf of all the legal heirs alongwith cost and compensation within 45 days from the date of receipt of copy of this order. In case of non-compliance within the stipulated period, the amount of Rs. 2,00,000/- would carry interest @ 9% P.A. from the date of institution of complaint ie. 23-8-2010 till realisation.

A copy of this order be sent to the parties concerned free of cost and the file be consigned.

Pronounced

31-03-2011

(Vikramjit Kaur Soni) Presidet

(Dr. Phulinder Preet)

Member

(Amarjeet Paul)

Member