Haryana

StateCommission

CC/93/2020

SONI SINGH AND OTHERS - Complainant(s)

Versus

IFFCO TOKIO GENERAL INSURANCE CO. LTD. - Opp.Party(s)

ANSHUL MANGLA

15 Sep 2022

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                                                 

                                                   Consumer complaint No.93 of 2020

                                                 Date of Institution: 08.07.2020

                                                         Date of Final hearing: 15.09.2022

Date of pronouncement: 19.12.2022

 

1. Soni Singh aged 30 years W/o Late Sh.Dharambir Singh.
2. Lakshita aged 10 years D/o Late Sh.Dharambir singh through her mother Smt. Soni Singh.
3. Abhay Singh aged 9 years S/o Late Sh.Dharambir Singh through his mother Smt.Soni Singh

All residents of village Khanda,Tehsil Kharkhoda, Distt. Sonipat, Haryana

…..Complainants

Versus

1. M/s Iffco Tokio General Insurance Company Limited, registered office at IFFCO Sadan, C-1, District Centre, Saket, New Delhi-110017 through its Managing Director.
2. M/s Iffco Tokio General Insurance Company Limited, Branch office at Bhagwan Complex, Ist Floor, 214, Zone-1, MP N agar, Bhopal, Madhya Pradesh 462011 through its Branch Manager.
3. M/s Iffco-Tokio General Insurance Company Limited, Office at Minerva Complex, Rai Market, Ambala Cantt, Ambala through its Branch Manager.

…..Opposite Parties

CORAM:    S.P.Sood, Judicial  Member

                    Suresh Chander Kaushik, Member

                   

Present:-    Mr.Davneet Sangwan, Advocate for the complainant.

                   Mr.Yogesh Gupta, Advocate for the  opposite parties.

 

                                                 ORDER

S P SOOD, JUDICIAL MEMBER:

          The brief facts giving rise for the disposal of the present complaint are that deceased namely Dharambir Singh was employed with Narmada Hydroelectric Development Corporation Limited. The deceased was posted as Assistant  Grade-I (W-6) S.No.920195-Y. The employer of the deceased had obtained a group personal accident insurance policy from the opposite party for the purpose of providing insurance cover to its employees.  The insurance policy issued by the opposite parties was bearing policy No.54372544 vide invoice no.54372544 and the duration of the insurance was from 20.10.2018 to 19.10.2019. The deceased being the employee of NHDC Limited was also covered by the said policy. During the course of his employment,  he fell down and sustained injury on his head and became unconscious on 12.11.2018. The deceased was rushed to Indira Sagar Power Station Hospital for treatment, from where he was  referred to Civil Hospital, Indore for further treatment.  However, the DLA succumbed to his injuries.  After this development, intimation was given to the police.  On the same day, his mortal remains were forwarded for post mortem.  On 12.11.2018 post mortem of the DLA was conducted and cause of death was ascertained as severe grevious head injury leading to internal hemorrhage shock which led to cardio respiratory arrest followed by death. On 08.12.2018, complainant submitted claim form with the employer of the deceased and the same was forwarded to OP for the purpose of claim settlement. The OP vide letter dated 28.03.2019 rejected the genuine claim of the complainant on the ground that death was due to heart attack. Two reminders were sent to the OP vide letter dated 08.05.2019 and 13.06.2019 but OP did not pay any heed and issued letter dated 20.07.2019 and re-iterated their stand of rejecting the claim.  The complainant approached office of Insurance Ombudsman Bhopal and submitted the complaint on 05.09.2019 against OP, the complaint was forwarded to the office of Insurance Ombudsman Chandigarh, which was decided vide award dated 18.03.2020. The complaint of the complainant was closed by citing the lack of financial authority i.e. pecuniary jurisdiction.     Thus there being deficiency in service on the part of the OPs, hence this complaint.

2.      Notice being issued, opposite parties filed separate written statement. It was submitted that  NHDC Ltd. had obtained a group personal Accident (GPA) insurance policy for its employees and a personal accident claim in respect of the death of Sh.Dharamveer Singh who was an employee of NHDC Ltd. was reported who allegedly had fallen suddenly and got injured while working in the Guest House of NHDC Limited and thereafter died. Investigator was appointed, who submitted his report dated 27.02.2019 to the OPs. The death had occurred due to heart attack.  The order dated 31.12.2018 passed by SDM accepting the closure report  which stated that deceased died due to heart attack.   The claim was rightly repudiated vide letter dated 28.03.2019 on the ground that proximate cause of death of deceased was heart attack, which was not covered under the GPA policy.

          On merits, it was submitted that death of deceased was due to heart attack and not on account of any injury sustained. The OPs reiterated the facts mentioned above, which are not necessary to reproduce again for sake of brevity. Thus there being no deficiency in service on the part of the OPs.

3.      When the complaint was posted for recording evidence of complainant, learned counsel for complainant tendered in evidence affidavit of one of the complainant–Mrs. Soni Singh as Ex.CA vide which she has reiterated all the averments taken in the complaint and further tendered the documents Ex.C-1 to Ex.C-14 and closed his evidence.

4.                On the other hand, in order to rebut the evidence led on behalf of the complainants, O.Ps have tendered in evidence two affidavits one is as Ex. R-1/A of Mr. Pankaj Dhingra, Legal Head, Coporate Office, IFFKO Tokio General Ins. Co. and second affidavit as Ex.R-1/B of Mr. A.P.Khan , Investigator and further tendered the documents Ex.R-1 to R-5 and closed its evidence.

5.                The arguments have been advanced by Mr.Davneet Sangwan, learned counsel for the complainants as well as Mr.Yogesh Gupta, learned counsel for the opposite parties.  With their kind assistance entire record including documentary evidence as well as whatever evidence had been led during the proceedings of the complaint have also been properly perused and examined.

6.                Learned counsel for the complainant argued that during the subsistence of the group housing policy, the husband of the complainant has died and they are entitled for the claim amount as prayed for.

7.                Learned counsel  for the respondent argued that as per the terms and conditions of the insurance policy, the complainants are not entitled for the claim amount as the DLA has expired due to heart attack.

8.                It is not disputed that during the subsistence of the policy, the employee of employer has died.  It is also not disputed that as per EX.R-1, Members covered 581, NHDC Limited is insured with the insurance company Iffco Tokio General Insurance Company Limited.   Perusal of Ex.C-5 post mortem report dated 12.11.2018 reveals that  cause of death of Sh.Dharamveer Singh is due to Severe grievous head injury leading to brain hemorrhage and shock that led to cardio respiratory arrest and finally death.   It is clear that the deceased has died due to severe grievous head injury and not due to heart attack.  The post mortem report carries evidentiary value under law, which cannot be rebutted by any document. The plea of the insurance company was that the SDM, Investigator and staff of the deceased stated that the Dharamveer Singh has died due to heart attack is not relevant, because as per  Ex.C-5, the death occured due to head injury only which ultimately led to heart attack. The OPs did not lead any evidence which could rebut to post mortem report.  Since the deceased has expired due to head injury as per the post mortem report, the complainants are entitled for the insured amount as prayed for.  Hence, we are of the considered opinion that the complainants are entitled to Rs.40,89,600/- towards the insurance claim on account of death of Sh.Dharambir Singh and OPs are directed to pay the insured amount to them. In case, there is a breach in making payment within the stipulated period  of  45 days, in that eventuality, the complainants would be entitled to get the simple interest @ 6% per annum, for the defaulting period.   The complainants are also entitled of Rs.50,000/- (Fifty Thousand Only) for compensation of mental and physical agony.  In addition, the complainants are also entitled of Rs.11,000/-  (Eleven Thousand Only) as litigation charges.  It is also made clear that for non-compliance, the provisions enshrined under section 72 of the C.P.Act  would also be attractable. 

9.                Applications pending, if any stand disposed of in terms of the aforesaid order.

10.              A copy of this order be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986/2019. The order be uploaded forthwith on the website of the commission for the perusal of the parties.

11.              File be consigned to record room.

 

 

19th  December, 2022       Suresh Chander Kaushik            S. P. Sood                                                                Member                                             Judicial Member                            

 

S.K

(Pvt. Secy.)