Punjab

Sangrur

CC/341/2017

Kaka Singh - Complainant(s)

Versus

IFFCO TOKIO General Insurance Company Limited - Opp.Party(s)

Sh.Amit Goyal

07 Nov 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                               

 

                                                Complaint No.  341

                                                Instituted on:    17.07.2017

                                                Decided on:       07.11.2017

 

Kaka Singh son of Hajura Singh R/O Village Khai, LokeI Patti, Tehsil, Lehra Gagga, Distt. Sangrur.

                                                        ..Complainant

                                        Versus

1.             IFFCO TOKIO General Insurance Co. Ltd. 2^nd Floor, Above Hot Chop Hotel, Sangrur through its Branch Manager.

2.             IFFCO TOKIO General Insurance Co. Ltd. Regd. Office: IFFCO Sadan C1, District Centre, Saket, New Delhi 110 017 through its MD/GM.

                                                        ..Opposite parties

 

For the complainant  :       Shri Amit Goyal, Adv.

For OPs                    :       Shri Darshan Gupta, Adv.

 

 

Quorum:   Sukhpal Singh Gill, President

                Sarita Garg, Member

                Vinod Kumar Gulati, Member

 

 

Order by : Sukhpal Singh Gill, President.

 

1.             Shri Kaka Singh,  complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the son of the complainant, namely, Shri Kamaldeep Singh (referred to as DLA in short) got insured his motorcycle bearing registration number PB-13-AN-6509 from the Ops vide insurance cover note number 69186658 for the period from 28.09.2016 to 27.09.2017 and under the above said insurance policy the Ops further charged Rs.50/- as premium for personal accident death risk cover of driver owner for the sum of Rs.1,00,000/-. The case of the complainant is that on 19.10.2016, the DLA was going on his motorcycle from village Khai to Sunam along with one Tarsem Singh resident of Village Khandebad and when they reached near Village Chhajli Kothe, then his motorcycle slipped on the road and both the complainant and pillion rider fell on the road and suffered serious injuries, as  a result of which the DLA was brought to Rajindera Hospital, Patiala and from where he was referred to PGI Chandigarh, but he succumbed to the injuries on 25.10.2016.  The complainant also lodged the DDR number 22 dated 19.10.2016 at PS Chhajli about the said accident.  Thereafter the complainant submitted all the required documents to the Ops for settlement of the claim amount of Rs.1,00,000/-, but the amount was not paid despite serving of legal notice upon the Ops.  Earlier the complainant also filed a complaint number 29 dated 19.1.2017, which was decided vide order dated 26.4.2017, whereby the Ops were directed to decide the claim within a period of thirty days, but the Ops on 10.4.2017 repudiated the claim of the complainant as ‘no claim’.  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.1,00,000/- along with interest @ 18% per annum and further claimed compensation and litigation expenses.

 

2.             In reply filed by the OPs, legal objections are taken up on the grounds that the complainant has not come to the Forum with clean hands, that the complainant has not submitted the copy of post-mortem report and legal heir certificate, that the complaint is not maintainable and that intricate questions of law and facts are involved in the present case. On merits, it is admitted that the motorcycle in question as well as the DLA was insured under the policy.  However, it is stated that the complainant has failed to submit the documents like FIR, driving license, registration certificate, post-mortem report and legal heir certificate. It is further averred that as per the terms and conditions of the policy post-mortem report is a necessary document, which was not submitted by the complainant, as such the claim of the complainant is stated to has been rightly repudiated vide letter dated 10.4.2017.

 

3.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-13 copies of documents and affidavit and closed evidence.    On the other hand, the learned counsel for the Ops has produced Ex.OP-1 to Ex.OP-5 copies of documents and affidavit and closed evidence.

 

4.             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.

 

5.             It is an admitted fact that the motorcycle in question as well as the DLA was insured with the OPs under the policy in question and the DLA was insured for Rs.1,00,000/- in case of accidental death.  It is an admitted fact on record that the DLA met with an accident on 19.10.2016, when he was going on his motorcycle and suffered multiple injuries and as such he was taken to Rajindera Hospital Patiala, from where he was referred to PGI Chandigarh, where he succumbed to the injuries on 25.10.2016, as is evident from the copy of DDR Ex.C-5,  death certificate Ex.C-8, copy of driving license Ex.C-9, copy of registration certificate Ex.C-10 and bed head ticket and lama summary Ex.C-12. But, the grievance of the complainant is that the Ops have illegally repudiated the rightful claim of the complainant only on the ground that the complainant has not submitted the post mortem report.  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.

 

6.             Ex.C-5 is the copy of DDR, which shows that the DLA died an accidental death.  Ex.C-1 is the affidavit of complainant to support the allegations levelled in the complaint.  On the other hand, the stand of the OPs 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 post-mortem report and legal heir certificate which are very much necessary for just decision of the claim by the OPs.  Since it is clear cut case of the complainant that no post-mortem on the dead body of the DLA was conducted, then how he can produced the post mortem report of the DLA.  On the other hand, the OPs have not produced any conclusive evidence to show that the DLA did not die an accidental death in the accident.  We have also perused the investigation report dated 20.03.2017 submitted by Er. Vikas Gulati, wherein he has clearly mentioned that the claim be processed and settled as per the terms and conditions of the policy of insurance.   It is worth mentioning here that if the complainant has not produced the post-mortem report, then it is not fatal to the case of the complainant, as there are other sufficient evidence on record, which clearly proves that the DLA died an accidental death.  Further it is worth mentioning here that if any one dies an accidental death, it is not mandatory to get the post-mortem conducted. The same view has also been taken by the Hon’ble Punjab State Commission in Narinder Kaur versus Bajaj Allianz General Insurance Company Limited and others 2017(3) CLT 378 (Punjab State Commission). Further the Hon’ble Punjab State Commission in Harpal Singh and another versus Bajaj Allianz General Insurance Co. Ltd., complaint number 199 of 2014 has held that the production of post-mortem and FIR is necessary, only if the FIR is lodged and post-mortem is conducted. But, in the present case, admittedly, no post-mortem on the dead body of the DLA has been conducted.

 

7.             Further 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.           

8.             In the present case, we are of the considered opinion that the OPs have wrongly and illegally repudiated the rightful claim of the complainant and hold that the OPs are deficient in rendering service to the complainant.

 

9.             In view of our above discussion, we allow the complaint and direct the OPs to pay to the complainant the claim amount of Rs.1,00,000/- along with interest @ 9% per annum from the date of repudiation of the claim i.e. 10.04.2017 till realisation. The OPs are also directed to pay to the complainant an amount of Rs.5000/- on account of compensation for mental tension, agony and harassment and Rs.5500/- on account of litigation expenses.

 

10.           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.

                November 7, 2017.

                                                        (Sukhpal Singh Gill)

                                                           President

 

                                                                          

 

                                                                (Sarita Garg)

                                                                   Member

 

 

                                                        (Vinod Kumar Gulati)

                                                                    Member