Haryana

Karnal

CC/610/2019

Kachan - Complainant(s)

Versus

Indian Overseas Bank - Opp.Party(s)

Charanjit Wadhwa

15 Dec 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                    Complaint no.610 of 2019

                                                    Date of instt.: 06.09.2019

                                                    Date of decision:15.12.2022

 

Kanchan wife of late Shri Pritam Kumar, resident of House no.213, Braham Nagar, Hansi Road, Karnal.

 

                                                                         ……..Complainant.

                                        Vs.

1.     Indian Overseas Bank, Karan Gate, Karnal through its Branch Manager.

2.     Universal Sompo General Insurance Company through its Managing Director/Authorized Signatory, Registered & Corporate office: Unit no.401, 4^th floor, Sangam Complex 127, Andheri Kurla Road, Andheri (E), Mumbai-400059.

                                                                          

         ….… Opposite Parties.

 

Complaint Under Section 12 of the Consumer Protection Act, 1986 and after amendment Under Section 35 of Consumer Protection Act, 2019.

 

Before:     Sh. Jaswant Singh………..President

                Sh.Vineet Kaushik ………..Member

                   Dr. Rekha Chaudhary……Member

               

 Present:  Shri C.J. Wadhwa, Advocate for complainant.

                  Shri Brijesh Sharma, Advocate for OP no.1.

                   Shri Y.P. Arora, counsel for the OP no.2.   

 

                   (Jaswant Singh President)

ORDER: 

 

                    The complainant has filed the present complaint Under Section 12 of the Consumer Protection Act, 1986 as after amendment Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that husband of complainant Shri Pritam Kumar was an employee in the Haryana Agriculture Market Board, Market Committee, Karnal and  was having saving bank account with OP no.1 bearing Saving Bank Account no.141401000001896 and customer ID no.6835267. OP no.1 allured the husband of complainant to obtain the IOB-Personal Accidental Insurance Policy for a sum of Rs.10,00,000/- and on the persuasion of the OP no.1, the husband of complainant took a policy of sum assured Rs.10,00,000/- through OP no.1 from the OP no.2 and Rs.118/- was deduced by the OP no.1 from the account of husband of complainant and OP no.2 was given the Accidental Insurance Cover for a period of one year i.e. 14.04.2018 to 13.04.2019, vide master policy no.3333/58241289/00/000 and the complainant is the nominee in the said policy. The husband of complainant was died in a Railway Accident on 22.01.2019 and postmortem on the dead body was conducted on 23.01.2019, vide PMR no.MB/07/19, dated 23.01.2019 and the police also prepared the report Under Section 174 Cr.P.C. and as per enquiry report and postmortem report, the husband of complainant was died in an accident. After the death of her husband, complainant being nominee in the abovesaid policy lodged the claim with the OPs for the payment accidental insurance claim but OPs did not pay the claim and rejected the same, vide letter dated 19.06.2019 on the ground of committing or attempting suicide, intentional self injury. The OPs wrongly and illegally rejected the claim of complainant without any sufficient cause because after the death of Shri Pritam Kumar, police investigated the matter and submitted its enquiry report u/s 174 Cr.P.C. and in the said report, it has been clearly mentioned that the deceased Pritam Kumar was died due to the railway accidental and similarly the postmortem report also clearly says that the deceased Pritam Kumar died due to railway accident and there is no evidence on record that Pritam Kumar committed any suicide. In this way there is deficiency in service on the part of the OPs. Hence this complaint.

2.             On notice, OP no.1 appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action; locus standi and concealment of true and material facts. On merits, it is denied that OP has allured the husband of complainant whereas the requisite amount was deducted as per the norms of the Government of India upon which accidental insurance policy was issued by the OP no.2 in favour of the husband of complainant. After issuance policy in question, the OP has no role to play for the grant or rejection of the claim as alleged by the complainant. There is no deficiency in service on the part of the OP. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             OP no.2 filed its separate written version raising preliminary objections with regard to maintainability; jurisdiction; cause of action; locus standi and concealment of true and material facts. On merits, it is pleaded that the complainant lodged the claim on account of death of her husband. OP deputed an investigator, Secure Risk Management and Insurance Services to investigate the matter and the Investigator submitted his report with the company and after going through the documents, the OP found that the said claim is not payable due to the below reason: as per submitted claim documents on 22.01.2019, the insured was crossing railway track without using bridge while doing his foot struck in railway line and on going train hit him. Based on the above observation, claim is recommended for repudiation under policy clause-What we Exclude-committing or attempting suicide, intentional self injury. Hence the claim is repudiated. The act of the deceased himself was illegal as he was crossing the railway line without bridge. Therefore, OP has rightly repudiated the claim of complainant. There is no deficiency in service on the part of the OP. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

4.             Parties then led their respective evidence.

5.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.C1, copy of rejection letter dated 19.06.2019 Ex.C2, copy of insurance cover Ex.C3, copy of post mortem report of Pritam Kumar Ex.C4, copy of inquest report dated 22.01.2019 Ex.C5 and closed the evidence on 18.02.2021 by suffering separate statement.

6.             On the other hand, learned counsel for the OP no.1 has tendered into evidence affidavit of Vivek Kumar Branch Manager Ex.DW1/A and closed the evidence on 26.08.2022 by suffering separate statement.

7.             Learned counsel for the OP no.2 has tendered into evidence affidavit of Prashant V. Shuka Manager Ex.OP1, copy of insurance policy Ex.OP2 and closed the evidence on 29.07.2022 by suffering separate statement.

8.             We have heard the learned counsel of the parties and perused the case file carefully and have also gone through the evidence led by the parties.

9.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that husband of complainant Shri Pritam Kumar (since deceased) was an employee in the Haryana Agriculture Market Board, Market Committee, Karnal and was having saving bank account with OP no.1. Husband of complainant obtained an Personal Accidental Insurance Policy for a sum of Rs.10,00,000/- through OP no.1 from the OP no.2 and Rs.118/- was deducted by the OP no.1 from the account of husband of complainant and OP no.2 has issued the Personal Accidental Insurance Cover for a period of one year i.e. 14.04.2018 to 13.04.2019. The complainant is the nominee in the said policy. The husband of complainant was died in a Railway Accident on 22.01.2019. After the death of her husband, complainant being nominee lodged the claim with the OPs for the payment of accidental insurance claim but OPs did not pay the claim and rejected the same on the ground that Pritam Kumar had committing suicide. The OPs have wrongly and illegally rejected the claim of complainant without any sufficient cause and on the flimsy ground. Learned counsel for complainant relied upon the case law cited in Oriental Insurance Company Limited Versus Madhu Khadelwal in Rivision Peition no.1098 of 2020, decided on 27.01.2021 and Manager, New India Assurance Company Limited Versus Jaiwanti Bai Vishwakarma in Revision Petition no.2846 of 2011, decided on 11.01.2016 and lastly prayed for allowing the complaint.

10.           Per contra, learned counsel for OP no.1, while reiterating the contents of written version, has vehemently argued that the requisite premium was deducted as per the norms of the Government of India upon which accidental insurance policy was issued by the OP no.2 in favour of the husband of complainant. After issuance of the said policy, the OP has no role to play for the grant or rejection of the claim and lastly prayed for dismissal the complaint qua OP no.1

11.           Learned counsel for the OP no.2, while reiterating the contents of written version, has vehemently argued that complainant lodged the claim on account of death of her husband. OP deputed an investigator to investigate the matter and the Investigator submitted his report and after going through the documents, the OP found that the said claim is not payable on the ground that the insured was crossing railway track without using bridge and committed suicide. Thus, OP has rightly repudiated the claim of complainant and lastly prayed for dismissal of the complaint.

12.           We have duly considered the rival contentions of the parties.

13.           Admittedly, Pritam Kumar (since deceased) was an employee in the Haryana Agriculture Market Board, Market Committee, Karnal and was having saving bank account with the OP no.1. He has obtained a Group Personal Accidental Insurance policy from the OP no.2 through OP no.1 for the sum insured of Rs.10,00,000/- and in this regard an amount of Rs.118/- was deducted by the OP no.1 from his account. It is also admitted facts that on 22.01.2019, Pritam Kumar met with an accident while crossing the railway track and expired. Post mortem upon the dead body of Pritam Kumar was conducted in the Civil Hospital, Karnal, Police also prepared the inquest report under section 174 Cr.P.C.

14.           The claim of the complainant has been repudiated by the OPs, vide repudiation letter Ex.C2 dated 19.06. 2019 on the grounds, which reproduced as under:-

“On perusal of the submitted claim documents, we observed that the said claim is not payable due to below reason:

As per submitted claim documents on 22.01.2019, the insured while crossing railway track (without using bridge) to go another his foot stuck in railway line and on-going hit him.

Based on the above observation, claim is recommended for repudiation under:-

Policy clause-What we exclude-committing or attempting suicide, intentional self injury. Hence we regret to inform you that the said claim is not tenable”.

 

15.           The claim of the complainant has been repudiated by the OP no.2 on the ground that insured has committed suicide or attempted for suicide, hence not payable as per terms and conditions of the insurance policy.

16.           Now the question arises for consideration is that whether the deceased had died in a train accident or he committed suicide?

17.           As per the version of the OP no.2, life assured committed suicide, hence OP is not liable to pay the claim. The onus to prove its version lies upon the OP but OP has miserably failed to prove the same by leading any cogent and convincing evidence. The case of the OP is based upon the investigation report filed by the OP in another complaint filed by the complainant titled as Kanchan vs Indian Overseas Bank bearing no.612/2019 and fixed for order on today. On perusal of the said report, it is nowhere mentioned that Pritam Kumar has committed suicide or tried to commit suicide. Rather as per investigation repot Ex.C5, conducted by the police, the concerned SHO has opined that, as per the doctor’s opinion and witness’s statement, the cause of death in this case is railway accident.

18.           Thus, it has been proved on record that insured Pritam Kumar has not committed suicide rather he died while crossing the railway track. Thus, the act of the OP no.2 amounts to deficiency in service while repudiating the claim of complainant, which is otherwise proved genuine one. As per the Group Accidental Insurance Policy Ex.C3/Ex.OP2, the sum assured amount is 10,00,000/- (ten lakh). Hence the complainant is entitled for the same alongwith compensation for harassment, mental agony and litigation expenses etc.

19.           Thus, as a sequel to above discussion, we allow the present complaint and direct the insurance company i.e. OP no.2 to pay Rs.10,000,00/- as insured amount to the complainant with interest @ 9% per annum from the date of repudiation of claim till its realization. We further direct the OP to pay Rs.20,000/- to the complainant on account of mental agony and harassment suffered by her and Rs.11,000/- for the litigation expense. Complaint qua the OP no.1 stands dismissed. This order shall be complied within 45 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 15.12.2022                                                                    

                                                                      President,

                                                      District Consumer Disputes

                                                      Redressal Commission, Karnal.

 

 

 

 (Vineet Kaushik)               (Dr. Rekha Chaudhary)

      Member                               Member

 

 

Sushma

Stenographer