Punjab

Sangrur

CC/1572/2015

Rajinder Kaur - Complainant(s)

Versus

Jay Kay Enterprises - Opp.Party(s)

Shri A.K. Dullet

08 Aug 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                             

                                                Complaint No.  1572

                                                Instituted on:    01.12.2015

                                                Decided on:       08.08.2016

 

1.Rajinder Kaur widow of Gurdarshan Singh.

2.Harmandeep Kaur minor daughter of late Gurarshan Singh.

3.Balwinder Singh minor son of late Gurdarshan Singh, all residents of village Kheri Chandwan, Tehsil and District Sangrur.

                                                        …Complainants

                                Versus

1.             Jay Kay Enterprises, Sangrur Road, Bhawanigarh, Tehsil and District Sangrur through its Manager.

2.             Bharti AXA General Insurance Company Limited, First Floor, FemsIconSurveyno.28, Doddanekundi, Bangalore through its General Manager/ MD.

                                                        ..Opposite parties.

 

For the complainant  :       Shri A.S.Dullat, Adv.

For OP No.1             :       Shri Navit Puri, Adv.

For OP No.2             :       Shri GS Shergill, Adv.

 

Quorum:   Sukhpal Singh Gill, President

                Sarita Garg, Member

 

Order by : Sukhpal Singh Gill, President.

 

1.             Smt. Rajinder Kaur, Harmandeep Singh and Balwinder Singh, complainants (referred to as complainant in short) have preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the complainants are the legal heirs of deceased Gurdarshan Singh. Complainant number 1 is the widow and complainants number 2 and 3 are the children of the deceased Gurdarshan Singh (referred to as DLA in short). The case of the complainant is that the DLA purchased a motorcycle bearing registration number PB-13-AD-4632 from OP number 1 on 10.09.2014 and the same was got insured from the OP number 2 under policy number S0659593 comprehensively and the amount of Rs.1,00,000/- was also payable in case of death of the insured/driver. 

 

2.             Further case of the complainant is that on 26.7.2013, the DLA was coming from Dhuri to his village on the motorcycle in question and when he reached near village Dhura, a truck bearing registration number PB-10-L-9800 coming from the opposite side struck with the motorcycle in question, as a result of which the DLA fell down on the road along with the motorcycle and suffered multiple injuries on his head, face and on vital parts of the body, as such the DLA was immediately taken to Civil Hospital, Dhuri, from where was referred to Rajindra Hospital Patiala and subsequently to PGI Chandigarh, where he died on 27.08.2013.  As such, the complainant approached OP number 1 to get the motorcycle repaired, but the OP number 1 advised the complainant to get the lump sum claim of Rs.14,000/-.  The complainant also claimed the amount of Rs.1,00,000/- from the OPs and submitted all the documents to OP number 2, but the OP number 2 did not pay the insurance Claim.  As such, 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 insurance claim amount of Rs.1,00,000/- on account of death claim and further to pay Rs.14,000/- on account of loss of the motorcycle and further claimed compensation and litigation expenses.

 

3.             In reply filed by OP number 1, legal objections have been taken up on the grounds that the complaint is not maintainable, that the complainants have got no locus standi to file the complaint and that this Forum has no jurisdiction to hear and try the present complaint. On merits, the sale and purchase of the motorcycle and insurance is admitted. However, it is also admitted that the accident took place on 26.7.2013 and the DLA died on 27.8.2013. The other allegations levelled in the complaint have been denied.

 

4.             In reply filed by OP number 2, preliminary objections are taken up on the ground that the complaint is false, frivolous, vague and vexatious in nature. The insurance of the vehicle in question is admitted. However, it is stated that the accident took place on 26.7.2013 and the claim was lodged on 16.10.2013 with a delay of 82 days and the police report was lodged on 9.8.2013 with a delay of 14 days, therefore there is a violation of condition number 1 of the policy. It is further stated that the complainant did not provide the post-mortem report and that the DLA was under the influence of liquor and the accident took place due to his negligence, that the complicated questions of law and facts are involved in the present complaint and that the complainant has not come to the Forum with clean hands. On merits, it is denied that the accident took place due to wrong driving of truck number PB-10-L-9800, rather the accident took place due to the negligence of the DLA himself. It is stated that after getting the information from the complainant, the OP appointed Rishabh Malhotra surveyor and loss assessor for assessing the loss and the said surveyor assessed the loss to the tune of Rs.26,507/- on repair basis, but the complainant agreed to get the claim of Rs.14,000/- in full and final settlement. Thereafter driving license of Grudarshan Singh was sent for verification through RTI on 9.12.2013 to the licensing Authority Fatehgarh and appeal of RTI was also sent on 19.2.2014, but no reply was received.  As such the claim of the complainant was repudiated vide letter dated 14.7.2014 as per the terms and conditions of the policy. However, any deficiency in service on the part of the OPs has been denied.

 

5.             The learned counsel for the complainant has produced Ex.C-1 affidavit, Ex.C-2 copy of order dated 3.8.2015, Ex.C-3 copy of policy, Ex.C-4 copy of death certificate, Ex.C-5 copy of DDR, Ex.C-6 certificate of Singla Nursing Home and closed evidence. The learned counsel for Op number 1 has produced Ex.Op1/1 affidavit and closed evidence. The learned counsel for OP number 2has produced Ex.Op2/1 copy of repudiation letter, Ex.Op2/2 copy of declaration, Ex.Op2/3 copy of letter dated 15.4.2014, Ex.Op2/5 copy of reminder, Ex.OP2/6 copy of reminder, Ex.Op2/7 copy of claim form, Ex.OP2/8 copy of terms and conditions and Ex.Op2/9 affidavit and closed evidence.

 

6.             We have carefully perused the complaint, version of the opposite parties and evidence produced on the file and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.

 

7.             It is an admitted case that the DLA got insured his 7motorcycle bearing registration number PB-13-AD-4632 from OP number 2 comprehensively and the DLA was also himself insured for Rs.1,00,000/- in case of accidental death under cover note number 31694773 for the period from 10.09.2012 to 09.09.2013 as is evident from the copy of cover note on record as Ex.C-3. It is further not in dispute that the DLA died an accidental death on 27.8.2013, as he suffered multiple injuries on 26.7.2013 while he was coming from Dhuri to his village and suffered an accident with the truck bearing registration number PB-10-L-9800.  The grievance of the complainant is that though the claim was lodged with the OP number 2 and submitted all the documents, but the OP number 2 did not settle the claim rather repudiated the same on flimsy grounds that the claim was lodged after a delay of 82 days.  On the other hand, the stand of the OP number 2 is that the claim is not payable as the complainant has violated the terms and conditions of the policy and the claim was lodged after a delay of 82 days and the DDR was lodged after a delay of 14 days, as such, it is contended by the learned counsel for the OP number 2 that the claim of the complainant has rightly been repudiated according to the terms and conditions of the policy.

 

8.             After carefully perusing the whole case file and hearing the arguments of the learned counsel for the parties, the question which arises for determination before us is whether the complainant lodged the claim after a period of 82 days with the OP number 2 and whether the claim is payable or not.

 

9.             First of all, we may mention that earlier the complainant also filed a complaint number 702 dated 22.7.2015, which was disposed of on 3.8.2015 with a direction to the OP to decide the claim of the complainant within a period of 30 days of receipt of the copy of the order with liberty to approach this Forum for redressal of his grievance, if any.  As such, the complainant has filed the present complaint to get the claim on account of accidental death of the DLA as well as on account of damage to the motorcycle in question.

 

10.           A bare perusal of the case shows that the DLA met with an accident on 26.07.2013 while he was going to his village on the motorcycle, as such, he suffered multiple injuries and was taken to the Civil Hospital, Dhuri, from where he was referred to Rajindra Hospital, Patiala and PGI Chandigarh, where he succumbed to the injuries on 27.08.2013, as such, the complainant gave intimation to the OPs about the death of the DLA.  In the present case, the case of the OP number 2 is that the complainant gave intimation to the OP number 2 on 16.10.2013 after a delay of 82 days, but we are unable to accept such a contention of the learned counsel for the OP number 2 and when counted the days after the death of the DLA which took place on 27.8.2013, it comes only 49 days and not 82 days as mentioned by the OPs, as the claim is payable only in case of death of the DLA.  It is worth mentioning here that first of all the attendants of the DLA will care the person who is under treatment in the hospital/dying and will not rush to the insurance company to give intimation about the accident of the DLA.  Moreover, an intimation to the police has been given about the accident which was entered in their record at rapat number 12 dated 09.08.2013, which clearly reveals that the DLA died due to an accident with the truck bearing registration number PB-10-L-9800.  However, it was open for the OP number 2 to get the claim investigated and further to get the information about the genuineness death of the DLA.  Further it is not the case of the Op number 2 that the DLA did not die an accidental death on 27.8.2013 due to the injuries sustained in the accident on 26.7.2013, as he remained under treatment from 26.7.2013 to 27.8.2013 in the PGI Hospital Chandigarh.  The learned counsel for the complainant has contended that since the DLA was in the hospital and the complainant even lodged the DDR with the police when the DLA was under treatment, the claim of the complainant cannot be rejected/thrown on this technical ground of late intimation of the claim. The learned counsel for the complainant has cited Shriram General Insurance Company Limited versus Rajesh Kumar 2014(2) CLT 390 (HR), wherein it has been held that the insurance company cannot repudiate the bonafide claims on technical grounds like delay in intimation and submission of some required documents.    Further we find that the OPs are also deficient in rendering service by not considering the merits of the claim and in repudiating the whole claim of the complainant.  Further there is no explanation from the side of the OP number 2 that why they did not settle the claim of the complainant on own damage basis, as the motorcycle in question also suffered loss to the tune of Rs.14,000/- as agreed between the parties.  As such, we feel that the complainant is entitled to get the insurance claim from the Op number 2.

 

11.           The insurance companies are in the habit to take these type of projections to save themselves from paying the insurance claim. The insurance companies are only interested in earning the premiums and find ways and means to decline claims. The above said view was taken by the Hon’ble Justice Ranjit Singh of Punjab and Haryana High Court in case titled as New India Assurance Company Limited versus Smt. Usha Yadav and others 2008(3) R.C.R. 9 Civil) 111.

 

12.           Accordingly, in view of our above discussion, we allow the complaint and direct OP number 2 to pay to the complainants in 1/3^rd share an amount of Rs.1,00,000/- on account of the death of the DLA and further Rs.14,000/- on account of damage to the motorcycle,  along with interest @ 9% per annum from the date of filing of the present complaint i.e. 01.12.2015 till realisation.  We further order the OPs to pay to the complainant an amount of Rs.10,000/- in lieu of consolidated amount of compensation and further an amount of Rs.5500/- on account of  litigation expenses.

 

13.           This order of ours be complied with within a period of thirty days of its communication. A copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                August 8, 2016.

                                                        (Sukhpal Singh Gill)

                                                                President

                                     

                                       

                                                                (Sarita Garg)

                                                                    Member