BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Lakhwinder Singh (Aged 34 years) s/o Lt. Manjit Singh R/o 378, Vill. Panjokhra (29), Panjokhra Sahib, Distt. Ambala.

          ……. Complainant.

Versus

Liberty General Insurance Limited, through its Manager, ocean Heights, Unit No. 20-202, 2nd Floor, Block K-4, Sec-18, Noida.

                                                                                   ….…. Opposite Party

Before:        Smt. Neena Sandhu, President.

                      Smt. Ruby Sharma, Member,

          Shri Vinod Kumar Sharma, Member.           

Present:       Shri Abhisham Verma, Advocate, counsel for the complainant.

                      Shri Dev Batra, Advocate, counsel for the OP.

Order:        Smt. Neena Sandhu, President.

1.                Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Party (hereinafter referred to as ‘OP’) praying for issuance of following directions to it:-

1. To pay insured amount of Rs.15,00,000/- along with 12% interest from the date of accident i.e. 04-01-2020 till realization.
2. To pay Rs.2,00,000/- as compensation for harassment and mental agony
3. To pay Rs.55,000/- on account of litigation expenses.
4. Grant any other directions which this Hon’ble Commission may deems fit.

2.             Brief facts of the case are that the complainant is the son of Manjit Singh S/o Bakhatawar Singh who was an owner of Scooty no. HR85A-1522 which was duly insured with the OP vide policy no.201220050218800140300000 valid for the period from 07.03.2019 till 06.03.2020. The complainant is nominee of the insured Manjit Singh.  On 04.01.2020, Manjit Singh was going from Ambala to Gurudwara Sahib Singh Shaida, Vill. Bhudda, Distt. SAS Nagar, Mohali on his insured scooty. The complainant and his relative Didar Singh were following Manjit Singh on separate motorcycle no. PB70E-3682. However, when Manjit Singh reached Ambala- Chandigarh highway near village Gholumajra in the area of P.S Lalru, District SAS Nagar, the scooty was unbalanced and struck against the divider, as a result of which, Manjit Singh received serious injuries and  ultimately he died.  After the incident, the complainant informed the OP and requested to pay the insured amount of Rs.15 Lakh covered under the policy i.e. Personal Accident Claim. Instead of settling the claim, the OP sent letter dated 26-02-2020 asking the complainant to send the damaged vehicle for repairs. Thereafter, the complainant sent letter dated 01-05-2020 to OP to settle the Personal Accident Claim. However, OP vide letter dated 01.05.2020 and 22.6.2020 demanded some documents, which were sent to the OP on 06.07.2020. After receiving all the documents the OP failed to settle the claim of complainant without any cogent reasons. Thereafter, the complainant has approached the OP number of times with a request to settle the claim but to no avail. OP has taken more than 10 months just to settle the lawful claim, which invloves no dispute and it is a simple case of DDR where the police was promptly informed regarding the accident and the post mortem of the deceased i.e. insured was also conducted by the doctors on duty in SDH Derabassi Hospital, SAS Nagar. The OP cannot take advantage of the exclusion clause/terms and conditions which never formed a part of the insurance policy which was never communicated to the complainant. Hence, the present complaint.
3.           Upon notice, OP appeared through its counsel and filed written version wherein it raised preliminary objections to the effect that the complaint is false, frivolous, vague and vexatious in nature; there is no cause of action in favour of the complainant; the complaint is not maintainable as the complainant has not come to this Commission with clean hands and suppressed the material facts etc. On merits, it has been stated that the alleged occurrence took place in the morning of 04.01.2020 near village Gholu Majra on Ambala-Chandigarh Road. As per the GD No.031 dated 04.01.2020 recorded on the statement of Nanak Singh S/o Manjit Singh, he along with Didar Singh was following his father who was riding his scooter little ahead to them but in the written statement thereafter given to investigator, he stated that he got phone call from Piyara Singh from his father mobile and was told about the accident of his father. Thus his statement is mismatching. It seems that some false story of accident is being fabricated just to extract compensation under insurance cover head "Personal Accident Cover for Owner- Driver". It had never been the contention of the Law Makers to allow misuse of process of law. As alleged there is only a DDR (which does not require investigation & no police challan/papers are prepared, no site plan, no inquest report etc). In present high tech arena only within few seconds all things could be easily managed, facts could be changed, vehicle could be involved, name of actual driver could be replaced under legal advice, with a sole motive to extract compensation, Mere on oral version or alleged oral prepared bogus evidence or getting prepared any paper documents, does not give any right to the claimants to claim compensation. None of the relevant documents i.e. MLR, Rukka, Damage report of alleged Scooty No HR85-A-1522 in question, Damaged report 6 Photographs of damaged Scooty No HR85-A-1522, police Panchnama, Inquest Panchnama, statement of any such eye witness etc. have been attached or supplied to the OP. More so simply alleging that the death has been occurred, therefore one should not be allowed to flitter away public money by way of involving the vehicle & by getting prepared any paper document, which is infact not even investigated. Terms and conditions, exceptions etc of the policy cannot be kept aside or ignored. It is not that all cases of PA are to be blindly accepted & paid, infact neither all claims are claimable nor payable. The complainant cannot be allowed to agitate without any basis. Rest of the averments of the complainant were denied by the OP and prayed for dismissal of the present complaint.
4.           Learned counsel for the complainant tendered affidavit of complainant as Annexure C-W1/A alongwith documents as Annexure C-1 to C-11 and closed the evidence on behalf of complainant. On the other hand, learned counsel for the OP tendered evidence by way of affidavit of Shraddha P. Kinare, Liberty General Insurance Company Ltd., 10^th Floor, Tower A, Penninsula Business Park, Lower Parel (West), Mumbai as Annexure OP1/A alongwith documents Annexure OP-1/1 to OP-1/7 and closed the evidence on behalf of OP.
5.           We have heard the learned counsel for the parties and have carefully gone through the case file and also gone through the written arguments filed by the learned counsel for the complainant and learned counsel for the OP.
6.           Learned counsel for the complainant submitted that by not paying the claim amount to the complainant (nominee of the deceased insured) which fell due under the policy in question after death of the insured, the OP is deficient in providing service, negligent and adopted unfair trade practice. 
7.           On the contrary, the learned counsel for the OP submitted that since the complainant failed to provide necessary documents sought from him qua the accident in question and also the statement given to the investigator and the police was mismatching, as such, the claim was not paid to the complainant.    
8.           The moot question which falls for consideration is, as to whether, the complainant being nominee of deceased Manjit Singh, insured, is entitled to any relief in this case or not. It may be stated here that from perusal of contents of Investigation Report dated 13.02.2020, Annexure OP-1/3 prepared by the Investigator appointed by the OP itself, it is clearly coming that that the said investigator has concluded that he is of the opinion that Manjit Singh while driving his TVSA Jupiter in question had met with an accident, when he reported lost balance of his scooter and suffered head injuries and that claim lodged by deceased’s son/complainant may be considered, subject to terms and conditions of the policy and satisfaction of the competent authority.  Relevant part of the said report is reproduced hereunder:-

“……CONCLUSION:- In view of the statement of deceased's son Nanak Singh duly countersigned by his employer Sh Mohit, police report copy, post mortem report, death certificate copy and also based on the scratch/grazed marks on the front left side of the scooter, we are of the opinion that Sh Manjit Singh while driving his TVSA Jupiter Scooter no-HR-85-A-1522 had met with an accident when he reportedly lost balance of his scooter resulting he fell down on the divider and suffered head injuries. Owner/driver claim as had been lodged by the deceased's son Lakhwinder Singh may be considered subject to terms and conditions of insurance policy and also subject to the satisfaction of the competent authority. ….”

In his Investigation Report dated 13.02.2020, Annexure OP-1/3, there is nothing found mentioned if the said investigator has doubted the claim raised by the complainant except regarding statement of Nanak Singh regarding his location at the time of accident. At the same time, in the postmortem report Annexure C-4 also, the cause of the immediate death of the insured has been recorded by the doctor concerned as “Head Injury”. In our considered opinion when it is proved on record that the insured died due to head injury on account of the accident of the vehicle in question then OP was not justified in repudiating the claim of the complainant, in the case of Om Prakash vs Reliance General Insuarance, CIVIL APPEAL NO.15611  of 2017, decidedon 4 October, 2017, the Hon’ble Supreme Court of India has held that the decision of the insurer to reject the claim has to be based on valid grounds and that rejection of the claims on purely technical grounds in a mechanical manner will result in loss of confidence of policy-holders in the insurance industry.

9.           Now coming to the second ground taken by the OP regarding non-submission of  following documents:-
   1. Clarification regarding medium through which Mr.Lakhwinder Singh come to know about the subjected accident, as there is difference in Police Report and written statement
   2. Copy of ration card;
   3. Police panchnama copy.
10.           First coming to the clarification regarding medium through which Mr.Lakhwinder Singh/complainant came to know about the subjected accident, it may be stated here that when it is proved on record from the postmortem report Annexure C-4  that the cause of the immediate death of the insured was “Head Injury” and from the Investigation Report dated 13.02.2020, Annexure OP-1/3, also, it is clearly coming out that the investigator has opined that Manjit Singh while driving his TVSA Jupiter in question had met with an accident, when he reported lost balance of his scooter and suffered head injuries and that claim lodged by his deceased son/complainant may be considered, subject to terms and conditions of the policy and satisfaction of the competent authority, as such, in our considered opinion, on this hyper-technical ground alone, the claim of the  complainant cannot be rejected.
11.           As far as non supply of copy of ration card and copy of police panchnama is concerned, it may be stated here that the OP did not disclose as to why  it needed these documents, when the investigator vide his Investigation Report dated 13.02.2020, Annexure OP-1/3 has supplied to the OP all the documents i.e. statement of complainant; application addressed to village sarpanch; police report; post mortem report; death certificate of insured; aadhaar card of the complainant; scooter RC copy; insured driving licence and aadhar card of Mohit Kumar.   Thus, it has been proved that the OP has failed to pay the claim amount to the complainant on flimsy grounds, especially when it is proved that the insured died because of head injury in the accident, while he was driving the insured vehicle. The complainant is therefore held entitled to claim amount of Rs.15 lacs being nomine of the deceased insured under the policy in question, under PA COVER FOR OWNER DRIVER OF RS.15 LACS, Annexure C-2. 
12.           In view of the aforesaid discussion, we hereby allow the present complaint and direct the OP, in the following manner:-
    1. To reimburse/pay claim amount to the tune of Rs.15 lacs to the complainant being nominee of insured Manjit Singh (deceased)   under PA COVER FOR OWNER DRIVER OF RS.15 LACS under the policy in question alongwith interest @6% p.a., w.e.f 02.11.2020 i.e the date of filing of the complaint, till realization.
    2. To pay Rs.5,000/-, as compensation for the mental agony and physical harassment suffered by the complainant.
    3. To pay Rs.3,000/-, as litigation expenses.

The OP is further directed to comply with the aforesaid directions within the period of 45 days, from the date of receipt of the certified copy of the order, failing which the OP shall pay interest @ 8% per annum on the awarded amount, from the date of default, till realization. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

Announced:- 10.11.2023