Chandigarh

DF-II

CC/206/2020

Usha Rani - Complainant(s)

Versus

M/s United India Insurance Company Limited - Opp.Party(s)

Adv. Kamal Kant Verma

10 Oct 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II

U.T. CHANDIGARH

 

Consumer Complaint No.	:	CC/206/2020
Date of Institution	:	20/03/2020
Date of Decision	:	10/10/2024

 

 

Usha Rani wd/o Late Sh. Manohar Lal, resident of H.No.160/E, Maheshpura, Panchkula.

                                ...  Complainant

V E R S U S

M/s United India Insurance Company Limited, SCO 177-178, 1^st Floor, Sector 8-C, Chandigarh through its Divisional Manager.

…. Opposite Party

 

BEFORE:
	SHRI AMRINDER SINGH SIDHU	PRESIDENT
	SHRI BRIJ MOHAN SHARMA	MEMBER

 

ARGUED BY:
	Ms. Nilakshi Joseph, Counsel for complainant
	Sh. Sukaam Gupta, Counsel for OP

       

ORDER BY AMRINDER SINGH SIDHU, M.A.(Eng.),LLM,PRESIDENT

1.        The complainant has filed the present consumer complaint alleging that she alongwith her husband Sh.Manohar Lal had availed housing loan from Union Bank of India, Sector 40, Chandigarh which was got insured from the OP vide Uni-Home Policy (Annexure C-1) from 21.3.2007 to 20.3.2027 and the same also included personal accident cover of ₹2,50,000/-.  Unfortunately, on 24.6.2019, at about 9:00 a.m., husband of the complainant fell from the stairs and died on the way to the hospital.  On 2.10.2019 DDR No.17 (Annexure C-3) regarding the incident was entered at Police Post, Sector 21, Panchkula. Due information was also given to the OP.  However, despite of receipt of all the documents demanded as well as service of legal notice dated 13.2.2020 (Annexure C-5) by the complainant, OP failed to proceed further with the genuine claim of the complainant.  Alleging that the aforesaid acts amount to deficiency in service and unfair trade practice on the part of OP, complainant has filed the instant consumer complaint for grant of various reliefs as prayed therein.
2.        In its written version OP/insurer admitted that the deceased husband of the complainant had purchased a construction loan from Union Bank of India and as per the MOU between the OP and the said bank, he was covered under personal accident policy for sum insured of ₹2,50,000/- subject to certain terms & conditions of the policy. However, it is averred that there was delay on the part of the complainant in intimating the claim as her husband had died on 24.6.2019 whereas the claim was intimated for the first time on 25.9.2019, that too by the financier bank and not the complainant.  Neither any FIR had been registered nor any post mortem was conducted over the dead body of the deceased and, therefore, it cannot be held that he had died due to accidental injuries. The remaining allegations have been denied being false. Pleading that there is no deficiency in service or unfair trade practice on its part, OP prayed for dismissal of the consumer complaint.
3.        The parties filed their respective affidavits and documents in support of their case.
4.        In replication, complainant controverted the stand of the OP and reiterated her own.
5.        We have heard the learned Counsel for the parties and have gone through the documents on record, including written arguments.
6.        Admittedly, the deceased husband of the complainant was covered for personal accident cover of ₹2,50,000/- under the policy in question (Annexure C-1).  It is also not disputed that the husband of the complainant had died on 24.6.2019 as is also evident from the death certificate (Annexure C-2).
7.        It is observed from the record that the case of the complainant is that her husband had died on account of fall from the stairs i.e. accidental death.  In support of her case complainant has relied on the DDR No.17 dated 2.10.2019 (Annexure C-3) as well as the report dated 22.11.2019 (Annexure C-6) of the investigator namely Dr. Joseph K. Masih appointed by the OP.  On the other hand, the defence of the OP is that as the husband of the complainant had not died on account of accidental death, therefore, the claim is not payable. 
8.        However, we do not find any merit in the defence of the OP as it is settled law that one who asserts must prove and since it is the OP who has asserted that the husband of the complainant had not died on account of accidental death, burden to prove the same lies on its shoulders only.  Here we are fortified by the judgment of the Hon’ble Apex Court in Mahakali Sujatha Vs.  Branch Manager, Future Generali India Life Insurance Co. Ltd. & Anr., II (2024) CPJ 66 (SC) and the relevant portion of the same reads as under :-

“50. …….. The cardinal principle of burden of proof in the law of evidence is that “he who asserts must prove”, which means that if the respondents herein had asserted that the insured had already taken fifteen more policies, then it was incumbent on them to prove this fact by leading necessary evidence. The onus cannot be shifted on the appellant to deal with issues that have merely been alleged by the respondents, without producing any evidence to support that allegation………. A fact has to be duly proved as per the Evidence Act, 1872 and the burden to prove a fact rests upon the person asserting such a fact………..”

9.        It is further observed from the record that it is the OP who had appointed Dr. Joseph K. Masih to investigate the claim of the complainant and the said investigator, after going through the documents/record before him and recording the statement of the witnesses, vide his report (Annexure C-6) had concluded that the claim case is genuine.  The relevant portion of the report is reproduced below for ready reference :-

“Keeping in view the circumstances explained above it concluded that claim case of Sh.Manohar Lal s/o Sh. Prabhu Dayl resident of H.No.160-E, Maheshpur, Sector 21, Panchkula covered under PERSONAL ACCIDENT died due to injuries received due to fall from the stairs thus claim case is genuine.

        Both Smt. Usha Rani and Manohar Lal are covered for ₹2.50 lac each under the PERSONAL ACCIDENT policy.”

Hence, once the investigator of the OP itself had considered the claim of the complainant as genuine, the OP should have settled the claim but it just delayed the claim and failed to settle the same, till date, without any rhyme or reason. The OP has not even placed on record any documentary evidence to show that the claim has been repudiated by it, despite of lapse of more than 4½ years from the date of report of the investigator and the said fact itself amounts to gross deficiency in service and unfair trade practice on its part.  

10.        So far as the plea of the OP/insurer regarding delay in intimating it is concerned, complainant in her replication has stated that when the investigator, Dr.Joseph K. Masih visited her house on 8.9.2019, only then she came to know that the banker of her deceased husband had obtained policy and immediately after obtaining documents from the bank she lodged the claim with the OP/insurer.
11.        We find merit in the contention of the complainant as there was bereavement in the family and it takes time to overcome the grief of loss of near and dear ones and in many cases the nominees/legal heirs do not even know the investments made/policies taken by the deceased.  In the present case, as it is clear that as soon as the complainant came to know about the personal accident death cover under the policy in question, she immediately lodged the claim, it cannot be said that there was any delay in intimating the claim to the OP from the date of knowledge of the complainant i.e. 8.9.2019. 
12.        Otherwise also, insurance companies should not resort to hyper-technicalities while settling claims.  The Hon’ble Apex Court in Om Prakash Vs. Reliance General Insurance & Anr., IV (2017) CPJ 10 (SC) has held that it would not be fair and reasonable to reject genuine claims which had already been verified and found to be correct by the Investigator.  The relevant portion of the judgment is reproduced below :-

                ………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. If the reason for delay in making a claim is satisfactorily explained, such a claim cannot be rejected on the ground of delay. It is also necessary to state here that it would not be fair and reasonable to reject genuine claims which had already been verified and found to be correct by the Investigator. The condition regarding the delay shall not be a shelter to repudiate the insurance claims which have been otherwise proved to be genuine. It needs no emphasis that the Consumer Protection Act aims at providing better protection of the interest of consumers. It is a beneficial legislation that deserves liberal construction. This laudable object should not be forgotten while considering the claims made under the Act.”

 

13.        In view of the foregoing discussion and the ratio of law laid down above, it is clear the present consumer complaint deserves to succeed and the same is accordingly partly allowed.  OP is directed to pay the sum insured under personal accident cover i.e. ₹2,50,000/- to the complainant alongwith interest @ 6% per annum from the date of institution of the present consumer complaint till the date of its actual realization. The OP shall also pay lump sum compensation of ₹10,000/- to the complainant for the harassment caused to her.
14.        This order be complied with by the OP within 60 days from the date of receipt of its certified copy.
15.        The pending application(s) if any, stands disposed of accordingly.
16.        Certified copy of this order be sent to the parties, as per rules. After compliance file be consigned to record room.

 

ANNOUNCED 10/10/2024 hg	[AMRINDER SINGH SIDHU] PRESIDENT
	[BRIJ MOHAN SHARMA] MEMBER