Delhi

New Delhi

CC/783/2011

Bijender Kumar - Complainant(s)

Versus

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

02 Jul 2015

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTT. NEW DELHI),

 ‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN,

      I.P.ESTATE, NEW DELHI-110002.

 

Case No.CC/783/11             Dated:

In the matter of:

SHRI BIJENDER KUMAR,

H.NO.1137/31,GALI NO,

4B LAXMAN VIHAR,

PHASE-1 GURGAON-01

                                       

........COMPLAINANT

 

VERSUS

UNITED INDIA INSURANCE CO. LTD.,

307, AKASHDEEP BUILDING,

26-A, BARAKHAMBA ROAD,

NEW DELHI-02

                  ……..OPPOSITE   PARTIES

 

 

 

 

 

 

 

 

 

 

 

 

 

ORDER

 

Member: Ritu Garodia

        The short facts of alleged deficiency are that the complainant, a Jal Board employee purchased UNI Home Care policy with OP from 27.8.2009 onwards vide policy No.0400801/46/09/90/00000168.  The wife of complainant received burn injuries on 12.1.2010 and was subsequently hospitalized .  The death of the complainant’s wife occurred on 22.4.2010.  Claim was filed.  Investigator by OP was appointed and investigation as duly conducted Medical Papers and documents and death certificate are annexed with the complaint.

        OP in its version has stated that the insurance policy is assigned in favour of Union Bank of India, Union Loan Point, Sushant Lok-II, Gurgaon.  OP has repudiated the claim in the absence of required documents like FIR, post martom report and panchnama.   OP has alleged that the treating hospital should have booked a medico legal case and duration of treatment for 3 months was too long.  OP while admitting burn injuries is questioning the cause of death.  OP has further alleged that the insurance policy is for two persons and their liability is limited to Rs.5,00,000/- with respect to death of one person OP has annexed investigation report with its version.

        After giving due consideration to argument advanced by both parties and examination of all documents reveal that insurance policy is admitted by both parties.  The investigation report of                                      OP is elucidated as:

        “These circumstances and in absence of any point or evidence to this contrary we have no reason to disbelieve the husband, kids and neighbours that burn injuries were accidental.  Any how still to confirm this angle we have requested the claimant and are tying to contact and question the parents family of deceased and will bring to the notice of Insurance authorities of the result an specially if there is any possibility of doubt on this point.

        Husband of the deceased immediately took her to hospital and we feel that as a prudent person this was the right step on his part.  But the hospital people seem to have not discharged their duty in informing the Police as this should have been treated as a medico-legal case.  The facts do indicate that the patient had been admitted in hospital as a result of burn injuries suffered on 12.1.10 and was treated for such injuries.  But the long duration from 18.1.10 to 18.4.10 (3 months) when she remained out of hospital, even though under treatment as an outdoor patient from Jal Board Dispensary , casts a serious doubt on the cause of death if it could be a direct result of burn injuries.”

        Thus, the report clearly states that the fire and burn injury was accidental but as no post mortem was conducted, death may not be direct effectof injuries.  Death summary prepared by Metro Hospital states that patient was FUC (Follow up case) of burn on 12.1.10 and was admitted for further management.  The medical certificate annexed with complaint reveals that cause of death was septicemia with shock, ARF ARPS and follow up case of burnt.        Since the decease continued to undergo treatment for severe burn injuries for 3 months, though not being continuously hospitalized.  The OP insurance company cannot shun its liability of settling the claim on this ground.  The burn injuries were accidental as admitted by both parties and as such there was no requirement of FIR, or post mortem.

        OP has also annexed a letter by Union Bank 30.3.11 (annexed at page 14 of WS) wherein the bank has asked the OP company to settle the claim as the matter is already delayed.  Further, there is no clause in the policy which limits OP’s liabilities to half of sum insured in case of personal accident of one person. If such was the case, OP’s could have assigned separate policy to two persons.

        We, hence find OP guilty of imperfection in service and direct it to pay sum insured Rs.10,00,000/- with 9% interest from the date of policy till realization.  We also award Rs.1,00,000/- compensation for complete non-application of mind in repudiation of claim arbitrarily and negligently resulting in gross injustice, mental trauma, harassment and physical inconveniences.

The order shall be complied with within 30 days of the receipt of the copy of the order; otherwise action can be taken under Section 25 / 27 of the Consumer Protection Act.

 Copy of the order be sent to the parties free of cost.

        Pronounced in open Court on 02.07.2015.

 

 (C.K.CHATURVEDI)

    President      

 

 

(RITU GARODIA)

Member