Haryana

StateCommission

A/1102/2017

THE ORIENTAL INSURANCE COMPANY LTD. - Complainant(s)

Versus

MUNESH DEVI - Opp.Party(s)

SWATANTAR KAPOOR

18 Jul 2018

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

 

First Appeal No. 1102 of 2017

Date of Institution:12.09.2017

Date of Decision: 18.07.2018

 

 

The Oriental Insurance Company Limited, Bhiwani through Regional Office, LIC Building, 2^nd Floor, Jagadhari Road, Ambala Cantt.

                                      Appellant-Opposite Party

 

Versus

 

Munesh Devi wife of Jagbir Singh, resident of Dadri Delhi Bye Pass, Near Dandi Ashram, P.O. Ralwaldhi, Tehsil Charkhi Dadri, District Bhiwai.

Respondent-Complainant

 

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri Balbir Singh, Judicial Member.

                                                                                                                                                                            

Argued by:          Mrs. Swatantar Kapoor, Advocate for the appellant

                             Rajbir-brother of respondent-complainant

 

                                                   O R D E R

 

NAWAB SINGH J. (ORAL)

 

          Challenge is to the order dated July 24^th, 2017 of District Consumer Disputes Redressal Forum, Bhiwani (for short ‘District Forum’) whereby it directed The Oriental Insurance Company Limited-opposite party (for short, ‘Insurance Company’) to pay Rs.1,00,000/- to Munesh Devi-complainant on account of hospitalization of her husband Jagbir Singh-person insured.

2.      Jagbir Singh (since deceased) purchased Nagriksuraksha Individual Policy (Annexure A-1) from the Insurance Company.  The period of insurance was from September 11^th, 2013 to September 10^th, 2017.  The person insured was covered for personal accident.  The sum insured was Rs.5,00,000/-.  Out of which, 80% was under the coverage personal accident and Rs.1,00,000/- for hospitalization. The person insured died on December 10^th, 2013.  The claim lodged by the complainant was repudiated by the Insurance Company.   

3.      Aggrieved of the repudiation of the claim, complainant filed complaint under Section 12 of the Consumer Protection Act, 1986 before District Forum.

4.      Learned counsel for the Insurance Company has stated that Jagbir Singh died due to hemorrhage as per death summary (Annexure C-2), which cannot be termed as accident and the Insurance Company was not liable to pay the insured amount to the complainant. 

5.      It is an admitted fact the person insured died due to brain hemorrhage. The policy covered personal accident and hospitalization expenses on account of injuries sustained in the accident.  In the insurance policy, definition of accident and injury is given, which reads as under:-

          “Accident

          ‘An accident is a sudden unforeseen and involuntary event caused by external, visible and violent means.’     

          Injury

          Injury means accidental physical bodily harm, excluding illness and disease, solely and directly caused by external, violent and visible and evident means which is verified and certified by Medical Practitioner.”

 

6.      Since, the person insured died due to brain hemorrhage and the policy was issued for personal accident, the Insurance Company was not liable to indemnify the complainant on account of death of person insured.  In this view of the matter, the impugned order passed by the District Consumer Forum cannot be sustained. Accordingly, the appeal is accepted, impugned order is set aside and complaint is dismissed.

7.      The statutory amount of Rs.25000/- deposited at the time of filing the appeal be refunded to the appellant against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any in this case.

 

 

Pronounced 18.07.2018

(Balbir Singh) Judicial Member

(Nawab Singh) President

UK