Haryana

Yamunanagar

CC/589/2011

Maya devi - Complainant(s)

Versus

Naharpur Primary Agriculture co-op. - Opp.Party(s)

Ravinder Kumar

25 Nov 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA   NAGAR

                                                                                         Complaint No. 589 of  2011.

                                                                                         Date of institution: 03.06.2011.

                                                                                         Date of decision: 25.11.2016.

 

       Maya Devi aged about 32 years wd/o Sanjay Kumar son of Ram Singh,

       2. Sonia minor daughter of Sanjay Kumar.

       3. Vikas minor son of Sanjay Kumar

       4. Balkishan minor son of Sanjay Kumar

     Minors through their mother Smt. Maya Devi, as their natural guardian and next friend. All residents of village Sukhpura, P.O. Karehra Khurd, Tehsil Jagadhri, District Yamuna Nagar.                                                                                                                                                                                                      

                                                                                                                                                …Complainants.

                                    Versus

1. The Naharpur Primary Agricultural Co-op. Society Ltd. Naharpur, District Yamuna Nagar through its Manager/ Secretary.
2. Oriental Insurance Company Limited, Opp. Madhu Hotel, Jagadhri Road, Yamuna Nagar through its Branch Manager ( Insurance Company of deceased Sanjay Kumar vide policy No. 261700/47/2009/000170).
3. Future General India Insurance Company Limited, M-10, Deensons Building, NDSE, Part-II, 2^nd Floor, New Delhi through its Branch Manager ( Insurance Company of deceased Sanjay Kumar vide Policy No. A 0008695)

                                                                                                                                                  …Respondents.

 

BEFORE:         SH. ASHOK KUMAR GARG, PRESIDENT

                        SH. S.C.SHARMA, MEMBER.

 

Present: Sh. Ravinder Kumar, Advocate, counsel for complainant.   

              Sh. Surjeet Singh Saini, Advocate, counsel for respondent No.1.

              Sh. Karnesh Sharma, Advocate, counsel for respondent No.2.

              Sh. Rajiv Gupta, Advocate, counsel for respondent No.3.

 

ORDER

 

1.                     Complainants have filed the present complaint under section 12 of the Consumer Protection Act 1986.

 2.                    Brief facts, of the present complaint, as alleged by the complainants, are that the present complaint has been filed being LRs of the deceased Sanjay Kumar who obtained a loan from the respondent No. 1 (hereinafter referred as OP No.1 Society) vide his account No. 2751. The OP No.1 society obtained an insurance policy after charging the premium from the complainant covering the risk of Rs. 1,00,000/- per insured on account of accidental death. When, on 07.07.2009 deceased Sanjay Kumar was going on motorcycle bearing registration No. HR-02M-3741 he met with an accident with truck bearing No. HR-58-7643, near Zimidara Petrol Pump, Jagadhri and died at the spot. The postmortem on his dead body was conducted in Civil Hospital, Jagadhri on 08.07.2009 and an FIR bearing No.324 dated 08.07.2009 under section 279/304-A IPC was registered in P.S. City Jagadhri. Thereafter, the complainants contacted the OPs and submitted all the relevant documents and requested to release the insurance amount of Rs. 1,00,000/- to the complainants but the OPs did not give any response to the said request. Hence this complaint.

3.                     Upon notice, OPs appeared and filed their written statement separately. OP No.1 filed its written statement by taking some preliminary objections such as complaint is not maintainable; complaint is bad for non-joinder and mis joinder of necessary parties and on merit it has been admitted that Sanjay Kumar ( now deceased) had obtained a loan from the OP No.1 society but he has not paid installments regularly. Further, it has also been admitted that deceased Sanjay Kumar was insured with the OPs Insurance Company. However, it has been denied that complainant has submitted all the relevant documents with OP No.1. When the death of Sanjay Kumar came to the knowledge of OP No.1, the OP No.1 had conveyed to the abovesaid insurance companies for necessary action and for disbursement of the insurance claim amounts. Rest contents of the complaint were denied for want of knowledge as well as being incorrect.

4.                     OP No.2 filed its written statement by taking some preliminary objections such as  complaint is not maintainable; complaint is bad for non-joinder and mis joinder of necessary parties; complainant has no locus standi to file the present complaint. The Naharpur Primary Agriculture Co-op. Society Ltd. Village Naharpur, had purchased an insurance policy under Janta Personal Accident (Group) insurance from the OP No.2 vide insurance policy bearing No. 261700/47/2009/170 which was valid w.e.f. 20.05.2008 to 19.05.2009. On going through the claim papers submitted with the OP No.2, it was found that Sanjay Kumar son of Ram Singh village Sukhpura died on 07.07.2009 whereas the policy period was from 20.05.2008 to 19.05.2009. As such, the policy does not cover the date of death and the claim was not admissible. The OP No.2 also informed about the claim to OP No.1 vide registered letter dated 23.06.2010 and on merit controverted the plea taken in the complaint and reiterated the stand taken in the preliminary objections and lastly prayed for dismissal of complaint against OP No.2.

5.                     OP No.3 filed its written statement by taking some preliminary objections such as complaint is not maintainable; no negligence or deficiency in service on the part of OP No.3; complainant has not come to this Forum with clean hands; in this case an intimation dated 29.07.2010 was received by the OP Company from Yamuna Nagar Central Co-Operative Bank Limited in respect of death of Sanjay Kumar, who was insured under Personal Accident Insurance Policy for a sum of Rs. 50,000/- being member of Naharpur Primary Agrl. Co-op. Society. On receipt of said intimation, the OP Insurance Company started processing the claim and found that the alleged date of death is 07.07.2009 but insurance company was intimated on 29.07.2010 i.e. after delay of 387 days ( more than one year).  In the present policy, it is mandatory condition to immediately intimate to the insurance company on the happening of incident but in this case there was inordinate delay in giving intimation to company. Therefore, the OP Insurance Company legally and justifiably repudiated the claim of the complainant vide letter dated 31.07.2010 and on merit controverted the plea taken in the complaint and reiterated the stand taken in the preliminary objections. Lastly prayed for dismissal of complaint against OP No.3 Insurance Company.

6.                     In support of their complaint, counsel for the complainant tendered into evidence affidavit of Maya Devi complainant as Annexure CW/A and documents such as photo copies of Kisan Credit Card as Annexure C-1, Photo copy of death certificate of Sanjay Kumar as Annexure C-2, Photo copy of postmortem report as Annexure C-3, Photo copy of FIR as Annexure C-4, Photo copy of ration card as Annexure C-5 and closed the evidence on behalf of complainant.

7.                     On the other hand, counsel for OP No.1 tendered into evidence photo copy of letter dated 02.08.2010 written to Central Cooperative Ltd. Yamuna Nagar by Naharpur Primary Agriculture Coop. as Annexure R.1/1, Photo copy of Kisan Credit Card as Annexure R.1/2 and R.1/3, Photo copy of list of insured persons as Annexure R.1/4 and closed the evidence on behalf of OP No.1.

8.                     Counsel for OP No. 2 tendered into evidence affidavit of Sh. R.S.Kalra, Divisional Manager, OIC as Annexure RW2/A and documents such as Photo copy of insurance policy as Annexure R.2/1, Photo copy of letter dated 23.06.2010 as Annexure R.2/2 and closed the evidence on behalf of OP No.2.

9.                     Counsel for Op No.3 tendered into evidence affidavit of Sh. Ved Tripathi, Senior Executive Legal as Annexure RW3/A and documents such as Photo copy of repudiation letter dated 31.07.2010 as Annexure R.3/1, Photo copy of insurance policy as Annexure R.3/2, Photo copy of Notification of Center Claims as Annexure R.3/3 and closed the evidence on behalf of OP No.3.

10.                   We have heard the learned counsel for both the parties and have gone through the pleadings as well as documents placed on file very minutely and carefully.

11.                   It is not disputed that deceased Sanjay Kumar husband of complainant No.1 had not obtained a loan from the OP No.1 society and Op No.1 society got insured the deceased Sanjay Kumar from the Op No.3 Future General India Insurance Ltd. under the Group Personal Accident Insurance Policy for a sum of Rs. 50,000/- vide insurance policy bearing No. 2009-A0008695FGP valid from 01.04.2009 to 31.03.2010 (Annexure R-3/2) covering the risk of death due to accident caused by outward violent and visible means. It is also not disputed that deceased Sanjay Kumar met with an accident with truck bearing No. HR-58-7643 while driving motorcycle bearing registration No. HR-02M-3741 and died at the spot which is duly evident from the copy of death certificate (Annexure C-2), copy of postmortem report (Annexure C-3) and copy of FIR bearing No. 324 dated 08.07.2009 registered in the police station City, Jagadhri (Annexure C-4).

12                    The only version of the OPs Insurance Company is that the claim of the complainants have been rightly repudiated vide letter dated 31.07.2010 (Annexure R.3/1) as the OP No.3 Insurance Company was intimated on 29.07.2010 whereas Sh. Sanjay Kumar policy holder died on 07.07.2009 i.e. there was a delay of 387 days. Learned counsel for the OP No.3 Insurance Company draw our attention towards the terms and conditions of the insurance policy i.e. condition No. F(i)(b) and argued that as the complainants have not intimated and lodged the claim with the OPs Insurance Company within 15 days as prescribed under the condition. Hence, nothing is payable to the complainant and the complaint is liable to be dismissed.

13.                   On the other hand, learned counsel for the complainant argued at length that the complainants intimated to the OPNo.1 Bank as the deceased Sanjay Kumar had obtained the loan from the Op No.1 Society and the complainants were not having any knowledge that from which insurance company the OP No.1 has got insured the deceased Sanjay Kumar. Learned counsel for the complainant further argued that OP No.1 Society earlier informed to the OP No.2 i.e. Oriental Insurance Company as the previous insurance policy was issued by OP No.2 and draw our attentions towards the letter dated 02.08.2010 (Annexure R.1/1) vide which the complainants lodged their claim with OP No.1 Cooperative Society.

14                    Learned counsel for the OP No.2 i.e. Oriental Insurance Company also argued that a wrong intimation was given by the OP No.1 to OP No.2 that deceased Sanjay Kumar was insured with OP No.2 whereas the deceased Sanjay Kumar was insured with OP No.3 on the date of alleged accident. Hence, the complaint qua OP No.2 is liable to be out rightly dismissed with costs.

15.                   After hearing both the parties, we are of the considered view that the genuine claim of the complainants have been wrongly rejected by the OP No.3 Insurance Company merely on the ground of delayed intimation whereas from the perusal of documents placed on file, it is duly evident that complainants duly intimated to OP No.1 Society who got the insurance policy from the OP No.3 covering the risk of death on behalf of deceased Sanjay Kumar. The case of the complainants is duly proved from the copy of FIR (Annexure C-4) lodged on the same day vide FIR No. 324 dated 08.07.2009 and copy of postmortem report dated 08.07.2009 (Annexure C-3). It is not the case of the OPs Insurance Company that deceased Sanjay Kumar was not insured with Op No.3 Insurance Company and not died/expired during the currency of insurance policy. We are of the considered view that the OPs Insurance Company cannot repudiate the genuine claim on the technical grounds on the point of delay in intimation. Moreover, OP No.3 Insurance Company has totally failed to convince this forum that they have ever supplied the terms and conditions of the insurance Policy to the complainant or deceased Sanjay Kumar and in the absence of any cogent evidence that the OP Insurance Company has supplied the terms and conditions of the Insurance policy to the complainants, we are of the opinion that the OP No.3 Insurance Company cannot take the benefits of delay in intimation and violation of the terms and conditions of the insurance policy on the part of complainant. The same view has been held in case titled as The Oriental Insurance Company Ltd. Versus Satpal Singh and others, 2014(2) CLT page 305 wherein it has been held that Insurance Policy- Terms and conditions- Held-Insured not bound by the terms and conditions of the Insurance Policy unless it is proved that policy was supplied to the insured by the Insurance Company-Onus of proof that terms and conditions of the policy were supplied to the insured lies upon the insurance company-Plea of insurance company that in the cover note itself it is mentioned that the insurance under this policy is subject to conditions, clauses, warranties, exclusions, IMTS and OIC endorsements, mentioned herein above, which are available on companies website: www.orientalinsurance.org. in or on demand from policy issuing office itself proves that Insurance Company, did not supply the terms and conditions, with cover note- Revision Petition dismissed

16.                   In the circumstances noted above, we are of the considered view that the OP No.3 Insurance Company has wrongly repudiated the claim of the complainant vide letter dated 31.07.2010 and the same is hereby quashed.

17.                   Resultantly, we partly allow the complaint of complainant and direct the OP No.3 to pay a sum of Rs. 50,000/- in equal shares alongwith interest at the rate of 9% per annum from the date of filing of complaint till its realization and further to pay a sum of Rs. 3000/- as litigation expenses to the complainants. Further, the share of the minor Baby Sonia, Vikas and Balkishan will be deposited in the shape of FDR in the Nationalized Bank till attaining the age of majority. Order be complied within a period of 30 days after preparation of copy of this order failing which complainants shall be at liberty to initiate action as per law. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced in open court. 25.11.2016

                                                                                                                                                                                                                      

                                                                                   (ASHOK KUMAR GARG)

                                                                                    PRESIDENT

 

                                                                                   (S.C.SHARMA  )

                                                                                    MEMBER