Haryana

Ambala

CC/90/2012

SH RAVI BHALA S/O SH RAJINDER PAL BHALA - Complainant(s)

Versus

NATIONAL INSURANCE CO.LTD. - Opp.Party(s)

RAJESH SHARMA

10 Mar 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA.

 

             Complaint Case No.    : 90 of 2012

Date of Institution       : 20.03.2012

             Date of Decision         : 10.03.2017

 

 

1.         Ravi Bhala S/o Sh. Rajinder Pal Bhala, Prop. M/s Bhala Auto Mobile, Opposite Telephone Exchange, Raipur Rani, District Panchkula.

 

2.         Surinder Pal S/o Sh. Kishori Lal

 

3.         Kamla Devi W/o Surinder Pal (ii & iii are  parents  ofdeceased Sh. Jatinder Pal)

                                                                                   

……Complainants.

 

Versus

 

National Insurance Company Ltd. Chandigarh Nahan Road, near Bus Stand,

Naraingarh, District Ambala. (Haryana) through its Branch Manager/Manager.

Mumbai.

                                                                                    ……Opposite Party.

 

 

Complaint Under Section 12 of the Consumer Protection Act.

 

BEFORE:       SH. D.N. ARORA,  PRESIDENT.

                        SH. PUSHPENDER KUMAR, MEMBER.

                       

Present:          Sh. Rajesh Sharma, Adv. for complainants.

                        Sh. Mohinder Bindal,Adv. for OP.

 

ORDER.

 

                        In nutshell, brief facts of the complaint are that Sh. Jatinder Pal son of complainants no.2 & 3 and employee of complainant no.1 was duly insured under Workmen’s Welfare Personal Accident Policy vide No.420201/42/09/8100000040 w.e.f. 07.01.2010 to 06.01.2011 for a sum of Rs.100 lac.  It has been submitted that  during  the said policy period complainant’s son died in road side accident, at the age of 24 years on 07.12.2010 at 9:00 a.m. near Trilokpur Turn, Raipur Rani. FIR No.111  qua the said accident  was lodged at 10:15 a.m. at P.S. Raipur Rani. It has been submitted that complainants  supplied  all the desired documents  but the OP vide their letter dated 26.12.2011 repudiated the genuine claim of complainants. It has been submitted that as per FIR, the deceased Jatinder Pal was working with Bhalla Auto Mobile, Raipur Rani (OP No.1).  So, a legal notice dated 08.02.2012 was served upon the OP but of no avail.  As such, the  complainant has prayed that  the act of Op amounts to deficiency in service. Hence, the present complaint seeking relief as per prayer clause.

2.                     Upon notice, Op appeared through counsel and filed written statement raising preliminary objections qua maintainability of complaint, cause of action  and suppression of material facts.  On merits, it has been submitted that   OP No.1 availed the said insurance policy for his 6 employees working in different capacity at their workshop and there was a specific term under the said insurance policy that the risk of workers was covered only if any untoward incident happened with said employees at the place of the workshop/premises of the insured which means that  scope  of the said insurance policy was limited to the premises of OP No.1 but since the deceased Jatinder Pal suffered injuries and death at a far away place that too when he was  going with his father so reported in the claim was outside the purview of the insurance policy hence, the claim was not legally maintainable and payable, hence, rightly repudiated by the Op.

3.                     To prove his version, counsel for complainant tendered affidavit as Annexure PA alongwith documents as Annexures C-1 to C-16 and closed the evidence.  On the other hand, counsel for OP tendered affidavits as Annexures RX & RY alongwith documents as Annexures R-1 & R-2 and closed the evidence.

4.                     We have heard learned counsel for the parties and gone through the case file very carefully.  The case of the complainants No.2 & 3 is that during the pendency of policy period their son namely Jatinder Pal died in road side accident on 07.12.2010 but the OP wrongly repudiated their legal and valid claim vide letter (Annexure R-2). Counsel for OP has argued that they have rightly repudiated the claim of complainant as the complainant does not cover under the insurance policy because it covers a person while working at the site.  Further  the counsel for OP has drawn our towards repudiation letter Annexure R-2 written in the name of OP No.1 M/s Bhalla Automobiles, Raipur Rani is reproduced as under:-

On going through the claim papers as submitted including investigation report, it is observed that you have not shown  the original record of attendance register of employees to the investigator during his visits. Only you have submitted the photocopy of record (attendance register) through courier.  So, he cannot preparation of attendance Register vouchers & number of worker’s  were  shown after  the claim then shown submitted the photocopy of attendance register to the investigatory. 

5.                     We have seen insurance policy Annexure R-1 wherein it has been mentioned that ‘insurance on the six workers of above insured working at abovesaid Bajaj Authorized Service Station.’  Further the terms and conditions of the policy document reveals that ‘company undertakes  that ‘if during the period stated in  the schedule or during the continuance of this policy by renewal any insured person shall sustain  any bodily injury resulting  solely  and directly from road/rail accident or an accident caused by external, violent and visible means arising out of and in the course of employment.’

6.                     It is admitted case of the complainants that their son Jatinder Pal died in a road side accident which means that at the time of accident he was not under the course of employment under OP No.1. Copy of FIR No.111 dated 07.12.2010 U/s 279,304-A (Annexure C-2)   also fortifies the fact that at the time of accident deceased Jatinder Pal was not under the course of employment. In view of the above discussion, we are of the view that the case of complainants does not fall under the present policy. So, the OP company has rightly repudiated their claim. Accordingly, the present complaint being devoid of merits is hereby dismissed with no order as to costs. Copy of the order be sent to the parties concerned, as per rules.  File after due compliance be consigned to record room.

 

ANNOUNCED ON:  10.03.2017                                       

                                                                                                         Sd/-                          

                                                                                         (D.N. ARORA)

                                 PRESIDENT    

           

                                                                                                                   Sd/-

                    (PUSHPENDER KUMAR)

                                                                                                            MEMBER