District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No. 497/2021.
Date of Institution:28.09.2021.
Date of Order:21.04.2023.
Meenakshi Sharma @ Minakshi.W/o Late Sh. Raj Kumar Sharma, R/o DB/947, Dabua Colony, Faridabad, Haryana-121001
Presently R/o: Pipal wali Gall, Gali no. 4 Palla Chowk, Tilpat, Faridabad, Haryana-121003.
…….Complainant……..
Versus
National Insurance Co. Ltd., through its authorized representative B-234, Okhla Industrial Area,Phase-1, New Delhi 110020.
…Opposite party
Complaint under section-12 of Consumer Protection Act, 1986
Now amended Section 34 of Consumer protection Act 2019.
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
Indira Bhadana………….Member.
PRESENT: Complainant with Shri Vikas Bhadana Advocate.
Sh. Jatinder Singh, counsel for opposite party.
ORDER:
The facts in brief of the complaint are that the opposite party issued a Personal accident insurance policy no. 354802/42/16/8100001198 in favour of the husband of the complainant which was started from the year 2012 and continuously renewed every year till the month of May 2017. The husband of the complainant on dated 11.03.2017 while working on the roof, accidently fall down and due to impact of the unfortunate incident the husband suffered multiple injuries, therefore, he was taken to the Max Smart Super specialty hospital at New Delhi. The police also registered an FIR dated 11.03.2017 in the police station Fatehpur Beri, New Delhi. Due to the unfortunate accident, the husband of the complainant expired on dated 13.03.2017. As per the postmortem report, the cause of death was shock due polytrauma caused by blunt external force/ impact. Due to the death of the husband, the complainant was in a mental shock and trauma. The complainant faced many health issues as well as property issues with the brother of the deceased husband. The complainant was taken to her maternal home after the performance of the last rites. The complainant was living in the house which was already in the name of the brother of the deceased husband therefore after some time while the complainant again went to her matrimonial house, due to the property dispute, the complainant could not be allowed to enter into the said house.The complainant had no option left therefore after the death of the husband the complainant shifted to the rented accommodation with her three children without any goods. It was important to mention here that the brother and mother of the deceased husband have possession of all the goods & documents related to the deceased husband. In the month of July 2021 after 3-4 years, the mother in law of the complainant come to meet the children of the complainant wherein she given some documents related to the deceased husband and after perusing the said documents it has come to the knowledge of the complainant that an accidental insurance policy was earlier insured in the name of the husband. of the complainant. The complainant was not aware of the existence of the said accidental insurance policy thereafter the complainant approached the opposite party insurance company and lodged a claim. The complainant submitted all the necessary documents include FIR, PMR and death certificate etc. with the opposite party company. The complainant being less educated, written everything as per the officials of the respondent company . The complainant was shocked to know that the opposite party insurance company without considering any documents, repudiated the said claim on dated 06.08.2021. The said claim was repudiated on the unreasonable, technical ground, stating that the complainant was not given intimation of the claim within time therefore the claim was repudiated. The opposite party insurance company failed to consider the guideline issued by Insurance Regulatory and Development Authority through its circular no. IRDA/HLTH/MISC/CIR/216/09/2011 date 20.09.2011 in which it was strictly mentioned that:
"The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc. However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of circumstances," documents due to unavoidable circumstances.”
The complainant was not aware of the said insurance policy and as the complainant was not allowed to enter inside the house by the brother of the deceased husband. The good and documents related to the husband were in the possession of the brother of the deceased and beyond the control of the complainant therefore the complainant had no opportunity left to know about the said policy. Further, the circular issued by the IRDA is specifically mentioned that despite the delay in lodging the claim in the life insurance policy, the genuine claim should be considered. He fails to consider that recent apex court judgement. wherein it was held that the insurers decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such a limitation clause does not work in isolation and is not absolute. It was also held in a plethora of judgements given by Hon'ble National commission that "Rejection of claims on purely technical grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation therefore the insurer has to pay the genuine clam even if intimation given in delay.”
The aforesaid act of opposite party amounts to deficiency of service and hence the complaint. The complainant has prayed for directions to the opposite party to:
a) pay the sum insured amount of rs.5,00,000/- alongwith interest @24% p.m.
b) pay a sum of Rs.50,000/- towards compensation for deficiency in services and unfair trade practice.
c) pay Rs. 20,000/- as compensation for causing mental agony and harassment .
d) pay Rs. 30,000 /-as litigation expenses.
2. Opposite party put in appearance through counsel and filed written statement wherein Opposite party refuted claim of the complainant and submitted that the present complaint was not legally maintainable before this Hon'ble Commission as the present complaint was hopelessly time barred by period of limitation. Under the provisions of Consumer Protection Act, a Consumer or the aggrieved person can approach the Hon'ble District Consumer Disputes Redressal Commission Faridabad within a period of two years from the date of cause of action. Admittedly in the present case, the deceased insured under Insurance Policy No. 354802/42/16/8100001198 covering Insurance risk from 24.05.2016 to 23.05.2017 had a fall from roof on 11.03.0217 and died on 13.03.2017 due to the injuries sustained. The written intimation of the death of the deceased was passed on to the respondent M/s National Insurance Company Ltd. on 30.07.2021 highly belatedly after a gap of 52 months, whereas under the terms and conditions of the Personal Accident Insurance Policy, the complainant was required to intimate the insurer immediately after the happening of any event/loss as per Condition no.1 of the Personal Accident Insurance (Individual) Policy, which runs as under:
"Upon the happening of any event which may give rise to a claim under this Policy written notice with full particulars must be given to the Company immediately. In case of death written notice also of the death must, unless reasonable cause is shown, be so given before interment cremation and in any case, within one calendar month after the death and in the event of loss of sight or amputation of limbs written notice thereof must be given within one calendar month after such loss of sight or amputation.
The FIR No. 0108 dated 11.03.2017 registered under Sections 288/337 IPC in Police Station Fatehpur Beri, District South Delhi regarding the incident of fall of Raj Kumar Sharma since deceased was Annexure R-3 The husband of the complainant died on 13.03.2017 whose Post Mortem was conduct in All India Institute of Medical Sciences, New Delhi vide PMR No. 332-17. The photocopy of which was Annexure R-4 The photocopy of the death certificate of the deceased Raj Kumar Sharma was Annexure R-5. The photocopy of the intimation letter signed by the complainant, the wife of deceased Raj Kumar Sharma, received in the office of respondent M/s National Insurance Company Ltd. Okhla Phase-1, New Delhi on 30.07.2021 was Annexure R-6. The competent authority of the opposite party M/s National Insurance Company Ltd., perused all the above mentioned documents and noted that the PA Claim was intimated highly belatedly after a gap of 4 years and was Not Payable as per the terms and conditions of the insurance policy and the PA Claim was not accepted, the intimation of which was duly passed on to the complainant on 01.09.2021. Opposite party denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
3. The parties led evidence in support of their respective versions.
4. We have heard learned counsel for the parties and have gone through the record on the file.
5. In this case the complaint was filed by the complainant against opposite party–National Insurance Co. Ltd.. with the prayer to: a) pay the sum insured amount of rs.5,00,000/- alongwith interest @24% p.m. b)pay a sum of Rs.50,000/- towards compensation for deficiency in services and unfair trade practice. c) pay Rs. 20,000/- as compensation for causing mental agony and harassment . d) pay Rs. 30,000 /-as litigation expenses.
To establish his case the complainant has led in his evidence, Ex.CW1/a – affidavit of Menakshi Sharma @ Minakshi, Ex.CW2/a – affidavit of Prem Wati w/o late Jaipal aged about 7- years presently residing at House No. 947, Gali No.1, Dabua colony, Faridabad, Ex.C-1- personal accident insurance policy valid from 24.05.2016 to 23.05.2017, Ex.C-2 – FIR, Ex.C-3 – Postmortem report, Ex.C-4 – death certificate, Ex.C-5 – letter written by the complainant which was received by the insurance company on 30.07.2021, Ex.C-6 – reply to letter which was received by the insurance company on 30.07.2021, Ex.C-7 IRDA circular dated 20.09.2011.
On the other hand counsel for the opposite party strongly agitated and opposed. As per the evidence of the opposite party Ex.RW1/A – affidavit of Rameshwar Dass, administrative Officer, M/s. national Insurance company Limited, Divisional Office, 5C-1&2, BP, Railway Road, Neelam Chowk, NIT, Faridabad, Ex.R-1 - insurance policy valid from 24.05.2016 to 23.05.2017, Ex.r-2 – terms and conditions of the policy, Ex.R-3 – FIR, Ex.R-4 – Postmortem report, Ex.R-5 – death certificate, Ex.R-6 – letter written by the complainant which was received by the insurance company 30.07.2021, Ex.R-7 – reply to letter which was received by the insurance company on 30.07.2021.
6. During the course of arguments, counsel for the complainant has placed on record authority in case titled National Insurance Company Ltd. Vs. Hukam Bai Meena passed by the Hon’ble National Insurance Company Ltd., decided on 01.08.2018.
7. After going through the citation as well as Circular placed on record vide Ex,C-7, the Commission is of the opinion that the Commission is bound by the Consumer Protection Act. As per dictum of Section 69 of Consumer Protection Act, the District Commission is empowered to admit a complaint within two years from the date on which the cause of action has arisen. The present complaint is time barred under Limitation Act as the date of occurrence is 11.03.2017 and date of filing of complaint 21.04.2023 after expiry of six years.
8. Resultantly, the complaint is dismissed being time barred. Copy of this order be given to the parties free of costs and file be consigned to the record room.
Announced on: 21.04.2023 (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharma)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
(Indira Bhadana)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
