Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. : 343
Instituted on : 26.07.2018
Decided on : 04.10.2023
1. Jyoti W/o. Lt. Sonu Kumar, H.No. 1383, Sec.2, Rohtak (since deceased) through her legal heir:- Shobit minor aged-9 years through his natural guardian and next friend Kamlesh Devi w/o Chander Pal R/o H.No.2431/11 Nehru Colony,Rohtak.
2. Kamlesh Devi W/o Chander Pal R/o H.No.2431/11 Nehru Colony, Rohtak
………..Complainant.
Vs.
- The Manager of National Insurance Co.Ltd. #3 Middleton Street, Post Box No. 9229, Kolkatta- 700071.
- The Manager, National Insurance Co. Ltd., Narian Shopping Complex, Near Civil Road, Rohtak, Haryana- 124001.
- The Manager of M/s Swadesh Engineering Industries, # 7.4 K.M. stone, Jind Road, VPO Titoli, Distt. Rohtak-124001.
……….Opposite parties.
COMPLAINT U/S 35 OF CONSUMER PROTECTION ACT,2019.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
DR. VIJENDER SINGH, MEMBER.
Present: Sh.Pawan Balhara, Advocate for the complainant.
Sh. A.S.Malik, Advocate for opposite party No.1 & 2.
Sh.Amarjeet Ahlawat, Advocate for opposite party No.3.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that initially the complaint was filed by the complainant Jyoti for the death claim of her husband Sonu Kumar. But during the pendency of complaint, complainant Jyoti also died and thereafter Shobit(minor) and Kamlesh Devi were impleaded as L.Rs of Jyoti and Sonu. As per complainant Jyoti(since deceased) her husband namely Sonu Kumar was working in M/s Swadesh Engineering Industries i.e. respondent no.3 in 2011 and insured with respondent under Group Personal Accident policy no. 421600/42/11/8200000097 for the period 26/12/2011 to midnight 25/12/2012. That the husband of Jyoti(since deceased) namely Sonu Kumar was mentioned in this policy on a specific Sr. No. 27 and sum insured with Rupees Seven Lakhs and assignee name Jyoti(since deceased). The husband of Jyoti(since deceased) namely Sonu Kumar unfortunately died on 10/06/2012 in an accident i.e. due to drowning and regarding this incident a D.D. was entered at No. 28 dated 10/06/2012 in Police Station, Lakhan Majra, Rohtak and Post Mortem report was also conducted on 11/06/2012 vide PMR No.212/16/27. Jyoti(since deceased) met with respondents many times for claim under this insurance policy but respondents completely failed to give a satisfactory reply. Sonu Kumar was only bread earner of his family but after death of Sonu Kumar no one remaining for care of Jyoti(since deceased). That the Jyoti(since deceased) also sent a legal notice dated 29.05.2018 to the respondent through her Counsel but no response was given by the respondent till date. Hence this complaint and it is prayed that opposite parties may kindly be directed to release insurance claim of Rs. 7,00,000/-, to pay a sum of Rs. 2,00,000/- as compensation on account of mental harassment and Rs.15,000/- as cost of litigation to the complainants.
2. After registration of complaint, notices were issued to the opposite parties. Opposite party no.1 & 2 in preliminary objections of their reply has submitted that all the documents regarding the P.A. claim of Sonu were submitted by the insured/opposite party no.3 in the company. Thereafter, opposite party no.2 appointed an investigator to investigate the case and he submitted his report alongwith forensic Science Laboratory Report of Madhuban. The opposite party No.2 thoroughly and minutely examined all the documents and it transpires that the person Mr. Sonu was under the influence of Ethyl Alcohol at the time of death. As such it is violation of terms and conditions of policy and law. The claim was settled after the scrutiny by the competent authority and decided the claim as “No Claim”. A repudiation letter dated 12.02.2013 was sent through registered post to the insured. The complaint has been filed after 5 years of repudiation of claim. So complaint is barred by limitation. On merits, it is submitted that Sonu was working with opposite party No.3 and the opposite party No.3 had purchased group personal accident policy from opposite party No.2 in which employees risk of death was covered. Premium was also paid by the opposite party No.3 and intimation and claim form regarding the death of Sonu was also submitted by the opposite party No.3. Complainant Jyoti(since deceased) never visited the office of opposite party No.1 and 2 regarding the said claim. All the correspondence regarding the claim was made with the opposite party no.3 insured. All the other contents of the complaint were stated to be wrong and denied and opposite parties prayed for dismissal of complaint with cost.
3. Opposite party no.3 in its reply has submitted that answering opposite party has deposited the premium amount to the respondent no.1 & 2, so it is the liability of respondent no.1 & 2 to pay the compensation amount in case of any claim.. It is further submitted that respondent no.1 & 2 being the insurer are liable to pay the insurance claim to the complainant. The complainant Jyoti(since deceased) is not entitled for any relief against the opposite party No.3 and dismissal of complaint has been sought.
3. Ld. Counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C8 and has closed his evidence on dated 04.12.2019. On the other hand, ld. counsel for the opposite party No.1 & 2 has tendered affidavit Ex.R1, documents Ex.R2 to Ex.R13 and has closed his evidence on dated 10.03.2021. Ld. counsel for the opposite party No.3 has tendered affidavit Ex.RW3/A and has closed his evidence on dated 10.03.2021.
4. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
5. The main objections of the respondents are that in the present case, date of death of insured is 10.06.2012 and the claim has been repudiated by the opposite party vide its letter Ex.R2 dated 12.02.2013. Present complaint has been filed belatedly on 26.07.2018 i.e. after a lapse of 5 years. We have also perused the repudiation letter Ex.R2, as per which it is submitted that : “While going through the investigator report and Forensic Science Laboratory Report, Madhuban, it has been found that the person named Sonu was under the influence of Ethyl alcohol at the time of death which void our policy conditions which clearly states that at the time of accident/death the person should not be under the influence of alcohol or drugs”. We have also perused the document Ex.C5 i.e. forensic Science Laboratory report, as per which Viscera of the deceased with Exbt-1a: Stomach and its contents, Exbt-1b:Parts of small and large intestines, Exbt-1c: Parts of liver spleen and kidneys, Exbt-1d: Saline preservative approx 300ml were sent to the laboratory and as per the result of examination, : “1. Ethyl alcohol was detected in exhibits-1a, 1b and 1e, 2. No common poison could be detected in exhibit-id”. The alleged report has been placed on record by the complainant herself. From this report it is itself proved that Ethyl alcohol was detected in Stomach, small and large intestine, liver, spleen and kidneys. Hence it is also proved that at the time of accident, the deceased was under the influence of alcohol. As such the claim has rightly been repudiated by the opposite parties vide their letter Ex.R2 and there is no deficiency in service on the part of opposite parties.
7. In view of the facts and circumstances of the case, we hereby dismiss the present complaint with no order as to costs.
8. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
04.10.2023.
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Nagender Singh Kadian, President
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Tripti Pannu, Member.
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Vijender Singh, Member.
