DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

PATIALA.

                                      Consumer Complaint No. 47 of 15.2.2017

                                      Decided on:   16.12.2020

1. Bhuri Devi aged about 36 years wd/o Rakesh Kumar S/o Sh.Jit Ram.
2. Paramraj aged about 12 years.
3. Priyanka aged about 5 years all minors sons and daughters of Late Sh.Rakesh Kumar through their next friend and natural guardian their mother Bhuri Devi
4. Jit Ram aged about 67 years s/o Baba Ram all residents of H.No.18/27, Anand Nagar B, Patiala-147001, District Patiala.

                                                                   …………...Complainants

                                      Versus

New India Assurance Company Ltd., Opposite Income Tax Office, Leela Bhawan, Patiala through its Branch Manager.

                                                                   …………Opposite Party

                                      Complaint under Section 12 of the

                                      Consumer Protection Act, 1986.

QUORUM

                                      Sh. Jasjit Singh Bhinder, President

                                      Sh.Y.S.Matta, Member 

ARGUED BY

                                       Sh.Vinay Sood, counsel for the complainants.

                                       Sh.D.P.S.Anand, counsel for OP.

 ORDER

                                      JASJIT SINGH BHINDER,PRESIDENT

1. This is the complaint filed by Bhuri Devi and others   (hereinafter referred to as the complainants) against New India Assurance Co. Ltd. (hereinafter referred to as the OP/s).
2. The brief facts of the case are that Rakesh Kumar, since deceased was husband of complainant No.1, father of complainants No.2to4 and son of complainant No.5. It is averred that he was the owner of motor cycle No.PB-11-AF-6967 and had got the same insured from the OP vide policy No.36150031160200005265 for the period from 11.8.2016 to 10.8.2017 by paying the premium  of Rs.619/-. It is further averred that in this policy the OP had also provided Personal Accident Cover of owner to the tune of Rs.1,00,000/-.
3. It is averred that on 1.10.2016, Rakesh Kumar alongwith Vijay Kumar was coming back to home from Rouni on his motor cycle. Rakesh Kumar was driving the motor cycle and Vijay Kumar was his pillion rider. When they reached near P.S.Civil Lines, a stray dog came in front of the motor cycle. Rakesh Kumar applied brakes but he lost his control and motor cycle struck against the divider, as a result of which both Rakesh Kumar and Vijay Kumar received injuries and due to leakage of petrol the motor cycle caught fire. The people at the spot shifted the injured to Rajindera Hospital, Patiala. Due to serious injuries on the head, Vijay Kumar was referred to Sector 32,Hospital and Rakesh Kumar was referred to PGI, Chandigarh and was admitted vide CR No.201605792522 dated 2.10.2016. He was relieved from PGI on 4.10.2016 after treated for the head injury. On the same date  i.e. on 4.10.2016 Rakesh Kumar was admitted in Rajindra Hospital Patiala and while  he was under the treatment for the injuries including the head injury, he suffered Cardiac Arrest and  died on 13.10.2016 .
4. It is further averred that after the death of Rakesh Kumar, his legal heirs lodged the claim with the OP but the OP vide letter dated 3.1.2017 repudiated the claim on the ground that the cause of death of Rakesh Kumar was Cardiac Arrest which is natural death and not accidental death.
5. It is averred that the deceased had died in the hospital when he was under the treatment for the injuries suffered by him in a roadside accident and the act of the OP in not paying the genuine claim is deficient in service and unfair trade practice on its part, which caused lot of mental agony and harassment to the complainants.
6. On this background of the facts, the complainants have filed this complaint with the prayer to accept the same by giving direction to the OP to pay the insurance claim to the complainants to the tune of Rs.1,00,000/- alongwith interest @18% per annum; to pay Rs.2lac as compensation and Rs.50,000/- as litigation expenses.
7. Upon notice OP appeared through counsel and contested the complaint by filing written statement. In the written statement, the OP raised preliminary objections that the complaint is not maintainable as the claim of the complainant has already been repudiated vide letter dated 3.1.2017 on the ground that Rakesh Kumar had died a natural death due to cardiac arrest as per report of Dr.Neha Rai of Rajindra Hospital, Patiala, which is not covered under the terms and conditions of the policy; that the insurance is a contract of indemnity and it has to be viewed as a normal contract as per the Indian Contract Act. Any violation of the insurance contract by the parties to the contract of insurance, the contract becomes void and in such an event the insurance company would not be liable to answer the claim of the other party; that complicated questions of law and facts are involved in the present case and as such only the civil court is competent to try the present dispute; that the OP has already settled the claim and the claimant may be directed to get the settled amount after executing the necessary documents.
8. On merits, insurance of the motor cycle is admitted .It is submitted that the claimants have given wrong version of the accident. As per discharge summary of PGI Chandigarh, the injured was a pillion rider on two wheeler when hit by a bus. As such the claim is not maintainable as they lodged false report.
9.  It is denied that Rakesh Kumar was remained admitted in PGI Chandigarh from 2.10.2016 to 4.10.2016 for treatment of head injury. It is submitted that the injured was referred to PGI Chandigarh by Rajindera Hospital, Patiala for Neuro treatment but he was referred back to Rajindera Hospital, Patiala for general treatment as injured was not suffering from any head injury. It is further submitted that the injured was again admitted in Rajindra Hospital, Patiala where he died on 13.10.2016 due to cardiac arrest, which has got no relevancy with the accidental injuries as per report of treating doctor Neha Rai of Rajindera Hospital, Patiala.
10. It is however, submitted that on receipt of intimation of the accident on 24.10.2016, through the brother of deceased Sh.Karam Chand, the OP immediately deputed M/s Bee Vee Investing Agency, Patiala to investigate the case, who in his report dated 12.11.2016 has found that Rakesh Kumar was not died because of accidental injury rather he had died because of cardiac arrest which is a natural death. The claim was thus rejected after getting it duly investigated as per terms and conditions of the policy and being a natural death no postmortem was conducted on the dead body of the deceased.
11. It is further submitted that the deceased had not suffered any accidental injury on his head but died a natural death which is not covered under the policy. As such the claim has been rightly repudiated vide letter dated 3.1.2017.There is no deficiency in service or unfair trade practice on the part of the OP.

After denying all other averments made in the complaint, the OP prayed for the dismissal of the complaint.

12. In support of the complaint, the ld. counsel for the complainant has tendered affidavit of the complainant, Ex.CA alongwith documents Exs.C1 to C5 and Ex.C9 to C10 and closed the evidence.

Here it is stated that statement of Ms.Neha Rai, Jr.Resident , Department of General Surgery, Rajindra Hospital, Patiala was recorded where she was examined in chief and also cross examinedand hastendered the documents Ex.C6 to C8.

13. On behalf of the OP, the ld, counsel has tendered affidavit Ex.OPA of I.S.Sidhu, alongwith documents Exs.OP1 to OP4 and closed the evidence .
14. The ld. counsel for the complainant has also filed the written arguments. We have gone through the same, heard the ld. counsel for the parties and have also gone through the record of the case, carefully.
15. The ld. counsel for the complainant has argued that there is medical evidence on the record which shows that deceased Rakesh Kumar suffered injuries. The ld. counsel further argued that reports of PGI Chandigarh and of Rajindera Hospital, Patiala are on the file. The ld. counsel further argued that cause of death has been mentioned by Dr.Neha Rai as Cardiac Arrest vide Ex.C7. Dr.Neha Rai has also appeared in the witness box and examined in chief. She has clarified that ‘basic cause of death was due to the consequences and complications of injuries,  the patient had received from roadside accident’.The ld. counsel further argued that Dr.Neha Rai has also stated in examination in chief that ‘patient was fully conscious but the cognitive abilities of the patient was not proper’.The ld. counsel further argued that from the medical record and from the statement of Dr.Neha Rai, it is clear that the deceased had died due to cardiac arrest in view of the injuries suffered by him in road side accident. The ld. counsel relied upon the citations Bajaj Allianz General Insurance Co. Ltd. and others Vs. Harpal Singh and  others 2018(1)CLT 335, Aviva Life Insurance Co. India Ltd. and others Vs. Mamta Rani 2019(3)CLT 581, Sushila Kumari  Versus LIC of India 2018(4)CLT 163, Bharti Axa Life Ins.Co. Ltd. and others Versus Mamta Kumar 2018(3)CLT 208, Manish Goyal Versus Max Bupa Health Insurance Co. Ltd. and others 2018(2)CLT 205 and has prayed that the complaint be accepted.
16. On the other hand, the ld. counsel for the OP has argued that as per medical record,Ex.C7, the cause of death has been shown as Cardiac Arrest. The ld. counsel further argued that now the complainant and Dr.Neha Rai had given cause of death as cardiac arrest cannot say that cardiac arrest was due to injuries suffered by deceased Rakesh Kumar in the roadside accident. The ld. counsel has further argued that in the complaint, it is stated that deceased was driving the motor cycle but in the medical record, it is mentioned that he was pillion rider. So it is contradictory in the pleadings and in the medical evidence that he was driving the motor cycle or he was pillion rider. The ld. counsel has relied upon the judgment of the Hon’ble Supreme Court of India passed in Smt.Alka Shukla Vs. Life Insurance Corporation of India (2020-3)199 PLR 747 and prayed that complaint be dismissed.
17. To prove his case, the complainant Bhuri Devi has tendered her affidavit, Ex.CA and has deposed as per the averments made in the complaint,Ex.C3 is the repudiation letter dated 3.1.2017,Ex.C4 is policy document,Ex.C5 death certificate of deceased Rakesh Kumar, in which date  of death has been mentioned as 13.10.2016 at Rajindra Hospital, Patiala.Ex.C6 is bed head ticket of Rajindra Hospital, Patiala wherein it is mentioned that ‘Pt. expired at 3:40 am on 13.10.2016’.Ex.C7 is the medical certificate of cause of death,Ex.C8 is the case summary report,Ex.C9 is RC and C10 is the driving licence of deceased Rakesh Kumar.
18. The OP tendered affidavit, Ex.OPA of I.S.Sidhu, Regional Manager  who has deposed as per the written version, Ex.OP1 is the document  of policy schedule cum certificate of insurance,Ex.OP4 is the report of surveyor.
19. Admittedly Sh.Rakesh Kumar had died on 13.10.2016 at 3:40AM and as per medical certificate, the cause of death as per Ex.C7 is Cardiac Arrest. To clarify the matter our Ld. predecessor allowed the examination of Dr.Neha Rai who has issued the document Ex.C7. In examination, which was conducted on 10.5.2018, she had stated that ‘the patient Sh.Rakesh Kumar died due to sudden Cardiac Arrest, which could be due to the consequences of the injuries, he suffered on 1.10.2016’. She has further deposed that ‘she has mentioned in the death certificate that the death was due to cardiac arrest which was immediate natural cause but the basic cause of death is due to the consequences and complications patient had due to the injuries from the road side accident’.She has further deposed that ‘the patient was fully conscious but the cognitive abilities of the patient was not proper’.She has proved the bed head ticket,Ex.C6 and discharge summary of PGI Ex.C8.

In the cross examination she has stated that ‘conservative treatment was provided to the patient in entire treatment given at Rajindra Hospital, Patiala and PGI’. She has further stated that ‘patient suffered injuries while he was a pillion rider and hit by a bus’.

20. Dr.Neha Rai had clarified in her deposition before the then Forum that           ‘cause of death was due to consequences and the complications that the patient had suffered from road side accident.
21. The claim was rejected/repudiated vide letter,Ex.C3 of the OP, wherein it is mentioned that Sh.Rakesh Kumar had died a natural death. From the medical record of the PGI and Rajindera Hospital, Patiala ,placed  on the file, show that infact deceased suffered injuries . Now there is contradiction, in the complaint, it is stated that Sh.Rakesh Kumar was driving the motor cycle and was hit by dog whereas in the medical record it is mentioned that he was pillion rider and hit by bus. But it is clear from the record that the deceased had received injuries when he was riding the motor cycle whether he was driving the motor cycle or he was pillion rider.
22. From the medical record, Ex.C8 placed on the file, it is mentioned that the patient was a pillion rider and hit by bus but in the medical record it is mentioned that he suffered injuries and injuries were stitched on 11.10.2016 and the entire record clearly shows that he got treatment from PGI Chandigarh and from Rajindera Hospital, Patiala. From PGI, Chandigarh he was referred to Rajindra Hospital Patiala for nursing care. So it is clear by going through the medical record that the main cause was Cardiac Arrest due to injuries suffered by the deceased Rakesh Kumar .
23. In view of the fact, in fact he has suffered injuries .As such the law cited by the ld. counsel for the OP is not applicable to the facts of the present case.
24. So due to our above discussion, it is clear that Rakesh Kumar died due to injuries he has suffered in road side accident while he was pillion rider. As such the OP is liable to pay Rs.1,00,000/- to all of his natural legal heirs.
25. The complaint stands allowed accordingly and the OP is directed to pay Rs.1,00,000/- in equal share to all of the natural legal heirs of the deceased Rakesh Kumar. They are also held entitled interest @6% per annum from the date of his death i.e. 13.10.2016 till realization of the whole of the amount.The complainants No.2,3 and 4 being minors, so their share be deposited in the nationalized bank in the shape of FDR till they attain the age of maturity. The OP is also directed to pay Rs.10,000/- as compensation for causing mental agony and harassment to the complainants and Rs.5000/-as litigation expenses.        

Compliance of the order be made by the OP within a period of 45 days from the date of the receipt of the certified copy of this order.

ANNOUNCED

DATED:16.12.2020

                                   Y.S.Matta                        Jasjit Singh Bhinder

                                    Member                                  President