BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 02 of 2016
Date of Institution : 1.1.2016
Date of Decision : 23.2.2017
1. Chando Devi wife of Shree Bhagwan @ Sheo Bhagwan
2. Parveen Kumar, aged 21 years
3. Sunil Kumar, aged 17 years sons
4. Sonu aged 19 years
5. Ravina aged 24 years daughters
of Shri Sheo Bhagwan @ Shree Bhagwan son of Shri Lallu Ram, minor through his mother/ natural guardian namely Chando Bai wife of Late Shree Bhagwan Dass @ Sheo Bhagwan, all residents of village Kulchander, P.S. Tibbi, District Hanumangarh.
….Complainants.
Versus
1. National Insurance Company Ltd., Divisional Office at Sirsa, through its Divisional Manager (Insurer of Car No. RJ-31CA/3126, vide policy no. 3510100311236132483813, for the period w.e.f. 05.01.2013 to 4.1.2013.
..…Opposite party.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SHRI S.B.LOHIA…………………PRESIDENT
SHRI RANBIR SINGH PANGHAL ……….……MEMBER.
Present: Sh. Surjit Singh, Advocate for the complainant.
Sh. Ashish Singla, Advocate for opposite party.
ORDER
The present complaint has been filed by Smt. Chando Devi etc. legal heirs/ legal representatives of Shree Bhagwan @ Sheo Bhagwan.
2. The case of the complainants is that deceased Shree Bhagwan son of Lallu Ram was owner of Car No. RJ-31CA/3216 which was insured vide policy No.3101031126132483813 for the period w.e.f. 5.1.2013 to 4.1.2014 and an amount of Rs.100/- was also paid for compulsory personal accident of owner and insurance company was liable for payment of Rs.2,00,000/- to the LRs of deceased from the date of accidental death as mentioned in limit of liability clause. On 20.3.2013, Sheo Bhagwan while riding his above said car which was being driven by his nephew Vijay Kumar son of Shri Indraj, resident of village Basir was going towards Masita head and when they reached one km. ahead from village Silwasa Khurd towards Masita Head, then all of sudden an animal came in front of the car, due to which the car became unbalanced and struck into a safeda tree alongwith the road and badly damaged and Sheo Bhagwan sustained serious injuries. After accident, he was taken to General Hospital, Hanumangarh from where he was shifted to Amba Hospital, Shree Ganga Nagar on 20.3.2013 and injuries were diagnosed as cervical spine injuries (C3-C4) and head injury and was discharged on 27.3.2013. It is further averred that due to his serious condition, he was admitted to V.K. Neuro Care Hospital, Hisar on 30.3.2013 from where he was discharged on 31.3.2013 and further he was admitted to Shekhawati Hospital, Jaipur from 1.4.2013 to 3.4.2013 for the treatment. Thereafter, on 4.4.2013 he was admitted to JCD Super Specialty Hospital, Sirsa and was discharged on 6.4.2013. Then he was taken to Sarvodya Hospital, Hisar on 6.4.2013 for treatment of cervical and spine injury, where he died on 20.4.2013 during treatment at 6.40 p.m. Due to serious condition of Sheo Bhagwan, the attendant could not be able to report the matter to the police on the day of accident. However, factum of accident was reported to police of Police station Tibbi by Indraj son of Sh Khyali Ram, resident of village Basir and DDR No.1178 dated 29.3.2013 was registered in this regard. Later on, police also recorded the statement of driver of the car namely Vijay Kumar and Parveen and factum of accident was verified by ASI Kaidar Nath and SHO of P.S. Tibbi. It is further averred that claim intimation on account of death of Sheo Bhagwan was given to insurance company/ Divisional Officer, Sirsa on 11.6.2013 by the complainant Smt. Chando Devi and all the relevant documents which were required by company were provided vide two letter No.420700/Claim/13/1128/16/10 dated 15.10.2013 and letter No.420700/13/1224/30/10 dated 30.10.2013. The documents i.e. claim form, final bills/ receipts regarding repair of vehicle, loss voucher, driving licence of the driver, copy of bank account, MLR of Amba Hospital, list of legal heirs of deceased as per the demand of op, were supplied by the complainant to the authorized representative of the company well in time, but no receipt was provided. It is further averred that vide letter No.420700/claim13/1612 dated 31.12.2013 which was received by complainant in January, 2014 the company mentioned the reason for closing the claim file due to non supply of documents mentioned above which is wrong. Thereafter, the complainant visited time and again to the office of op but the op put off the matter on one pretext or the other. Thereafter, the complainant sent a registered letter with the attested copies of documents required by the company on 12.2.2015 for payment of CPA claim but the op never replied the same. Then complainant sent a legal notice to the insurance company on 24.4.2015 through registered post for making payment, but op lingered on the matter by giving false and evasive reply and failed to redress the grievance of complainants. It is further averred that thereafter on approaching to the insurance company by the complainant, the company flatly declined to indemnify the CPA claim in the month of November, 2015. The conduct of the opposite party for wrongly withholding the claim of the complainant falls under the deficiency of service. Hence, this complaint.
3. On notice, opposite party appeared and filed written statement submitting therein that complainants have concealed and suppressed true and material facts from this Forum and have not come with clean hands. As a matter of fact and reality no such accident as mentioned in the complaint ever took place. The complainants have not produced any cogent proof to prove the happening of any such road side accident. The answering op is not liable to pay any compensation to the complainants as firstly the car No. RJ-31 CA/ 3126 was not insured with the op at any time and secondly the same was being plied on road in violation of the terms and conditions & exceptions and limitations of the insurance policy as well as the rules framed under the Act & Section 64 VB of the Insurance Act. The deceased as well as the driver of the vehicle was not having a valid and effective driving licence to drive the vehicle at the time of alleged accident. The complainants do not fall within the definition of Consumer under Section 2 (1) (d) of the Act. The complainants have got no cause of action to file the present complaint as firstly the complaint is pre-mature as complainants were required to file the claim with the insurance company and only if the insurance company denies from making payment of the claim amount, the complainants can knock the doors of this Forum. The complainants have never applied the insurance company for any such PA death claim. Secondly, in the present complaint, as per the submissions of the complainants themselves, it is very much clear that the death of Shree Bhagwan is not the result of any road side accident rather the same may have caused due to long illness and/or due to any incurable disease, which is a matter yet to be investigated properly. The treatment record produced on file shows that he had remained under treatment for long and died and no post mortem has been conducted on the body of deceased, which was very much necessary in accidental cases to evaluate the reason of death. As per the statement of the complainants themselves, the claim is time barred as they have not informed the insurance company within the prescribed reasonable time. Remaining contents of the complaint have also been denied.
4. By way of evidence, the complainants produced affidavit of complainant Parveen Kumar Ex.C1/A, DDR dated 29.3.2013 Ex.C1, report of ASI Kedar Lal, P.S. Tibbi verified by of SHO Ex.C2, copy of application dated 17.6.2013 Ex.C3, statements Ex.C4, Ex.C5, rough site plan Ex.C6, report Ex.C6/A, envelopes Ex.C7 and Ex.C8, copy of certificate of registration Ex.C9, copy of certificate cum policy schedule Ex.C10, death certificate Ex.C11, copy of family card Ex.C12, reports of revenue officials regarding LRs of deceased Ex.C13, copy of driving licence of Vijay Kumar Ex.C14, copy of pass book Ex.C15, reply to legal notice Ex.C16, copy of voter card Ex.C17, copy of voter card of deceased Ex.C18, postal cards Ex.C19, Ex.C20, copy of application Ex.C21, reminder-I dated 15.10.2013 Ex.C23, letter dated 30.10.2013 Ex.C24, copy of application dated 12.2.2015 Ex.C25, postal receipt Ex.C26, legal notice Ex.C27, postal receipt Ex.C28, treatments records and bill Ex.C29 to Ex.C35, copy of death certificate Ex.C36, copies of aadhar cards Ex.C37 to Ex.C39 and copy of ration card Ex.C40, affidavit of complainant Smt. Chando Devi Ex.CW2. On the other hand, op produced affidavit Ex.R1, copy of certificate cum policy schedule Ex.R2 and copy of private car package policy Ex.R3
5. We have heard learned counsel for the parties and have gone through the case file carefully.
6. It is established on record that Car bearing registration No.RJ31CA3126 owned by deceased Sri Bhagwan was insured with the opposite party w.e.f. 5.1.2013 to 4.1.2014 as is evident from copy of certificate cum policy schedule Ex.C10 (and Ex.R2 also). From the said document, it is also evident that Rs.100/- were charged for compulsory personal accident cover premium and Rs.50/- were paid for legal liability to driver. Now we see whether the complainants are entitled for the death claim of deceased Shree Bhagwan @ Sheo Bhagwan or not. The opposite party has placed on file terms and conditions of private cum package policy as Ex.R3 and in clause 2 of Section III- Personal Accident Cover for Owner-Driver it is mentioned that this cover is subject to (a) the owner-driver is the registered owner of the vehicle insured herein; (b) the owner-driver is the insured named in this policy, (c) the owner-driver holds an
effective driving licence, in accordance with the provisions of Rule 3 of the Central Motor Vehicles Rules, 1989, at the time of the accident. The opposite party vide its letters dated 15.10.2013 and 30.10.2013 asked the complainant Chando Devi to submit driving licence of deceased Shree Bhagwan besides some other documents but complainants have failed to show that copy of driving licence was supplied to the opposite party as per terms and conditions of the policy in question. The complainants have not even placed on file copy of driving licence of deceased. Therefore, it cannot be said that copy of driving licence was supplied to the opposite party. Further as per progress chart of Sarvodya Hospital Ex.C34, the patient had sudden cardiac arrest at 6.15 a.m. on 20.4.2013 and patient was declared dead at 6.40 a.m. on 20.4.2013. It is not mentioned in any of the document that death of deceased is the result of the injuries sustained in the above said accident. As such the death of the deceased Shree Bhagwan is not the direct result of the injuries caused in the accident as per the terms and conditions of the policy in question.
7. Thus, keeping in view the facts and circumstances of the present case, we are of the considered view that complainants are not entitled to any claim amount from the opposite party. The authorities cited by learned counsel for the complainant in cases titled as Branch Manager, LIC Vs. Raj Kumar Mishra, I (2000) CPJ 113, State Insurance & PF. Deptt. & Ors. Vs. Parmali, III (2006) CPJ 199 and National Insurance Co. Ltd. Vs. Asha Mamdar Prasad, I (2009) CPJ 147 are regarding the fact that post mortem report is not necessary and we also do not differ with the said observations in such like cases but in the present case the complainants have failed to fulfill the requirement of the policy in question. As such the present complaint is hereby dismissed but with no order as to costs. A copy of this order be supplied to the parties as per rules. File be consigned to record room after due compliance.
Announced in open Forum. President,
Dated:23.2.2017 Member. District Consumer Disputes
Redressal Forum, Sirsa
