Punjab

StateCommission

A/11/1792

Modan Singh - Complainant(s)

Versus

OIC Ltd. - Opp.Party(s)

G.L.Bajaj

15 Jul 2015

ORDER

                                                               FIRST ADDITIONAL BENCH

 

STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION, PUNJAB, SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.

 

First Appeal No.1792 of 2011

                                                Date of Institution:   06.12.2011.

                                                Date of Decision:             15.07.2015.

1.      Modan Singh son of Sh. Dal Singl;

2.      Kulvinder Kaur w/o Sh. Modan Singh; residents of Village          Pathrala, Tehsil and Distt. Bathinda.

                                           …..Appellants/complainants

Versus

 

1.      The Oriental Insurance Company Limited, C.B.O. 21, 10184,    Arya Samaj Road, Hotel Landmark Inn, Third Floor, Karol   Bagh, New Delhi, through its Sr. Branch Manager.

2.      The Oriental Insurance Company Limited, Divisional Office,      Bathinda, through its Divisional Manager.

                                                        .….Respondents/opposite parties

First appeal against order dated 31.10.2011 passed by the District Consumer Disputes Redressal Forum, Bathinda.

Quorum:-

     Shri J. S. Klar, Presiding Judicial Member.

             Shri H.S. Guram, Member.

Present:-

 

     For the appellants        :     Sh. G.L. Bajaj, Advocate

For the respondents    :     Sh. R.K. Bashamboo, Advocate.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

J. S. KLAR, PRESIDING JUDICIAL MEMBER:-

                   The appellants of this appeal (the complainants in the complaint) has directed this appeal against respondent herein (the opposite party in the complaint), assailing order dated 31.10.2011 of District Consumer Disputes Redressal Forum Bathinda (in short, “the District Forum”), dismissing the complaint of the complainants.

2.                The complainants have filed the complaint under Section 12 of the Consumer Protection Act, 1986 (in short "Act") against the OPs on the averments that son of complainants Sukhjinder Singh purchased insurance policy no.271201/48/2007/7421 from the OPs issued by branch office of the OPs at New Delhi for the period from 19.08.2006 to 18.08.2010.  The assured amount of the policy was Rs.1 lakh. Unfortunately the son of complainants met with an accident on 31.05.2010, while proceeding from Anandgarh (Rawla) to Nimbaherha in truck trailer no.PB-03Q-9415 and it struck with another truck no.HR-37A-6241 resulting into his death on 31.05.2010. After said accident, Sukhjinder Singh son of complainants was taken to the hospital at Bikaner (Rajasthan), but he could not survive. The post postmortem of his body was conducted on 31.05.2010 and FIR no.133 dated 31.05.2010 under Sections 279/337/304-A IPC was also registered about this accident at Police Station Ganga Shahar, Bikaner. The complainants were not aware about the medical insurance policy purchased by the son of the complainant, but they came to know about the said policy on 22.03.2011 when they laid their hands suddenly on the copy of the insurance policy after search of the documents of deceased Sukhjinder Singh. The insurance claim was lodged by the complainants on 23.03.2011 through register post by supplying all the documents. It was rejected by the OPs, vide letter dated 31.03.2011 on the ground that the claim has not been lodged within the period of 7 days from the date of accident. The complainants termed the act of the OPs as unfair trade practice and deficient in service. The complainants, thus, prayed that OPs be directed to pay the amount of Rs.1 lakh to the complainants on account of death of Sukhjinder Singh, besides compensation of Rs.75,000/- and Rs.11,000/- as costs of litigation.

3.                Upon notice, OPs appeared and filed written reply raising legal objections that the complainants have filed the complaint only to injure the goodwill of the OPs and complaint merits dismissal. The complainants concealed the material facts and withheld the documents from the Consumer Fora and hence complainants are not entitled to any relief. It was imperative under the terms and conditions of the policy to lodge the claim of insurance within 7 days from the date of accidental injury. The complainant has not lodged the claim within 7 days from the date of accident and hence the claim of the complainants was rightly rejected on account of above referred delay. The OPs controverted the other averments of the complainants with regard to any compensation. The OPs prayed for the dismissal of the complaint.

4.                The complainants tendered in evidence, the affidavits of Modan Singh dated 30.06.2011 Ex.C-1 and Ex.C-8 alongwith documents Ex.C-2 to C-7 and closed the evidence. As against it, OPs tendered in evidence affidavit of Dr.J.L. Ahuja, Sr. Divisional Manager Ex.R-1 alongwith documents Ex.R-2 to Ex.R-5 and closed the evidence. On conclusion of evidence and arguments, the District Forum Bathinda dismissed the complaint of the complainant by virtue of order dated 31.10.2011 under challenge in this appeal.

5.                We have heard the learned counsel for the parties and have also examined the record of the case. From perusal of evidence on the record, particularly the affidavit of Modan Singh complainant no.1 Ex.C-1 and Ex.C-8, copy of letter dated 31.03.2011 Ex.C-2, copy of insurance cover note Ex.C-3, copy of FIR Ex.C-4 and copy postmortem report Ex.C-5, we find that the insured Sukhjinder Singh died due to accidental death, because his death has been proved due to accidental injuries by the postmortem report and final cause of death was to be declared after receipt of chemical examiner report. Ex.C-6 is copy of death certificate on the record. Ex.C-7 is the copy of driving licence of Sukhjinder Singh deceased.

6.                The OPs main defence is that the insurance claim was to be lodged within 7 days from the date of accident and hence it was not admissible. We have examined the evidence of the OPs on the record, the affidavit of Dr. J.L. Ahuja, Sr. Divisional Manager of OPs, which is totally silent on this point. Ex.R-2 is the copy of insurance cover note and it contains no such term that insurance claim would not be admissible, if not lodged within 7 days from the date of accident. Ex.R-3 is the copy of circular dated 27.11.2001. A circular could never be a part of the contract between complainants and OPs. The circular was not brought to the notice of the insured and the complainants by the OPs and hence insured and the complainants cannot be held to be bound by it. There is nothing on the record that it was ever conveyed to the insured and the complainants and was received by the complainants or deceased or was ever a part of the terms of the contract. Ex.R-4 are the salient features of the policy. We also find that it was never conveyed or communicated to the insured and the complainants at any time. Ex.R-5 is the copy of prospectus. We find that there is no evidence on the record that it was ever communicated to the complainants, the complainants or assured could not be held to be bound by it, unless and until it was duly communicated to the complainants or insured. Consequently, we are of this view that no such terms and conditions were communicated to the insured or the complainants to the effect that insurance claim will not be admissible after 7 days from the date of accident of insured. There is sufficient explanation of the complainants on the record contained in affidavits of Modan Singh Ex.C-1 and Ex.C-8 and the pleadings in the complaint that the complainants were not aware about the policy taken by Sukhjinder Singh insured since deceased prior to the date of its discovery. They laid their hand upon it subsequently, when they searched the documents of Sukhjinder Singh after his death. Generally, the limitation commences from the date of knowledge of a particular fact, when it comes to the notice of a person. We find that District Forum has not appreciated the controversy in proper perspective. The counsel for the OPs/respondents could not point out any specific clause of insurance contract ever communicated to the insured or complainants that the claim would not be admissible, if not lodged within 7 days from the date of accident.

7.                In view of our findings as recorded above, the order of the District Forum is erroneous and is ordered to be set aside in this appeal. We accept the appeal of the appellants and direct the OPs to pay the assured amount of Rs.1 lakh to the complainants. The OPs are further directed to pay Rs.20,000/- as compensation for mental harassment and Rs.15,000/- as costs of litigation  to the complainants within 30 days from the date of receipt of certified copy of the order, failing which, the awarded amount shall further carry the interest @9% per annum from the date of accident till its realization. We accept the complaint of the complainants accordingly.

8.                Arguments in this appeal were heard on 10.07.2015 and the order was reserved. Now the order be communicated to the parties. The appeal could not be decided within the statutory period due to heavy pendency of court cases.

                                                                          (J. S. KLAR)

                                                         PRESIDING JUDICIAL MEMBER

                       

                                                                           (H.S.GURAM)

                                                                              MEMBER

 

July 15, 2015.                                                            

(MM)