Haryana

Ambala

CC/331/2010

KEHAR SINGH - Complainant(s)

Versus

OIC LTD - Opp.Party(s)

NARENDER SHARMA

15 Jul 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA.

                   Complaint Case No.        :  331 of 2010

                   Date of Institution           :   20.07.2010

                   Date of Decision             :   15.07.2015

Kehar Singh  son of Shri Shibu Ram R/o village Dadiana, Tehsil & District Ambala.

                                                                                                                                                                       ……Complainant. 

                                                                                                  Versus

1.         The Oriental Insurance Company Limited, Regional Office, LIC Building, IInd Floor, Jagadhri Road, Ambala Cantt through its Regional Manager.

2.         The Oriental Insurance Company Limited, Head Office A-25/27, Asaf Ali Road, New Delhi-110002.

3.         M/s Dauphin Touch Network Pvt. Ltd., Registered Office at A-212-C, Tirupati Plaza, Street No.01, Shakarpur, Delhi-92.

                                                                                                ……Opposite Parties.

Complaint Under Section 12 of the Consumer Protection Act

CORAM:        SH. A.K. SARDANA, PRESIDENT.

                        SH. ANIL SHARMA, MEMBER.

                        MS. ANSUYA BISHNOI, MEMBER.                       

Present:          Sh. Narender Sharma, Adv. counsel for complainant.

                        Sh. R.K. Vig, Adv. counsel for Ops No.1 & 2.

                        OP No.3 exparte.

ORDER.

1.                     Present complaint under section 12 of  the Consumer Protection Act, 1986 (hereinafter in short called as the ‘Act’) has been filed by the complainant alleging therein that complainant got himself insured with Ops No.1 & 2 vide G.P.A. Policy No.271700/48/2009/1181, cover note No.270000381218 for a sum of Rs.3.00 lacs for the period from 22.10.2008 to 21.10.2009.   The complainant submitted that he is a Distributor vide I.D No.481438 issued by the OP No.3 which is a registered incorporation with Registrar of Companies and the Ops No.1 & 2 issued a Certificate dated 12.12.2006  to the effect that there is an agreement between Op-insurance

company and OP No.3 according to which the Op shall got insured all the members/distributors for citizen safety policy qua Rs.4.00 lacs for accidental insurance and Rs.1.00 lac for expenses i.e. medical treatment etc. The Ops also assured the complainant that in case of accident with any vehicle, train, machine, burnt, electricity current or falling down from the roof, tree or stair case, the Ops are liable to pay Rs.5,00000/-.  The complainant further submitted that on 22.11.2008, he fell down from roof and suffered fracture in the backbone and multiple injuries on the body and was got admitted in Civil Hospital, Ambala City  & incurred  more than Rs.1.00 lac on his treatment and  has become disabled and cannot walk. Complainant informed the Ops vide letter dated 22.12.2008 regarding the accident and requested for payment of insurance claim.  Again a letter dated 13.02.2009 was sent to the Ops requesting that he is unable to walk and  thus to make the payment of the claim but the Ops failed to pay anything to the complainant.  OP No.2 vide letter dated 01.01.2009 informed the complainant that the mater is taken with concerned office to expedite the claim but no fruitful result. As such, having no other alternative, the complainant has filed the present complaint seeking relief as per prayer clause.

2.                     Upon notice, OPs No.1 & 2 appeared through counsel and filed written statement raising preliminary objections qua non-maintainability of complaint  stating that it is clearly mentioned in the policy that the insurance cover is available to the “Death” case only & copy of Cover was also supplied to M/s Daupin Touch Network Pvt. Limited i.e. Op No.3.  There is no ambiguity in the policy and as such the Policy is only applicable  to the table of benefits when casualty is there.  But in the absence of any documentary proof, answering Op is not legally entitled to suo motto take up the matter and decide the same on the basis of purely rumor etc..  On merits,  it has been urged that  the policy in question is applicable only in case of ‘Death’ and not for  the injury cases.  Since,  the claim was not maintainable, so information was sent to the complainant vide letter dated 01.01.2009. As such, the Ops No.1 & 2 have prayed that there is no deficiency in service on their part and complaint deserves to be dismissed with heavy costs.

                        Op No.3 filed separate written statement raising preliminary objections qua non-maintainability  of  the complaint  as well as there is no territorial jurisdiction to entertain the present complaint by the Forum.  On merits, it has been submitted that the complainant has not purchased any insurance policy from any of the Ops rather he purchased a package worth Rs.4500/- from the answering Op called as family/standard package which inter alia include safari suit length, family holiday package for 2 nights. However, as per the prevailing schemes of OP No.3, they provided  an accidental insurance policy to the complainant absolutely free of cost in the form of a welcome gift for its Business Distributors which was purchased from the office of OP No.2 at Delhi.  The premium cost of the policy has been borne by OP No.3 alone and nothing was chargeable from the complainant for the policy cost at all. None of the Ops have charged any premium amount from the complainant for the insurance policy.  As such, there is no deficiency in service on their part and prayed for dismissal of the complaint with costs.

 

3.                     In evidence, the counsel for complainant tendered affidavit Annexure CX of complainant alongwith documents as Annexures C-1  to C-38 and closed the evidence.  On the other hand, the counsel  for Ops NO.1 & 2 tendered in evidence affidavit of Sh. B.R. Batra, the then DM of the OP company as  Annexure RX alongwith documents as Annexures R-1 & R-2 on behalf of Ops and closed their evidence whereas after filing reply, none bothered to contest the case on behalf of Op No.3 and as such they were proceeded against exparte vide order dated 08.11.2013.

 

4.                     We have heard the learned counsel of parties and gone through the record. The counsel for the complainant argued that the complainant  got himself insured from Ops No.1 & 2 through OP No.3 being a distributor  of Op No.3 vide ID No.481438 as OP No.3 made an agreement with the Op No. 2 and got insured all the distributors for citizen safety policy for a sum of Rs.4.00 lacs for accidental insurance and one lac for expenses i.e. medical treatment etc. Unfortunately, the complainant met with an accident and suffered multiple injuries for which he incurred more than Rs.1.00 lac for hospitalization etc.  Several requests were made with the OPs No.1 & 2 for settlement of the claim but the Ops did not pay any heed to the requests of complainant and ultimately repudiated the claim of complainant on flimsy grounds which is an admittedly deficiency in service on the part of Ops.  

                        On the other hand, the counsel for the Ops No.1 & 2 argued that there is no deficiency on the part of the Ops No.1 & 2 as the insurance policy provided to complainant at the behest of Op No.3 clearly reveals that the insurance is available to the “Death” case only  and thus  the complainant is not entitled for any penny.  Further the  company is not permitted to give any oral assurance as alleged.  What is written in the policy, the same is binding on both the parties i.e. insured & insurer and therefore, the claim of the complainant  has been rightly rejected by the Ops No.1 & 2.

5.                     After hearing Ld. Counsel for the parties and going through  the records, we are of the confirmed view that the complainant is not entitled for any  insurance claim under this policy since from perusal of Insurance Policy (Annexure R-1) purchased by Op No.3. i.e. ‘M/s DAUPHIN TOUCH NETWORK PVT. LTD., DELHI ‘ from ‘THE ORIENTAL INSURANCE CO. LTD. DELHI’ i.e. Op No.2,  it is clear that “ the policy under reference is G.P.A. Policy and covers only death cases whereas cases pertaining to injury are not covered,” as clearly mentioned in the column of ‘Details of Insured Persons’ in the policy.  Further, this Forum also lacks territorial jurisdiction since the complaint itself does not disclose any cause of action to have taken place       within the jurisdiction of this Forum as both the Ops i.e. Ops No.2 & 3  resides & do business within the territorial jurisdiction of DCDRF, Delhi and OP No.1 has  been arrayed as a party  to the complaint only  to circumvent  the jurisdiction.  Hence, in  view of  law laid down by Hon’ble Supreme Court of India in ‘Civil Appeal No.1560 of 2004 titled as Sonic Surgical Vs. National Insurance Company Ltd. reported in 2010 (1) Consumer Law Today page 252, we hold that this Forum lacks territorial jurisdiction.  Besides it, there is no any document on the file wherefrom it is concluded that Ops are in any way deficient in service qua complainant.

                        In view of the facts discussed above, the complainant has failed to prove his case and as such, the present complaint is dismissed with no order as to costs. Copies of this order be sent to the parties concerned free of costs. File be consigned to the record room.

 

Announced:15.07.2015

                                                                                                         Sd/-

                                                                                              (A.K. SARDANA)

                           PRESIDENT                

                                                                                               

                                                                                                        Sd/-

                    (ANIL SHARMA)

                                                                                                    MEMBER

 

                                                                                                     Sd/-

              (ANSUYA BISHNOI)

                                                                                              MEMBER