BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SIRSA.
Consumer Complaint no. 181 of 2020
Date of Institution : 24.08.2020
Date of decision : 05.05.2023
Fakir Chand aged about 57 years son of Shri Parkash Chand, resident of Ward No.7, village Mojukhera, Tehsil Ellenabad, District Sirsa.
……Complainant.
Versus.
1. Oriental Insurance Company Ltd., Divisional Office, Kapila Theertham Road, Near Anna Rao Circle, Tirupati, Andhra Pradesh through its Authorized Signatory.
2. Oriental Insurance Company Ltd., Branch Office Ellenabad, Tehsil Ellenabad District Sirsa through its Authorized Signatory.
3. Corporation Bank Ellenabad Branch, Sirsa, Tehsil Ellenabad, District Sirsa.
...…Opposite parties
Complaint under Section 35 of the Consumer Protection Act, 2019.
Before: SHRI PADAM SINGH THAKUR………….PRESIDENT
SMT. SUKHDEEP KAUR…………….MEMBER
Present: Sh. S.N. Grover, Advocate for the complainant.
Sh. K.L. Gagneja, Advocate for opposite parties no.1 and 2.
Sh. Sandeep Goyal, Advocate for opposite party no.3.
ORDER
The complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite parties (herein after referred as ops).
2. In brief, the case of complainant is that his son Bunty @ Balwant was an account holder bearing No. 520101249061847 which was being maintained by him, with op no.3. As per scheme of the Government, there was a collaboration between the ops and under this scheme the son of complainant was insured with ops no.1 and 2 and some amount was being deducted from the above account of son of complainant regularly as premium and all the risks of life were covered under the policy no. 432700/48/2019/211. It is further averred that on 23.10.2019, the son of complainant was present in his house and he was heating the water on hearth (Chulha). A bottle of petrol was lying there on the wall near the hearth and suddenly the hand of the son of complainant touched to the bottle of the petrol. The petrol lying in the bottle fell on the body of the son of complainant which attracted the fire towards the son of complainant and his body was burnt. He was immediately taken to the Government Hospital, Ellenabad by the brother of the complainant where his medico-legal examination was conducted vide MLR dated 23.10.2019, according to which he was burnt to the extent of 60-65%. It is further averred that thereafter he was referred to Civil Hospital, Sirsa from where he was further shifted to Soni Hospital, Hisar for treatment. Thereafter, he was discharged from the hospital on 29.10.2019 and his statement was recorded by the police on 30.10.2019 on the basis of which a Rapat bearing No.19 dated 30.10.2019 was registered in Police Station Ellenabad. It is further averred that unfortunately on 5.11.2019 the son of complainant died on account of burn injuries. After his death, complainant got lodged a claim with the ops under claim No. 432700/48/2020/00000214 with a request to indemnify the claim under the aforesaid insurance policy and he was asked to submit the necessary documents and to fulfill some necessary formalities. It was promised to him that thereafter claim shall be indemnified. It is further averred that despite submission of required documents and completion of all the formalities, his claim has not been indemnified rather he was avoided by the ops with one false pretext or the other and ultimately vide letter dated 24.01.2020, the claim of complainant was repudiated by the ops with the remarks that at the time of incident, the son of complainant was under the influence of liquor and was smoking near petrol can as per history of M/s Soni Burns and Plastic Surgeon, Hospital, Hisar and same is totally unlawful and is arbitrary. That complainant approached the ops and requested them to make the payment of amount of compensation by indemnifying his claim and to withdraw repudiation letter but the ops have flatly refused to admit the claim of complainant about a week ago and have caused unnecessary harassment and mental agony to him. Hence, this complaint seeking sum insured amount of Rs. five lacs besides compensation for harassment and litigation expenses.
3. On notice, opposite parties appeared. Ops no.1 and 2 filed written statement submitting therein that son of complainant Balwant Singh @ Bunty, since deceased was insured vide policy No. 432700/48/2019/211 under Group Personal Accident Scheme launched in collaboration with Corporation Bank for the account holders of the bank, but the account holders of the bank were insured subject to the terms and conditions of the policy of answering ops. All the claims were to be settled as per terms and conditions of the insurance policy. It is further submitted that this is a concocted story presented by complainant that a bottle of petrol was fallen on the deceased accidently while taking hot water from hearth. No sane person will keep the petrol near fire. This is a made up story to get the claim from the answering ops. It is further submitted that as per medico legal report dated 23.10.2019, the deceased was drunken and under intoxication as smell of alcohol from the breath of son of complainant was noticed by the doctor during examination for the purpose of issuing MLR. This fire incident took place because the deceased was under influence of alcohol and negligently split the petrol on his body and as per LAMA summary issued by the doctor Sunil Soni of Soni Burn and Plastic Surgery Hospital, Hisar, he sustained burn injuries accidently while smoking near a can of petrol, which must have been told to the doctor by deceased himself or the person attending the deceased. In both the cases, the deceased was negligent and responsible for sustaining burn injuries which resulted into his death and both the reasons were sufficient to repudiate the claim of complainant. It is further submitted that the cause of death differs from the deceased’s statement made to police and as per LAMA summary and as per exclusion clause, the claim of the complainant was rightly and legally repudiated by the answering ops. Remaining contents of complaint are also denied to be wrong and prayer for dismissal of complaint made.
4. Op no.3 also filed written version submitting therein that bank is only a medium and the rest of the responsibilities are of the insurance company and the bank while fulfilling its responsibility sent all the documents provided by the complainant to the insurance company in due time. It is further submitted that claim of complainant was not considered justified and same was rejected in which the bank/ answering op has no activity and it is only the discretion of insurance company. With these averments, prayer for dismissal of complaint qua op no.3 made.
5. The complainant in evidence has tendered his affidavit Ex.CW1/A and copies of documents Ex.C1 to Ex.C16.
6. On the other hand, ops no.1 and 2 have tendered affidavit of Ms. Puja as Ex.R1 and copies of documents Ex.R2 to Ex.R5. Op no.3 has tendered affidavit of Sh. Vikram Singh, Branch Manager, Union Bank of India as Ex.R6 as Corporation Bank has been merged in Union Bank of India.
7. We have heard learned counsel for the parties and have gone through the case file carefully.
8. It is an admitted fact between the parties that son of complainant namely Bunty @ Balwant was an account holder of op no.3 and his account number was 520101249061847 and it is also an admitted fact that son of complainant was insured with the ops no.1 and 2 vide policy No. 432700/48/2019/211 under Group Personal Accident Scheme launched in collaboration with Corporation Bank for the account holders of the bank. The bank of op no.3 has been merged with Union Bank of India. The son of the complainant was insured against all the risks of life under the above said policy and sum insured under the policy is Rs.5,00,000/- and for obtaining the said insurance policy the son of complainant was regularly paying premium amounts to the ops no.1 and 2 through op no.3 which is also not in dispute. According to the complainant on 23.10.2019, Mr. Bunty @ Balwant son of complainant was heating the water on a hearth and a bottle of petrol was lying there on the wall and suddenly the hand of son of complainant touched to the bottle of the petrol. The petrol lying in the bottle fallen on the body of son of complainant and same caught fire and as such his body was burnt. It has also come on record that immediately he was taken to Government Hospital, Ellenabad by his uncle and as per MLR, he was burnt to the extent of 60-65% and was referred to Civil Hospital where from also he was further shifted to Soni Hospital, Hisar for treatment. On discharge of the son of complainant from the hospital on 29.10.2019, his statement was also recorded by the police on 30.10.2019 and a rapat bearing No.19 dated 30.10.2019 was registered in Police Station, Ellenabad, copy of which is placed on file by complainant as Ex.C2. However, due to burn injuries the son of complainant could not survive and died on 05.11.2019. So the complainant has claimed sum insured amount of Rs.5,00,000/- from the ops no.1 and 2 due to death of his son in a fire incident.
9. The ops no.1 and 2 vide their letter dated 24.01.2020 has repudiated the claim of the complainant on the ground that as per post mortem report, there was smell of alcohol and as per exclusion clause 11(ii) of the policy claim is not payable as insured was under influence of intoxication liquor or drugs. The repudiation letter dated 24.01.2020 Ex.C1 further mentions that “the cause of death differs from the deceased statement to the Police and LAMA summary because as per deceased self statement to the Police, while taking water from stove (Chulha) there was a petrol bottle placed on wall and during this my hand got contacted with it and petrol fall on my body and from this my body catch fire from stove. But as per Soni Burns and Plastic Surgeon Hospital (where the deceased was treated) LAMA summary- sustained burns accidentally while smoking near a petrol can and the insured had exposed himself to risk under the influence of alcohol”. However, we are of the considered opinion that ops no.1 and 2 have wrongly and illegally repudiated the claim of the complainant. Though in the MLR dated 23.10.2019 Ex.C3, it is mentioned by the doctor that there was smell of alcohol from breath of the patient but without any further tests like blood & urine tests etc. it cannot be said that patient was under the influence of liquor or not any other medicines because without proper tests for ascertaining whether he was actually under the influence of liquor, it cannot be said that he was under the influence of liquor or any other drugs because it is well known that some amount of alcohol is also found in some medicines/ syrups.
10. During the course of arguments, learned counsel for ops has also contended that insured now deceased attempted to commit suicide because in the police information regarding MLR sent to the SHO Police Station, Ellenabad by the doctor, the copy of which is placed on file as Ex.C5, the doctor has mentioned that there is alleged history of burn with fire self. He has further contended that as insured attempted to commit suicide, therefore, as per section 11 (i) of exclusion clause contained in document Ex.R2 of the policy for committing or attempting suicide, intentional self injury claim is not payable. However, the ops have not proved by leading any cogent and reliable evidence that son of complainant tried to commit suicide and the burn injuries received by him was not accidental. The complainant himself has relied upon document Ex.C5 in which doctor has mentioned that alleged history of burn with fire self and from it cannot be at all presumed that meaning of fire self is that insured now deceased tried to commit suicide by setting himself on fire rather same supports the version of complainant that deceased insured caught fire self accidently and in this case self mean is that no body was responsible for the said incident as deceased self accidently caught fire. Moreover, the contention of learned counsel for ops no.1 and 2 in this regard is altogether different from their written version as in the written version there is no such averments of the ops no.1 and 2 that claim of the complainant was repudiated because deceased himself set himself on fire and even in the repudiation letter also there is no mention of the said fact by ops no.1 and 2 and as such contention of learned counsel for ops no.1 and 2 taken for the first time beyond their pleadings cannot be looked into and is hereby repelled. As such the ruqa/ document Ex.C5 relied upon by complainant himself is not helpful to the ops no.1 and 2. Moreover, police also did not find that injured tried to commit any suicide and has only registered DDR of the accidental fire caught by the insured now deceased. Further, the ops have not pointed out any material difference in the statements of insured made to the treating doctor and made to the police and as insured in his both the statements stated that incident took place accidently as his hand touched the bottle of petrol and as such petrol fallen on his body and caught fire and difference if any in his both the statements is immaterial and same cannot be the ground for repudiation of genuine claim. As such the repudiation of claim of complainant is wrong, illegal and arbitrary and is hereby set aside. The complainant is entitled to the sum insured amount of Rs.5,00,000/- from ops no.1 and 2 for the accidental death of his son Bunty @ Balwant.
11. In view of our above discussion, we allow the present complaint qua ops no.1 and 2 and direct the opposite parties no.1 and 2 to pay the sum insured amount of Rs.5,00,000/- to the complainant within a period of 45 days from the date of receipt of copy of this order, failing which ops no.1 and 2 will be liable to pay the said amount of Rs.5,00,000/- to the complainant alongwith interest @6% per annum from the date of this order till actual payment. We also direct the ops no.1 and 2 to further pay a sum of Rs.15,000/- as composite compensation for harassment and litigation expenses to the complainant within above said stipulated period. However, complainant qua op no.3 stands dismissed as there is no any kind of deficiency in service on the part of op no.3 bank. A copy of this order be supplied to the parties as per rules. File be consigned to the record room.
Announced. Member President,
Dated: 05.05.2023. District Consumer Disputes
Redressal Commission, Sirsa.
