Haryana

Karnal

CC/365/2021

Parveen - Complainant(s)

Versus

Oriental Insurance Company Limited - Opp.Party(s)

Narender Shandilya

14 Jul 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                       Complaint No. 365 of 2021

                                                        Date of instt.29.07.2021

                                                        Date of Decision:.14.07.2022

 

1.     Parveen son of late Shri Jaipal

2.     Sudesh wife of late Shri Jaipal

residents of village Gangatehri, Tehsil Assandh, District Karnal.

 

                                               …….Complainants.

                                              Versus

 

1.     Oriental Insurance Company Ltd. through its Branch Manager, Karnal.

2.     Oriental Insurance Company Ltd. through its Branch Manager, Panipat.

3.     Oriental Insurance Company Ltd. through its Branch Manager, Safidon, District Jind.

 

                                                                      …..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.

              Shri Vineet Kaushik……Member

      Dr. Rekha Chaudhary…….Member

                   

Argued by: Sh.Narender Shandilya, counsel for the complainants.

                  Shri R.S.Mann, counsel for the opposite parties.

 

                    (Jaswant Singh President)

ORDER:   

                

                   The complainants have filed the present complaint under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that Amit brother of complainant no.1 and son of complainant no.2 was owner of one motorcycle CT 100, make Bajaj Model 2020 bearing engine no.G4166, chasis no.MD2B37AXOLPG02278 and the said vehicle was insured with the OPs, vide policy no.261404/31/2021/2731, valid from 12.11.2020 to 11.11.2021. On 16.01.2021 the said Amit met with an accident while driving the abovesaid motorcycle and he remained under treatment in Civil Hospital, Assandh, District Karnal, but considering his serious condition, he was referred to Civil Hospital, Karnal and then he was taken to Dua Multispecialty Hospital, Karnal. However, there was no improvement in his condition, therefore, he was referred to PGI Chandigarh and he had passed away on the way to PGI Chandigarh. It is averred that complainants do not know the technicalities of law and after the death of Amit, they were in deep grief and therefore, the postmortem of Amit could not be got conducted nor any FIR was got registered in this regard. The complainants duly informed the OPs about the abovesaid accident as well as death of Amit and requested them to release the payment of claim amount of Rs.15,00,000/- and other benefits under the abovesaid policy. The complainants also moved an application through registered post on 22.02.2021 with relevant documents i.e. M.L.R., police ruka treatment record of Amit, test report insurance, Aadhar card, death certificate, but OPs did not release the claim amount to the complainants. There is no other legal heir of Amir Kumar except the complainants. Then complainants served a legal notice dated 19.03.2021 upon the OPs but it also did not yield any result. In this way there is deficiency in service on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action and concealment of true and material facts. On merits, it is pleaded that deceased Amit had not met with an accident while driving the motorcycle insured with the OP. No FIR or DDR had been registered regarding the alleged accident. Moreover, no postmortem was conducted to establish the death of Amit due to the injuries sustained in the alleged accident and hence the claim filed by the complainants before the OPs was repudiated being found false. It is further pleaded that complainants have not mentioned as to what manner said Amit met with an accident. The concerned hospitals have also not sent the rukka to the concerned police regarding the alleged suffering of injuries by said Amit in the alleged accident. Infact, there is no evidence on the file regarding the alleged accident. Since the death of said Amit had not occurred due to the alleged accident and as such the complainants have not got registered the FIR nor got conducted the post mortem of the deceased. It is further pleaded that there is no iota of evidence on file to connect the death of the insured Amit, due to the accident occurred involving the insured motorcycle, hence the complainant is not entitled to any compensation and the OPs have rightly repudiated the claim of the complainants and intimated the same, vide letter dated 18.06.2021. There is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied by the OPs and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of police Rukka dated 16.01.2021 Ex.C1, copy of MLR of deceased Ex.C2, copy of insurance policy Ex.C3, copy of treatment record of Dua Multispecialty Hospital, Karnal Ex.C4, copy of medical bills Ex.C5 and Ex.C6, copy of Registration Certificate of vehicle Ex.C7, copy of Aadhar card of Amit Ex.C8, copy of Aadhar card of Sudesh (complainant) Ex.C9, photos of motorcycle Ex.C10 to Ex.C13, copy of legal notice dated 22.03.2021 Ex.C14, copy of letter dated 22.02.2021 regarding intimation to OP Ex.C15, postal receipts Ex.C16 to Ex.C19 and closed the evidence on 20.1.2022 by suffering separate statement.

5.             On the other hand, learned counsel for OPs has tendered into evidence affidavit of Sanjeev Madaan, Senior Divisional Manager Ex.OP1/A and closed the evidence on 21.03.2022 by suffering separate statement.

6.             We have heard the learned counsel of the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that Amit (since deceased) was owner of one motorcycle in question and the said vehicle was insured with the OPs. On 16.01.2021 the said Amit met with an accident while driving the abovesaid motorcycle and he remained under treatment in various hospital and laslty he passed away. The complainants duly informed the OPs about the abovesaid accident as well as death of Amit and requested them to release the payment of claim amount of Rs.15,00,000/- and other benefits under the abovesaid policy. The complainants also moved an application through registered post on 22.02.2021 with relevant documents i.e. M.L.R., police ruka treatment record of Amit, test report insurance, Aadhar card, death certificate, but OPs did not release the claim amount to the complainants and lastly prayed for allowing the complaint.

8.             Learned counsel for OPs, while reiterating the contents of the written version, has vehemently argued that deceased Amit had not met with an accident while driving the motorcycle insured with the OP. No FIR or DDR had been registered regarding the alleged accident. Moreover, no postmortem was conducted to establish the death of Amit due to the injuries sustained in the alleged accident and hence the claim filed by the complainants before the OPs was repudiated being found false and lastly prayed for dismissal of the complaint.

9.             We have duly considered the rival contentions of the parties.

10.           The claim of the complainants has been repudiated by the OP, vide repudiation letter dated 18.06.2021 on the following grounds, which reproduced as under:-

“Claim on account of death of Shri Amit who died on 17.01.2021 while driving his motorcycle. After computing all informations, the file was put-up before the Competent Authority for final decision. The Competent Authority after going through the facts of the case was constrained to repudiate the claim inter-alia on the following grounds:-

1.     The evidence of brother, mother of the deceased and two other persons of village without supported by any documentary evidence and hearsay evidence has no value in the eyes of law.

2.     In the case, neither the FIR was reported with the police nor postmortem was conducted. Moreover, no record of Ruka sent to police by Sub Divisional Hospital, Assandh or by Dua Multi Specialty Hospital, Karnal which could prove that Police was informed about the accident in which Shri Amit sustained injuries and lateron died.

3.     Own Damage Claim for motorcycle not lodged which was being driven by the deceased.

In the absence of FIR and without inspection of damaged vehicle or any photographs of damaged motorcycle, it is essential to undertake autopsy in cases where death has been caused due to act of criminality, as an aid to preventive medicines or when death is caused by road, industrial or domestic accidents, or when the precise cause of death has to be determined for the purpose of pension and insurance claims. 

In the present case, the accidental death of Amit has not been proved without post mortem which could prove that the injuries sustained by Amit are sufficient to cause of death. Further, it is also not proved that deceased was driving his motorcycle at the time of accident. There is no iota of evidence except oral that deceased was driving his motorcycle at the time of accident.

In light of above, legal opinion of advocate and after due application of mind, we regret to inform you that the claim lodged by you is not maintainable under the contract of indemnity entered into between the parties. Hence, your claim is not payable and the same is repudiated”.

       

11.           As per the version of the complainants, Amit had died in a road side accident. The onus to prove their version lies upon the complainants, but complainants have miserably failed to prove their version by leading any cogent and convincing evidence.

12.           It is admitted facts that neither First Information Report (FIR) was got lodged in the Police Station nor the post mortem was conducted upon the dead body of Amit. Complainant relied upon Ex.C1 allegedly a Police Rukka but on perusal of the said document it is not a Police Rukka, rather it is a prescribed slip issued by the concerned doctor. Furthermore, in the said prescribed slip the patient was referred to Government Hospital, Karnal and said document has not been addressed to the concerned police station.

13.           There is nothing on the file to prove that Amit (since deceased) was driving the motorcycle and met with an accident. Without conducting the post mortem upon the dead body of Amit, it cannot be ascertained that death was occurred due to sustained injury in the alleged road accident. Furthermore, complainants also failed to place on file the death certificate of Amit. Only placing on the MLR and photographs of motorcycle do not establish that Amit had expired due to injury sustained in the alleged accident. Complainants have also taken a plea that they did not know the technicalities of law, and due to that they could not get conducted the post mortem and lodging the FIR with regard to the accident. Ignorance of the law is of no excuse. It has not been proved on the file that in what circumstances Amit had died. Furthermore, reason for not lodging the FIR and not conducting the post mortem of the body of Amit is best known to the complainants. Hence, in view of the above discussion, we are of the considered view that present complaint is devoid of any merits and same deserves to be dismissed.

14.           Thus, as a sequel to abovesaid discussion, we dismiss the present complaint. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Dated:14.07.2022

                                                                       

                                                                  President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal.

 

 

 

(Vineet Kaushik)        (Dr. Rekha Chaudhary)

                    Member                         Member