Haryana

Karnal

748/2010

Narain Dass S/o Jagdish Chand - Complainant(s)

Versus

Oriental Insurance Company, Oriental Insurance Company, Oriental Insurance Company, Dauphin Touch Ne - Opp.Party(s)

Sh. K.G. Sharma

28 Aug 2014

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL  FORUM KARNAL.

 

                                                          Complaint No.748 of 2010

                                                          Date of instt.21.09.2010

                                                          Date of decision: 07.04.2015

 

Narain Dass son of Shri Jagdish Chand resident of house No.318, New Ram Nagar, Karnal tehsil and District Karnal.

 

                                                                  ……..Complainant.

                                  Vs.

1.The Oriental Insurance Company Limited, 80, First Floor, F.I.E. Patparganj, Industrial Area,  Delhi 110092 through its Branch Manager.

2.The Oriental Insurance Company Limited, GT Road, Karnal 132001 through its Branch Manager.

3.The Oriental Insurance Company Limited, G80, Gupta Market, Main Bazar, Luxmi Nagar, Delhi through its Divisional Manager.

4.Dauphin Touch Net Work Private Limited, A212 C304,  Tirupati Plaza, Street No.1, Shakarpur Delhi 110 092 through its Director

 

                                                                        …..Opposite Parties.

.

 

                                      Complaint u/s 12 of the Consumer

                                      Protection Act.

 

Before        Sh.Subhash Goyal……..President.

                   Smt.Shashi Sharma……Member.

 

Argued by :-Sh. K.G.Sharma Advocate for the complainant.

                    Sh.Rohit Gupta Advocate for OP No.1 to 3.

                    None for OP No.4.

ORDER

                        The complainant has filed the present complaint u/s 12 of the Consumer Protection Act against the Ops on the allegations Smt.Sushma wife of complainant had purchased a Package of Dauphin Touch Net work Private Limited company from OP no.4 on 29.7.2008 for a period of one year i.e. upto 28.7.2009 whereby policy holder was insured to the tune of Rs.3, 00,000/- lakh in case of death of the policy holder as shown in the insurance policy 271700/48/2009/652. Unfortunately Smt.Sushma slipped  in bath room on 20.6.2009  i.e. during the continuance of the policy and suffered head injury and doctor  was called at the home  who declared her dead. The complainant being nominee has lodged the claiam with the OP but in vain.  To substantiate his case the complainant has tendered his affidavit alongwith some other documents which would be discussed at the relevant stages.

 

2.                On notice the Ops appeared and filed written statement.  The OP No.1 to 3 have filed their separate written statement raising the preliminary objections that the complainant was estopped by his own act and conduct from filing the present complaint; that the complainant has got no locus standi to file the present complaint; that the complainant has got no cause of action for filing the present complaint and there was no cause of action for filing of the present complaint.

 

                   On merits, it was contended on behalf of answering OP No.1 to 3 that the claim has rightly been repudiated because there was no FIR, DDR and post mortem report and in the absence of the said authentic documents, the death of life assured Smt.Sushma cannot be described as accidental death so as to cover under the insurance policy. It was also contended that there was no deficiency in services on the part of answering OP no.1 to 3 and dismissal of the complaint has been sought. Sh.A.K.Ahmed , Sr. Divisional Manager has also tendered his affidavit on behalf of OP no.1 to 3 in support of the contentions made in the written statement.

 

                   The OP no.4 has contended that deceased Smt.Sushma w/o complainant had purchased the package of OP no.4 to become its business distributor and no payment has been made by the deceased to the OP no.4 as against any premium for any of the insurance policy. However, as per the schemes of the OP no.4, an insurance policy has been issued to the deceased by the office of OP no.1 and hence it is strictly denied that OP no.4 has any pre arrangement with OP no.1 to 3 to issue any insurance certificate under the package it sold to the deceased late Smt.Sushma wife of Narain Dass.

 

 

3.                We have heard the learned counsel for the parties and have gone through the case file very carefully.

 

4.                Therefore, from the facts and circumstances of the case, evidence on the file and the arguments advanced by the learned counsel for the parties, it emerges that

he complainant has filed the present complaint alleging deficiency in services on the allegations  that Smt.Sushma wife of complainant had purchased a Package of Dauphin Touch Net work Private Limited company from OP no.4 on 29.7.2008 for a period of one year i.e. upto 28.7.2009 whereby policy holder was insured to the tune of Rs.3.00 lakh  in case of death of the policy holder as shown Ex.C3 and Ex.C4.  Unfortunately Smt.Sushma slipped in bath room on 20.6.2009 i.e. during the continuance of the policy and suffered head injury and doctor was called at the home  who declared her dead. The complainant being nominee has lodged the claim with the OP but in vain.  To substantiate his case the complainant has tendered his affidavit Ex.C1, affidavit of Mohinder Singh Ex.C2, letter misusing DTN connection Ex.C3, certificate of insurance Ex.C4, affidavit of Sunil Kumar Ex.C5, affidavit of Ramesh Kumari Ex.C6, affidavit of Dr.Naresh Kaushal Ex.C7, certificate of Tagore hospital Ex.C8, certificate of insurance Ex.C9, claim form Ex.C10, certificate of incorporation  Ex.C11, Certificate of insurance Ex.C12, letter Ex.C13 and Ex.C14, postal receipt Ex.C15, copy of legal notice Ex.C16 Ads eX.C17 and Ex.C18, copy of ration card Ex.C19, death certificate Ex.C20.

 

                   However, as per the contention of the OP the claim has rightly been repudiated because there was no FIR, DDR  no post mortem report and in the absence of the said authentic  documents, the death of life assured Smt.Sushma  cannot be described as accidental death so as to  cover under the insurance policy.

 

                   Therefore, after going through the evidence and circumstances of the case, it emerges that Smt.Sushma wife of complainant was policy holder and she was insured to the extent of three lakhs as shown  vide Ex.C3 and Ex.C4. the complainant has placed on record his affidavit Ex.C1 and affidavit of Mohinder Ex.C2, Affidavit of Sunil Ex.C5, Ramesh Kumari Ex.C6 and Affidavit of Dr.Naresh Kaushal Ex.C7 and certificate Ex.C8 , intimation letter Ex.C12 and copy of legal notice Ex.C13.

 

5.                No doubt there is neither FIR, nor DDR nor post mortem report on the file but in view of the law laid down in cases Manager, Health Administrator Team, Bajaj Allianz General Insurance Co.Ltd. Vs.Ravinder Kaur and others 2012(1) CPC page 100 and New India Assurance Co.Ltd. Vs.Jatinder Kumar Sharma 2013(2) CPC page 543 no FIR/DDR was required to be lodged for getting the claim under the policy. Similarly, the argument that the claim has been repudiated for want of post mortem report is also not sustainable in the eyes of law because in view of the law laid down in cases,  Jairam Khatik Vs.NIC Latd. 2012(1) CPC page 420 and  LIC of India and another Versus Anita Devi and others 2011(2) CPC page 235,  the post mortem report was not necessary to get the compensation  when the factum of  death has been proved by the doctor Naresh Kaushal who has tendered his affidavit Ex.C7 and issued certificate Ex.C8 and as such  the claim of the complainant has been wrongly with held  and there was deficiency in services on the part of the Ops.

 

 6.                   Therefore, as a sequel to our above discussion, we accept the present complaint and direct the OP  no.1 to 3 to make the payment of the sum insured to the complainant alongwith interest @ 9% per annum from the date of filing of the present complaint i.e. 21.09.2010 till its actual realization. The complainant shall also be entitled for a sum of Rs.25000/- for the harassment to him and a sum of Rs.2200/- towards legal fee and litigation expenses. The OP no.1 to 3  shall make the compliance of this order within a period of thirty days from the date of receipt of the copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced
dated: 07.04.2015                                                                            

                                                              (Subhash Goyal)

                                                             President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

                   (Smt.Shashi Sharma)

                             Member.

ealth AdH

 

 

Argued by :  -Sh. K.G.Sharma Advocate for the complainant.

                    Sh.Rohit Gupta Advocate for OP No.1 to 3.

                    None for OP No.4.

 

                   Arguments heard. For orders, the case is adjourned to 7.4.2015.

 

Announced
dated: 06.04.2015                                                                            

                                                              (Subhash Goyal)

                                                             President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

                   (Smt.Shashi Sharma)

                             Member.

 

Argued by :  -Sh. K.G.Sharma Advocate for the complainant.

                    Sh.Rohit Gupta Advocate for OP No.1 to 3.

                    None for OP No.4.

 

                   Vide our separate order of the even date, the present complaint has been accepted. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated: 07.04.2015                                                                           

                                                              (Subhash Goyal)

                                                             President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

                   (Smt.Shashi Sharma)

                             Member.

ealth AdH

ealth AdH