Haryana

StateCommission

A/826/2018

ORIENTAL INSURANCE CO. - Complainant(s)

Versus

REENA AND OTHERS - Opp.Party(s)

D.C.KUMAR

27 Apr 2023

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

 

                                                      First Appeal No.826 of 2018

                                                Date of Institution: 02.07.2018

                                                          Date of Order: 27.04.2023

 

The Oriental Insurance Company Limited Branch office Lower Parel Oriental House Mezzanine, 7 J tata Road Church Gate Mumbai  through Sh. P.N Bodh Manager Oriental Insurance Company Limited, Regional Office, LIC Building, 2^nd Floor Jagadhri Road Ambala Cantt.

…..Appellants

Versus

1.      Reena W/o Late Dharmender R/o Village Rohna, Distt. Sonepat.

2.      HDFC Bank Ltd., Plot No.28, Phase 1, Industrial Area, Chandigarh.

3.      HDFC Bank Subhash Chowk, Sonepat.

…..Respondent

CORAM:    S.P.Sood, Judicial  Member

                  

Present:-    Mr.D.C.Kumar, Advocate for theappellants.

                   Mr.R.S.Dahiya, Advocate for the respondent No.1.

                   Mr. Bhawandeep Jindal, Advocate for respondent Nos.2 and 3.

 

                                                ORDER

S P SOOD, JUDICIAL MEMBER:

The brief facts of the case are that complainant has been a legally wedded wife of late Dharmender. The husband of the complainant was serving in Haryana Police as EHC bearing belt No.627. At the time of his death i.e. 06.02.2016 he was posted at Distt Jhajjar. The deceased alongwith other officials and officers of Haryana police had purchased an insurance policy of Rs.10.00 lacs from the Ops. The policy number of the deceased was 12491/48/2016/1 and was valid from 19.05.2015 to 18.05.2016.  On 16.1.2016 the husband of the complainant met with an accident and he suffered serious and grevious injuries on his head, hand, abdomen and other parts of body. The vehicle also got damaged.  After accident, an ambulance shifted the deceased to PGIMS Rohtak for treatment and was discharged on 17.01.2016.  DDR was recorded on the next day.  On 18.01.2016, the deceased experienced pain in chest, hand and abdomen and was taken to G.D.Sharma Hospital Sonepat, where treating doctor advised for some  tests alongwith CT scan. The report of C.T.Scan of deceased revealed that there was  pulmonary contusion in RT upper and middle Lobe and a small laceration in right lobe of his liver. There were haemotoma at various places in abdomen and fractures were noticed in right iliac bone and in right inferior pubic. Non displaced fracture of spinous process of D4 vertebra and fracture in posterior end of left rib were also seen. There was intraparenchymal heaemotone in the right adrenal glands. Faced with this he was taken to PGIMS for further treatment and was discharged on 20.07.2016 after prescribing some medicines and treating doctor advised him for 7 days rest but due to some fresh problem, he was again taken to PGIMS Rohtak on 27.01.2016  and after examining him, the treating doctor advised some medicines and rest for one month. During the inter regnum period on 03.02.2016 the deceased felt acute pain in abdomen and pelvis region due to which he was taken to Nidan Hospital, Sonepat and during his treatment several tests were also conducted.  On 06.02.2016, the condition of the deceased got worsened and deteriorated further so the complainant and her family members shifted the deceased to General Hospital, Sonepat  where he was declared as brought dead by the doctor on duty.  Post mortem was conducted. After the death of the deceased, the department through DGP moved an application alongwithrequired documents for issuance of accidental claim. HoweverOPs repudiated the liability by saying that injuries described in the PMR of the deceased cannot be corroborated with the injuries in the road side accident.  Thus there being deficiency in service on the part of the OP, hence the complaint.

2.      Notice issued to the Ops and OP No.1 and 3 filed separate replies alleging that they are not the necessary parties in the present complaint which has been filed only to harass and humiliate them. OP Nos.1 and 3 also raised preliminary objections about maintainability of complaint, accruing cause of action, complaint being bad for mis joinder and non joinder of parties and  locus standi and requested to dismiss the same.

3.      OP No.2 filed separate written statement submitting that the claim was rightly repudiated  vide speaking order after considering the report of expert i.e. medicolegal opinion given by Dr.CH Asrani. The complainant herself mentioned contradictory dates about treatment and discharge of the patient. The complainant mentioned discharge date as 20.07.2016 of her husband, whereas his date of death was 05.01.2016.The cause of death mentioned did not corroborate with the accident of deceased.   It was further alleged that the OP No.2 has rightly repudiated the claim on the basis of legal and genuine reason given  by Dr. C.H.Asrani in his report  that “ after perusal of available medical documents, it is concluded that the injuries described in the post mortem report of Mr.Dharmender Singh cannot be corroborated with the accident (Road traffic Accident) met by Dr.
Dharmender Singh.” The answering OP legally repudiated the claim vide letter dated 16.06.2017. Thus there was no deficiency in service on the part of the answering OP and requested to dismiss the complaint.

4.      After hearing both the parties, the learned District Commission, Sonepathas allowed the complaint qua respondent No.2-insurance company vide order dated 15.05.2018, which is as under:-

“Accordingly, it is held that the complainant is legally entitled to get the claim of Rs.10 lakh  from the respondent No.2 insurance company as the death of Dharmender has occurred during the validity of the insurance policy.  Thus, we hereby direct the respondent No.2 insurance company to make the payment of Rs.10 lakh in respect of death of Dharmender. The complainant is also directed to submit the list of LRs of deceased Dharmender and the respondent insurance company respondent No.2 shall make the payment of claim amount in equal share to the LRs of the deceased Dharmender. However, in case there is any minor LR of Dharmender (either male or female), the respondent insurance company shall invest the share of the said minor LR in the shape of FDR in any nationalized bank for the period till the minor attained the majority. The respondent, however is directed to make the payment within a period of 60 days from the date of passing of this order failing which the above said amount shall fetch interest at the rate of 09% per annum from the date of passing of this order till its realization.

With these observations, findings and directions, the present complaint stands allowed, qua respondent NO.2. insurance company since we find no deficiency in service on the part of the respondent no.1 and 3.”

5.      Feeling aggrieved therefrom, O.P No.2-appellant has preferred this appeal.

6.      This arguments have been advanced by Sh.D.C.Kumar, learned counsel for the appellants as well as Sh.R.S.Dahiya, learned counsel for respondent No.1 and Mr.Bhawandeep Jindal, Advocate for the respondent Nos.2 and 3. With their kind assistance entire record of appealas well as original record of the District Commission including whatever evidence has been led on behalf of  both the parties has been properly perused and examined.

7.      Learned counsel for the appellant vehemently argued that  complainant is not entitled for the insurance amount  because the injuries reflected in the post mortem. Report did not correspond to the injuries allegedly received by the insured in this road side accident. Even this claim was rejected after considering various documents by experts including specific report of Dr. C.H.Asranias per which “after perusal of available medical documents, it is concluded that the injuries described in the post mortem report of Mr.Dharmender Singh cannot be corroborated with the accident (Road traffic Accident) met by Sh.Dharmender Singh.” The appellant has legally repudiated the claim vide letter dated 16.06.2017, so the impugned order cannot sustain and has to go.

8.      Learned counsel for the respondent No.1 vehemently argued that the husband of the complainant expired during the subsistence of the policy as such she was entitled for the insurance amount as claimed for.

9.      Learned counsel for the respondent Nos.2 and 3 vehemently argued that they were neither necessary nor proper party in the complaint and the learned District Commission has allowed the complaint against the OP No.2  i.e. Oriental Insurance company and prayed for dismissal of the appeal.

10.    It is not disputed that the husband of the complainant has died during the subsistence of the policy.   The claim of the complainant was repudiated on the ground that the injuries described in the post mortem report of Sh.Dharmender Singh do not corroborate with the accident (Road Traffic Accident) met said Dharmender Singh. As per follow up record of PGI, Rohtak, the diagnosis was DER ® and as per the terms  DER means  (Distal radius fracture) and treating doctor discharged the patient on 17.01.2016 after prescribing some medicines.  As per DDR dated  18.01.2016, the husband of the complainant  had reported Police Chowki Ashaudah, Jhajjar with regard to the accident. As per CT scan report dated 18.1.2016, the deceased was suffering from multiple injuries,  like a comminuted fracture of the right iliac bone extending from the iliac crest to involve the roof of the acetabulum, further involving the anterior column and the right quadrilateral plate.  All the relevant record revealed that accident took place on 16.01.2016 and intimation about accident was given to the Police authority on the following day.   Well when injured was discharged on the next day perhaps the doctors who attended him on 16.01.2016 could not gather or realized about other injuries also suffered by him and must have discharged him hurriedly.  It was not the case that the insured might have suffered other injuries in some other incident rather he had suffered injuries on his head , hand abdomen and other bodily parts.  Therefore all these injuries duly correspond to various problems which all were disclosed in the PMR.  It is also possible that injured might have failed to disclose all his injuries to doctors on the day of accident and could not be addressed on the first day itself.   So for all these reasons the complainant was entitled for the insurance amount as prayed for. The appellant has wrongly rejected the claim of the complainant. The learned District Commission has rightly allowed the claim of the complainant against OP No.2. The learned District Commission had committed no illegality while passing the order dated 15.05.2018.  The appeal is also devoid of merits and stands dismissed.

11.    The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the complainant-respondentNo.1-Reena against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

12.    A copy of this order be provided to all the parties free of cost as mandated by the Consumer Protection Act, 2019. This order be uploaded forthwith on the website of the Commission for the perusal of the parties.

13.    Application(s), pending, if any, stands disposed off in terms of the aforesaid order.

14.    File be consigned to record room.

 

 

27^thApril, 2023                                                                                  S. P. Sood                                                                                                                            Judicial Member    

S.K

(Pvt. Secy.)