Haryana

Kaithal

305/21

Sumit Kumar - Complainant(s)

Versus

Reliance Genral Insurance Co. - Opp.Party(s)

Sh.S.S Kundu

03 Apr 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KAITHAL.

                                                     Complaint Case No.305/2021.

                                                     Date of institution: 17.12.2021.

                                                     Date of decision:03.04.2023.

1. Sumit Kumar age 22 years 2. Vikas Kumar 20 years ss/o Suresh Kumar 3. Sunita Devi age 37 years widow of Suresh Kumar, resident of Village Dulyani P.O. Teontha, Tehsil and District Kaithal.

                                                                        …Complainants.

                        Versus

1. Reliance General Insurance Company Limited Circle Office, 2^nd Floor, S.C.O. No.147-148, Madhya Marg, Sector 9-C, Chandigarh-160009 through its Branch Manager.
2. Reliance General Insurance Company Limited, Regd. Office, Flat No.301, 3^rd Floor Krishe Block, Krishe Sapphire, Madhapur, Hyderabad Pincode-500081 through its ….Respondents.

           Complaint under Section 35 of the Consumer Protection Act

   CORAM:     SMT. NEELAM KASHYAP, PRESIDENT.

                   SMT. SUMAN RANA, MEMBER.

                   SH. SUNIL MOHAN TRIKHA, MEMBER.

          

   Present:     Sh. Shamsher Singh Kundu, Advocate, for the complainants.   

                   Sh. C.L.Uppal, Advocate for the respondents.

                  

   ORDER

   NEELAM KASHYAP, PRESIDENT

           Sumit Kumar and others-Complainants have filed this complaint under Section 35 of Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the respondents.

                   In nutshell, the facts of present case are that the father of complainants No.1, 2 and husband of complainant No.3 namely Suresh Kumar (since deceased) had purchased the commercial vehicle insurance policy bearing No.200422023340011606 for vehicle No.HR46-C-1078 under the product namely Reliance Commercial Vehicles Package Policy from the OPs.  It is alleged that as per the insurance policy, sum assured for personal accident cover for owner driver was Rs.15,00,000/-.  It is further alleged that on 15.09.2021 three boys booked the insured vehicle from Pundri Taxi Stand.  In the way, the boys snatched the insured vehicle from Suresh Kumar and shot a gun fire on him.  In this regard, a FIR bearing No.526 dt. 16.09.2021 under Section 397 IPC and 25-54-59 of Arms Act was got lodged in P.S.Pundri.  Suresh Kumar (since deceased) was referred to P.G.I. where he was declared dead and post-mortem was got conducted.  The complainants duly applied for the personal accident claim as per the insurance policy and also submitted all the documents but the said claim of complainants was repudiated by the OPs vide letter dt. 17.11.2021.  The said repudiation of claim is stated to be wrong and illegal.  So, it is a clear cut case of deficiency in service on the part of respondents and prayed for acceptance of complaint.     

   2.            Upon notice, the respondents appeared before this Commission and contested the complaint by filing their written version raising preliminary objections that the complainant intimated a claim with the answering OPs and the answering OPs registered the claim of complainant vide claim No.33212000257 and requested the complainant to submit all the necessary documents in support of his claim.  On scrutiny of the claim by the answering OPs, it was observed that at the time of loss, the deceased was not present inside the vehicle; that there is no deficiency in service on the part of respondents.  On merits, the objections raised in the preliminary objections are rebutted and so, prayed for dismissal of complaint.

   3.             To prove his case, the complainant tendered into evidence affidavit Ex.CW1/A alongwith documents Annexure-C1 to Annexure-C7 and thereafter, closed the evidence.

   4.             On the other hand, the respondents tendered into evidence affidavit Ex.RW1/A alongwith documents Annexure-R1 to Annexure-R4 and thereafter, closed the evidence.

   5.             We have heard the learned Counsel for both the parties and perused the record carefully.

   6.             Ld. counsel for the complainants has reiterated all the points mentioned in the complaint.  He argued that the father of complainants No.1, 2 and husband of complainant No.3 namely Suresh Kumar (since deceased) had purchased the commercial vehicle insurance policy bearing No.200422023340011606 for vehicle No.HR46-C-1078 under the product namely Reliance Commercial Vehicles Package Policy from the OPs.  It is further that as per the insurance policy, sum assured for personal accident cover for owner driver was Rs.15,00,000/-.  It is further argued that on 15.09.2021 three boys booked the insured vehicle from Pundri Taxi Stand.  In the way, the boys snatched the insured vehicle from Suresh Kumar and shot a gun fire on him.  In this regard, a FIR bearing No.526 dt. 16.09.2021 under Section 397 IPC and 25-54-59 of Arms Act was got lodged in P.S.Pundri.  Suresh Kumar (since deceased) was referred to P.G.I. where he was declared dead and post-mortem was got conducted.  The complainants duly applied for the personal accident claim as per the insurance policy and also submitted all the documents but the said claim of complainants was repudiated by the OPs vide letter dt. 17.11.2021.  During the course of arguments, ld. counsel for the complainant has placed on file copy of FIR, which is Mark-A on the file, copy of disclosure statement, Mark-B and copy of post-mortem report, Mark-C.  There is deficiency in service on the part of Ops and prayed for acceptance of complaint.   

   7.             On the other hand, ld. counsel for the Ops argued that it was observed that at the time of loss, the deceased was not present inside the vehicle.  It has been further argued that the claim of complainant was repudiated by the Ops vide letter dt. 17.11.2021 as per Annexure-R4.  The said repudiation of claim is stated to be legal and valid.  During the course of arguments, ld. counsel for the OPs has placed on file copy of terms and conditions of policy, which are Mark-Z on the file.  There is no deficiency in service on the part of Ops and so, prayed for dismissal of complaint. 

   8.             We have considered the rival contentions of both the parties.  The main objection of ld. counsel for the OPs is that at the time of loss, the deceased was not present inside the vehicle and in this regard, he has drawn our attention towards Section IV-Personal cover for owner-driver subject otherwise to the terms exceptions conditions and limitations of this policy, the Company undertakes to pay compensation as per the following scale for bodily injury/death sustained by the owner/driver of the vehicle in direction condition with the vehicle insured or whilst mounting into/dismounting from or travelling in the insured vehicle as a co-driver, caused by violent accidental and visible means which independent of any other cause shall within six calendar months of such injury result. 

                      We have perused the disclosure statement of Sanjay @ Sanju as per Mark-B, wherein it has been mentioned that “In fact Neelu and Bittu are residents of Tohana.  Bittu has mobile No.90537-08814 and Neelu has mobile No.94670-78675.  He had to go outside to sale the snatched pick-up vehicle.  They had booked the vehicle in Pundri and they snatched the pick-up vehicle after making shot from the gun to the driver”.  So, from this disclosure statement, it is clear that the deceased was present inside the vehicle at the time of loss, so, the OPs have wrongly repudiated the claim of complainant on the ground that at the time of loss, the deceased was not present inside the vehicle.  As per post-mortem report Mark-C, it is mentioned that “As per records issued by Civil Hospital, Kaithal, the deceased was brought with alleged history of Gunshot injury on 15.09.2021 at about 4.00 p.m.  On arrival, he was conscious and well oriented.  Vitals were stable.  He was referred to PGIMER Chandigarh on the same day for further management.  At PGIMER, the deceased was diagnosed with right lung contusion with pneumothorax with grade III liver injury with perforation peritonitis.  Emergency laparotomy, side to side colo colic anastomosis with resection of perforated segment and retrieval bullet was done.  As per hospital records issued by PGIMER Chandigarh, the cause of death is septic shock MODS with gunshot injury with grade III liver and colon perforation with hemothorax and pneumothorax”.  So, in view of aforesaid post-mortem report, it is clear that the deceased Suresh Kumar was died due to gunshot.  Section IV-Personal Accident cover for owner-driver of terms and conditions as per Mark-C is not applicable in the present case.  Hence, we are of the considered view that there is deficiency in service on the part of OPs.  As per policy Annexure-3 at page No.3, it is mentioned in the column of Limits of liability-PA cover for owner driver under Section III CSI-Rs.15,00,000/-. 

   9.             Thus, as a sequel of aforesaid discussion, we accept the present complaint and direct the OPs to pay the amount of Rs.15,00,000/- to the complainants in equal share within 45 days and further to pay Rs.5,000/- as compensation on account of physical harassment as-well-as Rs.5,000/- as litigation charges. 

   10.            In default of compliance of this order, proceedings against respondents-OPs shall be initiated under Section 72 of Consumer Protection Act, 2019 as non-compliance of court order shall be punishable with imprisonment for a term which shall not be less than one month, but which may extend to three years, or with fine, which shall not be less than twenty five thousand rupees, but which may extend to one lakh rupees, or with both.  A copy of this order be sent to both the parties free of cost.  File be consigned to the record room after due compliance.     

   Announced in open court:

   Dt.:03.04.2023.

                                                                   (Neelam Kashyap)

                                                                   President.

    

   (Sunil Mohan Trikha),           (Suman Rana),          

   Member.                            Member.

   Typed by: Sanjay Kumar, S.G.