Haryana

Karnal

CC/838/2019

Kamla Devi - Complainant(s)

Versus

SBI General Insurance Company Limited - Opp.Party(s)

Ashok Kumar

05 Jun 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                        Complaint No. 838 of 2019

                                                        Date of instt.20.12.2019

                                                        Date of Decision:05.06.2023

 

1.     Kamla Devi wife of late Shri Prem Chand son of Shri Mani Ram,

2.     Rajesh Kumar.

3.     Naresh Kumar, sons of late Shri Prem Chand son of Shri Mani Ram,

        All residents of village Shekhanpur, District Karnal.

 

                                               …….Complainant.

                                              Versus

 

1.     SBI General Insurance Company Ltd., corporate and registered office: “Natraj” 301, Junction of Western Express Highway and Andheri-Kurla Road, Andheri (East), Mumbai 400 069 through its authorized signatory.

 

2.     SBI General Insurance Company Ltd., Mugal Canal, Karnal through its Divisional Manager.

 

                                                                      …..Opposite Parties.

 

Complaint Under Section 12 of the Consumer Protection Act, 1986 and after amendment Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary……Member

          

 Argued by: Shri Pawan Gahlotra, counsel for the complainant.

                    Shri Naveen Khetarpal, counsel for the OPs.

 

                    (Jaswant Singh President)

ORDER:   

                

                   The complainant has filed the present complaint Under Section 12 of the Consumer Protection Act, 1986 as after amendment Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that Shri Prem Chand during his life time had obtained a policy under Personal Accident policy having Master policy no.143990-0000-00 w.e.f. 13.04.2015 to 12.04.2016 for an amount of Rs.10,00,000/- and he had appointed the complainant no.1 being wife as his nominee in the said policy. Prem Chand was quite hale and hearty at the time of obtaining the said policy. Unfortunately, due to drowning in water, Prem Chand was expired on 06.11.2015 and his post mortem was conducted in Civil Hospital, Karnal, vide PMR no.RS/123/15 dated 06.11.2015. The report in this regard vide GD entry no.005 was got registered on 11.11.2015 with the Police of Police Station Taraori. Complainant no.1 informed the OPs about the death of her husband and lodged the death claim with the OPs. Complainants submitted all the required documents with the OPs as per their demand and also requested the OPs to release the benefits under the policy in question but the officials of the OPs did not pay any heed to the request of complainants and lingered the matter on one pretext or the other and lastly repudiated the claim of complainant, vide letter dated 11.01.2019 on the false and frivolous ground. In this way there is deficiency in service and unfair trade practice on the part of the OP. Hence this complaint.

2.             On notice, OP appeared and filed its written version raising preliminary objections with regard to maintainability; limitation; cause of action and concealment of true and material facts. On merits, it is pleaded that as per claim from and documents submitted by the complainants, the death of insured Shri Prem Chand was claimed to be due to drowning. However, chemical analysis report clearly established that insured was under influence of alcohol at the time of accident. Also police inquest paper confirmed that insured was under influence of alcohol. Any claim or claims under this policy arising from being under the influence or use/abuse of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a physician and taken as prescribed is not covered under this police, hence there was gross violation of terms and conditions of the policy and being not maintainable, claim of the insured was repudiated by the company as per terms and conditions of the policy and same has been intimated to the complainant, vide letter dated 11.01.2019. There is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of ration card Ex.C1, copy of voter card of Rajesh son of Prem Chand Ex.C2,  copy of aadhar card of Kamla Devi Ex.C3, copy of aadhar card of Prem Chand Ex.C4, copy of death certificate of Prem Chand Ex.C5, copy of DDR no.05 dated 11.11.2015 Ex.C6, copy of Add. General Diary Report no.14 dated 06.11.2015 Ex.C7, copy of notice to Kamla Devi Ex.C8, copy of certificate of insurance in the name of Prem Chand Ex.C9, copy of FSL report dated 28.04.2016 Ex.C10, copy of post mortem report of Prem Chand dated 06.11.2015 Ex.C11 and closed the evidence on 10.06.2022 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Jitendra Dhabhai, Deputy Manager, Ex.RW1/A, copy of letters dated 18.04.2016, 03.05.2016, 18.05.2016, 07.11.2016, 12.07.2018, 22.07.2018, 13.08.2018, 04.10.2018, 22.10.2018, 04.09.2018, 19.09.2018 Ex.R1 to Ex.R11, copy of investigation report Ex.R12, copy of Forensic Science Laboratory report Ex.R13, copy of repudiation letter dated 11.01.2019 Ex.R14, copy of Add. General Diary Details Ex.R15, copy of PA Insurance Cover Confirmation letter dated 24.02.2020 Ex.R16 and closed the evidence on 22.11.2022 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 Prem Chand during his life time had obtained a Personal Accident Policy from the OPs and appointed the complainant no.1 being his nominee. On 06.11.2015, due to drowning in water, Prem Chand was expired and postmortem was conducted on the dead body in Civil Hospital, Karnal. Complainant informed the OPs about the death of her husband and lodged the death claim with the OPs and submitted all the required documents and also requested the OPs to release the benefits under the policy in question but the officials of the OPs did not pay any heed to the request of the complainants and repudiated the claim of complainant, vide letter dated 11.01.2019 on the false and frivolous ground and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that insured was under influence of alcohol at the time of incident. Claim under the policy, arising from being under the influence or use/abuse of drugs, alcohol, or other intoxicants is not covered. hence the clam of complainant has been rightly repudiated by the OPs, vide letter dated 11.01.2019 and lastly prayed for dismissal of the complaint.

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

10.           Admittedly, life assured purchased the personal accident policy from the OPs and the same was effected from dated 13.04.2015 to dated 12.04.2016 for the sum assured of Rs.10 lakhs. It is also admitted that life assured had expired due to drowning in water.

11.           The claim of the complainant has been repudiated by the OPs, vide repudiation letter Ex.R14 dated 11.01.2019 on the ground, which is reproduced as under:-

“We have carefully perused claim documents and noted that death of insured Mr. Prem Chand is claimed to be due to drowning. However, chemical analysis report received by us clearly established that insured was under influence of alcohol at the time of accident. Also, policy inquest paper received by us confirmed that insured was under alcohol of influence. Any claim or claims under this policy arising from being under the influence or use/abuse of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a physician and taken as prescribed is not covered under this policy. Hence basis of terms and conditions the claim is repudiated”.

12.           The claim of the complainant has been repudiated by the OPs on the ground that at the time of accident, the insured was under the influence of alcohol. The onus to prove its version was relied upon the OPs. To prove its version, OPs have relied upon the Forensic Science Laboratory Report Ex.R13 dated 28.04.2016. The result of said examination report is as under:-

1.     Ethyl alcohol was detected

2.     Blood was found to contain ethyl alcohol in strength of 28.75mg%.

3.     No common poison could be defected.

 

From the said report, it is clear that at the time of incident, life assured was under the influence of alcohol. OPs further relied upon the Add. General Diary Details Ex.R15 dated 06.11.2015, wherein the son of Prem Chand has stated that the death of his father died due to drowning in water under the influence of alcohol. OPs further relied upon the terms and conditions of the insurance policy Ex.OP16, wherein it is clearly mentioned that the company shall not be liable for any claim being under the influence or use/abuse of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a physician and taken as prescribed is not covered under this policy. Complainants have failed to prove on the record that deceased life assured had taken the alcohol on the advice of the doctors. It is also proved from the investigation report Ex.R12, deceased life assured used to drink alcohol. DDR was got recorded by Rajesh Kumar son of the deceased, in the said DDR, it has been specifically mentioned that his father expired due to drowning under the influence of liquor.

13.           Thus, in view of the above discussion, the present complaint is devoid of any merits and same deserves to be dismissed and same is hereby dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance

Dated: 05.06.2023.                                                                   

                                                                 President,

                                                    District Consumer Disputes

                                                    Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Rekha Chaudhary)

                     Member                        Member