BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL COMMISSION, JALANDHAR.

Complaint No.174 of 2022

      Date of Instt. 01.06.2022

      Date of Decision: 01.08.2023

Kanchan Rajput aged about 49 years DOB 18/10/1972 (Aadhar Card No.632135163675) wife of Late Sh. Raman Kumar, R/o House No.170, M.I.G. Flats, Housing Board Colony, Urban Estate, Phase-I, Jalandhar, Punjab.

..........Complainant

Versus

1.       Shriram General Insurance Co. Ltd., SCO-4, Ladowali Road, PUDA Complex, Rajinder Nagar, Jalandhar Through its    Authorized Representative.

2.       Shriram General Insurance Co. Ltd., E-8, EPIP, RIICO Industrial      Area, Sitapur, Jaipur-302022, Rajasthan. Through its authorized representative.

3.       Globe Tractor Ltd., G. T. Road, Jalandhar Through its   Authorized Representative.

4.       CMO, Civil Hospital, Jyoti Chowk, Near Police Station, Islam          Ganj, Jalandhar.

….….. Opposite Parties

Complaint Under the Consumer Protection Act.

Before:         Dr. Harveen Bhardwaj            (President)

                   Smt. Jyotsna                            (Member)                                          Sh. Jaswant Singh Dhillon       (Member)

Present:       Complainant in Person.

                   Sh. A. K. Gandhi, Adv. Counsel for OPs No.1 and 2.

                   OPs No.3 & 4 withdrawn.

Order

Dr. Harveen Bhardwaj (President)

1.                This complaint has been filed by the complainant, wherein alleged that the late husband, Sh. Raman Kumar of the complainant, purchased one auto rickshaw Piaggio-ape Cargo D600, bearing engine no.S9A8944929, Chassis no.MBX0003ABXA785315, model 2019 from OP No.3, allured by the agents of the OPs got insured the said auto rickshaw make Piaggio-ape Cargo D600 with OPs No.1 and 2 for period 15/04/2019 to 14/04/2020 vide policy no.105021/31/20/000392, No terms and Conditions were every provided or explained. The complainant is the nominee and class-1 legal heir of the deceased Sh. Raman Kumar. Premium amount Rs.5701/- has been duly paid for taking the said policy and cover note was issued by OP No.1. The auto rickshaw was financed by Hunduja Leyland Finance. Unfortunately, the husband of the complainant died on 09/10/2019 after meeting with an accident at Guru Nanak Mission Chowk, Jalandhar. At the time of the accident the earlier License bearing no.PB-0820130136355 of the deceased Raman Kumar had already expired on 25/08/2018, but had applied for a fresh license vide application no.1005290219 dated 05/04/2019 had applied for fresh LMV MCWG. The said vehicle in the name of Late Sh. Raman Kumar was duly got insured by OPs No.1 to 3 as per their internal arrangement without any independent choice of the insured i.e. the consumer's husband even though with so many companies in the market offering better plans, which could be opted for. The loan application and other related documents were filled in by the OPs No.1 & 2 themselves and the deceased husband of the complainant was made to sign on dotted lines in a routine manner. As per requisite a duly sworn affidavit was tendered before Hunduja Leyland Finance to stop the installments of the auto rickshaw as per their terms and conditions. Subsequent to the death of the husband of the complainant on 09/10/2019, the complainant moved application for claim alongwith all the requisite documents and as per norms but however the same was rejected by OP No.1 vide closer letter dated 11/02/2021 in complete defiance of the IRDAI regulations after repeated requests for the same by the complainant. The policy document had not been supplied at any point of time by the OPs No.1 and 2 in complete defiance of the IRDAI Regulation. The claim of the complainant has also not been decided within the statutory period of 30 days itself attracting the odium of deficiency on the part of OPs No.1 and 2 in settling the claim as per requisites. After the accident the husband of the complainant was immediately taken Civil Hospital at Jalandhar/OP No.4, where the attending doctor for reasons best known to her did not report the matter to the police and told the complainant that at that point of time it was necessary to treat the husband of the complainant urgently and there was no time to call the police and waste time in his treatment. The complainant all baffled at that time did as and what she was being told but unfortunately the husband of the complainant could not be saved. Due to this fact, it could not come on record that the death of the husband of the complainant took place due to an accident. It is pertinent to mention here that no FIR could be got registered at that time and now it is not possible due to the time gap. It is pertinent to mention here that the complainant did make a request to the police in this regard but due to the time gap the same could not be registered. However after the accident the vehicle in question was badly damaged and the cousin of the complainant namely Salman took the vehicle to Ludhiana by towing the same as the complainant did not have money to get the same repaired and this cousin of the complainant runs his own workshop at Tajpur Road, Ludhiana by the name and style Romio Auto Centre and repairs total worth Rs.22950/- was carried on the said vehicle which the complainant is repaying in small amounts. The complainant is a simple housewife and after the death of her husband is totally dependent on her father who has retired from Indian Air Force and little amount which she earns from running of this vehicle. It is reiterated here that the detailed policy document along with other documents were never supplied at any point of time prior by the OPs No.1 and 2 only the cover note was supplied and the present claim is well within the time period of the said policy. The complainant has been continuously contacting the OP to decide the claim of the complainant but after sitting over the claim of the complainant for long finally the claim of the complainant was closed vide closer letter dated 11/02/2021. The surveyor of the OP No.1 was fully made aware about the facts of the case and even taken to the spot where the accident took place and he fully agreed to accident haven taken place, but still later on what report was made by the surveyor was not known to the complainant, again against the IRDAI regulations as copy of the report has to be provided to the complainant also attracting the odium of deficiency on the part of the OP No.1. The IRDAI Regulations also stipulate that the insurance company should not raise piece meal queries and non-adherence is sufficient to saddle OPs with odium of deficiency. All the lapses and laches are on the part of the opposite parties. There has been no lapse in any manner whatsoever on the part of the Complainant. All documents were duly supplied as called for by the opposite parties from time to time. The genuine claim of the complainant has been wrongly and perversely repudiated by the OPs No.1 and 2 in complete defiance of provisions under the IRDAI Regulations. It is a settled law that the OPs are fully liable and answerable for the act and conduct on the part of their agents, who in turn in the lust for commission goes out of the way to procure policies eventually misrepresenting facts for mis-selling of the insurance products to the consumer at large. The OPs are guilty of rendering deficient service, negligent and adopted unfair trade practice in unilateral arbitrary and malafide repudiating claim of the complainant and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to pay claim amount of Rs.15,00,000/- as fully described in foregoing para of the complaint covering for the medical expenditure with interest @ 12% on the claimed amount from the date of submission of claim to the date of payment. Further, OPs be directed to pay a compensation of Rs.2,00,000/- for causing mental tension and harassment to the complainant and any other relief which this Commission may deem fit.

2.                Notice of the complaint was sent to the OPs and accordingly, OPs No.1 & 2 appeared through its counsel and filed their joint written reply and contested the complaint by taking preliminary objections that the present complaint is premature, false, vexatious and has been filed with a malafide intention to harass the OPs No.1 and 2 by misusing the process of law and to avail undue advantages. It is an attempt to waste the precious time of this Court and hence is liable to be dismissed. It is further averred that the present complaint is not maintainable against the answering OPs No.1 and 2 is liable to be dismissed. The OPs No.1 and 2 rightly repudiated the deals claim of the Deceased Raman Kumar vide letter dated 11-02-2021 and intimation regarding the same duly sent to the complainant by the OPs No.1 and 2. As per the Medical Record of Civil Hospital Jalandhar the Deceased Raman Kumar was not died in any Roadside accident. The complainant is trying to get the false claim from the answering opposite parties by using fraudulent means. In the Investigation of the present claim, the complainant got recorded her statement that on 03-10-2019 she along with her husband was returning from the Ludhiana in a Auto Rickshaw bearing Temporary no. PB08-T-7141 and when they reached at BMC chowk then Auto Rickshaw bearing Temporary no. PB08-1-7141 struck against the stationary Truck and her husband lost the control and got attack. Then she sent him to the Civil Hospital. But as per the Medical Record of the Civil Hospital the deceased Raman Kumar admitted in the ICU of the Hospital on 02-10-2019 at 4:00 PM with a complaint of fever of last 15 days. Rt sided weakness 5 days with a history of High Blood Sugar and infection. He was died on 09-10-2019 due to Cardio Respiratory arrest and Diabetes Mellitus. So, the Medical Record of the deceased clearly established the fact that no accident of the Deceased Raman Kumar took place on 03-10- 2019 with any vehicle rather the Deceased Raman Kumar died due to the critical illness. It is also established by the Medical Record that when the Deceased Raman Kumar was admitted in the ICU of the Civil Hospital on 02-10-2019 and remained admitted in the Civil Hospital till his death i.e. 09-10-2019 then how he could drive the Auto Rickshaw in question on 03-10- 2019 and suffered injuries in a Roadside accident The medical record also established the truth regarding the cause of the death of the Deceased Raman Kumar and also established the facts that the complainant is trying to get the false compensation from the answering opposite parties by using of unlawful means. Moreover, No FIR pertaining to the alleged accident in question got registered by the complainant nor the Postmortem of the body of the deceased got conducted by the Complainant. So, the act and conduct of the Complainant clearly established the malafide intention of the complainant, to cause the unlawful loss to the OPs No.1 and 2. So, the present claim does not fall under the Personal Accident claim and the present complaint is liable to be dismissed with cost being not maintainable one and is liable to be dismissed in the light of the violation of the terms and conditions of the insurance policy.

As per the Clause 4.1 of the Insurance policy in question:-

‘An Accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means’

As per Clause 7.10 of the Insurance policy in question:

On the occurrence of loss within the scope under the policy, the insured/insured person shall.

7.10.1 give written notice with full particulars to the company immediately, in case of accidental death written notice of the death must, unless reasonable cause is shown, be so given before internment/cremation and in any case, within one calendar month after the death and in the event of loss of sight or amputation of limb(s), written notice thereof must be given within one calendar month after such loss of sight or amutation’

                   But in the present case the deceased Raman Kumar died in a Civil Hospital on 09-10-2019 due to Cardio Respiratory arrest and Diabetes Mellitus. So the claim in question does not fall under the definition of Accident as terms and conditions of the insurance policy in question.

                   It is further averred that the complainant has not come before the Forum with clean hands. The complainant is herself guilty of misrepresentation and suppression of material facts It is pertinent to mention here that the Malafide intention of the Complainant also clear from the record that the complainant got changed in the nomination of the Policy in question on 06-11-2019 i.e. after the death of the insured Raman Kumar without disclosing the facts regarding the death of the Insured Raman Kumar to the answering OPs with a malafide intention to get the false claim. Earlier the nominee of the policy Shanker i.e. the father of the Insured, but the complainant by in question was Gouri concealment of facts herself become the nominee of the said Insurance Policy in question by concealment of facts. Due to above noted unlawful acts of the complainant, the insurance policy in question become void one. So the present complaint is liable to be dismissed. It is further averred that the complainant is estopped by his own acts and conducts from filing the present complainant.  It is further averred that there was no privity of contract was exist between the complainant and the answering OPs at the time of the death of the Deceased Raman Kumar as the complainant was not the nominee of the insurance policy in question at the time of the death of the deceased Raman Kumar i.e. on 09-10-2019. At time of the death of the Deceased Raman Kumar it was the Gouri Shanker i.e. the father of the Insured who was the nominee of the Insurance policy in question. So, the complainant cannot claim any benefits under the insurance policy in question. It is further averred that no cause of action has been arose against the answering OPs. So the present complaint is liable to be dismissed being premature one. It is further averred that the complaint is false and vexatious to the knowledge of the complainant. The answering OPs reserve its right to file the amended written reply as and when required. It is further averred that the present complainant is bad for mis-joinder and non-joinder of necessary party. It is further averred that the Court no territorial Jurisdiction to entertain the present complaint. So, the present complaint is liable to be dismissed. On merits, it is admitted that the deceased Raman Kumar purchased one auto rickshaw from the OP No.3 and got insured with the OPs No.1 & 2, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.

3.                Complaint against OP No.3 and OP No.4 withdrawn by the complainant, vide its separate statement dated 22.11.2022.

4.                Rejoinder not filed by the complainant.

5.                In order to prove their respective versions, both the parties have produced on the file their respective evidence.

6.                We have heard the learned counsel for the respective parties and have also gone through the case file very minutely.

7.                The complainant has alleged and proved on record that her deceased husband purchased the Auto Rickshaw make Piaggio-Ape Cargo D600 and got insured the same from the OP as per insurance cover Ex.C-1. The same policy was valid from 15.04.2019 to 14.04.2020. She has alleged herself to be the nominee and Clause-1 legal heir of the deceased husband Raman Kumar. She has proved on record Ex.C-4 the delivery challan of the vehicle Auto Rickshaw in the name of Raman Kumar issued by the OP No.3. The year of the manufacturing of the Auto Rickshaw has been mentioned as 2019 and it was purchased on 10.04.2019. She has alleged that her husband met with an accident on 09.10.2019. The driving license of her husband had expired on 25.08.2018 and he had applied for renewal of the license vide Ex.C-6. She has proved the Declaration Ex.C-7 also. She has alleged that after the death of her husband, she moved application for claim alongwith documents, but the OP rejected the claim, vide application Ex.C-10. Perusal of Ex.C-10 shows that the claim was repudiated on the ground that the investigator appointed by the OP had told them that the insured was admitted at C. T. Jalandhar for treatment of High Blood, Sugar and Infection and on his person no injuries were seen and it was not a road accident nor he was having valid driving license. The complainant has proved on record the death certificate of her husband Ex.C-9. She has also proved on record the letter written to Police Commissioner for registration of FIR Ex.C-11. In this letter, she has alleged that her husband met with an accident on 02.10.2019 by some unknown truck and her husband had died on 09.10.2019. Now the insurance company is demanding the copy of the FIR, therefore she made request for the registration of the FIR.

8.                The OP has filed on record the report of the investigation Ex.OP-6 and a letter written by Kanchan Rajput Ex.OP-7, in which she has mentioned different facts. She has alleged that on 03.10.2019, she alongwith her husband Raman Kumar was returning from Ludhiana in their Auto and met with an accident on 03.10.2019. The OPs have proved on record the admission record of the deceased Raman Kumar in Civil Hospital Ex.OP-14. As per this record, he was admitted in ICU on 02.10.2019 at 04:00 PM with the complaint of fever for 15 days. The entire record of the Civil Hospital and the treatment chart proved by the OP nowhere shows that the deceased Raman Kumar ever suffered injuries or ever met with an accident.

9.                The contention of the complainant is that she was told not to inform the hospital that he met with an accident as his condition is serious and it will be the police case and no treatment shall be given to the husband of the complainant, but these facts nowhere find mention in the hospital record or in any of the document. Even the application given by the complainant shows the date of  accident as 03.10.2019, whereas he was admitted in hospital on 02.10.2019. The report of the investigator Ex.OP-6 shows that the date of accident has been narrated by the complainant to the investigator as 03.10.2019. No FIR was registered as she moved application at the instance of the insurance company for getting the FIR registered, but at the time of accident, no information was given to the Police. As per Ex.OP-6, the deceased Raman Kumar was having High Blood Sugar and Infection with fever and he was admitted for that only. As per his report, no injuries were found on the person of the deceased. He has also given the report that no accident ever took place nor there is any document on the record to show that any such accident ever took place. Perusal of the policy shows that it was personal accident claim and personal accident claim form was duly filled by the complainant, who is alleging herself to be nominee. As per the clause 4.1 of the insurance policy that ‘an accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means’. And as per Clause 7.10 of the Insurance policy in question:-

          On the occurrence of loss within the scope under the policy, the insured/insured person shall.

7.10.1 give written notice with full particulars to the company immediately, in case of accidental death written notice of the death must, unless reasonable cause is shown, be so given before internment/cremation and in any case, within one calendar month after the death and in the event of loss of sight or amputation of limb(s), written notice thereof must be given within one calendar month after such loss of sight or amutation’.

                   But the death summary of the Civil Hospital shows that the deceased Raman Kumar died on 09.10.2019 due to Cardio Respiratory Arrest and Diabetes Mellitus. This report also proves that he never met with any accident. So from all the angles, the complainant has failed to prove her case and failed to prove any deficiency in service and unfair trade practice on the part of the OPs and thus, the complaint of the complainant is without merits and the same is dismissed with no order of costs. Parties will bear their own costs. This complaint could not be decided within stipulated time frame due to rush of work.

10.              Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

Dated          Jaswant Singh Dhillon    Jyotsna               Dr. Harveen Bhardwaj     

01.08.2023         Member                          Member           President