Haryana

Ambala

CC/247/2022

Smt Davinder Kaur - Complainant(s)

Versus

Shriram General Insurance Co Ltd - Opp.Party(s)

J.P. Chauhan

02 Jan 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	247 of 2022
Date of Institution	:	08.07.2022
Date of decision	:	02.01.2024

Smt. Davinder Kaur aged about 69 years w/o Late Shri Gurdeep Singh, R/o Village Dadupur, Post Office-Rajo Kheri, Tehsil Barara, District Ambala- 133201

          ……. Complainant

                                                Versus

1. Shriram General Insurance Company Limited, E-8, EPIP, Sitapura Industrial Area, Jaipur (Rajasthan)-302022, through its' Authorized Signatory.
2. Shriram General Insurance Company Limited, 1st Floor, Plot No.57/75, Thapar Colony, Workshop Road, Yamuna Nagar, (Haryana)-135001, through its' Authorized Signatory.

                                                                                                    ….…. Opposite Parties.

Before:       Smt. Neena Sandhu, President.

                      Smt. Ruby Sharma, Member,

          Shri Vinod Kumar Sharma, Member.           

 

Present:      Shri Jaipal Singh Chauhan, Advocate, counsel for the complainant.

                   Shri Mohinder Bindal, Advocate, counsel for OPs.

Order:        Smt. Neena Sandhu, President.

                   Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’) praying for issuance of following directions to them:-

1. To make payment of claim amount of Rs.15,00,000/- alongwith interest @18% p.a. on account of Personal Accident Cover under the policy in question to the complainant for the death of Shri Kanwaljit Singh being owner of insured Motor Cycle bearing Registration No.HR-54-E-8578;
2. To pay Rs.3,00,000/- on account of compensation for causing deficiency in services and unfair trade practice and harassment, mental torture and agony and harassment to the complainant
3. To pay cost of litigation to the tune of Rs.22,000/-.
4. Grant any other relief which this Hon’ble Commission may deems fit.

 

2.             Brief facts of the case are that Shri Kanwaljit Singh s/o Shri Gurdeep Singh was son of the complainant, who was owner in possession of a Motor Cycle bearing Registration No.HR- 54-E-8578 bearing Engine No.PFYPKJ00328, Chassis No.MD2A76AY1KPJ32793 Make-Bajaj Auto Platina 100 ES CBS (in short the vehicle). The said vehicle was insured with the OPs under Policy No.102017/31/20/026918 having validity with effect from 03.03.2020 to 02.03.2025 for which he paid premium of Rs.5,756/- in total against the said policy. This Policy was covered under PA Cover to Owner-Driver for an amount of Rs.15,00,000/-. The OPs through the Agent disclosed to the son of the complainant that in case of untimely accidental death of owner-driver of the aforesaid motor cycle, the nominee or the legal heir will be paid the P.A. amount of Rs.15,00,000/- without any agitation, which will be valid for a period of 05 years from the date of its issuance i.e. with effect from 03.03.2020 to 02.03.2025. Kanwaljit Singh was also informed that when the Policy Period would be near to expiry, he would be informed by the representative of the OPs to get it renewed. On 13.10.2021 during evening hours, Shri Kanwaljit Singh was going from Village Sarakpur to Barara by driving his said vehicle on his correct left side of the road in a very carefully, cautiously and in normal speed by observing the traffic rules and his vehicle was being followed by his cousin brother namely Shri Manjeet Singh s/o Shri Surjeet Singh, R/o Village Dadupur, Tehsil barara, District Ambala, hardly at a distance of about 50 Meters. At about 07.30 p.m., the said son of the complainant by driving his said motor cycle reached on Barara Road, just Opposite the Satsang Bhawan at Sarakpur S.D.M.Office, Tehsil Barara, District Ambala, which falls within the area of Police Station-Barara and in the meanwhile a Platina Motor Cycle bearing Registration No.HR-54-B-8663 came from Barara side, which was being driven by Sunil Kumar s/o Shri Ajmer Singh, R/o Village and Post Office-Nahoni, Tehsil Barara, District Ambala in a very rash, negligent and in high speed, without blowing any horn and also without observing the traffic rules and caused the accident. Shri Kanwaljit Singh sustained multiple, grievous and serious injuries on his person including injuries on his head, face and internal injuries etc. On seeing the accident, many passersby gathered at the spot and the said cousin-Manjeet Singh noted number of the offending Platina Motor Cycle at the spot and got his statement recorded to the police against the said Sunil Kumar for causing this accident; upon which FIR No.0196 dated 14.10.2021, Under Sections-279, 304-A of IPC has been registered against the said Sunil Kumar. However, Shri Kanwaljit Singh died in the said accident. Thereafter, the complainant approached the OPs and requested them to settle the claim and pay Rs.15,00,000/- to her for untimely death of her son-Shri Kanwaljit Singh as Personal Accident was covered to Owner-Driver under the aforesaid Policy,  being natural mother/legal heir of late Shri Kanwaljit Singh. Shri Gudeep Singh husband of the complainant, who was the nominee in the policy also expired prior to the death of her son Shri Kanwaljit Singh. However, despite submitting all the  necessary documents, the claim of the complainant under PA cover was not paid to her by the OPs.  Under constrained circumstances, the complainant served legal notice dated 07.02.2022 upon the OPs in the matter but to no avail.  Hence, the present complaint.
3.           Upon notice, OPs appeared and filed written version and raised preliminary objections with regard to maintainability, not come with clean hands and suppressed the material facts and cause of action etc. On merits, it has been stated that the complainant has tried to manipulate the facts for imposing this false and frivolous complaint. As a matter of fact the reported claim of the complainant was duly entertained immediately on receipt of the intimation of alleged loss. All the papers submitted by the complainant in support of her said claim under issue were gone through while evaluating each and every facet of this case under the limitation and scope of the insurance policy. After scrutinizing and elaborating the whole facts, situation, records and the scope of the said insurance policy, the competent authority, repudiated the said reported claim of the complainant being not falling within the purview and scope of the said insurance policy since the husband of the complainant had not availed any such personal accident coverage for the relevant period under the said insurance policy in question. The deceased husband of the complainant had availed Insurance Policy for coverage of his motorcycle no.HR-54E-8578 for the period from 03.03.2020 to 02.03.2025 only with regard to third party loss and own damage clause but he availed the benefit of personal accident claim under the said policy for the period from 03.03.2020 to 02.03.2021 only for one year by paying a specific premium of Rs.315/- which fact was also duly endorsed on the insurance policy itself. Since the insured deceased husband of the complainant met with an accident and died on 13.10.2021 i.e. after the lapse of the insurance policy with regard to the risk against the accidental death of the insured cum owner of the said motorcycle in question thus her claim of PA against the death of her deceased husband being driver cum owner of the said motorcycle was repudiated being falling outside the purview and scope of the insurance policy in question as such death was not covered under the said policy at that time of loss. The complainant was duly informed about the fate of her claim vide letter dated 24.01.2022 and even the complainant was further clarified about the fate of her claim with legal bindings due to the scope and coverage of the insurance policy vide letter dated 04.07.2022 in reply to the legal notice sent by her through her advocate Sh. Jai Pal Singh Chauhan. But the complainant has now in order to put undue pressure filed this present false complaint by exploiting the process of law with concocted version just to make a case inspite of being fully aware of the scope and limitations of the insurance policy in question. Rest of the averments of the complainants were denied by the OPs and prayed for dismissal of the present complaint with costs.
4.           Learned counsel for the complainant tendered affidavit of complainant as Annexure CW1/A alongwith documents as Annexure C-1 to C-11 and closed the evidence on behalf of the complainant. On the other hand, learned counsel for the OPs tendered affidavit of Santosh Kumar & Authorized Signatory of the OPs-Company-Shriram General Insurance Co. Ltd., registered office Jaipur as Annexure OP-A alongwith document as Annexure OP-1 to OP-4 and closed the evidence on behalf of the OPs.
5.           We have heard the learned counsel for complainant and the learned counsel for the OPs and have also carefully gone through the case file.
6.           Learned counsel for the complainant submitted that by not making payment of the amount of Rs.15 lacs, after the death of insured, during subsistence of the policy in question, the OPs are deficient in providing service, negligent and adopted unfair trade practice. 
7.           On the contrary, learned counsel for the OPs submitted that the vehicle in question was insured alongwith CPA (Personal accident) cover of Rs.15 lacs for the period from 03.03.2020 to 02.03.2021 (one year) and for damage to own vehicle and third party for the period from 03.03.2020 to 02.03.2025, (five years). He further submitted that since the insured died on 13.10.2021 i.e. after lapse of the insurance policy for the benefit under personal accident, as such, the complainant is not entitled to get any claim out of the policy in question.  
8.           Since neither the issuance of policy in question in favour of the insured nor the death of the insured in the accident in question are in dispute, as such, the moot question which falls for consideration is, as to whether, the complainant is entitled to get any insurance claim out of the policy in question, being legal heir of the insured- deceased (Sh.Kanwaljit Singh) against PA cover or not. For coming to any conclusion, in the matter,  this Commission has to find out, as to whether,  on the day of accident, the insured was covered under the insurance policy in question for PA cover or not.  It may be stated here that though the complainant has contended with vehemence that the policy in question was valid for the period of 5 years under which the insured was also covered for personal accident, yet, when we peruse terms and conditions of the policy in question, Annexure C-3 it is clearly found mentioned therein that the vehicle in question was insured alongwith CPA (Personal accident) cover of Rs.15 lacs for the period from 03.03.2020 to 02.03.2021, whereas from 03.03.2020 to 02.03.2025 the insured was covered only  for the third party loss and also for own damage. In our considered opinion, since the accident of the insured occurred on 13.10.2021 and he ultimately died on 13.10.2021 i.e. after about more than 6 months of expiry of policy giving benefit of Personal Accident cover from 03.03.2020 to 02.03.2021  as such, the complainant is not entitled to get any claim amount under the said policy.  It is significant to mention here that the insurance policy between the  insurer and the insured represents a contract between the parties and the insured or his legal heirs cannot claim  anything more than what is covered by the insurance policy. Our this view is supported by the ratio of law laid down by the Hon’ble Supreme Court of India in Oriental Insurance Co. Ltd Vs Sony Cherian (II 1999 CPJ 13 SC) wherein it was held that- ― “..The insurance policy between the insurer and the insured represents a contract between the parties. Since the insurer undertakes to compensate the loss suffered by the insured on account of risks covered by the insurance policy, the terms of the agreement have to be strictly construed to determine the extent of liability of the insurer. The insured cannot claim anything more than what is covered by the insurance policy. That being so, the insured has also to act strictly in accordance with the statutory limitations or terms of the policy expressly set out therein…”.
9.           In view of peculiar facts and circumstances of this case, it is held that because the complainant has failed to prove her case, therefore, no relief can be given to her. Resultantly, this complaint stands dismissed with no order as to cost. Certified copies of the order be sent to the parties concerned as per rules.  File be annexed and consigned to the record room.

  Announced:- 02.01.2024

 

(Vinod Kumar Sharma)	(Ruby Sharma)	(Neena Sandhu)
Member	Member	President