Delhi

New Delhi

CC/600/2015

Amitava Acharjee - Complainant(s)

Versus

Sr Divisional Manager - Opp.Party(s)

10 Dec 2019

ORDER

 

 

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTRICT NEW DELHI,  M-BLOCK, 1^ST FLOOR,

VIKAS BHAWAN, I.P. ESTATE. NEW DELHI-1100001.

 

C.C.No.600/2015

 

1. Amitava Acharjee,

         S/o late Sudhamay Acharjee,

        R/o 61-B, Abul Fazal Apartment,

        22, Vasundhara Enclave, Delhi-96.

 

2. Anuradha Acharjee,

          D/o Amitava Acharjee ,

         R/o 61-B, Abul Fazal Apartment,

          22, Vasundhara Enclave, Delhi-96.

                               ….Complainants

Vs.

 

United India Insurance Co. Ltd.,

Sr. Divisional Manager D O NO.8,

503-504, Kailash Building, 5^th Floor,

26, Kasturba Gandhi Marg,  New Delhi.

 

Opposite Party

NIPUR CHANDNA, MEMBER

O R D E R

 

 

The complainant has filed the present complaint against the OPs under section 12 of Consumer Protection Act, 1986. The facts as alleged in the complaint are that the complainant had purchased an Individual Personal Accident Policy  bearing No.040800/42/08/01/0000259 for himself, his wife, son, daughter and his mother.  The said  policy was issued by the OP for the period from 13.11.2008 to 12.11.2009 and the complainant paid a premium of Rs.1864/-.   On 29.12.2008, the complainant along with his family met with an accident  wherein, the complainant and all the occupants were injured, for which, the wife of  complainant lodged a claim along with necessary papers with the OP.  The OP after considering the entire report had paid a sum of Rs.4,37,500/- only towards fatal claim. 

2.     Thereafter, when the MACT Claim petition was subjudice, the complainants faced a  difficulty in daily course of life, as such, FORM G under Motor Vehicle Act was filed before concerned MACT Ld. Judge. Medical Boards were constituted  in the AIIMS and LBS Hospitals wherein both the complainants were diagnosed to have suffered permanent disability.  After being assessed disability, the complainant lodged a claim on account of disability to the OP Co., which was repudiated solely on the ground “delay in communication of injury”. The complainant further appealed before Hon’ble High Court of Delhi at New Delhi for enhancement of compensation in all the cases including the injury cases which are subject matter of present complainant and in both the injury cases Hon’ble High court enhanced the compensation and upheld the MACT Tribunal order. Therefore, the complainant had again requested the OP to reconsider the disability claim but went in vein, complainant, therefore, approached this Forum for redressal of his grievance.

3.     Complaint has been contested by the OP. OP denied any deficiency on its part and stated that the complaint of the complainant was rightly repudiated vide letter dt. 28.10.2013 on the ground of delay in lodging the claim.  The accident in question  took place on 29.12.2008, the claim on account of injury was lodged on 6.6.2013 after the delay of approx. 5 years of the incident, hence, the present complaint be dismissed on the ground of inordinate delay. 

4.     Both the parties have  filed their evidences  by way affidavits.

5.     We have heard arguments advanced at the Bar and have perused the record

6.         Admittedly, the complainant lodged the claim with the OP on 6.6.2013, whereas the accident in question took place on 29.12.2008.  The complainant ought to have lodged the claim with the OP in year 2008, whereas he approached the OP in the month of June, 2013 i.e with a long delay of 5 years, which is not at all tenable.  On the issue of delay in lodging the claim, the complainant has taken the shelter of the MACT case pending before the Hon’ble High Court, whereas the present claim has nothing to do with the outcome of the Appeal pending before Hon’ble High Court of Delhi.  In the present case, the complainant has sought a relief under the individual personal accident policy, which is a separate contract of insurance between and the complainant, for which he has separately paid  the premium and on the basis of which he is claiming the relief.   Insurance is a contract between the insured and insurer and both the parties are bound by the terms contained therein. The Hon’ble NCDRC in the matter of National Insurance Co. Ltd. vs. Vinod Puri as reported in I [2014] CPJ 341 (NC) is pleased to hold as under:

Insurance contract has to be construed like any other contract on basis of its terms and conditions and outside aid for construction of insurance policy is impermissible.

 The Hon’ble Apex Court in the case of Oriental Insurance Co. Ltd. versus Sony Cheryan reported in (1999) 6 SCC 451 is pleased to hold as under:

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.

Similarly in the case of General Assurance Society Ltd. vs. Chandumull Jain and Anr., reported in (1996) 3 SCR, 500, the Constitution Bench has observed that the policy document being a contract and it has to be read strictly. It was observed:

In interpreting documents relating to a contract of insurance, the duty of the court is to interpret the words in which the contract is expressed by the parties, because it is not for the court to make a new contract, however, reasonable, if the parties have not made it themselves. Looking at the proposal, the letter of acceptance and the cover notes, it is clear that a contract of insurance under the standard policy for fire and extended to cover floor, cyclone etc. had come into being.

The Hon’ble NCDRC in the matter of Ind Swift Ltd. versus New India Assurance Co. Ltd. reported in IV[2012] CPJ 148 (NC) is pleased to rule as under:

Construction of the policy is to be construed strictly as per the terms and conditions of the policy document which is binding contract between the parties and nothing can be added or subtracted by different meaning.

 Similarly in LIC versus Banwarilal Yadav reported in IV[2013] CPJ 38 (NC) the Hon’ble NCDRC observed as under:

“Forum has no jurisdiction to go beyond terms and conditions of the Policy.”

        The NCDRC in yet another matter in the matter of Morien Chemicals Ltd. versus UCO Bank reported in III [2013] CPJ 261 (NC) is pleased to hold as under:

“Insurance Company is not liable to pay damages which are not covered under the policy.”

 7.    Having regard to the facts and circumstances of the case, we are of the considered view that since the complainant had failed to lodge the claim with the OP immediately resulting in the violation of terms and conditions of the policy in question, hence, the repudiation is justified. We find no merits in the present complaint, same is hereby dismissed.

        A copy of this order each be sent to both parties free of cost by post.  This final order be sent to server (www.confonet.nic.in ). File be consigned to Record Room.

Announced in open Forum on 10/12/2019.

 

 

 

 

(ARUN KUMAR ARYA)

          PRESIDENT

(NIPUR CHANDNA)                                                 (H M VYAS)

       MEMBER                                                                MEMBER